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Introduction Global surveillance of physical activity (PA) of children and adolescents with questionnaires is limited by the use of instruments developed in high-income countries (HICs) lacking sociocultural adaptation, especially in low- and middle-income countries (LMICs); under-representation of some PA domains; and omission of active play, an important source of PA. Addressing these limitations would help improve international comparisons, and facilitate the cross-fertilisation of ideas to promote PA. We aim to develop and assess the reliability and validity of the app-based Global Adolescent and Child Physical Activity Questionnaire (GAC-PAQ) among 8–17 years old in 14 LMICs and HICs representing all continents; and generate the ‘first available data’ on active play in most participating countries.Methods and analysis Our study involves eight stages: (1) systematic review of psychometric properties of existing PA questionnaires for children and adolescents; (2) development of the GAC-PAQ (first version); (3) content validity assessment with global experts; (4) cognitive interviews with children/adolescents and parents in all 14 countries; (5) development of a revised GAC-PAQ; (6) development and adaptation of the questionnaire app (application); (7) pilot-test of the app-based GAC-PAQ; and, (8) main study with a stratified, sex-balanced and urban/rural-balanced sample of 500 children/adolescents and one of their parents/guardians per country. Participants will complete the GAC-PAQ twice to assess 1-week test–retest reliability and wear an ActiGraph wGT3X-BT accelerometer for 9 days to test concurrent validity. To assess convergent validity, subsamples (50 adolescents/country) will simultaneously complete the PA module from existing international surveys.Ethics and dissemination Approvals from research ethics boards and relevant organisations will be obtained in all participating countries. We anticipate that the GAC-PAQ will facilitate global surveillance of PA in children/adolescents. Our project includes a robust knowledge translation strategy sensitive to social determinants of health to inform inclusive surveillance and PA interventions globally.

Background Fludarabine in combination with cyclophosphamide (FC) is the standard lymphodepletion regimen for CAR T-cell therapy (CAR T). A national fludarabine shortage in 2022 necessitated the exploration of alternative regimens with many centers employing single-agent bendamustine as lymphodepletion despite a lack of clinical safety and efficacy data. To fill this gap in the literature, we evaluated the safety, efficacy, and expansion kinetics of bendamustine as lymphodepletion prior to axicabtagene ciloleucel (axi-cel) therapy.Methods 84 consecutive patients with relapsed or refractory large B-cell lymphoma treated with axi-cel and managed with a uniform toxicity management plan at Stanford University were studied. 27 patients received alternative lymphodepletion with bendamustine while 57 received FC.Results Best complete response rates were similar (73.7% for FC and 74% for bendamustine, p=0.28) and there was no significant difference in 12-month progression-free survival or overall survival estimates (p=0.17 and p=0.62, respectively). The frequency of high-grade cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome was similar in both the cohorts. Bendamustine cohort experienced lower proportions of hematological toxicities and antibiotic use for neutropenic fever. Immune reconstitution, as measured by quantitative assessment of cellular immunity, was better in bendamustine cohort as compared with FC cohort. CAR T expansion as measured by peak expansion and area under the curve for expansion was comparable between cohorts.Conclusions Bendamustine is a safe and effective alternative lymphodepletion conditioning for axi-cel with lower early hematological toxicity and favorable immune reconstitution.

Abstract Background Insufficient physical activity, high screen time, and unhealthy dietary patterns among adolescents may have worsened during the pandemic, but data are lacking. This study compared physical activity, screen time and fruit and vegetable intake in adolescents from Dunedin, New Zealand, 5–6 years before (Study 1) and during (Study 2) the COVID-19 pandemic. Methods Adolescents completed an online survey as part of the Built Environment and Active Transport to School (BEATS) studies in 2014/2015 (Study 1; n = 1,266; age: 15.3 ± 1.4 years; 54.6% female) and 2021/2022 (Study 2; n = 819; age: 15.2 ± 1.4 years; 47.4% female). The proportion of adolescents meeting guidelines for physical activity (≥ 60 min/day of moderate-to-vigorous physical activity), outside school screen time (≤ 2 h/day) and fruit and vegetable intake (> 1 serving/day for both fruit and vegetables) was calculated. Data were analysed using multivariable linear and logistic regression modelling. Results Few adolescents met recommended health behaviour guidelines. Compared to Study 1, significantly greater proportions of adolescents at Study 2 met guidelines for physical activity (16.7% vs. 23.1%; p

