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Background: PARAMEDIC2 was a medicines trial comparing adrenaline with placebo in out-of-hospital cardiac arrest (OHCA). At the time, United Kingdom (UK) Emergency Medical Systems (EMS) were inexperienced in delivering such research. Aim: To identify barriers and facilitators to delivery of the PARAMEDIC2 (Adrenaline) trial by five UK NHS EMS. Methods: This qualitative study took a grounded theory approach to thematic analysis of workshop data. Members of the trial teams from each service attended a workshop in November 2018 and discussed their experiences in answer to two prompt questions. Data were coded and themes presented. Results: Three main themes were identified: professionalism, organisational investment and unique features of EMS. The study provided an opportunity for recruiting paramedics and research paramedics to demonstrate their professionalism. Research paramedics felt it was part of their professional duty to initiate discussions with the patient/family regarding the trial rather than leave this task to the hospital teams as would usually happen. Organisational investment was reflected by prioritising trial training and further development of research paramedics. By these means, research culture was developed. The unique features of EMS such as geographical challenges were often addressed with technological solutions and through building relationships with internal teams. Conclusion: Barriers to trial delivery included infrequent exposure to the condition of interest and lack of continuity in research paramedic roles. Facilitators identified included flexibility of the research protocol, and organisational investment in the development of research paramedics.Participating in PARAMEDIC2 was challenging for the EMS involved, but ultimately strengthened their research culture.

Aims: The PARAMEDIC-3 trial evaluates the clinical and cost-effectiveness of an intraosseous first strategy, compared with an intravenous first strategy, for drug administration in adults who have sustained an out-of-hospital cardiac arrest. Methods: PARAMEDIC-3 is a pragmatic, allocation concealed, open-label, multi-centre, superiority randomised controlled trial. It will recruit 15,000 patients across English and Welsh ambulance services. Adults who have sustained an out-of-hospital cardiac arrest are individually randomised to an intraosseous access first strategy or intravenous access first strategy in a 1:1 ratio through an opaque, sealed envelope system. The randomised allocation determines the route used for the first two attempts at vascular access. Participants are initially enrolled under a deferred consent model.The primary clinical-effectiveness outcome is survival at 30-days. Secondary outcomes include return of spontaneous circulation, neurological functional outcome, and health-related quality of life. Participants are followed-up to six-months following cardiac arrest. The primary health economic outcome is incremental cost per quality-adjusted life year gained. Conclusion: The PARAMEDIC-3 trial will provide key information on the clinical and cost-effectiveness of drug route in out-of-hospital cardiac arrest.Trial registration: ISRCTN14223494, registered 16/08/2021, prospectively registered.

BackgroundOver a quarter of children aged 2-17 years living in Australia are overweight or obese, with a higher prevalence reported in regional and remote communities. Systems thinking approaches that seek to support communities to generate and implement locally appropriate solutions targeting intertwined environmental, political, sociocultural, and individual determinants of obesity have the potential to ameliorate this. There have however been reported challenges with implementation of such initiatives, which may be strengthened by incorporating implementation science methods.MethodsThis pilot randomised controlled trial protocol outlines the development and proposed evaluation of a multicomponent implementation strategy (Action-RESPOND). to increase the implementation of community-based systems thinking child obesity prevention initiatives The target of this intervention is ten rural and regional communities (or local government areas as the unit of allocation) within Northeast Victoria who were participants in a whole-of-systems intervention (RESPOND). Action-RESPOND builds on this intervention by assessing the impact of offering additional implementation strategies to five communities relative to usual care. The development of the multicomponent implementation strategy was informed by the Promoting Action on Research Implementation in Health Services (PARIHS) framework and consists of seven implementation strategies primarily delivered via 'facilitation' methods. Implementation strategies aimed to ensure initiatives implemented are i) evidence-based, ii) address community's specific needs and iii) are suitable for local context. Strategies also aimed to increase the community's capacity to implement, through iv) improving the health promotion team's implementation knowledge and skills, fostering v) leadership, vi) physical resources and vii) community culture to drive implementation. The feasibility, acceptability, potential impact, and cost of the strategy will be assessed at baseline and follow up using surveys administered to key representatives within the community and internal records maintained by the research team.DiscussionBy leveraging an existing community-based whole-of-systems intervention, Action-RESPOND offers a unique opportunity to collect pilot feasibility and early empirical data on how to apply implementation and systems science approaches to support obesity prevention in rural and regional communities in Victoria.

