Hoosier Sport: a research protocol for a multilevel physical activity-based intervention in rural Indiana.

Introduction: Currently, only 1 in 4 children in the U.S. engage in the recommended amount of physical activity (PA) and disparities in PA participation increase as income inequities increase. Moreover, leading health organizations have identified rural health as a critical area of need for programming, research, and policy. Thus, there is a critical need for the development and testing of evidence-based PA interventions that have the potential to be scalable to improve health disparities in children from under-resourced rural backgrounds. As such, the present study utilizes human-centered design, a technique that puts community stakeholders at the center of the intervention development process, to increase our specific understanding about how the PA-based needs of children from rural communities manifest themselves in context, at the level of detail needed to make intervention design decisions. The present study connects the first two stages of the NIH Stage Model for Behavioral Intervention Development with a promising conceptual foundation and potentially sustainable college student mentor implementation strategy. Methods: We will conduct a three-phase study utilizing human-centered community-based participatory research (CBPR) in three aims: (Aim 1) conduct a CBPR needs assessment with middle school students, parents, and teachers/administrators to identify perceptions, attributes, barriers, and facilitators of PA that are responsive to the community context and preferences; (Aim 2) co-design with children and adults to develop a prototype multi-level PA intervention protocol called Hoosier Sport; (Aim 3) assess Hoosier Sport's trial- and intervention-related feasibility indicators. The conceptual foundation of this study is built on three complementary theoretical elements: (1) Basic Psychological Needs mini-theory within Self-Determination Theory; (2) the Biopsychosocial Model; and (3) the multilevel Research Framework from the National Institute on Minority Health and Health Disparities. Discussion: Our CBPR protocol takes a human-centered approach to integrating the first two stages of the NIH Stage Model with a potentially sustainable college student mentor implementation strategy. This multidisciplinary approach can be used by researchers pursuing multilevel PA-based intervention development for children.

Assessment of the appropriateness of antibiotic prescribing in an acute UK hospital using a national audit tool: a single centre retrospective survey.

INTRODUCTION: Antibiotic use drives antibiotic resistance. The UK antimicrobial resistance (AMR) strategy aims to reduce antibiotic use. We aimed to quantify excess antibiotic use in a district general hospital in south-west England. METHODS: Medical patients discharged in August 2020 who had received antibiotics were included. An audit tool of antibiotic prescribing appropriateness was used to collect relevant clinical information regarding each patient case. The appropriateness of antibiotic use was then determined by two infection specialists and excess days of therapy (DOTs) calculated. RESULTS: 647 patients were discharged in August 2020. Of the 1658 antibiotic DOTs for the 184 patients reviewed, 403 (24%) were excess DOTs. The excess antibiotic DOTs were prescribed in 92 patients (50%); 112/403 (27.8%) excess DOTs originated at the initiation of antibiotic therapy (time point A); 184/403 (45.7%) of excess DOTs occurred at the antibiotic review pre-72 hours (time point B); and 107/403 (26.6%) of excess DOTs were due to protracted antibiotic courses (time point C). CONCLUSION: 24% of antibiotic DOTs were deemed unnecessary. The greatest opportunity to reduce antibiotic use safely was the pre-72 hours antibiotic review, which may provide a target for reducing excess antimicrobial therapy in line with the national AMR strategy.

Barriers, facilitators, and opportunities to promote healthy weight behaviors among preschool-aged children in two rural U.S communities.

