Use of planar covariation in lower limb kinematics to characterize adaptations of running after cycling in elite triathletes.

Purpose: To characterize alterations of lower limb intersegmental coordination during the acute phase of running after cycling among highly trained triathletes using an analysis of planar covariation. Methods: Nine highly trained triathletes completed a control run (CR) and a run after transitioning from cycling exercise (transition run, or TR condition) on a motorized treadmill at a self-selected pace. Sagittal plane kinematics were recorded using a 3D Vicon motion capture system. Intersegmental coordination of the thigh, shank and foot segments of the right lower limb and run loop planarity were calculated during running before cycling and at four different times after the end of cycling. Results: PCA showed a significant within-subject phase shift of the run loop planarity (F = 6.66, P = 0.01). Post hoc analysis showed significance median differences increase for u 3t parameter between CRSS vs. TR30 (P = 0.01), TRt1/2 (P = 0.01) and TRMRT (P = 0.01). No difference for u 3t parameter existed between CRSS vs. TRSS. Conclusion: Prior variable-cadence, moderate intensity cycling has a significant effect on run loop planarity and therefore intersegmental coordination during the acute transition phase among highly trained triathletes. However, alterations to lower limb coordination are corrected by the 3rd minute after the beginning of the post cycle run. We suggest that planar covariation can be used as a more sensitive measure of cycling-induced variations in running to characterize adaptation in elite and importantly, developing athletes.

Is Moderate Intensity Cycling Sufficient to Induce Cardiorespiratory and Biomechanical Modifications of Subsequent Running?

Walsh, JA, Dawber, JP, Lepers, R, Brown, M, and Stapley, PJ. Is moderate intensity cycling sufficient to induce cardiorespiratory and biomechanical modifications of subsequent running? J Strength Cond Res 31(4): 1078-1086, 2017-This study sought to determine whether prior moderate intensity cycling is sufficient to influence the cardiorespiratory and biomechanical responses during subsequent running. Cardiorespiratory and biomechanical variables measured after moderate intensity cycling were compared with control running at the same intensity. Eight highly trained, competitive triathletes completed 2 separate exercise tests; (a) a 10-minute control run (no prior cycling) and, (b) a 30-minute transition run (TR) (preceded by 20-minute of variable cadence cycling, i.e., run versus cycle-run). Respiratory, breathing frequency (fb), heart rate (HR), cost of running (Cr), rate constant, stride length, and stride frequency variables were recorded, normalized, and quantified at the mean response time (MRT), third minute, 10th minute (steady state), and overall for the control run (CR) and TR. Cost of running increased (p ≤ 0.05) at all respective times during the TR. The V[Combining Dot Above]E/V[Combining Dot Above]CO2 and respiratory exchange ratio (RER) were significantly (p < 0.01) elevated at the MRT and 10th minute of the TR. Furthermore, overall mean increases were recorded for Cr, V[Combining Dot Above]E, V[Combining Dot Above]E/V[Combining Dot Above]CO2, RER, fb (p < 0.01), and HR (p ≤ 0.05) during the TR. Rate constant values for oxygen uptake were significantly different between CR and TR (0.48 ± 0.04 vs. 0.89 ± 0.15; p < 0.01). Stride length decreased across all recorded points during the TR (p ≤ 0.05) and stride frequency increased at the MRT and 3 minutes (p < 0.01). The findings suggest that at moderate intensity, prior cycling influences the cardiorespiratory response during subsequent running. Furthermore, prior cycling seems to have a sustained effect on the Cr during subsequent running.

Evaluating return on investment in a school based health promotion and prevention program: the investment multiplier for the Stephanie Alexander Kitchen Garden National Program.

Successful health promotion and disease prevention strategies in complex community settings such as primary schools rely on acceptance and ownership across community networks. Assessing multiplier impacts from investment on related community activity over time are suggested as key alongside evidence of program health effects on targeted groups of individuals in gauging community network engagement and ownership, dynamic impacts, and program long term success and return on investment. An Australian primary school based health promotion and prevention strategy, the Stephanie Alexander Kitchen Garden National Program (SAKGNP), which has been providing garden and kitchen classes for year 3-6 students since 2008, was evaluated between 2011 and 2012. Returns on Australian Federal Government investment for school infrastructure grants up to $60,000 are assessed up to and beyond a two year mutual obligation period with: (i) Impacts on student lifestyle behaviours, food choices and eating habits surveyed across students (n = 491 versus 260) and parents (n = 300 versus 234) in 28 SAKGNP and 14 matched schools, controlling for school and parent level confounders and triangulated with SAKGNP pre-post analysis; (ii) Multiplier impacts of investment on related school and wider community activity up to two years; and (iii) Evidence of continuation and program evolution in schools observed beyond two years. SAKGNP schools showed improved student food choices (p = 0.024) and kitchen lifestyle behaviour (p = 0.019) domains compared to controls and in pre-post analysis where 20.0% (58/290) reported eating fruit and vegetables more often and 18.6% (54/290) preparing food at home more often. No significant differences were found in case control analysis for eating habits or garden lifestyle behaviour domains, although 32.3% of children helped more in the garden (91/278) and 15.6% (45/289) ate meals together more often in pre-post analysis. The multiplier impact on total community activity up to two years was 5.07 ($226,737/$44,758); 1.60 attributable to school, and 2.47 to wider community, activity. All 8 schools observed beyond two years continued garden and kitchen classes, with an average 17% scaling up and one school fully integrating staff into the curriculum. In conclusion evidence supports the SAKGNP to be a successful health promotion program with high community network impacts and return on investment in practice.

