Effects of intraoperative liposomal bupivacaine on postoperative opioid usage in kidney transplant recipients.

This study retrospectively evaluated the use of intraoperative locally infiltrated peri-incisional liposomal bupivacaine in kidney transplant recipients with the primary outcome of oral morphine equivalent reduction during the transplant admission. Secondary outcomes included pain scores, time to first bowel movement and length of stay. Postoperative morphine equivalents were significantly lower in the liposomal bupivacaine group <24 hours (50% reduction, p < 0.05) and 24-48 hours (56.5% reduction, p < 0.05). When accounting for analgesic medication choices, liposomal bupivacaine did not result in a significant reduction in opioid use within 48 hours postoperatively with the exception of a 51% (p = 0.02) median reduction in fentanyl patient-controlled analgesia morphine equivalents <24 hours postoperatively. Morphine equivalence reductions >48 hours, differences in pain scores, time to first bowel movement or length of stay did not reach significance. Intraoperative liposomal bupivacaine reduced kidney transplant recipient's postoperative opioid requirements, but this benefit did not reliably extend past 24 hours postoperatively.

System for Observing Play and Leisure Activity in Youth: A Systematic Review of US and Canadian Studies.

BACKGROUND: The System of Observing Play and Leisure Activity in Youth (SOPLAY) has assisted in providing valid and reliable data of youth physical activity and characteristics specific to environmental contexts. The review aimed to examine empirical research that employed the SOPLAY instrument to measure physical activity in leisure-based activity environments in North American countries. METHODS: The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A systematic search was conducted with an exhaustive process using 10 electronic databases to locate peer-reviewed studies implementing SOPLAY that were published between 2000 and 2021. RESULTS: A total of 60 studies were included in the review. Most studies (n = 35) reported physical activity findings related to contextual characteristics measured using SOPLAY. Interestingly, a few of the studies (n = 8) found the provision of equipment and supervision, particularly adult supervision, significantly increased child physical activity observed. CONCLUSIONS: This review provides information relative to the group-level physical activity observed across multiple contexts (ie, playgrounds, parks, recreation centers) using a validated direct observation instrument.

Flipping the Script: An Initial Exploration of Flipped Learning as an Enhanced Alternative to Traditional Physical Education Lessons.

BACKGROUND: Physical activity (PA) is related to a variety of positive outcomes for youth and physical education (PE) represents a primary school-based environment where students can engage in moderate-to-vigorous physical activity (MVPA). Limitations exist in secondary schools with low socio-economic status, where MVPA engagement is generally below the recommended 50% of lesson time. Growing evidence suggests that using a flipped learning approach (FLA) may naturally enhance PE lessons as outlined by The Theory of Expanded, Extended, and Enhanced Opportunities for Youth Physical Activity Promotion. PURPOSE: The purpose of this study was to compare the impact of the FLA to traditional instruction on student MVPA, lesson context, and teacher involvement during middle school PE lessons. METHODS: Participants were 56 male students from two 7th-grade classes from a low-SES, suburban school. This study employed the System for Observing Fitness Instruction Time (SOFIT). Data were examined through descriptive statistics. Linear regression models were used to predict SOFIT outcomes as a function of FLA versus traditional instruction. RESULTS: Students in the FLA class spent significantly more class time in MVPA (p < 0.01). Regression models predicted participants in FLA classes would spend 55% more class time in MVPA (p < 0.01). After adjusting for covariates, models showed students in FLA classes would spend almost 18 more minutes in MVPA than students in traditional classes (p < 0.01). DISCUSSION/CONCLUSION: The FLA may be a practical lesson enhancement strategy to increase student MVPA and improve PE opportunities for students in low SES schools when compared to the use of traditional instruction. The results of this study demonstrated positive potential of using FLA in PE but should be considered within the context of their limitations. Further examination of the FLA is warranted.

Long-term benzodiazepines and z-drug prescribing in Australian general practice between 2011 and 2018: A national study.

