Detecting the most critical clinical variables of COVID-19 breakthrough infection in vaccinated persons using machine learning.

Background: COVID-19 vaccines offer different levels of immune protection but do not provide 100% protection. Vaccinated persons with pre-existing comorbidities may be at an increased risk of SARS-CoV-2 breakthrough infection or reinfection. The aim of this study is to identify the critical variables associated with a higher probability of SARS-CoV-2 breakthrough infection using machine learning. Methods: A dataset comprising symptoms and feedback from 257 persons, of whom 203 were vaccinated and 54 unvaccinated, was used for the investigation. Three machine learning algorithms - Deep Multilayer Perceptron (Deep MLP), XGBoost, and Logistic Regression - were trained with the original (imbalanced) dataset and the balanced dataset created by using the Random Oversampling Technique (ROT), and the Synthetic Minority Oversampling Technique (SMOTE). We compared the performance of the classification algorithms when the features highly correlated with breakthrough infection were used and when all features in the dataset were used. Result: The results show that when highly correlated features were considered as predictors, with Random Oversampling to address data imbalance, the XGBoost classifier has the best performance (F1 = 0.96; accuracy = 0.96; AUC = 0.98; G-Mean = 0.98; MCC = 0.88). The Deep MLP had the second best performance (F1 = 0.94; accuracy = 0.94; AUC = 0.92; G-Mean = 0.70; MCC = 0.42), while Logistic Regression had less accurate performance (F1 = 0.89; accuracy = 0.88; AUC = 0.89; G-Mean = 0.89; MCC = 0.68). We also used Shapley Additive Explanations (SHAP) to investigate the interpretability of the models. We found that body temperature, total cholesterol, glucose level, blood pressure, waist circumference, body weight, body mass index (BMI), haemoglobin level, and physical activity per week are the most critical variables indicating a higher risk of breakthrough infection. Conclusion: These results, evident from our unique data source derived from apparently healthy volunteers with cardiovascular risk factors, follow the expected pattern of positive or negative correlations previously reported in the literature. This information strengthens the body of knowledge currently applied in public health guidelines and may also be used by medical practitioners in the future to reduce the risk of SARS-CoV-2 breakthrough infection.

Natural soils in OECD 222 testing - influence of soil water and soil properties on earthworm reproduction toxicity of carbendazim.

Soil sorption properties can influence the bioavailability of substances and consequently the toxicity for soil organisms. Current standardised laboratory testing for the exposure assessment of pesticides to soil organisms uses OECD artificial soil that does not reflect the high variation in chemical-physical soil properties found in natural agroecosystems. According to guideline OECD 222, earthworm reproduction tests with Eisenia fetida and the pesticide carbendazim were performed in four natural soils and OECD artificial soil. By using pF 1.6, which ensures a uniformity in actual soil water availability, the control reproduction performance of E. fetida in all natural soils was at the same level as OECD artificial soil. In a principle component analysis, the variation in toxicity between the tested soils was attributable to a combination of two soil properties, namely total organic carbon content (TOC) and pH. The largest difference of 4.9-fold was found between the typical agricultural Luvisol with 1.03% TOC and pH 6.2 (EC10: 0.17 (0.12-0.21) mg a.i. kg-1 sdw, EC50: 0.36 (0.31-0.40) mg a.i. kg-1 sdw) and OECD artificial soil with 4.11% TOC and pH 5.6 (EC10: 0.84 (0.72-0.92) mg a.i. kg-1 sdw, EC50: 1.07 (0.99-1.15) mg a.i. kg-1 sdw). The use of typical agricultural soils in standardised laboratory earthworm testing was successfully established with using the measure pF for soil moisture adjustment. It provides a more application-oriented approach and could serve as a new tool to refine the environmental risk assessment at lower tier testing or in an intermediate tier based approach.

Reasons and Strategies for Privacy Features in Tracking and Tracing Systems-A Systematic Literature Review.

