Sex as a moderator of the sleep and cognition relationship in middle-aged and older adults: A preliminary investigation.

OBJECTIVES: Despite known sex differences in the prevalence of sleep disturbance and cognitive impairment, research investigating sex differences in sleep/cognition associations is limited. We examined sex as a moderator of associations between self-reported sleep and objective cognition in middle-aged/older adults. METHODS: Adults aged 50+ (32 men/31 women, Mage = 63.6 ± 7.7) completed the Pittsburgh Sleep Quality Index (PSQI) and cognitive tasks: Stroop (processing speed, inhibition), Posner (spatial attentional orienting) and Sternberg (working memory). Multiple regressions examined whether PSQI metrics (global score, sleep quality ratings, sleep duration, sleep efficiency) were independently or interactively (with sex) associated with cognition, controlling for age and education. RESULTS: Sex interacted with sleep quality ratings in its association with endogenous spatial attentional orienting (∆R2 = .10, p = .01). Worse ratings of sleep quality were associated with worse orienting in women (B = 22.73, SE = 9.53, p = .02), not men (p = .24). Sex interacted with sleep efficiency in its associations with processing speed (∆R2 = .06, p = .04). Lower sleep efficiency was associated with slower Stroop control trial performance in women (B = -15.91, SE = 7.57, p = .04), not men (p = .48). CONCLUSIONS: Preliminary findings suggest middle-aged/older women are more vulnerable to associations between poor sleep quality and low sleep efficiency on spatial attentional orienting and processing speed, respectively. Future studies in larger samples investigating sex-specific prospective sleep and cognition associations are warranted.

Implementation of entrustable professional activities in multiple surgical residencies: A quality improvement approach.

BACKGROUND: The COVID-19 pandemic decreased the operative case volume for surgical residents. Our institution implemented Entrustable Professional Activities (EPAs) in all core surgical training programs to document the competency of graduating residents. Continuation of this project aimed to improve implementation. METHODS: This project occurred at a large academic center with eight surgical specialties during the 2020-21 (Year 1) and 2021-22 (Year 2) academic years. Each specialty chose five EPAs, and residents were asked to obtain three micro-assessments per EPA. After the initial pilot year, program directors were surveyed regarding perceptions of EPA utility and barriers to implementation. RESULTS: Seventy senior residents completed 732/906 (80.8%) micro-assessments. Of these, 99.6% were deemed practice ready. Total micro-assessment completion rates in four specialties, four specific EPAs (including one EPA identified "at risk" due to the COVID-19 pandemic), and overall were significantly higher in Year 2 than Year 1 (p â€‹< â€‹0.05) CONCLUSIONS: Implementing EPAs in all core surgical specialties at an institution is achievable, though expectedly initially imperfect. An ongoing quality collaborative initiative focused on barriers to implementation can improve completion rates.

Multiple propane gas burn rates procedure to determine accuracy and linearity of indirect calorimetry systems: an experimental assessment of a method.

