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Kevin A Zwetsloot,1 Casey S John,1 Marcus M Lawrence,1 Rebecca A Battista,1 R Andrew Shanely1,2 1Department of Health, Leisure, and Exercise Science, Appalachian State University, Boone, NC, USA; 2Human Performance Laboratory, North Carolina Research Campus, Appalachian State University, Kannapolis, NC, USA Abstract: The purpose of this study was to determine: 1) the extent to which an acute session of high-intensity interval training (HIIT) increases systemic inflammatory cytokines and chemokines, and 2) whether 2 weeks of HIIT training alters the inflammatory response. Eight recreationally active males (aged 22±2 years) performed 2 weeks of HIIT on a cycle ergometer (six HIIT sessions at 8–12 intervals; 60-second intervals, 75-second active rest) at a power output equivalent to 100% of their predetermined peak oxygen uptake (VO2max). Serum samples were collected during the first and sixth HIIT sessions at rest and immediately, 15, 30, and 45 minutes post-exercise. An acute session of HIIT induced significant increases in interleukin (IL)-6, IL-8, IL-10, tumor necrosis factor-α, and monocyte chemotactic protein-1 compared with rest. The concentrations of interferon-γ, granulocyte macrophage-colony-stimulating factor, and IL-1β were unaltered with an acute session of HIIT. Two weeks of training did not alter the inflammatory response to an acute bout of HIIT exercise. Maximal power achieved during a VO2max test significantly increased 4.6%, despite no improvements in VO2max after 2 weeks of HIIT. These data suggest that HIIT exercise induces a small inflammatory response in young, recreationally active men; however, 2 weeks of HIIT does not alter this response. Keywords: cycle ergometer, inflammatory cytokines, exercise training

Objective: To compare the IOP-lowering efficacy of a.m.-dosed travoprost and latanoprost at 24-h post-dose. Research design and methods: Open-angle glaucoma patients not naïve to prostaglandin therapy and currently controlled on p.m.-dosed (2100) latanoprost (n=21) or travoprost (n=30) had baseline IOPs measured at 0900. In a randomized, single-masked, crossover design, patients received travoprost (Travatan) or latanoprost (Xalatan) at 0900 for 4 weeks, then were crossed over to receive the second prostaglandin for another 4 weeks. Treatment IOP was measured at 0900 prior to morning dose at both 4 and 8 week visits. Patient dosing preference (a.m./p.m.) was surveyed on exit. Main outcome measure: Intraocular pressure (IOP). Results: The mean IOP in the first period when all patients were dosed in the evening was assessed 12 h after dosing at 09:00 and it was similar in the two treatment groups (mean±standard deviation: 17.9±2.7 mmHg for travoprost versus 17.7±2.5 mmHg for latanoprost, p=0.812). In the a.m.-dosing crossover comparison, the 24-h post-dose IOP was significantly lower (p<0.001) on travoprost (16.9±3.1 mmHg) compared to latanoprost (18.6±3.3 mmHg). In the exit survey, 51% of patients preferred a.m.-dosing. Conclusions: a.m.-dosed travoprost is superior to a.m.-dosed latanoprost by 1.7 mmHg at 24-h post-dose. [ABSTRACT FROM AUTHOR]

During the last decade, there has been active interest in indoor cycling (e.g., spinning) as a method of choreographed group exercise. Recent studies have suggested that exercise intensity during indoor cycling may be quite high and may transiently exceed Vo2max. This study sought to confirm these findings, as the apparent high intensity of indoor cycling has implications for both the efficacy and the risk of indoor cycling as an exercise method. Twenty healthy female students performed an incremental exercise test to define Vo2max and performed 2 videotaped indoor exercise classes lasting 45 minutes and 35 minutes. Vo2, heart rate (HR), and rating of perceived exertion (RPE) were measured during the indoor cycling classes, with Vo2 data integrated in 30-second intervals. The mean %Vo2max during the indoor cycling classes was modest (74 +/- 14% Vo2max and 66 +/- 14%Vo2max, respectively). However, 52% and 35% of the time during the 45- and 35-minute classes was spent at intensities greater than the ventilatory threshold (VT). The HR response indicated that 35% and 38% of the session time was above the HR associated with VT. In 10 of the 40 exercise sessions, there were segments in which the momentary Vo2 exceeded Vo2max observed during incremental testing, and the cumulative time with exercise intensity greater than Vo2max ranged from 0.5 to 14.0 minutes. It can be concluded that although the intensity of indoor cycling in healthy, physically active women is moderate, there are frequent observations of transient values of Vo2 exceeding Vo2max, and a substantial portion of the exercise bouts at intensities greater than VT. As such, the data suggest that indoor cycling must be considered a high-intensity exercise mode of exercise training, which has implications for both efficacy and risk. [ABSTRACT FROM AUTHOR]

