Loss of tumor suppressor TMEM127 drives RET-mediated transformation through disrupted membrane dynamics

Internalization from the cell membrane and endosomal trafficking of receptor tyrosine kinases (RTKs) are important regulators of signaling in normal cells that can frequently be disrupted in cancer. The adrenal tumor pheochromocytoma (PCC) can be caused by activating mutations of the rearranged during transfection (RET) receptor tyrosine kinase, or inactivation of TMEM127, a transmembrane tumor suppressor implicated in trafficking of endosomal cargos. However, the role of aberrant receptor trafficking in PCC is not well understood. Here, we show that loss of TMEM127 causes wildtype RET protein accumulation on the cell surface, where increased receptor density facilitates constitutive ligand-independent activity and downstream signaling, driving cell proliferation. Loss of TMEM127 altered normal cell membrane organization and recruitment and stabilization of membrane protein complexes, impaired assembly, and maturation of clathrin-coated pits, and reduced internalization and degradation of cell surface RET. In addition to RTKs, TMEM127 depletion also promoted surface accumulation of several other transmembrane proteins, suggesting it may cause global defects in surface protein activity and function. Together, our data identify TMEM127 as an important determinant of membrane organization including membrane protein diffusability and protein complex assembly and provide a novel paradigm for oncogenesis in PCC where altered membrane dynamics promotes cell surface accumulation and constitutive activity of growth factor receptors to drive aberrant signaling and promote transformation.

Loss of Tumour Suppressor TMEM127 Drives RET-mediated Transformation Through Disrupted Membrane Dynamics

Internalization from the cell membrane and endosomal trafficking of receptor tyrosine kinases (RTK) are important regulators of signaling in normal cells that can frequently be disrupted in cancer. The adrenal tumour pheochromocytoma (PCC) can be caused by activating mutations of the RET receptor tyrosine kinase, or inactivation of TMEM127, a transmembrane tumour suppressor implicated in trafficking of endosomal cargos. However, the role of aberrant receptor trafficking in PCC is not well understood. Here, we show that loss of TMEM127 causes wildtype RET protein accumulation on the cell surface, where increased receptor density facilitates constitutive ligand-independent activity and downstream signaling, driving cell proliferation. Loss of TMEM127 altered normal cell membrane organization and recruitment and stabilization of membrane protein complexes, impaired assembly, and maturation of clathrin coated pits, and reduced internalization and degradation of cell surface RET. In addition to RTKs, TMEM127 depletion also promoted surface accumulation of several other transmembrane proteins, suggesting it may cause global defects in surface protein activity and function. Together, our data identify TMEM127 as an important determinant of membrane organization including membrane protein diffusability, and protein complex assembly and provide a novel paradigm for oncogenesis in PCC where altered membrane dynamics promotes cell surface accumulation and constitutive activity of growth factor receptors to drive aberrant signaling and promote transformation.

Reliability and validity of the Patient Health Questionnaire-4 scale and its subscales of depression and anxiety among US adults based on nativity

BACKGROUND

The burdens of anxiety and depression symptoms have significantly increased in the general US population, especially during this COVID-19 epidemiological crisis. The first step in an effective treatment for anxiety and depression disorders is screening. The Patient Health Questionnaire-4 (PHQ-4, a 4-item measure of anxiety/depression) and its subscales (PHQ-2 [a 2-item measure of depression] and Generalized Anxiety Disorder [GAD-2, a 2-item measure of anxiety]) are brief but effective mass screening instruments for anxiety and depression symptoms in general populations. However, little to no study examined the psychometric properties (i.e., reliability and validity) of the PHQ-4 and its subscales (PHQ-2 and GAD-2) in the general US adult population or based on US nativity (i.e., foreign-born vs. the US-born). We evaluated the psychometric properties of the PHQ-4 and its subscales in US adults, as well as the psychometric equivalence of the PHQ-4 scale based on nativity.

METHODS

We conducted a cross-sectional survey of 5,140 adults aged ≥ 18 years. We examined the factorial validity and dimensionality of the PHQ-4 with confirmatory factor analysis (CFA). A multiple-group confirmatory factor analysis (MCFA) was used to evaluate the comparability of the PHQ-4 across nativity groups. Reliability indices were assessed. Also, the scales' construct validities were assessed by examining the associations of both the PHQ-4 and its subscales' scores with the sociodemographic characteristics and the 3-item UCLA Loneliness scale.

RESULTS

The internal consistencies were high for the PHQ-4 scale (α = 0.92) and its subscales of PHQ-2 (α = 0.86) and GAD-2 (α = 0.90). The CFA fit indices showed evidence for the two-factor structure of the PHQ-4. The two factors (i.e., anxiety and depression) were significantly correlated (r = 0.92). The MCFA demonstrated measurement invariance of the PHQ-4 across the nativity groups, but the model fits the data better in the foreign-born group. There were significant associations of the PHQ-4 scale and its subscales' scores with the sociodemographic characteristics and the UCLA Loneliness scale (all p < 0.001).

CONCLUSIONS

The PHQ-4 and its subscales are reliable and valid measures to screen anxiety and depression symptoms in the general US adult population, especially in foreign-born individuals during the COVID-19 pandemic.

Examining associations between school-level determinants and the implementation of physical activity opportunities

School-based physical activity (PA) opportunities can help students engage in greater amounts of daily PA, meet PA guidelines, and lead to improved health and educational outcomes. However, we do not completely understand the organizational challenges to implementing these opportunities successfully. This exploratory study examined associations between school-level determinants and the implementation of school-based PA opportunities. We analyzed cross-sectional survey data from schools (n = 46) participating in the Healthy Zone School Program (HZSP) (Dallas, Texas, USA) during 2019-2020. Respondents completed an electronic survey that included measures of school-level determinants (e.g. culture, leadership, priority) and the implementation of school-based PA opportunities. We used linear regression models to examine associations between determinants and implementation outcomes (number of PA opportunities delivered, perceived overall success of each PA program/activity used). After adjusting for campus type (i.e. elementary, middle, high, K-12), student race/ethnicity, and percentage of economically disadvantaged students, no constructs were associated with the number of PA opportunities implemented. Linear regression models suggest access to knowledge and information (β = 0.39, P = .012, 95% CI = 0.24-1.44) and implementation climate (β = 0.34, P = .045, 95% CI = 0.02-1.59) were positively associated with the success of school-based PA opportunities. Our findings provide suggestive evidence that access to knowledge and information and a supportive school climate may improve the overall success of PA opportunities provided to students. Future research should examine additional school-level determinants to understand their importance to implementation and inform the development of strategies to improve schools' capacity for implementing PA opportunities successfully.

Using the R = MC2 heuristic to understand barriers to and facilitators of implementing school-based physical activity opportunities: a qualitative study

BACKGROUND

Schools are a key setting for supporting youth physical activity, given their broad reach and diverse student populations. Organizational readiness is a precursor to the successful implementation of school-based physical activity opportunities. The R = MC2 heuristic (Readiness = Motivation x Innovation-Specific Capacity x General Capacity) describes readiness as a function of an organization's motivation and capacity to implement an innovation and can be applied to better understand the implementation process. The purpose of this study was to explore the barriers to and facilitators of implementing school-based physical activity opportunities in the context of organizational readiness.

METHODS

We analyzed interview data from 15 elementary school staff (principals, assistant principals, physical education teachers, and classroom teachers) from a school district in Texas. We focused on factors related to adopting, implementing, and sustaining a variety of school-based physical activity opportunities. We used the Framework Method to guide the analysis and coded data using deductive (informed by the R = MC2 heuristic) and inductive approaches. Themes were generated using the frequency, depth, and richness of participant responses.

RESULTS

Four themes emerged from the data: (1) implementation is aided by the presence of internal and external relationships; (2) physical activity opportunities compete with other school priorities; (3) seeing the benefits of physical activity opportunities motivates school staff toward implementation; and (4) staff buy-in is critical to the implementation process. Themes 1-3 aligned with subcomponents of the R = MC2 heuristic (intra- and inter-organizational relationships, priority, and observability), whereas Theme 4 (staff buy-in) related to multiple subcomponents within the Motivation component but was ultimately viewed as a distinct construct.

CONCLUSION

Our results highlight and explain how key readiness constructs impact the implementation of school-based physical activity opportunities. They also highlight the importance of obtaining staff buy-in when implementing in the school setting. This information is critical to developing readiness-building strategies that help schools improve their capacity to deliver physical activity opportunities effectively.

TRIAL REGISTRATION

Not applicable.

Comparing the Use and Effectiveness of In-Person and Remote Physical Education Delivery During the COVID-19 Pandemic

BACKGROUND

Physical Education is a key component to improve youth health, but there is limited information on Physical Education delivery in different formats.

PURPOSE

We compared PE formats (in-person versus remote) across evaluation aspects: weekly minutes; perceived effectiveness; and student-to-teacher ratio.

METHODS

We distributed questionnaires (2020-2021 school year) to school contacts who represented NFL Play 60 FitnessGram® Project (n=216) schools in multiple US cities. Questionnaires entailed learning format, weekly PE minutes, perceived effectiveness, and student-to-teacher ratio. We used linear mixed models to compare PE formats across evaluation variables.

