Search

Background: There are no proven radiographic guidelines for predicting fracture risk in children and young adults with a benign skeletal lesion. An in vivo diagnostic study was conducted to determine whether a reduction in the load-carrying capacity of a bone measured with quantitative computed tomography was more accurate than current radiographic guidelines for predicting pathologic fracture in patients with a benign skeletal lesion.Methods: Eighteen patients who presented with a fracture through a benign skeletal lesion were compared with eighteen patients who had a benign skeletal lesion that had been thought to be at increased risk for fracture on the basis of currently used radiographic criteria but had not fractured over a two-year period. Structural analysis was performed to calculate the resistance of the affected bones to compressive, bending, and torsional loads with use of serial transaxial quantitative computed tomography data obtained along the length of the bone containing the lesion and from homologous cross sections through the contralateral, normal bone. At each cross section, the ratio of the structural rigidity of the affected bone divided by that of the normal, contralateral bone was determined. The cross section with the greatest reduction in compressive, bending, and torsional rigidity was identified as that most likely to fracture.Results: The mean age (and standard deviation) of the thirty-six patients was 12.5 +/- 3.6 years. Twenty lesions were located in the femur; eleven, in the tibia; three, in the humerus; one, in the ulna; and one, in the pelvis. A combination of the minimum bending and torsional rigidities calculated from the tomographic data provided optimal performance in differentiating between the fracture and non-fracture groups (100% sensitivity and 94% specificity). In contrast, plain radiographic criteria demonstrated 28% to 83% sensitivity and 6% to 78% specificity.Conclusions: The combination of bending and torsional rigidity measured noninvasively with quantitative computed tomography was more accurate (97%) for predicting pathologic fracture through benign bone lesions in children than were standard radiographic criteria (42% to 61% accuracy). We believe that this method can provide accurate objective criteria for planning treatment of benign bone lesions and monitoring treatment response. [ABSTRACT FROM AUTHOR]

Twenty-seven paired human cadaveric knee specimens were used to determine the effect of surgical technique and various interference screw parameters on the pullout strength of patellar tendon femoral bone blocks. The study compared the fixation strength of endoscopically inserted and conventional 'rear-entry' screws of different mode of failure was bone block pullout from the interference screw. There was no significant difference in fixation strength between 9-mm diameter screws inserted through a conventional rear-entry technique and 7-mm diameter screws inserted through an endoscopic technique. There was no significant effect of screw length on fixation strength. The pullout force for 20-mm long screws were compared with 5.5-mm diameter screws. There was no significant effect of increased screw core diameter on fixation strength. There was a weak positive correlation (r squared = 0.45) between screw insertion torque and pullout force. Our measured mean pullout force for the 7-mm endoscopically inserted screws of 362 + or - 198 N represents 20.1% of the failure load of the normal young adult anterior cruciate ligament. Our data indicate that properly inserted 7-mm diameter endoscopic interference screws can provide fixation strengths of patellar tendon anterior cruciate ligament grafts equivalent to those of conventional 9-mm diameter rear-entry, outside-in screws. [ABSTRACT FROM AUTHOR]

Abstract Background Esophageal squamous cell carcinoma (ESCC), the predominant histological subtype of esophageal cancer, is characterized by high mortality. Previous work identified important mRNA expression differences between normal and tumor cells; however, to date there are limited ex vivo studies examining expression changes occurring during normal esophageal squamous cell differentiation versus those associated with tumorigenesis. In this study, we used a unique tissue microdissection strategy and microarrays to measure gene expression profiles associated with cell differentiation versus tumorigenesis in twelve cases of patient-matched normal basal squamous epithelial cells (NB), normal differentiated squamous epithelium (ND), and squamous cell cancer. Class comparison and pathway analysis were used to compare NB versus tumor in a search for unique therapeutic targets. Results As a first step towards this goal, gene expression profiles and pathways were evaluated. Overall, ND expression patterns were markedly different from NB and tumor; whereas, tumor and NB were more closely related. Tumor showed a general decrease in differentially expressed genes relative to NB as opposed to ND that exhibited the opposite trend. FSH and IgG networks were most highly dysregulated in normal differentiation and tumorigenesis, respectively. DNA repair pathways were generally elevated in NB and tumor relative to ND indicating involvement in both normal and pathological growth. PDGF signaling pathway and 12 individual genes unique to the tumor/NB comparison were identified as therapeutic targets, and 10 associated ESCC gene-drug pairs were identified. We further examined the protein expression level and the distribution patterns of four genes: ODC1, POSTN, ASPA and IGF2BP3. Ultimately, three genes (ODC1, POSTN, ASPA) were verified to be dysregulated in the same pattern at both the mRNA and protein levels. Conclusions These data reveal insight into genes and molecular pathways mediating ESCC development and provide information potentially useful in designing novel therapeutic interventions for this tumor type.

