There is a consensus that students should be involved in interdisciplinary activities that promote a solid education in STEAM subjects from an early age. The outdoor settings of schools present an advantageous context for STEAM education, allowing for a myriad of learning experiences. To understand how teachers perceive the pedagogical use of the school’s outdoor space, a study was carried out in a cluster of schools in a Portuguese city, including one middle school and 10 kindergarten and elementary schools. A mixed methods approach was used, combining a questionnaire for teachers (N = 49) with interviews (N = 8). The results indicate that teachers’ perceptions of the characteristics of their school’s outdoor spaces either facilitate or hinder the implementation of outdoor pedagogical activities. Most teachers concur that the outdoors provides contact with nature and encourages interdisciplinary and collaborative activities. However, the teachers surveyed admit to using the school’s outdoor spaces only occasionally, and this use decreases as the educational level at which they teach increases. The most common use of outdoor spaces is for physical and motor activities, promoting the well-being of children and youth. Although interdisciplinary activities in outdoor spaces are recognised, their implementation is limited and hampered by factors such as the length of curricula and the lack of training for teachers in these approaches. In this sense, there is an urgent need to train teachers in the interdisciplinary use of outdoor spaces to promote a solid education in STEAM subjects.
Acute: chronic workload ratio (ACWR) and training monotony have been criticized as injury risk predictors. Therefore, the use of intensity measures should be oriented to understand the variations of intensity across the season. The aim of this systematic review is to summarize the main evidence about the ACWR and training monotony variations over the season in professional soccer players. The search was made in PubMed, SPORTDiscus, and FECYT according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. From the 225 studies initially identified, 27 were fully reviewed, and their outcome measures were extracted and analyzed. Existing literature revealed a variety of designs, ACWR and training monotony ranges, variables assessed and durations of the studies. Overall, the range values for ACWR were 0.4–3.39 AU, while those focused on monotony were 0.49–5.7 AU. Regarding ACWR, the ratios located around 0.85–1.25 could predict lower risk values and ratios around ≥1.50 could predict higher risk values. On the contrary, with respect to training monotony, the ratios are approximately between 0.5 and 2.00 (low values in the preseason and low competition weeks and high values when soccer players are in highly scheduled competition weeks). Nevertheless, ACWR and training monotony methods should be addressed and considered based on their real value before using this indicator to reduce injury risk. In fact, the data did not conclusively define injured and non-injured players. For this reason, utilizing standardized approaches will allow for more precise conclusions about professional soccer players.
Vaccination has been widely implemented for mitigation of coronavirus disease-2019 (Covid-19), and by 11 November 2022, 701 million doses of the BNT162b2 mRNA vaccine (Pfizer-BioNTech) had been administered and linked with 971,021 reports of suspected adverse effects (SAEs) in the European Union/European Economic Area (EU/EEA).1 Vaccine vials with individual doses are supplied in batches with stringent quality control to ensure batch and dose uniformity.2 Clinical data on individual vaccine batch levels have not been reported and batch-dependent variation in the clinical efficacy and safety of authorized vaccines would appear to be highly unlikely. However, not least in view of the emergency use market authorization and rapid implementation of large-scale vaccination programs, the possibility of batch-dependent variation appears worthy of investigation. We therefore examined rates of SAEs between different BNT162b2 vaccine batches administered in Denmark (population 5.8 million) from 27 December 2020 to 11 January 2022. Data on all SAE cases with corresponding vaccine batch labels reported to the Danish Medical Agency (DKMA) and classified by the DKMA according to SAE seriousness, and numbers of BNT162b2 doses in individual vaccine batches registered by the Danish Serum Institute, respectively, are publicly available and were retrieved upon