In the course of the digitization of production facilities, tracking and tracing of assets in the supply chain is becoming increasingly relevant for the manufacturing industry. The collection and use of real-time position data of logistics, tools and load carriers are already standard procedure in entire branches of the industry today. In addition to asset tracking, the technologies used also offer new possibilities for collecting and evaluating position and biometric data of employees. Thus, these technologies can be used for monitoring performance or for tracking worker behaviour, which can lead to additional burdens and stress for employees. In this context, the collection and evaluation of employee data can influence the workplace of the affected employee in the company to his or her disadvantage. The approach of Privacy by Design can help to benefit from all the advantages of these systems, while ensuring that the impact on employee privacy is kept to a minimum. Currently, there is no survey available that reviews tracking and tracing systems supporting this important and emerging field. This work provides a systematic overview from the perspective of the impact on employee privacy. Additionally, this paper identifies and evaluates the techniques used with regard to employee privacy in industrial tracking and tracing systems. This helps to reveal new privacy preserving techniques that are currently underrepresented, therefore enabling new research opportunities in the industrial community.

Children's physical activity level and sedentary behaviour in Norwegian early childhood education and care: effects of a staff-led cluster-randomised controlled trial.

BACKGROUND: A growing body of evidence suggest that the children's physical activity (PA) level in early childhood education and care (ECEC) settings are insufficient. Since most children attend ECEC settings for many hours on most days of the week, and these institutions reach children across the socioeconomic spectrum, the ECEC settings may serve as an ideal avenue for increasing physical activity level, reduce sedentary time and enhance the overall health of young children. This paper investigates the effectiveness of the "Active Kindergarten - Active Children" study to increase children's PA level and reduce sedentary time within the ECEC setting. METHODS: Accelerometers were used to asses PA and sedentary time. A total of 116 three to four-year olds took part in a randomised controlled trial in 11 ECEC settings. Participants were cluster-randomised, by ECEC setting, to either a 12 week staff-led and expert-supported intervention or a waiting list control group. RESULTS: The intervention group increased time spent in moderate- and vigorous intensity PA by 10 min/day (95% CI = 3, 18; P = 0.01), took 1909 more steps per day (95% CI = 1130, 2688; P < 0.01) and reduced sedentary time with 14 min/day (95% CI = - 27, - 1; P = 0.04) compared to the control group. The intervention group had a 2.4 higher odds (95% CI = 1.05, 5.7; P = 0.04) of meeting the PA recommendations compared to the control group at follow-up. CONCLUSIONS: Our results show that a flexible staff-led and expert-supported multicomponent PA intervention can increase total PA level, moderate- and vigorous intensity PA and reduce time spent sedentary in three to four-year old children during their stay in ECEC settings. TRIAL REGISTRATION: The trial was retrospectively registered on September 19, 2020 and available online at ClinicalTrials.gov: No. NCT04555746 .

Visual assessment of digital ulcers in systemic sclerosis analysed by eye tracking: implications for wound assessment.

OBJECTIVES: The assessment of digital ulcers (DUs) in systemic sclerosis (SSc) depends crucially on visual aspects. However, little is known about the differences in visual assessment of these wounds between experts and non-experts or medical lay persons (novices). To develop potential training recommendations for the visual assessment of digital ulcers in SSc, we analysed gaze pattern data during assessment of digital ulcers between assessors with different levels of expertise. METHODS: Gaze pattern data from 36 participants were collected with a mobile eye tracking device. 20 pictures from digital ulcers of SSc patients were presented to each participant. The analysis comprised the scan path, the dwell times (for areas of interest), fixation counts and the entry time for each picture and subject. RESULTS: Most significant differences were found between novices and medically educated groups. Dwell times in the wound area for novices differed statistically significantly from all medically educated groups (1.76s-3.1s less). Above all, novices had lower dwell times in wound margin and wound surrounding and spent more time in other areas (up to 1.92s longer). Correspondingly, they had less fixation points and longer overall scan paths in wound areas. Similar gaze pattern data were generated for medically educated groups. CONCLUSIONS: For the first time, we could analyse the visual assessment of digital ulcers in SSc and detected differences according to levels of medical education and expertise. Adequate training on proper interpretation of changes in all wound areas are warranted to improve wound assessment in digital ulcers.