In this study, we examined the relations between biological maturity status, body mass index, age, and perceptions of adult autonomy support in the context of youth soccer. A total of 70 female and 43 male soccer players, aged 9-15 years, completed three adult-specific versions (i.e. mother, father, coach) of the perceived autonomy support subscale from the Interpersonal Style Scale. The participants' percent predicted adult stature was used as an estimate of biological maturity status. Multiple linear regression analyses revealed that advanced maturity status in male players predicted lower perceptions of autonomy support from the coach. Maturity status was unrelated to perceptions of autonomy support from the coach in female soccer players, and paternal and maternal autonomy support in male and female players. Age and body mass index were unrelated to perceptions of adult (i.e. coach, mother, father) autonomy support in male and female players. [ABSTRACT FROM AUTHOR]

Abstract Background Breast cancer (BC) detection in women with a genetic susceptibility or strong family history is considered mandatory compared with BC screening in the general population. However, screening modalities depend on the level of risk. Here we present an update of our screening programs based on risk classification. Methods We defined different risk categories and surveillance strategies to identify early BC in 1325 healthy women recruited by the Modena Study Group for familial breast and ovarian cancer. Four BC risk categories included BRCA1/2 carriers, increased, intermediate, and slightly increased risk. Women who developed BC from January 1, 1994, through December 31, 2005 (N = 44) were compared with the number of expected cases matched for age and period. BRCA1/2 carriers were identified by mutational analysis. Other risk groups were defined by different levels of family history for breast or ovarian cancer (OC). The standardized incidence ratio (SIR) was used to evaluate the observed and expected ratio among groups. All statistical tests were two-sided. Results After a median follow-up of 55 months, there was a statistically significant difference between observed and expected incidence [SIR = 4.9; 95% confidence interval (CI) = 1.6 to 7.6; p < 0.001]. The incidence observed among BRCA carriers (SIR = 20.3; 95% CI = 3.1 to 83.9; P < 0.001), women at increased (SIR = 4.5; 95% CI = 1.5 to 8.3; P < 0.001) or intermediate risk (SIR = 7.0, 95% CI = 2.0 to 17.1; P = 0.0018) was higher than expected, while the difference between observed and expected among women at slightly increased risk was not statistically significant (SIR = 2.4, 95% CI = 0.9 to 8.3; P = .74). Conclusion The rate of cancers detected in women at high risk according to BRCA status or strong family history, as defined according to our operational criteria, was significantly higher than expected in an age-matched general population. However, we failed to identify a greater incidence of BC in the slightly increased risk group. These results support the effectiveness of the proposed program to identify and monitor individuals at high risk, whereas prospective trials are needed for women belonging to families with sporadic BC or OC.