Abstract Objective: To understand the relationship between adolescents’ unhealthy snacking behaviour during their school journey and their perceived and objective measures of food outlet availability in the school neighbourhood. Design: A cross-sectional survey enquired about socio-demographic information, school transport modes, perceived presence of food outlets in the school neighbourhood and unhealthy food purchase and consumption on the school journey. A geographical information system analysis of the food outlets within 500 m and 1000 m school buffers was undertaken. Data were analysed using generalised linear mixed modelling. Setting: All twelve secondary schools in Dunedin, Aotearoa New Zealand, March 2020–June 2022. Participants: Adolescents aged 13–18 years (n 725) who reported being familiar with their school neighbourhood. Results: Perceived availability of food outlets in the school neighbourhood was inversely correlated with distance to the closest food outlet from school and positively correlated with food outlet density within 500 m and 1000 m school buffers. Adolescents’ purchase and consumption of unhealthy snacks and drinks during the school journey were associated with perceived availability of food outlets and with shorter distance to the closest food outlet from school. Mixed transport users, girls and those living in high-deprivation neighbourhoods had higher odds of purchasing and consuming unhealthy snacks and drinks during the school journey than active transport users, boys and those living in low-deprivation neighbourhoods, respectively. Conclusions: Adolescents perceptions of the food environment and close access to food outlets in the school neighbourhood may influence adolescents’ food purchase and consumption behaviours during the school journey.

Power Up Schools (Power Up) was a temporary intervention involving a range of activities aimed at increasing children's active school travel (AST) with a focus on physical and social aspects of schools and their surrounding environs. We evaluated the impact of Power Up on children's AST and how multiple stakeholders (children, school representatives, parents, residents) perceived the overall intervention and its components. This was a multiple methods evaluation study with four primary (elementary) schools in Auckland and their wider communities. The study involved longitudinal data collection (daily travel modes reported by children), repeat cross-sectional surveys with parents, single time-point cross-sectional surveys with residents, post intervention focus groups with children and parents, and post intervention interviews with school representatives. Findings showed evidence for increased AST; general support for Power Up by children, parents, and school representatives; mixed support by residents for some components; the importance of considering diverse needs and preferences in future interventions; the need for more comprehensive communication across stakeholders; and the value of streamlining processes for schools and parents. Comprehensive approaches that are embedded within, and accepted by, the wider school community are recommended for sustainable and effective AST interventions.

Active school travel (AST) confers considerable health and environmental benefits. While evidence on AST associates for older children, and in relation to the physical built environment, has grown significantly over time, less is known regarding AST associates in younger children and socio-environmental associates of AST in this age group. In this research, we seek to determine the relationships between a range of factors across the ecological spectrum and children’s AST at 6 years and at 8 years of age, controlling for maternal education and number of times moved since 4 years. Structural equation modelling was used to identify factors associated with AST at 6 years. Due to the poor overall fit for the 8 year SEM model, a path model was instead performed to explore the direct relationships between AST and other observed variables. At both 6 and 8 years, importance of living close to schools had a significant and positive relationship with AST (standardised estimates = 0.31 and 0.19 respectively, both p

There has been a growing interest in policies that encourage local living by promoting accessible and walkable communities, such as the 20-minute neighborhood concept. Despite the widespread adoption of this policy worldwide, little research has been conducted on the characteristics of children's 20-minute neighborhoods and their association with time spent locally.This study aimed to explore the features of Scottish children's 20-minute neighborhoods by analysing an 800 m road and path network buffer surrounding 687 children's homes. Based on existing literature, the study identified key features associated with children's time spent locally and the 20-minute neighborhood policy. The study then examined variations in these features by socioeconomic status, urbanicity, and gender.The findings revealed significant inequalities in the presence of health-benefiting (e.g., green spaces, recreational facilities, healthy food outlets) and health-harming (e.g., major roads, unhealthy commodity retailers) environments within children's 20-minute neighborhoods. Children from more deprived areas had access to more of both types of environments. The study also found that having a school within a 20-minute neighborhood was associated with an increased amount of time spent locally (IRR 1.62, 95% CI 1.5 to 1.8, p

Abstract Background The purpose of this study was to examine socio-demographic differences in physical activity (aerobic and muscle-strengthening) among young adults (18–24 years). Methods Data collected between 2017–2019 as a part of Sport New Zealand’s Active NZ survey were examined using logistic regression analyses to determine the odds of participants meeting aerobic, muscle-strengthening and combined physical activity recommendations. Gender, ethnicity, employment/student status, disability status, and socio-economic deprivation were included as explanatory variables in analyses. Results The proportion of young adults meeting recommendations varied according to physical activity type (aerobic:63.2%; strength:40.1%; combined:37.2%). Young adults not employed/studying had lower odds of meeting recommendations than those full-time employed (OR = 0.43 [0.34–0.54]). Physical activity levels differ according to gender and this intersects with ethnicity, employment/student status, and social deprivation. For example, the odds of Pasifika young adults meeting combined physical activity recommendations compared to Europeans were not different (OR = 0.95 [0.76–1.19]), but when stratified by gender the odds were significantly higher for men (OR = 1.55 [1.11–2.16]) and significantly lower for women (OR = 0.64 [0.47–0.89]. Similarly, young adults in high deprivation areas had lower odds of meeting combined physical activity recommendations than those in low deprivation areas (OR = 0.81 [0.68–0.95]), but this was mainly due to the difference among women (OR = 0.68 [0.54–0.85]) as there was no difference among men (OR = 0.97 [0.76–1.25]). Conclusions Intersections between socio-demographic characteristics should be considered when promoting physical activity among young adults in Aotearoa New Zealand, particularly young adults not employed/studying, and young women who live in deprived areas or identify as Asian or Pasifika. Tailored approaches according to activity type for each of these groups are required.

