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This study aimed to determine differences in angular kinematics and critical power between younger and older cyclists during the 3-min all-out test. Younger (n = 15, 21.8 ± 2.4y) and older (n = 15, 53.3 ± 6.6 y) Category 1 or 2 riders completed maximal aerobic testing and a 3-min all-out test on separate days using their own bicycle on a cycle ergometer. Eight retroreflective markers determined right side sagittal plane angular kinematics during the 3-min all-out test. Younger cyclists displayed higher VO2max, VO2 @ VEbp, HRmax, Power @ VO2max and Critical Power (p < 0.05) than older cyclists. Cadence decreased over time for the combined group (time 1 (T1) = 87.3 ± 4.5 rpm, time 2 (T2) = 83.7 ± 4.6 rpm, and time 3 (T3) = 83.6 ± 5.0 rpm) where T1 was significantly higher than T2 and T3 (p < 0.001), but there were no differences between age groups. Ankle (T1 > T2 > T3, p < 0.026) and foot ranges of motion (T1, T2 > T3, p < 0.01) decreased over time for both age groups. Additionally, younger cyclists had larger ankle and foot ranges of motion (ROM) compared to older cyclists (p = 0.036 and p = 0.032, respectively). Age related differences in physiological measures occurred as expected, although the skill level of the cyclists may explain their similar cadence. Smaller ankle and foot ROM may be strategies to assist force and power generation, particularly in older cyclists as they attempt to overcome aging related physiological declines. With smaller ROM, older cyclists may aim to strengthen ankle musculature and deemphasize high cadence to maintain force generation and critical power.

A small proportion of health care users are recognised to use a significantly higher proportion of health system resources, largely due to systemic, inequitable access and disproportionate health burdens. These high-resource health system users are routinely characterised as older, with multiple comorbidities, and reduced access to adequate health care. Geographic trends also emerge, with more rural and isolated regions demonstrating higher rates of high-resource use than others. Despite known geographical discrepancies in health care access and outcomes, health policy and research initiatives remain focused on urban population centers. To alleviate mounting health system pressure from high-resource users, their characteristics must be better understood within the context in which it arises. To examine this, a scoping review was conducted to provide an overview of characteristics of high-resource users in rural and remote communities in Canada and Australia. In total, 21 papers were included in the review. Using qualitative thematic coding, primary findings characterised rural high-resource users as those of an older age; with increased comorbid conditions and condition severity; lower socioeconomic status; and elevated risk behaviours.

Introduction: Despite the promises of universal health care in most developed countries, health inequities remain prevalent within and between rural and remote communities. Remote health technologies are often promoted as solutions to increase health system efficiency, to enhance quality of care, and to decrease gaps in access to care for rural and remote communities. However, there is mixed evidence for these interventions, particularly related to how they are received and perceived by health providers and by patients. Health technologies do not always adequately meet the needs of patients or providers. To examine this, a broad-based scoping review was conducted to provide an overview of patient and provider perspectives of eHealth initiatives in rural communities. The unique objective of this review was to prioritize the voices of patients and providers in discussing the disparities between health interventions and needs of people in rural communities. eHealth initiatives were reviewed for rural communities of Australia and Canada, two countries that have similar geographies and comparable health systems at the local level. Methods: Searches were performed in PubMed, Scopus, and Web of Science with results limited from 2000 to 2018. Keywords included combinations of 'eHealth', 'telehealth', 'telemedicine', 'electronic health', and 'rural/remote'. Individual patient and provider perspectives on health care were identified, followed by qualitative thematic coding based on the type of intervention, the feedback provided, the affected population, geographic location, and category of individual providing their perspective. Quotes from patients and providers are used to illustrate the identified benefits and disadvantages of eHealth technologies. Results: Based on reviewed literature, 90.1% of articles reported that eHealth interventions were largely positive. Articles noted decreased travel time (18%), time/cost saving (15.1%), and increased access to services (13.9%) as primary benefits to eHealth. The most prevalent disadvantages of eHealth were technological issues (24.5%), lack of face-to-face contact (18.6%), limited training (10.8%), and resource disparities (10.8%). These results show where existing eHealth interventions could improve and can inform policymakers and providers in designing new interventions. Importantly, benefits to eHealth extend beyond geographic access. Patients reported ancillary benefits to eHealth that include reduced anxiety, disruption on family life, and improved recovery time. Providers reported closer connections to colleagues, improved support for complex care, and greater eLearning opportunity. Barriers to eHealth are recognized by patient and providers alike to be largely systemic, where lack of rural high-speed internet and unreliability of installed technologies were significant. Conclusion: Regional and national governments are seen as the key players in addressing these technical barriers. This scoping review diverges from many reviews of eHealth with the use of first-person perspectives. It is hoped that this focus will highlight the importance of patient voices in evaluating important healthcare interventions such as eHealth and associated technologies.

