Learning and Developing Individual Exercise Skills (L.A.D.I.E.S.) for a Better Life: A Church-Based Physical Activity Intervention - Baseline Participant Characteristics.

OBJECTIVE: Physical activity (PA) is beneficial for health, yet most African American women do not achieve recommended levels. Successful, sustainable strategies could help to address disparities in health outcomes associated with low levels of PA. The Learning and Developing Individual Exercise Skills (L.A.D.I.E.S.) for a Better Life study compared a faith-based and a secular intervention for increasing PA with a self-guided control group. DESIGN SETTING AND PARTICIPANTS: This cluster randomized, controlled trial was conducted from 2010 - 2011 in African American churches (n=31) in suburban North Carolina. Participants were 469 self-identified low active African American women. MEASURES: Baseline data were collected on participant demographics, objective and self-reported PA, and constructs related to social ecological theory and social cognitive theory. RESULTS: Complete baseline data were available for 417 participants who were aged 51.4 ± 12.9 years, with average BMI (kg/m2) 35.8 ± 9.9; 73% of participants were obese (BMI >30). Participants averaged 3,990 ± 1,828 pedometer-assessed daily steps and 23.9 ± 37.7 accelerometer-assessed minutes of daily moderate-to-vigorous PA, and self-reported 25.4 ± 45.4 minutes of weekly walking and moderate- and vigorous-intensity PA. Baseline self-reported religiosity and social support were high. CONCLUSIONS: L.A.D.I.E.S. is one of the largest PA trials focused on individual behavior change in African American women. Baseline characteristics suggest participants are representative of the general population. Findings from the study will contribute toward understanding appropriate strategies for increasing PA in high-risk populations.

Increasing Physical Activity in Black Women: Results from a Randomized Trial Conducted in Faith-Based Settings.

Objective: The Learning and Developing Individual Exercise Skills (L.A.D.I.E.S.) for a Better Life study compared a faith-integrated (FI) and a secular (SEC) intervention for increasing physical activity with a self-guided (SG) control group among African American women. Design/Setting/Participants: L.A.D.I.E.S. was a cluster randomized, controlled trial. Churches (n=31) were randomized and women within each church (n=12 - 15) received the same intervention. Interventions: FI and SEC participants received 24 group-based sessions, delivered over 10 months. SG participants received printed materials to review independently for 10 months. Participants were followed for 12-months post-intervention to assess long-term intervention impact. Main Outcome Measures: Data on participant characteristics, physical activity, and intervention-related constructs were collected at baseline, 10 months, and 22 months. Results: Intervention session attendance was greater for FI compared with SEC participants (15.7 + 5.7 vs 12.4 + 7.3 sessions, respectively, P<.01). After 10 months, FI and SEC participants significantly increased daily walking (+1,451 and +1,107 steps/day, respectively) compared with SG participants (-128 steps/day). Increases were maintained after 22 months in the FI group compared with the SG group (+1092 vs. +336 daily steps, P<.01). Between-group changes in accelerometer-assessed physical activity were not statistically significant at any time point. Conclusions: The FI intervention is a feasible strategy for short- and long-term increases in physical activity among African American women. Additional dissemination and evaluation of the strategy could be useful for reducing chronic disease in this high-risk population.

Integrating Sonography Training Into Undergraduate Medical Education: A Study of the Previous Exposure of One Institution's Incoming Residents.

OBJECTIVES: Sonography is a crucial and versatile tool within the field of medicine. Recent advancements in technology have led to increased use of point-of-care sonography. We designed a survey to assess prior point-of-care sonography training among incoming interns at an academic teaching hospital. METHODS: In 2012 and 2013, we surveyed incoming interns (n = 154 and 145, respectively) regarding point-of-care sonography training received during medical school. The survey questions included formal didactic sessions, bedside instruction, and the use of simulation technology. RESULTS: One-fourth (26.3% in 2012 and 23.4% in 2013) of responding interns reported having never done an ultrasound scan at the bedside. In 2012 and 2013, 55.0% and 55.6% of respondents reported never having done an ultrasound scan in a simulation center, respectively. Interns agreed that sonography education should be provided during medical school. On average, interns disagreed with the statement that sonography should be taught in residency only. There was no significant difference in the sex or general previous experience with sonography across both intern classes. CONCLUSIONS: Point-of-care sonography is inconsistently taught in medical school. The interns in our study also thought that sonography education should begin in medical school, and sonography should be taught by using simulation and at the bedside.