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.)

Built environment features, including parks, often exacerbate health disparities. We examined built environment perceptions and park use among a population at high risk for negative physical health outcomes: racially diverse, low-income mothers across the United States. Perceived safety from crime and living near a park were associated with more frequent park use for mothers with their children, and neighborhood walkability was linked to longer park visits. However, only 40% of mothers lived within a 10-minute walk of a park, and overall perceptions of walkability and safety from crime were low. To enhance physical activity and health of low-income mothers with their children, investments are needed to close disparities in park access and improve neighborhood safety., Competing Interests: Conflict of interest statement: We have no conflicts of interest to disclose., (© JHEAL, 2021.)

Clinical applications of precision oncology require accurate tests that can distinguish true cancer-specific mutations from errors introduced at each step of next-generation sequencing (NGS). To date, no bulk sequencing study has addressed the effects of cross-site reproducibility, nor the biological, technical and computational factors that influence variant identification. Here we report a systematic interrogation of somatic mutations in paired tumor-normal cell lines to identify factors affecting detection reproducibility and accuracy at six different centers. Using whole-genome sequencing (WGS) and whole-exome sequencing (WES), we evaluated the reproducibility of different sample types with varying input amount and tumor purity, and multiple library construction protocols, followed by processing with nine bioinformatics pipelines. We found that read coverage and callers affected both WGS and WES reproducibility, but WES performance was influenced by insert fragment size, genomic copy content and the global imbalance score (GIV; G > T/C > A). Finally, taking into account library preparation protocol, tumor content, read coverage and bioinformatics processes concomitantly, we recommend actionable practices to improve the reproducibility and accuracy of NGS experiments for cancer mutation detection., (© 2021. This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply.)

Objective: Radiographic measurement of the change in knee joint space width (ΔJSW) is often affected by image parallax, which causes an apparent exaggeration of JSW due to projectional differences. This issue with parallax (quantified by intermargin distance) can in part be addressed with a novel mid-coronal plane (MCP) measurement method. The objectives of the study were to determine 1) accuracy and 2) reproducibility of the MCP method, and 3) compare the MCP method to that used in the Osteoarthritis Initiative (OAI) for different categories of parallax., Methods: Posteroanterior radiographs (n = 70) with known JSW were digitally reconstructed from CT images of cadaver knees and used to determine the accuracy of ΔJSW using the MCP method for parallax categories of None, Mild/Moderate, and Severe. Reproducibility was determined from pairs of clinical radiographs selected from the OAI (n = 170). The MCP method was also compared to the OAI methodology. Both reproducibility and agreement were characterized by Bland-Altman analysis and intraclass correlation coefficients (ICC)., Results: The MCP method was accurate to 0.11 mm in cases with no parallax, and 0.18 mm across all categories of parallax for medial and lateral compartments. Reproducibility of the MCP method was graded "excellent" (ICC 0.98, 95% CI [0.98, 0.99]). The MCP results agreed very well with the OAI (ICC 0.92, 95% CI [0.89, 0.94]), with mean absolute differences between methods increasing with increasing parallax., Conclusion: The MCP method is an accurate, reproducible alternative to the OAI method for multi-center clinical trials where subject and X-ray beam positioning may be variable., (Copyright © 2021 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.)

