A Pilot Remote Curriculum to Enhance Resident and Medical Student Understanding of Machine Learning in Healthcare.

BACKGROUND: Despite the expanding role of machine learning (ML) in health care and patient expectations for clinicians to understand ML-based tools, few for-credit curricula exist specifically for neurosurgical trainees to learn basic principles and implications of ML for medical research and clinical practice. We implemented a novel, remotely delivered curriculum designed to develop literacy in ML for neurosurgical trainees. METHODS: A 4-week pilot medical elective was designed specifically for trainees to build literacy in basic ML concepts. Qualitative feedback from interested and enrolled students was collected to assess students' and trainees' reactions, learning, and future application of course content. RESULTS: Despite 15 interested learners, only 3 medical students and 1 neurosurgical resident completed the course. Enrollment included students and trainees from 3 different institutions. All learners who completed the course found the lectures relevant to their future practice as clinicians and researchers and reported improved confidence in applying and understanding published literature applying ML techniques in health care. Barriers to ample enrollment and retention (e.g., balancing clinical responsibilities) were identified. CONCLUSIONS: This pilot elective demonstrated the interest, value, and feasibility of a remote elective to establish ML literacy; however, feedback to increase accessibility and flexibility of the course encouraged our team to implement changes. Future elective iterations will have a semiannual, 2-week format, splitting lectures more clearly between theory (the method and its value) and application (coding instructions) and will make lectures open-source prerequisites to allow tailoring of student learning to their planned application of these methods in their practice and research.

Association between asthma, obesity, and health behaviors in African American youth.

Background: There is a clear relationship between obesity and asthma, with obesity recognized as a risk factor for asthma. There is mounting evidence, however, that asthma may predict obesity risk via behavioral pathways. Objectives: The purpose of this study was to assess the cross-sectional relationships between asthma, body mass index (BMI) percentile, and behavioral factors including caloric intake, dietary inflammatory index, moderate-vigorous physical activity (MVPA), and sedentary time (SED) among African American adolescents. Methods: A community-based sample of 195 African American youth (ages 11-18 years) were included in this analysis. Asthma status was based on self-report using the International Study of Asthma and Allergies in Children's Phase Three questionnaire. MVPA and SED were measured via accelerometry, and caloric intake and dietary inflammatory index were evaluated with the Food Frequency Questionnaire. Weight status was assessed via BMI percentile using measured weight, height, and CDC growth charts. Results: Adolescents with a history of asthma were significantly more overweight (62% vs. 43%, p = 0.04) and consumed a higher inflammatory diet (1.6 ± 0.3 vs. 1.0 ± 0.2, p = 0.02) than their peers who never had asthma. After adjusting for all covariates, activity and dietary variables, odds ratio analysis revealed adolescents who reported ever having asthma were 3.1 ± 1.5 times as likely to be overweight or obese than adolescents with no asthma history (p = 0.02). Conclusions: Presence of asthma history was associated with increased obesity risk in African American adolescents, independent of behavioral factors. Longitudinal studies are needed to better understand the relationship between asthma and obesity in African American adolescents.

Stress-Induced Suppression of Food Intake in Overweight and Obese Adolescents.

OBJECTIVE: Overweight adolescents exhibit greater cortisol reactivity in response to acute stress and are more likely to eat in response to emotional cues, which suggest an increased susceptibility to stress-induced eating. The purpose of this study was to examine the biological (cortisol and α-amylase reactivity) and behavioral (caloric intake) responses to an acute stressor in overweight adolescents. METHODS: Fifty-one adolescents ages 14 to 19 years (47% female, 55% white; body mass index, 31.2 ± 0.8 kg/m) were exposed to the Trier Social Stress Test and a control condition on separate days. Immediately after each condition, participants were provided with snacks to eat at their leisure. Reactivity was assessed via salivary cortisol and α-amylase area under the curve (AUC), and adolescents were categorized as high or low reactors. RESULTS: Cortisol AUC was higher during the stress condition (19.6 ± 0.2 µg/dl · min) compared with the control condition (11.4 ± 0.9 µg/dl · min, p < .001). α-Amylase AUC was not different during the stress condition (9999 ± 987 U/ml · min) compared with the control condition (8762 ± 865 U/ml · min, p = .145). Overall, adolescents consumed fewer calories during the stress condition (488 ± 51 kcal) compared with the control condition (637 ± 42 kcal, p = .007). High cortisol reactors decreased their calorie consumption from the control condition (716 ± 52 kcal) to the stress condition (457 ± 53 kcal, p = .001), whereas low cortisol reactors did not change their consumption (stress: 518 ± 87 kcal versus control: 561 ± 62 kcal, p = .574). CONCLUSION: High cortisol reactivity in overweight adolescents resulted in decreased calorie consumption after an acute stressor. Further research is needed to understand the mechanisms underlying stress-induced suppression of food intake in overweight adolescents.

