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Parks are one component of the built environment to promote regular physical activity (PA) among youth. This study investigated differences in park-based PA among youth based on demographics and park features in racially or ethnically diverse communities. In 2017-2018, parks were selected in majority Asian (n = 3), Latino (n = 5), and Black (n = 4) neighborhoods in North Carolina (n = 6) and New York (n = 6). Researchers recruited parents/caregivers of 5-10-year-olds to participate. Children wore an Actigraph GT3 + waist accelerometer and a QStarz GPS unit and were instructed to play normally for at least 15 min. Evenson cut-points were used to classify PA levels as sedentary, light, moderate, and vigorous. Chi-squared tests and non-parametric Kruskal-Wallis tests were used to examine differences in PA intensity minutes (sedentary, light, moderate-to-vigorous) across study location and demographic variables. Youth participated from NY (n = 200) and NC (n = 157). Overall, most park-based PA was spent in light intensity (59.9%), followed by moderate-to-vigorous intensity (32.4%). Females, compared to male participants, spent more time in sedentary behavior (9.0%, 6.1%) and less time in moderate-to-vigorous PA (26.6%, 38.1%). Participants who identified as Black (32.9% MVPA), Latino (35.8%), and Other (39.8%) spent higher percentages of time in moderate-to-vigorous PA than Asian (26.6%) and non-Hispanic White (21.3%) participants. The highest proportion of moderate-to-vigorous PA occurred on swing sets (46%) and basketball courts (45%). Racial and ethnic, sex, and activity area differences in park-based PA indicate that diverse youth use parks uniquely; these factors should be considered in designing parks for various ages and backgrounds., (© 2024. The New York Academy of Medicine.)

Background Context: Failure to fuse following anterior cervical discectomy and fusion (ACDF) may result in symptomatic pseudoarthrosis. Traditional diagnosis involves computerized tomography to detect bridging bone and/or flexion-extension radiographs to assess whether segmental motion is above specific thresholds; however, there are currently no well-validated diagnostic tests. We propose a biomechanically rational approach to achieve a reliable diagnostic test for pseudoarthrosis., Purpose: Develop and test a biomechanically based approach to the diagnosis of pseudoarthrosis., Study Design: Literature review, development of theory, reanalysis of a previously published study with surgical exploration as the gold-standard, and retrospective analysis of pooled studies to understand time to fusion., Methods: Fully automated methods were used to measure disc space strains (change in disc space height divided by initial height). Measurement error combined with the reported failure strain of trabecular bone led to a proposed strain threshold for diagnosis of pseudoarthrosis following ACDF. We reanalyzed previously reported flexion-extension radiographs for asymptomatic volunteers to assess whether flexion-extension radiographs, in the absence of fusion surgery, can be expected to provide sufficient stress on motion segments to allow for reliable strain-based fusion assessment. The sensitivity and specificity of strain- and rotation-based pseudoarthrosis diagnosis were assessed by reanalysis of previously reported post-ACDF flexion-extension radiographs, where intraoperative fusion assessments were also available. Finally, we assessed changes in strain over time using 9,869 flexion-extension radiographs obtained 6 weeks to 84 months post-ACDF surgery from 1,369 patients., Results: The estimated error in automated measurement of disc space strain from radiographs was approximately 3%, and the reported failure strain of bridging bone was less than 2.5%. On that basis, we propose a 5% strain threshold for pseudoarthrosis diagnosis. Reanalysis of a study in which intraoperative fusion assessments were available revealed 67% sensitivity and 82% specificity for strain-based diagnosis of pseudoarthrosis, which was comparable to rotation-based diagnosis. Analysis of post-ACDF flexion-extension radiographs revealed rapid strain reduction for up to 24 months, followed by a slower decrease for up to 84 months. When rotation is less than 2°, the strain-based diagnosis differed from the rotation-based diagnosis in approximately 14% of the cases., Conclusions: We propose steps for standardizing diagnosis of pseudoarthrosis based on the failure strain of bone, measurement error, and retrospective data. These steps include obtaining high-quality flexion-extension studies, the application of