Despite reducing benzodiazepine prescribing, benzodiazepine-involving deaths have substantially increased in Australia. This study aimed to explore patterns in long-term prescribing of medications (benzodiazepine and z-drugs [BZD]) used for sleep-issues/insomnia in Australia to better understand these changes. Open cohort study using de-identified electronic health records of 1 414 593 adult patients regularly attending 404 Australian general practices from 2011 to 2018 (MedicineInsight). We used logistic regression adjusted for patient and practice characteristics to; (1) estimate long-term BZD prescribing prevalence (≥3 prescriptions in 6 months) and the associated sociodemographic factors, and (2) Poisson regression to compute annual changes in prescribing rates. Long-term BZD prescribing changed from 4.4% in 2011 to 5.8% in 2015, remaining relatively stable until 2018 (annual increase +2.5% [95% CI +2.0%;+3.0%]). Long-term BZD prescribing in any year was up to six times more likely in elderly rather than in younger patients and 30%-43% more prevalent in females, or patients living in or attending a practice located in more disadvantaged areas. The increase was more pronounced among males, adults aged 35-49 years, and individuals living in advantaged areas. The median duration among incident cases decreased from 1183 to 322 days between 2011 and 2017, and was up to 197 days longer among elderly females than males. Despite a slight increase and recent stability in long-term BZD prescribing, the higher rates and durations among elderly patients, women, or those living in more disadvantaged areas are concerning and highlights the need for interventions that reduce the potential harms of long-term BZD use in vulnerable groups.

Trends in the prescription of drugs used for insomnia: an open-cohort study in Australian general practice, 2011-2018.

BACKGROUND: Despite an increase in the prevalence of sleep problems, few studies have investigated changes in the prescribing of drugs that are often used to manage insomnia. AIM: To explore changes in the pattern of benzodiazepine (BZD), Z-drug (zolpidem, zopiclone), and non-BZD prescriptions. DESIGN AND SETTING: Open-cohort study comprising 1 773 525 patients (55 903 294 consultations) who attended one of 404 Australian general practices at least three times in two consecutive years between 2011 and 2018. METHOD: Data were extracted from MedicineInsight, a database of 662 general practices in Australia. Prescription rates per 1000 consultations, the proportion of repeat prescriptions above recommendations, and the proportion of prescriptions for patients with a recent (within 2 years) recorded diagnosis of insomnia were analysed using adjusted regression models. RESULTS: Rates of BZD, Z-drug, and non-BZD prescriptions were 56.6, 4.4, and 15.5 per 1000 consultations in 2011 and 41.8, 3.5, and 21.5 per 1000 consultations in 2018, respectively. Over the whole study period, temazepam represented 25.3% of the prescriptions and diazepam 21.9%. All BZD and zolpidem prescriptions declined over the whole study period (annual change varying from -1.4% to -10.8%), but non-BZD and zopiclone prescriptions increased in the same period (annual change 5.0% to 22.6%). Repeat prescriptions that exceeded recommended levels remained at <10% for all medications, except melatonin (64.5%), zolpidem (63.3%), zopiclone (31.4%), and alprazolam (13.3%). In 2018, >50% of Z-drug and melatonin prescriptions were for patients with insomnia. There was an annual increase of 0.8-5.9% in the proportion of prescriptions associated with a recently recorded diagnosis of insomnia. CONCLUSION: Overall, BZD prescriptions in Australia declined between 2011 and 2018. However, the prescription of some of these drugs increased for patients with a recently recorded diagnosis of insomnia. This is concerning because of the potential adverse effects of these medications and the risk of dependence.

Assessment Practices in K-12 Physical Education in the United States: A Scoping Review of Research, 2000-2020.

Appropriate assessment practices are recognized as a critical part of the learning process and represent a key component of quality physical education. Recent shifts in school reform efforts toward more accountability in the United States and an emerging emphasis on student-centered approaches challenge historical approaches to assessment. Purpose: Therefore, the purpose of this review was to (a) identify research conducted on physical education teachers' assessment practices during the years 2000-2020, (b) determine the impact of assessment practices on student outcomes, and (c) describe research that explores factors associated with the SHAPE America guidelines for appropriate assessment practices. Method: The Preferred Reporting Items for Systematic Reviews extension for Scoping Reviews (PRISMA-Sc) Checklist guided this review. All related empirical, peer-reviewed, English-language studies conducted in U.S. schools and published since January 1, 2000 qualified for inclusion. Results: A total of 17 articles met the inclusion criteria for this review. Most used non-experimental methods and were conducted in the secondary (grades 6-12) physical education context. Limited studies examined the relationship between assessment practices and learning outcomes. Recommendations for future research are provided based on the results. Conclusions: A diverse body of studies provides valuable, yet limited evidence related to teacher assessment practices. Systematic research is needed to better understand the impact of teacher assessment practices on student outcomes and to build a stronger foundation for evidence-based recommendations for practice.

Rationale for the Essential Components of Physical Education.