RESULTS

Among 165 schools, 10% (n=17) offered in-person instruction, 31% (n=51) offered remote instruction, and 59% offered both (n=97). Results revealed higher in-person PE minutes (77.2±7.3) compared to remote minutes (67.1±14.6), but results were not significantly different (p=0.19). School contacts reported significantly more effective in-person PE (4.0) than remote PE (2.8, p<0.001). In-person PE also had significantly smaller reported student-to-teacher ratio (16.7) compared to remote PE (23.7, p<0.001).

DISCUSSION

Findings indicate PE was offered during the pandemic, but remote learning appeared less effective than in-person PE.

TRANSLATION to HEALTH EDUCATION PRACTICE

Efforts are needed to improve remote PE to reinforce high-quality PE in the future.

TMEM127 suppresses tumor development by promoting RET ubiquitination, positioning, and degradation

The TMEM127 gene encodes a transmembrane protein of poorly known function that is mutated in pheochromocytomas, neural crest-derived tumors of adrenomedullary cells. Here, we report that, at single-nucleus resolution, TMEM127-mutant tumors share precursor cells and transcription regulatory elements with pheochromocytomas carrying mutations of the tyrosine kinase receptor RET. Additionally, TMEM127-mutant pheochromocytomas, human cells, and mouse knockout models of TMEM127 accumulate RET and increase its signaling. TMEM127 contributes to RET cellular positioning, trafficking, and lysosome-mediated degradation. Mechanistically, TMEM127 binds to RET and recruits the NEDD4 E3 ubiquitin ligase for RET ubiquitination and degradation via TMEM127 C-terminal PxxY motifs. Lastly, increased cell proliferation and tumor burden after TMEM127 loss can be reversed by selective RET inhibitors in vitro and in vivo. Our results define TMEM127 as a component of the ubiquitin system and identify aberrant RET stabilization as a likely mechanism through which TMEM127 loss-of-function mutations cause pheochromocytoma.

Examining readiness for implementing practice changes in federally qualified health centers: A rapid qualitative study

Implementing evidence-based interventions remains slow in federally qualified health centers (FQHCs). The purpose of this study is to qualitatively examine the R = MC2 (Readiness = motivation × innovation specific capacity × general capacity) heuristic subcomponents in the context of implementing general and colorectal cancer screening (CRCS)-related practice changes in FQHCs. We conducted 17 interviews with FQHC employees to examine (1) experiences with successful or unsuccessful practice change efforts, (2) using approaches to promote CRCS, and (3) opinions about R = MC2 subcomponents. We conducted a rapid qualitative analysis to examine the frequency, depth, and spontaneity of subcomponents. Priority, compatibility, observability (motivation), intra- and interorganizational relationships (innovation-specific capacity), and organizational structure and resource utilization (general capacity) emerged as highly relevant. For example, organizational structure was described as related to an organization's open communication during meetings to help with scheduling procedures. The results contribute to understanding organizational readiness in the FQHC setting and can be helpful when identifying and prioritizing barriers and facilitators that affect implementation.

Observed and perceived benefits of providing physical activity opportunities in elementary schools: a qualitative study

Introduction

Schools play an important role in promoting physical activity for youth. However, school-based physical activity opportunities often compete with other academic priorities, limiting their implementation. The purpose of this study was to qualitatively explore elementary school teacher and staff perspectives on providing physical activity opportunities and how they impact students and learning.

Methods

We partnered with a school district in Texas to conduct semi-structured individual interviews. We used a purposeful sampling approach to recruit elementary teachers and staff knowledgeable about the physical activity opportunities provided at their school. Interviews included questions about participant opinions of providing physical activity opportunities and the types of opportunities provided. We analyzed data using a directed content analysis and iterative categorization approach.

Results

Fifteen participants (4 teachers, 4 physical education teachers, 3 assistant principals, and 4 principals) completed interviews from 10 elementary schools. Participants discussed observed and perceived benefits when providing physical activity opportunities, which emerged into four themes and subthemes: (1) academic benefits (learning readiness, learning engagement, and academic performance); (2) social-emotional benefits (behavior, interpersonal and social skills, and classroom culture); (3) physical benefits (brain health, skill development, physical health); and (4) instructional benefits (quality teaching time, helpful teaching tools, and teacher-student relationships).

Conclusions

Teachers and staff observed numerous benefits when students had opportunities to be physically active, including the positive impact on academic and social-emotional outcomes. Our findings highlight the alignment of physical activity with other school priorities. Physical activity programming can be used in ways to support academics, learning, behavior, and other important outcomes.

Elementary school staff perspectives on the implementation of physical activity approaches in practice: an exploratory sequential mixed methods study

Introduction

A whole-of-school approach is best to promote physical activity before, during, and after school. However, multicomponent programming is often complex and difficult to deliver in school settings. There is a need to better understand how components of a whole-of-school approach are implemented in practice. The objectives of this mixed methods study were to: (1) qualitatively explore physical activity approaches and their implementation in elementary schools, (2) quantitatively assess implementation levels, and (3) examine associations between school-level physical activity promotion and academic ratings.

Methods

We used an exploratory sequential mixed methods design. We conducted semi-structured qualitative interviews with elementary school staff from a Texas school district and used a directed content analysis to explore physical activity approaches and their implementation. Using qualitative findings, we designed a survey to quantitatively examine the implementation of physical activity approaches, which we distributed to elementary staff district wide. We used Pearson correlation coefficients to examine the association between the amount of physical activity opportunities present in individual schools and school-level academic ratings.

Results

We completed 15 interviews (7 principals/assistant principals, 4 physical educators, and 4 classroom teachers). Elementary school teachers and staff indicated PE and recess implementation was driven from the top-down by state and district policies, while implementation of classroom-based approaches, before and after school programming, and active transport were largely driven from the bottom-up by teachers and school leaders. Teachers and staff also discussed implementation challenges across approaches. Survey respondents (n = 247 from 22 schools) indicated 54.6% of schools were implementing ≥135 min/week of physical education and 72.7% were implementing 30 min/day of recess. Classroom-based approaches were less common. Twenty-four percent of schools reported accessible before school programs, 72.7% reported accessible after school programs, and 27% promoted active transport. There was a direct association between the number of physical activity opportunities provided and school-level academic ratings r(22) = 0.53, p = 0.01.

Conclusion

Schools provided physical activity opportunities consistent with a whole-of-school approach, although there was variability between schools and implementation challenges were present. Leveraging existing school assets while providing school-specific implementation strategies may be most beneficial for supporting successful physical activity promotion in elementary schools.

Differences in American adolescent sport participation during the COVID-19 pandemic by learning mode: A national survey

This study aimed to examine the relation between learning mode with sport participation and compare participation prevalence in different settings by learning mode among United States adolescents during the COVID-19 pandemic. A cross-sectional, national survey was conducted by a market research company (December 2021-January 2022) among parents whose child participated in sports pre-pandemic. Parents were asked about their child's learning mode (in-person, online, hybrid); sports participation (yes/no) during the pandemic; and participation setting (school, community, club/elite). Weighted logistic regression models examined the relation between learning mode with sport participation. Weighted prevalence estimates of participation setting were compared by learning mode. Among youth included in the analysis (n = 500; Mean_age = 14.0 years), 71.0% played sports during the pandemic. Learning mode was significantly associated with participating (versus not participating) among adolescents attending school online (aOR = 0.09; 95% CI: 0.04-0.18) and in a hybrid modality (aOR = 0.30; 95% CI: 0.15-0.58) versus those attending in-person. Those attending school online (versus in-person or hybrid) had significantly lower participation prevalence in community, school, and club/elite sports. Findings may reflect parents opting out of in-person activities or schools canceling organized sport opportunities. To inform engagement strategies, research is needed to understand reasons for declined participation and extent to which participation resumed.

Using cognitive interviews to improve a measure of organizational readiness for implementation

BACKGROUND

Organizational readiness is a key factor for successful implementation of evidence-based interventions (EBIs), but a valid and reliable measure to assess readiness across contexts and settings is needed. The R = MC² heuristic posits that organizational readiness stems from an organization's motivation, capacity to implement a specific innovation, and its general capacity. This paper describes a process used to examine the face and content validity of items in a readiness survey developed to assess organizational readiness (based on R = MC²) among federally qualified health centers (FQHC) implementing colorectal cancer screening (CRCS) EBIs.

METHODS

We conducted 20 cognitive interviews with FQHC staff (clinical and non-clinical) in South Carolina and Texas. Participants were provided a subset of items from the readiness survey to review. A semi-structured interview guide was developed to elicit feedback from participants using "think aloud" and probing techniques. Participants were recruited using a purposive sampling approach and interviews were conducted virtually using Zoom and WebEx. Participants were asked 1) about the relevancy of items, 2) how they interpreted the meaning of items or specific terms, 3) to identify items that were difficult to understand, and 4) how items could be improved. Interviews were transcribed verbatim and coded in ATLAS.ti. Findings were used to revise the readiness survey.