proposed diagnostic thresholds, and the use of image stabilization for conclusive diagnosis, when motion is near thresholds. The necessity for an accurate diagnosis with minimal radiation exposure underscores the need for further optimization and standardization in diagnosing pseudoarthrosis following ACDF surgery., Clinical Significance: In a symptomatic postspine fusion patient, it is important to diagnose or rule-out pseudoarthrosis. There are currently no well-validated diagnostic tests for this condition. Incorporating strain-based intervertebral motion analysis into the diagnosis could lead to a standardized and validated test for detecting spine pseudoarthrosis., Competing Interests: Declaration of competing interest One or more of the authors declare financial or professional relationships on ICMJE-TSJ disclosure forms., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Evidence to support nature contact and nature prescriptions to reduce loneliness is scant. A total of 2100 individuals took part in a survey conducted in Australia (n = 525, mean age = 34.1), India (n = 526, mean age = 29.5), Singapore (n = 523, mean age = 36.1), the UK (n = 526, mean age = 37.3), and the US (n = 525, mean age = 43.6) in 2022 (overall age range 18-89yrs). Multilevel logistic regressions adjusted for confounding indicated mean levels of overall loneliness tended to be higher in India (Odds Ratio [OR] 1.21, 95% Confidence Interval [95%CI] 0.90-1.62), Singapore (OR = 1.54, 95%CI = 1.15-2.07), the UK (OR = 1.26, 95%CI = 0.96-1.67) and the US (OR = 1.24, 95%CI = 0.94-1.64) compared with Australia. Notable differences were observed by loneliness type, for example, with lower odds of social loneliness (OR = 0.57, 95%CI = 0.41-0.79) and higher odds of emotional loneliness (OR = 1.57, 95%CI = 1.14-2.06) in India compared with Australia. Findings with regards to loneliness and nature contact varied between country. In general, social loneliness was lower in participants who visited natural surroundings regularly (OR = 0.81, 95%CI = 0.61-0.98) and spent two hours or more per week in nature (OR = 0.65, 95%CI = 0.49-0.81). Overall loneliness (OR = 1.98, 95%CI = 1.48-2.47) and emotional loneliness (OR = 2.84, 95%CI = 2.13-3.51) were substantially higher among those who felt having no-one to go with was a barrier to spending time in nature. Emotional loneliness was higher in those who had more time in nature (OR = 1.32, 95%CI = 0.94-1.75) or more frequent visits (OR = 1.24, 95%CI = 0.94-1.49), which may be indicative of selective processes by which some people who feel emotionally lonely seek meaningful sources of connection or solace in natural environments. In sum, these findings highlight potentially important contingencies in how people feel lonely in different countries, and the potential of contact with nature as a means to address this critical issue of modern times. Randomised trials of nature prescription interventions for loneliness co-designed with respect to contrasting cultural, economic, and climatic contexts are needed to ensure programs intended to reconnect people with nature are effective, equitable, and acceptable for everyone., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Despite its well-documented physical and psychosocial benefits, sport remains the least engaged form of physical activity (PA) among adults. Many adults may lack the skills needed to play or continue to play sports and aging adults are more likely to avoid participation for fear of poor performance or injury. A sport that shows great promise for adults seeking new sports participation outlets is curling. Curling is a team sport comprised of four interchangeable positions working collectively to deliver granite stones across a sheet of ice in an effort to outscore the opponent team. While it seems reasonable that walking on ice, "throwing" a 44 lb granite stone across a sheet of ice, and periodically sweeping while walking on ice over a two-hour period would generate at least a moderate amount of physical activity, research to date is quite limited. Therefore, the purpose of this study was to objectively measure the amount and intensity of PA achieved by average recreational curling participants during a typical curling match. Members of a curling club in NC were asked to wear ActiGraph Accelerometers (model GT3X) while they participated in their regularly scheduled curling match. All participants had at least one year of curling experience. Curling matches lasted between 90 and 120 minutes. Participants were asked to indicate their age, gender, and curling position during the match (lead, second, vice, skip) which were matched