Acute Effect of Intermittent Exercise and Action-Based Video Game Breaks on Math Performance in Preadolescent Children.

PURPOSE: The purpose of this study was to compare the acute effects of video game breaks and intermittent exercise breaks, performed at varying intensities, on math performance in preadolescent children. METHODS: A total of 39 children (18 males and 21 females; aged 7-11 y) completed 4 experimental conditions in random order: 8 hours of sitting interrupted with 20 two-minute low-, moderate-, or high-intensity exercise breaks or 20 two-minute sedentary computer game breaks. The intensity of exercise breaks for the low-, moderate-, and high-intensity conditions corresponded with 25%, 50%, and 75% of heart rate reserve, respectively. Math performance was assessed 3 times throughout each condition day using a 90-second math test consisting of 40 single-digit addition and subtraction questions. RESULTS: There were no significant differences in percent change in math scores (correct answers out of attempted) by condition [low: -1.3 (0.8), moderate: 0.1 (1.3), high: -1.8 (0.7), and computer: -2.5 (0.8); P > .05]. There were significant differences in percent change in math scores over the course of the condition days with lower math scores reported at end-of-day test compared with midday test [-2.4 (0.5) vs -0.4 (0.3); P = .01]. There were no significant condition × time, time × age, condition × age, or condition × time × age interactions (all Ps > .05). CONCLUSION: Action-based video game and exercise breaks elicit the same level of math performance in children; however, time of day may impact this relationship. These findings may have important implications for instructional time in elementary classrooms.

Acute Compensatory Responses to Interrupting Prolonged Sitting With Intermittent Activity in Preadolescent Children.

PURPOSE: The purpose of this study was to compare the effects of intermittent activity performed at varying intensities and of prolonged sitting on physical activity compensation. METHODS: A total of 33 children (14 boys and 19 girls; age 7-11 y; 24% overweight/obese; 61% nonwhite) completed 4 experimental conditions in random order: 8 hours of sitting interrupted with 20 two-minute low-, moderate-, or high-intensity activity breaks or 20 two-minute sedentary computer game breaks. Physical activity energy expenditure (PAEE) was assessed via accelerometry to establish baseline PAEE and throughout each condition day (8-h in-lab PAEE, out-of-lab PAEE, and 3-d postcondition). RESULTS: Compared with baseline PAEE, total daily PAEE was significantly higher during the high-intensity condition day (153 ± 43 kcal, P = .03), unchanged during the low-intensity (-40 ± 23 kcal, P > .05) and moderate-intensity condition days (-11 ± 18 kcal, P > .05), and decreased in response to prolonged sitting (-79 ± 22 kcal, P = .03). There were no significant differences in PAEE 3-day postcondition across conditions (P > .05). CONCLUSION: Despite the varying levels of PAEE accumulated during the 8-hour laboratory conditions, out-of-lab PAEE during each condition day and 3-day postcondition did not change from the baseline. These findings provide preliminary evidence that spontaneous physical activity in children does not change in response to intermittent activity or prolonged sitting.

The effects of interrupting prolonged sitting with intermittent activity on appetite sensations and subsequent food intake in preadolescent children.