RESULTS

Key recommendations included reducing the survey length and removing redundant or difficult to understand items. Additionally, participants recommended using consistent terms throughout (e.g., other units/teams vs. departments) the survey and changing pronouns (e.g., people, we) to be more specific (e.g., leadership, staff). Moreover, participants recommended specifying ambiguous terms (e.g., define what "better" means).

CONCLUSION

Use of cognitive interviews allowed for an engaged process to refine an existing measure of readiness. The improved and finalized readiness survey can be used to support and improve implementation of CRCS EBIs in the clinic setting and thus reduce the cancer burden and cancer-related health disparities.

Assessing the Australian occupational driver behavior questionnaire in U.S. taxi drivers: Different country, different occupation and different worker population

BACKGROUND

Promoting safe driver behaviors is an important aspect of road safety. To better understand road safety behaviors, there is a role for practical instruments that can validly measure typical road safety behaviors among occupational drivers. The Occupational Driver Behavior Questionnaire (ODBQ) was developed to assess road safety behaviors among home health nurses in Australia.

METHODS

We administered a cross-sectional survey to a sample of taxi drivers in two U.S. metropolitan areas. The survey included Newnam's ODBQ-12 and a study-specific 15-item version (ODBQ-15) assessing 4 different road safety behaviors with 3 more items added and motor-vehicle crashes in the past year. Logistic regression analyses examined the association of the road safety behaviors with motor vehicle crashes. A series of confirmatory factor analysis (CFA) models assessed the construct validity of the ODBQ-12 and ODBQ-15.

RESULTS

We pooled survey data from 497 Houston drivers and 500 Los Angeles drivers to assess study aims. CFA models examining the 12-item and the 15-item ODBQ versions had good model fit (Comparative Fit Index > 0.95, Tucker Lewis Index ≥ 0.95, root mean square error of approximation < 0.06, standardized root mean square residual ≤ 0.05). The ODBQ's road safety behaviors were significantly associated (p < 0.001) with crashes while working (ORs 0.51-0.75) and not working (ORs 0.57-0.84).

CONCLUSIONS

The ODBQ-12 and ODBQ-15 were both significantly associated with motor vehicle crashes among taxicab drivers in two large U.S. metropolitan areas. Researchers studying occupational drivers who transport passengers may want to consider using the ODBQ-15. The 3 additional items are meaningful to this workforce and are priority areas for international road safety efforts.

Evidence-Based Intervention (EBI) Mapping: a systematic approach to understanding the components and logic of EBIs

BACKGROUND

Despite the development of numerous evidence-based interventions (EBIs), many go unused in practice. Hesitations to use existing EBIs may be due to a lack of understanding about EBI components and what it would take to adapt it or implement it as designed. To improve the use of EBIs, program planners need to understand their goals, core components, and mechanisms of action. This paper presents EBI Mapping, a systematic approach based on Intervention Mapping, that can be used to understand and clearly describe EBIs, and help planners put them into practice.

METHODS

We describe EBI Mapping tasks and provide an example of the process. EBI Mapping uses principles from Intervention Mapping, a systematic framework for planning multilevel health promotion interventions. EBI Mapping applies the Intervention Mapping steps retrospectively to help planners understand an existing EBI (rather than plan a new one). We explain each EBI Mapping task and demonstrate the process using the VERB Summer Scorecard (VSS), a multi-level community-based intervention to improve youth physical activity.

RESULTS

EBI Mapping tasks are: 1) document EBI materials and activities, and their audiences, 2) identify the EBI goals, content, and mechanisms of action, 3) identify the theoretical change methods and practical applications of those methods, 4) describe design features and delivery channels, and 5) describe the implementers and their tasks, implementation strategies, and needed resources. By applying the EBI Mapping tasks, we created a logic model for the VSS intervention. The VSS logic model specifies the links between behavior change methods, practical applications, and determinants for both the at-risk population and environmental change agents. The logic model also links the respective determinants to the desired outcomes including the health behavior and environmental conditions to improve the health outcome in the at-risk population.

CONCLUSIONS

EBI Mapping helps program planners understand the components and logic of an EBI. This information is important for selecting, adapting, and scaling-up EBIs. Accelerating and improving the use of existing EBIs can reduce the research-to-practice gap and improve population health.

Understanding implementation strategies to support classroom-based physical activity approaches in elementary schools: A qualitative study

BACKGROUND

Classroom-based physical activity approaches can improve children's physical activity levels during school. However, the implementation of these approaches remains a challenge. The purpose of this study was to examine implementation strategies to support the delivery of classroom-based physical activity approaches from the perspectives of elementary school staff.

METHODS

We conducted individual interviews with elementary school staff from a mid-sized school district in Texas. Interviews lasted approximately 60 min and were audio recorded and transcribed for analyses. We used directed content analysis and an iterative categorization approach to identify emerging themes related to implementation strategies.

RESULTS

We interviewed 15 participants (4 classroom teachers, 4 physical education teachers, 3 assistant principals, and 4 principals) about implementation strategies supporting classroom-based physical activity approaches. Four prominent themes related to implementation strategies emerged: 1) the role of program champions, 2) the use and function of staff training, 3) the importance of strategic planning, and 4) the use of positive reinforcements to support implementation.

CONCLUSIONS

Results highlight the need for multiple implementation strategies to support the delivery of classroom-based physical activity approaches. Results also highlight potential mechanisms through which the implementation strategies operate. This information is valuable to future planning efforts for classroom-based physical activity approaches.

Using Implementation Mapping to Build Organizational Readiness

Organizational readiness is essential for high-quality implementation of innovations (programs, policies, practices, or processes). The R = MC² heuristic describes three readiness components necessary for implementation—the general functioning of the organization (general capacities), the ability to deliver a particular innovation (innovation-specific capacities), and the motivation to implement the innovation. In this article, we describe how we used the Readiness Building System (RBS) for assessing, prioritizing, and improving readiness and Implementation Mapping (IM), a systematic process for planning implementation strategies, to build organizational readiness for implementation of sexual assault prevention evidence-based interventions (EBIs). While RBS provides an overarching approach for assessing and prioritizing readiness constructs (according to the R = MC² heuristic; Readiness = Motivation x general Capacity × innovation specific Capacity), it does not provide specific guidance on the development and/or selection and tailoring of strategies to improve readiness. We used the five IM tasks to identify and prioritize specific readiness goals and develop readiness-building strategies to improve subcomponents described in the R = MC² heuristic. This article illustrates how IM can be used synergistically with the RBS in applied contexts to plan implementation strategies that will improve organizational readiness and implementation outcomes. Specifically, we provide an example of using these two frameworks as part of the process of building organizational readiness for implementation of sexual assault prevention EBIs.

Using Implementation Mapping to develop and test an implementation strategy for active learning to promote physical activity in children: a feasibility study using a hybrid type 2 design

Background

Incorporating physical movement in the teaching of academic content (active learning) is a promising approach to improve children’s health and academic performance. Despite documented benefits, implementation of active learning remains challenging for schools. The aims of this study are to develop an implementation strategy to support the delivery of active learning in elementary schools and examine the impact of the developed implementation strategy on the implementation and effectiveness of active learning.

Methods

Aim 1 will use Implementation Mapping, which is a multi-step approach that guides the use of theory, stakeholder input, and existing literature to develop a scientifically based implementation strategy for active learning in elementary schools. Aim 2 will feature a feasibility study to examine the impact of the implementation strategy on both implementation and effectiveness outcomes, consistent with a Hybrid Type 2 design. Acceptability and implementation fidelity will be the primary implementation outcomes, and student physical activity levels will be the primary effectiveness outcome. We will recruit two elementary schools within our partner district, and one will be randomly assigned to receive usual support while the other will receive the newly developed implementation strategy. Participants from each school will complete baseline, 6-, and 12-month assessments. Bayesian statistical approaches will quantitatively examine preliminary effectiveness outcomes. We will also use an embedded mixed methods approach to triangulate findings.

Discussion

This study’s innovative overarching conceptual framework (centered on Implementation Mapping) will inform the development and testing of the implementation strategy. This study also uses methodological approaches optimal for feasibility studies, including mixed methods and Bayesian statistics. As a result, we will be able to gain a thorough understanding about the feasibility and preliminary effectiveness of the implementation strategy, which will inform subsequent research and practice for implementing active learning in schools.

Trial registration

ClinicalTrials.gov, NCT05048433, registered on September 8, 2021.