CT fluoroscopy-guided transforaminal and intra-articular facet steroid injections for the treatment of cervical radiculopathy: injectate distribution patterns and association with clinical outcome.

OBJECTIVES: To investigate injectate dispersal patterns and their association with therapeutic efficacy during a transforaminal (TFSI) or an intra-articular facet steroid injection (IFSI) to treat cervical radiculopathy. METHODS: This retrospective study examined the post-intervention cervical spine CT of 56 patients randomized to receive one CT fluoroscopy-guided IFSI (29 patients; 10 (34.5%) males; mean age 45.0 years; SD 8.8 years; range 26-61 years) or TFSI (27 patients; 13 (48.2%) males; mean age 51.1 years; SD 11.2 years; range 29-72 years) (December 2010 to August 2013). The presence of contrast within the intra-articular facet, juxta-articular facet, retrodural, epidural, and foraminal and extraforaminal spaces during IFSI, and within the extraforaminal, foraminal, and epidural spaces during TFSI was assessed. Descriptive data are presented as frequencies. The association between injectate dispersal patterns and therapeutic efficacy, 4-week post-intervention, was assessed with ANCOVA models. RESULTS: During IFSI, the injectate predominantly spread to the retrodural (62%; 18/29) or juxta-articular (21%; 6/29) space. During TFSI, the injectate predominantly spread to the extraforaminal/foraminal spaces (41%; 11/27) or to the extraforaminal/foraminal/epidural spaces (33%; 9/27). Injectate presence in the juxta-articular (p = .007) or extraforaminal (p < .001) space was a predictor of therapeutic efficacy but not in the foraminal (p = .54), epidural (p = .89), or retrodural (p = .75) space. CONCLUSIONS: TFSI and IFSI led to preferential extraforaminal and retrodural injectate spread, respectively. Targeting the extraforaminal or juxta-articular facet space improved the clinical efficacy of steroid injections when treating cervical radiculopathy. KEY POINTS: • During intra-articular facet injection, the injectate spreads from the facet joint to the retrodural space and rarely reaches the epidural and/or foraminal spaces. • Epidural spread of the injectate during an anterolateral transforaminal steroid injection is the least effective for pain relief in patients with cervical radiculopathy. • Injection techniques targeting the extraforaminal or juxta-articular facet space are safer than transforaminal injections and effectively relieve pain in patients with cervical radiculopathy.

Feasibility of assessing vegetative and generative endpoints of crop- and non- crop terrestrial plant species for non-target terrestrial plant (NTTP) regulatory testing under greenhouse conditions.

Agriculture is the dominating land-use in the EU member states covering nearly half of the surface area. Using herbicides to reduce weed competition in agricultural areas can adversely affect Non-Target Terrestrial Plants (NTTP) growing in field margins. According to the EFSA Scientific Opinion on NTTPs an important protection goal is to maintain the biodiversity of plant species in agricultural areas. EFSA recommends to include also non-crop species mentioned in OECD guidelines (OECD 208 and 227) in the testing and to assess not only vegetative but also generative endpoints during the plant life-cycle such as flowering and seed production. The objectives of this study were to evaluate the feasibility of assessing generative endpoints of crop and non-crop species for NTTP regulatory testing under greenhouse conditions and to assess if generative endpoints are more sensitive than vegetative endpoints. The experimental design consisted of one control and four herbicide (Atlantis® WG) application rates, with 6 replicates each. The application rates of the test substance were the maximum field rate and 30%, 10% and 3% of the field rate. Biomass, plant height, flowering, seed production as well as seedling emergence of the F1 generation were assessed. The study shows a feasible approach to assess vegetative and generative endpoints of (non-) crops species under greenhouse conditions on the basis of the OECD guideline 227. The vegetative endpoints plant height and biomass were not more sensitive if assessed during the generative growth stage when compared to the vegetative growth stage of the plants. In contrast to that, the generative endpoint seed production was partly more sensitive in comparison to the vegetative endpoints biomass and plant height. For regulatory NTTP studies, 5 or more test substance rates at non-lethal levels should be tested so to allow the determination of ER10/50 values for vegetative and generative endpoints.