The impact of a total hip replacement on jaw position, upper body posture and body sway.

OBJECTIVES: The purpose of this study was to examine whether, and to what extent, a total hip replacement can influence the position and the movement of the jaw, the upper body posture and body sway. METHODS: Twenty test subjects (6 females, 14 males) participated in this study pre- and post-total hip replacement, in addition to a healthy control group of 20 subjects (5 females, 15 males). The measurements were conducted by means of an ultrasound system to measure jaw condyle position and movement of the lower jaw, a three-dimensional back scan to analyze upper back posture, and a static and dynamic force plate to measure body sway. For statistical analysis the Wilcoxon-Matched-Pairs-Test or Man-Whitney-U-Test, including a Bonferroni-Holm correction, respectively, was used. RESULTS: After surgery, the mean values of the left and right jaw condyles of the test group moved posterior, and the left condyle position was located more caudally. There were no significant differences concerning the jaw position between the two groups. There was little change in upper body posture in both groups. The test group had a more anteriorly inclined thoracic spine and a less pronounced lumbar lordosis. During static body sway measurements, increased fluctuations in the test group after surgery could be seen. CONCLUSION: Differences between both groups in the pre- and post-surgical condition could be detected. These differences were more prominent when the measured body segments were more distally located with respect to the hip region.

Scaling maximal oxygen uptake to predict performance in elite-standard men cross-country skiers.

The purpose of this study was to: 1) establish the optimal body-mass exponent for maximal oxygen uptake (VO(2)max) to indicate performance in elite-standard men cross-country skiers; and 2) evaluate the influence of course inclination on the body-mass exponent. Twelve elite-standard men skiers completed an incremental treadmill roller-skiing test to determine VO(2)max and performance data came from the 2008 Swedish National Championship 15-km classic-technique race. Log-transformation of power-function models was used to predict skiing speeds. The optimal models were found to be: Race speed = 7.86 · VO(2)max · m(-0.48) and Section speed = 5.96 · [VO(2)max · m(-(0.38 + 0.03 · α)) · e(-0.003 · Δ) (where m is body mass, α is the section's inclination and Δ is the altitude difference of the previous section), that explained 68% and 84% of the variance in skiing speed, respectively. A body-mass exponent of 0.48 (95% confidence interval: 0.19 to 0.77) best described VO(2)max as an indicator of performance in elite-standard men skiers. The confidence interval did not support the use of either "1" (simple ratio-standard scaled) or "0" (absolute expression) as body-mass exponents for expressing VO(2)max as an indicator of performance. Moreover, results suggest that course inclination increases the body-mass exponent for VO(2)max.

Weight gain prevention among black women in the rural community health center setting: the Shape Program.