with accelerometer data. Overall, 110 participants (37 female, 73 male, avg. age 50 yrs) spent most of their curling time in light or moderate-intensity activity (18.1% Sedentary; 49.5% light; 32.4% moderate; .03% vigorous). In terms of minutes, the average participant spent 35.9 minutes engaged in Moderate-to-Vigorous PA (MVPA) per curling experience. This represents 23.9% of the weekly 150min of MVPA suggested by the CDC. Estimates of METs indicated that curling would be classified on the border of light and moderate physical activity. While total step data indicated that participation in beginning curling could make a significant contribution toward meeting the 10,000 - 13,000 daily step recommendation with an average of 2936 steps (~30%) within the curling sessions. The second position had the highest percentage of moderate activity level and a small percentage of vigorous activity. No other position reached a vigorous level. The skip position had the highest amount of sedentary activity as well as light activity. Females had a higher level of moderate activity in comparison to males. However, males reached a small amount of vigorous activity. The age group of 18 - 36 had the highest amount of moderate activity and the lowest amount of sedentary activity. This age group reached an average of 41.0 minutes of MVPA per curling experience. The age group of > 58 had the highest amount of sedentary activity and the lowest amount of moderate activity. Findings clearly show that regardless of position, curling participants achieved a moderate amount of physical activity during typical gameplay and that a majority of playing time was spent engaged in light or moderate levels. Participants should consider playing in one of the first three positions to maximize the amount and intensity of PA achieved while playing. Furthermore, since curling also requires balance, coordination, muscular strength, multitasking, strategic reasoning, and can cater to most physical challenges without compromising the integrity of the game, it may be an ideal sport to promote for adults of all ages and sport abilities. Findings should be used to inform strategies for promoting curling as an opportunity for team sport involvement that has the added value of contributing to daily physical activity. However, access and opportunities to play, especially for underserved populations, are limited. Given that most curling clubs in America are private and require a membership to play (Kanters, et. al, 2023), partnership arrangements between existing clubs and public parks and recreation departments could increase both access and opportunities to play., (© JHEAL, 2024.)

Background: Fewer than 1/4th of US children and adolescents meet physical activity (PA) guidelines, leading to health disparities that track into adulthood. Neighborhood opportunity may serve as a critical modifiable factor to improve fitness attainment and reduce these disparities. We drew data from the Child Opportunity Index to examine associations between neighborhood indicators of opportunity for PA and multiple fitness indicators among New York City public school youth. Methods: Multilevel generalized linear mixed models were used to estimate the overall and sex-stratified associations between neighborhood indicators (green space, healthy food, walkability, commute time) and indicators for physical fitness [curl-ups, push-ups, Progressive Aerobic Cardiovascular Endurance Run (PACER), sit-and-reach] using the New York City FITNESSGRAM data set. Results: The analytic sample [ n  = 299,839; median (interquartile range) age = 16 (12-17)] was 50.1% female, 37.5% Hispanic, 26.2% non-Hispanic Black, and most (69.5%) qualified for free/reduced price school meals. Neighborhood indicators were positively associated with higher values of indicators for physical fitness. The strongest associations were observed between walkability and both BMI and PACER, and commute time with BMI, push-ups, and PACER. For example, walkability had the greatest magnitude of effects for BMI and muscular strength and endurance (BMI: β : -0.75, 95% confidence interval, CI: -1.01 to -0.49; PACER: β : 1.98, 95% CI: 1.59 to 2.37), and particularly for girls compared with boys (BMI, girls: β : -0.91, 95% CI: -1.22 to -0.66); BMI, boys: β : -0.56, 95% CI: -0.86 to -0.25); PACER, girls: β : 2.11, 95% CI: 1.68 to 2.54; push-ups, boys: β : 1.71, 95% CI: 1.31 to 2.12). Conclusion: Neighborhood indicators were associated with multiple measures of youth fitness. Continued research on neighborhood opportunity and youth fitness may better inform place-based public health interventions to reduce disparities.