The coolest I know - a qualitative study exploring the participation experiences of children with disabilities in an adapted physical activities program.

Purpose: The first aim of the study was to obtain a broader understanding of how children 10-13 years old with disabilities experience participation in self-selected physical activities during an intensive group rehabilitation program. A second aim was to explore how new skills and experiences gained from intensive group rehabilitation can be transferred to meaningful participation in local environments.Material and methods: Individual in-depth interviews obtained the perspectives on participation of a purposive sample of eleven children with disabilities. The study applied inductive thematic coding of the content associated with participation followed by deductive analysis.Results: Five main themes were derived; "to learn and to show others new activities", "belonging, solidarity and friendship", "activity and participation enjoyment", "participation on my own terms" and "transfer to the local environment at home". To practice and learn physical activities during intensive group rehabilitation seemed to enhance transferring of meaningful participation to the local environment, and was related to the children's activity competence, preferences and self-efficacy.Conclusions: The rehabilitation stay created a setting where children learned diverse activities together with equal peers, which resulted in mastery, friendship and enjoyment. The children participated on their own terms, and continued to do so in their local environment.Implications for RehabilitationA context of freedom to learn preferred adapted physical activities on children's own terms is important for transferring meaningful participation to local environments.A high intensity rehabilitation program with enough time to try and to learn diverse adapted physical activities is essential to increased activity competence in children with disabilities.Attendance in a group of equal peers provides opportunities to experience new roles and thus strengthens the sense-of-self and creates a feeling of belonging, solidarity, friendship and joy.

Exploring the workplace climate and culture in relation to food environment-related factors in Norwegian kindergartens: The BRA-study.

BACKGROUND: Kindergartens represent an important arena for promoting vegetable intake when it is essential to establish healthy dietary behaviours early in life. To develop and implement successful interventions targeting dietary behaviours in kindergartens, a good understanding of the factors influencing their food environment and the interplay between these factors is essential. The present study aimed to explore associations between workplace climate and culture in the kindergarten setting and the staff's food-related practices, vegetables served and the possible mediating role of staff's food-related practices. METHOD: Vegetables served, staff's food-related practices, and data on workplace climate and culture were collected using a 5-day, weighted, vegetable diary and three paper-based questionnaires. Seventy-three kindergartens in the Norwegian counties of Vestfold and Buskerud participated in the study. Spearman's rho was used to assess the association between workplace climate and culture, and staff's food-related practices and vegetables served. Mediation analyses were conducted to assess the mediating role of staff's food-related practices in the relationship between workplace climate and culture and vegetables served in this setting. RESULTS: There was one significant positive correlation between factors in the workplace climate and culture, and staff's food-related practices and vegetables served. The staff's food-related practices were found to mediate the association between support from superior and the variety of vegetables served. They also mediated the association between commitment to the organization and the frequency, as well as the variety, of vegetables served. CONCLUSION: The results identified commitment to the organization and support from superior as two important factors in the workplace climate and culture. Furthermore, these two factors seems to be important to target when developing kindergarten-based interventions aimed at increasing the variety and frequency of vegetables served as they were associated with more favourable food-related practices among staff.

Radiographic/MR Imaging Correlation of the Wrist.

In this review article, the authors discuss the imaging features of the most common pathologic conditions of the wrist by putting the emphasis on radiographic and MR imaging correlations. A topographic approach based on the 3 functional columns of the wrist (radial, central, and ulnar) serves as a framework. The pathologic conditions are classified, based on the structures involved, as fractures, ligament injuries, arthropathies, bone abnormalities, and tendinopathies. The authors describe and evaluate classic radiographic signs and explain how they correlate with MR imaging. The advantages and limitations of each technique are thoroughly discussed as well as other imaging modalities.