Purpose: Striking disparities persist in cardiovascular disease risk factors among minority youth. We examined the association between multiple indicators of neighborhood quality and minority youth fitness., Methods: The primary exposure was the Child Opportunity Index (COI), a measure comprised of indicators that facilitate healthy child development. Outcome data were drawn from the 2018-2019 Fit2Play Study (Miami-Dade County, FL). Hotspot analysis evaluated COI spatial clustering. Generalized linear mixed models examined cross-sectional COI-fitness associations., Results: The sample included 725 youth (53% Black, 43% Hispanic; 5-17 years). Significant neighborhood quality spatial clusters were identified (Gi* z-score = -4.85 to 5.36). Adjusting for sociodemographics, walkability was associated with lower percentiles in body mass index (BMI) and diastolic blood pressure percentiles (DBP) (β = -5.25, 95% CI: -8.88, -1.62 and β = -3.95, 95% CI: -7.02, -0.89, respectively) for all, lower skinfold thickness (β = -4.83, 95% CI: -9.97, 0.31 and higher sit-ups (β = 1.67, 95% CI: -0.17, 3.50) among girls, and lower systolic blood pressure percentiles (SBP) (β = -4.75, 95% CI: -8.99, -0.52) among boys. Greenspace was associated with higher BMI (β = 6.17, 95% CI: 2.47, 9.87), SBP (β = 3.47, 95% CI: -0.05, 6.99), and DBP (β = 4.11, 95% CI: 1.08, 7.13)., Conclusions: COI indicators were positively associated with youth fitness. Disparities in youth cardiovascular disease risk may be modifiable through community interventions and built environment initiatives targeting select neighborhood factors., (Copyright © 2021. Published by Elsevier Inc.)

Objective: To show concordance between heel stick and placental blood sample pairs for newborns' pre-transfusion testing and to validate placental blood's tube and gel methodology. Methods: Placental samples were collected for pre-transfusion testing at birth from 78 singleton and twin newborns admitted to our Mother-Baby Unit to compare with the results of heel stick samples taken from same newborns. Gestational age ≥35 weeks, weight ≥2,000 g. The study was approved by the Institutional Review Board (IRB). Informed consent was obtained from newborn parents. ABO blood group, Rhesus factor (Rh), direct antiglobulin test (DAT), and antibody screen were performed. Ortho ProVue Analyzer was used for tube and gel methods. McNemar's test for paired categorical data was performed. Results: One hundred percent concordance in 78 pairs for ABO and Rh. Seventy-four pairs were tested for antibodies, 72 were both negative, 1 was both positive, and 1 gave discordant result. Ninety-nine percent concordance, p = 0.999. Sixty-five pairs were both DAT negative, seven were both DAT positive, and six gave discordant results. Ninety-two percent concordance, p = 0.68. Placental blood gave identical results comparing tube with gel methods. Conclusions: Placental blood is suitable for pre-transfusion testing and can replace heel sticks. Placental blood tube and gel methods are validated., 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 © 2021 Alissa, Williams, Baker, Hipp, Saremian and Aysola.)

While many studies suggest evidence for the health benefits of nature, there is currently no standardized method to measure time spent in nature or nature contact, nor agreement on how best to define nature contact in research. The purpose of this review is to summarize how nature contact has been measured in recent health research and provide insight into current metrics of exposure to nature at individual and population scales. The most common methods include surrounding greenness, questionnaires, and global positioning systems (GPS) tracking. Several national-level surveys exist, though these are limited by their cross-sectional design, often measuring only a single component of time spent in nature, and poor links to measures of health. In future research, exposure assessment combining the quantifying (e.g., time spent in nature and frequency of visits to nature) and qualifying (e.g., greenness by the normalized difference of vegetation index (NDVI) and ratings on perception by individuals) aspects of current methods and leveraging innovative methods (e.g., experience sampling methods, ecological momentary assessment) will provide a more comprehensive understanding of the health effects of nature exposure and inform health policy and urban planning.

Background: Neighborhood parks are recognized as important spaces for facilitating physical activity (PA); however, it remains unclear how the frequency of park use is associated with PA. The purpose of this study was to examine associations between minutes of moderate to vigorous PA and multiple park use indicators: (1) use of a neighborhood park, (2) unique number of neighborhood parks used, and (3) frequency of neighborhood park use., Methods: Adults were surveyed from 4 US cities (Brooklyn, NY; Greenville County, SC; Raleigh, NC; and Seattle, WA). Using a map-based survey platform, participants indicated all neighborhood parks they used and the frequency of use in the past 30 days. Participants self-reported their weekly moderate to vigorous PA. Quantile regression was used to examine associations between PA and park use indicators., Results: Of all respondents (N = 360), 60% indicated visiting a neighborhood park in the past 30 days, with an average of about 13 total neighborhood park visits (SD = 17.5). Significant, positive associations were found between moderate to vigorous PA and both unique neighborhood park visits and total number of neighborhood parks visits., Conclusions: Frequency of park visitation is associated with PA among US adults. Ensuring equitable and safe access to neighborhood parks has the potential for population-level PA health benefits.

