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Objectives/Goals: Collaborations between Academic Medical Centers (AMCs) and Historically Black Colleges & Universities (HBCUs) are critical to addressing health disparities and building research capacity. Herein, we examine the Duke-NCCU Collaborative Translational Research pilot funding program [2018–2023] to identify opportunities, challenges, and lessons learned from querying key stakeholders. Methods/Study Population: The Duke-NCCU collaborative pilot funding program was launched to support new inter-institutional collaborations that aim to accelerate research discoveries into testing in clinical or population settings. Eight one-year, $50,000 collaborative grants were awarded. Each funded team was assigned a CTSI Project Leader (PL) for project management support. To evaluate the program, we developed surveys targeting principal investigators (PI) and PLs. Questions covered collaboration motivation, goals, outcomes, operational processes, project management support, institutional differences, and challenges. Qualitative analysis will be employed to evaluate the responses and identify common themes. Results/Anticipated Results: The PI survey examines aspects of inter-institutional collaborations, focusing on common themes, such as authorship, definition of success, and institutional culture. The PL survey prompts feedback on managing inter-institutional teams, expectations, and challenges. Select questions were shared between both surveys to capture both perspectives. Surveys were reviewed by members of the Duke CTSI evaluation and team science teams. The PI survey will be disseminated to 16 investigators, while the PL survey will reach 5 project leaders. Built on Qualtrics, each survey takes 20–30 minutes to complete. To encourage participation, incentives will be offered as two $100 gift card drawings. Respondents can choose to complete the survey on Qualtrics or through a recorded and transcribed Zoom session. Discussion/Significance of Impact: AMC-HBCU inter-institutional collaborations drive innovation, workforce development, and equitable dissemination of outcomes. This study exemplifies collaboration, offering insights into translational research collaborations critical to advance equitable healthcare and improving population health.
The recent expansion of cross-cultural research in the social sciences has led to increased discourse on methodological issues involved when studying culturally diverse populations. However, discussions have largely overlooked the challenges of construct validity – ensuring instruments are measuring what they are intended to – in diverse cultural contexts, particularly in developmental research. We contend that cross-cultural developmental research poses distinct problems for ensuring high construct validity owing to the nuances of working with children, and that the standard approach of transporting protocols designed and validated in one population to another risks low construct validity. Drawing upon our own and others’ work, we highlight several challenges to construct validity in the field of cross-cultural developmental research, including (1) lack of cultural and contextual knowledge, (2) dissociating developmental and cultural theory and methods, (3) lack of causal frameworks, (4) superficial and short-term partnerships and collaborations, and (5) culturally inappropriate tools and tests. We provide guidelines for addressing these challenges, including (1) using ethnographic and observational approaches, (2) developing evidence-based causal frameworks, (3) conducting community-engaged and collaborative research, and (4) the application of culture-specific refinements and training. We discuss the need to balance methodological consistency with culture-specific refinements to improve construct validity in cross-cultural developmental research.
Racial and ethnic variations in antibiotic utilization are well-reported in outpatient settings but little is known about inpatient settings. Our objective was to describe national inpatient antibiotic utilization among children by race and ethnicity.
Methods:
This study included hospital visit data from the Pediatric Health Information System between 01/01/2022 and 12/31/2022 for patients <20 years. Primary outcomes were the percentage of hospitalization encounters that received an antibiotic and antibiotic days of therapy (DOT) per 1000 patient days. Mixed-effect regression models were used to determine the association of race-ethnicity with outcomes, adjusting for covariates.
Results:
There were 846,530 hospitalizations. 45.2% of children were Non-Hispanic (NH) White, 27.1% were Hispanic, 19.2% were NH Black, 4.5% were NH Other, 3.5% were NH Asian, 0.3% were NH Native Hawaiian/Other Pacific Islander (NHPI) and 0.2% were NH American Indian. Adjusting for covariates, NH Black children had lower odds of receiving antibiotics compared to NH White children (aOR 0.96, 95%CI 0.94–0.97), while NH NHPI had higher odds of receiving antibiotics (aOR 1.16, 95%CI 1.05–1.29). Children who were Hispanic, NH Asian, NH American Indian, and children who were NH Other received antibiotic DOT compared to NH White children, while NH NHPI children received more antibiotic DOT.