BACKGROUND: Nearly 60% of black women are obese. Despite their increased risk of obesity and associated chronic diseases, black women have been underrepresented in clinical trials of weight loss interventions, particularly those conducted in the primary care setting. Further, existing obesity treatments are less effective for this population. The promotion of weight maintenance can be achieved at lower treatment intensity than can weight loss and holds promise in reducing obesity-associated chronic disease risk. Weight gain prevention may also be more consistent with the obesity-related sociocultural perspectives of black women than are traditional weight loss approaches. METHODS/DESIGN: We conducted an 18-month randomized controlled trial (the Shape Program) of a weight gain prevention intervention for overweight black female patients in the primary care setting. Participants include 194 premenopausal black women aged 25 to 44 years with a BMI of 25-34.9 kg/m2. Participants were randomized either to usual care or to a 12-month intervention that consisted of: tailored obesogenic behavior change goals, self-monitoring via interactive voice response phone calls, tailored skills training materials, 12 counseling calls with a registered dietitian and a 12-month YMCA membership.Participants are followed over 18 months, with study visits at baseline, 6-, 12- and 18-months. Anthropometric data, blood pressure, fasting lipids, fasting glucose, and self-administered surveys are collected at each visit. Accelerometer data is collected at baseline and 12-months.At baseline, participants were an average of 35.4 years old with a mean body mass index of 30.2 kg/m2. Participants were mostly employed and low-income. Almost half of the sample reported a diagnosis of hypertension or prehypertension and 12% reported a diagnosis of diabetes or prediabetes. Almost one-third of participants smoked and over 20% scored above the clinical threshold for depression. DISCUSSION: The Shape Program utilizes an innovative intervention approach to lower the risk of obesity and obesity-associated chronic disease among black women in the primary care setting. The intervention was informed by behavior change theory and aims to prevent weight gain using inexpensive mobile technologies and existing health center resources. Baseline characteristics reflect a socioeconomically disadvantaged, high-risk population sample in need of evidence-based treatment strategies. TRIAL REGISTRATION: The trial is registered with clinicaltrials.gov NCT00938535.

The impact of a total knee arthroplasty on jaw movements, upper body posture, plantar pressure distribution, and postural control.

Objective: The purpose of this study was to examine the influence of a total knee arthroplasty (TKA) on linked cranial and caudal structures. Methods: Thirty-five (14f/21m) subjects participated in this study: 15 subjects (9f, 6m) pre- and post- TKA and a control group of 20 subjects (5f, 15m). The measurements included: jaw condyle position and movement, back scan, plantar pressure distribution, and body sway. Results: There were no significant differences in electronic position analysis of the jaw; however, the protrusion of the TKA group improved (p = 0.001). The test group had a more anteriorly inclined thoracic spine and a less pronounced lumbar lordosis. Before and after surgery, the body sway in the test group was larger. Conclusion: The TKA affected most prominently the static mechanisms of the postural control and the spine position. The trajectories of the mandible during protrusion also changed slightly.

Upper body power as a determinant of classical cross-country ski performance.

The purpose of this study was to evaluate the relationship between short (< or =60 s) and long duration (4-12 min) measures of upper body power (UBP) and mass start classical cross-country ski performance. Several experienced skiers (eight men, five women) completed three separate tests of UBP on a double poling ergometer: two tests of highest average power output for 10 s (UBP(10)) and 60 s (UBP(60)), and an incremental test to exhaustion to measure peak oxygen uptake (VO(2PEAK)) and peak power output (UBP(PEAK)). Lastly, subjects competed in a 10-km classical cross-country ski race from which race speed (RS) was computed. RS correlated highly with UBP(10) (r = 0.93; P < 0.05), UBP(60) (r = 0.92; P < 0.05), and UBP(PEAK) (r = 0.94; P < 0.05); the correlation was lower but still significant for VO(2PEAK) (r = 0.88; P < 0.05). These findings suggest that both short and long duration measures of UBP are important determinants of mass start classical ski race performance.

The Energy Expenditure of Tinikling: A Culturally Relevant Filipino Dance.

Filipino Americans have higher risks for developing cardiovascular disease than many other U.S. minority groups and Caucasians. As a precursor to developing a culturally-relevant physical activity (PA) intervention targeting high-risk Filipino Americans, this study sought to evaluate the energy cost and intensity of Tinikling, or bamboo dance, a popular type of Philippine folk dance. These energy cost values were directly compared to the moderate-to-vigorous PA (MVPA) cut-points commonly used to define the PA guidelines. Twenty-two pairs of Filipino American adults performed five minutes of continuous Tinikling dance to a three-count rhythm and standardized music. Each dancer wore a portable metabolic system to directly assess the oxygen uptake from the last two minutes of dancing. These metabolic data were then transformed to units of metabolic equivalents (METs). Mean METs for all dancers (Mean ± SD; 6.9 ± 1.4 METs; P<0.001), as well as for women (6.9 ± 1.3 METs; P<0.001) and men analyzed separately (7.0 ± 1.0 METs; P<0.001), were significantly higher than both 3.0 and 6.0 MET MVPA cut-points. These results support the use of Tinikling dance with Filipino American adults as a PA intervention tool in future studies, as well as a means to satisfy the guidelines for prescribed weekly PA.

