The Effects Of Ellipical Cross Training on VO2 max in Recently Trained Runners

This study examined the effects of elliptical cross training on VO2max in recently-trained runners. 12 female and 8 male participants (mean SD; age = 23.70 6.33 years, body mass index = 24.85 5.89 kg/m2) completed an initial four-week run training program, exercising four days/week, 30 minutes/day, at 80% maximal heart rate. VO2max was predicted based on the duration of a Bruce graded-maximal treadmill test (GXT) prior to and after the run training. After initial training phase and post-test, subjects volunteered for the detrain group (n = 6) or were assigned to the run (n = 7) or elliptical (n = 7) based on a matched-pair design. Elliptical and run groups exercised three weeks under same prescription as initial program. GXT again performed after mode-specific training phase. VO2max (ml/kg/min) increased (p \u3c 0.001) from the pre-training (39.89 10.74) to post-training (41.66 10.90) after the initial run training program. Although not statistically significant, VO2max declined (0.8% running, 1.5% elliptical, and 4.8% detraining) for all groups following the additional mode-specific program. Despite declines, repeated measures ANOVA showed no significant differences within or between groups before and after the mode-specific training phase. However, dependent sample t-test did reveal a decline (p \u3c 0.05) in GXT time (minutes) for the detrain group from before (11.01 2.80) and after (10.54 2.72) their detrain phase. Future research should determine if elliptical exercise maintains VO2max when away from running for longer periods. KEY WORDS: Elliptical, VO2max, Run, Cross Trai

Comparison of Portable Metabolic Devices during Walking, Jogging, and Running

Oxygen uptake measurements enable performance professionals, clinicians, and scientists to quantify energy expenditure and aerobic work capacity for various purposes. Devices that accurately detect the composition of expired gases and changes in oxygen uptake, open new possibilities in research methodology and accessibility. PURPOSE: The purpose of this study was to compare the O2 uptake measurements of the VO2 Master Pro (VM) to the Cosmed K5 (K5) during walking, jogging, and running in field and lab conditions. METHODS: Twelve proficient runners, with a current 10k pace \u3c 5:19 min/km, performed 3 matched intervals at 3 different speeds (4.82, 8.05, 11.27 kph) on a treadmill and on an outdoor track while expired gasses were measured. Each interval was 10 minutes and data from minutes 6-9 were averaged for comparisons. An airflow test was performed on both devices by forcing air through the devices using a 3 L syringe timed to a metronome at 15, 25, and 35 strokes/min. RESULTS: During walking intervals, the VM did not report data for the majority of participants, and therefore were excluded from analysis. Jogging and running measurements were analyzed using a repeated measures ANOVA and Tukey multiple comparison test to analyze pairwise comparisons. The indoor running analysis revealed significant differences in VO2 (3017 vs. 1880 ml/min), VE (71 vs 57 ml/min), and TV (1.89 vs 1.56 L) between the K5 and VM respectively (p \u3c .023). Outdoor analysis revealed a significant difference between devices in VO2, VE­, and TV (p \u3c .035). The airflow test also demonstrated significant differences between the devices in VE and TV (p \u3c .001). Neither the jogging nor running analysis showed a significant difference in FeO2 or HR (p \u3e .16). CONCLUSION: We concluded that there were significant discrepancies between the K5 and the VM due to differences in TV measurement

Risk of asthma in children diagnosed with bronchiolitis during infancy: Protocol of a longitudinal cohort study linking emergency department-based clinical data to provincial health administrative databases