Public parks offer free and easy access to spaces for outdoor recreation, which is essential for children's outdoor play and physical activity in low-income communities. Because parks and playgrounds contribute to children's physical, social, and emotional development, it is critical to understand what makes them attractive and welcoming for families with young children. Parents can be a key determinant to children visiting parks, with their preferences influencing whether or not families visit parks in their neighborhoods. Our study examined attributes associated with parental preferences for parks in low-income diverse communities in New York City, New York, and Raleigh-Durham, North Carolina, USA. Parents' responses were grouped into 10 categories using content analysis, with four key preference themes identified: physical attributes, experiences, social environment, and amenities. Physical attributes (i.e., playgrounds, sports fields, green spaces) were most desired among all groups. A significant difference across race/ethnic groups was found in New York but not in Raleigh-Durham. In New York, Latino parents had a strong preference for experience attributes (i.e. safety, safe facilities, cleanliness), which differed from other groups. Examining only Latino parents across both cities, we found no significant difference in preferences between the two cities. Although there is no one-size-fits-all approach to encourage park use, our finding suggests facilities and park safety are modifiable ways local government agencies could design and maintain parks that would be preferred by parents for their children. Future research should examine how neighborhood context may influence parent preferences related to parks., (© JHEAL, 2020.)

Background Context: Abnormalities in intervertebral rotation and translation are important to diagnosis and treatment planning for common spinal disorders. Tests that do not sufficiently load the spine can result in mis-diagnosed motion abnormalities. Upright flexion and extension x-rays are commonly used despite known limitations. Additional evidence is needed in support of preliminary studies suggesting that the change from standing to supine may sufficiently stress the spine to diagnose motion abnormalities., Purpose: Compare intervertebral translation between flexion and extension to translation between upright and supine positions in a representative clinical population., Study Design/setting: Prospective analysis of images retrospectively collected from routine clinical practices., Methods: After obtaining IRB approval for analysis of previously obtained images, patients were identified via chart reviews where a neutral-lateral x-ray and an MRI or CT exam were obtained for diagnosis of a spinal disorder and where flexion-extension x-rays had been obtained to help diagnose abnormal intervertebral motion. The mid-sagittal slice from the MRI or CT exam was paired with the neutral-lateral radiograph. Intervertebral translation at the L4-L5 and L5-S1 levels between supine and standing and between flexion and extension were measured from the images using previously validated methods. The translations were classified as normal or abnormal with reference to a previously obtained database of intervertebral motion in radiographically normal and asymptomatic volunteers., Results: At the L5-S1 level in particular, there tended to be greater translation between the supine and standing than between upright flexion and extension. On average, translations were below that found in asymptomatic volunteers. No abnormal translations were detected from flexion-extension radiographs whereas approximately 7% of levels had abnormal translations between supine and upright positions., Conclusions: Intervertebral translations between supine and standing, measured using the mid-sagittal slice from a MRI or CT exam and a lateral x-ray with the patient standing can help to identify abnormal motion. This would be particularly valuable for patients with limited flexion and extension. This study thereby adds to the evidence in support of measuring intervertebral motion between the supine and upright positions to detect abnormal intervertebral motion., Competing Interests: 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., (© 2020 The Authors. Published by Elsevier Ltd on behalf of North American Spine Society.)

Composite metrics integrating park availability, features, and quality for a given address or neighborhood are lacking. The purposes of this study were to describe the validation, application, and demonstration of ParkIndex in four diverse communities. This study occurred in Fall 2018 in 128 census block groups within Seattle(WA), Brooklyn(NY), Raleigh(NC), and Greenville County(SC). All parks within a half-mile buffer were audited to calculate a composite park quality score, and select households provided data about use of proximal parks via an online, map-based survey. For each household, the number of parks, total park acreage, and average park quality score within one half-mile were calculated using GIS. Logistic regression was used to identify a parsimonious model predicting park use. ParkIndex values (representing the probability of park use) were mapped for all study areas and after scenarios involving the addition and renovation/improvement of parks. Out of 360 participants, 23.3% reported visiting a park within the past 30 days. The number of parks (OR = 1.36, 95% CI = 1.15-1.62), total park acreage (OR = 1.13, 95% CI = 1.07-1.19), and average park quality score (OR = 1.04, 95% CI = 1.01-1.06) within one half-mile were all associated with park use. Composite ParkIndex values across the study areas ranged from 0 to 100. Hypothetical additions of or renovations to study area parks resulted in ParkIndex increases of 22.7% and 19.2%, respectively. ParkIndex has substantial value for park and urban planners, citizens, and researchers as a common metric to facilitate awareness, decision-making, and intervention planning related to park access, environmental justice, and community health., Competing Interests: 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., (© 2020 The Author(s).)