Using Community-Academic Partnerships and a Creative Expression Contest to Engage Youth in the Development of Communication Materials for Promoting Behaviors That Prevent COVID-19

Youth can transmit COVID-19 to adults, but few communication materials exist for engaging youth in COVID-19 prevention behaviors. We describe the process of leveraging a community-academic partnership in a rapid response initiative to engage youth in a contest (i.e., Youth-Led Creative Expression Contest to Prevent COVID-19 across Texas) to develop creative public health messaging centered on the prevention of COVID-19 transmission and infection for their peers. Core activities included developing a request for applications that solicited submission of creative expression materials promoting the use of COVID-19 prevention behaviors (mask-wearing, social distancing, handwashing, not touching the face) from Texas youth in elementary, middle, and/or high school; sending the request for applications to 48 organizations in Austin, Brownsville, Dallas, El Paso, Houston, and San Antonio in summer 2020; and recruiting a youth advisory board to score submissions and award prizes. We report on youth engagement in the COVID communication contest across Texas and use statistics (chi-square and t-tests) to characterize and compare youth participants and their creative expression artwork. The contest resulted in 3,003 website views and 34 submissions eligible for scoring. Each submission averaged >2 prevention behaviors. On average, winning submissions included a higher number of prevention behaviors than nonwinning submissions. The prevention behavior "not touching the face" was included more often in winning submissions than nonwinning submissions. Elementary school children were less likely to include a mask in their submission compared with older youth. Existing community-academic networks can engage youth in the development of geographically and age-tailored communication materials.

Application of community - engaged dissemination and implementation science to improve health equity

Community engagement is critical to accelerate and improve implementation of evidence-based interventions to reduce health inequities. Community-engaged dissemination and implementation research (CEDI) emphasizes engaging stakeholders (e.g., community members, practitioners, community organizations, etc.) with diverse perspectives, experience, and expertise to provide tacit community knowledge regarding the local context, priorities, needs, and assets. Importantly, CEDI can help improve health inequities through incorporating unique perspectives from communities experiencing health inequities that have historically been left out of the research process. The community-engagement process that exists in practice can be highly variable, and characteristics of the process are often underreported, making it difficult to discern how engagement of community partners was used to improve implementation. This paper describes the community-engagement process for a multilevel, pragmatic randomized trial to increase the reach and impact of evidence-based tobacco cessation treatment among Community Health Center patients; describes how engagement activities and the resulting partnership informed the development of implementation strategies and improved the research process; and presents lessons learned to inform future CEDI research.

Evaluating Cell Membrane Localization and Intracellular Transport of Proteins by Biotinylation

Protein translocation to the cell membrane and transport through intracellular compartments are dynamic processes frequently altered in cancer cells. Abnormal protein localization can affect key cell functions, including transduction of extracellular signals and organization of the cytoskeleton, significantly affecting oncogenicity and therapeutic responses. In this chapter, we describe a surface protein biotinylation method that allows the study of membrane localization and endosomal transport of membrane-associated proteins. Surface biotinylation can be used to evaluate baseline protein levels at the membrane, and other processes such as internalization, recycling, and degradation of proteins in response to different treatments or as a consequence of oncogenic mutations. Further, the combination of this technique with other strategies, such as treatments with transport inhibitors, allows investigation of specific steps of protein trafficking through the cell.

Applying evidence-based intervention (EBI) mapping to identify the components and logic of colorectal cancer screening interventions

Implementation of evidence-based interventions (EBIs) can help to increase colorectal cancer screening (CRCS). Potential users of CRCS EBIs are often unclear about the specific features, logic, and core elements of existing EBIs, making it challenging to use or adapt them. We used EBI Mapping, a systematic process developed from Intervention Mapping that identifies an EBI's components and logic, to characterize existing CRCS EBIs from the National Cancer Institute's Evidence-Based Cancer Control Programs website. The resulting information can facilitate intervention adoption, adaptation, and/or implementation. Two trained coders independently coded intervention materials to describe intervention components and logic (n = 20). We display CRCS EBI components (potential mechanism of change) using evidence tables and heat maps. All EBIs addressed completion of at least one CRCS behavior (stool-based test, n = 9; stool-based test or another CRCS test, n = 8; colonoscopy, n = 3; colonoscopy or sigmoidoscopy, n = 1). The psychosocial determinants most frequently addressed by these interventions were knowledge (n = 19), attitudes (n = 17), risk perception/perceived susceptibility (n = 16), skills (n = 15), and overcoming barriers (n = 15). Multi-level EBIs (n = 9) attempted to change an average of 2.1 ± 1.1 conditions in the patients' environment (e.g., accessibility of CRCS); only four EBIs used environmental change agents (e.g., providers, nurses). From the heat maps of EBIs, we describe common theoretical change methods' (e.g., facilitation) used for addressing determinants (e.g., overcoming barriers). EBI Mapping can help users identify important components of a CRCS EBI's logic; these proposed mechanisms of action can inform adoption, adaptation, and implementation in new settings, and facilitate scale up of EBIs.

Physical Activity and Healthy Eating Programming in Schools to Support Student's Health-Related Fitness: An Observational Study

Centers for Disease Control (CDC) guidelines recommend schools use a coordinated health approach to support healthy eating and physical activity. This study examines whether the number of healthy eating and physical activity programs and activities used by schools and their perceived success relate to students’ health-related fitness. This observational study used data from the Healthy Zone Schools Program. Data (collected in 2017–2019) were integrated from three sources: (1) school surveys, (2) FitnessGram^®, and (3) the Texas Education Agency. Independent variables were the number of health promotion programs and activities and their perceived success; dependent variables were meeting Healthy Fitness Zone Standards (HFZ) for aerobic capacity and body mass index (BMI). We used mixed-effects logistic regression models. Fifty-six schools were in the analytic sample (n = 15,096 students with aerobic capacity data and n = 19,969 with BMI data). Results indicated the perceived success of physical activity programs/activities was significantly associated with students meeting HFZ standards for aerobic capacity (OR = 1.32, CI = 1.06–1.63). There was a significant direct association between the number of physical activity and healthy eating activities implemented (OR = 1.04, CI = 1.01–1.06) and students meeting HFZ for BMI. Schools using multiple health programs and activities need to balance the number provided with their capacity to maintain success.

Examining the Validity and Reliability of Measures for Individual-Level Constructs related to Implementation of School-Based Physical Activity Approaches

Valid and reliable measures are important to understanding the implementation of physical activity approaches in schools. The study purpose is to examine the psychometric properties of measures of individual-level constructs (knowledge, attitudes, outcome expectations, self-efficacy, innovativeness, and support) in the context of implementing school-based physical activity approaches. We collected data from a sample of elementary school employees (administrators, classroom teachers, physical educators, and support staff) from an urban school district in southeast Texas. Confirmatory factor analysis (CFA) models were used to examine structural validity. We also examined correlations between constructs to assess discriminant and convergent validity. Last, we used a CFA-based approach to examine scale reliability. The analytic sample consisted of 205 employees. CFA results for each individual measure revealed good-fitting models for most measures (χ²(df)>0.05, RMSEA<0.08, CFI>0.90, TLI>0.90, SRMR≤0.07). A combined model that included all the measures also indicated good fit across indices: χ2(306)=485, p<0.001; RMSEA=0.05, CFI=0.93, TLI=0.92, SRMR=0.07. All correlations between constructs were <0.70, and all but one construct (innovativeness) demonstrated moderate correlations with support for classroom-based physical activity approaches (>0.30). In addition, reliability point estimates were all >0.70. The measures tested in this study were found to have good reliability, as well as good structural, discriminant, and convergent validity. These measures are useful in efforts to better understand how individual-level constructs relate to implementation behaviors for physical activity approaches in schools.

Examining the Validity and Reliability of Measures for Individual-Level Constructs Related to Implementation of School-Based Physical Activity Approaches

Valid and reliable measures are important to understanding the implementation of physical activity approaches in schools. The study purpose is to examine the psychometric properties of measures of individual-level constructs (knowledge, attitudes, outcome expectations, self-efficacy, innovativeness, and support) in the context of implementing school-based physical activity approaches. We collected data from a sample of elementary school employees (administrators, classroom teachers, physical educators, and support staff) from an urban school district in southeast Texas. Confirmatory factor analysis (CFA) models were used to examine structural validity. We also examined correlations between constructs to assess discriminant and convergent validity. Last, we used a CFA-based approach to examine scale reliability. The analytic sample consisted of 205 employees. CFA results for each individual measure revealed good-fitting models for most measures (χ2 (df) >0.05, RMSEA <0.08, CFI >0.90, TLI >0.90, SRMR≤0.07). A combined model that included all the measures also indicated good fit across indices: χ2(306) = 485, p <0.001; RMSEA = 0.05, CFI = 0.93, TLI = 0.92, SRMR = 0.07. All correlations between constructs were <0.70, and all but one construct (innovativeness) demonstrated moderate correlations with support for classroom-based physical activity approaches (>0.30). In addition, reliability point estimates were all >0.70. The measures tested in this study were found to have good reliability, as well as good structural, discriminant, and convergent validity. These measures are useful in efforts to better understand how individual-level constructs relate to implementation behaviors for physical activity approaches in schools.