Introduction The Canadian Bronchiolitis Epinephrine Steroid Trial (CanBEST) and the Bronchiolitis Severity Cohort (BSC) study enrolled infants with bronchiolitis during the first year of life. The CanBEST trial suggested that treatment of infants with a combined therapy of high-dose corticosteroids and nebulised epinephrine reduced the risk of admission to hospital. Our study aims to - (1) quantify the risk of developing asthma by age 5 and 10 years in children treated with high-dose corticosteroid and epinephrine for bronchiolitis during infancy, (2) identify risk factors associated with development of asthma in children with bronchiolitis during infancy, (3) develop asthma prediction models for children diagnosed with bronchiolitis during infancy. Methods and analysis We propose a longitudinal cohort study in which we will link data from the CanBEST and BSC study with routinely collected data from provincial health administrative databases. Our outcome is asthma incidence measured using a validated health administrative data algorithm. Primary exposure will be treatment with a combined therapy of high-dose corticosteroids and nebulised epinephrine for bronchiolitis. Covariates will include type of viral pathogen, disease severity, medication use, maternal, prenatal, postnatal and demographic factors and variables related to health service utilisation for acute lower respiratory tract infection. The risk associated with development of asthma in children treated with high-dose corticosteroid and epinephrine for bronchiolitis will be assessed using multivariable Cox proportional hazards regression models. Prediction models will be developed using multivariable logistic regression analysis and internally validated using a bootstrap approach. Ethics and dissemination Our study has been approved by the ethics board of all four participating sites of the CanBEST and BSC study. Finding of the study will be disseminated to the academic community and relevant stakeholders through conferences and peer-reviewed publications. Trial registration number ISRCTN56745572; Post-results

Intranasal ketamine for procedural sedation and analgesia in children: A systematic review

Background Ketamine is commonly used for procedural sedation and analgesia (PSA) in children. Evidence suggests it can be administered intranasally (IN). We sought to review the evidence for IN ketamine for PSA in children. Methods We performed a systematic review of randomized trials of IN ketamine in PSA that reported any sedation-related outcome in children 0 to 19 years. Trials were identified through electronic searches of MEDLINE (1946±2016), EMBASE (1947±2016), Google Scholar (2016), CINAHL (1981±2016), The Cochrane Library (2016), Web of Science (2016), Scopus (2016), clinical trial registries, and conference proceedings (2000±2016) without language restrictions. The methodological qualities of studies and the overall quality of evidence were evaluated using the Cochrane Collaboration\u27s Risk of Bias tool, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system, respectively. Results The review included 7 studies (n = 264) of children ranging from 0 to 14 years. Heterogeneity in study design precluded meta-analysis. Most studies were associated with a low or unclear risk of bias and outcome-specific ratings for quality of evidence were low or very low. In four of seven studies, IN ketamine provided superior sedation to comparators and resulted in adequate sedation for 148/175 (85%) of participants. Vomiting was the most common adverse effect; reported by 9/91 (10%) of participants. Conclusions IN ketamine administration is well tolerated and without serious adverse effects. Although most participants were deemed adequately sedated with IN ketamine, effectiveness of sedation with respect to superiority over comparators was inconsistent, precluding a recommendation for PSA in children

CAEP 2015 Academic Symposium: Leadership within the emergency medicine academic community and beyond

OBJECTIVES: 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

Scalp Hematoma Characteristics Associated with Intracranial Injury in Pediatric Minor Head Injury