RESUMENEn este trabajo se presentan las características del sistema global de pronóstico desarrollado para el Río de la Plata y Frente Marítimo, denominado PronUy_RPFM, y en particular la componente del pronóstico de nivel de mar disponible actualmente en tiempo real. El prototipo actual (prototipo_1) del sistema de pronóstico desarrollado está automatizado y en funcionamiento desde el año 2021, publicando resultados en tiempo real, y refiere al pronóstico de niveles de marea. El modelo numérico de base utilizado es el TELEMAC2D y es forzado con el pronóstico diario oceánico global RTOFS- HYCOM y el pronóstico meteorológico global del NCEP (NOAA), ambos con información horaria. El pronóstico de niveles es evaluado en tiempo real con datos medidos in-situ por 10 mareógrafos ubicados en al área de estudio cuyos datos están disponibles online publicados por Argentina y Uruguay y son descargados diariamente por el sistema. El modelo hidrodinámico fue calibrado en base a la modificación de los parámetros vinculados a fricción de fondo y tensión de corte superficial del viento. Como resultado el modelo ha sido ajustado y el pronóstico disponible permite predecir los niveles con buena calidad tanto en condiciones medias como en condiciones de niveles extremos altos y bajos.

Background Calls for the adoption of a systems approach to chronic disease prevention date back at least ten years because of the potential to empower communities to identify and address the complex causes of overnutrition, undernutrition and climate change. Australia, like many countries, has high levels of obesity and extreme climate events. The Reflexive Evidence and Systems interventions to Prevent Obesity and Non-communicable Disease (RESPOND) trial aims to prevent unhealthy weight gain in children in 10 intervention and two pilot communities in north-east Victoria, Australia using community-based participatory approaches informed by systems science. Intervention activities co-designed in 2019 were disrupted by COVID-19 and bushfires. This paper explores the impacts of these ‘shocks’ on the local prevention workforce to implement actions within communities. Methods A case study design involving one-hour online focus groups and an on-line survey (November 2021-February 2022). Purposive sampling was used to achieve diverse representation from RESPOND stakeholders including local council, health services, primary care partnerships and department of health. The focus group interview schedule and survey questions were based on Durlak and DuPre’s implementation factors. Results Twenty-nine participants from seven different communities participated in at least one of nine focus groups to discuss the impacts of COVID-19 and bushfires on localised implementation. Twenty-eight participants (97% of focus group sample) also completed the on-line survey. Implementation of RESPOND stalled or stopped in most communities due to bushfires and/or COVID-19. These shocks resulted in organisational priorities changing, loss of momentum for implementation, redeployment of human resources, culminating in fatigue and exhaustion. Participants reported adaptation of RESPOND, but implementation was slowed due to limited resources. Conclusion Further research is needed to advance risk management strategies and protect resources within health promotion. System shocks such as bushfires and COVID-19 are inevitable, and despite multiple adaptation opportunities, this intervention approach was not ‘shock proof’.

