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BackgroundVirtual care has historically faced barriers to widespread adoption. However, the COVID-19 pandemic has necessitated the rapid adoption and expansion of virtual care technologies. Although the intense and prolonged nature of the COVID-19 pandemic has renewed people’s interest in health systems resilience, which includes how services adapt or transform in response to shocks, evidence regarding the role of virtual care technologies in health systems resilience is scarce. ObjectiveAt Toronto General Hospital in Ontario, Canada, the rapid virtualization of cardiac care began on March 9, 2020, as a response to the pandemic. The objective of this study was to understand people’s experiences with and the barriers and facilitators of the rapid virtualization and expansion of cardiac care resulting from the pandemic. MethodsA single-case study was conducted with 3 embedded units of analysis. Patients, clinicians, and staff were recruited purposively from an existing mobile, phone-based telemonitoring program at a heart function clinic in Toronto, Canada. Individual, semistructured phone interviews were conducted by two researchers and transcribed verbatim. An inductive thematic analysis at the semantic level was used to analyze transcripts and develop themes. ResultsA total of 29 participants were interviewed, including patients (n=16), clinicians (n=9), and staff (n=4). The following five themes were identified: (1) patient safety as a catalyst for virtual care adoption; (2) piecemeal virtual care solutions; (3) confronting new roles and workloads; (4) missing pieces in virtual care; and (5) the inequity paradox. The motivation to protect patient safety and a piecemeal approach to virtual care adoption facilitated the absorptive and adaptive resilience of cardiac care during the COVID-19 pandemic. However, ad hoc changes to clinic roles and workflows, challenges in building relationships through remote methods, and widened inequities were barriers that threatened virtual care sustainment. ConclusionsWe contend that sustaining virtual care hinges upon transformative actions (rather than adaptive actions) that strengthen health systems so that they can face the dynamic and emergent challenges associated with COVID-19 and other shocks. Based on the barriers and facilitators we identified, we present the lessons we learned and recommend transformations for sustaining virtual care during and beyond the COVID-19 pandemic.

BackgroundTo minimize the spread and risk of a COVID-19 outbreak, societal norms have been challenged with respect to how essential services are delivered. With pressures to reduce the number of in-person ambulatory visits, innovative models of telemonitoring have been used during the pandemic as a necessary alternative to support access to care for patients with chronic conditions. The pandemic has led health care organizations to consider the adoption of telemonitoring interventions for the first time, while others have seen existing programs rapidly expand. ObjectiveAt the Toronto General Hospital in Ontario, Canada, the rapid expansion of a telemonitoring program began on March 9, 2020, in response to COVID-19. The objective of this study was to understand the experiences related to the expanded role of a telemonitoring program under the changing conditions of the pandemic. MethodsA single-case qualitative study was conducted with 3 embedded units of analysis. Semistructured interviews probed the experiences of patients, clinicians, and program staff from the Medly telemonitoring program at a heart function clinic in Toronto, Canada. Data were analyzed using inductive thematic analysis as well as Eakin and Gladstone’s value-adding approach to enhance the analytic interpretation of the study findings. ResultsA total of 29 participants were interviewed, including patients (n=16), clinicians (n=9), and operational staff (n=4). Four themes were identified: (1) providing care continuity through telemonitoring; (2) adapting telemonitoring operations for a more virtual health care system; (3) confronting virtual workflow challenges; and (4) fostering a meaningful patient-provider relationship. Beyond supporting virtual visits, the program’s ability to provide a more comprehensive picture of the patient’s health was valued. However, issues relating to the lack of system integration and alert-driven interactions jeopardized the perceived sustainability of the program. ConclusionsWith the reduction of in-person visits during the pandemic, virtual services such as telemonitoring have demonstrated significant value. Based on our study findings, we offer recommendations to proactively adapt and scale telemonitoring programs under the changing conditions of an increasingly virtual health care system. These include revisiting the scope and expectations of telemedicine interventions, streamlining virtual patient onboarding processes, and personalizing the collection of patient information to build a stronger virtual relationship and a more holistic assessment of patient well-being.

BackgroundTo improve health outcomes in patients with heart failure, guideline-directed medical therapy (GDMT) should be optimized to target doses. However, GDMT remains underutilized, with less than 25% of patients receiving target doses in clinical practice. Telemonitoring could provide reliable and real-time physiological data for clinical decision support to facilitate remote GDMT titration. ObjectiveThis paper aims to present findings from an internal pilot study regarding the effectiveness of remote titration facilitated by telemonitoring. MethodsA 2-arm randomized controlled pilot trial comparing remote titration versus standard care in a heart function clinic was conducted. Patients were randomized to undergo remote medication titration facilitated by data from a smartphone-based telemonitoring system or standard titration performed during clinic visits. ResultsA total of 42 patients with new-onset (10/42, 24%) and existing (32/42, 76%) heart failure and a mean age of 55.29 (SD 11.28) years were randomized between January and June 2019. Within 6 months of enrollment, 86% (18/21) of patients in the intervention group achieved optimal doses versus 48% (10/21) of patients in the control group. The median time to dose optimization was 11.0 weeks for the intervention group versus 18.8 weeks for the control group. The number of in-person visits in the intervention group was 54.5% lower than in the control group. ConclusionsThe results of this pilot study suggest that remote titration facilitated by telemonitoring has the potential to increase the proportion of patients who achieve optimal GDMT doses, decrease time to dose optimization, and reduce the number of clinic visits. Remote titration may facilitate optimal and efficient titration of patients with heart failure while reducing the burden for patients to attend in-person clinic visits. Trial RegistrationClinicalTrials.gov NCT04205513; https://clinicaltrials.gov/ct2/show/NCT04205513 International Registered Report Identifier (IRRID)RR2-10.2196/preprints.19705