Purpose: To test the validity of the Ecological Video Identification of Physical Activity (EVIP) computer vision algorithms for automated video-based ecological assessment of physical activity in settings such as parks and schoolyards., Methods: Twenty-seven hours of video were collected from stationary overhead video cameras across 22 visits in nine sites capturing organized activities. Each person in the setting wore an accelerometer, and each second was classified as moderate-to-vigorous physical activity or sedentary/light activity. Data with 57,987 s were used to train and test computer vision algorithms for estimating the total number of people in the video and number of people active (in moderate-to-vigorous physical activity) each second. In the testing data set (38,658 s), video-based System for Observing Play and Recreation in Communities (SOPARC) observations were conducted every 5 min (130 observations). Concordance correlation coefficients (CCC) and mean absolute errors (MAE) assessed agreement between (1) EVIP and ground truth (people counts+accelerometry) and (2) SOPARC observation and ground truth. Site and scene-level correlates of error were investigated., Results: Agreement between EVIP and ground truth was high for number of people in the scene (CCC = 0.88; MAE = 2.70) and moderate for number of people active (CCC = 0.55; MAE = 2.57). The EVIP error was uncorrelated with camera placement, presence of obstructions or shadows, and setting type. For both number in scene and number active, EVIP outperformed SOPARC observations in estimating ground truth values (CCC were larger by 0.11-0.12 and MAE smaller by 41%-48%)., Conclusions: Computer vision algorithms are promising for automated assessment of setting-based physical activity. Such tools would require less manpower than human observation, produce more and potentially more accurate data, and allow for ongoing monitoring and feedback to inform interventions.

Introduction: Crime and the fear of crime can be a barrier to park use, and locations of crimes can have varied effects. Unsafe areas in or around the park, around the residence, or along the route to the park can alter park use behavior. Our study aimed to examine associations between objective measures of types and location of crimes and park use behaviors., Methods: In 2013 we surveyed a sample (N = 230) of residents in Greensboro, North Carolina, about park use, with responses matched to objective crime and spatial measures. We measured all crimes and violent crimes near home, near the closest park, and along the shortest route between home and park. By using ordered and binary logistic modeling, we examined the relationships between the locations of crime and park use and duration of park visit, park rating, and never visiting parks. Additional models included distance to the closest park., Results: Increased crime in parks and near home was associated with fewer park visits. Greater violent crime in all locations was related to fewer park visits. Park ratings were lower for parks with high violent crime rates., Conclusion: Given the importance of parks as settings for outdoor recreation and physical activity, crime may have a detrimental effect on physical activity and, therefore, public health.

Nature prescription programs have emerged to address the high burden of chronic disease and increasingly sedentary and screen-based lifestyles. This study examines the base of evidence regarding such programs. We conducted a narrative review of published literature using four electronic databases. We included case studies, research design articles, and empirical studies that discussed any type of outdoor exposure or activities initiated by a health-care provider from an outpatient clinic. We examined articles for information on target populations, health outcomes, and structural and procedural elements. We also summarized evidence of the effectiveness of nature prescription programs, and discussed needs and challenges for both practice and research. Eleven studies, including eight empirical studies, have evaluated nature prescription programs with either structured or unstructured formats, referring patients either to nearby parks or to formal outdoor activity programs. Empirical studies evaluate a wide variety of health behaviors and outcomes among the most at-risk children and families. Research is too sparse to draw patterns in health outcome responses. Studies largely tested program structures to increase adherence, or patient follow-through, however findings were mixed. Three published studies explore providers' perspectives. More research is necessary to understand how to measure and increase patient adherence, short and long-term health outcomes for patients and their families, and determinants of provider participation and participation impacts on providers' own health.