The COVID-19 pandemic has seen an unusually high proportion of the population suffering from mental health difficulties, but of particular concern is the disproportionate increase in psychological distress among younger adults. In this article, we exploit an explanatory sequential mixed-methods design to examine which aspects of the COVID-19 pandemic 18-25-year-olds found most challenging. We report analyses of American Voices Project (AVP) qualitative in-depth interview data, a MyVoice text-message open-ended survey, and Census Bureau Household Pulse Survey (HPS) data, all collected in 2020. Our interview and text-message results show that young adults were distressed about the effects of COVID-19 on the health of loved ones and older Americans. Young adults expressed concerns that the pandemic was not being treated sufficiently seriously by some politicians and the general public. The policy response was seen to be inadequate to the task of containing the disease, and some feared that the pandemic would never end. Statistical analyses of the HPS confirm that young adults’ scores on the HPS’s anxiety scale were significantly negatively associated with state-level policy responses. Overall, our results show that young adults found virus mitigation strategies challenging, but that a strong policy response was associated with reduced levels of psychological distress. Our results suggest that public health policy might have also operated as mental health policy during the COVID-19 pandemic.

This work implements a dynamical downscaling approach, based on a set of nested two-dimensional hydrodynamic models, to quantify the expected changes in the total sea level climate and its components for the Uruguayan coast, using surface wind and sea level pressure projections from global climate models generated during the Phase 5 of the Coupled Models Inter-Comparison Project, considering three time horizons: historical period (1986-2005), short term (2027-2045) and long term (2082-2100), and the future scenarios RCP 4.5 and RCP 8.5. It is concluded that the main contribution to the projected changes in the area is the regional mean sea level rise, followed in importance by the effect that the increase in the water depth has on the amplitude of the tidal components. Moreover, it is concluded that changes in the meteorological residuals (or surges), associated with potential changes in the atmospheric circulation patterns, are negligible in the study area. The obtained results reinforce the need to resort to dynamic downscaling for projecting total sea level changes in areas characterized by wide and shallow continental shelfs and estuaries, as this approach allows to resolve the interactions that may arise between tides, surges and the mean sea level rise, something that cannot addressed with an approach based solely on statistical downscaling.

The South African government’s COVID-19 pandemic risk mitigation strategies significantly limited social contact, which necessitated a novel approach to existing face-to-face career guidance practices. The Grade 9 Career Guidance Project, originally developed as a group-based career development intervention, required radical adaptation into a self-directed, manualized format to offer career guidance to Grade 9 learners from low-income communities amid a global pandemic. The adaptation and continuation of the project was deemed essential as secondary school learners in low-income communities have limited career guidance support. Furthermore, a close collaboration with the teachers at eight resource-constrained South African secondary schools was vital for successful implementation. To assess the success of the adaptation to a self-directed format, a mixed-methods design was employed, and Life Orientation teachers’ evaluative feedback was solicited (n = 11). Favorable quantitative results were obtained; majority of teachers agreed that learners enjoyed the booklet (manualized format) and that it was deemed an adequate substitute to the previous contact-based format of the Career Guidance Project. This was also confirmed by the qualitative findings revealing teachers’ satisfaction with the booklet’s content, specifically that the booklet is complementary to the Life Orientation curriculum. Qualitative findings identified specific contextual barriers that contributed to some learners struggling to use the booklet optimally. The results suggest that it is feasible and acceptable to implement a self-directed career guidance intervention among secondary school learners amid a global pandemic. Teachers recommended ways to integrate the booklet, resources, and contact sessions as a preferred way forward. These findings have important implications for similar resource-constrained settings that may not have readily access to in-person career guidance and counseling human development.

The science of inequality has delivered robust evidence on the depth and severity of inequality in the contemporary United States. Yet despite the accumulation of evidence highlighting the consequences of profound inequality for individuals and communities, our inequality policy is largely focused on incremental interventions. Faced with this disconnect, sociologists reasonably ask what can be done to forge closer links between research and policy. In this commentary, for the Socius “Special Collection: Sociology’s Role in Responding to Inequality,” I consider just how such links might be forged. I argue that we must invest in infrastructures that support sociologists in developing policies that reflect the ambition and insights of our discipline. Of special importance is building institutions that increase cross-disciplinary research communication, improve access to administrative data, and increase the influence of sociologists in the public sphere.

