Paramedic attitudes towards prehospital spinal care: a cross-sectional survey.

BACKGROUND: The optimal application of spinal motion restriction (SMR) in the prehospital setting continues to be debated. Few studies have examined how changing guidelines have been received and interpreted by emergency medical services (EMS) personnel. This study surveys paramedics' attitudes, observations, and self-reported practices around the treatment of potential spine injuries in the prehospital setting. METHODS: This was a cross-sectional survey of a North American EMS agency. After development and piloting, the final version of the survey contained four sections covering attitudes towards 1) general practice, 2) specific techniques, 3) assessment protocols, and 4) mechanisms of injury (MOI). Questions used Likert-scale, multiple-choice, yes/no, and free-text responses. Exploratory factor analysis (EFA) was used to identify latent constructs within responses, and factor scores were analyzed by ordinal logistic regression for associations with demographic characteristics (including qualification level, gender, and years of experience). MOI evaluations were assessed for inter-rater reliability (Fleiss' kappa). Inductive qualitative content analysis, following Elo & Kyngäs (2008), was used to examine free-text responses. RESULTS: Two hundred twenty responses were received (36% of staff). Raw results indicated that respondents felt that SMR was seen as less important than in the past, that they were treating fewer patients than previously, and that they follow protocol in most situations. The EFA identified two factors: one (Judging MOIs) captured paramedics' estimation that the presented MOI could potentially cause a spine injury, and another (Treatment Value) reflected respondents' composite view of the effectiveness, importance, and applicability of SMR. Respondents with advanced life support (ALS) qualification were more likely to be skeptical of the value of SMR compared to those at the basic life support (BLS) level (OR: 2.40, 95%CI: 1.21-4.76, p = 0.01). Overall, respondents showed fair agreement in the evaluation of MOIs (k = 0.31, 95%CI: 0.09-0.49). Content analysis identified tension expressed by respondents between SMR-as-directed and SMR-as-applied. CONCLUSION: Results of this survey show that EMS personnel are skeptical of many elements of SMR but use various strategies to balance protocol adherence with optimizing patient care. While identifying several areas for future research, these findings argue for incorporating provider feedback and judgement into future guideline revision.

Clinical Burden of Injuries in Students at a Professional Circus College: A 7.5-Year Longitudinal Study.

OBJECTIVE: To characterize clinical burden of injuries incurred by circus students enrolled in a 3-year college training program. METHODS: Student (n=334) injury data derived from an in situ clinic was examined over a 7.5-year time frame from August 2009 to December 2016. Injury incidence rate (per 1,000 training hours) was calculated and clinical incidence (injuries/year) was examined in relation to year in program, sex, age, and circus discipline. Weekly and monthly injury incidence were plotted with respect to milestones in the scholastic training year. Clinical burden (injury incidence and duration) was examined according to anatomic location and circus discipline. RESULTS: The overall injury incidence rate was 1.89 injuries/1,000 training hours and 0.94 injuries/1,000 training hours for injuries with a duration longer than 4 weeks. Clinical incidence decreased with year in program (p<0.05) and there were no sex or age differences. Temporal analysis demonstrated elevated weekly injury incidence for the 3 weeks following return from both summer and winter vacation (p<0.01) and for the weeks leading up to technical exams (p<0.01). According to anatomical location, shoulder injuries accounted for the greatest clinic burden followed by ankles and according to discipline, ground acrobat flyers followed by ground acrobats with equipment accounted for the greatest clinic burden. CONCLUSION: Overall injury incidence rate in the circus training program was within the range reported by other circus training programs and similar artistic and athletic training programs. Resources should be designated for enhanced rehabilitation efficacy and prevention of shoulder and ankle injuries and for ground acrobats with equipment and flyers. Preventative strategies to improve safety upon return-to-training after vacations should be examined.

Assessment of Professional Circus Students' Psychological Characteristics at Four Strategic Timepoints over the Scholastic Year: A Longitudinal Study Using the Stress Process Model.

