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Background Loneliness and social isolation are increasingly recognised as global public health threats, meaning that reliable and valid measures are needed to monitor these conditions at a population level. We aimed to determine if robust and practical scales could be derived for conditions such as loneliness and social isolation using items from a national survey. Methods We conducted psychometric analyses of ten items in two waves of the Household, Income and Labour Dynamics in Australia Survey, which included over 15,000 participants. We used the Hull method, exploratory structural equation modelling, and multidimensional item response theory analysis in a calibration sample to determine the number of factors and items within each factor. We cross-validated the factor structure using confirmatory factor analysis in a validation sample. We assessed construct validity by comparing the resulting sub-scales with measures for psychological distress and mental well-being. Results Calibration and cross-validation consistently revealed a three-factor model, with sub-scales reflecting constructs of loneliness and social isolation. Sub-scales showed high reliability and measurement invariance across waves, gender, and age. Construct validity was supported by significant correlations between the sub-scales and measures of psychological distress and mental health. Individuals who met threshold criteria for loneliness and social isolation had consistently greater odds of being psychologically distressed and having poor mental health than those who did not. Conclusions These derived scales provide robust and practical measures of loneliness and social isolation for population-based research.

Whether the vaccine adjuvant potential of acute exercise is uniform among different populations, e.g., inactive persons, is unknown. This meta-analysis examines influenza vaccine antibody responses and the effect of physical activity, acute exercise, and their interaction. Inclusion criteria comprised randomized controlled trials with acute exercise intervention and influenza vaccination antibody measurements at baseline and 4–6 weeks, and participant baseline physical activity measurement; there were no exclusion criteria. Searching via six databases (Medline, Embase, CINAHL, Scopus, Web of Science, and Physiotherapy Evidence) and two clinical registries (WHO and NIH), nine studies were identified and assessed with the Cochrane revised risk-of-bias tool. Data analysis comprised one-stage random-effects generalized linear mixed-effects models with random intercept. Seven of nine identified studies, all of high risk of bias, provided data for 550 included participants. Clinical measures of antibody response tended to be higher in the acute-exercised participants compared to rested controls and physically active compared to inactive. Physical activity significantly increased H1 strain seroconversion (adjusted odds ratio (aOR) 1.69, 95%CI: 1.02–2.82) among all participants and titer response (aOR 1.20, 95%CI: 1.03–1.39) among the acute exercise group. Increasing age frequently reduced immunogenic responses whereas body mass index and sex had little-to-no effect. Adjuvant effects were more pronounced with interventions exercising the same arm in which the vaccination was administered. H1 response was increased by both physical activity and the acute exercise-physical activity interaction. Given the observed modifications by age and the subset analysis suggesting the benefit is more pronounced in older populations, future attention is due for acute exercise-PA interactions to impact vaccination response in the at-risk population of older adults. Further, we identify localized exercise as the likely most-effective protocol and encourage its use to augment the available evidence.

The purpose of this article is to illustrate innovations in text analysis associated with understanding conflict-related communication events. Two innovations will be explored: LIWC (Linguistic Inquiry and Word Count), the text modeling program from the open-source data analysis software program R, and SPSS Modeler. The LIWC analysis revisits the 2009 study by Donohue and Druckman and the 2014 study by Donohue, Liang, and Druckman focusing on text analyses of the Oslo I Accords between the Palestinians and Israelis to illustrate this approach. The R and SPSS modeling of text analysis use the same data set as the LIWC analysis to provide a different set of pictures associated with each leader’s rhetoric during the period in which the Oslo I accords were being negotiated. Each innovation provides different insights into the mind-set of the two groups of leaders as the secret talks were emerging. The implications of each approach in establishing an understanding of the communication exchanges are discussed to conclude the article.