Purpose: Managing postoperative complications is crucial in reconstructive surgery. Indocyanine green fluorescence video-angiography (ICGA) aids in assessing flap vascularization intraoperatively, potentially reducing complications., Methods: An ambispective study enrolled head and neck cancer patients undergoing ablative surgery with soft tissue reconstruction. An experimental arm (March 2021-May 2023) used ICGA, while a control arm (January 2017-December 2020) did not. Complications were graded by Clavien-Dindo classification. We also evaluated the effect of systemic inflammation on the sensitivity of ICGA in detecting hypoperfused areas of the flap., Results: Complications were less frequent in the experimental arm, both overall (11.4% vs. 36.4%) and major ones (Clavien-Dindo ≥ 3) (8.6% vs. 30.9%). ICGA showed a protective effect in univariate and multivariate analyses. Previous radiation and ICGA were independent predictors of major complications. ICGA altered the surgical strategy in 25.7% of cases., Conclusions: Real-time perfusion assessment, particularly with ICGA, can improve outcomes in head and neck cancer patients undergoing soft tissue reconstruction by reducing complications. Further research with larger cohorts is warranted for validation., Competing Interests: Declarations. Ethical approval: The protocol on which this ambispective observational study was based has been approved by the ethics committee of IRCCS Hospital San Raffaele (number 181/INT/2021). This study was conducted in accordance with all the principles established by the Eighteenth World Medical Assembly (Helsinki, 1964) and all relevant amendments drafted by the World Medical Assemblies and the ICH guidelines for GMP. In addition, the study was conducted in accordance with all international laws and standards and the national laws and regulations of the country in which it was conducted (Italy), as well as the relevant guidelines. The study leader (according to the requirements of the applicable regulations) or a person designated by him/her and under his/her responsibility informed the patient of all relevant aspects of the research protocol. All participants were informed as comprehensively as possible about all aspects of the study in a language and in terms they could fully understand. Written informed consent was obtained prior to the patient’s participation. It was made clear to the patient that he could withdraw from the study at any time without explanation and that he would have no disadvantages from his withdrawal. The investigators involved performed the study in accordance with this protocol, ICH, GMP and all applicable regulatory requirements. The research protocol manager has ensured compliance with all procedures required by the protocol. We declare no conflict of interests. We declare no funding. Conflict of interest: Authors declare no financial interests that are directly or indirectly related to the work submitted for publication., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Sentinel lymph node biopsy (SLNB) is currently considered as a viable alternative to elective neck dissection (END) for the management of cN0 oral cavity squamous cell carcinoma (OCSCC). However, some difficulties were detected in sentinel lymph node (SLN) identification in floor of mouth (FOM) and ventral tongue tumors because of the so-called "shine-through radioactivity" of the injection site, which may mask nodal hotspots in proximity. We assessed the feasibility and the potential strengths of combining 99m Tc-Tilmanocept with indocyanine green (ICG) fluorescence lympho-angiography in a dedicated multimodal protocol for SLNB in T1/T2N0 oral cancer to evaluate the synergistic role of each of these two tracers in providing the appropriate sensitivity and ease of learning, even in such a critical anatomical subsite. A detailed, stepwise description of our multimodal protocol is provided, together with the presentation of its application in two cases of early-stage ventral tongue tumors. Radioactive guidance with 99m Tc-Tilmanocept was used preoperatively to perform planar lymphoscintigraphy and single-photon emission computed tomography/computed tomography and to define the nodal hotspot(s) and the surgical "roadmap". In addition, it was used intraoperatively to pinpoint the SLN location within each nodal hotspot with high specificity but limited spatial resolution. Optical guidance with ICG injection at the tumor bed and near-infrared fluorescence imaging was then added, providing intuitive intraoperative guidance within each nodal hotspot with high spatial resolution. Our small experience with this protocol is illustrated and future perspectives are highlighted.

Background: The interplay between cancer cells and the immune system is crucial in cancer progression and treatment. In this regard, the tumor immune microenvironment and macroenvironment, marked by systemic inflammation markers and TILs, could be considered key prognostic factors in tumors, including oral and lung squamous cell carcinoma., Methods: We conducted a retrospective clinical study on patients with Oral Squamous Cell Carcinoma (OSCC) and Lung Squamous Cell Carcinoma (LUSCC), examining stages, comorbidities, treatments, and outcomes. We evaluated the prognostic significance of pre-surgical systemic inflammation markers and tumor microenvironment composition., Results: Associations were found between systemic inflammation markers-NLR, MLR, and PLR-and tumor microenvironment factors, such as TILs and CD8+ cell prevalence-elevated inflammation markers correlated with advanced stages. Specifically, NLR was prognostic in OSCC, whereas PLR was prognostic in LUSCC. Using a cutoff value, we divided our tumor samples into two prognostic groups. Moreover, TILs levels >15% of tumor stroma correlated with prolonged overall survival in both OSCC and LUSCC, while increased CD8+ expression was linked to extended disease-free survival in LUSCC., Discussion: Systemic inflammation markers and TILs can be valuable prognostic factors of survival, highlighting the immune response's role in OSCC and LUSCC. Despite limited clinical integration of the presented cohorts due to a lack of standardization, we concluded that analyzing tumor immune profiles may offer novel prognostic insights., Conclusions: Future integration into cancer classification could improve risk stratification and treatment guidance.