This study compared marginal and conditional modeling approaches for identifying individual, park and neighborhood park use predictors. Data were derived from the ParkIndex study, which occurred in 128 block groups in Brooklyn (New York), Seattle (Washington), Raleigh (North Carolina), and Greenville (South Carolina). Survey respondents (n = 320) indicated parks within one half-mile of their block group used within the past month. Parks (n = 263) were audited using the Community Park Audit Tool. Measures were collected at the individual (park visitation, physical activity, sociodemographic characteristics), park (distance, quality, size), and block group (park count, population density, age structure, racial composition, walkability) levels. Generalized linear mixed models and generalized estimating equations were used. Ten-fold cross validation compared predictive performance of models. Conditional and marginal models identified common park use predictors: participant race, participant education, distance to parks, park quality, and population >65yrs. Additionally, the conditional mode identified park size as a park use predictor. The conditional model exhibited superior predictive value compared to the marginal model, and they exhibited similar generalizability. Future research should consider conditional and marginal approaches for analyzing health behavior data and employ cross-validation techniques to identify instances where marginal models display superior or comparable performance., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Wende et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Congenital cytomegalovirus (CMV) infection is the leading cause of hearing loss and neurocognitive delay among children. Affected infants may be asymptomatic at birth and even pass their universal hearing screen. Early identification of CMV-infected infants will allow earlier detection, evaluation and management. The prevalence of congenital CMV infection in the developed world varies geographically from 0.6% to 0.7% of all deliveries and certain regions are at higher risk. The prevalence of congenital CMV is unknown for our region., Aim: The purpose of this study was to determine the prevalence of CMV infection among the neonatal population at an urban, tertiary hospital in northeast Florida which serves a large population of patients with low socioeconomic status to assess if universal screening program for congenital asymptomatic CMV infection can be determined., Methods: The study was submitted and approved by our Institutional Review Board. We tested the urine for CMV infection in 100 asymptomatic newborns (>32 weeks gestational age and >1,750 g weight at the time of delivery) delivered between June 2016 and July 2017., Results: Urine CMV was tested on 100 infants. One infant had a positive urine NAAT for CMV, making the prevalence of congenital CMV infection among asymptomatic newborns in our hospitals' population 1%., Conclusion: CMV prevalence in our setting of an urban, tertiary hospital is relatively consistent with the national average of all congenital CMV infections. A policy of universal screening for congenital CMV may be necessary., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Alissa, Maraqa, Williams, Hipp, Nath, Torres, Lee, Matoq and Rathore.)

Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: M.B., J.H., C.B., and C.M. are shareholders in NatureQuantTM, which created the NatureScoreTM and NatureDoseTM tools highlighted in this article.

The exposome, reflecting the range of environmental exposures individuals encounter throughout their life, can influence a variety of health outcomes and can play a role in how the environment impacts our genes. Telomeres, genetic structures regulating cell growth and senescence, are one pathway through which the exposome may impact health. Greenspace exposure, representing the amount of green areas in one's neighborhood, is one component of the exposome and has been associated with multiple health benefits. To investigate the potential link between greenspace exposure and telomere length, we analyzed data from the 1999-2001 National Health and Nutrition Examination Survey (NHANES) sample. Our study examined individual, risk, and contextual factors. We found that greater greenspace exposure in one's neighborhood was associated with longer telomere lengths when considering individual and risk factors, suggesting a positive effect of living in greener neighborhoods. However, this relationship became non-significant when contextual factors, such as air pollution and deprivation, were included in the analysis. These findings highlight a complex relationship between greenspace and telomere length, warranting further research to explore contextual factors in detail., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Regular physical activity is widely considered by public health and parks and recreation professionals as a key determinant of individual and community health and well-being. Prior research has shown that building sustainable health partnerships with community organizations can help parks and recreation departments meet many US health challenges. This descriptive study examined the perceptions of North Carolina public parks and recreation directors regarding physical activity and health partnership practices in their communities. The study was also a 15-year follow-up to a study and examined whether park and recreation director perceptions of health partnerships had changed given the many social, economic, and health events that have occurred since the original survey. Directors from two hundred seventy-five North Carolina city and county parks and recreation departments were surveyed in the Spring of 2022 to determine 1) directors' effort allocation in promoting physical activity toward vulnerable populations, 2) challenges associated with promoting community physical activity, and 3) differences in effort allocation, future priorities, and partnership among varying director and departmental demographics. Results were compared to findings from a 2007 study of NC perceptions of health partnerships, upon which the present study was based. One hundred twenty-three completed questionnaires were returned, resulting in a response rate of 45%. Directors in 2022 allocated similarly higher levels of effort toward older adults, families, and people with low income as did directors in 2007, while youth and adults with disabilities and people with chronic health conditions received lower allocations of effort from directors in 2022. Barriers such as lack of staff knowledge on how to promote physical activity, lack of citizen and political support, and lack of knowledge of under-represented groups' physical activity preferences were less pronounced in 2022 compared to 2007. Several distinct differences were revealed between female and male directors' rankings of effort and future priorities, as well as their perceptions of physical activity opportunities for women and people with disabilities. Partnerships with county health departments are being reported more in counties with the highest health disparities compared to more healthy counties, indicating that partnerships are being targeted and implemented in areas where resources are most needed. This study represents a meaningful extension of research conducted prior to the 2008 Great Recession and COVID-19 pandemic and provides recommendations for public parks and recreation departments to consider promoting physical activity and building community resilience in the face of future economic and health challenges., Competing Interests: Conflict of Interest statement: We have no conflicts of interest to disclose., (© JHEAL, 2023.)