Purpose: This introductory article provides the context and rationale for conducting systematic literature reviews on each of the essential components of physical education, including policy and environment, curriculum, appropriate instruction, and student assessment. Methods: Four research teams from Doctoral Physical Education Teacher Education programs (D-PETE) conducted these systematic reviews using the PRISMA guidelines process. Results: This article explains the role of the national framework for increasing physical education and physical activity (i.e., Comprehensive School Physical Activity Program) in supporting the essential components of physical education. It also highlights the expectations for physical education and provides a brief history of these components. Lastly, this article highlights each of the articles presented in the special feature. Conclusion: Understanding the implementation of these components may be important for improving the physical education experience for all students and creating a foundation for lifelong physical activity and health.

State Lawmaker's Views on Childhood Obesity and Related School Wellness Legislation.

BACKGROUND: School wellness legislation has potential to impact the health of children and alter the obesity crisis in the United Sates. Little is known about how state lawmakers perceive child wellness legislation effectiveness relative to obesity prevention. Our purpose was to understand state lawmakers' perceptions of childhood obesity and school wellness policies relative to the Social Ecological Model (SEM). METHODS: Twenty-one state representatives and nine state senators from one US state completed in-depth interviews. Member checks and peer debriefing occurred throughout data collection and analysis. Transcripts were coded and triangulated. A conventional content analysis generated consistent themes. RESULTS: Five main themes developed: (1) child overweight and obesity is problematic; (2) current legislation is ineffective; (3) funding and enforcing child wellness legislation is difficult; (4) it is difficult to legislate personal behavior; and (5) efforts from other levels of the SEM are more effective at promoting wellness. CONCLUSIONS: Lawmakers understand negative impacts of child obesity, but perceive immediate legislative issues like budgetary concerns inhibit robust policy-oriented action. Participants believe parents, guardians, and individuals should ultimately be responsible for child wellness. Community, school, and family efforts to address childhood obesity and support wellness may be more effective in achieving positive outcomes than state and federal policy.

My Turn to Make a Difference: Efficacy Trends among Induction Physical Educators.

Purpose: This study provides a longitudinal examination of the influences enhancing or constraining the development of efficacy in ten induction physical educators. Method: Over a span of three years, data from structured interviews and responses to the Physical Education Teaching Efficacy Scale were collected at seven time points. Utilizing a mixed-methods approach, data were analyzed for qualitative themes and quantitative trends through the lens of various factors known to influence the career cycle. Results: In the personal environment, the presence of positive individual dispositions, the ability to balance competing demands, and high levels of perceived support emerged as constructive enhancers of efficacy. In the organizational environment, positive influences included the ability to meet the expectations of stakeholders and perceived confidence related to the tasks of teaching. Over time, significant differences existed for the survey categories measuring efficacy in content knowledge, accommodating skill level differences, teaching students with special needs, and instruction. Furthermore, significant differences also occurred related to gender, geographical location/setting, and school classification. Conclusion: Efficacy levels in beginning physical educators are highly dynamic and context-specific, but the presence of high levels of perceived support, both personally and organizationally, can positively enhance the efficacy of induction teachers related to balancing demands both inside and outside the classroom. Implications include the necessity for authentic and thorough preservice training and upon employment, access to adequate resources.

School Lunch Timing and Children's Physical Activity During Recess: An Exploratory Study.

OBJECTIVE: To examine the relationship between school lunch timing (before vs after recess) on physical activity (PA) during recess and energy balance and food intake at lunch. METHODS: A cross-sectional study design was used to examine lunch intake and PA during recess among fourth- and fifth-graders (n = 103) over 5 school days. Lunch and PA were measured using a weighted plate waste technique and accelerometry, respectively. RESULTS: Children who received lunch before recess accumulated lower residual energy (ie, energy intake at lunch minus energy expenditure during recess) and consumed a greater proportion of milk servings. No timing effects were observed for other lunch and PA variables. CONCLUSIONS AND IMPLICATIONS: Lunch intake and activity during recess are related to lunch timing policy. Findings warrant further examination using experimental and quasi-experimental studies to better understand the impact of timing on health behaviors.

What's Physical Activity Got to Do With It? Social Trends in Less Active Students at Recess.

BACKGROUND: Public health concerns regarding childhood obesity and sedentary behavior make investigations of children's physical activity (PA) promotion crucial. School recess, a highly discretional time, plays a central role in shaping children's activity preferences. METHODS: Participants included 40 children (30 girls, 10 boys) from fourth and fifth grades, categorized as low active during recess (<26% moderate-to-vigorous PA [MVPA]). PA was measured via accelerometer (Actigraph wGT3X+) and activity choice gauged through a self-report measure over a 3-day period. To assess attitudes and perceptions of recess, individual interviews were conducted. Accelerometer data were analyzed into minutes and percentage of MVPA; interviews were transcribed verbatim and analyzed utilizing open and axial coding. RESULTS: Participants were active for 18% of recess, choosing activities that were primarily individual-based. Interview data showed low active children attribute recess enjoyment to social interaction and time away from schoolwork as well as an intention to avoid other children who were unkind and/or caused social conflict. CONCLUSIONS: This study supports the importance of gaining a child's perspective of their own behavior, particularly those children classified as less active. Findings add a unique contribution to school health research through an innovative, child-centered approach to explore perceptions of PA.

