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The environment plays a role in healthcare-associated Clostridioides (formerly Clostridium) difficile infection (CDI); however, the role of the environment in community-associated CDI is unknown. The objective of this scoping review was to describe the literature related to the transmission of C. difficile in the household environment. We conducted searches of four electronic health and science databases to identify relevant studies. In total, 39 articles published between 1981 and 2020 met the a priori inclusion criteria. Slightly over one half (51.3%, 20 out of 39) of the articles were nonsystematic review articles and thus we excluded them from the synthesis of results. Overall, we included 19 articles in the synthesis of results. None of the studies were experimental studies. Studies assessed or estimated the prevalence of C. difficile on household surfaces, colonization of household members (human and animal), or the risk of transmission in the household. This scoping review provides an overview of the global literature related to the role of the household environment in transmission of C. difficile. We found a lack of research in this area. Further studies are needed and ideally would be designed to follow household members over time and to test the effectiveness of interventions such as targeted hygiene protocols., Introduction Clostridioides difficile is a pathogen that has been recognized for decades. Historically, C. difficile infection (CDI) has been regarded as a healthcare-associated infection (Roth, 2016). Cases of CDI, however, [...]

Students at a K-8 magnet school drastically lacked opportunities for physical activity throughout their school day. The authors (physical education teacher and graduate advisors) describe how the physical education teacher advocated and made positive change in her school. The physical education teacher conducted a physical activity needs assessment focusing on existing programs within the school and the assessment results revealed that only one-fourth of all K-8 students were currently scheduled for either a physical activity or physical education option each quarter. The physical education teacher shared results with the school principal and received immediate support to increase PE and PA options. Upon conducting a document review of a school-wide program called Fridays in Freemont (FIF; name changed for anonymity), and using the Comprehensive School Physical Activity Program model as a guide, the physical education teacher was able to create the following changes: (1) amend the master schedule to allow for all K-3 students to participate in physical education twice a week, (2) create a userfriendly guide for school staff to use to increase PA opportunities for grades four through eight during FIF, and (3) make progress implementing a quarterly program called Families in Freemont to include families and students in PA events, in order to support the healthy futures of students on a broader scale.

Given that preparing preservice classroom teachers (PCTs) for movement integration (MI) has gained traction in recent years as a focus of policy and research related to children's school-based physical activity (PA) promotion, the purpose of this study was to examine PCTs' field experiences of learning to integrate movement in elementary classrooms. PCTs (N = 23) who enrolled in a university course focused on school PA promotion participated in the study. Participants' MI-related field experiences were investigated through focus group interviews, PCT reflections, researcher field notes from observations, and PCT-developed MI plans. Data were qualitatively analyzed for themes pertaining to challenges, successes, and lessons learned. Findings show challenges with planning and preparation, lack of experience, and classroom management. Successes were characterized by positive elementary pupil responses and learning from experience. Lessons learned included to plan extensively and that MI is easy to learn and beneficial. This study highlights the value of field experiences in PCTs' learning to integrate movement and identifies aspects of such experiences that should be considered in preservice training.

Previous research has not explored the potential of distance learning to prepare preservice teachers (PCTs) for promoting children's physical activity. The purpose of this study was to (a) examine the perceptions and experiences of PCTs, inservice classroom teachers, university instructors, and elementary students who were involved in a semester-long distance delivery course that included a service-learning (SL) component with an emphasis on classroom movement integration (MI). Using a qualitative single case study design, interviews, observations, and artifacts (e.g. PCTs' reflections and academic work) were thematically analyzed. Findings produced three themes including student-centered approach, benefit/importance of physical activity, and connect and reflect. These themes showed that participants' perceptions and experiences support constructivist-guided SL using a distance delivery design. This study adds to the emerging research base on school-university partnerships to support schools in the implementation of comprehensive school physical activity programming.