Background/Objective: This article reports the methods and findings for Aotearoa New Zealand's 2022 Report Card on Physical Activity for Children and Youth indicators, and on inequities within these indicators. Methods: Grades were assigned to indicators using the Active Healthy Kids Global Alliance criteria depending on data availability, and inequities reported based on gender, ethnicity, disability status, area-level socioeconomic deprivation, urbanicity, and school year. Two additional indicators were included in this report card: Sleep, and Physical literacy. Results: Grades were assigned to indicators as follows: Overall physical activity: C+, Organised sport and physical activity: B-, Physical literacy: B, Active transportation: D, Sedentary behaviours: C-, Sleep: B+, Whānau (family) and peers: D, School: C+, Government: A. Inequities across all socio-demographic variables were observed. An ‘inconclusive’ grade was assigned to the Active play, Physical fitness, and Community and Environment indicators due to insufficient data. Conclusion: It is imperative that targeted, comprehensive, and population-specific approaches are implemented to support health-promoting physical activity behaviours and reduce inequities among children and youth in Aotearoa. There is a need to promote all dimensions of physical activity (overall activity, active play, recreation, organised sport, active transportation) and the reduction of screen time through policy, research, evidence-based social marketing campaigns, and urban design. Regular, nationally representative surveys that enable the consistent and regular measurement of key Report Card indicators are needed.

ABSTRACTTo be realistic and meaningful, positive ageing conceptualisations should involve a diverse range of perspectives. Yet, problematically, perspectives are often distinguished as ‘researcher versus older adult’. In this scoping review, we suggest that distinguishing perspectives based on the data collection and interpretation approach is more meaningful. Guided by Arksey and O’Malley’s scoping review framework, we explored diverse positive ageing literature (from across conceptual origins and discourses) to clarify how positive ageing for community-dwelling older adults has been conceptualised. To reflect diverse data and interpretation perspectives, we considered both etic (closed/validatory) and emic (open/exploratory) approaches and developed a conceptual model of positive ageing that consolidated diverse literature and approaches. We synthesised 75 articles and determined that etic and emic approaches generally included similar features; however, emic approaches considered more comprehensive and complex features. Our multidimensional and holistic positive ageing model illustrates the range of unique factors which contribute to the health and well-being of older adults. Furthermore, we find that positive ageing literature largely focuses on individualistic behaviours. Future positive ageing research and policy would have more traction, in our view, if it included wider structural environments to stimulate real-world change. We offer our conceptual model as a useful guide.

ABSTRACTThere are no government policies in Aotearoa, New Zealand (NZ) sufficient to protect children from unhealthy food and beverage marketing. Repeated exposure to advertising can have long-term impacts on children’s dietary preferences, ultimately increasing the risk of non-communicable diseases in adulthood. An important food environment for children is the area around their school. This study aims to describe outdoor food and beverage advertising on convenience stores within 500 m of all primary schools (n = 371) within the Auckland region. Images of advertisements were captured from Google Street View. A total of 3693 advertisements were collected from 296 stores. The majority (n = 2628, 78.2%) of advertisements were classified as marketing to children. Convenience stores in areas surrounding low decile schools (n = 1170, 51.8%) had twice as many advertisements than areas around medium (n = 561, 24.8%) or high (n = 529, 23.4%) decile schools. Approximately half (n = 1863, 50.5%) of advertisements were for unhealthy food or beverages, and less than ten percent (n = 350, 9.4%) were for healthy products. These findings highlight the need for policies to reduce children’s exposure to unhealthy advertising in their school food environment.

Action research and grounded theory are popular methodologies in qualitative health research. The aim of this structured narrative review was to develop a contemporary understanding of combining action research and grounded theory. We searched Web of Science Core Collection and Google Scholar for empirical peer-reviewed articles that used both methodologies in a health- or healthcare-focused study. We identified 28 studies published from 2004 to 2022 that combined various types of action research and interpretations of grounded theory in innovative ways. Our results highlighted that combining the two methodologies is feasible and growing in use. Benefits identified by the study authors were opportunity to work with participants, methodological compatibility, enhancement of action, theoretical understanding, and perceived legitimacy of research processes and outputs. Key challenges were compromising on both methodologies, and conceptual and practical limitations. Our findings also highlighted that important synergies and tensions exist between the two methodologies, but tensions are not insurmountable. We suggest a combined action research and grounded theory approach underpinned by pragmatism as a methodologically congruent path forwards. In an academic environment which increasingly implores health researchers to translate new-found knowledge to timely real-world change, innovative approaches to research methodologies and design are required.

