Evidence That Rating of Perceived Exertion Growth During Fatiguing Tasks is Scalar and Independent of Exercise Mode

Introduction: The relationship between the percentage of a fatiguing ambulatory task completed and rating of perceived exertion (RPE) appears to be linear and scalar, with a relatively narrow “window.” Recent evidence has suggested that a similar relationship may exist for muscularly demanding tasks. Methods: To determine whether muscularly demanding tasks fit within this “ambulatory window,” we tested resistance-trained athletes performing bench press and leg press with different loadings predicted to allow 5, 10, 20, and 30 repetitions and measured RPE (category ratio scale) at the end of the concentric action for each repetition. Results: There was a regular, and strongly linear, pattern of growth of RPE for both bench press (r = .89) and leg press (r = .90) during the tasks that allowed 5.2 (1.2), 11.6 (1.9), 22.7 (2.0), and 30.8 (3.2) repetitions for bench press and 5.5 (1.5), 11.4 (1.6), 20.2 (3.0), and 32.4 (4.2) repetitions for leg press, respectively. Conclusions: The path of the RPE growth versus percentage task fit within the window evident for ambulatory tasks. The results suggest that the RPE versus percentage task completed relationship is scalar, relatively linear, and apparently independent of exercise mode

Increasing confidence and changing behaviors in primary care providers engaged in genetic counselling.

BackgroundScreening and counseling for genetic conditions is an increasingly important part of primary care practice, particularly given the paucity of genetic counselors in the United States. However, primary care physicians (PCPs) often have an inadequate understanding of evidence-based screening; communication approaches that encourage shared decision-making; ethical, legal, and social implication (ELSI) issues related to screening for genetic mutations; and the basics of clinical genetics. This study explored whether an interactive, web-based genetics curriculum directed at PCPs in non-academic primary care settings was superior at changing practice knowledge, attitudes, and behaviors when compared to a traditional educational approach, particularly when discussing common genetic conditions.MethodsOne hundred twenty one PCPs in California and Pennsylvania physician practices were randomized to either an Intervention Group (IG) or Control Group (CG). IG physicians completed a 6 h interactive web-based curriculum covering communication skills, basics of genetic testing, risk assessment, ELSI issues and practice behaviors. CG physicians were provided with a traditional approach to Continuing Medical Education (CME) (clinical review articles) offering equivalent information.ResultsPCPs in the Intervention Group showed greater increases in knowledge compared to the Control Group. Intervention PCPs were also more satisfied with the educational materials, and more confident in their genetics knowledge and skills compared to those receiving traditional CME materials. Intervention PCPs felt that the web-based curriculum covered medical management, genetics, and ELSI issues significantly better than did the Control Group, and in comparison with traditional curricula. The Intervention Group felt the online tools offered several advantages, and engaged in better shared decision making with standardized patients, however, there was no difference in behavior change between groups with regard to increases in ELSI discussions between PCPs and patients.ConclusionWhile our intervention was deemed more enjoyable, demonstrated significant factual learning and retention, and increased shared decision making practices, there were few differences in behavior changes around ELSI discussions. Unfortunately, barriers to implementing behavior change in clinical genetics is not unique to our intervention. Perhaps the missing element is that busy physicians need systems-level support to engage in meaningful discussions around genetics issues. The next step in promoting active engagement between doctors and patients may be to put into place the tools needed for PCPs to easily access the materials they need at the point-of-care to engage in joint discussions around clinical genetics

Comparison of rating of perceived exertion scales during incremental and interval exercise

The Rating of Perceived Exertion (RPE) is an important measure of exercise intensity, which is useful both as a primary and adjunctive method of exercise prescription. However, there are multiple variants of the Borg RPE scale, primarily the Borg 6-20 RPE scale (BORG-RPE) and the Borg Category-Ratio-10 scale (BORG-CR10). There are inadequate data available to address the comparability and interchangeability of these two widely used scales. Well-trained non-athletes performed two increment cycle tests, with each scale used in a random sequence. Subjects also performed interval sessions at three intensities (50, 75 and 85% of peak power output) with each scale used in a random sequence. There were very large correlations during the incremental exercise between the conventional physiological measures (% heart rate reserve – r=0.89 & r=.87); and %VO2reserve (r=.88 & r=.90) and RPE measured by either the BORG-RPE or the BORGCR10, respectively. This pattern was also evident during the interval exercise (% heart rate reserve (r=.85 & r=.84; and blood lactate concentration – r=.74 & r=.78) and RPE measured by either the BORG-RPE or the BORG-CR10, respectively. The relationship between RPE measured by the BORG-RPE and the BORGCR10 was large and best described by a non-linear relationship for both the incremental (R2=89) and the interval (R2=.89) exercise. The incremental and interval curves were virtually overlapping. We concluded that the two most popular versions of the RPE scale, BORG-RPE and BORG-CR10, were both highly related to the conventional physiological measures and very strongly related to each other, with an easily described conversion

Supporting genetics in primary care: investigating how theory can inform professional education

Evidence indicates that many barriers exist to the integration of genetic case finding into primary care. We conducted an exploratory study of the determinants of three specific behaviours related to using breast cancer genetics referral guidelines effectively: 'taking a family history', 'making a risk assessment', and 'making a referral decision'. We developed vignettes of primary care consultations with hypothetical patients, representing a wide range of genetic risk for which different referral decisions would be appropriate. We used the Theory of Planned Behavior to develop a survey instrument to capture data on behavioural intention and its predictors (attitude, subjective norm, and perceived behavioural control) for each of the three behaviours and mailed it to a sample of Canadian family physicians. We used correlation and regression analyses to explore the relationships between predictor and dependent variables. The response rate was 96/125 (77%). The predictor variables explained 38-83% of the variance in intention across the three behaviours. Family physicians' intentions were lower for 'making a risk assessment' (perceived as the most difficult) than for the other two behaviours. We illustrate how understanding psychological factors salient to behaviour can be used to tailor professional educational interventions; for example, considering the approach of behavioural rehearsal to improve confidence in skills (perceived behavioural control), or vicarious reinforcement as where participants are sceptical that genetics is consistent with their role (subjective norm)

Complexity vs. Simplicity: Groundwater Model Ranking Using Information Criteria

A groundwater model characterized by a lack of field data about hydraulic model parameters and boundary conditions combined with many observation data sets for calibration purpose was investigated concerning model uncertainty. Seven different conceptual models with a stepwise increase from 0 to 30 adjustable parameters were calibrated using PEST. Residuals, sensitivities, the Akaike information criterion (AIC and AICc), Bayesian information criterion (BIC), and Kashyap's information criterion (KIC) were calculated for a set of seven inverse calibrated models with increasing complexity. Finally, the likelihood of each model was computed. Comparing only residuals of the different conceptual models leads to an overparameterization and certainty loss in the conceptual model approach. The model employing only uncalibrated hydraulic parameters, estimated from sedimentological information, obtained the worst AIC, BIC, and KIC values. Using only sedimentological data to derive hydraulic parameters introduces a systematic error into the simulation results and cannot be recommended for generating a valuable model. For numerical investigations with high numbers of calibration data the BIC and KIC select as optimal a simpler model than the AIC. The model with 15 adjusted parameters was evaluated by AIC as the best option and obtained a likelihood of 98%. The AIC disregards the potential model structure error and the selection of the KIC is, therefore, more appropriate. Sensitivities to piezometric heads were highest for the model with only five adjustable parameters and sensitivity coefficients were directly influenced by the changes in extracted groundwater volumes