P66 is a bacterial mimic of CD47 that binds the anti-phagocytic receptor SIRPα and facilitates macrophage evasion by Borrelia burgdorferi.

Innate immunity, the first line of defense against pathogens, relies on efficient elimination of invading agents by phagocytes. In the co-evolution of host and pathogen, pathogens developed mechanisms to dampen and evade phagocytic clearance. Here, we report that bacterial pathogens can evade clearance by macrophages through mimicry at the mammalian anti-phagocytic "don't eat me" signaling axis between CD47 (ligand) and SIRPα (receptor). We identified a protein, P66, on the surface of Borrelia burgdorferi that, like CD47, is necessary and sufficient to bind the macrophage receptor SIRPα. Expression of the gene encoding the protein is required for bacteria to bind SIRPα or a high-affinity CD47 reagent. Genetic deletion of p66 increases phagocytosis by macrophages. Blockade of P66 during infection promotes clearance of the bacteria. This study demonstrates that mimicry of the mammalian anti-phagocytic protein CD47 by B. burgdorferi inhibits macrophage-mediated bacterial clearance. Such a mechanism has broad implications for understanding of host-pathogen interactions and expands the function of the established innate immune checkpoint receptor SIRPα. Moreover, this report reveals P66 as a novel therapeutic target in the treatment of Lyme Disease.

Aminoquinoline-based Re(I) tricarbonyl complexes: Insights into their antiproliferative activity and mechanisms of action.

In an effort to develop new potent anticancer agents, two Schiff base rhenium(I) tricarbonyl complexes, containing the ubiquitous aminoquinoline scaffold, were synthesized. Both aminoquinoline ligands and Re(I) complexes showed adequate stability over a 48-h incubation period. Furthermore, the cytotoxic activity of the precursor ligands and rhenium(I) complexes were evaluated against the hormone-dependent MCF-7 and hormone-independent triple negative MDA-MB-231 breast cancer cell lines. Inclusion of the [Re(CO)3Cl]+ entity significantly enhanced the cytotoxicity of the aminoquinoline Schiff base ligands against the tested cancer cell lines. Remarkably, the incorporation of the Schiff-base iminoquinolyl entity notably enhanced the cytotoxic activity of the Re(I) complexes, in comparison with the iminopyridyl entity. Notably, the quinolyl-substituted complex showed up to three-fold higher activity than cisplatin against breast cancer cell lines, underpinning the significance of the quinoline pharmacophore in rational drug design. In addition, the most active Re(I) complex showed better selectivity towards the breast cancer cells over non-tumorigenic FG-0 cells. Western blotting revealed that the complexes increased levels of γH2AX, a key DNA damage response protein. Moreover, apoptosis was confirmed in both cell lines due to the detection of cleaved PARP. The complexes show favourable binding affinities towards both calf thymus DNA (CT-DNA), and bovine serum albumin (BSA), and the order of their interactions align with their cytotoxic effects. The in silico molecular simulations of the complexes were also performed with CT-DNA and BSA targets.

PRG4 deficiency in mice alters skeletal structure, mechanics, and calvarial osteoclastogenesis, and rhPRG4 inhibits in vitro osteoclastogenesis.

Osteoporosis is a chronic disease characterized by reduced bone mass and increased fracture risk, estimated to affect over 10 million people in the United States alone. Drugs used to treat bone loss often come with significant limitations and/or long-term safety concerns. Proteoglycan-4 (PRG4, also known as lubricin) is a mucin-like glycoprotein best known for its boundary lubricating function of articular cartilage. In more recent years, it has been shown that PRG4 has anti-inflammatory properties, contributes to the maintenance of subchondral bone integrity, and patients with PRG4 mutations are osteopenic. However, it remains unknown how PRG4 impacts mechanical and material properties of bone. Therefore, our objective was to perform a phenotyping study of bone in a Prg4 gene trap (GT) mouse (PRG4 deficient). We found that femurs of Prg4 GT mice have altered mechanical, structural, and material properties relative to wildtype littermates. Additionally, Prg4 GT mice have a greater number of calvarial osteoclasts than wildtype mice, but do not have a notable inflammatory serum profile. Finally, Prg4 GT mice do not have an altered rate of bone formation, and exogenous recombinant human PRG4 (rhPRG4) administration inhibited osteoclastogenesis in vitro, suggesting that the skeletal phenotype may be due to changes in bone resorption. Overall, this work demonstrates that PRG4 deficiency affects several integral properties of bone structure, mechanics, and skeletal cell activity, and provides the foundation and insight toward future work evaluating PRG4 as a potential therapeutic target in treating bone loss.