Differences in psychosocial constructs among elementary school staff that implement physical activity programs: a step in designing implementation strategies

Multiple types of school staff members (e.g., classroom teachers, principals) are involved in implementing physical activity programs (e.g., classroom-based, gym), but factors specific to their job responsibilities may inhibit their ability to implement programming effectively. Thus, implementation strategies tailored by job type may be needed. We compare perceptions of behavioral constructs related to implementation of school-based physical activity programs, by job type, among school staff. School staff (n = 139), including principals/assistant principals (n = 21), physical education teachers (n = 41), and classroom teachers (n = 77), from elementary schools (n = 25), completed a cross-sectional survey measuring perceptions of attitudes, barriers, knowledge, and outcome expectations related to the implementation of physical activity programs. We compared constructs between job types using complex samples general linear models. Classroom teachers reported more perceived implementation barriers, lower physical activity knowledge, and lower outcome expectations than physical education teachers. Principals reported more perceived implementation barriers than physical education teachers. Classroom teachers reported lower physical activity knowledge than principals. Attitudes towards physical activity were not different by job type. Each job type has a unique constellation of factors affecting their capacity to implement physical activity programs. Understanding these differences enables tailoring of implementation strategies by job type.

The relation between individual-level factors and the implementation of classroom-based physical activity approaches among elementary school teachers

Classroom-based physical activity approaches can improve students' physical activity; however, their implementation remains a challenge. This study examined teacher-level factors associated with implementing two classroom-based physical activity approaches (active learning and physical activity breaks). We collected cross-sectional survey data from classroom teachers (n = 133) from 20 elementary schools in an urban Texas school district. Surveys included questions about theoretical constructs (e.g., knowledge, self-efficacy), personal characteristics (e.g., age, gender), and the implementation of active learning and physical activity breaks. We used linear regression models to assess associations between independent variables and implementation outcomes. We also assessed variable importance by examining the unique variance explained. Knowledge (b = .31, p = .001), outcome expectations (b = .18, p = .015), self-efficacy (b = .40, p ≤ .001), and support (b = .22, p = .028) were directly associated with active learning implementation. Teacher physical activity level (b = .29, p = .004) and grade level (third to fifth had lower levels than kindergarten to second grade, b = -.45, p = .022) were also associated with active learning implementation. In fully adjusted models, self-efficacy explained the most variance (≈5%) in active learning implementation compared to other variables. Knowledge (b = .18, p = 0.026), attitudes (b = .18, p = .019), self-efficacy (b = .15, p = .036), and teacher grade level (third to fifth had lower levels than kindergarten to second grade, b = -.80, p < .001) were associated with activity break implementation. In fully adjusted models, teacher grade level explained the most variance (≈13%) in activity break implementation compared to other variables. Results suggest multiple theoretical constructs and personal characteristics are important to target/consider when developing implementation strategies for classroom-based physical activity approaches. Additionally, self-efficacy and teacher grade level are two factors to prioritize.

Use of School Wellness Policy Templates in One Texas Public Health Region: A Mixed-Methods Analysis

BACKGROUND

Federal law requires most school districts to develop school wellness policies (SWPs), which state agencies assist in by providing templates. Templates provide standard language, which districts may edit for numerous reasons. We aimed to identify the frequency/consistency of template usage and identify the types of edits districts make when using SWP templates.

METHODS

We identified SWPs (N = 117) and templates (N = 2) from districts in 1 Texas public health region. We developed template specific coding guides, which allowed us to examine the frequency SWPs used template text within multiple areas (eg, nutrition goals, reporting). We also collected/categorized SWP edits from the template text and conducted a thematic analysis of locally developed SWPs and SWP templates.

RESULTS

Of 117 SWPs, 81.2% used a 2020 template, 13.7% used a 2005 template, and 5.1% created their own SWP. Across template-based SWPs, 44 content edits (0.4 per policy) occurred in 9 categories. Thematic analysis revealed: (1) locally developed SWPs created an informed mission statement linked to their goals; (2) Locally developed SWPs provided details that the current template includes in wellness plans.

CONCLUSIONS

Most districts used exact template language when writing their SWP. Adding spaces where districts can specify details could improve SWP content.

Keeping children healthy during and after COVID-19 pandemic: meeting youth physical activity needs

Background

The purpose of this study was to: 1) examine the maintenance of Physical Education and physical activity during the distance learning time, 2) determine the resources educators are utilizing to deliver PE curricula, and 3) understand the challenges experienced by educators during distance learning.

Methods

A survey was sent to a cohort of school-based fitness assessment software users. Respondents were largely school-based individuals including PE teachers (n = 1789), school (n = 62) and district administrators (n = 64), nurses (n = 3), and “other” (n = 522).

Results

Of 2440 respondents, most were from a city or suburb (69.7%), elementary or middle school (72.3%), and had Title 1 status (60.4%), an indicator of low socioeconomic status. Most campuses were closed during the COVID-19 pandemic (97.8%). Of the schools closed during the pandemic, only 2.8% had no prior PE requirements and that increased to 21% during the pandemic. In schools that remained open during the pandemic, 7.7% had no prior PE requirements and this increased to 60.5%. Importantly, 79% of respondents reported that students were either “significantly less” or “somewhat less” physically active during the closure. For closed schools, the most frequently cited challenges included “student access to online learning“, “teacher/student communication” and “teacher remote work arrangements”. For open schools, the most commonly reported challenges included “social distancing”, “access to gymnasium/equipment”, and “concern for personal health and wellbeing”.

Conclusion

The COVID-19 pandemic has caused important reductions in PE requirements and time engaged in physical activity. Challenges experienced by teachers were identified for closed and open schools.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10545-x.

Y-PATHS: A Conceptual Framework for Classifying the Timing, How, and Setting of Youth Physical Activity

BACKGROUND

Multiple models and frameworks exist for the measurement and classification of physical activity in adults that are applied broadly across populations but have limitations when applied to youth. The authors propose a conceptual framework specifically designed for classifying youth physical activity.

METHODS

The Youth Physical Activity Timing, How, and Setting (Y-PATHS) framework is a conceptualization of the when (timing), how, and where (setting) of children's and adolescents' physical activity patterns. The authors developed Y-PATHS using the design thinking process, which includes 3 stages: inspiration, ideation, and implementation.

RESULTS

The Y-PATHS includes 3 major components (timing, how, and setting) and 13 subcomponents. Timing subcomponents include (1) school days: in-school, (2) school days: out-of-school, and (3) nonschool days. How subcomponents include: (1) functional, (2) transportation, (3) organized, and (4) free play. Setting subcomponents include: (1) natural areas, (2) schools, (3) home, (4) recreational facilities, (5) shops and services, and (6) travel infrastructure.

CONCLUSIONS

The Y-PATHS is a comprehensive classification framework that can help researchers, practitioners, and policymakers to better understand youth physical activity. Specifically, Y-PATHS can help to identify the domains of youth physical activity for surveillance and research and to inform the planning/evaluation of more comprehensive physical activity programming.

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

INTRODUCTION

Health professionals promote transport-related physical activity because travelers oftentimes walk or bike to and from transit stops or stations. Although previous studies have examined the associations between macro-scale built environment features surrounding light rail transit (LRT) stations (e.g., density) and LRT ridership, this study examined the associations between numerous micro-scale features (e.g., street-level noise pollution) and ridership.

METHODS

This analysis originated from the Houston Travel-Related Activity in Neighborhoods (TRAIN) Study, a project evaluating how an LRT extension impacted adult physical activity in Houston, Texas. In 2014, researchers used the Analytic Audit Tool to quantify 58 micro-scale built environment features within six categories: Land Use Environment, Transportation Environment, Facilities, Aesthetics, Signage, and Social Environment. Feature data were obtained from 590 street segments within 0.25 miles of 22 LRT stations. For each station, separate composite indices were created per category by averaging the computed feature scores (1-7) within each category, with higher scores signifying more physical activity-promoting features. Station-level LRT ridership data were obtained from monthly ridership reports for the 12 months following station opening. Linear mixed models were constructed to examine the associations of the six built environment categories with ridership, adjusting for season, weekday vs. weekend day, and station as a random intercept.

RESULTS

Holding all other variables constant, every one-unit increase in composite index scores for Transportation Environment and Social Environment was associated with an increase in daily ridership by 425 and 488 riders, respectively (p < 0.05). Every one-unit increase in composite index score for Signage was associated with a decrease of 722 riders daily (p < 0.05). The relations of Land Use Environment, Facilities, and Aesthetics with ridership were statistically null (p > 0.05).

CONCLUSIONS

Enhancements to the Transportation Environment and Social Environment may slightly increase overall LRT ridership, and consequently, utilitarian physical activity.

Development of a comprehensive measure of organizational readiness (motivation × capacity) for implementation: a study protocol

BACKGROUND

Organizational readiness is important for the implementation of evidence-based interventions. Currently, there is a critical need for a comprehensive, valid, reliable, and pragmatic measure of organizational readiness that can be used throughout the implementation process. This study aims to develop a readiness measure that can be used to support implementation in two critical public health settings: federally qualified health centers (FQHCs) and schools. The measure is informed by the Interactive Systems Framework for Dissemination and Implementation and R = MC2 heuristic (readiness = motivation × innovation-specific capacity × general capacity). The study aims are to adapt and further develop the readiness measure in FQHCs implementing evidence-based interventions for colorectal cancer screening, to test the validity and reliability of the developed readiness measure in FQHCs, and to adapt and assess the usability and validity of the readiness measure in schools implementing a nutrition-based program.