Background: Sedentarism is uniquely associated with numerous health problems (e.g., obesity). School-age youth spend a considerable portion of their time being sedentary, although relatively little attention has been given to examining youth sedentary time or behaviors during school.Purpose: This systematic review and meta-analysis examined sedentarism (time, behaviors) in children and adolescents during school hours. Methods: Two separate electronic-databases searches were conducted. The first focused on sedentary time and looked for studies that: (1) were conducted in the U.S., (2) targeted the K-12 setting during school-day hours, (3) were an intervention, (4) included objective measures, and (5) reported sedentary outcomes as a time-based metric. The second search focused on sedentary behavior and looked for studies that: (1) were conducted in the U.S., (2) targeted the K-12 setting during school-day hours, and (3) included reporting of sedentary behaviors. A pooled estimate of percent-time spent sedentary was calculated. Results: On average, youth spent 63% of their time in school sedentary. There were no studies that met the inclusion criteria for the sedentary behavior portion of the review. Discussion: The limited number of studies found that report sedentary-time, coupled with the absence of studies describing sedentary behaviors, suggests that further descriptive research is needed to understand school-based sedentarism in youth. Translation to Health Education Practice: Professional development for school staff and intervention work should encompass sedentary time and behaviors across the school day.

Recently, there has been growing attention on the importance of the staff involvement component of a comprehensive school physical activity program (CSPAP). In particular, classroom teachers (CTs) are increasingly being called upon to promote physical activity (PA) in their classrooms as part of the PA during school component of a CSPAP. Consistent with this view, a burgeoning research base highlights several theoretical perspectives that provide insight into key factors associated with CTs' classroom-based PA promotion. The purpose of this article is to provide an up-to-date, comprehensive review of the theoretically framed research on CTs' classroom-based PA promotion and consider the implications of this research for the design of in-service professional development trainings that can be used to maximize staff involvement in CSPAPs.

Objective: This study assessed the impact of Partnerships for Active Children in Elementary Schools (PACES) on children's moderate-to-vigorous physical activity (MVPA) during physical education (PE) and teachers' incorporation of physical activity promotion strategies after one academic semester (i.e. 4 months) of the intervention. Design: Single group pre-post pilot study. Setting: Three elementary schools in one southeastern metropolitan city in the USA. Methods: Using principles of community-based participatory-research, researchers worked with teachers to identify contextually appropriate physical activity promotion strategies aligned with prevailing recommendations, principles and theories. Outcome measures included accelerometer-derived percent of time children (N = 150) engaged in MVPA. The System for Observing Fitness Instruction Time+ assessed changes in teachers' incorporation of physical activity promotion strategies. Multi-level mixed-effects linear regression estimated differences over time. Results: MVPA increased for girls (22.7%-26.6%) and boys (33.2%-39.0%). Small-sided games (1.0%-9.0%) and teachers' verbal promotion of physical activity (6.4%-13.5%) increased while student's off-task behaviour (6.0%-2.0%) decreased. Lines (20.2%-8.4%) and elimination games (21.6%-13.3%) decreased, but these changes were not statistically significant. Conclusion: PACES shows promise for increasing the percent of time children spend in MVPA during PE but requires further evaluation.

National attention on whole-of-school approaches to decrease children's sedentary behavior and increase physical activity includes movement integration (MI) in classrooms. The purpose of this study was to describe instrument development, reliability, and validity of the System for Observing Student Movement in Academic Routines and Transitions (SOSMART), designed to assess MI in elementary classrooms. An a priori conceptual framework was developed based on existing literature. The framework was expanded/refined using videos from elementary classrooms and a Delphi survey. The survey, sent to 85 experts, yielded a 38% response rate. The final system includes 11 MI variables (three categories of teacher variables, two categories of student variables) and uses a 20-second continuous interval recording format. Reliability and validity data were collected in 12 classrooms across four elementary schools. Instrument reliability was tested using interval-by-interval percentage agreement for each category. Construct validity was tested by estimating multilevel random effects logistic regression models comparing student accelerometer derived activity with the presence/absence of each MI variable. Intraobserver reliability resulted in 97.5% agreement and exceeded 80% on all variables. Construct validity was supported for 8 out of 11 MI variables. SOSMART can provide valid, reliable, and objective data about MI in elementary schools.