Abstract Background Geographic information systems (GIS) are often used to examine the association between both physical activity and nutrition environments, and children’s health. It is often assumed that geospatial datasets are accurate and complete. Furthermore, GIS datasets regularly lack metadata on the temporal specificity. Data is usually provided ‘as is’, and therefore may be unsuitable for retrospective or longitudinal studies of health outcomes. In this paper we outline a practical approach to both fill gaps in geospatial datasets, and to test their temporal validity. This approach is applied to both district council and open-source datasets in the Taranaki region of Aotearoa New Zealand. Methods We used the ‘streetview’ python script to download historic Google Street View (GSV) images taken between 2012 and 2016 across specific locations in the Taranaki region. Images were reviewed and relevant features were incorporated into GIS datasets. Results A total of 5166 coordinates with environmental features missing from council datasets were identified. The temporal validity of 402 (49%) environmental features was able to be confirmed from council dataset considered to be ‘complete’. A total of 664 (55%) food outlets were identified and temporally validated. Conclusions Our research indicates that geospatial datasets are not always complete or temporally valid. We have outlined an approach to test the sensitivity and specificity of GIS datasets using GSV images. A substantial number of features were identified, highlighting the limitations of many GIS datasets.

Cellular therapies have transformed the treatment of relapsed/refractory diffuse large B-cell lymphoma (r/r DLBCL), which typically does not respond well to salvage chemotherapy. Recently, approximately 40% of r/r DLBCL patients across three different trials achieved a complete remission at 1 year after receiving treatment with autologous chimeric antigen receptor (CAR) T cells (auto-CARs). These successes have prompted studies of auto-CARs in second-line settings, in which axicabtagene ciloleucel and lisocabtagene maraleucel both showed improved event-free survival over autologous hematopoietic cell transplantation (AHCT). While encouraging, this data also highlights that 60% of patients relapse or progress following treatment with auto-CARs. Individual disease characteristics and logistical challenges of cell engineering also limit patients’ eligibility for auto-CARs. Allogeneic CAR T cells (allo-CARs) may address some of these limitations as they may mitigate delays associated with auto-CARs, thereby reducing the need for bridging chemotherapies and increasing availability of cellular products for patients with aggressive lymphomas. By being sourced from healthy donors who have never been exposed to cytotoxic chemotherapy, allo-CARs can be created from T cells with better fitness. Allo-CARs made from specific cellular subsets (e.g., stem cell memory or naïve/early memory T cells) may also have increased efficacy and long-term persistence. Additionally, allo-CARs have been successfully created from other cell types, including natural killer cells, gamma-delta T-cells and induced pluripotent stem cells. These cell types can be engineered to target viral antigens, enabling precision targeting of virally driven DLBCL. As allogeneic donor cells can be banked and cryopreserved in batches, they can be made more readily available, potentially reducing logistical hurdles and costs compared to engineering auto-CARs. This may ultimately create a more sustainable platform for cell therapies. Challenges with allo-CARs that will need to be addressed include graft versus host disease, alloimmunization, potentially decreased persistence relative to auto-CARs, and antigen escape. In short, the adaptability of allo-CARs makes them ideal for treating patients with r/r DLBCL who have progressed through standard chemotherapy, AHCT, or auto-CARs. Here, we review the published literature on patients with r/r DLBCL treated with allogeneic CAR products manufactured from various cell types as well as forthcoming allogeneic CAR technologies.

We aim to understand how a streetscape intervention, Te Ara Mua- Future Streets, designed to improve the ease and safety of active modes, influenced perceptions of neighbourhood safety and security in Māngere, New Zealand. In this controlled intervention study, survey, focus group and in-depth interview data on neighbourhood perceptions were gathered from adults and children in 2014 and 2017, before and after the intervention. General Linear Mixed Modelling (GLMM) was used to undertake a difference in differences analysis of the individual level survey data on traffic and neighbourhood safety perceptions. Focus group and interview data were analysed thematically. Survey data indicate improvements in neighbourhood safety but not traffic safety perceptions after the streetscape upgrade. Conversely, focus group and interview data suggest enduring fears around people and dogs, but an easing of traffic-related fears attributed to safer crossings and slower vehicle speeds. Our contrasting quantitative and qualitative findings demonstrate a complex interplay of neighbourhood people and place attributes in shaping residents’ experiences of safety and security, and therefore the importance of combining personal safety and traffic safety, as well as multiple measures, when investigating pathways between built environment change and active travel.