BackgroundSuicide is a prominent cause of death worldwide, particularly among young people. It was the second leading cause of death among those aged 15-29 years globally in 2016. Treatment for patients with suicidal thoughts or behaviors often includes face-to-face psychological therapy with a mental health professional. These forms of interventions may involve maintaining and updating paper-based reports or worksheets in between sessions. Mobile technology can offer a way to support the implementation of evidence-based psychological techniques and the acquisition of protective coping skills. ObjectiveThis study aims to develop a mobile app to facilitate service users’ access to mental health support and safety planning. This process involved eliciting expert input from clinicians who are actively engaged in the provision of mental health care. MethodsA survey was distributed to targeted health care professionals to determine what features should be prioritized in a new mobile app relating to suicide prevention. On the basis of the survey results, a clinical design group, comprising 6 members with experience in fields such as mobile health (mHealth), clinical psychology, and suicide prevention, was established. This group was supplemented with further input from additional clinicians who provided feedback over three focus group sessions. The sessions were centered on refining existing app components and evaluating new feature requests. This process was iterated through regular feedback until agreement was reached on the overall app design and functionality. ResultsA fully functional mobile app, known as the SafePlan app, was developed and tested with the input of clinicians through an iterative design process. The app’s core function is to provide an interactive safety plan to support users with suicidal thoughts or behaviors as an adjunct to face-to-face therapy. A diary component that facilitates the generalization of skills learned through dialectical behavior therapy was also implemented. Usability testing was carried out on the final prototype by students from a local secondary school, who are representative of the target user population in both age and technology experience. The students were asked to complete a system usability survey (SUS) at the end of this session. The mean overall SUS rating was 71.85 (SD 1.38). ConclusionsThe participatory process involving key stakeholders (clinicians, psychologists, and information technology specialists) has resulted in the creation of an mHealth intervention technology that has the potential to increase accessibility to this type of mental health service for the target population. The app has gone through the initial testing phase, and the relevant recommendations have been implemented, and it is now ready for trialing with both clinicians and their patients.

BackgroundDigital interventions are proposed as one way by which effective treatments for self-harm and suicidal ideation may be improved and their scalability enhanced. Mobile devices offer a potentially powerful medium to deliver evidence-based interventions with greater specificity to the individual when the intervention is needed. The recent proliferation of publicly available mobile apps designed for suicide prevention underlines the need for robust evidence to promote safe practice. ObjectiveThis review aimed to examine the effectiveness of currently available mobile health (mHealth) technology tools in reducing suicide-specific outcomes. MethodsThe following databases were searched: Cochrane Central Register of Controlled Trials (The Cochrane Library), MEDLINE, EMBASE, PsycINFO, and relevant sources of gray literature. All published and unpublished randomized controlled trials (RCTs), pseudo-RCTs, and pre-post observational studies that evaluated the effectiveness of mHealth technology in suicide prevention delivered via mobile computing and communication technology were included. Studies were included if they measured at least one suicide outcome variable (ie, suicidal ideation, suicidal intent, nonsuicidal self-injurious behavior, and suicidal behavior). A total of 2 review authors independently extracted data and assessed study suitability, in accordance with the Cochrane Collaboration Risk of Bias Tool, on July 31, 2018. Owing to the heterogeneity of outcomes found across studies, results were not amenable for pooled synthesis, and a meta-analysis was not performed. A narrative synthesis of the available research is presented here. ResultsA total of 7 studies met criteria for inclusion . Four published articles that reported on the effectiveness of the following mobile phone apps were included: iBobbly, Virtual Hope Box, BlueIce, and Therapeutic Evaluative Conditioning. Results demonstrated some positive impacts for individuals at elevated risk of suicide or self-harm, including reductions in depression, psychological distress, and self-harm and increases in coping self-efficacy. None of the apps evaluated demonstrated the ability to significantly decrease suicidal ideation compared with a control condition. In addition, 3 unpublished and recently completed trials also met criteria for inclusion in the review. ConclusionsFurther research is needed to evaluate the efficacy of stand-alone mHealth technology–based interventions in suicide prevention. The small number of studies reported in this review tentatively indicate that such tools may have a positive impact on suicide-specific outcomes. Future mHealth intervention evaluations would benefit from addressing the following 3 main methodological limitations : (1) heterogeneity of outcomes: a lack of standardized measurement of suicide outcomes across studies; (2) ecological validity: the tendency to exclude potential participants because of the elevated suicide risk may reduce generalizability within clinical settings; and (3) app regulation and definition: the lack of a standardized classification system for mHealth intervention type points to the need for better definition of the scope of such technologies to promote safe practice. Trial RegistrationPROSPERO CRD42017072899; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=72899 International Registered Report Identifier (IRRID)RR2-10.2196/resprot.8635

In this article a cadre of Daryl's former doctoral students and/or close colleagues from The Ohio State University offer their personal descriptions/interpretations of Daryl's vision for physical education, physical education teacher education (PETE) and doctoral programming (D-PETE). Daryl mentored over 80 doctoral students at Ohio State, many of whom went on to be productive researchers, teachers, scholars and doctoral mentors themselves, allowing many of his seminal ideas to endure for more than four decades, and which are still considered "best practice" today in physical education and physical education teacher education around the world.