Supporting self-determination among internationally educated nurses: a discussion.

Background: The COVID-19 pandemic has exacerbated the global nursing shortage. As the shortage worsens, reliance on internationally educated nurses is expected to increase, presenting challenges and opportunities for health care systems and nurse leaders worldwide. While internationally educated nurses bring cultural and ethnic diversity to domestic workforces, they face significant hurdles in successfully integrating due to racism, discrimination, and isolation, which can have a negative impact on their self-determination. The challenges encountered by internationally educated nurses can not only affect their self-determination, but they can also pose risks to patient safety.Objectives: This purpose of this paper was to examine the extant literature to describe the experiences of internationally educated nurses through the lens of Ryan and Deci's Self-Determination Theory. Another aim was to offer nurse managers and administrators strategies for supporting internationally educated nurses within their health care facilities.Design: Discussion Paper.Conclusions: Health care organizations should allocate time and resources to facilitate the professional transition of internationally educated nurses, promoting their psychological well-being and self-determination by fostering autonomy, competence, and relatedness.

SIRPα controls CD47-dependent platelet clearance in mice and humans.

Over the last decade, more data has revealed that increased surface expression of the "don't eat me" CD47 protein on cancer cells plays a role in immune evasion and tumor progression, with CD47 blockade emerging as a new therapy in immuno-oncology. CD47 is critical in regulating cell homeostasis and clearance, as binding of CD47 to the inhibitory receptor SIRPα can prevent phagocytosis and macrophage-mediated cell clearance. The purpose of this study was to examine the role of the CD47-SIRPα signal in platelet homeostasis and clearance. Therapeutic reagents targeting the CD47-SIRPα axis are very promising for treatment of hematologic malignancies and solid tumors, but lead to transient anemia or thrombocytopenia in a subset of patients. We found that platelet homeostatic clearance is regulated through the CD47-SIRPα axis and that therapeutic blockade to disrupt this interaction in mice and in humans has a significant impact on platelet levels. Furthermore, we identified genetic variations at the SIRPA locus that impact platelet levels in humans such that higher SIRPA gene expression is associated with higher platelet levels. SIRPA expression at either end of the normal range may affect clinical outcomes of treatment with anti-CD47 therapy.

Exploration of Cyberethics in Health Professions Education: A Scoping Review.

As digital technologies rapidly integrate into Health Professions Education (HPE), understanding cyberethics is increasingly crucial. This scoping review explores the pedagogy of cyberethics in HPE, highlighting a significant gap in explicit definitions and conceptualizations. Additionally, the absence of specific theoretical frameworks in most documents raises concerns about research progression. Only four articles introduce educational interventions in cyberethics, indicating a promising avenue for future research. While comprehensive search methods are employed, limitations, including language biases, exist. Future investigations should broaden the discourse to encompass ethical implications of emerging technologies within HPE. Cultivating comprehensive, culturally sensitive, and inclusive guidelines is vital for ethical digital practices in the health care community.

The use of photovoice in nursing education: A scoping review.

Given the variety of uses of photovoice in nursing education, the importance of clarifying and describing this method is apparent. This scoping review aimed to explore the evidence on the use of photovoice in nursing education, describe the state of knowledge in this area, and identify knowledge gaps within the existing literature. A comprehensive search was performed in seven databases including MEDLINE, CINAHL, Embase, and Education Full Text. Three gray literature databases (ProQuest Dissertations and Theses Global database, EThOS, and PapersFirst) were also searched. This scoping review was conducted with reference to the JBI scoping review guidelines and reported using the PRISMA-ScR statement. A total of 22 studies published between 2001 and 2022 were included in this scoping review. The findings indicate that photovoice is used globally in nursing education to teach in various courses and content areas within online, hybrid, and in-person environments. Despite the heterogeneity within the definition of photovoice and associated pedagogical strategies, the results of this scoping review suggest that photovoice can serve as an educational tool for nursing students.