Background: Growing evidence shows the positive influence of neighbourhood green space on mental well-being among adults through multiple health behaviours, but similar studies are lacking for adolescents. Methods: Data were drawn from the 2019 wave of the Youth2000 survey series in Aotearoa, New Zealand with secondary school students (aged 10-19 years) from the city of Tamaki Makaurau, Auckland. Emotional well-being was measured with the World Health Organization-5 Well-being Index, and depressive symptoms were assessed using the Reynolds Adolescent Depression Scale-short form. Neighbourhood green space was assessed using three different measures: percentage of green space, Normalised Difference Vegetation Index (NDVI) and the distance to nearest green space from place of residence. Exposure areas of these measures were calculated using Euclidean buffers of 100m, 300m, 800m and 1600m around participants’ meshblock residential addresses. Three mediating (physical activity, social cohesion, sleep) and ten control variables (in adjusted models) were included in path analysis to test the direct and indirect relationships between green space and adolescent mental well-being. Results: In unadjusted models, percentage of green space had a negative relationship with emotional well-being, and inconsistent effects of NDVI were detected in different buffers. Minor indirect effects of physical activity and sleep were also found. Depressive symptoms and emotional well-being were more strongly related to other individual and neighbourhood factors (e.g., neighbourhood deprivation). After adjusting for control variables, no significant associations of green space with adolescent depressive symptoms and emotional well-being were identified. Conclusions: Urban neighbourhood green space does not appear to be a dominant factor contributing to adolescent mental well-being through physical activity, social cohesion and sleep. Appropriate individual and environmental control variables are needed to take into consideration in future studies that explore the green space-mental well-being relationships in adolescents.

Abstract Background The IPEN International Physical Activity and Environment Network Adolescent project was conducted using common study protocols to document the strength, shape, and generalizability of associations of perceived neighborhood environment attributes with adolescents’ physical activity and overweight/obesity using data from 15 countries. Countries did not use identical versions of the Neighborhood Environment Walkability Scale for Youth (NEWS-Y) to measure perceived neighborhood environment attributes. Therefore, this study derived a measurement model for NEWS-Y items common to all IPEN Adolescent countries and developed a scoring protocol for the IPEN Adolescent version of the NEWS-Y (NEWS-Y-IPEN) that maximizes between-country comparability of responses. Additionally, this study examined between- and within-country variability, and construct validity of the NEWS-Y-IPEN subscales in relation to neighborhood-level socio-economic status and walkability. Methods Adolescents and one of their parents (N = 5714 dyads) were recruited from neighborhoods varying in walkability and socio-economic status. To measure perceived neighborhood environment, 14 countries administered the NEWS-Y to parents and one country to adolescents. Confirmatory factor analysis was used to derive comparable country-specific measurement models of the NEWS-Y-IPEN. Country-specific standard deviations quantified within-country variability in the NEWS-Y-IPEN subscales, while linear mixed models determined the percentage of subscale variance due to between-country differences. To examine the construct validity of NEWS-Y-IPEN subscales, we estimated their associations with the categorical measures of area-level walkability and socio-economic status. Results Final country-specific measurement models of the factor-analyzable NEWS-Y-IPEN items provided acceptable levels of fit to the data and shared the same factorial structure with five latent factors (Accessibility and walking facilities; Traffic safety; Pedestrian infrastructure and safety; Safety from crime; and Aesthetics). All subscales showed sufficient levels of within-country variability. Residential density had the highest level of between-country variability. Associations between NEWS-Y-IPEN subscales and area-level walkability and socio-economic status provided strong evidence of construct validity. Conclusions A robust measurement model and common scoring protocol of NEWS-Y for the IPEN Adolescent project (NEWS-Y-IPEN) were derived. The NEWS-Y-IPEN possesses good factorial and construct validity, and is able to capture between-country variability in perceived neighborhood environments. Future studies employing NEWS-Y-IPEN should use the proposed scoring protocol to facilitate cross-study comparisons and interpretation of findings.

Introduction Neighbourhood environments can have significant and enduring impacts on children’s physical, psychological and social health. Environments can impact health through promoting or hindering physical activity, active travel, and healthy eating in addition to opportunities for social interaction, cognitive development, rest and relaxation. There is a paucity of research that has examined neighbourhood and health priorities, strengths and needs from the perspectives of the community, and even less that has focused on the perspectives of children within communities. The aim of this article is to describe the research protocol for a project to gather child-identified needs and strengths-based solutions for promoting child health and well-being in urban neighbourhood environments.Methods and analysis This participatory research project is designed to partner with children in school settings in Tāmaki Makaurau Auckland and Ōtepoti Dunedin, Aotearoa New Zealand. An abundant communities approach will be used with children to identify needs and strengths related to neighbourhoods and health. Specific methods including collaborative, creative, play-based methods such as concept-mapping activities and co-creation of final dissemination material on the key messages are described. Plans for researcher reflections, data analysis and dissemination are also detailed.Ethics and dissemination This research has been approved by the University of Auckland Human Participants Ethics Committee. Results will be disseminated through child and researcher co-created output, a technical report and academic journal articles. By using evidence-based child-centred approaches to knowledge generation, we anticipate the research will generate new localised insights about children’s preferences and needs for healthy neighbourhoods which will be shared with stakeholders in planning and practice. The detailed session protocol including critical researcher reflections is shared in this manuscript for application, development and refinement in future research.