Conclusions:
Antibiotic utilization in children’s hospitals differs by race and ethnicity. Hospitals should assess policies and practices that may contribute to disparities in treatment; antibiotic stewardship programs may play an important role in promoting inpatient pharmacoequity. Additional research is needed to examine individual diagnoses, clinical outcomes, and drivers of variation.
From early on, infants show a preference for infant-directed speech (IDS) over adult-directed speech (ADS), and exposure to IDS has been correlated with language outcome measures such as vocabulary. The present multi-laboratory study explores this issue by investigating whether there is a link between early preference for IDS and later vocabulary size. Infants’ preference for IDS was tested as part of the ManyBabies 1 project, and follow-up CDI data were collected from a subsample of this dataset at 18 and 24 months. A total of 341 (18 months) and 327 (24 months) infants were tested across 21 laboratories. In neither preregistered analyses with North American and UK English, nor exploratory analyses with a larger sample did we find evidence for a relation between IDS preference and later vocabulary. We discuss implications of this finding in light of recent work suggesting that IDS preference measured in the laboratory has low test-retest reliability.
Edited by
William J. Brady, University of Virginia,Mark R. Sochor, University of Virginia,Paul E. Pepe, Metropolitan EMS Medical Directors Global Alliance, Florida,John C. Maino II, Michigan International Speedway, Brooklyn,K. Sophia Dyer, Boston University Chobanian and Avedisian School of Medicine, Massachusetts
Providing medical care during a mass event requires important situational awareness and preparation. Significant planning and relationship building provides a foundation for creating an operational outline, and establishing crowd dynamics and expectations for related medical activities. Collaboration with stakeholders will provide insight into the operations of various other event management entities, and allows for more seamless operations during the event. Once an operational plan has been established and circulated, the event medical team can be prepared for the expected external and crowd conditions and respond appropriately, while maintaining vigilance for any emergency that may arise. Contingency planning is key for the medical team to have appropriate emergency response defaults. Special attention is also needed on communications strategies for real-time intel, information dissemination, and crowd management. Once the event reaches its end, it is important to establish stand-down procedures to be followed as the crowd disperses to ensure an orderly event closure. After action reports can provide valuable insights for future crowd management.
Parkinson’s disease (PD) is a neurodegenerative disorder affecting over 10 million people worldwide. PD is characterized by both motor (e.g., tremor, rigidity, and bradykinesia) and non-motor (including cognitive impairment and neuropsychiatric symptoms such as apathy, disinhibition, executive dysfunction) symptoms. Caregiver burden is prevalent in those providing care for patients with PD and can result in negative health complications. Past work shows associations between motor symptoms, cognitive impairment, neuropsychiatric symptoms, and caregiver burden in PD. However, their relative contributions are poorly understood. This study examined these relationships, hypothesizing that while motor symptoms, cognitive impairment, and neuropsychiatric symptoms would all affect caregiver burden, neuropsychiatric symptoms would predict burden above and beyond the contribution of the other factors
Participants and Methods:
Participants were 42 people living with PD who were assessed at a hospital-based tertiary movement disorders specialty clinic for deep brain stimulation (DBS) candidacy evaluation with their caregiver. Motor exam was assessed by a PD specialist using the Unified Parkinson’s Disease Rating Scale (UPDRS). The Mini Mental State Examination (MMSE) assessed global cognition. Frontal Systems Behavior Scale (FrSBe) Family Form captured caregiver ratings of neuropsychiatric symptoms under 3 subscales: apathy, disinhibition, and executive dysfunction. The Multidimensional Caregiver Strain Index (MCSI) captured caregiver burden. Linear regression analyses examined relationships between caregiver burden (MCSI) and motor symptoms (UPDRS), cognitive impairment (MMSE), and neuropsychiatric symptoms (FrSBe).
Results:
Using linear regression analyses, cognitive impairment (R2=0.08, F(1,41)=4.42, p=0.04) and neuropsychiatric symptoms (R2=0.35, F(1, 41)=21.0, p<0.01) predicted caregiver burden but motor symptoms did not (R2=0.03, F(1,41)=1.30, p=0.26). Hierarchical linear regression revealed that neuropsychiatric symptoms predicted caregiver burden above and beyond the contribution of cognitive impairment (AR2=0.28, AF(1)=12.7, p=0.001), accounting for an additional 28% of the variance in caregiver burden. Follow-up linear regression to examine the relationships between caregiver burden and the FrSBe subscales indicated that apathy (p<0.001), versus disinhibition (p=0.16) and dysexecutive behaviors (p=0.80), was the driver of the significant relationship.