Neoliberalism is a pervasive phenomenon. A fundamental neoliberal concept allows for the selection of the best and most suitable option available for a specific course of action in any aspect of society. Not unexpectedly, the educational field, including physical education (PE), has been influenced by neoliberal ideas. A key element of neoliberalism in PE is the selection of workers external to the school system, as a suitable option to improve the educational experience. The involvement of external workers increases the diversity of stakeholders in the school system, who, with their actions and decisions, have the potential to influence the content and status of PE in schools. The purpose of this study was to understand the external provision infrastructure supporting PE in an Irish primary school. Specifically, we used network ethnography to understand the structure and the impact of external provision on school PE. Participants included two primary school teachers, the school PE coordinator and one PE external provider. Data analysis resulted in two themes. The first theme refers to the structure of the external provider system, and the second to the dynamics of the network between the main stakeholders. Taken together, a well-established external provision network in the school is revealed but the structure of the network, as designed, is not supporting PE as intended by the Irish educational system.

The purpose of this paper was to examine Irish Physical Education teachers' views on curriculum change at the beginning of its implementation stage, with a particular focus on revision to the Physical Education curriculum and the new Wellbeing programme. In the light of these revisions, teachers were asked to make considerable changes to their beliefs and pedagogical approaches. Teacher change theory provided a lens through which to examine teachers' views. We reimaged the three aspects of teacher change as a triangle or 'three-legged stool' where the three elements of curriculum materials/resources, pedagogy, and beliefs combine to offer a sense of security to sustain the impending changes. A survey and a series of semi-structured interviews provided data and in total 119 second level Physical Education teachers participated. Analysis was conducted using descriptive statistics of quantitative data and inductive and deductive analysis of qualitative data. Three themes were developed: A Learning Focus, Embracing Change, and Curriculum Enactment. Contrary to recent findings in the change literature, the teachers in this study welcomed curriculum changes as their beliefs aligned with the purpose of the reform of Physical Education. The results indicated that the new curriculum was catching up with teachers' core beliefs about the purpose of Physical Education. However, in line with recent research, teachers were sceptical about ongoing support for resourcing and continued professional development. In conclusion, the 'three-legged stool of sustained change has the potential to be unbalanced thereby maintaining teacher buy-in to the new reforms is potentially fragile.

Guided by Dewey's [1966. "Democracy and education." New York: The Free Press] concept of 'education as growth', the purpose of this paper is to explore learners' enactments of student voice in Physical Education (PE) at a time of curricular reform. A qualitative comparative case study design gathered data from 18 students across 10 months in a triad of Irish secondary schools using focus group interviews. Data were gathered and coded to identify emergent themes. Five experiential themes emerged: puppeteering; early enlightenment; enjoyment in living; equitable inquiry and critique; and learning to grow. Findings demonstrate how student voice encounters were necessary to enhance students' democratic experience of PE but the extent to which student voice was enacted to improve learning and assessment of curriculum was problematic for students to assert. Implementing student voice cannot be perceived and implemented as a fixed process but rather a fluid continuum of practice allowing more transformative experiences follow.

This McCloy Lecture sheds light on the "hidden profession" of Physical Education Teacher Educators (PETEs) by sharing my perspectives on the challenges and opportunities faced by PETE scholars and teachers globally. I begin with an overview of my biography and how it has influenced my thinking about PETE. I present some scholarly critiques of PETE, a selection of PETE research findings and address key policy issues within teacher education across several national educational systems describing how Physical Education teacher educators manage (or not) the challenges and opportunities in the practice of teacher education in modern-day universities. I draw on data from my international study of experienced Physical Education teacher educators about the nature of their work in academe and the status of physical education teacher education locally, nationally and globally. I also draw on the perspectives of Irish teacher educators about the challenges of being active producers and users of research in a challenging national policy context. I conclude with a set of observations about how best to build capacity among Physical Education teacher educators so they can thrive as research active and innovative teachers in the modern university.

This paper explored physical education (PE) teachers' perspectives of giving voice to students to understand how the practice is enacted in lessons at a time of curricular reform. A qualitative comparative case study followed three teachers in a triad of Irish secondary schools, eliciting their experiences of giving voice to students using focus groups, interviews, and a reflection journal. Data were gathered and coded to identify emergent themes. The practices challenged included instruction, teacher control, and teacher-student relationships. The teachers demonstrated the capacity to activate students' voices and respond, changing the way they perceived and facilitated the practice in PE. Worryingly, teachers made no connection between student voice and learning and assessment in PE and were not forthcoming implementing the practice in high-stakes examination scenarios. Research recognizing and appreciating the challenges and opportunities PE teachers face in attempting to acquire the spirit to do such work espousing reform is important to the field and our students.

The purpose of this research was to examine pre-service teachers' articulation of their learning through the development of a shared professional language of teaching practice focused on meaningful physical education. Qualitative data gathered from 90 pre-service teachers over four years in Canada and Ireland were analysed. Framed by a didactical research framework, pre-service teachers used elements of the shared language to articulate "why" they would promote meaningful experiences in physical education, "what" the features of meaningful experiences tend to consist of, and "how" they would use particular strategies to promote meaningful experiences. This research demonstrates how a shared language that reflects a coherent approach in physical education teacher education can support pre-service teachers to access, interpret, and articulate their learning about teaching in ways that support meaningful experiences for pupils.