Abstract: As the adult hematology and oncology fellowship training pathways have merged in the United States and concerns have arisen about the aging of practicing hematologists, the American Society of Hematology and hematology education leaders are looking to improve their understanding of the factors that contribute to fellows' plans to enter hematology-only careers. With the support of the American Society of Hematology, we collected and analyzed data from a survey of hematology/oncology fellows (n = 626) to examine the relationship between training and mentorship experiences and fellows' plans to enter hematology-only careers. Fellows who planned to enter hematology-only careers were significantly more likely to report having clinical training and mentorship experiences in hematology throughout their training relative to fellows with oncology-only or combined hematology/oncology career plans. After controlling for prior interest in hematology and demographic characteristics, exposure to hematology patients in medical school and fellowship, hematology research experiences, and hematology mentorship (research collaboration and career coaching) were positively and significantly associated with hematology-only career plans. These findings suggest that increasing opportunities for exposure to hematology patients, research opportunities and mentors throughout training could be helpful in building a strong pipeline of potential hematologists.

Abstract Background Active school travel (AST) is influenced by multiple factors including built and social environments, households and individual variables. A holistic theory such as Mitra’s Behavioural Model of School Transportation (BMST) is vital to comprehensively understand these complex interrelationships. This study aimed to assess direct and indirect associations between children’s AST and environmental, household and child factors based on the BMST using structural equation modelling (SEM). Methods Data were drawn from Neighbourhoods for Active Kids (NfAK), a cross-sectional study of 1102 children aged 8–13 years (school years 5–8) and their parents from nine intermediate and 10 primary schools in Auckland, New Zealand between February 2015 and December 2016. Data were collected using an online participatory mapping survey (softGIS) with children, a computer-assisted telephone interviewing survey (CATI) with parents, and ArcGIS for built environment attributes. Based on the BMST a conceptual model of children’s school travel behaviour was specified for SEM analyses (‘hypothesised SEM’), and model modification was made to improve the model (‘modified SEM’). SEM analyses using Mplus were performed to test the hypothesised/modified SEM and to assess direct and indirect relationships among variables. Results The overall fit of the modified SEM was acceptable (N = 542; Root mean square error of approximation = 0.04, Comparative fit index = 0.94, Tucker-Lewis index = 0.92). AST was positively associated with child independent mobility, child-perceived neighbourhood safety, and parent-perceived importance of social interaction and neighbourhood social environment. Distance to school, and parental perceptions of convenience and concerns about traffic safety were negatively associated with AST. Parental fears of stranger danger were indirectly related to AST through those of traffic safety. Distance to school and child independent mobility mediated relationships between AST and child school year and sex. Conclusions Increasing children’s AST requires action on multiple fronts including communities that support independent mobility by providing child friendly social and built environments, safety from traffic, and policies that promote local schools and safe vehicle-free zones around school.

Active participation in community and cultural life is a basic right of all children and young people (CYP) and is central to wellbeing. For disabled CYP, mobility can be constrained through a range of environmental and social/attitudinal barriers. The aim of this research was to understand the enablers and barriers to mobility from the perspectives of disabled CYP. Thirty-five disabled CYP aged between 12 and 25 years took part. Data were collected in Tāmaki Makaurau Auckland, Aotearoa New Zealand from mid-2016 to early 2018. Face-to-face interviews and go-along interviews were conducted and were transcribed verbatim. An iterative, thematic approach to analysis was undertaken. Mobility played an essential role in enabling wellbeing, connecting CYP to people, places and possibilities. While the possible impediments to smooth transit appeared infinite, numerous examples of overcoming barriers to mobility were evidenced across a range of factors. Dis/ableism was a pervasive barrier to mobility. The rights to access and experience the city for young people in this study were compromised by transport networks and social norms as well as values that privilege the movement of non-disabled bodies. The findings demonstrate that reducing ableist presumptions about preferences and abilities of disabled CYP, alongside ensuring practical enablers across the transport system must be key priorities for enhancing the wellbeing of this group.

One of the key social determinants of health that can impact children and young people is migration. Advances in health research have seen a shift away from a biomedical model of health to understanding health as a multifactorial, holistic state - mentally, physically, and socially. The aim of this article is to illustrate how different methods (i.e., adult-centric, child/youth-centered) and frameworks (i.e., biomedical, strengths-based) can impact on research findings in childhood research. Drawing on findings from a systematic review, we examine the approaches taken in eleven studies investigating the health and wellbeing of young migrants in the Western Pacific region. The systematic review highlighted a range of methods (quantitative surveys, drawings, photo novellas) that were used to capture child/youth perspectives, and identify contextual factors beyond immediate biomedical factors that impacted their wellbeing. Adult-centric biomedical approaches were limited in understanding these broader environmental contexts, yet these approaches were prevalent in this body of literature. We highlight the importance of developing more strengths-based approaches and child/youth-centered methods to gain a comprehensive understanding of social and physical environments that child and youth migrants draw upon to support their wellbeing.