Competing Interests: Disclosure Statement No potential conflict of interest was reported by the authors.

The coronavirus disease 2019 (COVID-19) pandemic has had a global impact. Patients with cancer, their caregivers, and physicians need to balance the challenges associated with COVID-19 while ensuring cancer care. Nevertheless, emotional distress and hospital departmental reorganization could have led to a decrease in ED admissions even among oncological patients. Methods: We compared the 72 days of the pandemic in 2020 with the same calendar days in 2019 and 2021, defining a 20% decrease in ED visits as clinically significant. We studied the cause for visit, its severity, outcome (admission vs. discharge vs. death vs. hospice/palliative care), the tumor site, and method of arrival to the ED for the 3 time periods. Results: A significant decrease in ED oncological visits was found in 2020 compared to 2019, before returning to similar numbers in 2021. Fear, anxiety, and worry, in addition to hospital departmental reorganization, surely had an important role in the delay of ED visits, which resulted in irreparable consequences.

Purpose: Near-infrared autofluorescence is a new technology in thyroid surgery to better localize and preserve parathyroid glands. The purpose of this study is to assess if the adoption of NIR-AF can improve in short-, medium-, and long-term post-operative calcium and PTH levels compared to conventional "naked eye" surgery in patients undergoing TT for benign or malignant conditions., Methods: 134 patients undergone total thyroidectomy between January 2020 and June 2022; 67 were treated with conventional thyroidectomy, the other 67 underwent surgery adopting an autofluorescence detecting device., Results: Significant differences were found between the two groups in percentage of patients with short-term hypocalcemia (p = 0.04) and short-term hypoparathyroidism (p = 0.011). Median short-term (p = 0.01) and medium-term (p = 0.03) PTH levels were significantly higher in autofluorescence group, while, short- (p = 0.001), medium- (p < 0.001) and long-term (p = 0.019) percentage variation of PTH levels from baseline were significantly higher in the standard-care group. Finally, the prescription of oral calcium (p < 0.01) after surgery were significantly lower in the autofluorescence group., Conclusion: The adoption of near-infrared autofluorescence during total thyroidectomy is related to lower short-term hypocalcemia and hypoparathyroidism rates, decreased variation of post-operative PTH levels in short- and medium- and long-term, reducing the necessity of supplementation therapy with oral calcium compared to conventional surgery., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Introduction: During the COVID-19 pandemic, measures implemented to protect community health may have influenced how and where people engaged in physical activity. In rural communities, access to resources, the environment, and socioeconomic status could play a role in how adults are physically active. Our study examined locations where rural residents of a county in western North Carolina engaged in physical activity early in the COVID-19 pandemic, their reasons for being physically active, and their perceptions of benefits and barriers related to engaging in physical activity., Methods: Rural adults (N =297) completed an online survey from August 3 through September 15, 2020, describing their physical activity during the summer of 2020. Data were analyzed using nonparametric measures., Results: Survey respondents frequently engaged in physical activity in the home (57.8%), at parks or on trails (45.3%), and around their neighborhood (39.4%). The most common types of physical activities at parks or on trails were walking and hiking (99.5%). Across all locations, the most frequently reported reasons for engaging in physical activity were getting out of the house, maintaining fitness and mental health, and exercising., Conclusion: Our study showed many locations where rural residents were physically active and their reasons for participating in physical activity during the pandemic. Data about perceived benefits of and barriers to physical activity during the pandemic can assist in meeting the current need to increase physical activity levels in rural communities.