Recent studies suggest school communities accept the goods and services of external providers uncritically. Considering the pivotal role played by teachers in curriculum and policy enactment, this paper explores how and why teachers in Ireland advocate for, and engage with, the services and resources of one particular external provider, the Gaelic Athletic Association (GAA). This paper draws upon data generated from a purposive sample of teachers and external coaches who were involved in the provision of Gaelic games in primary schools. Semi-structured interviews were conducted with teachers and coaches, and policy documents were examined in order to gain a better understanding of the external provision provided by the GAA. The data were subsequently analysed thematically. Our findings suggest that teachers who promote Gaelic games within the core and extracurricular PE and sport programmes consider these games crucial to the development of children's sporting and cultural identity.

In Ireland, primary physical education (PE) is delivered by non-specialist classroom teachers. A growing number of primary schools are committing resources to external providers for partial delivery of the PE curriculum. Some researchers (Evans and Davies [2014; 2015]. "Neoliberal Freedoms, Privatisation and the Future of Physical Education." "Sport, Education and Society" 20 (1): 10-26. doi:10.1080/13573322.2014.918878; Powell [2015]. "Assembling the Privatisation of Physical Education and the 'Inexpert' Teacher." "Sport, Education and Society" 20 (1): 73-88. doi:10.1080/13573322.2014.941796) suggest the use of external providers in primary PE represents an increasing privatisation of the public education system. Thus, privatisation of PE raises questions about the future purpose, quality, and content of the subject. The goal of this paper is to identify the most common forms of external provision in support of PE in a small cohort primary schools. Network analysis was used to achieve a graphical representation of primary schools/external provision. Web pages of primary schools yielded data that allowed the creation of a social network analysis of external provision for 67 primary schools selected from the 2015/2016 list of Delivery of Equality of Opportunity in Schools (DEIS) programme. Results highlight that the most common forms of PE external provision in Irish primary schools are Gaelic Games (GAA), swimming, and dance and describe the network relationships between external provision types. Discussion provides possible reasons to justify the external provision trend for primary PE in Ireland.

Induction of lipid-laden foamy macrophages is a cellular hallmark of tuberculosis (TB) disease, which involves the transformation of infected phagolysosomes from a site of killing into a nutrient-rich replicative niche. Here, we show that a terpenyl nucleoside shed from Mycobacterium tuberculosis, 1-tuberculosinyladenosine (1-TbAd), caused lysosomal maturation arrest and autophagy blockade, leading to lipid storage in M1 macrophages. Pure 1-TbAd, or infection with terpenyl nucleoside-producing M. tuberculosis, caused intralysosomal and peribacillary lipid storage patterns that matched both the molecules and subcellular locations known in foamy macrophages. Lipidomics showed that 1-TbAd induced storage of triacylglycerides and cholesterylesters and that 1-TbAd increased M. tuberculosis growth under conditions of restricted lipid access in macrophages. Furthermore, lipidomics identified 1-TbAd-induced lipid substrates that define Gaucher's disease, Wolman's disease, and other inborn lysosomal storage diseases. These data identify genetic and molecular causes of M. tuberculosis-induced lysosomal failure, leading to successful testing of an agonist of TRPML1 calcium channels that reverses lipid storage in cells. These data establish the host-directed cellular functions of an orphan effector molecule that promotes survival in macrophages, providing both an upstream cause and detailed picture of lysosome failure in foamy macrophages., Introduction To benefit from immune cloaking and gain access to nutrients within host cells, intracellular bacteria must evade, withstand, or defeat host killing. Bacteria enter macrophages through phagocytosis, where infected [...]

ObjectiveIn postmenopausal black women in the Women's Health Initiative randomized trial, estrogen alone reduced breast cancers but its comprehensive influence on health outcomes in black women is unknown. Therefore, we examined this issue in the Women's Health Initiative overall and by African ancestry.MethodsA total of 1,616 black women with prior hysterectomy, including 1,061 with percent African ancestry determination, at 40 US centers were randomly assigned to conjugated equine estrogen (0.625 mg/d) or placebo for 7.2 years' (median) intervention with 13 years' cumulative follow-up. Coronary heart disease (CHD) and breast cancer were primary efficacy and safety outcomes, respectively. A global index also included stroke, colorectal cancer, hip fracture, pulmonary embolism, and death.ResultsBlack women in the estrogen-alone group compared with black women in the placebo group had fewer breast cancers (17 vs 40, hazard ratio [HR] 0.47, 95% CI 0.26-0.82). In women with more than 80% African ancestry, breast cancer HR was lower (0.32, 95% CI 0.12-0.86, trend P = 0.04 for ancestry effect). Most other outcomes including CHD, stroke, hip fracture, and the global index were null with estrogen use in black women; a global index effect was more favorable in younger black women (HR 0.65, 95% CI 0.43-0.98).ConclusionsIn black postmenopausal women with prior hysterectomy, estrogen alone significantly reduced breast cancer incidence with no adverse influence on CHD, venous thromboembolism, or all-cause mortality. Favorable estrogen-alone global index effects in younger black women warrant further study.