Background: South African schools have been severely impacted by the coronavirus disease 2019 (COVID-19) pandemic in 2020. State-imposed restrictions to mitigate the spread of the infection have significantly limited direct interpersonal contact, curtailing the existing career guidance and counselling activities in schools. Crucially, in low-income settings, the social distancing regulations implied that in a year of increasing anxiety and uncertainty, many high school learners would have had to make important career-related decisions with limited or no tacit career guidance. Objectives: In response to these challenges, this study developed a self-directed career guidance intervention to provide continued career guidance support for Grade 9 learners amidst the unfolding global pandemic. Method: A cross-sectional mixed-methods design was employed to evaluate feasibility and acceptability of the intervention amongst a sample of 498 learners across eight high schools in the Cape Winelands district, Western Cape province, South Africa. Results: Favourable quantitative results were obtained assessing learners’ experiences of participating in the intervention and on the perceived impact of the intervention on their career preparedness. Participants reported a mean score of 41.25 (out of 50) for acceptability of the intervention. In addition, they reported a mean score of 17.1 (out of 20) for perceived impact of the intervention on their career preparedness. In terms of feasibility, qualitative findings revealed that the intervention improved learners’ self-knowledge and career directionality. Conclusion: The mixed-methods results confirm the feasibility and utility of implementing a self-directed career guidance intervention amongst secondary school learners. Whilst learners reported positive evaluations of the self-directed career guidance booklet, they also expressed the need for one-on-one or group engagement with the intervention content.

Abstract Background Functional hand splinting is a common therapeutic intervention for children with neurological conditions. The aim of this study was to investigate the effectiveness of the Cognitive Orientation to daily Occupational Performance (CO-OP) approach over and above conventional functional hand splinting, and in combination with splinting, for children with cerebral palsy or brain injury. Methods A multisite, assessor-blinded, parallel, randomized controlled trial was conducted in Australia. Participants (n = 45) were randomly allocated to one of three groups; (1) splint only (n = 15); (2) CO-OP only (n = 15); (3) CO-OP + splint (n = 15). Inclusion: age 4–15 years; diagnosis of cerebral palsy or brain injury; Manual Ability Classification System I–IV; hand function goals; sufficient language, cognitive and behavioral ability. Primary outcome measures were the Canadian Occupational Performance Measure (COPM) and Goal Attainment Scale (GAS). Treatment duration for all groups was 2 weeks. CO-OP was provided in a group format, 1 h per day for 10 consecutive weekdays, with parents actively involved in the group. Hand splints were wrist cock-up splints that were worn during task practice. Three individual goals were set and all participants were encouraged to complete a daily home program of practicing goals for 1 h. Analyses were conducted on an intention to treat basis. Results The COPM showed that all three groups improved from baseline to immediately post-treatment. GAS showed a statistically significant difference immediately post-intervention between the splint only and CO-OP only groups p = 0.034), and the splint only and CO-OP + splint group (p = 0.047) favoring CO-OP after controlling for baseline. Conclusions The CO-OP Approach™ appeared to enhance goal achievement over and above a functional hand splint alone. There was no added benefit of using hand splints in conjunction with CO-OP, compared to CO-OP alone. Hand splints were not well tolerated in this population. Practice of functional goals, through CO-OP or practice at home, leads to goal achievement for children with cerebral palsy or brain injury. Trial registration Registered with the Australian New Zealand Clinical Trials Registry (ACTRN12613000690752) on 24/06/2013.