Purpose: Reductive rhinoplasty is generally intended as a facial plastic procedure aiming for functional and aesthetic outcomes in patients affected by nasal dysmorphism and/or obstruction. However, when applied to different pathologies of the nasal pyramid it holds great potentialities, beyond the solo cosmetic and functional objectives., Methods: We retrospectively analyzed preoperative conditions, surgical charts, and postoperative results of patients who underwent reductive rhinoplasty for different nasal diseases at our Institution., Results: Principles and techniques of reductive rhinoplasty were described in the different possible applications to the treatment of nasal disease, from nasal septal perforation to benign and malignant diseases of the nose., Conclusions: Reductive rhinoplasty showed to play a crucial role in the curative purpose of different nasal diseases, representing a versatile tool in the expert hand of rhinoplasty surgeons who approach them., Level of Evidence: N/A., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Backgrounds: Rhinoplasty necessarily concerns functional and cosmetic aspects, and outcomes of both should be assessed in each patient. There has been a lack in the literature in Italian for a comprehensive tool for assessing both aspects of rhinoplasty. The objective is to translate and validate the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) into Italian., Methods: Forward and back-translation was used. Content validity was evaluated by experts and by patient interviews. Internal consistency was assessed by a Cronbach's alpha. The structure validity was assessed by an exploratory factor analysis., Results: Cognitive interviews of 10 rhinoplasty patients resulted in a good overall comprehension of the SCHNOS. Of the 411 respondents, 281 (32%) were women, and the average age was 33.6 (11.3) years. The alpha was excellent for both the obstruction domain (SCHNOS-O) (0.90) and the cosmetic domain (SCHNOS-C) (0.94). All the correlations between repeated measures were moderate to very strong. The exploratory factor analysis demonstrated unidimensionality of both the SCHNOS-O and the SCHNOS-C scores., Conclusions: The SCHNOS was successfully translated and validated in Italian and can be recommended for a clinical use among rhinoplasty patients., Level of Evidence Iii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 ., (© 2021. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

In head and neck oncologic surgery a reconstructive phase is often required and pedicled flaps are still a viable option, though they may need a pedicle division performed at a later stage. Several techniques are commonly used for perfusion assessment of the flaps, with indocyanine green (ICG) fluorescence video-angiography representing a promising tool. We used ICG video-angiography to evaluate the perfusion of two of the most commonly adopted pedicled flaps in the head and neck field (the supraclavicular and the paramedian forehead flap) before and after second-stage pedicle division, allowing a safer in-setting. Moreover, the new high-resolution device that we have employed added further accuracy to the traditional video-angiography, providing a real-time flap-to-normal skin ICG ratio. Indeed, ICG video-angiography proved to be a useful tool in head and neck reconstructive surgery and it may allow an earlier second-stage pedicle division., (© 2022 The Authors. Head & Neck published by Wiley Periodicals LLC.)

Background: Obstructive pathology is a benign condition of the salivary glands that can affect elderly and co-morbid people. Sialoendoscopy is a minimally invasive surgical procedure with a success rate comparable to standard sialoadenectomy and has the advantage that it can be performed under local anaesthesia., Methods: This study aimed to assess sialoendoscopy benefits in elderly patients unfit for general anaesthesia. A group of elderly patients (aged 65 years or more) undergoing sialoendoscopy under local anaesthesia were evaluated. Age, co-morbidities, surgical time, hospital stay, and complication and recurrence rates were assessed., Results: Nineteen sialoendoscopies were performed in 18 elderly patients with a mean age of 69.7 ± 5.6 years, with some of them suffering from multiple co-morbidities. Surgery was successful in 16 patients, while surgery was unsuccessful in 2 patients because of intraglandular stones. The average surgical duration was 54.5 ± 30.1 minutes, and all patients were discharged 2-3 hours after surgery. No post-operative complications were found and only one patient had recurrence during follow up., Conclusion: Sialoendoscopy under local anaesthesia is a safe and effective procedure in elderly patients who are more prone to complications.