Objective: Indirect calorimetry (IC) systems measure the fractions of expired carbon dioxide (FeCO2), and oxygen (FeO2) recorded at the mouth to estimate whole-body energy production. The fundamental principle of IC relates to the catabolism of high-energy substrates such as carbohydrates and lipids to meet the body's energy needs through the oxidative process, which are reflected in the measured oxygen uptake rates (V̇O2) and carbon dioxide production rates (V̇CO2). Accordingly, it is important to know the accuracy and validity of V̇O2and V̇CO2 measurements when estimating energy production and substrate partitioning for research and clinical purposes. Although several techniques are readily available to assess the accuracy of IC systems at a single point for V̇CO2 and V̇O2, the validity of such procedures is limited when used in testing protocols that incorporate a wide range of energy production (e.g., basal metabolic rate and maximal exercise testing). Accordingly, we built an apparatus that allowed us to manipulate propane burn rates in such a way as to assess the linearity of IC systems. This technical report aimed to assess the accuracy and linearity of three IC systems using our in-house built validation procedure. Approach: A series of trials at different propane burn rates (PBR) (i.e., 200, 300, 400, 500, and 600 mL min-1) were run on three IC systems: Sable, Moxus, and Oxycon Pro. The experimental values for V̇O2 and V̇CO2 measured on the three IC systems were compared to theoretical stoichiometry values. Results: A linear relationship was observed between increasing PBR and measured values for V̇O2and V̇CO2 (99.6%, 99.2%, 94.8% for the Sable, Moxus, and Jaeger IC systems, respectively). In terms of system error, the Jaeger system had significantly (p < 0.001) greater V̇O2(mean difference (M) = -0.057, standard error (SE) = 0.004), and V̇CO2(M = -0.048, SE = 0.002) error compared to either the Sable (V̇O2, M = 0.044, SE = 0.004; V̇CO2, M = 0.024, SE = 0.002) or the Moxus (V̇O2, M = 0.046, SE = 0.004; V̇CO2, M = 0.025, SE = 0.002) IC systems. There were no significant differences between the Sable or Moxus IC systems. Conclusion: The multiple PBR approach permitted the assessment of linearity of IC systems in addition to determining the accuracy of fractions of expired gases.

Changes in muscle activity during the flexion and extension phases of arm cycling as an effect of power output are muscle-specific.

Arm cycling is commonly used in rehabilitation settings for individuals with motor impairments in an attempt to facilitate neural plasticity, potentially leading to enhanced motor function in the affected limb(s). Studies examining the neural control of arm cycling, however, typically cycle using a set cadence and power output. Given the importance of motor output intensity, typically represented by the amplitude of electromyographic (EMG) activity, on neural excitability, surprisingly little is known about how arm muscle activity is modulated using relative workloads. Thus, the objective of this study was to characterize arm muscle activity during arm cycling at different relative workloads. Participants (n = 11) first completed a 10-second maximal arm ergometry sprint to determine peak power output (PPO) followed by 11 randomized trials of 20-second arm cycling bouts ranging from 5-50% of PPO (5% increments) and a standard 25 W workload. All submaximal trials were completed at 60 rpm. Integrated EMG amplitude (iEMG) was assessed from the biceps brachii, brachioradialis, triceps brachii, flexor carpi radialis, extensor carpi radialis and anterior deltoid of the dominant arm. Arm cycling was separated into two phases, flexion and extension, relative to the elbow joint for all comparisons. As expected, iEMG amplitude increased during both phases of cycling for all muscles examined. With the exception of the triceps brachii and extensor carpi radialis, iEMG amplitudes differed between the flexion and extension phases. Finally, there was a linear relationship between iEMG amplitude and the %PPO for all muscles during both elbow flexion and extension.

University-based physical literacy programming for children: Canadian community stakeholders' recommendations.

'Physical literacy' (PL) education-that is, teaching foundational skills, attitudes, behaviors and knowledge about lifelong involvements in physical activities, is an important aspect for health promotion among children. Universities have been playing a critical role by teaching future PL professionals. Additionally, various universities have offered university-based PL programming for neighborhood children as a way of public health promotion service and community engagement. However, this additional role of universities and the ways of promoting the quality of this type of health promotion service programming have not been investigated in the current research literature. Therefore, the purpose of this study was to identify the practicable strategies to enhance the quality of university-based PL programming for children from the perspectives of community stakeholders. Overall, 24 community stakeholders who held professional positions that are related to PL education participated in a 90-min focus group interview. This grounded theory study identified that university-based PL programming for children should be (i) inclusive, (ii) collaborative, (iii) welcoming and (iv) responsive. Practical suggestions and recommendations were also provided. This study has provided empirical knowledge to prioritize aspects for the future actions in planning and implementing university-based PL programming for children and informed for further cross-cultural comparisons amongst the perspectives of participants, university service providers and community stakeholders. The knowledge acquired from this research will also be translated to university service providers who operate similar type of health promotion service programming to the public.