Entering the Field of Physical Education: The Journey of Fifteen First-Year Teachers.

PURPOSE: Given the significant challenges facing today's physical educators, the purpose of this study was to examine the expectations of induction teachers and identify the factors in both their personal and organizational environments enhanced or constrained their assimilation into the field during their 1st year. METHOD: Using occupational socialization theory as a guide, data from demographic surveys and a series of formal interviews with participants at the beginning, middle, and end of the school year were inductively analyzed for theme development. RESULTS: Results revealed positive acculturation experiences and unity regarding the purpose of physical education as preparing students to be fit for a lifetime. Barriers were noted to be family and personal crises, role conflict, isolation, marginalization, issues with classroom management and discipline, and difficulties in developing positive relationships with stakeholders. Enhancers were identified as positive interactions and rapport with students, colleagues, and administrators and favorable individual dispositions. CONCLUSION: Implications indicate a need for purposeful physical education teacher education training to proactively address these barriers during professional preparation as well as the creation of additional support systems for beginning teachers.

One physical educator's career cycle: strong start, great run, approaching finish.

PURPOSE: This article is nested within a longitudinal project examining 6 teachers' journeys along their career cycles (Lynn & Woods, 2010; Woods & Earls, 1995; Woods & Lynn, 2001). Two participants from the initial 6 continue to teach K-12 physical education; 1 of these participants, Everett, is examined in the current study. This veteran teacher's career-cycle movement and the environmental factors that both enhanced and constrained his career development are examined through the lens of Fessler and Christensen's career cycle model (1992). METHOD: Data sources included: 8 formal interviews with Everett; formal interviews with his university teacher educators, student-teacher supervisor, principal, and spouse; informal interviews; field notes; and systematic teaching observations. An interpretative framework was used to assess the perceptions and meanings Everett gave to experiences as a physical educator and coach. RESULTS: Several factors acutely influenced Everett's career progression, including: (a) his individual disposition, (b) the impact and continued influence of a professional preparation program, and (c) his school and community support. He entered the profession with great promise and spent most of his career in the enthusiastic and growing, and the career stability, stages before shifting into the career frustration stage where he currently remains. CONCLUSIONS: Everett was able to negotiate personal and organizational environmental factors that have been identified as barriers for some physical educators. Therefore, viewing his professional life through the lens of the career cycle provides insights into the areas of change necessary to motivate and retain high-quality physical educators such as Everett.

National Board Certified Physical Educators: perceived changes related to the certification process.

In this study, we examined National Board certified physical education teachers' (NBCPETs) perceptions of change as a result of certification. Randomly selected NBCPETs (65; women = 53, men = 12) were interviewed. Analysis was done through the lens of Lawson's (1989) Model of the interactive factors Influencing workplace conditions for the Physical Education Teacher Several themes connected to teachers' views of themselves as NBCPETs surfaced. In particular more teaching reflection and a greater focus on student learning and assessment, including an increased emphasis on individualizing teaching were described. An elevation in their perceived status and credibility and expanded opportunities within the educational community also emerged. Alternatively, several NBCPETs explained that the certification process had little or no effect on their teaching

"We move kids"-the consensus report from the roundtable to examine strategies for promoting walking in the school environment.

In conjunction with the Walking for Health Conference, a Roundtable with 12 physical education teachers and 11 pedagogy researchers and public health professionals was organized to initiate a dialog between practicing school teachers and a group of researchers to identify practical and effective strategies for increasing physical activity, particularly walking, in the school setting. Discussions were organized on the following major themes: (1) promoting physical activity, (2) barriers for physical activity promotion in children, and (3) integrating physical activity with other health behaviors in the curriculum. There was a focus that came through on strategies to overcome barriers to allow opportunities for students to increase their physical activity levels. These strategies require the commitment not only of physical education teachers but also of their fellow teachers, school administrators, parents, local community members, and of course the students themselves. The issue of limited resources continually came up, thus realistically limiting strategies to those that could be implemented without additional cost. Any progress to be made with respect to the implementation of these strategies depends on the infrastructure of support that can be built on the excellent recommendations provided by the Roundtable focus groups.