Evidence suggests European American (EA) women have two- to five-fold increased odds of having pelvic organ prolapse (POP) when compared with African American (AA) women. However, the role of genetic ancestry in relation to POP risk is not clear. Here we evaluate the association between genetic ancestry and POP in AA women from the Women's Health Initiative Hormone Therapy trial. Women with grade 1 or higher classification, and grade 2 or higher classification for uterine prolapse, cystocele or rectocele at baseline or during follow-up were considered to have any POP (N = 805) and moderate/severe POP (N = 156), respectively. Women with at least two pelvic exams with no indication for POP served as controls (N = 344). We performed case-only, and case-control admixture-mapping analyses using multiple logistic regression while adjusting for age, BMI, parity and global ancestry. We evaluated the association between global ancestry and POP using multiple logistic regression. European ancestry at the individual level was not associated with POP risk. Case-only and case-control local ancestry analyses identified two ancestry-specific loci that may be associated with POP. One locus (Chromosome 15q26.2) achieved empirically-estimated statistical significance and was associated with decreased POP odds (considering grade ≥2 POP) with each unit increase in European ancestry (OR: 0.35; 95% CI: 0.30, 0.57; p-value = 1.48x10-5). This region includes RGMA, a potent regulator of the BMP family of genes. The second locus (Chromosome 1q42.1-q42.3) was associated with increased POP odds with each unit increase in European ancestry (Odds ratio [OR]: 1.69; 95% confidence interval [CI]: 1.28, 2.22; p-value = 1.93x10-4). Although this region did not reach statistical significance after considering multiple comparisons, it includes potentially relevant genes including TBCE, and ACTA1. Unique non-overlapping European and African ancestry-specific susceptibility loci may be associated with increased POP risk.

In this article a cadre of Daryl's former doctoral students and/or close colleagues from The Ohio State University offer their personal descriptions/interpretations of Daryl's vision for physical education, physical education teacher education (PETE) and doctoral programming (D-PETE). Daryl mentored over 80 doctoral students at Ohio State, many of whom went on to be productive researchers, teachers, scholars and doctoral mentors themselves, allowing many of his seminal ideas to endure for more than four decades, and which are still considered "best practice" today in physical education and physical education teacher education around the world. [ABSTRACT FROM AUTHOR]

If teacher education is to be taken seriously, it must be research-based with teacher educators as active researchers and perceived as 'public intellectuals'. This re-positioning of teacher education to be 'research driven' comes with pressure on teacher educators to focus on securing research funding and increase publication output. This expectation for research productivity competes with increasing calls for more relevant and imaginative teacher preparation programmes. To present the challenging contexts in which Irish teacher educators operate with respect to fulfilling both a teaching and research remit, this paper maps the changing higher education landscape, the regulation of teacher education along with a myriad of curricular reforms at primary and post-primary level. The paper then explores current teacher educators' positioning in the Irish context as active users and producers of research through in-depth interviews with ten experienced teacher educators.

In this research we examined the ways we accessed and responded to students' engagement with a set of pedagogical principles of teacher education focused on meaningful physical education. The research was cross-cultural, taking place in universities in Country 1 and Country 2. Self-study of teacher education practice (S-STEP) methodology guided collection and analysis of the following data over one year: lesson planning and reflection documents, and critical friend and 'meta-critical friend' interactions. Findings indicate the value in teacher educators becoming more intentional and systematic in how they access student perspectives related to engagement with learning experiences of pedagogical innovations in pre-service teacher education, while also emphasising the challenges in doing so. The concepts of reflection on- and in-action provided a framework for understanding how being more intentional about accessing student perspectives can be enacted in teacher education practice. Our experiences demonstrate how focusing on student engagement can support the professional learning of teacher educators through enabling a deeper understanding of the challenges faced in being responsive to students' engagement with their learning.

This study explores the relationship between primary school physical education and physical activity as sites for the practice of physical activity of Irish primary school children. Understanding how children make connections between physical activity sites is important in shaping physical education experiences that promote lifelong participation. Children's (aged 8-11) awareness, knowledge, and understanding of physical activity and physical education were examined using participatory methods of 'draw and write' (n = 135) and focus group interviews (n = 34). In Phase 1, data collection focused on physical activity, while Phase 2 focused on physical education and connections between physical activity and physical education. Data were analysed using a general inductive approach. Data analysis resulted in four themes: gendered patterns of participation; connections between physical education and physical activity; the nature and choice of participation in activities; and perceptions of ability. Children had varying understandings of the connections between their participation in physical education and physical activity. These findings highlight the importance of supporting all children to make explicit connections between their learning in physical education and their wider physical activity participation. An implication of the findings is that children need to be explicitly prompted to engage in physical activity. Without such encouragement, children are unlikely to draw linkages between physical activity and physical education.

Objective To assess whether neonatal morbidities evident by the time of hospital discharge are associated with subsequent cerebral palsy (CP) or death. Study Design This is a secondary analysis of data from a multicenter placebo-controlled trial of magnesium sulfate for the prevention of CP. The association between prespecified intermediate neonatal outcomes (n = 11) and demographic and clinical factors (n = 10) evident by the time of discharge among surviving infants (n = 1889) and the primary outcome of death or moderate/severe CP at age 2 (n = 73) was estimated, and a prediction model was created. Results Gestational age in weeks at delivery (odds ratio [OR]: 0.74, 95% confidence interval [CI]: 0.67–0.83), grade III or IV intraventricular hemorrhage (IVH) (OR: 5.3, CI: 2.1–13.1), periventricular leukomalacia (PVL) (OR: 46.4, CI: 20.6–104.6), and male gender (OR: 2.5, CI: 1.4–4.5) were associated with death or moderate/severe CP by age 2. Outcomes not significantly associated with the primary outcome included respiratory distress syndrome, bronchopulmonary dysplasia, seizure, necrotizing enterocolitis, neonatal hypotension, 5-minute Apgar score, sepsis, and retinopathy of prematurity. Using all patients, the receiver operating characteristic curve for the final prediction model had an area under the curve of 0.84 (CI: 0.78–0.89). Using these data, the risk of death or developing CP by age 2 can be calculated for individual surviving infants. Conclusion IVH and PVL were the only neonatal complications evident at discharge that contributed to an individual infant's risk of the long-term outcomes of death or CP by age 2. A model that includes these morbidities, gestational age at delivery, and gender is predictive of subsequent neurologic sequelae. Key Points Factors known at hospital discharge are identified which are independently associated with death or CP by age 2. A model was created and validated using these findings to counsel parents. The risk of death or CP can be calculated at the time of hospital discharge. [ABSTRACT FROM AUTHOR]