A Faith-Integrated Physical Activity Intervention and Cardiometabolic Risk in African American Women.

PURPOSE: To determine the effects of a 10-month secular (SEC) versus faith-integrated (FI) community-based physical activity (PA) intervention on cardiometabolic risk factors in low active, African-American women. METHODS: Participants (age: 55.4±11.6 years; body mass index (BMI): 36.0±7.9 kg/m2; average baseline steps/day: 3,807±1,250) from a larger study (n=418) participated in a sub-study to measure cardiometabolic disease indicators (primary outcomes) and PA (secondary outcomes) pre- and post-intervention (SEC: n=42; FI: n=43). Height, weight, waist and hip circumferences, resting blood pressure, hemoglobin A1c, average steps/day, sedentary behavior, light-intensity physical activity (LPA), and moderate-to-vigorous-intensity physical activity (MVPA) were acquired at baseline and 10 months. Multivariate generalized linear mixed models that included churches as a random effect were used to compare mean changes in outcomes at 10 months between the two study groups (α=0.05). RESULTS: The FI group showed significant time effects for weight (93.4±2.4 to 92.2±2.3 kg), BMI (35.7±1.0 to 35.3±1.0 kg/m2), and waist circumference (106.9±2.2 to 103.8±2.5 cm), while the SEC group had a significant time effect for hip circumference (121.6±1.9 to 119.9±1.7 cm). There were no time effects in either group for blood pressure, hemoglobin A1c, steps/day, sedentary time, or MVPA. FI significantly decreased LPA in both 1-minute activity bouts (641±13 to 588±16 minutes/day) and 10-minute bouts (536±11 to 479±15 minutes/day). There were no significant differences between SEC and FI for any variable. CONCLUSIONS: The improvements in body weight, BMI, and waist circumference shown after the FI intervention could have long-term implications on cardiometabolic health, particularly if exercise is continued. Further research is needed to examine the effects of culturally-relevant interventions on chronic disease indicators in African-American women, particularly those established as high risk for cardiometabolic disease.

Pilot study of a faith-based physical activity program among sedentary blacks.

INTRODUCTION: Physical activity participation is low among blacks, and strategies are needed to successfully create immediate and sustained behavior change related to physical activity. Churches can play an important role in health promotion efforts among blacks because of their central role in spiritual guidance, communication, social support, and networking. This pilot study evaluated the feasibility and acceptability of implementing a physical activity program for sedentary black adults in churches. METHODS: We used a preintervention/postintervention single-group design to evaluate the effect of a 3-month faith-based physical activity intervention on daily walking and moderate- and vigorous-intensity physical activity among sedentary blacks. Eighty-seven black adults participated in eight group sessions that included discussion of physical activity-related topics, an instructor-led physical activity session, and weekly incentives to promote physical activity. We used a questionnaire to assess moderate and vigorous physical activity in minutes per week at baseline and after 3 months. Walking was assessed weekly in steps per day by using a pedometer. RESULTS: Participants (mean age, 52 yrs; mean body mass index, 35 kg/m(2)) reported 27 +/- 54 and 10 +/- 25 minutes per week in moderate-intensity and vigorous-intensity physical activity, respectively, and walked 4822 +/- 2351 steps per day at baseline. After 12 weeks, moderate- and vigorous-intensity physical activity increased by 67 +/- 78 and 44 +/- 66 minutes per week, respectively (P

Associations of vitamin D status with markers of metabolic health: A community-based study in Shanghai, China.