Supervised deep learning (DL) algorithms are highly dependent on training data for which human graders are assigned, for example, for optical coherence tomography (OCT) image annotation. Despite the tremendous success of DL, due to human judgment, these ground truth labels can be inaccurate and/or ambiguous and cause a human selection bias. We therefore investigated the impact of the size of the ground truth and variable numbers of graders on the predictive performance of the same DL architecture and repeated each experiment three times. The largest training dataset delivered a prediction performance close to that of human experts. All DL systems utilized were highly consistent. Nevertheless, the DL under‐performers could not achieve any further autonomous improvement even after repeated training. Furthermore, a quantifiable linear relationship between ground truth ambiguity and the beneficial effect of having a larger amount of ground truth data was detected and marked as the more‐ground‐truth effect. [ABSTRACT FROM AUTHOR]

Aims To analyse the prevalence of visual impairment (VI), compare it to certification of visual impairment (CVI) and analyse VI associations in patients with diabetic retinopathy (DR). Methods Retrospective cohort study, which included 8007 patients with DR referred from the English diabetic eye screening programme to a tertiary referral eye hospital. Main outcome measure was VI, defined as vision in the best eye of <6/24. We conducted a multivariable logistic regression for VI as primary outcome of interest, controlling for age, sex, type of diabetes, baseline DR grade, ethnicity and index of multiple deprivation (IMD). Results Mean age was 64.5 (SD 13.6) years; 61% of patients were men; and 31% of South Asian ethnicity. There were 68 patients with CVI during the study period, and 84% (272/325) of patients with VI did not have CVI after a mean follow-up of 1.87 (SD ±0.86) years. Older age showed a positive association with VI (OR per decade rise 1.88, 95% CI 1.70 to 2.08; p=1.8×10-34). Men had a lower risk of VI (OR 0.62, 95% CI 0.50 to 0.79, p=6.0×10-5), and less deprivation had a graded inverse association with VI (OR per IMD category increase 0.83, 95% CI 0.74 to 0.93, p value for linear trend 0.002). Conclusion The majority of people with vision impairment are not registered at the point of care, which could translate to underestimation of diabetes-related VI and all-cause VI at a national level if replicated at other centres. Further work is needed to explore rates of VI and uptake of registration. [ABSTRACT FROM AUTHOR]

This article has two purposes: (a) to consider existing platforms and future possibilities in the United States for what the authors refer to as Integrative Public Health-Aligned Physical Education (IPHPE), which integrates standards-based K-12 physical education with a public health agenda focusing on promoting increased physical activity and fitness, and (b) to consider the implications of IPHPE for the preparation of future physical education teachers and teacher educators/ researchers. First, the historical context that has nurtured the development of ideologies that inform IPHPE is summarized. Second, examples of these ideologies in terms of their current and prospective contributions to IPHPE perspectives are discussed. Third, building from existing public health-aligned recommendations for pre-service physical education teacher education (PETE) programs, IPHPE-based professional preparation requirements for future physical education teachers are considered. Finally, the focus shifts to doctoral PETE (D-PETE) programming and professional preparation requirements for future physical education teacher educators/researchers from an IPHPE perspective. The overall intention of this article is to propose a way forward for physical education which bridges educational priorities of the profession to contemporary and relevant public health needs.

Purpose Invasion of pigmented cells into the retina occurs in retinal degenerative diseases, such as macular telangiectasia type 2 (MacTel) and retinitis pigmentosa (RP). These intraretinal pigmented cells may be derived from the retinal pigment epithelium (RPE), but differences and similarities between intraretinal pigmented cells and RPE have so far not been well characterised. Clinicopathologic case report. Method Here, we compared intraretinal pigment cells with RPE cells by immunohistochemistry. Immunohistological stains for classic RPE markers (RPE65, CRALBP and KRT18) and blood vessel markers (lectin and collagen 4) were done on sections from postmortem eye tissue from two MacTel donors, an RP donor and a control donor. Main outcome measures Presence of specific immunohistochemistry markers on intraretinal pigmented and RPE cells. Results We found that intraretinal pigmented cells did not express RPE65 and CRALBP, with a small subset expressing them weakly. However, they all expressed KRT18, which was also present in normal RPE cells. Interestingly, we also found clusters of KRT18-positive cells in the retina that were not pigmented. Conclusions Our findings suggest that RPE cells invading the retina dedifferentiate (losing classic RPE markers) and can be pigmented or unpigmented. Therefore, the number of RPE cells invading the retina in retinal degenerative disease may be underappreciated by funduscopy. [ABSTRACT FROM AUTHOR]