Urban parks provide spaces and facilities for children's physical activity (PA) and can be a free resource in low-income communities. This study examined whether neighborhood characteristics were associated with children's park use and park-based moderate-to-vigorous PA (MVPA) in low-income diverse communities and how associations differed between ethnic groups. Data on park visits and MVPA came from 16,402 children 5-10-years old directly observed using the System for Observing Play and Recreation in Communities in 20 parks in low-income neighborhoods with majority Latino or Asian populations in New York City. Neighborhood characteristics included land use mix (LUM), street audits, crime rates, and an area deprivation index. We employed Poisson and negative binomial models to estimate effects of neighborhood-level variables on the number of children observed in parks and engaging in MVPA, overall and by ethnicity. Results for Asian, Latino, and African American children indicated that higher levels of LUM and pedestrian-friendly streets were associated with greater numbers of children in parks and higher MVPA across all three groups. For Asian and Latino children only, quality of environment was positively associated with MVPA, whereas level of deprivation and crime rates in the surrounding neighborhood were negatively associated with children's park-based MVPA. In contrast, a park's access to public transportation was negatively associated with number of all children observed and engaging in MVPA. Study findings suggest that park-based MVPA interventions can be informed by understanding how neighborhood characteristics facilitate and constrain park use and park-based MVPA., (Copyright © 2019. Published by Elsevier Inc.)

Background: Since its introduction in 2006, SOPARC (Systematic Observation of Play and Recreation in Communities) has become a fundamental tool to quantify park visitor behaviors and characteristics. We tested SOPARC reliability when assessing race/ethnicity, physical activity, contextual conditions at the time of observation, and settings of target areas to understand its utility when trying to account for individual characteristics of users., Methods: We used 4725 SOPARC observations completed simultaneously by two independent observers to evaluate intraclass correlation and agreement rate between the two observers when trying to assess sex, age group, race/ethnicity, and level of physical activity of urban park users in different park settings. Observations were in 20 New York City parks during Spring and Summer 2017 within the PARC 3 project., Results: Observers counted 25,765 park users with high interobserver reliability (ICC = .94; %Agreement.75). Reliability scores were negatively affected by the population being observed, the intensity of physical activity, and the contextual conditions and settings of the target area at the time of observation. Specific challenges emerged when assessing the combination of physical activity and race/ethnicity., Conclusions: SOPARC training should aim to improve reliability when assessing concurrent measures such as physical activity, race/ethnicity, age, and sex. Similarly, observing crowded park areas with many active users areas may require more observation practice hours.

This guest editorial introduces the rationale and goals of the Physical Activity Research Center. It provides an overview of the five papers in this Special Section plus six commissioned studies intended to inform advocacy efforts., (Copyright © 2019. Published by Elsevier Inc.)

Agonists for PPARα are used clinically to reduce triglycerides and improve high-density lipoprotein (HDL) cholesterol levels in patients with hyperlipidemia. Whether the mechanism of PPARα activation to lower serum lipids occurs in the liver or other tissues is unknown. To determine the function of hepatic PPARα on lipid profiles in diet-induced obese mice, we placed hepatocyte-specific peroxisome proliferator-activated receptor-α (PPARα) knockout ( Ppara HepKO ) and wild-type ( Ppara fl/fl ) mice on high-fat diet (HFD) or normal fat diet (NFD) for 12 wk. There was no significant difference in weight gain, percent body fat mass, or percent body lean mass between the groups of mice in response to HFD or NFD. Interestingly, the Ppara HepKO mice on HFD had worsened hepatic inflammation and a significant shift in the proinflammatory M1 macrophage population. These changes were associated with higher hepatic fat mass and decreased hepatic lean mass in the Pparα HepKO on HFD but not in NFD as measured by Oil Red O and noninvasive EchoMRI analysis (31.1 ± 2.8 vs. 20.2 ± 1.5, 66.6 ± 2.5 vs. 76.4 ± 1.5%, P < 0.05). We did find that this was related to significantly reduced peroxisomal gene function and lower plasma β-hydroxybutyrate in the Ppara HepKO on HFD, indicative of reduced metabolism of fats in the liver. Together, these provoked higher plasma triglyceride and apolipoprotein B100 levels in the Ppara HepKO mice compared with Ppara fl/fl on HFD. These data indicate that hepatic PPARα functions to control inflammation and liver triglyceride accumulation that prevent hyperlipidemia.