BACKGROUND: Short-term and long-term exposure to prolonged sitting is associated with excess food intake and weight gain in children. Interrupting prolonged sitting with low-intensity activity has been shown to not alter hunger, satiety, or food consumption in children, however it is unclear whether interrupting sitting with high-intensity activity will alter appetite regulation in children. PURPOSE: The purpose of this study was to examine the acute effects of interrupting prolonged sitting with intermittent activity performed at varying intensities on hunger, satiety, prospective food consumption (PFC), and food intake in preadolescent children. METHODS: Thirty-nine children (ages 7-11 years, 54% female, 33% overweight/obese) completed four experimental conditions in random order: 8 hours of sitting interrupted with 20, 2-minute low-, moderate-, or high-intensity activity breaks or 20, 2-minute sedentary screen time breaks. Exercise intensity corresponded with 25%, 50% and 75% of heart rate reserve, respectively. Hunger, satiety, and PFC were assessed using the Visual Analog Scale, at five time points (pre- and post-breakfast, pre- and post-lunch, and pre-dinner) during each experimental condition. Dietary compensation was assessed as total caloric intake during a post-condition dinner standardized to provide 70% of estimated daily energy requirements. RESULTS: There was a significant effect of time on hunger, satiety, and PFC throughout each condition day (p< 0.001). There were no differences across conditions for hunger (sedentary: 4.9±0.3 cm, low: 5.0±0.3 cm, moderate: 5.1±0.3 cm, high: 5.1±0.3 cm, p>0.05), satiety (sedentary: 4.7±0.3 cm, low: 4.4±0.3 cm, moderate: 4.6±0.3 cm, high: 4.2±0.3 cm, p>0.05), and PFC (sedentary: 4.9±0.3 cm, low: 4.7±0.3 cm, moderate: 4.9±0.3 cm, high: 5.0±0.3 cm, p>0.05). There were no significant differences in post-activity food intake across conditions (sedentary: 1071.9±53.6 kcals; low: 1092.6±43.4kcals; moderate: 996.2±54.6kcals; high: 1138.7±62.8kcals, p>0.05). However, there was a significant effect of condition on energy balance (sedentary: +61.4±65.9 kcals, low: +74.9±57.6 kcals, moderate: -58.3±62.8 kcals, high: -391.2±77.9 kcals; p<0.001). There were no significant effects of weight status on hunger, satiety, PFC, post-activity food intake, and mean energy balance across conditions (all p's>0.05). CONCLUSIONS: Interrupting prolonged sitting with physical activity of any intensity does not alter appetite sensations and subsequent food consumption in children. These data suggest that interventions targeting prolonged sitting with high-intensity intermittent activity may be an effective strategy to increase physical activity energy expenditure without increasing food intake, allowing for a short-term energy deficit in both healthy weight and overweight/obese children. Future studies should examine the long-term effects of interrupting prolonged sitting with activity on food consumption and weight status in preadolescent children.

Affective Responses to Intermittent Physical Activity in Healthy Weight and Overweight/Obese Elementary School-Age Children.

BACKGROUND: The purpose of this study was to examine the acute effects of intermittent physical activity (2-min bouts of varying intensities) on psychological mood and enjoyment in elementary school-age children and to examine the effect of weight status on these psychological outcomes. METHODS: A total of 39 children (healthy weight, n = 26; overweight/obese, n = 13) completed 4 experimental conditions in random order, which consisted of 8 hours of sitting interrupted with 20 two-minute low--, moderate-, or high-intensity activity breaks or 20 two-minute screen-time breaks. Mood was assessed using the Feeling Scale immediately following each break. Enjoyment was assessed using the Physical Activity Enjoyment Scale immediately following 10 and 20 breaks. RESULTS: Mood was significantly higher during the sedentary versus active conditions (P < .01). Overweight/obese children reported lower mood scores compared with healthy weight children at the initiation of the low- (P < .05) and high-intensity conditions (P < .001) but experienced improvements in mood throughout the day in all 3 active conditions (P = .02). Enjoyment was significantly higher after completing the active versus sedentary conditions (P = .02). CONCLUSION: These findings suggest that both healthy weight and overweight/obese children felt better immediately after engaging in screen-time breaks but subsequently rated the activity breaks as more enjoyable compared with screen-time breaks.