Diagnostic Accuracy of Echo Envelope Statistical Modeling Compared to B-Mode and Power Doppler Ultrasound Imaging in Patients With Clinically Diagnosed Lateral Epicondylosis of the Elbow.

OBJECTIVES: To compare the accuracy of homodyned K quantitative ultrasound (QUS) with that of B-mode and Doppler ultrasound imaging for discriminating between lateral epicondylosis (LE) and asymptomatic elbows. METHODS: This prospective study received Institutional Review Board approval, and participants provided written informed consent. Between February 2015 and March 2017, 30 LE elbows in 27 patients and 24 asymptomatic elbows in 13 volunteers underwent B-mode, Doppler, and radiofrequency ultrasound imaging of the common extensor tendon (CET) and radial collateral ligament (RCL). Two readers classified the elbows independently on the basis of a review of B-mode and Doppler images. The global and local estimates of QUS parameters (µ n , 1/α, and k) were computed in the CET and CET-RCL regions, respectively, and the area of each region was calculated. A random-forest classifier identified the most discriminating 3-parameter combination: CET global estimate of 1/α, CET-RCL area, and local estimate of k. RESULTS: The patients with LE had a mean age of 50 years (range, 31-66 years), and the volunteers had a mean age of 50 years (range, 37-57 years). The area under the receiver operating characteristic curve, sensitivity, and specificity of reader 1, reader 2, and the QUS-based model were 0.80 (95% confidence interval [CI], 0.66-0.95), 0.72 (95% CI, 0.56-0.89), and 0.88 (95% CI, 0.72-1.04); 0.79 (95% CI, 0.66-0.93), 0.65 (95% CI, 0.47-0.82), and 0.84 (95% CI, 0.67-1.01); and 0.82 (95% CI, 0.80-0.85), 0.73, and 0.79, respectively. CONCLUSIONS: An automated, computer-based QUS technique diagnosed LE with accuracy of 0.82. This technique could provide quantitative biomarkers for the characterization of LE disease.

Cementoplasty of pelvic bone metastases: systematic assessment of lesion filling and other factors that could affect the clinical outcomes.

OBJECTIVES: To evaluate lesion filling and other factors that could affect the clinical outcomes of cementoplasty for pelvic bone metastases. METHODS: We retrospectively reviewed the files of 40 patients treated for 44 pelvic bone metastases, collected the parameters related to patients (pain relief evaluated on a visual analog scale, subsequent fractures, and need for surgery), lesions (size, cortical breach score, fracture, soft-tissue extension), and cementoplasty procedures (number of needles, volume of cement, percentage of lesion filling, cement leaks, residual acetabular roof defect), and performed a statistical analysis. RESULTS: The lesions were on average 43.2 mm in diameter and the mean cortical breach score was 2.5 out of 6, with a pathological fracture in 14 lesions. The number of needles inserted was one in 32 out of 44, two in 10 out of 44, and three in 2 out of 44. On average, the volume of cement injected per lesion was 10.3 ml and the filling was 54.8%. Mild or moderate asymptomatic cement leakage occurred in 20 lesions (45.5%). The mean pain score was 84.2 mm before the procedure (with no correlation with lesion size, cortical breach score or fracture) and 45.6 mm at follow-up. The pain relief of 38.6 mm was statistically significant (p < 0.001) and did not correlate with the filling percentage. There were no fractures of the treated lesions at a mean follow-up of 355 days. CONCLUSIONS: Cementoplasty of pelvic bone metastases appears effective for providing pain relief and may prevent subsequent fractures. We were unable to demonstrate a correlation between the lesion filling and the degree of pain relief.

Is the environment in kindergarten associated with the vegetables served and eaten? The BRA Study.