Upper and lower body responses to repeated cyclical sprints.

PURPOSE: To compare the physiological and perceptual responses of the upper and lower body to all-out cyclical sprints with short or long rest periods between sprints. METHODS: Ten recreationally trained males completed four 10 × 10 s sprint protocols in a randomized order: upper body with 30 s and 180 s of rest between sprints, and lower body with 30 s and 180 s of rest between sprints. Additionally, maximum voluntary contractions (MVC) were measured at pre-sprint and post-sprints 5 and 10. Normalized (% of first sprint) peak power, MVC, heart rate (HR) and rating of perceived exertion (RPE) were compared between upper and lower body within the same recovery period, and absolute values (Watts, bpm, RPE scores) were compared within the same body part and between recovery periods. RESULTS: Trivial differences were identified in normalized peak power, HR and RPE values between the upper and lower body in both recovery conditions (<2%, d ≤ 0.1), but MVC forces were better maintained with the upper body (∼9.5%, d = 1.0) in both recovery conditions. Absolute peak power was lower (∼147 Watts, d = 1.3), and HR was higher (∼10 bpm, d = 0.73) in the 30 s compared to 180 s condition in both the upper and lower body whereas RPE scores were similar (<0.6 RPE units, d ≤ 0.1). Despite the reductions in peak power, MVC forces were better maintained in the 30 s condition in both upper (2.5 kg, d = 0.4) and lower (7.5 kg, d = 0.7) body. CONCLUSIONS: Completing a commonly used repeated sprint protocol with the upper and lower body results in comparable normalized physiological and perceptual responses.

Smoking and alcohol consumption patterns among elderly Canadians with mobility disabilities.

BACKGROUND: Mobility disability is a major adverse health outcome associated with aging and an impediment to older adults' well-being and behaviors in social and leisure activities. It has been shown that lifestyle factors, including smoking and alcohol consumption, have been used as coping strategies to deal with the negative impact of disability. The aim of this study was to determine the prevalence of smoking and alcohol consumption among older Canadians with different levels of mobility disabilities and to examine factors associated with these two lifestyle patterns among those with disabilities. METHODS: Secondary data analysis was performed using individuals (n = 6,038) aged 65 years and older from both the 2001 Participation and Activity Limitation Survey and the 2003 Canadian Community Health Survey. Multivariate logistic regressions examined the relationship between disability severity and smoking as well as alcohol consumption while controlling for potential confounding socioeconomic factors. RESULTS: The proportion of current smokers among seniors with less-severe and more-severe mobility disabilities and those in the general population was comparable with 12.55%, 11.57% and 11.93%, respectively. Forty-eight percent of seniors in the general population consumed alcohol regularly, compared to only 12.85% with more-severe mobility disabilities. No significant association was shown between the severity level of mobility disabilities and smoking (odds ratio = 0.90, 95% confidence interval: 0.75, 1.08). However, seniors having more-severe disability were less likely to consume alcohol regularly (odds ratio = 0.76, 95% confidence interval: 0.65, 0.89). Other variables including age, gender, income, living status, and social participation also impacted these lifestyle patterns among the study population. CONCLUSIONS: Smoking and alcohol patterns present different associations with the severity level of mobility disabilities. Compared with the general population, elderly Canadians with mobility disabilities had similar smoking prevalence but differ significantly in terms of alcohol consumption. Results from this research will be relevant to decision makers involved in program planning, health education, and policy development as it pertains to the prevention and management of age-related disability.

Economic evaluation of arthritis self management in primary care.