Neighborhood environments can support fitness-promoting behavior, yet little is known about their influence on youth physical fitness outcomes over time. We examined longitudinal associations between neighborhood opportunity and youth physical fitness among New York City (NYC) public school youth. The Child Opportunity Index (COI), a composite index of 29 indicators measuring neighborhood opportunity at the census-tract level, along with scores on 4 selected COI indicators were linked to NYC FITNESSGRAM youth data at baseline. Fitness outcomes (measured annually, 2011-2018) included body mass index, curl-ups, push-ups, and Progressive Aerobic Cardiovascular Endurance Run (PACER) laps. Unstratified and age-stratified, adjusted, 3-level generalized linear mixed models, nested by census tract and time, estimated the association between COI and fitness outcomes. The analytical sample (n = 204,939) lived in very low (41%) or low (30%) opportunity neighborhoods. Unstratified models indicated that overall COI is modestly associated with improved youth physical fitness outcomes. The strongest opportunity-fitness associations were observed for PACER. Stratified models show differences in associations across younger vs. older youth. We find that neighborhood factors are associated with youth fitness outcomes over time, with the strength of the associations dependent on age. Future implications include better informed place-based interventions tailored to specific life stages to promote youth health., (© The Author(s) 2023. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: "Nature prescriptions" are increasingly being adopted by health sectors as an adjunct to standard care to attend to health and social needs. We investigated levels of need and interest in nature prescriptions in adults with cardiovascular diseases, psychological distress and concomitants (e.g. physical inactivity, sedentary behaviour, obesity, loneliness, burn-out)., Methods: A nationally-representative survey of 3,319 adults across all states and territories of Australia was completed in February 2021 (response 84.0%). Participants were classified across 15 target groups using validated health indicators and surveyed on (1) time and frequency of visits to green and blue spaces (nature spaces), (2) interest in a nature prescription, and (3) potential confounders (e.g. age, income). Analyses were done using weighted logistic regressions., Results: The sample was 50.5% female, 52.0% were aged ≥45 years, 15.2% were living alone and 19.3% were born overseas in non-English-speaking countries. Two-thirds of the sample spent 2 hours or more a week in nature, but these levels were generally lower in target groups (e.g. 57.7% in adults with type 2 diabetes). Most participants (81.9%) were interested in a nature prescription, even among those spending fewer than 2 hours a week in nature (76.4%). For example, 2 hours a week or more in nature was lowest among sedentary adults (36.9%) yet interest in nature prescriptions in this group was still high (74.0%). Lower levels of nature contact in target groups was not explained by differences in access to or preference for local nature spaces., Conclusions: High levels of interest in nature prescriptions amid low levels of nature contact in many target health groups provides impetus for developing randomised trials of interventions that enable people to spend more time in nature. These findings can inform intervention co-design processes with a wide range of community stakeholders, end-users in target health groups, and the health professionals who support them., (Copyright © 2022. Published by Elsevier B.V.)

Background and Aims: Resolution of pathways that converge to induce deleterious effects in hepatic diseases, such as in the later stages, have potential antifibrotic effects that may improve outcomes. We aimed to explore whether humans and rodents display similar fibrotic signaling networks., Approach and Results: We assiduously mapped kinase pathways using 340 substrate targets, upstream bioinformatic analysis of kinase pathways, and over 2000 random sampling iterations using the PamGene PamStation kinome microarray chip technology. Using this technology, we characterized a large number of kinases with altered activity in liver fibrosis of both species. Gene expression and immunostaining analyses validated many of these kinases as bona fide signaling events. Surprisingly, the insulin receptor emerged as a considerable protein tyrosine kinase that is hyperactive in fibrotic liver disease in humans and rodents. Discoidin domain receptor tyrosine kinase, activated by collagen that increases during fibrosis, was another hyperactive protein tyrosine kinase in humans and rodents with fibrosis. The serine/threonine kinases found to be the most active in fibrosis were dystrophy type 1 protein kinase and members of the protein kinase family of kinases. We compared the fibrotic events over four models: humans with cirrhosis and three murine models with differing levels of fibrosis, including two models of fatty liver disease with emerging fibrosis. The data demonstrate a high concordance between human and rodent hepatic kinome signaling that focalizes, as shown by our network analysis of detrimental pathways., Conclusions: Our findings establish a comprehensive kinase atlas for liver fibrosis, which identifies analogous signaling events conserved among humans and rodents., (© 2022 The Authors. Hepatology published by Wiley Periodicals LLC on behalf of American Association for the Study of Liver Diseases.)