Objectives Minor head trauma accounts for a significant proportion of pediatric emergency department (ED) visits. In children younger than 24 months, scalp hematomas are thought to be associated with the presence of intracranial injury (ICI). We investigated which scalp hematoma characteristics were associated with increased odds of ICI in children less than 17 years who presented to the ED following minor head injury and whether an underlying linear skull fracture may explain this relationship. Methods This was a secondary analysis of 3,866 patients enrolled in the Canadian Assessment of Tomography of Childhood Head Injury (CATCH) study. Information about scalp hematoma presence (yes/no), location (frontal, temporal/parietal, occipital), and size (small and localized, large and boggy) was collected by emergency physicians using a structured data collection form. ICI was defined as the presence of an acute brain lesion on computed tomography. Logistic regression analyses were adjusted for age, sex, dangerous injury mechanism, irritability on examination, suspected open or depressed skull fracture, and clinical signs of basal skull fracture. Results ICI was present in 159 (4.1%) patients. The presence of a scalp hematoma (n = 1,189) in any location was associated with significantly greater odds of ICI (odds ratio [OR] = 4.4, 95% confidence interval [CI] = 3.06 to 6.02), particularly for those located in temporal/parietal (OR = 6.0, 95% CI = 3.9 to 9.3) and occipital regions (OR = 5.6, 95% CI = 3.5 to 8.9). Both small and localized and large and boggy hematomas were significantly associated with ICI, although larger hematomas conferred larger odds (OR = 9.9, 95% CI = 6.3 to 15.5). Although the presence of a scalp hematoma was associated with greater odds of ICI in all age groups, odds were greatest in children aged 0 to 6 months (OR = 13.5, 95% CI = 1.5 to 119.3). Linear skull fractures were present in 156 (4.0%) patients. Of the 111 patients with scalp hematoma and ICI, 57 (51%) patients had a linear skull fracture and 54 (49%) did not. The association between scalp hematoma and ICI attenuated but remained significant after excluding patients with linear skull fracture (OR = 3.3, 95% CI = 2.1 to 5.1). Conclusions Large and boggy and nonfrontal scalp hematomas had the strongest association with the presence of ICI in this large pediatric cohort. Although children 0 to 6 months of age were at highest odds, the presence of a scalp hematoma also independently increased the odds of ICI in older children and adolescents. The presence of a linear skull fracture only partially explained this relation, indicating that ruling out a skull fracture beneath a hematoma does not obviate the risk of intracranial pathology

Intranasal Dexmedetomidine for Procedural Distress in Children: A Systematic Review.

CONTEXT: Intranasal dexmedetomidine (IND) is an emerging agent for procedural distress in children. OBJECTIVE: To explore the effectiveness of IND for procedural distress in children. DATA SOURCES: We performed electronic searches of Medline (1946-2019), Embase (1980-2019), Google Scholar (2019), Cumulative Index to Nursing and Allied Health Literature (1981-2019), and Cochrane Central Register. STUDY SELECTION: We included randomized trials of IND for procedures in children. DATA EXTRACTION: Methodologic quality of evidence was evaluated by using the Cochrane Collaboration\u27s risk of bias tool and the Grading of Recommendations Assessment, Development, and Evaluation system, respectively. The primary outcome was the proportion of participants with adequate sedation. RESULTS: Among 19 trials ( LIMITATIONS: The adequacy of sedation was subjective, which possibly led to biased outcome reporting. CONCLUSIONS: Given the methodologic limitations of included trials, IND is likely more effective at sedating children compared to oral chloral hydrate and oral midazolam. However, this must be weighed against the potential for adverse cardiovascular effects

The Pongola Floodplain, South Africa – Part 2: Holistic environmental flows assessment

A holistic environmental flows (EFlows) assessment, undertaken as part of Ecological Reserve determination studies for selected surface water, groundwater, estuaries and wetlands in the Usuthu/Mhlatuze Water Management Area, South Africa, led to recommendations for modified releases from the Jozini Dam to support the socially, economically and ecologically important Pongola Floodplain situated downstream of the dam. The EFlows study analysed various permutations of flow releases from the dam based on the recommendations of pre-dam studies, and augmented by more recent observations, inputs from farmers and fishermen who live adjacent to the floodplain and discussion with the operators of Jozini Dam. The EFlows method used, DRIFT, allowed for the incorporation of detailed information, data and recommendations from a decades-old research project on the Pongola Floodplain that was undertaken prior to the construction of the Jozini Dam into a modern-day decision-making framework. This was used to assess the impact of a series of different flow releases on nature and society downstream of the dam. It was concluded that, within historic volumetric allocations to the floodplain, a release regime could be designed that considerably aided traditional fishing and grazing without necessarily prejudicing other uses, such as agriculture

The impact of pediatric emergency department crowding on patient and health care system outcomes: a multicentre cohort study.