BACKGROUND Adolescent girls are more likely to be inactive than boys. A range of factors including multiple psychosocial aspects are thought to influence their engagement in physical activity (PA). This study aimed to explore adolescent girls’ perceptions and experiences of school-based PA to inform a subsequent intervention, the Girls Peer Activity (G-PACT) project. METHODS Firstly, a PA questionnaire was used to assess adolescent girls’ current PA levels. Open-ended questions were used to investigate girls’ perceptions and experiences of school-based PA. Focus groups stratified by PA level were then conducted to explore their perceptions and experiences in depth. The focus group data were analysed using inductive thematic analysis. RESULTS The master themes emanating from the focus groups were non-competitive activities and after-school sport culture for lower active girls. Higher active girls’ master themes were PA perceptions and PE. Participants reported greater enjoyment from PA when participating with friends and having choice over activities provided within the school setting. CONCLUSIONS The findings highlight the importance of choice, peer groupings, non-competitive opportunities and PA competence to adolescent girls’ school-based PA behaviours. The school environment can support and restrict girls’ engagement in PA. The findings will be applied to the design, content and implementation of the G-PACT project. Keywords: Physical Activity, Adolescent, Girls, School, Exploration

Patient safety efforts have largely focused on reduction of events collectively called hospital-acquired conditions (HACs). These events include device-related events such as central line–associated bloodstream infections and catheter-associated urinary tract infections, immobility and pressure injuries, other hospital acquired infections, falls, and readmissions. This review will discuss causes of harm beyond traditional HACs. The authors hope to raise awareness that to achieve further reductions in patient harm events, physicians must play an increasingly active role in improvement efforts. Diagnostic error is a significant source of patient harm for all ages and healthcare settings. Hospital-acquired kidney injury occurs in children, may lead to chronic renal dysfunction, and can be mitigated by limiting the use of nephrotoxic medications and monitoring of creatinine in exposed patients. Adoption of restrictive red blood cell transfusion practices decreases transfusion-related harm by decreasing the number of exposures. Further reductions in patient harm will require active engagement of physicians and other providers to understand how practice habits and the systems in which we practice contribute to harm and implement strategies that will bring about changes in how we function as individuals, within teams and within systems. It is unlikely that continuing to focus on improvement project by project (HACs) will significantly reduce harm events.

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To evaluate the impact of interventions to improve inhaler technique on performance and clinical outcomes in people with COPD.

The ability to test general relativity in extreme gravity regimes using gravitational wave observations from current ground-based or future space-based detectors motivates the mathematical study of the symmetries of black holes in modified theories of gravity. In this paper we focus on spinning black hole solutions in two quadratic gravity theories: dynamical Chern-Simons and scalar Gauss-Bonnet gravity. We compute the principal null directions, Weyl scalars, and complex null tetrad in the small-coupling, slow rotation approximation for both theories, confirming that both spacetimes are Petrov type I. Additionally, we solve the Killing equation through rank 6 in dynamical Chern-Simons gravity and rank 2 in scalar Gauss-Bonnet gravity, showing that there is no nontrivial Killing tensor through those ranks for each theory. We therefore conjecture that the still-unknown, exact, quadratic-gravity, black-hole solutions do not possess a fourth constant of motion., Comment: 23 pages, 2 figures

The cost of both generalized least squares (GLS) and Gibbs sampling in a crossed random effects model can easily grow faster than $N^{3/2}$ for $N$ observations. Ghosh et al. (2020) develop a backfitting algorithm that reduces the cost to $O(N)$. Here we extend that method to a generalized linear mixed model for logistic regression. We use backfitting within an iteratively reweighted penalized least square algorithm. The specific approach is a version of penalized quasi-likelihood due to Schall (1991). A straightforward version of Schall's algorithm would also cost more than $N^{3/2}$ because it requires the trace of the inverse of a large matrix. We approximate that quantity at cost $O(N)$ and prove that this substitution makes an asymptotically negligible difference. Our backfitting algorithm also collapses the fixed effect with one random effect at a time in a way that is analogous to the collapsed Gibbs sampler of Papaspiliopoulos et al. (2020). We use a symmetric operator that facilitates efficient covariance computation. We illustrate our method on a real dataset from Stitch Fix. By properly accounting for crossed random effects we show that a naive logistic regression could underestimate sampling variances by several hundred fold., 32 pages, 5 figures