Aim: The aim of the present study was to explore the associations between the economic, political, sociocultural and physical environments in kindergartens, along with the frequency and variety of vegetables served, and the amount of vegetables eaten. Method: The BRA Study collected data through two paper-based questionnaires answered by the kindergarten leader and pedagogical leader of each selected kindergarten, and a five-day vegetable diary from kindergartens (n = 73) in Vestfold and Buskerud Counties, Norway. The questionnaires assessed environmental factors, and the frequency and variety of vegetables served. The non-parametric Mann-Whitney U and Kruskal-Wallis tests were used to explore the associations between factors in the kindergarten environments and vegetables served and eaten. Results: Kindergartens that included expenditures for food and beverages in the parental fees served a larger variety of vegetables (p = 0.046). A higher frequency of served vegetables (p = 0.014) and a larger amount (p = 0.027) of vegetables eaten were found in kindergartens where parents paid a monthly fee of 251 NOK or more. Similarly, the amount of vegetables eaten was higher (p = 0.017) in kindergartens where the employees paid a monthly fee to eat at work. Furthermore, a larger amount (p = 0.046) of vegetables was eaten in kindergartens that had written guidelines for food and beverages that were offered. Conclusions: This study indicates that the economic environment in a kindergarten seems to be positively associated with the vegetables served and eaten there. This is of high relevance for public health policy as vegetable consumption is an important factor in reducing the risk of non-communicable diseases.

Radiological identification and analysis of soft tissue musculoskeletal calcifications.

Musculoskeletal calcifications are frequent on radiographs and sometimes problematic. The goal of this article is to help radiologists to make the correct diagnosis when faced with an extraosseous musculoskeletal calcification. One should first differentiate a calcification from an ossification or a foreign body and then locate the calcification correctly. Each location has a specific short differential diagnosis, with minimal further investigation necessary. Intra-tendon calcifications are most frequently associated with hydroxyapatite deposition disease (HADD). In most cases, intra-articular calcifications are caused by calcium pyrophosphate dihydrate (CPPD) crystal deposition disease. Soft tissue calcification can be caused by secondary tumoural calcinosis from renal insufficiency, or collagen vascular diseases and by vascular calcifications, either arterial or venous (phlebolith). TEACHING POINTS: • Calcifications have to be differentiated form ossification and foreign body. • A musculoskeletal MRI study must always be correlated with a radiograph. • The clinical manifestations of calcifications may sometimes mimic septic arthritis or sarcoma. • HADD and CPPD crystal deposition have a distinct appearance on radiograph. • Calcinosis is more frequently caused by chronic renal failure and scleroderma.

A practical guide for planning pelvic bone percutaneous interventions (biopsy, tumour ablation and cementoplasty).

Percutaneous approaches for pelvic bone procedures (bone biopsies, tumour ablation and cementoplasty) are multiple and less well systematised than for the spine or extremities. Among the different imaging techniques that can be used for guidance, computed tomography (CT) scan is the modality of choice because of the complex pelvic anatomy. In specific cases, such as cementoplasty where real-time evaluation is a determinant, a combination of CT and fluoroscopy is highly recommended. The objective of this article is to propose a systematic approach for image-guided pelvic bone procedures, as well as to provide some technical tips. We illustrate the article with multiple examples, and diagrams of the approaches and important structures to avoid to perform these procedures safely. TEACHING POINTS: • Pelvic bone procedures are safe to perform if anatomical landmarks are recognised. • The safest approach varies depending on the pelvic level. • CT is the modality of choice for guiding pelvic percutaneous procedures. • Fluoroscopy is recommended when real-time monitoring is mandatory. • MRI can also be used for guiding pelvic percutaneous procedures.

Phonomyography as a non-invasive continuous monitoring technique for muscle ischemia in an experimental model of acute compartment syndrome.