request. The DKMA-managed spontaneous SAE reporting system accepts reports of SAEs from any source, for example healthcare providers, patients and other members of the public. SAEs are assigned Medical Dictionary for Regulatory Activities (MedDRA) terms that do not necessarily correspond to verified medical diagnoses, and more than 1 SAE may be assigned to a report. SAE seriousness was classified as non-serious, serious (hospitalization or prolongation of existing hospitalization, life-threatening illness, permanent disability or congenital malformation) or SAE-related death respectively. The study relied exclusively on the secondary use of these anonymized data and was thus exempt from research ethics board review. SAEs were counted on a batch level by linking individual SAEs to the batch label(s) of BNT162b dose(s) that the subject had received. The total number of SAEs associated with each batch was divided by the number of doses in the batch to obtain the rate of SAEs per 1000 doses. Since the observed relationship between the numbers of SAEs and BNT162b2 vaccine doses was highly heterogeneous, conventional regression statistics were not considered to be applicable. Therefore, heterogeneity in the relationship between the numbers of SAEs and doses per vaccine batch was assessed by log-transformation followed by non-hierarchical cluster analysis and general linear model (GLM) test for differences in SAE rates between batches. Reporting of the study conforms to broad EQUATOR guidelines.3 A total of 7,835,280 doses were administered to 3,748,215 persons with the use of 52 different BNT162b2 vaccine batches (2340–814,320 doses per batch) and 43,496 SAEs were registered in 13,635 persons, equaling 3.19 ± 0.03 (mean ± SEM) SAEs per person. In each person, individual SAEs were associated with vaccine doses from 1.531 ± 0.004 batches resulting in a total of 66,587 SAEs distributed between the 52 batches. Batch labels were incompletely registered or missing for 7.11% of SAEs, leaving 61,847 batch-identifiable SAEs for further analysis of which 14,509 (23.5%) were classified as severe SAEs and 579 (0.9%) were SAE-related deaths. Unexpectedly, rates of SAEs per 1000 doses varied considerably between vaccine batches with 2.32 (0.09–3.59) (median [interquartile range]) SAEs per 1000 doses, and significant heterogeneity (p < .0001) was observed in the relationship between numbers of SAEs per 1000 doses and numbers of doses in the individual batches. Three predominant trendlines were discerned, with noticeable lower SAE rates in larger vaccine batches and additional batch-dependent heterogeneity in the distribution of SAE seriousness between the batches representing the three trendlines (Figure 1). Compared to the rates of all SAEs, serious SAEs and SAE-related deaths per 1.000 doses were much less frequent and numbers of these SAEs per 1000 doses displayed considerably greater variability between batches, with lesser separation between the three trendlines (not shown). The observed variation in SAE rates and seriousness between BTN162b2 vaccine batches in this nationwide study was contrary to the expected homogenous rate and distribution of SAEs between batches. In Denmark and other EU/EEA countries, vaccine quality is monitored according to Official Control Authority Batch Release (OCABR) guidelines and to our knowledge, potential differences in BNT162b2 vaccine batch clinical safety or effectiveness have not been reported previously, for example in pre-authorization trials and subsequent population-based studies.4, 5 Such effects may be easier to detect in small countries like Denmark where BNT162b2 vaccines during the study period were generally provided in several smaller batches. Also, regulatory monitoring and scientific interest in COVID-19 vaccine safety have primarily focused on serious adverse events, for example myocarditis.6 In any case, identification of such effects evidently requires that observed adverse events are linked with the respective individual batch labels and sizes (dose numbers). Previously, variation in the production (culture growth) of the Bacille Calmette-Guérin vaccine has been shown to influence important immunological effects of this vaccine,7 and two cases of myocarditis have been reported in two young males after receiving mRNA-1273 COVID-19 vaccine (Moderna) from the same vaccine batch on the same day.8 Indeed, variations (batch-to-batch, vial-to-vial and even dose-to-dose) in vaccines may occur as a result of variabilities and practice breaches in, for example vaccine