BACKGROUND: Obesity levels are higher in rural versus urban children. Multi-level community-based interventions can be effective in promoting healthy child weight, but few of such interventions have focused on rural children. This formative study assessed barriers, facilitators, and opportunities to promote healthy child weight in two rural communities. METHODS: Multiple data collection methods were used concurrently in two rural communities in Indiana and North Carolina. Focus groups and interviews were conducted with participants, including parents of children aged 2-5 years (n = 41), childcare providers (n = 13), and stakeholders from 23 community organizations. Observational audits were conducted at 19 food outlets (grocery stores) and 50 publicly-accessible physical activity resources. Focus groups/interviews were analyzed thematically. Surveys were analyzed using descriptive statistics, Fisher's exact test, and t-tests. RESULTS: Family level barriers included limited financial resources and competing priorities, whereas parental role-modeling was perceived as a facilitator of healthy weight behaviors. At the organizational level, childcare providers and community stakeholders cited limited funding and poor parental engagement in health promotion programs as barriers. Childcare providers explained that they were required to comply with strict nutrition and physical activity guidelines, but expressed concerns that similar messages were not reinforced at home. Facilitators at the organizational level included healthy meals provided at no cost at childcare programs, and health promotion programs offered through community organizations. At the community level, lack of public transportation, and limited access to healthy food outlets and physical activity-promoting resources posed barriers, whereas existing physical activity resources (e.g., parks) and some ongoing investment to improve physical activity resources in the community were assets. In designing/implementing a potential child obesity prevention intervention, participants discussed the need to garner community trust, emphasize wellness instead of obesity prevention, establish community partnerships, and leverage existing community resources. CONCLUSIONS: Rural areas experience multiple challenges that make it difficult for children/families to engage in healthy weight behaviors. This study highlights several assets (existing programs/resources, expertise within communities) that can be leveraged as facilitators. Findings will guide the study team in developing a child obesity prevention intervention for the two rural communities.

Hair today, gone tomorrow: How personal protective equipment guidance changed doctor's facial hair during the COVID-19 pandemic.

OBJECTIVES: To investigate how personal protective equipment (PPE) guidance altered the facial hair of hospital doctors and explore the wider impact and implications of these changes. METHODS: A single site uncontrolled before-after survey study examining change in facial hairstyles, and wider implications on doctor's cultural, religious, and personal wellbeing. Outcome measures included change in facial hair between January and April 2020 and whether these changes adhered to guidance set by Public Health England. Participants were also asked about the wider impact of these changes which were thematically analyzed using an inductive approach. RESULTS: Of those who completed the survey, 257 participants met the inclusion criteria. 68% (n = 67) of doctors who could grow facial hair changed their facial hairstyle during the COVID-19 pandemic and 96% (n = 64) reported that the change was in response to PPE guidance. The odds of having a facial hairstyle that complied with PPE guidance before the pandemic was 0.32, which rose to 2.77 after guidance was released, giving an odds ratio of 8.54 (95% CI 4.49-16.23, P < .001). When compared to those who sported a shaven face prepandemic, the odds ratio of a change in style for those with prepandemic full beards was 37.92 (95% CI 7.45-192.8, P < .001), for goatees was 7.22 (95% CI 1.076-48.47, P = .04), for moustaches was 4.33 (95% CI 0.207-90.85, P = .345), and for stubble was 9.06 (95% CI 2.133-38.49, P = .003). Qualitative analysis revealed multiple themes, including skin irritation, loss of identity, and a significant impact on participants required to maintain a beard due to religious or cultural reasons. CONCLUSIONS: Facial hairstyles have changed significantly at our hospital during the COVID-19 pandemic. Facial hair can impact upon doctors' cultural, religious, and personal wellbeing and these factors need to be considered with policy and provision of PPE.

Modified Constraint-Induced Movement Therapy is a feasible and potentially useful addition to the Community Rehabilitation tool kit after stroke: A pilot randomised control trial.