Conclusions:
Consistent with our hypothesis, results revealed that cognitive impairment and neuropsychiatric symptoms (specifically apathy) were independent predictors of caregiver burden, with neuropsychiatric symptoms predicting caregiver burden above and beyond the contribution of cognitive impairment. Somewhat surprisingly, motor symptoms were not a predictor of caregiver burden contrary to some previous research, though findings are mixed. Results highlight the importance of assessing for neuropsychiatric symptoms in PD, which may be overlooked by care providers relative to motor or cognitive symptoms, but which appear stressful to caregivers. Future directions include reexamining results in a larger more heterogenous sample including people living with PD at different disease stages (i.e., everyone in the present sample had severe enough symptoms to be considering DBS). Cognitive measures of executive functioning (which are more specific to PD than measures of global cognition) should also be included in future works. Development of supportive caregiver interventions specifically targeting apathy in PD may be useful. Longitudinal designs would be helpful to reexamine relationships following DBS surgery, as there are some reports of increased neuropsychiatric symptoms following the procedure.
There are numerous adverse health outcomes associated with dementia caregiving, including increased stress and depression. Caregivers often face time-related, socioeconomic, geographic, and pandemic-related barriers to treatment. Thus, implementing mobile health (mHealth) interventions is one way of increasing caregivers’ access to supportive care. The objective of the current study was to collect data from a 3-month feasibility trial of a multicomponent mHealth intervention for dementia caregivers.
Participants and Methods:
40 community-dwelling dementia caregivers were randomized to receive the CARE-Well (Caregiver Assessment, Resources, and Education) App or internet links connected to caregiver education, support, and resources. Caregivers were encouraged to use the App or links at least 4 times per week for 3 months. The App consisted of self-assessments, caregiver and stress reduction education, behavior problem management, calendar reminders, and online social support. Caregivers completed measures of burden, depression, and desire to institutionalize at baseline and post-intervention. Feasibility data included App usage, retention and adherence rates, and treatment satisfaction. Data were analyzed via descriptive statistics.
Results:
Caregivers were mostly white (95%), female (68%), in their mid-60s, (M= 66.38, SD= 10.64), and well-educated (M= 15.52 years, SD= 2.26). Caregivers were mainly spouses (68%) or adult children (30%). Care recipients were diagnosed with mild (60%) or moderate (40%) dementia, with 80% diagnosed as having Alzheimer’s disease. Overall, the study had an 85% retention rate (80% for App group; 90% for links group). 58% of caregivers in the App group were considered high users, using the App >120 minutes over the course of 3 months (M= 362.42, SD= 432.68), and an average of 16.44 days (SD= 15.51). 15% of the sample was non-adherent due to time constraints, disinterest, and/or technology issues. Most participants (75%) using the App were mostly or very satisfied, about 87% would be likely or very likely to seek similar programs in the future, and 93% found the App mostly or very understandable. Groups did not significantly differ on clinical outcomes, although the study was not powered for an efficacy analysis. Within groups analysis revealed significant increases in depressive symptoms at post-treatment for caregivers in both groups.
Conclusions:
This study demonstrated initial feasibility of the CARE-Well App for dementia caregivers. App use was lower than expected, however, high satisfaction, ease of use, and willingness to use similar programs in the future were endorsed. Some caregivers did not complete the intervention due to caregiving responsibilities, general disinterest, and/or technology issues. Although the study was not designed to assess clinical outcomes, we found that both groups reported higher depressive symptoms at post-treatment. This finding was unexpected and might reflect pandemic-related stress, which has been shown to particularly impact dementia caregivers. Future studies should address the efficacy of multicomponent mHealth interventions for dementia caregivers and the effects of increased dose on clinical outcomes. mHealth interventions should be refined to cater to varying levels of technology literacy among caregivers, and further research should aim to better integrate interventions into caregivers’ routines to enhance treatment engagement.
Given the aging population, there are significant public health benefits to delaying the onset of Alzheimer’s disease (AD) in individuals at risk. However, adherence to health behaviors (e.g., diet, exercise, sleep hygiene) is low in the general population. The Health Belief Model proposes that beliefs such as perceived threat of disease, perceived benefits and barriers to behavior change, and cues to action are mediators of behavior change. The aim of this study was to gain additional information on current health behaviors and beliefs for individuals at risk for developing AD. This information can then be used to inform behavioral interventions and individualized strategies to improve health behaviors that may reduce AD risk or delay symptom onset.