OBJECTIVE: To assess the cost effectiveness of a self management programme plus education booklet for arthritis in primary care. DESIGN: Cost effectiveness and cost utility analysis from health and social care and societal perspectives alongside a randomised controlled trial. SETTING: 74 general practices in the United Kingdom. PARTICIPANTS: 812 patients aged 50 or more with osteoarthritis of the hips or knees, or both, and pain or disability, or both. INTERVENTIONS: Randomisation to either six sessions of an arthritis self management programme plus an education booklet (intervention group) or the education booklet alone (standard care control group). MAIN OUTCOME MEASURES: Total health and social care costs and total societal costs at 12 months; cost effectiveness (incremental cost effectiveness ratios and cost effectiveness acceptability curves) on basis of quality of life (SF-36, primary outcome measure), EuroQol visual analogue scale, and quality adjusted life years (QALYs). RESULTS: At 12 months health and social care costs in the intervention group were pound101 higher (95% confidence interval pound3 to pound176) than those in the control group because the additional costs of the arthritis self management programme did not seem to be fully offset by savings elsewhere. There were no significant differences in societal costs (which were up to 13 times the size of health and social care costs) or any of the outcomes. From the health and social care perspective the intervention was dominated by the control on the basis of QALYs (which were non-significantly lower in the intervention group) and had incremental cost effectiveness ratios between pound279 and pound13 473 for the other outcomes. From the societal perspective the intervention seemed superior to the control owing to non-significantly lower costs and non-significantly better outcomes on all measures except QALYs. Probabilities of the arthritis self management programme's cost effectiveness ranged between 12% and 97% (for thresholds ranging pound0 to pound1000) based on one point improvements in SF-36 outcomes, but the clinical significance of this is debatable. Probabilities of cost effectiveness on the basis of the visual analogue scale and QALYs were low. CONCLUSIONS: Cost effectiveness of an arthritis self management programme is not suggested on the basis of current National Institute for Health and Clinical Excellence cost perspectives and QALY thresholds. The probability of cost effectiveness is greater when broader costs and other quality of life outcomes are considered. These results suggest that the cost effectiveness of the Department of Health's expert patients programme cannot be assumed across all clinical conditions and that further rigorous evaluations for other conditions may be needed. TRIAL REGISTRATION: Current Controlled Trials ISRCTN79115352.

Self management of arthritis in primary care: randomised controlled trial.

OBJECTIVE: To evaluate clinical effectiveness of a self management programme for arthritis in patients in primary care with osteoarthritis. DESIGN: Randomised controlled trial. SETTING: 74 general practices in the United Kingdom. PARTICIPANTS: 812 patients aged 50 and over with osteoarthritis of hips or knees (or both) and pain or disability (or both). INTERVENTION: Participants were randomised to six sessions of self management of arthritis and an education booklet (intervention group) or the education booklet alone (control group). MAIN OUTCOME MEASURES: Primary outcome was quality of life, as assessed by the short form health survey (SF-36). Several other physical and psychosocial secondary outcomes were assessed. Data were collected at baseline, four months, and 12 months. RESULTS: Response rates were 80% and 76% at four and 12 months. The two groups showed significant differences at 12 months on the anxiety subscore of the hospital anxiety and depression scale (mean difference -0.62, 95% confidence interval -1.08 to -0.16), arthritis self efficacy scale for pain (0.98, 0.07 to 1.89), and self efficacy for other aspects of management (1.58, 0.25 to 2.90). Results were similar for intention to treat and per protocol analyses. No significant difference was seen in number of visits to the general practitioner at 12 months. CONCLUSIONS: The self management of arthritis programme reduced anxiety and improved participants' perceived self efficacy to manage symptoms, but it had no significant effect on pain, physical functioning, or contact with primary care. TRIAL REGISTRATION: Current Controlled Trials ISRCTN79115352 [controlled-trials.com].

Association between seclusion and restraint and patient-related violence.

This study assessed the effect of an intervention designed to reduce the use of seclusion and restraint on reported episodes of patient-related violence on an acute inpatient psychiatric service. Results showed a significant decrease in the total number of episodes of seclusion and restraint between the 12 months before and after the intervention. However, the number of episodes of assault on patients and staff increased significantly. Efforts to decrease seclusion and restraint may be accompanied by an increased risk of harm to psychiatric patients and staff, and intensive safety monitoring and staff training should accompany all such efforts.