OBJECTIVE: The circus professionalization process entails extensive training to mitigate the high-risk demands which increase stress in artists. In high-risk professions, everyday hassles (challenges) contribute greatly to overall stress. To capture the impact of daily challenges on student-artists, the aim of the current study was to describe the magnitude and pattern of daily challenges as well as their relationships with perceived coping, anxiety, fatigue, and psychological distress. METHODS: Ninety-two students at École Nationale de Cirque (ENC), in Montreal, Canada, completed the Circus Daily Challenges Questionnaire (CDCQ) and scales assessing perceived coping, state anxiety, and fatigue at four time points over 1 school year. The Kessler 6 Non-Specific Psychological Distress Scale (K6) was implemented at one time point. RESULTS: Findings revealed significant fluctuations in challenge level and management of challenges throughout the school year, with schedule, technical development, artistic expression, physical preparation, and sleep reported as high during the two examination periods. The lowest challenge-level scores were achieved following the extended breaks in the annual calendar. Daily challenge positively correlated to state anxiety and fatigue, and negatively correlated with perceived coping. The student-artists reported higher prevalence of moderate psychological distress to general populations. CONCLUSION: Befitting the Stress Process Model, a strong interplay between variables was observed, and the life challenges assessment provides a basis for interventions based upon commonalities across the group, as well as individually tailored.

Head-Neck Motion in Prehospital Trauma Patients under Spinal Motion Restriction: A Pilot Study.

BACKGROUND: Spinal precautions are intended to limit motion of potentially unstable spinal segments. The efficacy of various treatment approaches for motion restriction in the cervical spine has been rigorously investigated using healthy volunteers and, to a lesser extent, cadaver samples. No previous studies have objectively measured this motion in trauma patients with potential spine injuries during prehospital care. Objective: The purpose of this study was to characterize head-neck (H-N) kinematics in a sample of trauma patients receiving spinal precautions in the field. Methods: This was a prospective observational study of trauma patients in the prehospital setting. Trauma patients meeting criteria for spinal precautions were eligible for inclusion. Participants received usual care, consisting of either a long backboard, cervical collar, and head blocks (BC) or a cervical collar only (CO), and behavior was categorized as compliant (C) or non-compliant (N). Three inertial measurement units (IMUs), placed on each participant's forehead, sternum, and stretcher, yielded data on H-N motion. Outcomes were described in terms of H-N displacement and acceleration, including single- and multi-planar values, root mean square (RMS), and bouts of continuous motion above pre-determined thresholds. Data were analyzed to compare H-N motion by phase of prehospital care, as well as treatment type and patient behavior. RESULTS: Substantial single- and multi-plane H-N motion was observed among all participants. Maximum single-plane displacements were between 11.3 ± 3.0 degrees (rotation) and 19.0 ± 16.6 degrees (flexion-extension). Maximum multi-plane displacements averaged 31.2 ± 7.2 degrees (range: 7.2 to 82.1 degrees). Maximum multi-plane acceleration averaged 5.8 ± 1.4 m/s2 (range: 1.2 to 19.9 m/s2). There were no significant differences among participants between prehospital phase and treatment type. Non-compliant participants showed significantly more motion than compliant participants. Conclusion: Among actual patients, movement appears to be greater than previously recorded in simulation studies, and to be associated with patient behavior. Miniature IMUs are a feasible approach to field-based measurement of H-N kinematics in trauma patients. Future research should evaluate the effects of patient compliance, treatment, and phase of care using larger samples. Key words: spinal immobilization; cervical spine; cervical collar; long backboard.

Effects of Spinal Immobilization and Spinal Motion Restriction on Head-Neck Kinematics during Ambulance Transport.

Objective: To determine the influence of ambulance motion on head-neck (H-N) kinematics and to compare the effectiveness of two spinal precaution (SP) protocols: spinal immobilization (SI) and spinal motion reduction (SMR). Methods: Eighteen healthy volunteers (7 females) underwent a series of standardized ambulance transport tasks, across various speeds, under the two SP protocols in a balanced order (n = 12 drivers, n = 7 ambulances). Inertial measurement units were placed on participants' heads and sternums, with another affixed to the stretcher mattress frame. Outcome measures included H-N displacement and acceleration. Results: Ambulance accelerations varied across driving tasks (2.5-9.5 m/s2) and speeds (3.0-6.2 m/s2) and resulted in a wide range of H-N displacements (7.2-22.6 deg) and H-N accelerations (1.4-10.9 m/s2). Relative to SMR, SI resulted in reduced H-N motion during turning, accelerating, and speed bumps (1.9-10.7 deg; 0.4-2.6 m/s2), but increased H-N accelerations during abrupt starts/stops and some higher speed tasks (0.4-2.5 m/s2). Ambulance acceleration was moderately correlated to H-N acceleration (r = 0.68) and displacement (r = 0.42). Conclusion: H-N motion was somewhat coupled to ambulance acceleration and varied across a wide range, regardless of SP approach. In general, SI resulted in a modest reduction in H-N displacement and acceleration, with some exceptions. The results inform clinical decisions on SP practice during prehospital transport and demonstrate a novel approach to quantifying H-N motion in prehospital care.