Participants and Methods:
Surveys were sent to the Rhode Island AD Prevention Registry, which is enriched for at-risk, cognitively normal adults (i.e., majority with a family history and/or an APOE e4 allele). A total of 177 individuals participated in this study. Participants were 68% female; 93% Caucasian and non-Hispanic; mean age of 69.2; 74% with family history of dementia; 40% with subjective memory decline. The survey included measures from the Science of Behavior Change (SoBC) Research Network to measure specific health belief factors, including individual AD risk, perceived future time remaining in one’s life, generalized self-efficacy, deferment of gratification, consideration of future consequences as well as dementia risk awareness and a total risk score for dementia calculated from a combination demographic, health and lifestyle behaviors.
Results:
Participants who were older had higher scores for dementia risk (r=0.78), lower future time perspective (r=-0.33), and lower generalized self-efficacy (r=-0.31) (all at p<0.001). Higher education correlated with higher consideration of future consequences (r=-.31, p<0.001) and lower overall dementia risk score (r=-0.23, p=0.006). Of all scales examined, only generalized self-efficacy had a significant linear relationship to both frequency (r2=0.06) and duration (r2=0.08) of weekly physical activity (p<0.001). Total dementia risk score also had significant linear relationships (r2=0.19) with future time perspective (p<0.001) and generalized self-efficacy (p=0.48).
Conclusions:
Overall, individuals who rated themselves higher in self-efficacy were more likely to exercise more frequently and for a longer duration. Individuals who had lower overall risk for dementia due to both demographic and behavioral factors were more likely to endorse higher self-efficacy and more perceived time remaining in their lives. Increasing self-efficacy and targeting perceived future time limitations may be key areas to increase motivation and participation in behavioral strategies to reduce AD risk. Developing individual profiles based on these scales may further allow for individually tailored intervention opportunities.
To establish outcomes following photobiomodulation therapy for tinnitus in humans and animal studies.
Methods
A systematic review and narrative synthesis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The databases searched were: Medline, Embase, Cochrane Central Register of Controlled Trials (‘Central’), ClinicalTrials.gov and Web of Science including the Web of Science Core collection. There were no limits on language or year of publication.
Results
The searches identified 194 abstracts and 61 full texts. Twenty-eight studies met the inclusion criteria, reporting outcomes in 1483 humans (26 studies) and 34 animals (2 studies). Photobiomodulation therapy parameters included 10 different wavelengths, and duration ranged from 9 seconds to 30 minutes per session. Follow up ranged from 7 days to 6 months.
Conclusion
Tinnitus outcomes following photobiomodulation therapy are generally positive and superior to no photobiomodulation therapy; however, evidence of long-term therapeutic benefit is deficient. Photobiomodulation therapy enables concentrated, focused delivery of light therapy to the inner ear through a non-invasive manner, with minimal side effects.
Background: In spring 2021, the infection prevention and control department at a pediatric academic medical center identified 3 oncology patients with concern for invasive Rhizopus spp infections. An in-depth investigation was conducted, but a common source of the fungus was not identified. In August 2021, an additional oncology patient with concern for invasive Rhizopus spp was identified, resulting in an extended investigation for possible sources of fungus. Methods: A multidisciplinary work group was assembled. The CDC Targeted Environmental Investigation Checklist for Outbreaks of Invasive Infections Caused by Environmental Fungi was used as a framework for conducting the investigation. Stakeholders were engaged throughout the process, including the hematology–oncology service, hospital leadership, environmental services, patient safety and quality, and facilities and engineering. The investigation included hospital incident command system (HICS) activation; visual inspection of patient rooms and common spaces; heating, ventilation, and air conditioning (HVAC) review; environmental sampling (surfaces, linen, and air); chart review; and process mapping. Results: By early October 2021, 2 environmental samples grew isolates (each at 1 CFU/m3) of the same species of Rhizopus as one of the affected patients. One sample was from a patient room, and the other from an outdoor garden space. No source of indoor amplification of Rhizopus was identified. The investigation revealed several opportunities for improvement: annual room maintenance schedules, use of gardens and outdoor spaces by at-risk patients, linen storage, construction and/or infection control risk assessment (ICRA) processes, and appliances used by families (eg, washing machines and refrigerators). Work streams were established to address each of these areas. Conclusions: No definite source was identified for the 4 invasive Rhizopus spp infections. This extensive investigation highlighted multiple opportunities for improvement; the changes implemented may prevent future invasive fungal infections in high-risk pediatric patients.