A robust definition of normal vertebral morphometry is required to confidently identify abnormalities such as fractures. The Second National Health and Nutrition Examination Survey (NHANES-II) collected a nationwide probability sample to document the health status of the United States. Over 10,000 lateral cervical spine and 7,000 lateral lumbar spine X-rays were collected. Demographic, anthropometric, health, and medical history data were also collected. The coordinates of the vertebral body corners were obtained for each lumbar and cervical vertebra using previously validated, automated technology consisting of a pipeline of neural networks and coded logic. These landmarks were used to calculate six vertebral body morphometry metrics. Descriptive statistics were generated and used to identify and trim outliers from the data. Descriptive statistics were tabulated using the trimmed data for use in quantifying deviation from average for each metric. The dependency of these metrics on sex, age, race, nation of origin, height, weight, and body mass index (BMI) was also assessed. There was low variation in vertebral morphometry after accounting for vertebrae (eg, L1, L2), and the R 2 was high for ANOVAs. Excluding outliers, age, sex, race, nation of origin, height, weight, and BMI were statistically significant for most of the variables, though the F-statistic was very small compared to that for vertebral level. Excluding all variables except vertebra changed the ANOVA R 2 very little. Reference data were generated that could be used to produce standardized metrics in units of SD from mean. This allows for easy identification of abnormalities resulting from vertebral fractures, atypical vertebral body morphometries, and other congenital or degenerative conditions. Standardized metrics also remove the effect of vertebral level, facilitating easy interpretation and enabling data for all vertebrae to be pooled in research studies. © 2022 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research., (© 2022 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.)

Background: eHealth technologies offer an efficient method to integrate park prescriptions into clinical practice by primary health care (PHC) providers to help patients improve their health via tailored, nature-based health behavior interventions. This paper describes the protocol of the GoalRx Prescription Intervention (GPI) which was designed to leverage community resources to provide tailored park prescriptions for PHC patients., Methods: The GPI study was designed as a 3-arm, multi-site observational study. We enrolled low-income, rural adults either at-risk of or living with hypertension or diabetes ( n = 75) from Federally Qualified Health Centers (FQHC) in two counties in North Carolina, USA into the 3-month intervention. Eligible participants self-selected to receive (1) a tailored park prescription intervention; (2) a tailored home/indoor PA prescription intervention; or (3) a healthy eating prescription (with no PA prescription beyond standard PA counseling advice that is already routinely provided in PHC) as the comparison group. The GPI app paired patient health data from the electronic health record with stated patient preferences and triggered app-integrated SMS motivation and compliance messaging directly to the patient. Patients were assessed at baseline and at a 3-month follow-up upon the completion of the intervention. The primary outcome (mean difference in weekly physical activity from baseline (T0) to post-intervention (T1) as measured by the Fitbit Flex 2) was assessed at 3 months. Secondary outcomes included assessment of the relationship between the intervention and biological markers of health, including body mass index (BMI), systolic and diastolic blood pressure, HbA1c or available glucose test (if applicable), and a depression screen score using the Patient Health Questionnaire 9. Secondary outcomes also included the total number of SMS messages sent, number of SMS messages responded to, number of SMS messages ignored, and opt-out rate., Discussion: The goal was to create a protocol utilizing eHealth technologies that addressed the specific needs of rural low-income communities and fit into the natural rhythms and processes of the selected FQHC clinics in North Carolina. This protocol offered a higher standard of health care by connecting patients to their PHC teams and increasing patient motivation to make longer-lasting health behavior changes., Competing Interests: This project was funded by the North Carolina Division of Public Health's Community and Clinical Connections for Prevention and Health Branch, in collaboration with Goshen Medical Center, Inc. Representatives from the North Carolina Division of Public Health's Community and Clinical Connections for Prevention and Health Branch and Goshen Medical Center, Inc. were involved in the conceptualization of the study and had some input into the design. All other aspects of the study were managed by the research team at NC State University and Duke University along with the BHCs. The handling editor declared a past collaboration with one of the author CS., (Copyright © 2022 Schultz, Bocarro, Hipp, Bennett and Floyd.)