AIMS: This study investigated the associations of vitamin D status (i.e., serum 25(OH)D concentration) with markers of metabolic health and metabolic syndrome (MS), as well as possible gender differences in these associations, with metabolic syndrome (MS) for a sample from Shanghai, China. METHODS: Demographic and anthropometric data, as well as 25-hydroxyvitamin D (serum 25(OH)D), blood glucose, and lipid concentrations were obtained for 508 urban residents aged 19-70 years. After grouping into tertiles according to their serum 25(OH)D concentrations, linear and logistic regressions were used to evaluate associations between serum 25(OH)D concentration and risk factors for MS across tertiles. RESULTS: A 1 ng/mL increase in 25(OH)D was associated with a significant decrease in total cholesterol by 0.25 mmol/L [95% CI: (-0.44, -0.05); P = 0.014] for the third tertile, with reference to the first tertile. Also, 1 ng/mL increase in 25(OH)D was associated with a significant decrease in LDL by 0.18 mmol/L [95% CI: (-0.35, -0.02); P = 0.026] for the third tertile. In addition, participants in the third tertile had a 54% reduction in the OR for MS [95% CI: (-1.10,- 0.02), P = 0.041]. Lastly, while there was no gender difference in vitamin D deficiency status, the non-MS women had significantly higher 25(OH)D level than those with MS (30.1 ±â€¯5.8 vs. 28.5 ±â€¯5.9 ng/mL, P = 0.035), while no such difference was observed for men. CONCLUSIONS: Higher serum 25(OH)D concentration was associated with a better metabolic profile and thus a lower risk for developing MS in urban Shanghai residents of China.

Characterizing the Aerobic and Anaerobic Energy Costs of Polynesian Dances.

This study characterized both aerobic and anaerobic energy expenditure (EE) for several Polynesian dances in a group of experienced professional Polynesian dancers. Thirteen men and 17 women were tested using indirect calorimetry to assess aerobic EE (and converted to METs), and fingertip blood lactate to estimate anaerobic EE, during both resting and dancing activities. Total EE was then computed as the sum of both aerobic and anaerobic activity energy expenditure (AEE, or EE above resting). One sample t-tests compared mean MET values for each type of dance to the 3-MET and 6-MET thresholds for moderate and vigorous physical activity (MVPA), respectively. Mean MET values for all dances, except the Maori poi balls dance (Mean±SD: 3.7±1.1 METs; P=0.340), were significantly >3.0 METs (5.9±3.1 METS; P=0.005 for Maori haka; 6.5±2.4 METs for Hawaiian hula; 6.6±1.2 METs for Samoan sasa; 9.6±1.5 METs for Samoan slap; 8.3±1.8 METs for Tahitian; 6.0±2.3 METs for Tongan; 7.0±2.6 METs for Fijian; P<0.001). Mean METs for Samoan slap and Tahitian were also significantly >6.0 METs (P=0.002 and P<0.001, respectively). Aerobic and anaerobic AEE contributed an average of 83.4% and 16.6%, respectively, across all Polynesian dances, with Hawaiian hula being the most aerobic (88.7%) and Samoan slap being the least aerobic (74.2%). Thus, the Polynesian dances tested not only met the current MVPA intensity guidelines (i.e., ≥3.0 METs), each dance also had a large anaerobic EE. These data suggest that Polynesian dancing is an appropriate mode of aerobic exercise for health promotion and disease prevention.

Feasibility and outcomes of an out-of-school and home-based obesity prevention pilot study for rural children on an American Indian reservation.