METHODS

For aim 1, we will conduct a series of qualitative interviews to adapt the readiness measure for use in FQHCs. We will then distribute the readiness measure to a developmental sample of 100 health center sites (up to 10 staff members per site). We will use a multilevel factor analysis approach to refine the readiness measure. For aim 2, we will distribute the measure to a different sample of 100 health center sites. We will use multilevel confirmatory factor analysis models to examine the structural validity. We will also conduct tests for scale reliability, test-retest reliability, and inter-rater reliability. For aim 3, we will use a qualitative approach to adapt the measure for use in schools and conduct reliability and validity tests similar to what is described in aim 2.

DISCUSSION

This study will rigorously develop a readiness measure that will be applicable across two settings: FQHCs and schools. Information gained from the readiness measure can inform planning and implementation efforts by identifying priority areas. These priority areas can inform the selection and tailoring of support strategies that can be used throughout the implementation process to further improve implementation efforts and, in turn, program effectiveness.

Using Implementation Mapping to Develop Implementation Strategies for the Delivery of a Cancer Prevention and Control Phone Navigation Program: A Collaboration With 2-1-1

Cancer prevention and control (CPC) behaviors, such as cancer screening, human papillomavirus vaccination, and smoking cessation, are critical public health issues. Evidence-based interventions have been identified to improve the uptake of CPC behaviors; however, they are often inconsistently implemented, affecting their reach and effectiveness. Patient navigation is an evidence-based approach to increasing CPC behaviors. Nevertheless, there are few navigation programs that use systematically developed implementation strategies to facilitate adoption, implementation, and maintenance, which affects uptake and outcomes. This article describes the development of a multifaceted implementation strategy designed to facilitate delivery of a CPC phone navigation program to increase breast, cervical, and colorectal cancer screening; human papillomavirus vaccination; and smoking cessation among 2-1-1 Texas helpline callers. Using implementation mapping, a systematic approach for developing implementation strategies, we designed a strategy that involved training 2-1-1 information specialists to deliver the program, developed online tracking and quality-monitoring (audit and feedback) systems, and developed and distributed protocols and other materials to support training and implementation. Through this iterative process and our collaboration with 2-1-1 Texas call centers, our project resulted in a comprehensive training program with a robust curriculum of pertinent program content, for which we identified core components and appropriate delivery modes that are culturally relevant to the population. The results of this study can be applied to the development of more systematic, transparent, and replicable processes for designing implementation strategies. The study also demonstrates a process that can be applied to other contexts and other CPC program implementation efforts.

Associations between gender, school socioeconomic status, and cardiorespiratory fitness among elementary and middle school students

Background

Schools play an important role in providing access to physical activity opportunities for children. There are common economic and gender disparities in physical activity and health-related fitness among children, which may inform a school’s programming needs. The purpose of this study is to gain a better understanding about gender, school-level socioeconomic status, and children’s cardiorespiratory fitness.

Methods

This observational study used 2017–2018 school year data from schools in the Dallas Metropolitan area participating in the Healthy Zone School (HZS) program. Three data sources were integrated: 1) FitnessGram® data, 2) school-level data from the Texas Education Agency, and 3) HZS survey data. Being in the Healthy Fitness Zone (HFZ) for aerobic capacity was the dependent variable, and gender and the percentage of economically disadvantaged students (at the school-level) were key independent variables. Mixed-effects logistic regression models examined associations between dependent and independent variables. Final models were adjusted for age and type of aerobic test.

Results

There were 67 schools and 15,052 students included in the analysis. When testing main effects, girls had lower odds for being in the HFZ for aerobic capacity than boys (OR = 0.54, CI = 0.47–0.62). Additionally, having a greater percentage of students who were economically disadvantaged was associated with lower odds for being in the HFZ for aerobic capacity (0.98, CI = 0.98–0.99). There was a significant interaction between gender and the percentage of economically disadvantaged students. Results indicated girls had even lower odds (than boys) for being in the HFZ in schools with 90% economically disadvantaged students (OR = 0.44, CI = 0.35–0.55) versus in schools with 15% economically disadvantage students (OR = 0.62, CI = 0.51–0.76).

Conclusions

Results suggest girls in Healthy Zone Schools have lower odds to meet aerobic capacity fitness standards than boys. Additionally, boys and girls in schools serving a greater percentage of economically disadvantaged students have lower odds to meet aerobic capacity fitness standards. Last, girls have even lower odds of meeting HFZ standard when attending a school serving a greater percentage of economically disadvantaged students. Thus, schools need to provide more programs for girls targeting aerobic physical activity. This is especially important for schools serving a high percentage of low-income students.

Factors affecting aseptic loosening in primary total knee replacements: an in vitro study

Background

Implant surface integrity and cement bonding are assumed to be sufficient in primary total knee replacements to stabilize implants for extended wear without concerns over delamination and loosening. Yet there exists a significant rate of aseptic loosening where failure at implant cement interface occurs. The aim of this study is to look at specific aspects leading to aseptic loosening of the total knee replacement, where cement adhesion to the implant results in the lowest pull off strength.

Methods

Virgin ceramic coated and uncoated chrome cobalt tibial trays were used in a pull off study using differing viscosities of cement at varied time intervals to compare which combination is strongest compared to which is least resistant to pull off testing.

Results

Low viscosity cement had a 44% (5.9 kg verses 3.3 kg, p < 0.001) higher pull-off strength compared to high viscosity cement. Coated implants had a 30% (3.9 kg verses 5.5 kg, p = 0.037) lower pull-off strength compared to non-coated. Testing measures were limited to cement utilization less than 5 minutes due to the poor adhesion of the dowels beyond this time. Finally, there was a significant difference in adhesion properties between brand names when utilizing low viscosity cement on the non-coated trays (10.34 kg for Simplex verses 4.87 for Palacos, p = 0.021).

Conclusion

There are differences in adhesion properties between cement vendors, prompting significant concerns over the use of coated implants with particular cement types. Use of low viscosity cement on non-coated surfaces in the early liquid phase of cement curing was found to produce the best chance for adequate adhesion. This study demonstrates that there is variation in the adhesive properties of implants utilized in total knee replacements, and that the orthopedic community should consider not only the implant, cement, and curing time individually, but the overall integrity conferred from the combination of all of these variables.

Examining the Validity, Reliability, and Measurement Invariance of the Social Support for Exercise Scale among Spanish- and English- language Hispanics

The Social Support for Exercise Subscales are commonly used among Hispanic populations. The aims of this study were to test the validity and reliability of the Spanish-language version of the Social Support for Exercise Subscales, and test the invariance of the Spanish- and English-language versions. Data were from a subsample of Hispanic adults in the Cameron County Hispanic Cohort (n=1,447). A series of confirmatory factor analysis (CFA) models were used to assess the validity and reliability of the Spanish-language version of the subscales. A multi group CFA approach was used to test measurement invariance. Results indicated the Spanish-language versions of family and friend support subscales had good validity and reliability (RMSEA<.07, CFI>0.95, TLI>0.94, and SRMR<0.05). There was also evidence of measurement invariance between the Spanish- and English-language versions. These findings indicate the Spanish-language family and friend support subscales are valid and can be compared between Spanish- and English-language Hispanic respondents.

The Longitudinal Relationship Between Social Support and Physical Activity in Hispanics

PURPOSE

Social support has been identified as a determinant of physical activity (PA), but research has been primarily cross-sectional, with mixed findings for different Hispanic subgroups and limited longitudinal research with Hispanics. The purpose of this study is to assess the longitudinal associations of social support with PA in Hispanics on the Texas-Mexico Border.

DESIGN AND SAMPLE

We used 2 time points of data collected from Hispanic adults in the Cameron County Hispanic Cohort (N = 588).

MEASURES

We collected social support for PA and self-reported leisure-time PA.

ANALYSIS

We used cross-lagged panel models to assess the association between friend support, family support, family punishment (criticizing or complaining) and PA over time.

RESULTS

Although social support overall was low for PA, fully adjusted cross-lagged panel models indicated that time 1 friend support was associated with time 2 PA (adjusted rate ratio = 1.02, 95% confidence interval = 1.00 -1.04), though family support was not associated with time 2 PA. In males, time 1 friend support was inversely associated with time 2 family punishment.

CONCLUSION

As expected, the directionality of the relation appears to be from social support to PA. Friend support appears to be predictive of PA in Hispanics, whereas family support is not. This should be considered in intervention development, particularly because familismo (commitment and mutual obligation to family) is considered to be a strong value in these communities.

Validity and reliability of measures to assess constructs from the inner setting domain of the consolidated framework for implementation research in a pediatric clinic network implementing HPV programs

BACKGROUND

Accurate and valid measures for implementation constructs are critical to advance research and guide implementation efforts. However, there is a continued need for valid and reliable measures for implementation research. The purpose of this study was to assess the psychometric properties of measures for the Inner Setting domain of the Consolidated Framework for Implementation Research (CFIR) in a network of pediatric clinics.