Importance: Both indoor tanning and skin cancer are more common among sexual-minority men, defined as gay and bisexual men, than among heterosexual men. Convenient access to indoor tanning salons may influence use patterns., Objective: To investigate whether indoor tanning salons are disproportionately located in areas with higher concentrations of gay men., Design, Setting, and Participants: This cross-sectional study used geographic information systems to integrate census data and business location data obtained from ArcGIS and Google Maps for the 10 US cities with the largest lesbian, gay, bisexual, and transgender populations in 2010, ie, Los Angeles, California; Chicago, Illinois; San Francisco, California; Seattle, Washington; San Diego, California; Dallas, Texas; Phoenix, Arizona; Washington, DC; Portland, Oregon; and Denver, Colorado. The association of indoor tanning salon locations with proportions of gay men, using the concentration of male-male partnered households as a proxy measure for the latter, was examined. Data analysis was performed in October 2018., Exposures: Census tracts with at least 1%, 5%, or 10% male-male partnered households, adjusting for median household income, percentage young women, and percentage non-Hispanic white residents., Main Outcomes and Measures: Presence of 1 or more indoor tanning salons within census tracts., Results: Across the 10 cities and 4091 census tracts in this study, there were 482 823 unmarried partnered households, of which 35 164 (7.3%) were male-male. The median (interquartile range) percentage of male-male partnered households per census tract was 0% (0%-10.6%). Odds of indoor tanning salon presence in areas with at least 10% male-male households were more than twice those of areas with less than 10% male-male households (odds ratio, 2.17; 95% CI, 1.59-2.97). When sensitivity analyses using a 1-mile euclidian buffer around each tanning salon were conducted, this association remained significant (odds ratio, 2.48; 95% CI, 2.14-2.88). After adjusting for median household income, percentage young women, and percentage non-Hispanic white residents, the odds of an indoor tanning salon being within 1 mile of a census tract with at least 10% male-male households remained twice that of census tracts with less than 10% male-male households (odds ratio, 2.00; 95% CI, 1.71-2.35)., Conclusions and Relevance: In this study, indoor tanning salons were more likely to be located near neighborhoods with higher concentrations of male-male partnered households, possibly contributing to the disproportionate use of indoor tanning by sexual-minority men.

Physical activity typically declines between childhood and adolescence. Despite urban parks being a great venue for physical activity, children change both the frequency of park use and their park use habits as they age into adolescence. However, little is known about how these differences vary by gender and how distinct race/ethnicity groups differentially change their park habits. This study analyzed the differences in park use and per capita energy expenditure between children and teenagers of different gender and race/ethnicity backgrounds. Using the System for Observing Play and Recreation in Communities (SOPARC), systematic observations were conducted in 20 New York City parks in 2017, located in low-income areas with high presence of Latino or Asian residents. A total of 9963 scans in 167 distinct target areas counted 16,602 children (5-10 years old) and 11,269 teenagers (11 or older). Using adjusted marginal means, we estimated the number of park users of each age range, gender, and race/ethnicity expected to be found in each park activity setting. Teenagers of both genders and most race/ethnicity groups were less likely to be in a park and had lower per capita energy expenditure, compared with children. The difference in park attendance was greater than the difference in per capita energy expenditure. Dissimilarities were clearly gendered and race/ethnicity dependent. Asian and Latino females showed the greatest divergence between childhood and adolescence. African American boys were the only group to show a positive age contrast in park attendance and per capita energy expenditure.

Crime and safety perceptions are commonly cited barriers to park use and physical activity (PA). Given the importance of parks as settings for outdoor recreation and physical activity, the presence of crime may have a detrimental effect on public health. This study uses objective police crime reports and observational park use data to assess type of crime and the time when the crime was committed effects on park user behaviors in 20 parks located in low-income neighborhoods in New York City. The System for Observing Play and Recreation in Communities (SOPARC) was used to assess the number of park users and their physical activity during 78 park visits in Spring 2017. The association between crime rates and park use was assessed using two types of crimes (violent and property crimes). The timing of the crime was assessed using the crimes committed within periods of one week, one month, and three months prior to the visit to the park. By including objective measures of crime together with the exact time on which they were committed, we were able to analyze the short and long term effects of crime on park behavior. Overall, there was a consistent negative association between crime and park use. This relationship was stronger at the 1 month and 3 months' period and weaker at the 1-week period. Violent crimes were strongly associated with lower park use, and crimes proved to be associated with child park use to a greater degree. Girls were more affected by crime than boys., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background : Socioeconomic characteristics of locations where physical activity equipment is installed may affect the activity level of users. The purpose of this study was to verify patterns of use and physical activity levels in fitness zones installed in low- and high-income neighborhoods in the city of Curitiba, Brazil. Methods : Over 1200 observations were conducted in 20 fitness zones in the city of Curitiba, Brazil. Data were collected during the months of November and December 2012, in 4 periods of the day (8 AM, 11 AM, 2 PM, and 5 PM), on 2 weekdays and 2 weekend days. Results : A total of 2232 people were observed in the fitness zones. Age group, level of physical activity in the area, use of fitness zones during weekend days, and occupation of spaces were significantly associated with neighborhood income. Moreover, users of fitness zones located in high-income neighborhoods showed higher odds ratio (OR = 1.74; 95% confidence interval, 1.46-2.07) of moderate to vigorous physical activity than light or sedentary activities, regardless of gender or day of the week. Conclusions : The sole presence of equipment does not seem to favor the use of fitness zones in low-income neighborhoods. Future studies should investigate intrinsic factors for the use of fitness zones for physical activity.