ObjectivesTo compare the ability of the commonly used Women's Health Initiative (WHI) and Cardiovascular Health Study (CHS) frailty phenotypes to predict falls, hip fracture, and death in WHI Clinical Trial participants aged 65 and older.DesignLongitudinal cohort study.SettingWHI Clinical Trial.ParticipantsParticipants with data for WHI and CHS frailty phenotypes (N = 3,558).MeasurementsFrailty was operationally defined in the CHS as the presence of three or more of weight loss, poor energy, weakness, slowness, and low physical activity. WHI operationalized frailty similarly but with the RAND-36 physical function scale substituted for slowness and weakness (RAND-36 physical function scale score 78 = 0 points). Frailty was defined as a summary score of 3 or greater, prefrailty as a score of 2 or 1, and nonfrailty as a score of 0. Outcomes were modeled using Cox regression. Harrell C-statistics were compared for models containing alternative instruments.ResultsApproximately 5% of participants were frail based on the CHS or WHI phenotype. The WHI frailty phenotype was associated with higher rates of falls (hazard ratio (HR) = 1.48, P = .003), hip fracture (HR = 1.87, P = .04), and death (HR = 2.32, P < .001). Comparable HRs in CHS-phenotype frail women were 1.32 (P = .04), 1.08 (P = .83), and 1.91 (P < .001), respectively. Harrell C-statistics revealed marked but insignificant differences in predicting abilities between CHS and WHI phenotype models (P > .50 for all).ConclusionThe WHI phenotype, which does not require direct measurements of physical performance, might offer a practical advantage for epidemiological and clinical needs.

BackgroundThis post hoc analysis determined if the Women's Health Initiative (WHI) Diet Modification intervention (DM-I) resulted in a significantly different rate of incident hypertension (HTN), as well as longitudinal changes in blood pressure.MethodsParticipants were 48,835 postmenopausal women aged 50-79 years who were randomly assigned to either the intervention or comparison group. HTN was defined as self-report of treated HTN collected semiannually or blood pressure ≥140/90mm Hg at one of the annual follow-up clinic visits.ResultsAfter a mean follow-up of 8.3 years, and among those who did not have HTN at baseline (n = 31,146), there were 16,174 (51.9%) HTN cases and those assigned to the intervention group had a 4% lower overall risk of developing incident HTN (hazard ratio (HR): 0.96, 95% confidence interval (CI): 0.93-0.99). Although the risk of HTN was lower in the DM-I group in the first few years, the HR became greater than 1 after year 5 (P-trend < 0.01). Similarly, randomization to the DM-I arm resulted in a small but significantly lower average systolic blood pressure (SBP) at 1 year of follow-up (-0.66mm Hg, 0.44-0.89) that increased over the following 8 years (0.16mm Hg/year, 0.11-0.21), such that any early benefit was eliminated by year 5 and a minimal deleterious effect emerged by year 7.ConclusionRandomization to an intensive behavioral dietary modification program aimed at a lower total fat intake is not associated with sustained reductions in blood pressure or risk of HTN in postmenopausal women.Clinical trial registrationurl http://www.clinicaltrials.gov, unique identifier nct00000611.

ObjectiveWe developed and validated a hybrid risk classifier combining serum markers and epidemiologic risk factors to identify post-menopausal women at elevated risk for invasive fallopian tube, primary peritoneal, and ovarian epithelial carcinoma.MethodsTo select epidemiologic risk factors for use in the classifier, Cox proportional hazards analyses were conducted using 74,786 Women's Health Initiative (WHI) Observational Study (OS) participants. To construct a combination classifier, 210 WHI OS cases and 536 matched controls with serum marker measurements were analyzed; validation employed 143 cases and 725 matched controls from the WHI Clinical Trial (CT) with similar data.ResultsAnalyses identified a combination risk classifier composed of two elevated-risk groups: 1) women with CA125 or HE4 exceeding a 98% specificity threshold; and 2) women with intact fallopian tubes, prior use of menopausal hormone therapy for at least two years, and either a first degree relative with breast or ovarian cancer or a personal history of breast cancer. In the WHI OS population, it classified 13% of women as elevated risk, identifying 30% of ovarian cancers diagnosed up to 7.8years post-enrollment (Hazard Ratio [HR]=2.6, p