Background: Patients with coronavirus disease 2019 (COVID-19) exhibit high thrombotic risk. The evidence on a potential independent prognostic role of antiplatelet treatment in those patients is limited. The aim of the study was to evaluate the prognostic impact of pre-admission low-dose acetylsalicylic acid (ASA) in a wide series of hospitalized patients with COVID-19., Methods: This cohort study included 984 COVID-19 patients stratified according to ASA intake before hospitalization: ASA + (n = 253) and ASA - (n = 731). Patients were included in ASA + group if they received it daily in the 7 days before admission. 213 (83%) were on ASA 100 mg daily. Primary endpoint was a composite of in-hospital death and/or need for respiratory support upgrade, secondary endpoints were in-hospital death and need for respiratory support upgrade., Results: Mean age was 72 [62; 81] with 69% of male patients. ASA + patients were significantly older, with higher prevalence of comorbidities. No significant differences regarding the degree of respiratory dysfunction were observed. At 30-day Kaplan-Meier analysis, ASA + patients had higher survival free from the primary endpoint and need for respiratory support upgrade, conversely in-hospital death did not significantly differ between groups. At multivariate analysis ASA intake was independently associated with a lower probability of reaching primary endpoint (HR 0.697, 95% C.I. 0.525-0.924; p = 0.012)., Conclusions: In COVID-19 patients undergoing hospitalization, pre-admission treatment with ASA is associated with better in-hospital outcome, mainly driven by less respiratory support upgrade., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background and Objective: Colorectal cancer is one of the most common malignancies among the general population. Artificial Intelligence methodologies based on serum parameters are in continuous development to obtain less expensive tools for highly sensitive diagnoses. This study proposes a predictive system based on serum biomarkers and ensemble learning to predict colorectal cancer presence and the related TNM stage in patients., Methods: We have selected 17 significant plasmatic proteins, i.e., Carcinoembryonic Antigen, CA 19-9, CA 125, CA 50, CA 72-4, Tissue Polypeptide Antigen, C-Reactive Protein, Ceruloplasmin, Haptoglobin, Transferrin, Ferritin, α-1-Antitrypsin, α-2-Macroglobulin, α-1 Acid Glycoprotein, Complement C4, Complement C3, and Retinol Binding Protein, regarding 345 patients (248 affected by the neoplastic disease). The proposed system consists of two predictors, i.e., binary and staging; the former predicts the presence/absence of cancer, while the latter identifies the related TNM stage (I, II, III, or IV). The experiments were conducted by deploying and comparing Random Forest, XGBoost, Support Vector Machine, and Multilayer Perceptron with feature selection based on Gini Importance and with dimensionality reduction via PCA., Results: The results show that the system composed of XGBoost as binary and staging predictor reaches 91.30% accuracy, 90% sensitivity, and 93.33% specificity for the absence/presence outcome, while 66.66% accuracy for the staging response. With the expansion of the training set in favor of positive patients and majority voting, the system composed of the combination of Support Vector Machine, XGBoost, and Multilayer Perceptron as the binary predictor reaches 98.03% accuracy, 100% sensitivity, and 92.30% specificity, while the combination of Random Forest, XGBoost, and Multilayer Perceptron as staging predictor achieves 60% accuracy. The final system reaches, in terms of accuracy, 98.03%, and 66.66% for the binary and staging predictors, respectively. It was also found that the biomarkers which contribute most to the binary decision are Ceruloplasmin and α-2-Macroglobulin, while the least significant dimensions are CA 50 and α-1-Antitrypsin; instead, Carcinoembryonic Antigen and α-1 Acid Glycoprotein are the most significant to the staging decision., Conclusions: The present study proves the effectiveness of deploying serum biomarkers as feature dimensions for early colorectal cancer diagnosis and of using majority voting for noise reduction in the prediction., Competing Interests: Declaration of Competing Interest None., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Disparities in physical activity-related behaviors among rural and non-rural adolescents are important to consider given the relatively recent concerns surrounding the health of rural populations. Differences in rural and non-rural environments may facilitate or hinder physical activity opportunities. The purpose of this study is to examine differences between non-rural and rural adolescents' moderate-to-vigorous physical activity (MVPA), screen time, and active transportation, including the mediating role of neighborhood resources. Data came from 1,128 adolescents (207 rural, 18%) aged 12-17 years old and their parents living in the United States in the 2014 Family Life, Activity, Sun, Health, and Eating (FLASHE) study. Counterfactual mediation models were used to compare MVPA and screen time (linear regression) and active transit (log-binomial regression) among rural and non-rural adolescents, adjusting for demographics and health and measuring the mediating influence of neighborhood resources for PA. In adjusted models, rural adolescents engaged in less MVPA at school compared to non-rural adolescents (B = -1.14 min/day, p = 0.031) while no difference was found in MVPA at home or on weekends. Rural adolescents had less screen time (B = -2.1 min/day, p = 0.036) than their non-rural peers and were less likely to report active transit trips than non-rural adolescents (OR = 0.66, p = 0.016). Much of the differences in MVPA (70%) and active transit (54%) were mediated by differences in neighborhood resources. Improving the neighborhood resources in rural areas may encourage adolescents to be more active. This includes providing physical activity resources in rural areas such as sidewalks, bike lanes, greenways, playgrounds, fitness facilities, and parks/green space., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 The Authors.)