Outcomes Following Distal Nerve Blocks for Open Carpal Tunnel Release: A Single-Institution Retrospective Study.

Background Severe cases of carpal tunnel syndrome (CTS) are treated with surgical decompression, for which regional nerve blocks are often administered. There is little data about complications associated with these regional techniques for this surgery. The primary objective was to assess the association of ultrasound-guided regional anesthesia nerve blocks in patients undergoing carpal tunnel release with symptom resolution. Methods This single-institution, retrospective study analyzed all patients undergoing open carpal tunnel release from March 2018 to November 2020. Primary exposure was either regional anesthesia (median and ulnar nerve blocks) or non-regional anesthesia (general anesthesia or local infiltration by surgeon). The primary outcome measurement was symptom resolution at postoperative follow-up at 30-60 days. Secondary outcomes were postoperative surgical site infection, time in operating room (minutes), and post-anesthesia care unit (PACU) length of stay (min). The primary outcome was analyzed using multivariable logistic regression. Results A total of 417 patients were included in this study. Of these, 269 (64.5%) subjects received regional anesthesia as their primary anesthetic. When adjusting for confounders, the use of regional anesthesia was not associated with symptoms not improving at postoperative visit (OR 0.52, 95% CI 0.22 - 1.26, P = 0.15), postoperative surgical site infection (OR 1.47, 95% CI 0.44 - 4.85, p = 0.53), or operating room time duration (p = 0.09). However, the use of regional anesthesia was associated with an approximately 15-minute decrease in PACU length of stay (p < 0.001). Conclusions Regional anesthesia is a safe, effective, and time-efficient method for anesthesia in patients undergoing open carpal tunnel release.

The experience of resilience in newly graduated nurses: A qualitative metasynthesis.

AIM: The aim of the present study was to understand the experiences and perceptions of newly graduated nurses in relation to resilience by providing an interpretive synthesis of the existing qualitative literature on this topic. BACKGROUND: Resilience in newly graduated nurses has been associated with increased satisfaction and decreased turnover. As the experience of resilience is unique to each individual, qualitative studies are well suited to explore this concept, yet the existing data is heterogenous. DESIGN: A qualitative metasynthesis was conducted using a meta-ethnographic approach. METHODS: The search was performed using PubMed, CINAHL, Embase, PsycINFO, ProQuest Dissertations and Theses Global for the English literature and NDSL, KCI, RISS, KISS and DBpia for the Korean literature. The JBI Critical Appraisal Checklist for Qualitative Research was used to assess the quality of studies. An a priori protocol was created and registered on the Open Science Framework (Randall & De Gagne, 2022). RESULTS: The final review included seven articles published between 2008 and 2021. Three main themes were identified: (1) internal experience of resilience; (2) external sources of resilience; and (3) building resilience over time. Subthemes were also identified. CONCLUSIONS: This study indicates that resilience can be developed over time during the period of transition from student nurse to professional nurse and is impacted by personal and organizational influences. The promotion of resilience presents considerations and opportunities for health care leaders and administrators.

Intrathecal Morphine Injection for Postoperative Analgesia Following Gender-Affirming Pelvic Surgery: A Retrospective Case-Control Study.

Background Gender-affirming pelvic surgery (GAPS) can be associated with significant postoperative pelvic pain. Given the lack of available peripheral nerve blocks to the perineum, intrathecal morphine (ITM) injection could offer a potent analgesic modality for this patient population. No prior studies to date have been performed examining the analgesic effects of intrathecal morphine for these patients. Methods This retrospective case-control study aims to understand the postoperative analgesic effects of intrathecal morphine for these patients with a historical comparison group of patients who did not receive intrathecal morphine. Results Fourteen patients presented for gender-affirming pelvic surgery over an eight-month period at a single institution and were offered intrathecal morphine for postoperative analgesia. Their analgesic results were compared to a similar historical group of 13 patients who were not offered or declined intrathecal morphine. Conclusions Intrathecal morphine injection is a potent analgesic modality for patients presenting for gender-affirming pelvic surgery.

The Use of Metaverse in Nursing Education: An Umbrella Review.