Don't take down the monkey bars: Rapid systematic review of playground-related injuries.

OBJECTIVE: To synthesize the available evidence on playground-related injuries and to determine the prevalence of these injuries in pediatric populations. DATA SOURCES: A rapid systematic review was conducted using PubMed, EMBASE, and the Cochrane Library, as well as the gray literature. STUDY SELECTION: The search was limited to studies published between 2012 and 2016 and identified a total of 858 articles, of which 22 met our inclusion criteria: original quantitative studies published in peer-reviewed journals in the past 5 years, concerning unintentional injuries in playgrounds in children aged 0 to 18 years. SYNTHESIS: Information was collected on study and injury characteristics, and the proportion of pediatric injuries related to playground activity was determined. Studies were performed in various countries and most were retrospective cohort studies. The prevalence of playground-related injury ranged from 2% to 34% (median 10%). Studies varied in the types of injuries investigated, including head injuries, genitourinary injuries, ocular and dental trauma, and various types of fractures. Most injuries were low severity. CONCLUSION: Although playgrounds are a common location where pediatric injuries occur, these injuries are relatively low in frequency and severity.

Sleep and Fatigue of Elite Circus Student-Artists During One Year of Training.

AIMS: The development of elite circus artists requires extensive technical and artistic training, as well as a commensurate level of physical preparation in readiness for a demanding professional career as a performance artist. While sport research has identified the importance of monitoring sleep and fatigue in athletes to optimize performance and to prevent illness and injury, not a single study of circus artists exists. This study provides a longitudinal examination of sleep and fatigue in elite circus student-artists. METHODS: 92 student-artists (60 male, 32 female) were analyzed at 4 strategic time points over a preparatory year. At each time point, sleep parameters (duration, quality and latency), ratings of perceived exertion (RPE), wakefulness, and fatigue were obtained using questionnaires. RESULTS: Student-artists attained an average nightly sleep of 8 hours, 27 minutes, exceeding the recommended durations for general populations and those self-reported in athletes. The majority of the artists also indicated acceptable sleep latency (87%) and quality (83%) scores. Sleep parameters remained consistent throughout the year despite significant variations in training load and fatigue. Sleep parameters were not substantial predictors of overall fatigue. Fatigue covaried with yearly variation in sessional training loads. CONCLUSIONS: Although improvement in sleep could be postulated as a means to mitigate fatigue, it is likely that strategies aimed at optimizing the loading profile and additional recovery techniques be a first line approach.

Effects of intradialytic cycling compared with pedometry on physical function in chronic outpatient hemodialysis: a prospective randomized trial.

BACKGROUND: Individuals on hemodialysis have low physical function and activity levels. Clinical trials have shown improvements in these parameters with exercise programming. Pedometers have not been extensively evaluated in individuals on hemodialysis. This randomized clinical trial compared the effects of intradialytic cycling versus a pedometer program on physical function, physical activity and quality of life. METHODS: Sixty patients were randomly assigned to two study groups. The ergometer group cycled during each hemodialysis session for 24 weeks. Pedometer participants followed a home-based walking program for 24 weeks. The primary outcome was aerobic capacity [VO2peak and 6-minute walk (6MW) test]. Secondary outcomes included lower extremity strength [sit-to-stand (SS) test], flexibility [sit-and-reach (SR) test], physical activity (accelerometer) and health-related quality of life. Measurements were collected at baseline and at 12 and 24 weeks. RESULTS: At 12 and 24 weeks, there was no significant change in the VO2peak or 6MW test between or within study groups. SS testing in the ergometer group improved from 10.2 (SD 3.4) to 11.4 (SD 2.5) cycles from baseline to 24 weeks (P < 0.005). Similarly, in the pedometer group, SS cycles improved from 10.1 (SD 3.3) to 12.2 (SD 3.5) (P < 0.005). The SR test also significantly improved over time in both the study groups. No significant changes were noted for other secondary outcomes. CONCLUSIONS: Both intradialytic cycling and pedometer programming improved aspects of physical function. Neither intervention had a significant effect on aerobic capacity. No significant differences in any outcomes were identified between interventions groups.