BACKGROUND: Children living in rural areas are at higher risk for obesity compared to urban children, and Native American (NA) children have the highest prevalence of overweight/obesity for all races combined. Out-of-school programs (OOSPs) are a promising setting to improve children's health. Parents are important in supporting their child's obesity-related behaviors, yet it remains unclear what combination and dose of parent engagement strategies is feasible and optimal. This study's primary objective was to assess the feasibility of an OOSP and home-based obesity prevention intervention for rural NA and non-NA children. METHODS: This was an 11-week, two group, randomized feasibility study. Participants were children and their parents at one OOSP on a rural American Indian reservation. Children, ages 6-9, were randomized to receive the Generations Health (GH) intervention or comparison condition. The GH group received daily activities focused on physical activity (PA), nutrition, sleep, and reducing TV/screen time, and frequently engaged parents. The comparison group received usual OOSP activities. To assess intervention feasibility, we measured recruitment and participation rates and program satisfaction. We assessed pre- to posttest changes in body composition, PA and sleep patterns, dietary intake and Healthy Eating Index-2010 (HEI-2010) scores, TV/screen time, and nutrition knowledge. We report recruitment and participation rates as percentages and participants' program satisfaction as means. Two-tailed paired t tests and 95% confidence intervals were used to detect changes in behavioral and health outcome variables. RESULTS: Forty-six children met age eligibility criteria; following screening, 52% (24/46) met the inclusion criteria and 96% (23/24) were randomized to the study. Overall, 91% of the children participated in the intervention and 100% participated in at least some of the posttest assessments. Parents reported high program satisfaction (mean rating of 4, on a 1-5 scale). Our outcome measure for child adiposity, zBMI, was reduced by 0.15 in the GH group, but increased by 0.13 in the comparison condition. Meaningful changes were evident for total kilocalories, HEI-2010 scores, PA, TV/screen time, and nutrition knowledge. CONCLUSIONS: High recruitment, participation and program satisfaction and positive health and behavioral outcomes at 11 weeks provide encouraging indications of the feasibility and potential effectiveness of the intervention. TRIAL REGISTRATION: ISRCTN24274245.

A reverse signaling pathway downstream of Sema4A controls cell migration via Scrib.

Semaphorins comprise a large family of ligands that regulate key cellular functions through their receptors, plexins. In this study, we show that the transmembrane semaphorin 4A (Sema4A) can also function as a receptor, rather than a ligand, and transduce signals triggered by the binding of Plexin-B1 through reverse signaling. Functionally, reverse Sema4A signaling regulates the migration of various cancer cells as well as dendritic cells. By combining mass spectrometry analysis with small interfering RNA screening, we identify the polarity protein Scrib as a downstream effector of Sema4A. We further show that binding of Plexin-B1 to Sema4A promotes the interaction of Sema4A with Scrib, thereby removing Scrib from its complex with the Rac/Cdc42 exchange factor ßPIX and decreasing the activity of the small guanosine triphosphatase Rac1 and Cdc42. Our data unravel a role for Plexin-B1 as a ligand and Sema4A as a receptor and characterize a reverse signaling pathway downstream of Sema4A, which controls cell migration.

Evaluation of the ability of three physical activity monitors to predict weight change and estimate energy expenditure.

Activity monitors such as the Actical accelerometer, the Sensewear armband, and the Intelligent Device for Energy Expenditure and Activity (IDEEA) are commonly validated against gold standards (e.g., doubly labeled water, or DLW) to determine whether they accurately measure total daily energy expenditure (TEE) or activity energy expenditure (AEE). However, little research has assessed whether these parameters or others (e.g., posture allocation) predict body weight change over time. The aims of this study were to (i) test whether estimated energy expenditure or posture allocation from the devices was associated with weight change during and following a low-calorie diet (LCD) and (ii) compare free-living TEE and AEE predictions from the devices against DLW before weight change. Eighty-seven participants from 2 clinical trials wore 2 of the 3 devices simultaneously for 1 week of a 2-week DLW period. Participants then completed an 8-week LCD and were weighed at the start and end of the LCD and 6 and 12 months after the LCD. More time spent walking at baseline, measured by the IDEEA, significantly predicted greater weight loss during the 8-week LCD. Measures of posture allocation demonstrated medium effect sizes in their relationships with weight change. Bland-Altman analyses indicated that the Sensewear and the IDEEA accurately estimated TEE, and the IDEEA accurately measured AEE. The results suggest that the ability of energy expenditure and posture allocation to predict weight change is limited, and the accuracy of TEE and AEE measurements varies across activity monitoring devices, with multi-sensor monitors demonstrating stronger validity.

Prior resistance training and sex influence muscle responses to arm suspension.