The small size coupled with remoteness of rural communities in Canada, Australia, and Sweden introduce challenges in accessing sufficient health services (1-3). The sparse health services in rural areas impose “the tyranny of distance” on rural and remote populations, necessitating lengthy travel times to receive care. Despite the increased challenges rural communities face, a dearth of research on rural health persists, particularly rural youth health (4,5). A broad scoping review was undertaken to identify literature regarding rural youth health in Canada, Australia, and Sweden. The studies were coded according to population focus, health focus, access, and general. The scoping review produced the Rural Youth Health Scoping Review Database, which provides an overview of the available research on rural youth health.

While there have been many studies determining the effectiveness of training programs to decrease fall risk in the elderly, most of them require special equipment, leader training, or major time commitments (more than 8 weeks, multiple times per week). Individuals older than 66 years old identified an exercise program offered at home, twice a week, lasting 10 or 30 minutes, and with no associated cost as being more attractive than other training program options offered (Franco et al., 2015). The objective of this study was to determine the effectiveness of a simple six-week exercise program on fall risk factors. Thirty-eight older adults were assigned to a Training Group or a Control Group. Investigator-led balance and lower extremity strength exercises were performed twice a week. Mobility, leg strength and postural sway were measured before and after the six weeks for both groups. A survey determined perceptions of participant abilities and fear of falling at three different times. Timed Up and Go times decreased (p = .008), leg strength increased (p = .022), and postural sway decreased in the anteroposterior direction and overall, for the Training Group (p < .05) while the Control group displayed no differences. Surveys administered determined no differences for the Control group, but the Training Group perceived that they had better balance, mobility, and leg strength and a decreased fear of falling (p < .05). This simple training program led to changes that would likely decrease fall risk and did so in an extremely short time.

A review of recent literature related to eHealth technologies in Canada and Australia was conducted to better understand specific barriers and enablers for the uptake, acceptability, and success of eMental health programs. It has been shown that the more “rural” or “remote” a community, the access to mental health services decreases. By mitigating barriers and promoting enablers, successful eMental health integration can increase access to mental health services for rural residents. eMental health aims to bridge the gap between rural and urban mental health services by introducing electronic methods such as teleconferencing or videoconferencing for psychological services, virtual referral to psychiatrists, and sharing of electronic records. Successful integration of the technology remains a challenging task, with key actors, enablers, and barriers all influencing its success.