Relationship between sleep, pain, and disability in patients with spinal pathology.

OBJECTIVE: To characterize sleep and its relationship with disability and pain in patients with spine pathology. DESIGN: A survey study. SETTING: A university-based hospital spine clinic. PARTICIPANTS: Subjects (N=121) with mixed-etiology spine pathology. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Self-reported disability (Oswestry Disability Index [ODI]), back and leg pain intensity, the effect of back or leg pain on function, and sleep (Pittsburgh Sleep Quality Index [PSQI]) assessments were completed. RESULTS: Severe disability was evident with a mean ODI ± SD of 54.9±14, with mean pain intensities ± SD of 50±30 mm and 54±27 mm of 100mm for the leg and back, respectively. The mean PSQI ± SD was 10.4±5.3, with 87% of participants scoring greater than the sleep-disordered threshold of 5. PSQI was correlated to ODI (r=.53, P<.001), and ODI without the sleep component (r=.47, P<.001). Six of the subscales of PSQI were all also significantly correlated to ODI (.25

Investigating the relationship between emotions and physical literacy in a quality physical education context.

Affective experiences have been shown to influence attitudes and future behaviors related to physical activity, but no studies have related these experiences to physical literacy or examined affective experiences in quality physical education (QPE). The aim of this study was to describe emotions experienced in a QPE context and relate those emotions to students' physical literacy and self-esteem. A cross-sectional study of 145 4th and 5th grade students was surveyed after a single PE class on their emotional experiences (positive emotions: pride, enjoyment, and relief; negative, emotions: shame, anger, and boredom; aggregate emotional experience as the sum of positive and negative emotions) physical literacy (self-description and movement valuation) and self-esteem. In this QPE context, 73% of students reported only positive emotions, 26% mixed positive and negative emotions and 1% expressed only negative emotions. Pride and enjoyment were strongly co-occurring (89%). Among students expressing mixed emotions, 90% still yielded positive aggregate emotional experiences. Positive emotions have significant (p < 0.001), moderate to strong positive correlations with physical literacy (rho = 0.65 pride, 0.50 enjoyment) and self-esteem (rho = 0.48 pride, 0.38 enjoyment), and negative emotions have significant (p < 0.001), moderate negative correlations with physical literacy (rho = -0.47 shame, -0.30 anger, -0.32 boredom) and self-esteem (rho = -0.33 shame, -0.29 anger, -0.21 boredom). This study reveals strong positive emotional responses by students in a purported QPE context. The presence of mixed emotions with net positive aggregate experiences highlights the importance of consideration of both negative and positive emotions in movement contexts. Affective states have been proposed as key elements of physical literacy, and this study supports this through valence matched associations between both positive/negative affect with physical literacy and self-esteem.

Development of a Global Physical Literacy (GloPL) Action Framework: Study protocol for a consensus process.