BACKGROUND: Emergency department overcrowding has been associated with increased odds of hospital admission and mortality after discharge from the emergency department in predominantly adult cohorts. The objective of this study was to evaluate the association between crowding and the odds of several adverse outcomes among children seen at a pediatric emergency department. METHODS: We conducted a retrospective cohort study involving all children visiting 8 Canadian pediatric emergency departments across 4 provinces between 2010 and 2014. We analyzed the association between mean departmental length of stay for each index visit and hospital admission within 7 days or death within 14 days of emergency department discharge, as well as hospital admission at index visit and return visits within 7 days, using mixed-effects logistic regression modelling. RESULTS: A total of 1 931 465 index visits occurred across study sites over the 5-year period, with little variation in index visit hospital admission or median length of stay. Hospital admission within 7 days of discharge and 14-day mortality were low across provinces (0.8%-1.5% and \u3c 10 per 100 000 visits, respectively), and their association with mean departmental length of stay varied by triage categories and across sites but was not significant. There were increased odds of hospital admission at the index visit with increasing departmental crowding among visits triaged to Canadian Triage and Acuity Scale (CTAS) score 1-2 (odds ratios [ORs] ranged from 1.01 to 1.08) and return visits among patients with a CTAS score of 4-5 discharged at the index visit at some sites (ORs ranged from 1.00 to 1.06). INTERPRETATION: Emergency department crowding was not significantly associated with hospital admission within 7 days of the emergency department visit or mortality in children. However, it was associated with increased hospital admission at the index visit for the sickest children, and with return visits to the emergency department for those less sick

Multi-dose Oral Ondansetron for Pediatric Gastroenteritis: study Protocol for the multi-DOSE oral ondansetron for pediatric Acute GastroEnteritis (DOSE-AGE) pragmatic randomized controlled trial

BACKGROUND: There are limited treatment options that clinicians can provide to children presenting to emergency departments with vomiting secondary to acute gastroenteritis. Based on evidence of effectiveness and safety, clinicians now routinely administer ondansetron in the emergency department to promote oral rehydration therapy success. However, clinicians are also increasingly providing multiple doses of ondansetron for home use, creating unquantified cost and health system resource use implications without any evidence to support this expanding practice. METHODS/DESIGN: DOSE-AGE is a randomized, placebo-controlled, double-blinded, six-center, pragmatic clinical trial being conducted in six Canadian pediatric emergency departments (EDs). In September 2019 the study began recruiting children aged 6 months to 18 years with a minimum of three episodes of vomiting in the 24 h preceding enrollment,(1:1 allocation via an internet-based, third-party, randomization service) to receive a 48-h supply (i.e., six doses) of ondansetron oral solution or placebo, administered on an as-needed basis. All participants, caregivers and outcome assessors will be blinded to group assignment. Outcome data will be collected by surveys administered to caregivers 24, 48 and 168 h following enrollment. The primary outcome is the development of moderate-to-severe gastroenteritis in the 7 days following the ED visit as measured by a validated clinical score (the Modified Vesikari Scale). Secondary outcomes include duration and frequency of vomiting and diarrhea, proportions of children experiencing unscheduled health care visits and intravenous rehydration, caregiver satisfaction with treatment and safety. A preplanned economic evaluation will be conducted alongside the trial. DISCUSSION: Definitive data are lacking to guide the clinical use of post-ED visit multidose ondansetron in children with acute gastroenteritis. Usage is increasing, despite the absence of supportive evidence. The incumbent additional costs associated with use, and potential side effects such as diarrhea and repeat visits, create an urgent need to evaluate the effect and safety of multiple doses of ondansetron in children focusing on post-emergency department visit and patient-centered outcomes. TRIAL REGISTRATION: ClinicalTrials.gov: NCT03851835. Registered on 22 February 2019