Purpose: To describe a combinatory technique made of Mustardè cheek advancement flap and paramedian forehead flap as a reconstructive option after orbital exenteration., Methods: We retrospectively reviewed all patients who underwent orbital exenteration and subsequent reconstruction with this technique at our Head and Neck Department, Divisions of Ophthalmology and Otolaryngology, at San Raffaele Hospital, Milan, Italy., Results: Three patients were treated with the aforementioned technique, following orbital exenteration due to malignancies. All of them were affected by recurrent diseases arising from the ocular components or periorbital structures: one basal cell carcinoma and two squamous cell carcinomas. Excellent result was achieved considering skin texture and colour match, aesthetic results and intra and post-operative complications (only minor, surgically controlled haemorrhage and minimal dehiscence subsequent to defective healing occurred)., Conclusion: The proposed technique can be considered by the head and neck reconstructive surgeon as a good option in extended orbital exenteration.

Objectives: To assess prevalence of Personal Protective Equipment (PPE)-related symptoms and adverse reactions during Coronavirus Disease 2019 pandemics., Methods: We conducted an observational study among people exposed to various degree of infectious risk. Data were collected with a self-administered online questionnaire., Results: The entire cohort complained about a wide range of adverse reactions: respiratory symptoms affected 80.3% of respondents, 68.5% referred pressure-related skin lesions, fewer manifested a dermatosis of different grade or ocular symptoms. Most of the affected individuals belonged to healthcare staff and manifestations were predicted by wearing time (more than 6 h/d). Moreover, symptoms were higher in the healthcare staff wearing N95/FFP2 respirator mask., Conclusions: Given the crucial role of PPE to contain the pandemic infection, more attention has to be paid to exposed categories, establishing preventive measure of side effects to ensure total safety., Competing Interests: Declaration of Conflicting Interests: The authors declare that there is no conflicts of interest., (Copyright © 2020 American College of Occupational and Environmental Medicine.)

Objective: The purpose of this study was to assess vestibular findings and clinical history in a large cohort of patients affected by Ménière's disease., Methods: We retrospectively analysed 511 adult patients fulfilling criteria for definite unilateral Ménière's disease according to Barany Society. Thorough clinical history, audiometric exam, central nervous system MRI, quantification of serum autoantibodies and complete vestibular function test were performed., Results: Mean age at clinical record was 55.4 years, while age at onset of the first vertigo attack was 47.4 ± 14.3 years. Ménière's disease overlapped with migraine in 43.4% of patients. In 31.7% of cases, positivity was found for at least one autoantibody. Forty-nine patients (9.6%) had family history for Ménière's disease. Bedside examination resulted in 14.7% positivity for video head impulse test, 58.9% for skull vibration-induced nystagmus, 38.7% for the positional test and 23.1% for the post head shaking test. Complete negative examination was reported in 115 cases., Conclusions: Ménière's disease was seen to present a characteristic phenotypic pattern in our cohort, confirming the crucial role of thorough anamnesis and bedside examination in diagnosis., (Copyright © 2020 Società Italiana di Otorinolaringoiatria e Chirurgia Cervico-Facciale, Rome, Italy.)

Introduction: Physical activity has positive health benefits across the lifespan including reduced rates of chronic disease. Despite having ample availability of outdoor space for physical activity in the Appalachian Mountain region, there are low rates of physical activity along with high rates of sedentary time and increased prevalence of overweight individuals across all age groups. Therefore, there is a need to understand the factors that influence family's physical activity and sedentary time., Purpose: To assess whether parental attitudes and behaviors influence children's physical activity and sedentary time., Methods: The current study was a secondary analysis of the baseline data from a pilot study of a pediatrician prescription program for outdoor physical activity. Parents ( N = 70) with children aged 5-13 years living in a county served by a single-pediatrician office completed surveys in the pediatrician's office during a well-child visit. The survey included questions related to parental attitudes toward children's physical activity and the physical activity and sedentary time performed by the parent and their child., Results: Parent sedentary time was the only factor that had an impact on child sedentary time, with 18% of the variance in children's sedentary time being explained by parent sedentary time. No factors predicted children's physical activity., Implications: To decrease child sedentary time, interventions should focus on reducing parental and joint parent-child sedentary time., (Copyright © 2020 Allison V. Farrell, Richard W. Christiana, Rebecca A. Battista, and J. Joy James.)