PURPOSE: The magnitude of atrophy and strength loss induced by partial or complete disuse of skeletal muscles varies greatly among individuals. Factors predisposing some individuals to more extreme responses have not been identified. The purpose of this investigation was to determine whether 1) level of activity before disuse or 2) sex differences influence the magnitude of atrophy and changes in muscle strength, endurance, and sense of muscular effort in response to 21 d of arm suspension. METHODS: Thirty-one individuals (18 women, 13 men) completed either 8 wk of resistance training (TRAINED group) or no training (UNTRAINED group) before 21 d of elbow muscle arm suspension achieved by having one arm in a sling tethered to the body by a swathe. Muscle volume was measured using serial magnetic resonance imaging (MRI) cross-sectional images. Functional measurements included maximal isometric force (MIF) for elbow flexion, one-repetition maximum (1RM) for biceps curl, number of repetitions to fatigue at 50% of 1RM, and sense of muscular effort measured using a force-matching task. RESULTS: Flexor muscle volume decreased (P < 0.001) by -7.7 +/- 7.3% across all subjects. The decrease (P < 0.001) in flexor muscle volume was significant in men but not women. Arm suspension induced decreases (P < 0.001) in MIF and 1RM that did not differ across sex or training groups. The number of repetitions to fatigue decreased (P < 0.05) in the UNTRAINED but not TRAINED groups. No changes in sense of muscular effort were measured. CONCLUSION: The smaller initial muscle size or sex-specific factors attenuated muscle loss but not strength or endurance losses in females during disuse. Resistance training before disuse may attenuate the loss in muscular endurance.

Standardized patient assessment of medical student empathy: ethnicity and gender effects in a multi-institutional study.

PURPOSE: To examine, primarily, the effects of ethnicity and gender, which could introduce bias into scoring, on standardized patient (SP) assessments of medical students and, secondarily, to examine medical students' self-reported empathy for ethnicity and gender effects so as to compare self-perception with the perceptions of SPs. METHOD: Participants were 577 students from four medical schools in 2012: 373 (65%) were white, 79 (14%) black/African American, and 125 (22%) Asian/Pacific Islander. These students were assessed by 84 SPs: 62 (74%) were white and 22 (26%) were black/African American. SPs completed the Jefferson Scale of Patient Perceptions of Physician Empathy (JSPPPE) and the Global Ratings of Empathy tool. Students completed the Jefferson Scale of Empathy and two Interpersonal Reactivity Index subscales. The investigators used 2,882 student-SP encounters in their analyses. RESULTS: Analyses of SPs' assessments of students' empathy indicated significant interaction effects of gender and ethnicity. Female students, regardless of ethnicity, obtained significantly higher mean JSPPPE scores than men. Female black/African American, female white, and female Asian/Pacific Islander students scored significantly higher on the JSPPPE than their respective male counterparts. Male black/African American students obtained the lowest SP assessment scores of empathy regardless of SP ethnicity. Black/African American students obtained the highest mean scores on self-reported empathy. CONCLUSIONS: The significant interaction effects of ethnicity and gender in clinical encounters, plus the inconsistencies observed between SPs' assessments of students' empathy and students' self-reported empathy, raise questions about possible ethnicity and gender biases in the SPs' assessments of medical students' clinical skills.

Estimating energy expenditure in wildland fire fighters using a physical activity monitor.

This study piloted the use of an electronic activity monitor (MTI AM 7164-1.2) as a tool for estimating activity (EE(ACT), kcal day(-1)) and total (EE(TOT) kcal day(-1)) energy expenditure in wildland fire fighters during extended periods of wildland fire suppression. Ten Hot Shot fire fighters (9 men, 1 woman) volunteered to wear a MTI monitor during every work shift for 21 consecutive days. Summarizing whole-body motion data each 1 min, the raw activity data (counts min(-1)) were transformed into units of kcal min(-1) using a custom computer program with standard conversion equations. EE(TOT) averaged (Mean+/-SD) 4768+/-478 kcal day(-1), while EE(ACT) averaged 2585+/-406 kcal day(-1), neither of which differed significantly (P = 0.198 and 0.268, respectively) from literature values reported for Hot Shots using the doubly labeled water technique. These data suggest that the electronic activity monitor provided reasonable estimates of EE in wildland fire fighters. This study should be verified, however, with a more complete validation methodology to ensure these findings.