Design This study is a monocentre cohort study with a primary aim to assess the five-year survival of alumina-toughened zirconia (ATZ) implants (Metoxit AG, Thayngen, Switzerland). Secondary aims were to evaluate peri-implant marginal bone loss (MBL), soft tissue health and patient-reported outcome measures (PROMs). The implants were placed into healed ridges and, following a period of temporisation, were restored with either IPS e.max CAD LT or IPS e.max ZirCAD veneered with IPS e.max ZirPress (Ivoclar Vivadent, Schaan, Liechtenstein). Patients were followed up at prosthetic delivery, one-year and five-years post-implant placement. The clinical parameters recorded were clinical attachment levels (CAL), probing depth (PD), gingival recession (GR), modified bleeding index (mBI) and modified plaque index (mPI). MBL was evaluated using standardised radiographs. PROMs were used to assess patients' satisfaction utilising a visual analogue scale (VAS) to rate function, aesthetics, sense, speech and self-esteem. The null hypothesis assumed there was no difference in implant survival between one and five years post-operatively. This study was approved by the ethics committee at the University of Freigburg, Germany (No. 354/07).Cohort selection Forty patients from the Department of Prosthetic Dentistry requiring either an implant supported single crown or a three-unit implant-supported bridge were included in the study. Patients ranged from age 18 to 70 and were selected on a 'convenience basis'. Inclusion criteria stipulated patients must have good oral hygiene, compliance and be systemically healthy. Additionally, they were to have a stable occlusion, no signs of significant bruxism and sufficient bone volume to allow implant placement without the need for larger augmentative procedures.Data analysis Implant success was defined by three main criteria: (1) no local or systemic reactions; (2) no signs of radiolucency on an intraoral radiograph; and (3) provides support to a functional restoration. The MBL was classified as successful when at a one-year follow-up, implants demonstrating no clinical or radiographic signs of pathology are assigned a grade I success with

OBJECTIVE Background: Regular participation in physical activity during childhood and adolescence is important for good health. There is strong evidence of the physical and psychosocial benefits associated with recreational physical activity in these age groups, specifically in the context of organised sport. Most children in New South Wales (NSW), Australia, do not meet the recommended guidelines for physical activity, with financial cost commonly cited as a barrier to the initiation and maintenance of sport. The Active Kids program is a major policy initiative introduced in 2018 that aimed to overcome this barrier by implementing a statewide sport voucher scheme, allowing all NSW school-enrolled children (1.2 million) initial access to a $100 annual contribution towards organised sport and physical activity, with concurrent evaluation over the initial 4-year phase of the program. STUDY TYPE This paper presents the protocol for evaluation of the Active Kids program, including an assessment of program impact on children's organised sport participation and recreational physical activity level, and analysis of the correlates of participation at individual, state and national levels. METHODS A quasi-experimental and mixed-method evaluation will be used to examine the patterns of organised sport and recreational physical activity behaviour and the correlates associated with sports participation, voucher uptake and program reach. Sociodemographic information will be collected for each child who registers for a voucher. The effects of this program on children's health-enhancing physical activity, engagement with the sport sector, self-efficacy and social influences on participation will be monitored through a cohort study. Acceptability, engagement and experience of the voucher program will be assessed from both user and provider perspectives. Additionally, effects of the program on families' annual sport-related expenditure will be assessed. RESULTS AND CONCLUSION It is anticipated that the implementation of the NSW Government's Active Kids program will increase participation in recreational physical activity among NSW children. The results of this evaluation will contribute to the evidence base and policy directions for sport voucher programs in Australia and internationally.

This review examined qualitative evidence of self-determination theory tenets within physical education. We conducted systematic searches in four databases, included 34 studies, and thematically analysed data from all included studies. Results indicated that certain teaching strategies provided students with the opportunity to undermine other students’ relatedness. Low relatedness and competence satisfaction were associated with negative affect and reduced participation, meaning teacher behaviours that undermined competence and enabled peer teasing were counterproductive to the purpose of physical education. Need satisfaction, however, was associated with positive affect and increased participation. Therefore, teaching in line with self-determination theory may improve student outcomes.