Abstract Objective When using global positioning systems (GPS) to assess an individual’s exposure to their environment, a first step in data cleaning is to establish minimum GPS ‘inclusion criteria’ (a set of rules used to determine which GPS data are able to be included in analyses). Care is needed at this stage to avoid any data exclusion (data loss) systematically biasing results in terms of characteristics of the environment and participants. The extent of potential systematic bias in sample retention due to GPS data loss and application of GPS inclusion criteria is unknown. The aim of this study was to describe differences in sample size and socio-demographic characteristics of the retained sample when applying three different GPS inclusion criteria. The study assessed 7-day GPS data collected from children (aged 9–13 years) recruited from nine schools in Auckland, New Zealand as part of the Kids in the City study. Results Participants from ethnic minorities and those attending schools in lower socioeconomic areas were disproportionately excluded from the retained samples. This highlights potential equity implications in basing the assessment of exposure—which ultimately influences research results on the relationship between environment and health—on non-representative GPS data.

Abstract Background Participation in community life is vital for health and wellbeing, promoting a sense of belonging, networks of social support and opportunities for physical activity. Disabled young people have lower levels of mobility and participation in recreational activities (physical, social and cultural), education and employment, than their peers without disabilities. This has implications for their health and wellbeing and life course opportunities. Previous research on the participation levels of disabled young people has primarily relied on parent/caregiver reports and been oriented to home and school environments. This study investigates how physical and social environmental factors cohere to support or restrict the everyday mobility and participation of disabled young people. Methods/design The study is located in Auckland, Aotearoa/New Zealand (NZ). Participants comprise 35 young people aged 12–25 years with mobility, vision or hearing impairments. A mixed-methods research design combines objective (global positioning systems, accelerometers, geographical information systems) and self-report measures (travel diaries, and questionnaires) to assess young people’s mobility and levels of participation in leisure/educational and employment activities with in-depth interviews exploring their everyday experiences of inclusion/exclusion, and factors enabling or constraining community participation. Parents/caregivers and disability sector key informant viewpoints on the community participation of disabled young people have also been gathered through in-depth interviews. Follow-up workshops with young people and parents/caregivers will identify pathways to increase participation and challenge current disabling practices. Discussion This study looks beyond barriers in the physical environment to the interplay of personal, social and physical factors that enable or constrain the community participation of disabled young people. In keeping with the study’s overarching goal of increasing opportunities for effective community participation and full citizenship of disabled young people, research methods were applied flexibily – negotiated and adapted to maximise each young person’s participation in light of their abilities and preferences.

Abstract Background Evidence is mounting to suggest a causal relationship between the built environment and people’s physical activity behaviours, particularly active transport. The evidence base has been hindered to date by restricted consideration of cost and economic factors associated with built environment interventions, investigation of socioeconomic or ethnic differences in intervention effects, and an inability to isolate the effect of the built environment from other intervention types. The aims of this systematic review were to identify which environmental interventions increase physical activity in residents at the local level, and to build on the evidence base by considering intervention cost, and the differential effects of interventions by ethnicity and socioeconomic status. Methods A systematic database search was conducted in June 2015. Articles were eligible if they reported a quantitative empirical study (natural experiment or a prospective, retrospective, experimental, or longitudinal research) investigating the relationship between objectively measured built environment feature(s) and physical activity and/or travel behaviours in children or adults. Quality assessment was conducted and data on intervention cost and whether the effect of the built environment differed by ethnicity or socioeconomic status were extracted. Results Twenty-eight studies were included in the review. Findings showed a positive effect of walkability components, provision of quality parks and playgrounds, and installation of or improvements in active transport infrastructure on active transport, physical activity, and visits or use of settings. There was some indication that infrastructure improvements may predominantly benefit socioeconomically advantaged groups. Studies were commonly limited by selection bias and insufficient controlling for confounders. Heterogeneity in study design and reporting limited comparability across studies or any clear conclusions to be made regarding intervention cost. Conclusions Improving neighbourhood walkability, quality of parks and playgrounds, and providing adequate active transport infrastructure is likely to generate positive impacts on activity in children and adults. The possibility that the benefits of infrastructure improvements may be inequitably distributed requires further investigation. Opportunities to improve the quality of evidence exist, including strategies to improve response rates and representativeness, use of valid and reliable measurement tools, cost-benefit analyses, and adequate controlling for confounders.