Organizations that are becoming more diverse and relying on teams to achieve performance outcomes often employ organizational interventions to deliver these outcomes. Although some negative or null side effects have been demonstrated related to these interventions, we argue that many positive side effects are often not captured or are disregarded and warrant further attention. Using examples from the training literature, we provide evidence for positive side effects of organizational interventions. We also identify lapses in the field’s approach to the measurement of the effects of organizational interventions and how this prevents our attempts to improve these interventions to create better and more holistic outcomes for employees and organizations. We suggest opportunities to improve interventions that can be applied in our diverse workplaces.
Falls and fall-related injuries among older adults represent a substantial health burden. Approximately 30% of older adults experience at least one fall each year, and half of these individuals fall recurrently [1, 2]. Fall-related non-fatal injuries are associated with increased morbidity, decreased functioning, and increased health care resource utilization [3, 4]. Fall-related injuries such as fracture account for 10-15% of emergency department presentations of those aged 65 years and older [5, 6]. With the number of adults aged 65 and older expected to increase to 1 in 5 by 2050, the economic burden imposed by falls is expected to increase proportionally [7].
Psychiatric prescribers typically assess adherence by patient or caregiver self-report. A new digital medicine (DM) technology provides objective data on adherence by using an ingestible event monitoring (IEM) sensor embedded within oral medication to track ingestion. Despite likely clinical benefit, adoption by prescribers will in part depend on attitudes toward and experience with digital health technology, learning style preference (LSP), and how the technology s utility and value are described.
Objective
is to identify attitudes, experiences, and proclivities toward DM platforms that may affect adoption of the IEM platform and provide direction on tailoring educational materials to maximize adoption. Methods A survey of prescribers treating seriously mentally ill patients was conducted to assess drivers/barriers to IEM adoption. Factor analysis was performed on 13 items representing prior experience with and attitudes toward DM. Factor scores were correlated with prescriber characteristics including attitude and experience with digital technologies, LSP, and level of focus on healthcare cost.
Results
A total of 127 prescribers (56% female, 76% physicians, mean age 48.1yrs.) completed the survey. Over 90% agreed medication adherence is important, visits allow enough time to monitor adherence (84.1%), and tailoring treatment to level of adherence would be beneficial (92.9%). The majority (65.9%) preferred relying upon outcomes data as their learning style while 15.9% preferred opinion leader recommendations and 18.3% information about how the technology would affect practice efficiency. Factor analysis revealed four dimensions: Level of comfort with EHR; Concern over current ability to monitor medication adherence; Attitudes about value of DM applications; and Benefits vs cost of DM for payers. Women scored higher on attitudes about the value of digital applications (p<0.01). Providers who perceive non-adherence as costly, and those who believe DM could benefit providers and patients scored higher on the value of DM (p<.05). Those whose LSP focuses on improving efficiency and prescribers with a higher proportion of Medicaid/ uninsured patients displayed concern about their ability to monitor adherence (p<0.05). Willingness to be a Beta Test site for DM applications was positively correlated with concern about their ability to monitor adherence and attitudes about the value of DM (p <0.01).
Conclusions
Prescriber characteristics including LSP, focus on healthcare costs, and attitudes toward DM may be related to adoption of the IEM platform. Those with more Medicaid/ uninsured patients were more concerned about ability to monitor adherence while those focused-on cost and benefit to providers and patients viewed DM as part of a solution for managing outcomes and cost. Overall, LSP, patient panel size by payer type, and focus on healthcare cost containment should be considered when developing IEM provider training materials.
Funding
Otsuka Pharmaceutical Development & Commercialization, Inc.
People with CHD are at increased risk for executive functioning deficits. Meta-analyses of these measures in CHD patients compared to healthy controls have not been reported.
Objective:
To examine differences in executive functions in individuals with CHD compared to healthy controls.
Data sources:
We performed a systematic review of publications from 1 January, 1986 to 15 June, 2020 indexed in PubMed, CINAHL, EMBASE, PsycInfo, Web of Science, and the Cochrane Library.
Study selection:
Inclusion criteria were (1) studies containing at least one executive function measure; (2) participants were over the age of three.