BACKGROUND: Given the wide range of metaverse technologies, there is a need to synthesize evidence of metaverse pedagogy used effectively for nursing education. PURPOSE: This umbrella review synthesized systematic reviews on the use of metaverse in nursing education. METHODS: A search was performed in MEDLINE, EMBASE, CINAHL, Web of Science, and Education Full Text. This umbrella review was conducted with reference to the Joanna Briggs Institute (JBI) Reviewer's Manual and reported using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The JBI Critical Appraisal Checklist for Systematic Review was used to assess the quality of studies. RESULTS: The final review comprised 15 articles published between 2013 and 2021, most of which indicate that metaverse interventions support increased knowledge, self-confidence, engagement, satisfaction, and performance in nursing students. Several articles in this review presented mixed findings related to certain learning outcomes. CONCLUSION: This umbrella review supports the viability and effectiveness of metaverse in nursing education.

Increased macrophage phagocytic activity with TLR9 agonist conjugation of an anti- Borrelia burgdorferi monoclonal antibody.

Borrelia burgdorferi (Bb) infection causes Lyme disease, for which there is need for more effective therapies. Here, we sequenced the antibody repertoire of plasmablasts in Bb-infected humans. We expressed recombinant monoclonal antibodies (mAbs) representing the identified plasmablast clonal families, and identified their binding specificities. Our recombinant anti-Bb mAbs exhibit a range of activity in mediating macrophage phagocytosis of Bb. To determine if we could increase the macrophage phagocytosis-promoting activity of our anti-Bb mAbs, we generated a TLR9-agonist CpG-oligo-conjugated anti-BmpA mAb. We demonstrated that our CpG-conjugated anti-BmpA mAb exhibited increased peak Bb phagocytosis at 12-24 h, and sustained macrophage phagocytosis over 60+ hrs. Further, our CpG-conjugated anti-BmpA mAb induced macrophages to exhibit a sustained activation morphology. Our findings demonstrate the potential for TLR9-agonist CpG-oligo conjugates to enhance mAb-mediated clearance of Bb, and this approach might also enhance the activity of other anti-microbial mAbs.

Pay Equity Among Behavior-Analytic Practitioners Who Serve Children.

Pay disparities have numerous adverse effects upon organizations, employees, and clients, which can affect the organization's ability to deliver services, including culturally responsive services. Evidence is accumulating that pay inequity, particularly among females and males, is present within the field of behavior analysis (Li et al., 2018; Vance & Saini, 2022). The purpose of the present study was to examine the annual income of Board Certified Behavior Analysts (BCBA) and doctoral-level BCBAs (BCBA-Ds) who work with children, with a particular focus on the impact that salary practices have on the provision of services to this age group. A survey was distributed to collect information regarding annual income, demographics, and various aspects of service delivery. The sample included 236 (96.7%) BCBAs and eight (3.3%) BCBA-Ds who had been in the field an average of 11.3 years (N = 244). Annual income for female BCBAs and male BCBAs was $74,888 and $79,140, respectively. For those who served children and adolescents, female respondents earn an annual average of $75,840, while male respondents earn an average of $74, 673. The annual incomes of female BCBAs that served urban, rural, and combined rural and urban regions were $76,931, $69,198, and $77,199, respectively. The observed differences between service regions were statistically significant, whereas the difference observed between females and males was not. Considering this, females made less than male counterparts in nearly every comparison, which is alarming. The present study adds to the growing list of observations indicating that a change in salary practices is needed to improve behavior-analytic service delivery to clients.

Endogenous production of hyaluronan, PRG4, and cytokines is sensitive to cyclic loading in synoviocytes.

Synovial fluid is composed of hyaluronan and proteoglycan-4 (PRG4 or lubricin), which work synergistically to maintain joint lubrication. In diseases like osteoarthritis, hyaluronan and PRG4 concentrations can be altered, resulting in lowered synovial fluid viscosity, and pro-inflammatory cytokine concentrations within the synovial fluid increase. Synovial fibroblasts within the synovium are responsible for contributing to synovial fluid and can be targeted to improve endogenous production of hyaluronan and PRG4 and to alter the cytokine profile. We cyclically loaded SW982 synoviocytes to 0%, 5%, 10%, or 20% strain for three hours at 1 Hz. To assess the impact of substrate stiffness, we compared the 0% strain group to cells grown on tissue culture plastic. We measured the expression of hyaluronan turnover genes, hyaluronan localization within the cell layer, hyaluronan concentration, PRG4 concentration, and the cytokine profile within the media. Our results show that the addition of cyclic loading increased HAS3 expression, but not in a magnitude-dependent response. Hyaluronidase expression was impacted by strain magnitude, which is exemplified by the decrease in hyaluronan concentration due to cyclic loading. We also show that PRG4 concentration is increased at 5% strain, while higher strain magnitude decreases overall PRG4 concentration. Finally, 10% and 20% strain show a distinct, more pro-inflammatory cytokine profile when compared to the unloaded group. Multivariate analysis showed distinct separation between certain strain groups in being able to predict strain group, hyaluronan concentration, and PRG4 concentration from gene expression or cytokine concentration data, highlighting the complexity of the system. Overall, this study shows that cyclic loading can be used tool to modulate the endogenous production of hyaluronan, PRG4, and cytokines from synovial fibroblasts.