Abstract Background There is accumulating evidence supporting the association between neighborhood built environments and adults’ physical activity (PA) and sedentary time (ST); however, few studies have investigated these associations in adolescents. A better understanding of the features of the built environment that encourage PA or ST is therefore of critical importance to promote health and wellbeing in adolescents. The aim of this study was to estimate the associations of GIS-determined and perceived walkability components in individual residential buffer zones with accelerometer-assessed moderate-to-vigorous physical activity (MVPA) and ST in adolescents. Methods The Built Environment in Adolescent New Zealanders (BEANZ) study was conducted in two cities (Auckland and Wellington) during the 2013-2014 academic school years. The exposure measures were subjective and objective environmental indices of activity-friendliness using four residential buffers. Road network buffers were calculated around participant’s residential addresses using the sausage buffer approach at 250 m, 500 m, 1 km, and 2 km scales. A 25 m radius was used for the buffers. Data were analysed using Generalized Additive Mixed Models in R. Results Data were analysed from 524 participants (15.78 ± 1.62 years; 45% male). Participants accumulated ~114 min/day of moderate-to-vigorous PA (MVPA) and ~354 min/day of ST during accelerometer wear-time (~828 min/day). The estimated difference in MVPA between participants with the 1st and 3rd quartiles observed values on the composite subjective environmental index of activity-friendliness (perceived land use mix - diversity, street connectivity and aesthetics) was equivalent to ~8 min/day (~56 MVPA min/week) and for the objective environmental index of activity-friendliness (gross residential density and number of parks within 2 km distance from home) was ~6 min of MVPA/day (~45 MVPA min/week). When both indices were entered in a main-effect model, both indices remained significantly correlated with MVPA with sex as a moderator. The predicted difference in sedentary time between those with the minimum and maximum observed values on the subjective index of non-sedentariness was ~20 min/day. Conclusions The combined assessment of the main effects of subjective and objective indices of activity-friendliness on NZ adolescents’ PA and ST showed positive relationships with MVPA for the subjective index only. The subjective index was a significant correlate of PA in both girls and boys, while the objective index was significant only in boys when sex was entered as a moderator. Further research is warranted to understand the relationships of ST with the built environment.

This study aimed to assess the differences in participant retention and associations between physical activity and key variables when a range of accelerometer data inclusion criteria are employed. Data were drawn from 204 adolescents of Pacific Island heritage (survey, body composition, 7-day accelerometry) and their parents (date of birth, socioeconomic status) between October 2014 and February 2016 in Auckland, New Zealand. Data wear time criteria for inclusion were as follows: A) > =10 h/weekday or > = 8 h weekend day, > = 5 days (at least one weekend day); B) > =10 h/weekday or > = 8 h weekend day, > = 4 days; C) > =7 h/day, > = 3 days; D) > =10 h/day, > = 1 day. Overall, 49%, 62%, 88%, and 96% of participants met the criteria, respectively. Adjusted odds of meeting each criterion were examined using a multivariable logistic regression model. Almost 50% of participants were excluded by the most stringent inclusion criteria. Increased body fat percentage and proportion of time in moderate-to-vigorous activity were associated with decreased odds of meeting Criterions A and B. This research contributes to a growing understanding of the impact of differing accelerometer reduction approaches to sample retention and bias in adolescent physical activity research.

Toll-like receptor (TLR) agonists demonstrate therapeutic promise as immunological adjuvants for anticancer immunotherapy. To date, three TLR agonists have been approved by US regulatory agencies for use in cancer patients. Additionally, the potential of hitherto experimental TLR ligands to mediate clinically useful immunostimulatory effects has been extensively investigated over the past few years. Here, we summarize recent preclinical and clinical advances in the development of TLR agonists for cancer therapy.

Children rarely understand the full extent of the persuasive purpose of advertising on their eating behaviours. Addressing the obesogenic environments in which children live, through a quantification of outdoor advertising, is essential in informing policy changes and enforcing stricter regulations. This research explores the proportion of bus stop advertisements promoting non-core food and beverages within walking distance (500 m) from schools in Auckland, New Zealand while using Google Street View. Information was collected on: school type, decile, address, Walk Score®, and Transit Score for all 573 schools in the Auckland region. Ground-truthing was conducted on 10% of schools and showed an alignment of 87.8%. The majority of advertisements on bus shelters were for non-food items or services (n = 541, 64.3%). Of the advertisements that were for food and/or beverages, the majority were for non-core foods (n = 108, 50.2%). There was no statistically significant difference between the variables core and non-core food and beverages and School decile (tertiles), Walk Score (quintiles), and Transit Score (quintiles). 12.8% of all bus stop advertisements in this study promoted non-core dietary options; highlighting an opportunity for implementing stricter regulations and policies preventing advertising unhealthy food and drink to children in New Zealand.

Cytokines regulate virtually aspects of innate and adaptive immunity, including the initiation, execution and extinction of tumor-targeting immune responses. Over the past three decades, the possibility of using recombinant cytokines as a means to elicit or boost clinically relevant anticancer immune responses has attracted considerable attention. However, only three cytokines have been approved so far by the US Food and Drug Administration and the European Medicines Agency for use in cancer patients, namely, recombinant interleukin (IL)-2 and two variants of recombinant interferon alpha 2 (IFN-α2a and IFN-α2b). Moreover, the use of these cytokines in the clinics is steadily decreasing, mostly as a consequence of: (1) the elevated pleiotropism of IL-2, IFN-α2a and IFN-α2b, resulting in multiple unwarranted effects; and (2) the development of highly effective immunostimulatory therapeutics, such as immune checkpoint blockers. Despite this and other obstacles, research in the field continues as alternative cytokines with restricted effects on specific cell populations are being evaluated. Here, we summarize research preclinical and clinical developments on the use of recombinant cytokines for immunostimulation in cancer patients.