Class III obesity is associated with increased risk for cognitive impairment. Though hypothesized to be partially attributable to sedentary time (ST), past research examining the association between ST and cognitive function has produced mixed findings. One possible explanation is that studies do not typically account for the highly correlated and almost inverse relationship between ST and light intensity physical activity (LPA), such that ST displaces time engaging in LPA. Therefore, we aimed to evaluate whether: (1) higher ST-to-LPA time ratio associates with poorer performance across multiple cognitive domains in patients with Class III obesity seeking bariatric surgery; and (2) the associations differ by sex.

Participants (N = 121, 21-65 years of age, BMI > 40 kg/m2) scheduled for either Roux-en-Y Gastric Bypass (RYGB) or Sleeve Gastrectomy (SG) completed the NIH Toolbox, a computerized neuropsychological assessment battery and wore a waist-mounted ActiGraph monitor during waking hours for 7 days to measure minutes/day spent in ST, LPA, and moderate-to-vigorous physical activity (MVPA). A ratio of time spent in ST-to-LPA was calculated by dividing the percentage of daily wear time spent in sedentary behavior (SB) by the percentage of daily wear time spent in LPA.

On average, participants (mean age = 43.22 years old and BMI = 45.83 kg/m2) wore the accelerometer for 909±176 minutes/day and spent 642±174 minutes/day in ST, 254±79 minutes/day in LPA, and 14±13 minutes/day in MVPA. Mean daily ST-to-LPA time ratio was 2.81 ± 1.3 (0.73-7.11). Overall, bivariate Pearson correlations found no significant relationships between LPA and cognitive performance on any of the NIH Toolbox subtests (r values = -.002 to -.158, all p values >.05). Additionally, bivariate Pearson correlations also found no significant relationships between daily ST-to-LPA time ratio and cognitive performance on any of the subtests (r values = .003 to .108, all p values >.05). However, higher ST-to-LPA was associated with lower scores on the Dimensional Change Card Sort Test in women (r = -.26, p = .01).

Results showed that participants’ mean daily time spent in ST was 2.5 times higher than that spent in LPA and a higher ratio of ST-to-LPA was associated with poorer set-shifting in women with Class III obesity. Future studies should look to clarify underlying mechanisms, particularly studies examining possible sex differences in the cognitive benefits of PA. Similarly, intervention studies are also needed to determine if increasing LPA levels for individuals with Class III obesity would lead to improved cognitive performance by means of reducing ST.

A panel of emergency medicine (EM) leaders endeavoured to define the key elements of leadership and its models, as well as to formulate consensus recommendations to build and strengthen academic leadership in the Canadian EM community in the areas of mentorship, education, and resources.

The expert panel comprised EM leaders from across Canada and met regularly by teleconference over the course of 9 months. From the breadth of backgrounds and experience, as well as a literature review and the development of a leadership video series, broad themes for recommendations around the building and strengthening of EM leadership were presented at the CAEP 2015 Academic Symposium held in Edmonton, Alberta. Feedback from the attendees (about 80 emergency physicians interested in leadership) was sought. Subsequently, draft recommendations were developed by the panel through attendee feedback, further review of the leadership video series, and expert opinion. The recommendations were distributed to the CAEP Academic Section for further feedback and updated by consensus of the expert panel.

The methods informed the panel who framed recommendations around four themes: 1) leadership preparation and training, 2) self-reflection/emotional intelligence, 3) academic leadership skills, and 4) gender balance in academic EM leadership. The recommendations aimed to support and nurture the next generation of academic EM leaders in Canada and included leadership mentors, availability of formal educational courses/programs in leadership, self-directed education of aspiring leaders, creation of a Canadian subgroup with the AACEM/SAEM Chair Development Program, and gender balance in leadership roles.

These recommendations serve as a roadmap for all EM leaders (and aspiring leaders) to build on their success, inspire their colleagues, and foster the next generation of Canadian EM academic leaders.

The emergency telephone number 9-1-1 serves as a lifeline to the public during emergencies, and first responders rely on information gathered by 9-1-1 telecommunicators who speak with callers. Timely, accurate information from the telecommunicators is essential for providing appropriate care on scene. Language barriers can hamper these efforts and result in less efficient information exchange. Although 9-1-1 telecommunicators may access over-the-phone interpreter (OPI) services to facilitate communication, managing three-way communication during an emergency is challenging.

There is little published on the relationship between limited English proficient (LEP) callers and 9-1-1 police telecommunicators, and the role of OPI services during these calls. Further, little is known about effective strategies to manage such calls.

In King County, Washington, 9-1-1 police telecommunicators were surveyed about their experiences handling LEP calls and managing three-way communication with OPI services. The survey contained 13 multiple-choice and three open-response questions addressing communication strategies, challenges with LEP callers, and three-way communication with OPI services. Goodman-Kruskal Gamma and chi-square tests were conducted with OPI use as the dependent variable. Additional analyses were conducted using stress levels as the dependent variable.

Of 123 respondents, 69 (56.5%) 9-1-1 telecommunicators reported utilizing OPI services at least 75% of the time when receiving a call from an LEP caller. Further, 35 (28.7%) of these telecommunicators reported calls with LEP individuals as more stressful than calls with fluent English speakers. Dispatcher stress level during LEP calls compared with stress during calls with fluent English speakers was positively associated with use of OPI services (P < .01). Further, stress level was also positively associated with telecommunicator difficulties in assessing the situation with respect to officer safety (P < .01). Sixty-three (58.3%) of the telecommunicators described difficulties assessing the situation to determine the appropriate response as the biggest challenge with LEP callers. Additionally, 62 (53%) identified knowing their location in English as information LEP callers need to know prior to calling 9-1-1.

These results highlight intervention opportunities for both 9-1-1 telecommunicators and LEP communities. Together, interventions such as working with LEP communities to educate them on best communication practices during 9-1-1 calls, and with 9-1-1 telecommunicators to help them manage three-way communication and reduce stress associated with concern for officer safety may improve emergency communication during 9-1-1 calls.

CarrollLN, CalhounRE, SubidoCC, PainterIS, MeischkeHW. Serving Limited English Proficient Callers: A Survey of 9-1-1 Police Telecommunicators. Prehosp Disaster Med. 2013;28(3):1-6.