Introduction: Built and natural environments may provide opportunities for physical activity. However, studies are limited by primarily using residential addresses to define exposure and self-report to measure physical activity. We quantified associations between global positioning systems (GPS)-based activity space measures of environmental exposure and accelerometer-based physical activity., Methods: Using a nationwide sample of working female adults (N = 354), we obtained seven days of GPS and accelerometry data. We created Daily Path Area activity spaces using GPS data and linked these activity spaces to spatial datasets on walkability (EPA Smart Location Database at the Census block group level) and greenness (satellite vegetation at 250 m resolution). We utilized generalized additive models to examine nonlinear associations between activity space exposures and accelerometer-derived physical activity outcomes adjusted for demographic characteristics, socioeconomic factors, and self-rated health., Results: Higher activity space walkability was associated with higher levels of moderate-vigorous physical activity, and higher activity space greenness was associated with greater numbers of steps per week. No strong relationships were observed for sedentary behavior or light physical activity. Highest levels of moderate-vigorous physical activity were observed for participants with both high walkability and high greenness in their activity spaces., Conclusion: This study contributes evidence that higher levels of physical activity occur in environments with more dense, diverse, and well-connected built environments, and with higher amounts of vegetation. These data suggest that urban planners, landscape architects, and policy makers should implement and evaluate environmental interventions to encourage higher levels of physical activity., (Copyright © 2022. Published by Elsevier Ltd.)

The built environment is a key social determinant of health. Exposure to parks and greenspace can improve physical and mental health and provide other benefits that enhance well-being. Programs and initiatives that capitalize on nature-based opportunities offer health care providers with a cost-effective alternative for upstream health promotion., (©2022 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.)

Background: At times, electronic medical records (EMRs) have proven to be less than optimal, causing longer hours behind computers, shorter time with patients, suboptimal patient safety, provider dissatisfaction, and physician burnout. These concerning healthcare issues can be positively affected by optimizing EMR usability, which in turn would lead to substantial benefits to healthcare professionals such as increased healthcare professional productivity, efficiency, quality, and accuracy. Documentation issues, such as non-standardization of physician note templates and tedious, time-consuming notes in our mother-baby unit (MBU), were discussed during meetings with stakeholders in the MBU and our hospital's EMR analysts. Objective: The objective of this study was to assess physician note optimization on saving time for patient care and improving provider satisfaction. Methods: This quality improvement pilot investigation was conducted in our MBU where four note templates were optimized: History and Physical (H and P), Progress Note (PN), Discharge Summary (DCS), and Hand-Off List (HOL). Free text elements documented elsewhere in the EMR (e.g., delivery information, maternal data, lab result, etc.) were identified and replaced with dynamic links that automatically populate the note with these data. Discrete data pick lists replaced necessary elements that were previously free texts. The new note templates were given new names for ease of accessibility. Ten randomly chosen pediatric residents completed both the old and new note templates for the same control newborn encounter during a period of one year. Time spent and number of actions taken (clicks, keystrokes, transitions, and mouse-keyboard switches) to complete these notes were recorded. Surveys were sent to MBU providers regarding overall satisfaction with the new note templates. Results: The ten residents' average time saved was 23 min per infant. Reflecting this saved time on the number of infants admitted to our MBU between January 2016 and September, 2019 which was 9373 infants; resulted in 2.6 hours saved per day, knowing that every infant averages two days length of stay. The new note templates required 69 fewer actions taken than the old ones (H and P: 11, PN: 8, DCS: 18, HOL: 32). The provider surveys were consistent with improved provider satisfaction. Conclusion: Optimizing physician notes saved time for patient care and improved physician satisfaction., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Alissa, Hipp and Webb.)