IntroductionResults from the Women's Health Initiative clinical trials demonstrated no increase in the risk of lung cancer in postmenopausal women treated with hormone therapy (HT). We conducted a joint analysis of the Women's Health Initiative observational study data and clinical trials data to further explore the association between estrogen and estrogen-related reproductive factors and lung cancer risk.MethodsReproductive history, oral contraceptive use, and postmenopausal HT were evaluated in 160,855 women with known HT exposures. Follow-up for lung cancer was through September 17, 2012; 2467 incident lung cancer cases were ascertained, with median follow-up of 14 years.ResultsFor all lung cancers, women with previous use of estrogen plus progestin of less than 5 years (hazard ratio = 0.84; 95% confidence interval = 0.71-0.99) were at reduced risk. A limited number of reproductive factors demonstrated associations with risk. There was a trend toward decreased risk with increasing age at menopause (ptrend = 0.04) and a trend toward increased risk with increasing number of live births (ptrend = 0.03). Reduced risk of non-small-cell lung cancer was associated with age 20-29 years at first live birth. Risk estimates varied with smoking history, years of HT use and previous bilateral oophorectomy.ConclusionsIndirect measures of estrogen exposure to lung tissue, as used in this study, provide only weak evidence for an association between reproductive history or HT use and risk of lung cancer. More detailed mechanistic studies and evaluation of risk factors in conjunction with estrogen receptor expression in the lung should continue as a role for estrogen cannot be ruled out and may hold potential for prevention and treatment strategies.

ContextVasomotor symptoms (VMS) are common. Whether VMS are associated with fracture incidence or bone mineral density (BMD) levels is unknown.ObjectiveThis study aimed to examine associations of baseline VMS with fracture incidence and BMD.DesignThis was a prospective observational study with mean (SD) followup of 8.2 (1.7) years (1993-2005).SettingForty United States clinical centers.ParticipantsWe examined data from Women's Health Initiative Clinical Trial participants (n = 23 573) age 50-79 years not using menopausal hormone therapy, and 4,867 participants of the BMD sub-study.InterventionsNone.Main outcome measuresWe measured baseline VMS, incident adjudicated fractures, and BMD (baseline, annual visits 1, 3, 6, and 9).ResultsAfter adjustment for baseline age, body mass index, race/ethnicity, smoking, and education, the hazard ratio for hip fracture among women with baseline moderate/severe VMS (vs no VMS) was 1.78 (95% confidence interval [CI], 1.20-2.64; P = .01). There was no association between VMS and vertebral fracture. VMS severity was inversely associated with BMD during followup (P = .004 for femoral neck, P = .045 for lumbar spine). In repeated measures models, compared with women who reported no VMS, women with moderate/severe VMS had 0.015 g/cm(2) lower femoral neck BMD (95% CI, -0.025--0.005) and 0.016 g/cm(2) lower lumbar spine BMD (95% CI, -0.032--0.004).ConclusionsWomen with moderate/severe VMS have lower BMD and increased hip fracture rates. Elucidation of the biological mechanisms underlying these associations may inform the design of preventive strategies for at-risk women prior to occurrence of fracture.

ObjectivesTo determine whether statin treatment is associated with increased risk of haemorrhagic stroke (HS) in older women. A secondary objective was to evaluate HS risk in users of combined statin and antiplatelet treatment.DesignObservational study: secondary data analysis from the Women's Health Initiative (WHI) clinical trials.SettingWomen were recruited from 40 participating sites.ParticipantsCohort of 68,132 women followed through 2005 (parent study) and for an additional 5 years in the extension study.Main outcome measuresStatin use was assessed at baseline and at follow-up visits (1, 3, 6 and 9 years). Women brought medications in original containers for inventory. Strokes were ascertained semiannually and centrally adjudicated. Risk of HS by statin use (time-varying covariate, with the 'no use' category as the referent) was estimated from Cox proportional hazard regression models adjusted for age (model 1); risk factors for HS (model 2); and possible confounders by indication (model 3). Prespecified subgroup analyses were conducted by use of antiplatelet medications.ResultsFinal models included 67,882 women (mean age, 63±7 years). Over a mean follow-up of 12 years, incidence rates of HS were 6.4/10,000 person-years among statin users and 5.0/10,000 person-years among non-users (p=0.11). The unadjusted risk of HS in statin users was 1.21 (CI 0.96 to 1.53); after adjusting for age and HS risk factors the HR was 0.98 (CI 0.76 to 1.26). Risk of HS was higher among women on statins and antiplatelet agents versus women on antiplatelet medications alone (HR=1.59; CI 1.03 to 2.47); p for interaction=0.011.ConclusionsThis retrospective analysis did not show an association between statin use and HS risk among older women. HS risk was higher among women taking statins with antiplatelet agents. These findings warrant further investigation, given potential implications for clinical decision-making.

Current evidence suggests a multifactorial etiology to pelvic organ prolapse (POP), including genetic predisposition. We conducted a genome-wide association study of POP in African American (AA) and Hispanic (HP) women from the Women's Health Initiative Hormone Therapy study. Cases were defined as any POP (grades 1-3) or moderate/severe POP (grades 2-3), while controls had grade 0 POP. We performed race-specific multiple logistic regression analyses between SNPs imputed to 1000 genomes in relation to POP (grade 0 vs 1-3; grade 0 vs 2-3) adjusting for age at diagnosis, body mass index, parity, and genetic ancestry. There were 1274 controls and 1427 cases of any POP and 317 cases of moderate/severe POP. Although none of the analyses reached genome-wide significance (p

As legal structures for same-sex relationships are introduced in many contexts, the politics of sexuality are negotiated along religious/secular lines. Religious and Lesbian, Gay, Bisexual, Transgender, Queer (LGBT-Q) rights are pitted against one another such that LGBT-Q lives often assumed to be secular. Schools are crucibles of intermingling religious, secular and equality discourses and this complexity is carefully negotiated by LGBT-Q teachers in their everyday lives. Drawing on a study with LGB teachers as they entered into a Civil Partnership in Ireland (a legal structure in place for five years prior to enactment of Marriage Equality in 2015), this paper captures a 'structure of feeling'--new cultural work done as sexuality norms were in a state of flux. The teachers' accounts unravel the religious/secular binary and provide insight of universal interest into the ambivalent, messy ways in which the politics of sexuality are (re)negotiated across the overlapping social fields of religion and education.