manufacturing, storage, transportation, clinical handling and control aspects, and in 2021, three lots of the mRNA1273 vaccine totalling more than 1.6 million doses were recalled in Japan after 39 vials of the vaccine were found to contain foreign materials.9 Leaked and contested data have also suggested that some early commercial batches of the BNT162b2 vaccine contained lower than expected levels of intact mRNA.10 The present preliminary findings must be interpreted in the light of several limitations. The DKMA-managed spontaneous SAE reporting system in Denmark is a passive surveillance system akin to the Vaccine Adverse Event Reporting System (VAERS) in the US, and reports from these systems are subject to reporting biases, with potential for both under- and over-reporting, as well as incomplete data and variable quality of the reported information.11, 12 Owing to these inherent limitations, signals detected by these systems must be considered to be hypothesis-generating and generally cannot be used to establish causality.11-14 In addition, in the present study, the SAE case history of prior COVID-19 was unknown, and specific SAE types (MedDRA system organ class etc.), demographics of SAE cases, relationships of SAEs with consecutive vaccine doses in individuals cases, temporal trends in the observed batch-dependency of SAEs, and batch-dependent effects on vaccine effectiveness, respectively, were not examined. Notably, to our knowledge, the Danish Serum Institute has not issued recalls of BNT162b2 vaccine batches. In conclusion, the results suggest the existence of a batch-dependent safety signal for the BNT162b2 vaccine, and more studies are warranted to explore this preliminary observation and its consequences. None.
The aim of the present cross-sectional exploratory pilot study was to analyze the ability of the Phase Angle (PhA) to predict physical function, muscle strength and bone indicators, upon adjusting for potential confounders [age, sex, lean mass, and body mass index (BMI)]. This study included 56 physically independent older adults (age, 68.29 ± 3.01 years; BMI, 28.09 ± 4.37 kg/m2). A multi-frequency segmental bioelectrical impedance analysis was used to measure PhA at 50 KHz. Additionally, physical function was assessed through four functional capacity tests [30-sec chair-stand; seated medicine ball throw (SMBT); timed up & go; and 6-min walking test (6 MWT)], muscle strength through the handgrip test (dominant side) and maximal isokinetic strength of the dominant knee flexor and extensor. Moreover, bone indicators and body composition were assessed through the dual energy X-ray absorptiometry. PhA was significantly associated with SMBT (r = 0.375, effect size (ES) = moderate); 6 MWT (r = 0.396, ES = moderate); 30-sec chair-stand (rho = 0.314, ES = moderate); knee extension (rho = 0.566, ES = large) and flexion (r = 0.459, ES = moderate); handgrip (rho = 0.432, ES = moderate); whole-body bone mineral content (BMC) (r = 0.316, ES = moderate); femoral neck BMC (r = 0.469, ES = moderate); and femoral neck bone mineral density (BMD) (rho = 0.433, ES = moderate). Additionally, the results of multiple regression analysis demonstrated that PhA is significantly associated with SMBT (p < 0.001; R2 = 0.629), 6 MWT (p = 0.004; R2 = 0.214), knee extension (p < 0.001; R2 = 0.697), knee flexion (p < 0.001; R2 = 0.355), handgrip test (p < 0.001; R2 = 0.774), whole-body BMC (p < 0.001; R2 = 0.524), femoral neck BMC (p = 0.001; R2 = 0.249), and femoral neck BMD (p = 0.020; R2 = 0.153). The results of the preliminary analysis suggested that PhA is linked to muscle strength and some factors related to physical function and bone quality in community-dwelling older adults.
Refugees increasingly become part of the European societies. Afghans, Syrians, Ukrainians fled their countries due to war, conflicts, persecution, and settled, temporary or not, in more stable countries. During pandemics, with openness towards foreigners shrinking, and borders closing, the situation of refugees might become uncertain. Our scoping review explores what academics considered relevant about refugees to Europe in relation to the COVID-19 pandemic. The findings reveal increasing resentment against immigrants, a need for redesigning European migration policies, preparing welfare systems, asylum protection mechanisms, and societies as a whole, in order to prevent disruptions in the eventuality of large-scale crises. Such implications are to also be considered for the consequences of the current Russian aggression on Ukraine.
