Physiological assessment of a 16 day, 4385 km ultra-endurance mountain bike race: A case study.

The Tour Divide (TD) is a 4385 km ultra-endurance bicycle race that follows the continental divide from Canada to Mexico. In this case study, we performed a comprehensive molecular and physiological profile before and after the completion of the TD. Assessments were performed 35 days before the start (Pre-TD) and ∼36 h after the finish (Post-TD). Total energy expenditure was assessed during the first 9 days by doubly labelled water (2 H2 18 O), abdominal and leg tissue volumes via MRI, and graded exercise tests to quantify fitness and substrate preference. Vastus lateralis muscle biopsies were taken to measure mitochondrial function via respirometry, and vascular function was assessed using Doppler ultrasound. The 47-year-old male subject took 16 days 7 h 45 min to complete the route. He rode an average of 16.8 h/day. Neither maximal O2 uptake nor maximal power output changed pre- to post-TD. Measurement of total energy expenditure and dietary recall records suggested maintenance of energy balance, which was supported by the lack of change in body weight. The subject lost both appendicular and trunk fat mass and gained leg lean mass pre- to post-TD. Skeletal muscle mitochondrial and vascular endothelial function decreased pre- to post-TD. Overall, exercise performance was maintained despite reductions in muscle mitochondrial and vascular endothelial function post-TD, suggesting a metabolic reserve in our highly trained athlete.

Hospice shared-care saved medical expenditure and reduced the likelihood of intensive medical utilization among advanced cancer patients in Taiwan--a nationwide survey.

PURPOSE: Hospice shared care (HSC) is a new care model that has been adopted to treat inpatient advanced cancer patients in Taiwan since 2005. Our aim was to assess the effect of HSC on medical expenditure and the likelihood of intensive medical utilization by advanced cancer patients. METHODS: This is a nationwide retrospective study. HSC was defined as using "Hospice palliative care (HPC) teams to provide consultation and service to advanced cancer patients admitted in the nonhospice care ward." There were 120,481 deaths due to cancer between 2006 and 2008 in Taiwan. Patients receiving HSC were matched by propensity score to patients receiving usual care. Of the 120,481 cancer deaths, 12,137 paired subjects were matched. Medical expenditures for 1 year before death were assessed between groups using a database from the Bureau of National Health Insurance. Paired t and McNemar's tests were applied for comparing the medical expenditure and intensive medical utilization before death between paired groups. RESULTS: Compared to the non-HSC group, subjects receiving HSC had a lower average medical expenditure per person (US$3,939 vs. US$4,664; p<0.001). The HSC group had an adjusted net savings of US$557 (13.3%; p<0.001) in inpatient medical expenditure per person compared with the non-HSC group. Subjects that received different types of HPC had 15.4-44.9% less average medical expenditure per person and significantly lower likelihood of intensive medical utilization than those that did not receive HPC. CONCLUSIONS: HSC is associated with significant medical expenditure savings and reduced likelihood of intensive medical utilization. All types of HPC are associated with medical expenditure savings.

Brain and high metabolic rate organ mass: contributions to resting energy expenditure beyond fat-free mass.

BACKGROUND: The degree to which interindividual variation in the mass of select high metabolic rate organs (HMROs) mediates variability in resting energy expenditure (REE) is unknown. OBJECTIVE: The objective was to investigate how much REE variability is explained by differences in HMRO mass in adults and whether age, sex, and race independently predict REE after adjustment for HMRO. DESIGN: A cross-sectional evaluation of 55 women [30 African Americans aged 48.7 +/- 22.2 y (mean +/- SD) and 25 whites aged 46.4 +/- 17.7 y] and 32 men (8 African Americans aged 34.3 +/- 18.2 y and 24 whites aged 51.3 +/- 20.6 y) was conducted. Liver, kidney, spleen, heart, and brain masses were measured by magnetic resonance imaging, and fat and fat-free mass (FFM) were measured by dual-energy X-ray absorptiometry. REE was measured by indirect calorimetry. RESULTS: REE estimated from age (P = 0.001), race (P = 0.006), sex (P = 0.31), fat (P = 0.001), and FFM (P < 0.001) accounted for 70% (adjusted (2)) of the variability in REE. The addition of trunk HMRO (P = 0.001) and brain (P = 0.006) to the model increased the explained variance to 75% and rendered the contributions of age, sex, and race statistically nonsignificant, whereas fat and FFM continued to make significant contributions (both P < 0.05). The addition of brain to the model rendered the intercept (69 kcal . kg(-1) . d(-1)) consistent with zero, which indicated zero REE for zero body mass. CONCLUSIONS: Relatively small interindividual variation in HMRO mass significantly affects REE and reduces the role of age, race, and sex in explaining REE. Decreases in REE with increasing age may be partly related to age-associated changes in the relative size of FFM components.

Medical expenditure and family satisfaction between hospice and general care in terminal cancer patients in Taiwan.

BACKGROUND/PURPOSE: As the number of terminal cancer patients increases, several care models have been adopted to provide better care quality and reduce medical expenditure. This study compared inpatient medical expenditure and family satisfaction in a hospice ward (HW) and general ward (GW) for terminal cancer patients in Taiwan. METHODS: We enrolled terminal cancer patients who were admitted and died during the same admission period in a tertiary care hospital in Taiwan from January 2003 to December 2005. These patients were allocated into three groups: inpatient care in HW alone; inpatient care in GW alone; and inpatient care in mixed group (initially in GW, then transferred to HW). Inpatient medical expenditure and family satisfaction were compared between the three groups. RESULTS: A total of 1942 patients were recruited and allocated into HW (n = 292), GW (n = 1511) and mixed (n = 139) groups. The average medical expenditure per person or per inpatient day was lower in the HW than the GW or mixed group. Subjects who had ever been admitted to the intensive care unit or received cardiopulmonary resuscitation in the GW or mixed groups required more expenditure on medical care than that in the HW group. Daily medical expenditure in the HW group also was much lower than that in the GW and mixed groups, based on length of stay and cancer type. The family satisfaction score was significantly higher in the mixed and/or HW group than the GW group. CONCLUSION: For terminal cancer patients, hospice care can improve family satisfaction while reducing medical expenditure in Taiwan.