BACKGROUND: In acute compartment syndrome (ACS), clinicians have difficulty diagnosing muscle ischemia provoked by increased intra-compartmental pressure in a timely and non-invasive manner. Phonomyography records the acoustic signal produced by muscle contraction. We hypothesize that alterations in muscle contraction caused by muscle ischemia can be detected with phonomyography, serving as a potential non-invasive technique in the detection of ACS. METHODS: The left hind limb of 15 Sprague-Dawley rats was submitted to a reversible ischemic model of limb injury for 30min and 1, 2, 4, 6h (3 rats in each group). The right limb served as control. Phonomyography microphones were placed over the posterior calf of both limbs and the sciatic nerve was stimulated percutaneously at 10-min intervals to evaluate muscle contraction. Histopathological analysis of muscles and nerves biopsies was performed and correlation was made between duration of injury, phonomyography output and degree of muscle and nerve necrosis. RESULTS: There was a statistically significant decrease in the phonomyography signal output in the ischemic limb that correlated with the duration of ischemia and histological findings of muscle and nerve necrosis. The phonomyography signal decrease and histological findings were respectively: 55.5% (n=15;p=0.005) with rare muscle and nerve necrosis at 30min, 65.6% (n=12;p=0.005) with 5-10% muscle necrosis at 1h, 68.4% (n=9;p=0.015) with 100% muscle necrosis and little nerve damage at 2h, 72.4% (n=6;p=0.028) with 100% muscle necrosis and severe nerve damage at 4h, and 92.8% (n=3;p=0.109) with 100% muscle necrosis and severe nerve degeneration at 6h. CONCLUSION: Changes in phonomyography signal are observed in early ischemic injury prior to the onset of nerve or muscle necrosis. Therefore, phonomyography could serve as a non-invasive technique to detect early ischemic muscle changes in acute compartment syndrome. CLINICAL RELEVANCE: The detection of abnormal muscle contraction in a timely fashion and non-invasive manner is of interest in clinical settings where the presence of ischemia is not easy to diagnose.

Objectively measured physical activity level and sedentary behavior in Norwegian children during a week in preschool.

Although many studies have reported on physical activity (PA) levels using accelerometers, a thorough description of the PA pattern in preschool children during their stay in the preschool, is lacking in the current literature. Furthermore, there remains a lack of understanding of the PA level and pattern in children in the lower end of the PA continuum. The first aim of this study was therefore to describe the PA pattern during a week-long stay in a preschool in all children born in 2011 (either three or four-year-olds) attending public preschools in a municipality in Norway. The second aim was to describe the PA level and pattern of the children who are the least physically active. This cross-sectional study included baseline data from 95% of children (N = 111) participating in a randomized controlled physical activity intervention (Active Kindergarten - Active Children study). The participants wore an Actigraph accelerometer, in week 39 in 2015, from when they arrived at the preschool on Monday morning and throughout their stay of five consecutive days. The amount of moderate- to vigorous-intensity PA (MVPA) per day ranged from 16 min to 116 min, and sedentary time ranged from 2.7 h to 6.5 h per day in the least and most sedentary child, respectively. The least physically active 25% of children were less active throughout the entire day, and only a few of them managed to achieve the recommended level of MVPA on any weekday. The physical activity levels and patterns among the least active children described in this study may help to inform interventions targeting this group.

Having Fun and Staying Active! Children with Disabilities and Participation in Physical Activity: A Follow-Up Study.

AIM: This study investigated change in the participation profile of physical activity over 15 months after a three-week intensive rehabilitation that used physical activity as the main intervention. METHODS: The Children's Assessment of Participation and Enjoyment (CAPE) was used in a longitudinal prospective study (pre- and post-design) with three measurements over 15 months. Eighty children with physical disabilities (6-17 years old; mean score 11.1; SD 2.4), some with additional cognitive challenges, completed all three measurements. RESULTS: Participation diversity and intensity of all 55 leisure activities declined significantly over the 15-month period. The largest decline was for children aged between 10 and 13 years. Among physical activities, there was a stable level of participation of the total group, and sub-groups. Boys preferred "active physical activities" to a greater extent, while girls preferred "skill-based activities." Both genders expressed a higher level of enjoyment in their preferred activities according to the Preferences for Activities of Children. CONCLUSIONS: This intervention may have the potential to maintain the level of physical activity among children and youths with disabilities, yet further controlled studies are needed. Gender differences should be taken into consideration to facilitate stable participation in physical activities with a high level of enjoyment.