The Río de la Plata is a large fluvial–estuarine–sea system discharging into the southwestern Atlantic Ocean, which has relevant features such as high fluvial discharge, microtidal astronomical tidal scales, a relevant meteorological tide, and a strong atmospheric forcing effect, due to its large width. The objective of this study is to advance the understanding of the estuarine hydrodynamics and salt transport, as well as discussing the main characteristics of the spatiotemporal variability of the salinity field. To achieve this, the results of a 3D model of the Río de la Plata and its maritime front were used, simulating an extensive period of 10 years. In this study, the model was validated using vertical salinity profiles collected at different locations in the estuary. The temporal variability of the salinity stratification was characterised at different temporal scales: annual, monthly, and storm. At the same time, the influences of fluvial flow and winds were determined. The correlation analysis between fluvial flow and the salinity field showed that high annual fluvial flows generate an extension of the freshwater area, with larger longitudinal salinity gradients and a shift of the salinity front towards the ocean. The tendency at the monthly scale is not as clear as that observed at the annual scale. The results show that the effect of a storm coming from the northwest is quite similar to that of storms coming from the southwest, especially in the central and southern zones of the Río de la Plata, where mixing increases and stratification decreases, according to the intensity of the storm. The effect of south–southeasterly storms increases the mixing process and reduces stratification; the opposite effect was identified with respect to northeasterly storms, under the influence of which the stratified area increases. Synthesising the obtained results, a global zonification of the vertical salinity stratification for the Río de la Plata is proposed.

We ask whether the transition from socialism to the market is consequential for social mobility, and, by implication, the permeability of class structures. While the short-term effects of market transition on patterns of social mobility have been documented for a small number of countries, we are able to examine the long-term effects of market transition for a group of 13 central and eastern European (CEE) countries. Only in the longer term can we properly appreciate the settled effects of transition on the distribution of resources, the organization of class and economic structures, and the transmission of inequalities across generations. We use data drawn from nationally representative cross-national surveys of CEE countries to compare patterns of social mobility in the early 1990s with those in the late 2000s. We find a significant decline in relative social mobility between the two periods and show that this decline is a consistent feature of mobility patterns across the region. We argue that changes in the institutions that regulate the transfer of capital across generations are likely to explain why the move from socialism to the market is associated with declining levels of social fluidity.

The claim that the law can be an inequality-reducing weapon is a staple of legal and political discourse. Although it is hard to dispute that legal provisions sometimes work to reduce inequality, we argue that, at least in the domain of equal opportunity in education, the pattern of these effects can be more perverse than has typically been appreciated. Positive laws implemented in the name of promoting equality of opportunity may yield only a narrowly formal equality, with the goal of substantive equality undermined because a high-profile reform will often expose the pathway to educational success. The pathway, once exposed, can then be navigated and successfully subverted by the socioeconomically advantaged. We illustrate such pitfalls of a positive legal approach by examining educational inequality in Egypt, a country with long-standing constitutional protections for equality of opportunity in education. Using data recently collected from a cohort of young people, we show that despite the institutional commitments to equality of opportunity present in Egypt, privileged families have a range of options for subverting the aims of positive legal provisions. We argue that the pattern of educational inequality in Egypt is distinctive relative to countries without similar legal protections.

Background: Increasingly, there is a trend toward the use of left ventricular assist devices (LVADs) for treating advanced heart failure, as both bridge-to-transplant therapy and destination therapy. Living with an LVAD profoundly influences patients' lives. Only a few study authors investigated the experience of people with abdominal LVADs, and nothing is known about the unique experience of those with retro-auricular LVADs., Objective: The aim of this study was to explore and describe experiences and lifestyle adjustments in adults with retro-auricular LVADs implanted as destination therapy., Methods: Interpretive description methodology was used to explore the experiences of a purposeful sample of 10 individuals with retro-auricular LVADs implanted as destination therapy. Data were collected using in-depth semistructured interviews. Data collection and analysis were simultaneous. Triangulation, journaling, and the "thoughtful clinician test" were used to increase trustworthiness of the findings., Results: Three primary themes describing the experience of people with retro-auricular LVADs were developed: "a new life," "self-care," and "resilience"; in addition, a crosscutting theme was identified: "support system." This article focuses on the theme "a new life," described as a continuum of events. Individuals with advanced heart failure struggle with symptom burden and consider the implantation of the device as the final option to delay death; then, they wait for the surgery that represents a turning point, after which they begin to recover through a process of adjustment until they reach a new normality., Conclusions: Living with a retro-auricular LVAD impacts every aspect of people's lives. Knowing their experiences can help clinicians to develop targeted interventions and offer tailored support.