Evaluating the use of semi-structured crowdsourced data to quantify inequitable access to urban biodiversity: A case study with eBird.

Credibly estimating social-ecological relationships requires data with broad coverage and fine geographic resolutions that are not typically available from standard ecological surveys. Open and unstructured data from crowdsourced platforms offer an opportunity for collecting large quantities of user-submitted ecological data. However, the representativeness of the areas sampled by these data portals is not well known. We investigate how data availability in eBird, one of the largest and most popular crowdsourced science platforms, correlates with race and income of census tracts in two cities: Boston, MA and Phoenix, AZ. We find that checklist submissions vary greatly across census tracts, with similar patterns within both metropolitan regions. In particular, census tracts with high income and high proportions of white residents are most likely to be represented in the data in both cities, which indicates selection bias in eBird coverage. Our results illustrate the non-representativeness of eBird data, and they also raise deeper questions about the validity of statistical inferences regarding disparities that can be drawn from such datasets. We discuss these challenges and illustrate how sample selection problems in unstructured or semi-structured crowdsourced data can lead to spurious conclusions regarding the relationships between race, income, and access to urban bird biodiversity. While crowdsourced data are indispensable and complementary to more traditional approaches for collecting ecological data, we conclude that unstructured or semi-structured data may not be well-suited for all lines of inquiry, particularly those requiring consistent data coverage, and should thus be handled with appropriate care.

Effectiveness of speak-up training programs for clinical nurses: A scoping review.

BACKGROUND: Speaking up about patient safety concerns is critical when bedside nurses encounter unsafe situations. Training programs that encourage nurses' speaking up behavior have been introduced, but there is limited evidence regarding whether such training leads to behavior change or improves patient safety. OBJECTIVE: The aim of this review was to identify the effectiveness of speak-up training programs for clinical nurses, focusing on program content and outcomes. DESIGN: A scoping review was conducted using the Joanna Briggs Institute methodology and reported according to the Cochrane and Preferred Reporting Items for Systematic Review and Meta-Analyses Extension for Scoping Reviews guidelines. METHODS: This study used bibliographic databases of PubMed, Embase, PsycINFO, Scopus, ProQuest Dissertations and Theses Global for the English language, and NDSL, KCI, RISS, KISS, and DBpia for the Korean language. The literature search used a combination of keywords and subject headings related to speak-up training programs for nurses or any type of nurse training program with an assertiveness component. Training outcomes were evaluated according to the 4-level Kirkpatrick model. RESULTS: A total of 4808 references were retrieved, of which 21 articles were selected. These 21 studies were conducted in different parts of the world and published from 1981 to 2020. Speak-up training primarily increased some degree of nurses' levels of assertiveness and speak-up behavior, and also led to secondary outcomes such as job stress, work motivation, and communication conflicts. Most studies (n = 19) applied traditional training formats which consisted of multi-session lectures and practice, whereas three studies applied new methodologies such as high-fidelity simulations and online learning. According to the Kirkpatrick model, five studies assessed reactions to speak-up training (level 1), all studies evaluated learning as a result of training (level 2), two studies measured the effect of speak-up training on nurses' behavior (level 3), and one study evaluated nurses' results (level 4) while no studies evaluated patient-level outcomes. CONCLUSIONS: Speak-up training for nurses can improve their levels of assertiveness or speak-up behaviors. Despite inconsistent or mixed findings, speak-up training has the potential to improve nurses' psychological well-being, leading to positive organizational performance. New training methods are directed at specialized education for clinical situations. Future speak-up training should consist of training programs based on real clinical situations in which team members participate together to comprehensively evaluate the effect of training on behavioral changes of health professionals as well as patient safety.