Data extraction:
Data extraction and quality assessment were performed independently by two authors. We used a shifting unit-of-analysis approach and pooled data using a random effects model.
Results:
The search yielded 61,217 results. Twenty-eight studies met criteria. A total of 7789 people with CHD were compared with 8187 healthy controls. We found the following standardised mean differences: −0.628 (−0.726, −0.531) for cognitive flexibility and set shifting, −0.469 (−0.606, −0.333) for inhibition, −0.369 (−0.466, −0.273) for working memory, −0.334 (−0.546, −0.121) for planning/problem solving, −0.361 (−0.576, −0.147) for summary measures, and −0.444 (−0.614, −0.274) for reporter-based measures (p < 0.001).
Limitations:
Our analysis consisted of cross-sectional and observational studies. We could not quantify the effect of collinearity.
Conclusions:
Individuals with CHD appear to have at least moderate deficits in executive functions. Given the growing population of people with CHD, more attention should be devoted to identifying executive dysfunction in this vulnerable group.
True to its free market origins, the EU Trade Mark Directive (TMD)1 allows any sign to be registered as long as it is acting as a badge of origin and as long as it does not fall into one of the absolute grounds for refusal of registration. Some bars to registration cannot be overcome, such as those prohibiting the registration of functional shapes or signs that offend against public morality. However, other signs, which are descriptive, non-distinctive or generic, while disallowed from immediate registration, can subsequently be registered provided they have acquired distinctiveness through use. The EU trademark regime thus allows for the registration of signs that under previous laws of member states might have been denied registration in the public interest. For instance, in the United Kingdom and in Germany, this category included signs that were distinctive but, the courts held, should be left free for others to use, such as geographical names.2 For the same reason, under its 1938 Trade Marks Act, the UK courts would not allow the registration of functional and non-functional shape marks even with acquired distinctiveness.
The inclusion of students with autism spectrum disorder (ASD) is increasing, but there have been no longitudinal studies of included students in Australia. Interview data reported in this study concern primary school children with ASD enrolled in mainstream classes in South Australia and New South Wales, Australia. In order to examine perceived facilitators and barriers to inclusion, parents, teachers, and principals were asked to comment on the facilitators and barriers to inclusion relevant to each child. Data are reported about 60 students, comprising a total of 305 parent interviews, 208 teacher interviews, and 227 principal interviews collected at 6-monthly intervals over 3.5 years. The most commonly mentioned facilitator was teacher practices. The most commonly mentioned barrier was intrinsic student factors. Other factors not directly controllable by school staff, such as resource limitations, were also commonly identified by principals and teachers. Parents were more likely to mention school- or teacher-related barriers. Many of the current findings were consistent with previous studies but some differences were noted, including limited reporting of sensory issues and bullying as barriers. There was little change in the pattern of facilitators and barriers identified by respondents over time. A number of implications for practice and directions for future research are discussed.
Even though sub-Saharan African women spend millions of person-hours per day fetching water and pounding grain, to date, few studies have rigorously assessed the energy expenditure costs of such domestic activities. As a result, most analyses that consider head-hauling water or hand pounding of grain with a mortar and pestle (pilão use) employ energy expenditure values derived from limited research. The current paper compares estimated energy expenditure values from heart rate monitors v. indirect calorimetry in order to understand some of the limitations with using such monitors to measure domestic activities.
Design:
This confirmation study estimates the metabolic equivalent of task (MET) value for head-hauling water and hand-pounding grain using both indirect calorimetry and heart rate monitors under laboratory conditions.
Setting:
The study was conducted in Nampula, Mozambique.
Participants:
Forty university students in Nampula city who recurrently engaged in water-fetching activities.
Results:
Including all participants, the mean MET value for head hauling 20 litres (20·5 kg, including container) of water (2·7 km/h, 0 % slope) was 4·3 (sd 0·9) and 3·7 (sd 1·2) for pilão use. Estimated energy expenditure predictions from a mixed model were found to correlate with observed energy expenditure (r2 0·68, r 0·82). Re-estimating the model with pilão use data excluded improved the fit substantially (r2 0·83, r 0·91).
Conclusions:
The current study finds that heart rate monitors are suitable instruments for providing accurate quantification of energy expenditure for some domestic activities, such as head-hauling water, but are not appropriate for quantifying expenditures of other activities, such as hand-pounding grain.