Background: This study tested if the timing of meals, physical activity, light exposure, and sleep cluster within individuals and are associated with body mass index (BMI) in a sample of free-living adults (N = 125)., Methods: Data were collected between November 2015 and March 2016 at the University of California, San Diego, Children's Hospital of Philadelphia, and Washington University in St Louis. Height and weight were measured, and BMI (kg/m 2 ) was calculated. Sleep timing was estimated using actigraphy, and timing of meals, physical activity, and light exposure were self-reported using a smartphone application. General linear models estimated the mean BMI across time categories of behaviors, adjusting for covariates. A latent class analysis was used to identify patterns of timing variables that clustered within individuals and test for associations between identified patterns and BMI., Results: Later exposure to outdoor light was associated with a lower BMI (P trend < .01). The timing of other behaviors was not independently associated with BMI. The latent class analysis identified 2 distinct groups related to behavioral timing, reflecting an "early bird" and "night owl" phenotype. These phenotypes were not associated with BMI (P > .05)., Conclusion: Timing of exposures to light, meals, sleep, and physical activity were not strongly associated with BMI in this sample.

Zeitgebers such as light, eating and physical activity provide input to the circadian clock. Chronic circadian misalignment is associated with significant adverse health effects. An improved understanding of the impact of the timing of zeitgebers on the stability of 24-hour rest-activity rhythm in free-living settings may identify behavioural and environmental intervention targets. A total of 133 healthy adults, aged 21-60 years, wore a wrist actigraph for 7 consecutive days. We applied a non-parametric analysis to activity counts to derive rest-activity patterns. We administered a questionnaire through a smartphone app to collect self-reported timing of light exposure, eating episodes and physical activity. To assess the relationship between timing exposures (first and last exposure to outdoor light, first exposure to indoor light, last eating episode, first eating episode, morning physical activity proportion, evening physical activity proportion) and rest-activity or sleep outcomes (bedtimes, total sleep time, inter-daily stability, intra-daily variability, L5 and M10 midpoint), we first calculated Spearman correlations, using the false discovery rate method to control for multiple comparisons. From those significant associations, we then fit regression models adjusting for age, sex, race, household income, education level, study site, body mass index, as well as physical activity. Finally, we tested for interaction between chronotype and each timing-related exposure and stratified the analysis by morning type. All zeitgebers, except for evening physical activity proportion, were correlated with at least four of the seven sleep and rest-activity outcomes. In adjusted analysis, later timing of first (after 6:30 to 7:45 AM versus earlier) and last exposure to indoor light (after 11:00 PM versus earlier) and first (after 7:45-9:45 AM versus earlier) and last eating episode (after 8:00-09:00 PM versus earlier) were associated with a shift of 0.60-1.39 hours to later bedtimes, M10 and L5 midpoints (i.e. timing of peak activities or inactivities). Later timing of first exposure to outdoor light (after 09:30 AM versus earlier) was also associated with 0.51 (95% CI: 0.19 to 0.83) hours longer total sleep time. Higher morning physical activity proportion (> 33%) was associated with 0.95 (95% CI: -1.38 to -0.53) hours earlier in-bed time and 0.69 (95% CI: -1.14 to -0.24) hours earlier out-of-bed time, 0.92 (95% CI: -1.41 to -0.42) hours earlier M10 and 0.96 (95% CI: -1.42 to -0.49) min earlier L5 midpoint. The results did not change substantially with further adjustment for total activity. There was a significant interaction between morning chronotype and first eating episode with rest-activity patterns (p < 0.05), with first eating episode associating with timing of activities only in non-morning type adults. Timing of zeitgebers was associated with sleep and rest-activity patterns, including bedtimes, L5 and M10 midpoint. Future research should evaluate the impact of manipulating zeitgebers on both circadian rhythms and health outcomes.