BACKGROUND: The holistic concept of physical literacy (PL) has gained growing attention in recent research, policy, and practice. Many important policy documents of the physical activity and educational fields (e.g., Global Action Plan on Physical Activity 2018-2030 by the World Health Organization, UNESCO's Quality Physical Education guidelines for policymakers) have specified PL. However, a clear framework for action is needed, as most initiatives across the world are fragmented, lack a prospective orientation, can benefit from conceptual clarification, and are not linked to effective translation into practice. Therefore, we aim to consensually develop a Global Physical Literacy (GloPL) Action Framework to define goals and principles (asking what is needed) as well as actions and ways (asking how these can be achieved) to move PL forward. MATERIALS AND METHODS: We apply a three-stage group Delphi technique involving three representation groups: (a) geographical representatives to achieve global coverage of perspectives; (b) representatives of special thematic interest reflecting prominent gaps of current PL activities; and (c) representatives of societies from the broad field of physical activity and health to facilitate dissemination. The process will begin with an individual pre-Delphi exercise, in which experts generate initial ideas for the framework, followed by a four-eye document analysis to derive themes for the discussion. Subsequently, the experts will meet face-to-face in three online rounds to discuss and prioritize the themes. Interspersed formal voting with pre-defined agreement thresholds (via descriptive statistics) will inform the inclusion of themes within the final framework. CONCLUSIONS: A global consensus on goals, principles, actions, and ways for the development of PL has the potential to provide a largely accepted roadmap for future activities in research, policy, and practice. The co-production approach will help disseminate the GloPL Action Framework and benefit work in relevant application fields of physical activity and health worldwide.

The effect of two movement strategies on shoulder resultant joint moment during elastic resistance exercise.

Despite the common use of elastic resistance in training, only the static loading characteristics have been studied, whereas the dynamic components remain undetermined. The purpose was to determine the effect of two movement strategies on the shoulder resultant joint moment (RJM) during internal/external rotation exercise with elastic load. Ten healthy subjects performed sweep and step movement strategies over a constant range of motion and cadence (1:1). Shoulder RJM was determined using a Newtonian model with elastic force measured by force transducer, joint angle by electrogoniometer, and limb acceleration by accelerometer. Relative to the sweep strategy, the step strategy revealed a 49% increase in angle-specific RJM during the initial phase, RJM was reduced to 67-69% during midrange, and increased to over 110% at the end of the repetition. These RJM differences were wholly attributable to strategy-dependent changes in limb acceleration. Shoulder RJM in the sweep strategy was almost entirely explained by moment of elastic force. Movement strategy can substantially alter shoulder loading despite constant range of motion and cadence, impacting the magnitude and nature of the stimulus for neuromuscular adaptation. These acceleration-dependent changes in shoulder RJM may be important to consider for exercise efficacy and safety.

"Where was this when I was in Physical Education?" Physical literacy enriched pedagogy in a quality physical education context.

Introduction: In recent years, there has been a call to restructure physical education (PE) practices and outcomes. A physical literacy enriched pedagogy approach would support this change by more intentional design of lesson planning that includes concurrent development of competence & confidence and inclusion of students of all levels of ability, leading to holistic development of the student. Despite this potential, there is little research to date that outlines PE pedagogical practices with physical literacy as a foundation. The purpose was to explore pedagogical practices and perspectives from elementary PE teachers through a physical literacy enriched pedagogy lens in a high-quality PE context. Methods: One-on-one semi-structured interviews were conducted with a convenience sample of elementary PE teachers within one school division. Interviews with all participants focused on questions related to PE and physical literacy. Thematic analysis was used to analyze the data collected from the audio-recorded interviews. Results: Four themes were generated based on the semi-structured interviews from six elementary PE teachers from one school division. The results identified key physical literacy enriched pedagogical practices based on four themes: supporting a holistic PE experience based upon physical literacy as an outcome; movement within and beyond PE; inclusive and individualized experiences; and physical literacy practices bringing the school community together. The findings were then connected to the physical literacy cycle and UNESCO components of quality PE. Conclusions: All participants spoke to how their pedagogy focused on the holistic development and inclusion of their students based upon activation of various feedback pathways of the physical literacy cycle. The themes that emerged and subsequent insight gained from teachers went beyond existing physical literacy cycles, in particular by discussing development of students from cognitive, affective, social and creative (problem solving) perspectives, supporting an expansion to the existing physical literacy cycle as presented.

Patterns of change in prehospital spinal motion restriction: A retrospective database review.