Pollen limitation of native plant reproduction in an urban landscape.

PREMISE: Evidence suggests that bees may benefit from moderate levels of human development. However, the effects of human development on pollination and reproduction of bee-pollinated plants are less-well understood. Studies have measured natural variation in pollination and plant reproduction as a function of urbanization, but few have experimentally measured the magnitude of pollen limitation in urban vs. non-urban sites. Doing so is important to unambiguously link changes in pollination to plant reproduction. Previous work in the Southeastern United States found that urban sites supported twice the abundance of bees compared to non-urban sites. We tested the hypothesis that greater bee abundance in some of the same urban sites translates into reduced pollen limitation compared to non-urban sites. METHODS: We manipulated pollination to three native, wild-growing, bee-pollinated plants: Gelsemium sempervirens, Oenothera fruticosa, and Campsis radicans. Using supplemental pollinations, we tested for pollen limitation of three components of female reproduction in paired urban and non-urban sites. We also measured pollen receipt as a proxy for pollinator visitation. RESULTS: We found that all three plant species were pollen-limited for some measures of female reproduction. However, opposite to our original hypothesis, two of the three species were more pollen-limited in urban relative to non-urban sites. We found that open-pollinated flowers in urban sites received less conspecific and more heterospecific pollen on average than those in non-urban sites. CONCLUSIONS: These results suggest that even when urban sites have more abundant pollinators, this may not alleviate pollen limitation of native plant reproduction in urban landscapes.

No fry zones: How restaurant distribution and abundance influence avian communities in the Phoenix, AZ metropolitan area.

Urbanization is one of the most widespread and extreme examples of habitat alteration. As humans dominate landscapes, they introduce novel elements into environments, including artificial light, noise pollution, and anthropogenic food sources. One understudied form of anthropogenic food is refuse from restaurants, which can alter wildlife populations and, in turn, entire wildlife communities by providing a novel and stable food source. Using data from the Maricopa Association of Governments and the Central Arizona-Phoenix Long Term Ecological Research (CAP LTER) project, we investigated whether and how the distribution of restaurants influences avian communities. The research aimed to identify restaurants, and thus the associated food they may provide, as the driver of potential patterns by controlling for other influences of urbanization, including land cover and the total number of businesses. Using generalized linear mixed models, we tested whether the number of restaurants within 1 km of bird monitoring locations predict avian community richness and abundance and individual species abundance and occurrence patterns. Results indicate that restaurants may decrease avian species diversity and increase overall abundance. Additionally, restaurants may be a significant predictor of the overall abundance of urban-exploiting species, including rock pigeon (Columba livia), mourning dove (Zenaida macroura), and Inca dove (Columbina Inca). Understanding how birds utilize anthropogenic food sources can inform possible conservation or wildlife management practices. As this study highlights only correlations, we suggest further experimental work to address the physiological ramifications of consuming anthropogenic foods provided by restaurants and studies to quantify how frequently anthropogenic food sources are used compared to naturally occurring sources.

Activity Workstations in High Schools: Decreasing Sedentary Behavior Without Negatively Impacting Schoolwork.

High school students are at risk for increased sedentary behavior due in part to a decrease in physical activity throughout adolescence and to required sedentary behavior during much of the school day. The purpose of the current study is to examine the impact of using activity workstations in a high school English class for struggling readers. Twenty high school students participated in the study. The participants completed a 16-week study where each participant used an activity workstation for 8 weeks and a traditional desk for 8 weeks in a crossover design for a 40-min period during normal class. They responded to a series of subjective questions about reading and schoolwork at the beginning and end of each 8-week session and followed the READ 180 program designed to help struggling readers during the study. The results indicated that academic performance increased in both desk conditions during the study and from the beginning to the end of the study. In addition, there was a significant improvement in items in the subjective survey related to reading, motivation, and schoolwork in both desk conditions across the study. The current results suggest that using an activity workstation in the classroom did not negatively affect academic performance or students' perceptions of working on academic assignments compared to the traditional desk condition. These results indicate that activity workstations could be implemented in classrooms to provide students with a non-sedentary option during the school day thus increasing physical activity in students.