METHODS

This study used cross-sectional survey data collected from physicians, advanced practice providers, clinic managers, and clinical staff (n = 546) working in a pediatric clinic network (n = 51). Surveys included measures assessing Inner Setting constructs from CFIR (culture, learning climate, leadership engagement, and available resources). We used a series multilevel confirmatory factor analysis (CFA) models to assess factorial validity. We also examined measure correlations to test discriminant validity and intraclass correlation coefficients, ICC(1) and ICC(2), to assess inter-rater reliability.

RESULTS

Factor loadings were high (≥0.60) for all but one of the measurement items. Most CFA models for respective constructs demonstrated adequate or good model fit (CFI > 0.90, TLI > 0.90, RMSEA< 0.08, and SRMR< 0.08). The measures also demonstrated good discriminant validity (correlations< 0.90) aside from some evidence of overlap between leadership engagement and learning climate at the clinic level (0.91). The ICC(1) values ranged from 0.05-0.16 while the ICC(2) values ranged from 0.34-0.67.

CONCLUSIONS

The measures demonstrated good validity and adequate reliability with the exception of available resources, which had some evidence of lower than desired reliability and validity at the clinic level. Our findings extend previous work by providing additional psychometric evidence to support the use of these Inner Setting measures in pediatric clinics implementing human papillomavirus programs.

Unacceptable failure rate of a ceramic-coated posterior cruciate-substituting total knee arthroplasty

Background

Aseptic loosening is one of the most elusive problems in total knee arthroplasty. We compared the failure rates of posterior cruciate-substituting total knee arthroplasty utilizing implants with hardened surface coating to a previous cohort of patients who underwent the procedure with traditional cruciate-retaining noncoated cobalt-chrome implants.

Methods

A retrospective study was conducted of 1099 total knee arthroplasties performed from 2009 to 2017. Two hundred forty-nine total knee arthroplasties performed from January 2015 to March 2017 under a single design were reviewed retrospectively and compared to the author’s previous 850 total knee arthroplasties performed from January 2009 to December 2014 under a different design.

Results

This series demonstrated an alarming debonding of cement in the tibial implant. The resultant failure rate of 6% (P < .001) is higher than observed in 850 total knee arthroplasties in the previous 5 years and higher than those reported in the literature giving cause for concern regarding this implant.

Conclusions

Due to the observed excessive failure rate, the authors recommend exercising high levels of caution using this implant with hardened surface treatment until further testing can be ascertained as to the root cause of failure.

The combined effect of physical activity and sedentary behavior on subclinical atherosclerosis: a cross-sectional study among Mexican Americans

BACKGROUND

Physical activity and sedentary behavior are considered independent risk factors for chronic disease. However, we do not fully understand their interrelation with key health outcomes such as subclinical atherosclerosis. This study examines the combined effects of sedentary behavior and physical activity on carotid intima-media thickness (cIMT) and presence of carotid plaque in a Mexican American population on the Texas-Mexico border.

METHODS

This cross-sectional study was conducted using retrospective data from a sample (n = 612) of participants from the Cameron County Hispanic Cohort. Carotid ultrasound was used to measure cIMT and presence of carotid plaque. Self-reported questionnaires were used to assess leisure time physical activity and sedentary behavior (TV/movie sitting and total sitting). A series of multivariable regression models were used to assess study aims. An interaction term between physical activity and sedentary behavior was included in models for each respective outcome. Models were controlled for demographic and health-related variables.

RESULTS

There were no significant associations found between physical activity, sedentary behavior and mean cIMT, or cIMT thickness ≥ 75th percentile for age and gender. However, there was a significant interaction between physical activity and TV/movie sitting with presence of carotid plaque. Participants who reported moderate levels of physical activity had significantly lower odds for presence of plaque compared to participants with no activity when TV/movie sitting time was ≤3 h per day. However, there was no significant difference in odds for presence of plaque between physical activity groups when TV/movie sitting exceeded 3 h/day. These results were consistent with models examining total sitting time.

CONCLUSIONS

Our results indicate that for Mexican Americans, there is a combined effect of sedentary behavior and physical activity on presence of carotid plaque. Participating in moderate physical activity is optimal for having lower levels of carotid plaque in addition to avoiding excessive levels of TV/movie sitting (≥3 h/day) and/or total sitting (≥8.5 h/day).

Evaluation of a Worksite-Based Small Group Team Challenge to Increase Physical Activity

PURPOSE

To investigate whether participants in a small group team challenge had greater completion rates in an institution-wide step-challenge than other participants.

DESIGN

A quasi-experimental, posttest-only design with a comparison group was used to evaluate group differences in completion rates.

SETTING

A large university system provided the opportunity to participate in a physical activity challenge.

PARTICIPANTS

The study was limited to employees who participated in the physical activity challenge.

INTERVENTION

Two institutions offered participants the chance to compete as smaller groups of teams within their institution. These team-challenge participants (N = 414) were compared to participants from the same institutions that did not sign up for a team and tracked their steps individually (N = 1454).

MEASURES

Participants who reported 50 000 steps per week for 5 of the 6 weeks were classified as challenge completers. We also evaluated total step count and controlled for several potential covariates including age, gender, and body mass index.

ANALYSIS

Logistic regression was used to model the dichotomous outcome of challenge completion.

RESULTS

Team-challenge participants were more likely to complete the physical activity challenge than other participants. Team-challenge participants had 1922 more steps per day than individual participants. However, at an institution level, overall completion rates were not higher at institutions that offered a team challenge.

Evaluating centralized technical assistance as an implementation strategy to improve cancer prevention and control

PURPOSE

In 2015-2016, the Comprehensive Cancer Control National Partnership provided technical assistance workshops to support 22 cancer coalitions in increasing human papillomavirus (HPV) vaccination uptake and increasing colorectal cancer (CRC) screening in their local communities. As national efforts continue to invest in providing technical assistance, there is a current gap in understanding its use as a strategy to accelerate implementation of evidence-based interventions (EBIs) for cancer prevention. The objective of this study was to evaluate the impact of technical assistance on the participants' knowledge, attitudes, and skills for implementing EBIs in their local context and enhancing state team collaboration.

METHODS

Data were collected August-November 2017 using web-based questionnaires from 44 HPV workshop participants and 66 CRC workshop participants.

RESULTS

Both HPV vaccination and CRC screening workshop participants reported changes in knowledge, attitudes, and skills related to implementing EBIs in their local state context. Several participants reported increased abilities in communicating and coordinating with partners in their states and utilizing additional implementation strategies to increase HPV vaccination uptake and CRC screening rates.

CONCLUSIONS

Findings from this study suggest that providing technical assistance to members of comprehensive cancer control coalitions is useful in promoting collaborations and building capacity for implementing EBIs for cancer prevention and control.

Assessing Levels and Correlates of Implementation of Evidence-Based Approaches for Colorectal Cancer Screening: A Cross-Sectional Study With Federally Qualified Health Centers

Multiple evidence-based approaches (EBAs) exist to improve colorectal cancer screening in health clinics. The success of these approaches is tied to effective implementation. Therefore, the purpose of this study was to assess the implementation of EBAs for colorectal cancer screening and clinic-level correlates of implementation in federally qualified health centers (FQHCs). We conducted descriptive and cross-sectional analyses using data collected from FQHC clinics across seven states ( n = 51). A clinic representative completed electronic surveys about clinic characteristics (e.g., size, patient characteristics, and medical record system characteristics) and the implementation of Community Guide recommended EBAs (e.g., client reminders, small media, and provider assessment and feedback). We used bivariate Spearman correlations to assess clinic-level correlates with implementation outcomes. Most clinics were planning to implement, in the early implementation stages, or inconsistently implementing EBAs. No EBA was fully implemented by more than nine (17.6%) clinics. Clinic size variables were inversely related to implementation levels of one-on-one education; medical record variables were directly related to implementation levels of client and provider reminders as well as provider assessment and feedback; and rapid and timely feedback from clinic leaders was directly associated with implementation levels of four out of six EBAs. Given the varying levels of implementation, clinics need to assess current use of implementation strategies and improve effective program delivery to increase colorectal cancer screening among their patients. In addition, clinics should also consider how their characteristics may support or serve as a barrier to implementation in their respective settings.

Developing measures to assess constructs from the Inner Setting domain of the Consolidated Framework for Implementation Research

Background

Scientists and practitioners alike need reliable, valid measures of contextual factors that influence implementation. Yet, few existing measures demonstrate reliability or validity. To meet this need, we developed and assessed the psychometric properties of measures of several constructs within the Inner Setting domain of the Consolidated Framework for Implementation Research (CFIR).

Methods

We searched the literature for existing measures for the 7 Inner Setting domain constructs (Culture Overall, Culture Stress, Culture Effort, Implementation Climate, Learning Climate, Leadership Engagement, and Available Resources). We adapted items for the healthcare context, pilot-tested the adapted measures in 4 Federally Qualified Health Centers (FQHCs), and implemented the revised measures in 78 FQHCs in the 7 states (N = 327 respondents) with a focus on colorectal cancer (CRC) screening practices. To psychometrically assess our measures, we conducted confirmatory factor analysis models (CFA; structural validity), assessed inter-item consistency (reliability), computed scale correlations (discriminant validity), and calculated inter-rater reliability and agreement (organization-level construct reliability and validity).