BACKGROUND: Acute management of trauma patients with potential spine injuries has evolved from uniform spinal immobilization (SI) to spinal motion restriction (SMR). Little research exists describing how these changes have been implemented. This study aims to describe and analyze the practice of SMR in one emergency medical services (EMS) agency over the time frame of SMR adoption. METHODS: This was a retrospective database review of electronic patient care reports from 2009 to 2020. The effects of key practice changes (revised documentation and a collar-only treatment option) were analyzed in an interrupted time series using the rate of SI/SMR as the primary outcome. Secondary outcomes included patient age, sex, acuity, mechanism of injury, treatment provided, cervical collar size, and positioning. These were assessed for changes from year to year by Poisson regression. Associations between patient and treatment characteristics were investigated with binomial logistic regression. RESULTS: There were 25,747 instances of SI/SMR included. Among all patients, the median age was 40 (interquartile range 24-56), 58% (14,970) were male, and 20% (5062) were high-acuity. The rate of SI/SMR declined from 31.2 to 12.7 treatments per 100 trauma calls per month. The proportion of high-acuity patients increased by 9.6% per year on average (95% CI 8.7%-10.0%). When first available, collar-only treatment was provided to 47% of patients, rising by 6.3% per year (95% CI 3.2%-9.5%) to 60% in 2020. Collar-only treatment (compared to board-and-collar) was more likely to be applied to low-acuity patients (as compared to high): odds ratio 3.01 (95% CI 2.64-3.43). CONCLUSIONS: This study shows decreasing SI/SMR treatment and changing patient and practice characteristics. These patterns of care cannot be attributed solely to formal protocol changes. Similar patterns and their possible explanations should be investigated elsewhere.

A cross-sectional study of Canadian children's valuation of literacies across social contexts.

Background: Children, on average, do not engage in sufficient physical activity to reap the physical, mental, and social health benefits. Understanding the value that children place on movement across social contexts, and the relative ranking of this valuation, may help us to understand and intervene on activity levels. Method: This exploratory study examined the valuation of reading/writing, math, and movement across three social contexts (school, home, with friends) among children 6-13 years of age (N = 7,845; 51.3% male). Subjective task values across contexts were assessed with the valuing literacies subscale of the PLAYself. One-way Kruskal-Wallis ANOVAs were performed to test for differences between contexts and between literacies, respectively. Results: Sex differences and age-related variation were explored. Valuations of reading/writing (d = 1.16) and math (d = 1.33) decreased across context (school > family > friend), while the valuation of movement was relatively stable (d = 0.26). Valuations differed substantially with friends (p < 0.001, d = 1.03). Sex dependent effect sizes were minimal (d = 0.05-0.11). Conclusions: Movement is highly valued by children across social contexts; thus, programming across contexts should be prioritized to align with their valuation.

Database quality assessment in research in paramedicine: a scoping review.

BACKGROUND: Research in paramedicine faces challenges in developing research capacity, including access to high-quality data. A variety of unique factors in the paramedic work environment influence data quality. In other fields of healthcare, data quality assessment (DQA) frameworks provide common methods of quality assessment as well as standards of transparent reporting. No similar DQA frameworks exist for paramedicine, and practices related to DQA are sporadically reported. This scoping review aims to describe the range, extent, and nature of DQA practices within research in paramedicine. METHODS: This review followed a registered and published protocol. In consultation with a professional librarian, a search strategy was developed and applied to MEDLINE (National Library of Medicine), EMBASE (Elsevier), Scopus (Elsevier), and CINAHL (EBSCO) to identify studies published from 2011 through 2021 that assess paramedic data quality as a stated goal. Studies that reported quantitative results of DQA using data that relate primarily to the paramedic practice environment were included. Protocols, commentaries, and similar study types were excluded. Title/abstract screening was conducted by two reviewers; full-text screening was conducted by two, with a third participating to resolve disagreements. Data were extracted using a piloted data-charting form. RESULTS: Searching yielded 10,105 unique articles. After title and abstract screening, 199 remained for full-text review; 97 were included in the analysis. Included studies varied widely in many characteristics. Majorities were conducted in the United States (51%), assessed data containing between 100 and 9,999 records (61%), or assessed one of three topic areas: data, trauma, or out-of-hospital cardiac arrest (61%). All data-quality domains assessed could be grouped under 5 summary domains: completeness, linkage, accuracy, reliability, and representativeness. CONCLUSIONS: There are few common standards in terms of variables, domains, methods, or quality thresholds for DQA in paramedic research. Terminology used to describe quality domains varied among included studies and frequently overlapped. The included studies showed no evidence of assessing some domains and emerging topics seen in other areas of healthcare. Research in paramedicine would benefit from a standardized framework for DQA that allows for local variation while establishing common methods, terminology, and reporting standards.