Emergency department waiting times: Do the raw data tell the whole story?

OBJECTIVE: To determine whether there are real differences in emergency department (ED) performance between Australian states and territories. METHODS: Cross-sectional analysis of 2009-10 attendances at an ED contributing to the Australian non-admitted patient ED care database. The main outcome measure was difference in waiting time across triage categories. RESULTS: There were more than 5.8 million ED attendances. Raw ED waiting times varied by a range of factors including jurisdiction, triage category, geographic location and hospital peer group. All variables were significant in a model designed to test the effect of jurisdiction on ED waiting times, including triage category, hospital peer group, patient socioeconomic status and patient remoteness. When the interaction between triage category and jurisdiction entered the model, it was found to have a significant effect on ED waiting times (P<0.001) and triage was also significant (P<0.001). Jurisdiction was no longer statistically significant (P=0.248 using all triage categories and 0.063 using only Australian Triage Scale 2 and 3). CONCLUSIONS: Although the Council of Australian Governments has adopted raw measures for its key ED performance indicators, raw waiting time statistics are misleading. There are no consistent differences in ED waiting times between states and territories after other factors are accounted for. WHAT IS KNOWN ABOUT THE TOPIC? The length of time patients wait to be treated after presenting at an ED is routinely used to measure ED performance. In national health agreements with the federal government, each state and territory in Australia is expected to meet waiting time performance targets for the five ED triage categories. The raw data indicate differences in performance between states and territories. WHAT DOES THIS PAPER ADD? Measuring ED performance using raw data gives misleading results. There are no consistent differences in ED waiting times between the states and territories after other factors are taken into account. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS? Judgements regarding differences in performance across states and territories for triage waiting times need to take into account the mix of patients and the mix of hospitals.

Comparative effectiveness of 5-fluorouracil with and without oxaliplatin in the treatment of colorectal cancer in clinical practice.

BACKGROUND: First-line chemotherapeutic treatment of colorectal cancer (CRC) typically comprises oral (capecitabine) or intravenous 5-fluorouracil (5-FU) plus leucovorin (LV), in combination with oxaliplatin (XELOX or FOLFOX, respectively), although debate exists regarding the best course of treatment by modality in clinical practice. Evidence from practice comparisons is important in considering the net benefit of alternative chemotherapy regimens, given expected differences in survival associated with compliance and age of patients treated in real life versus controlled trial settings. PATIENTS AND METHODS: Practice variation in 5-FU treatment (i.e. 5-FU/leucovorin, FOLFOX, capecitabine and XELOX) of patients with CRC from an Australian area health service (n=636) was analyzed between modalities by patient age, tumour stage and site using non-parametric tests. Survival analyses (n=434) were conducted over a three-year follow-up period using Cox regression, adjusting for observed confounders. RESULTS: FOLFOX was the most commonly administered regimen. 5-FU modality was significantly associated with patient age (p<0.001), tumour stage (p<0.001) and site (p<0.001). Cox regression analyses found no significant difference in survival with the addition of oxaliplatin to 5-FU regimens. CONCLUSION: Our findings suggested no survival benefit with the addition of oxaliplatin to 5-FU modalities in treating CRC in practice. This raises questions as to the net benefit of oxaliplatin, given its known toxicity profile and expense.

Referral patterns and proximity to palliative care inpatient services by level of socio-economic disadvantage. A national study using spatial analysis.

BACKGROUND: A range of health outcomes at a population level are related to differences in levels of social disadvantage. Understanding the impact of any such differences in palliative care is important. The aim of this study was to assess, by level of socio-economic disadvantage, referral patterns to specialist palliative care and proximity to inpatient services. METHODS: All inpatient and community palliative care services nationally were geocoded (using postcode) to one nationally standardised measure of socio-economic deprivation - Socio-Economic Index for Areas (SEIFA; 2006 census data). Referral to palliative care services and characteristics of referrals were described through data collected routinely at clinical encounters. Inpatient location was measured from each person's home postcode, and stratified by socio-economic disadvantage. RESULTS: This study covered July - December 2009 with data from 10,064 patients. People from the highest SEIFA group (least disadvantaged) were significantly less likely to be referred to a specialist palliative care service, likely to be referred closer to death and to have more episodes of inpatient care for longer time. Physical proximity of a person's home to inpatient care showed a gradient with increasing distance by decreasing levels of socio-economic advantage. CONCLUSION: These data suggest that a simple relationship of low socioeconomic status and poor access to a referral-based specialty such as palliative care does not exist. Different patterns of referral and hence different patterns of care emerge.