What do young people believe sexuality education ought to be about? It is within the absence of a sustained and critical consideration of the possibilities and politics of engaging in research with rather than for young people in the reimagining of sexuality education that this paper is positioned. Data were generated as part of an 18-month Youth Participatory Action Research study in one co-educational secondary school with 43 student co-researchers (15-17 years). The findings presented are not intended to provide conclusive statements about future directions for sexuality education, but rather provide a platform on which to discuss how young people's ideas align with or diverge from current practice and debates surrounding what sexuality education should, could or ought to be about.

Mary O'Sullivan writes that she spent part of her sabbatical leave interviewing teacher educators from nine countries across three continents exploring teacher education contexts both nationally and locally, and the nature of the 'teacher educators' work in these contexts. Three issues struck her: (1) The intensification of regulation and policy changes around education globally was placing enormous strain on local and national initial teacher education (ITE) systems, higher education, schools and the teacher educators who enact these programmes; (2) demands on academic staff to be research active, socially engaged, AND committed to innovation in teaching and programme design was as a professor noted, 'gruelling and relentless; and (3) A sense of lack of interest in (and in a few cases a lack of respect for) teacher education research by several scholars. This special issue is part of a raft of recent publications focused on Physical Education Teacher Education (PETE), and suggests a resurgence of interest in PETE research. Exploration of how sociological and social justice issues are addressed and implemented in PETE programs internationally demands teacher educators to be more critically aware how and why they might value and advocate for social justice as part of their work. O'Sullivan believes that the contributors to this issue are more optimistic relative to the potential of transformative pedagogies in PETE than Patti Lather who claimed that implementing a critical pedagogy in the field of schooling is impossible. The contributions to this special issue provoke readers to engage with PETE and PETE research and encourage the sharing of best practices in fostering awareness and commitments to social justice and equal access for all to quality teaching and learning experiences

Background: Concerns that current forms of physical education teacher education (PETE) are not adequately providing teachers with the tools necessary for working with the realities and challenges of teaching physical education in contemporary schools has led some scholars to advocate for an approach that prioritises meaningfulness in physical education. There is, however, little empirical evidence of how future teachers might be taught to facilitate meaningful physical education experiences. Purpose: This paper describes a pedagogical approach to PETE to support pre-service teachers (PSTs) in learning how to facilitate meaningful experiences in physical education. We aim to contribute new understanding through sharing pedagogical principles that support PSTs' "Learning About Meaningful Physical Education" (LAMPE). Participants and setting: The research team consisted of three physical education teacher educators: Tim and Déirdre who implemented LAMPE pedagogies and Mary who acted as meta-critical friend (pseudonyms used for the review process). Results from the LAMPE innovation reported here are taken from implementation across four semesters of two academic years 2013-2015. Déirdre implemented LAMPE in an introduction to teaching physical education course for pre-service generalist elementary teachers. Tim implemented the approach in an undergraduate developmental games course for future physical education teachers. A total of 106 PSTs participated in the research. Data collection and analysis: Data included teacher educator reflections and non-participant observer data from 33 individual lessons, over 7 hours of transcribed teacher educator Skype conversations, 8 "turning point" documents, 15 sets of PST work samples, and transcripts of individual (n = 10) and 9 focus group interviews (n = 18 participants) with PSTs. Data were analysed inductively. Triangulation of multiple data sources and an expert member check supported trustworthiness of the LAMPE approach and data analysis. Findings: We share five pedagogical principles that reflect how PSTs were supported to learn how to facilitate meaningful physical education experiences. Pedagogies included planning for, experiencing, teaching, analysing, and reflecting on meaningful participation. Implementing pedagogies aligned with these five pedagogical principles helped participants learn "why" meaningful participation should be prioritised as well as "how" to facilitate meaningful physical education experiences. Conclusions: Pedagogical principles of LAMPE have been constructed from empirical evidence of both teacher educator and PST experiences that supported learning how to promote meaningful physical education. This research contributes new understanding of how to support PSTs in learning to teach with an emphasis on facilitating meaningful physical education experiences.

In addressing the theory-practice divide, this research provides valuable insight into preservice teachers' (PSTs) learning through an experiential learning (EL) framework during teacher education. Utilizing an interpretivist approach, this study aims at providing insight on how PSTs link the manner in which they learned during teacher education to how they teach during school placement. Evidence suggested participants valued faciliating enjoyable and meaningful learning experiences for their students in the course of learning through an EL approach. Learning through an experiential approach provided the PSTs with confidence in what to teach. However, the PSTs also assumed their own students would have similar responses to the learning experiences they had themselves when completing tasks during teacher education. PSTs were limited in their ability to recognize student learning and in understanding student capacity for progression. Implications of the findings for teacher education are discussed.