Database quality assessment in research in paramedicine: a scoping review protocol.

INTRODUCTION: The paramedic practice environment presents unique challenges to data documentation and access, as well as linkage to other parts of the healthcare system. Variable or unknown data quality can influence the validity of research in paramedicine. A number of database quality assessment (DQA) frameworks have been developed and used to evaluate data quality in other areas of healthcare. The extent these or other DQA practices have been applied to paramedic research is not known. Accordingly, this scoping review aims to describe the range, extent and nature of DQA practices within research in paramedicine. METHODS AND ANALYSIS: This scoping review will follow established methods for the conduct (Johanna Briggs Institute; Arksey and O'Malley) and reporting (Preferred Reporting Items in Systematic Reviews and Meta-Analyses extension for scoping reviews) of scoping reviews. In consultation with a professional librarian, a search strategy was developed representing the applicable population, concept and context. This strategy will be applied to MEDLINE (National Library of Medicine), Embase (Elsevier), Scopus (Elsevier) and CINAHL (EBSCO) to identify studies published from 2011 through 2021 that assess paramedic data quality as a stated goal. Studies will be included if they report quantitative results of DQA using data that relate primarily to the paramedic practice environment. Protocols, commentaries, case studies, interviews, simulations and experimental data-processing techniques will be excluded. No restrictions will be placed on language. Study selection will be performed by two reviewers, with a third available to resolve conflicts. Data will be extracted from included studies using a data-charting form piloted and iteratively revised based on studies known to be relevant. Results will be summarised in a chart of study characteristics, DQA-specific outcomes and key findings. ETHICS AND DISSEMINATION: Ethical approval is not required. Results will be submitted to relevant conferences and peer-reviewed journals. TRIAL REGISTRATION: 10.17605/OSF.IO/Z287T.

When the world stops: The impact of COVID-19 on physical activity and physical literacy.

Matched pre-during pandemic comparison (160 children) revealed a substantial reduction in physical activity (p < 0.001, rrb = 0.83), environmental participation (p = 0.046, rrb = 0.16), movement valuation (p < 0.001, rrb = 0.61), and parent perceptions of children's physical literacy (p < 0.001, rrb = 0.56). Examining physical activity trajectories, higher pre-pandemic physical literacy protected children from pandemic related activity decline. Emerging from the pandemic, interventions should address children's eroded belief in movement and consider physical literacy levels of children in individualizing movement opportunities for restoration of activity levels. Novelty: A substantial reduction in physical activity was associated with children who had lower physical literacy and resulted in reductions in children's valuation of movement.

Body Composition Adaptations Throughout an Elite Circus Student-Artist Training Season.

The purpose of this study was to perform a longitudinal assessment of body composition of circus student-artists in an elite 3-year college training program. Ninety-two student-artists participated (age = 20.39 ± 2.42 years; height = 170.01 ± 8.01 cm; mass = 66.48 ± 11.07 kg; 36% female and 64% male), representing 92% of the student population. Body composi- tion was assessed using multi-frequency bioelectrical impedance at four strategic time points throughout the training year to evaluate changes over the two semesters (September to December and January to April) and winter vacation (December to January). Workloads were subjectively assessed using ratings of perceived exer- tion (RPE). Averaged over the academic terms, fat mass was 11.5 ± 4.8%, muscle mass was 50.2 ± 3.4%, and body mass index was 22.9 ± 2.2. Males and females differed significantly across all absolute and relative body composition variables. Muscle mass increased (semester one, +1.0%, p < 0.001; semester two, +0.4%, p < 0.05) while fat mass decreased during each semester (semester one, -1.6%, p < 0.001; semester two, -0.6%, p < 0.05) co-varying with changes in RPE (semester one, +2.3, p < 0.05; semester two, +1.7, p < 0.05). During the winter vacation period, percent fat mass increased (males, +1.0%; females, +2.0%) and percent muscle mass decreased (males, -0.6%; females, -0.9%). Discipline-specific differences in body composition were also detected, and significant differences were observed between student-artists grouped by years in school. Over the training year, there was a positive adaptation for muscle and fat mass despite the negative adaptation experienced during the winter vacation period.