Critical power (CP) is a theoretical workload representative of an athlete's maximal sustainable pace. Recent research has validated a 3-minute all-out test on a cycle ergometer for determining CP; however, few studies have investigated the sustainability of CP using this test. The purpose of this study was to determine the sustainability of CP established during the 3-minute test and the determinants of sustainability. A group of elite cyclists (N = 21) performed a VO2max test, 3-minute all-out test, and a time to exhaustion (TTE) trial at CP on 3 different days separated by at least 24 hours. Expired gases were collected during all trials and analyzed for VO2 and VCO2. Heart rate was measured by telemetry. Multiple regression was used to determine predictors of sustainability with significance predetermined at p < 0.05. VO2max was measured at 58.9 ± 5.6 ml·kg(-1)·min(-1), ventilation breakpoint at 44.9 ± 5.7 ml·kg(-1)·min(-1) (75% VO2max), and maximum heart rate at 179 ± 10 b·min(-1). Peak power (PP) in the 3-minute all-out test was measured at 738 ± 170 W, and CP was determined at 305 ± 32 W or 79% of VO2max. The VO2 at CP was 55.4 ± 6.9 ml·kg(-1)·min(-1), representing 94% of measured VO2max. The mean TTE at CP was 14.79 ± 8.38 minutes. The difference score of PP - CP significantly predicted TTE (r = 0.65, p < 0.05). No other measured variables contributed to this prediction. Based on sustainability, these data suggest that the 3-minute all-out test may overestimate CP in elite cyclists, which could lead to overtraining if CP determined with this test is used to identify training intensities.

The basal cell-specific cytokeratin antibody (34betaE12) is widely used to aid in the diagnosis of cancer in challenging prostate needle biopsies (NBX) and transurethral resections of the prostate (TURP). Because prostate carcinoma (PCa) lacks basal cells, the absence of basal cell as determined by 34betaE12 can aid in the confirmation of a histologically suspicious lesion. However, false-negative staining occurs because of patchy cytoplasmic staining, making a definitive diagnosis difficult. A recently identified basal cell marker p63, a p53 homologue, stains basal cell nuclei but not secretory cells. The aim of this study is to determine if the p63 antibody offers any clinically useful advantage over 34betaE12 in the diagnosis of challenging atypical prostate lesions. Ninety-four cases, comprised of 25 consecutive prostate NBX and 2 TURP with an atypical suspicious focus, 55 NBX cases of histologically unequivocal PCa and 12 TURP specimen removed for benign prostate hyperplasia, were stained with the monoclonal antibodies 34betaE12 and 4A4 anti-p63. Basal cell staining intensity, percentage basal cell-positive glands in benign, malignant, and atypical foci, and number of benign glands not staining were evaluated for 34betaE12 and p63 stains. A total of 67 prostate NBX cases, including one TURP, were diagnosed with PCa, 1 atypical small acinar proliferation, 10 benign, and 4 cases excluded because of lost tissue on step sections. None of the 67 PCa NBX cases demonstrated 34betaE12 or p63 immunoreactivity (100% specific). Whereas 57 of 108 (53%) prostate NBX cores from 78 cases demonstrated a similar percentage of basal cell staining for both antibodies, 45 of 108 (41%) NBX cores demonstrated a higher percentage of p63 basal cell staining in benign glands. Only 6 of 108 NBX (6%) cores had a higher percentage of basal cell staining with 34betaE12 (Wilcoxon signed rank test, p

Equations that clarify the mechanical relationships between various parameter values and the velocity of the distal endpoint of a two-segment kinetic chain modeling the human arm were developed and analyzed. In particular, a single equation was presented that relates the distal endpoint velocity to the system’s angular momentum (as an indicator of muscular torque input), the ratio of the distal segment’s angular velocity to that of the proximal segment (the flail ratio), and the angle between the two segments (the configuration angle). These three system variables were analyzed to examine which values are best for creating a large value for the velocity of the distal endpoint. In addition, a sensitivity analysis was conducted to determine whether the relationships between the system values and the distal endpoint velocity were consistent for varying segment parameters. The relationships found were consistent for the various segment parameters. For any given values of the flail ratio and the configuration angle, the larger the value of the system angular momentum, the larger the value of the distal endpoint velocity. For any given values of the system angular momentum and the configuration angle, the larger the flail ratio, the larger the value of the distal endpoint velocity. For given values of the system angular momentum and the flail ratio, the optimal configuration angle that maximizes the distal endpoint velocity depends on the flail ratio value. While it may be impossible to generate simultaneously the combination of optimal parameter values determined, the knowledge of the relationships of these parameters with each other and with the distal endpoint velocity will aid in the search for an attainable optimal compromise.