BACKGROUND/AIM: The National Stroke Foundation recommends that Occupational Therapists use Constraint-Induced Movement Therapy (CIMT) with stroke survivors that experience an upper limb deficit. CIMT involves constraining the unaffected upper limb coupled with intensive therapy. The aim of this study was to evaluate the feasibility and effectiveness of a modified, low intensity version of CIMT (mCIMT) provided within usual resources of an Australian community rehabilitation setting. METHODS: A pilot randomised control trial (n = 19) was conducted with stroke survivors referred for community rehabilitation. Participants were randomly assigned to either mCIMT or usual care. Both groups received six one-hour outpatient Occupational Therapy sessions (focussed on upper limb rehabilitation) over a two-week period. The intervention group (mCIMT) were asked to wear a constraint device on their unaffected hand for 90% of their waking hours and were provided with a home exercise program based on CIMT principles. Participants were included if they had some active upper limb movement, no significant cognitive deficits and sufficient balance. Outcome measures included upper limb function (WMFT) and participation (MAL) evaluated at baseline, immediately following the two-week intervention period and at four-week follow-up. RESULTS: Only a very small proportion of patients met the eligibility criteria. There were no differences between groups, with the exception of a small increase in reported upper extremity use in functional tasks at post-intervention assessment when compared to the usual care group. CONCLUSIONS: Modified CIMT can be applied to a typical Australian community rehabilitation setting, to treat upper limb deficits in stroke survivors. The resources used for mCIMT largely equalled usual care, with no differences in outcomes, suggesting that the intervention is feasible and potentially beneficial. However, there were very few stroke survivors who met participation criteria, indicating that demand for the intervention is limited.

Nut crop yield records show that budbreak-based chilling requirements may not reflect yield decline chill thresholds.

Warming winters due to climate change may critically affect temperate tree species. Insufficiently cold winters are thought to result in fewer viable flower buds and the subsequent development of fewer fruits or nuts, decreasing the yield of an orchard or fecundity of a species. The best existing approximation for a threshold of sufficient cold accumulation, the "chilling requirement" of a species or variety, has been quantified by manipulating or modeling the conditions that result in dormant bud breaking. However, the physiological processes that affect budbreak are not the same as those that determine yield. This study sought to test whether budbreak-based chilling thresholds can reasonably approximate the thresholds that affect yield, particularly regarding the potential impacts of climate change on temperate tree crop yields. County-wide yield records for almond (Prunus dulcis), pistachio (Pistacia vera), and walnut (Juglans regia) in the Central Valley of California were compared with 50 years of weather records. Bayesian nonparametric function estimation was used to model yield potentials at varying amounts of chill accumulation. In almonds, average yields occurred when chill accumulation was close to the budbreak-based chilling requirement. However, in the other two crops, pistachios and walnuts, the best previous estimate of the budbreak-based chilling requirements was 19-32 % higher than the chilling accumulations associated with average or above average yields. This research indicates that physiological processes beyond requirements for budbreak should be considered when estimating chill accumulation thresholds of yield decline and potential impacts of climate change.

Detecting nonlinear response of spring phenology to climate change by Bayesian analysis.

The impact of climate change on the advancement of plant phenological events has been heavily studied in the last decade. Although the majority of spring plant phenological events have been trending earlier, this is not universally true. Recent work has suggested that species that are not advancing in their spring phenological behavior are responding more to lack of winter chill than increased spring heat. One way to test this hypothesis is by evaluating the behavior of a species known to have a moderate to high chilling requirement and examining how it is responding to increased warming. This study used a 60-year data set for timing of leaf-out and male flowering of walnut (Juglans regia) cultivar 'Payne' to examine this issue. The spring phenological behavior of 'Payne' walnut differed depending on bud type. The vegetative buds, which have a higher chilling requirement, trended toward earlier leaf-out until about 1994, when they shifted to later leaf-out. The date of male bud pollen shedding advanced over the course of the whole record. Our findings suggest that many species which have exhibited earlier bud break are responding to warmer spring temperatures, but may shift into responding more to winter temperatures (lack of adequate chilling) as warming continues.

Proventricular nematodiasis in wrinkled hornbills (Aceros corrugatus).

Three immature Sunda wrinkled hornbills (Aceros corrugatus) were diagnosed postmortem with proventricular spirurid nematodiasis. Concurrent severe disseminated larval granulomatosis in other visceral organs was considered contributory to mortality in each case. Clinical signs of nematodiasis were vague but generally consisted of weight loss, anorexia, and lethargy. Frequent antemortem fecal examinations were negative for spirurid eggs. In these present cases, based on routine histopathology, both prophylactic and empirically based therapeutic anthelmintic treatments had no evident benefit in the elimination of the proventricular nematodes. Spirurid nematodiasis may be an important cause of mortality in young hornbills.