Results

CFAs for most constructs exhibited good model fit (CFI > 0.90, TLI > 0.90, SRMR < 0.08, RMSEA < 0.08), with almost all factor loadings exceeding 0.40. Scale reliabilities ranged from good (0.7 ≤ α < 0.9) to excellent (α ≥ 0.9). Scale correlations fell below 0.90, indicating discriminant validity. Inter-rater reliability and agreement were sufficiently high to justify measuring constructs at the clinic-level.

Conclusions

Our findings provide psychometric evidence in support of the CFIR Inner Setting measures. Our findings also suggest the Inner Setting measures from individuals can be aggregated to represent the clinic-level. Measurement of the Inner Setting constructs can be useful in better understanding and predicting implementation in FQHCs and can be used to identify targets of strategies to accelerate and enhance implementation efforts in FQHCs.

Validity and Reliability of the 8-Item Work Limitations Questionnaire

Purpose To evaluate factorial validity, scale reliability, test-retest reliability, convergent validity, and discriminant validity of the 8-item Work Limitations Questionnaire (WLQ) among employees from a public university system. Methods A secondary analysis using de-identified data from employees who completed an annual Health Assessment between the years 2009-2015 tested research aims. Confirmatory factor analysis (CFA) (n = 10,165) tested the latent structure of the 8-item WLQ. Scale reliability was determined using a CFA-based approach while test-retest reliability was determined using the intraclass correlation coefficient. Convergent/discriminant validity was tested by evaluating relations between the 8-item WLQ with health/performance variables for convergent validity (health-related work performance, number of chronic conditions, and general health) and demographic variables for discriminant validity (gender and institution type). Results A 1-factor model with three correlated residuals demonstrated excellent model fit (CFI = 0.99, TLI = 0.99, RMSEA = 0.03, and SRMR = 0.01). The scale reliability was acceptable (0.69, 95% CI 0.68-0.70) and the test-retest reliability was very good (ICC = 0.78). Low-to-moderate associations were observed between the 8-item WLQ and the health/performance variables while weak associations were observed between the demographic variables. Conclusions The 8-item WLQ demonstrated sufficient reliability and validity among employees from a public university system. Results suggest the 8-item WLQ is a usable alternative for studies when the more comprehensive 25-item WLQ is not available.

The longitudinal relation between self-reported physical activity and presenteeism

This study evaluates the longitudinal relation between self-reported physical activity and health related work limitations (also known as presenteeism) among employees from a public university system. A retrospective longitudinal study design was used to examine research aims. Data were from self-reported health assessments collected from employees at a large University System in Texas during the 2013-2015 plan years (n=6515).Work limitations were measured using the self-report 8-item work limitations questionnaire. Latent growth curve models were used to test whether: 1) baseline physical activity was associated with baseline work limitations; 2) changes in physical activity were related to changes in work limitations; and 3) baseline physical activity predicted changes in work limitations. Models were adjusted for demographic and health-related variables. The final adjusted growth curve model demonstrated excellent fit. Results revealed baseline physical activity was inversely associated with baseline work limitations (β=-0.12, p<0.001). In addition, changes in physical activity were related to changes in work limitations (β=-0.33, p=0.02). However, no relation was found between baseline physical activity and changes in work limitations (β=-0.06, p=0.42). Results provide evidence that increasing physical activity among employees leads to decreases in health-related work limitations. Therefore, promoting physical activity among employee populations can help prevent and reduce presenteeism.

Association of Self-Reported Aerobic Physical Activity, Muscle-Strengthening Physical Activity, and Stretching Behavior With Presenteeism

OBJECTIVE

The aim of this study was to evaluate relations between aerobic physical activity (PA), muscle-strengthening PA, and stretching behavior and presenteeism in university employees.

METHODS

A cross-sectional study used health assessment data from two employee respondent groups (n2015 = 10,791 and n2009 = 10,165). Multivariable zero-inflated negative binomial regression models assessed the association between self-reported PA types and presenteeism.

RESULTS

There was consistent evidence that employees who reported participating in sufficient aerobic PA had higher odds for no work limitations [odds ratio (OR2015) = 1.45, P < 0.001; OR2009 = 1.55, P < 0.001] and lower levels of work limitations [incidence rate ratio (IRR)2015 = 0.92, P < 0.05; IRR2009 = 0.83, P < 0.001] than employees who reported participating in no activity. There was some evidence of an inverse association between muscle-strengthening PA and work limitations, but no evidence between stretching behavior and work limitations.

CONCLUSIONS

Promoting PA among employees is a key health behavior to target for worksites concerned about presenteeism.

How Do Stages of Change for Physical Activity Relate to Employee Sign-Up for and Completion of a Worksite Physical Activity Competition?

Introduction. This study evaluated whether stages of change for physical activity (PA) predict sign-up, participation, and completion in a PA competition. Method. Deidentified data were provided to evaluate a PA competition between 16 different institutions from a public university system. Employees who completed a health assessment (HA) prior to the start of the PA competition ( n = 6,333) were included in the study. Participants completed a self-report HA and logged their PA throughout the competition. Multivariable logistic regression models tested whether stages of change predicted PA competition sign-up and completion. An ordinal logistic regression model tested whether stages of change predicted number of weeks of PA competition participation. Results. Stages of change predicted PA competition sign-up and completion, but not weeks of participation. The odds for PA competition sign-up were 1.64 and 1.98 times higher for employees in preparation and action/maintenance (respectively) compared with employees in precontemplation/contemplation. The odds for PA competition completion were 4.17 times higher for employees in action/maintenance compared with employees in precontemplation/contemplation/preparation. Conclusion. The PA competition was more likely to reach employees in preparation, action, or maintenance stages than precontemplation/contemplation. Most of the completers were likely participating in regular PA prior to the competition.

In-school asthma management and physical activity: children's perspectives

OBJECTIVE

Regular physical activity (PA) is an important component of pediatric asthma management. No studies have examined how in-school asthma management influences PA from children's perspectives. The aim of this study was to explore children's perceptions of the impact of in-school asthma management on PA.

METHODS

Qualitative interviews with 23 inner-city minority children with asthma (aged 8-10 yrs; 12 girls, 11 boys) were conducted in 10 Bronx, New York elementary schools. Sampling continued until saturation was reached. Interviews were recorded, transcribed and independently coded for common themes.

RESULTS

Interviews produced five themes representing students' perceptions about (1) asthma symptoms during in-school PA; (2) methods to control asthma episodes during school PA; (3) methods to prevent asthma episodes during school; (4) limited accessibility of asthma medications; and (5) negative feelings about asthma and medication use. The majority of students experienced asthma symptoms while performing PA during school. Primary methods of managing asthma symptoms were sitting out during activity, drinking water, and visiting the nurse. Students lacked awareness or adherence to action plans to prevent or control asthma. Students reported limited access to medication during school and feelings of embarrassment and/or concerns of teasing when medicating in front of others.

CONCLUSIONS

Our results indicate inappropriate in-school management of asthma symptoms, poor asthma control, lack of accessible medication, and stigma around publicly using asthma medication. Thus, students often missed or were withheld from PA. Interventions to improve in-school asthma care must consider ways to address these issues.

Reproducibility of ambulatory blood pressure changes from the initial values on two different days

OBJECTIVE

We tested the reproducibility of changes in the ambulatory blood pressure (BP) from the initial values, an indicator of BP reactivity and cardiovascular health outcomes, in young, healthy adults.

METHOD

The subjects wore an ambulatory BP monitor attached by the same investigator at the same time of day until the next morning on two different days (day 1 and day 2) separated by a week. We compared the ambulatory BP change from the initial values at hourly intervals over 24 waking and sleeping hours on days 1 and 2 using linear regression and repeated measures analysis of covariance.

RESULTS

The subjects comprised 88 men and 57 women (mean age±SE 22.4±0.3 years) with normal BP (118.3±0.9/69.7±0.6 mmHg). For the total sample, the correlation between the ambulatory BP change on day 1 vs. day 2 over 24, waking, and sleeping hours ranged from 0.37-0.61; among women, the correlation was 0.38-0.71, and among men, it was 0.24-0.52. Among women, the ambulatory systolic/diastolic BP change was greater by 3.1±1.0/2.4±0.8 mmHg over 24 hours and by 3.0±1.1/2.4±0.8 mmHg over waking hours on day 1 than on day 2. The diastolic ambulatory BP change during sleeping hours was greater by 2.2±0.9 mmHg on day 1 than on day 2, but the systolic ambulatory BP change during sleeping hours on days 1 and 2 did not differ. Among men, the ambulatory BP change on days 1 and 2 did not differ.

CONCLUSION

Our primary findings were that the ambulatory BP change from the initial values was moderately reproducible; however, it was more reproducible in men than in women. These results suggest that women, but not men, may experience an alerting reaction to initially wearing the ambulatory BP monitor.