Competing Interests: Conflict of Interest None declared.

Ankle sprains and their common sequalae are thought to negatively affect physical activity levels and health-related quality of life among active populations, but limited evidence has described this among younger populations. This study aimed to determine the prevalence rate of ankle sprain and chronic ankle instability among rural adolescents and subsequently compare their physical activity levels based on ankle injury status. The study was conducted in a rural high school in North Carolina. High school students completed an online survey that assessed ankle injury history, perception of ankle instability and function, and physical activity. Respondents were categorized into one of four groups based on ankle injury history and complaints of instability: 1) uninjured (no history of injury); 2) unstable (history of injury >1 year and recurrent instability); 3) copers (history of injury >1 year and no recurrent instability); and 4) potentially unstable (injury within the past year). Frequency of physical activity was compared across groups using analysis of variance, Kruskall-Wallis test (α = 0.05), and responses to activity type were assessed using chi-square. Physical activity was found to differ significantly between the four groups [Formula: see text] with unstable respondents reporting more physical activity than uninjured respondents (unstable = 4706.05 ± 4610.56 MET-minutes/week; uninjured = 2592.93 ± 2946.02 MET-minutes/week). No differences were found between other groups. Despite injury history and sensations of instability, respondents with chronic ankle instability reported greater physical activity levels than uninjured participants. As this is contrary to pre-existing hypotheses, it is possible that continued physical activity after injury among adolescents may contribute to deleterious outcomes such as increased frequency of chronic instability., Competing Interests: The authors have declared that no competing interests exist.

Smartphone use among college students is prevalent across the world. Recently, research has begun to investigate the relationship between smartphone use and physical activity. This study examined the amount of time spent using a smartphone and the physical activity (PA) levels among college students majoring in health science-related disciplines in the United States (US) and Thailand. Using convenience sampling, college students in the US ( n = 242) and Thailand ( n = 194) completed an online survey, in Fall 2016, assessing smartphone usage and PA. Data were analyzed using chi-square tests and two-way ANOVA ( p < 0.05). US students reported more days per week ( U = 15,150.0 , p = 0.00 , r = 0.33 ) and greater duration of PA ( U = 11,234.0 , p = 0.00 , r = 0.33 ) than Thai students while Thai students used smartphones more per day than US students ( U = 13,137.5 , p = 0.00 , r = 0.40 ). No difference existed for years of smartphone use ( U = 22,207.0 , p = 0.27 ). Greater smartphone use per day inversely related to days per week of engaging in PA among Thai students ( X 2 ( 3 ) = 10.55 , p = 0.01 , ε 2 = 0.06 ), but not among US students ( X 2 ( 3 ) = 2.39 , p = 0.50 ). The high smartphone use among college students, especially in Thailand, may be a barrier to PA as well as a strategy for PA promotion in higher education settings. Research should examine the best techniques for smartphone application development to promote PA in college settings.

Background: Several studies support the impact of information communication technology-based interventions to promote physical activity among youth. However, little is known on how technology can be used by the entire family to encourage healthy behavior. Previous studies showed that children and youth rely and are dependent upon the decisions and values of their caregivers when it comes to having a healthy lifestyle. Thus, the exploration of behavior and attitudes of the entire family is needed., Objective: The study aimed to explore (1) perceptions of how the use of physical activity tracking devices (Fitbit Zip) by families in rural communities influence their patterns of participation in physical activity, (2) how attitudes toward physical activity change as a result of using physical activity tracking devices as a family, and (3) what factors influence participation in physical activity among families in rural communities., Methods: A total of 11 families with 1 to 3 children of different ages (7-13 years) took part in semistructured group interviews following 2 weeks of using physical activity tracking devices (Fitbit Zip) as a family. The participants were asked to discuss their experience using the Fitbit Zip as a family, the motivation to be physically active, the changes in their pattern of participation in those activities, the level of engagement by different family members, and the factors that affected their participation. All interviews were voice-recorded with the participants' permission and later transcribed verbatim using pseudonyms. To analyze the data, the principal investigator (IS) used open, axial, and selective coding techniques., Results: A total of 3 themes and several subthemes appeared from the data. The families in rural communities reported no or minimal changes in physical activities as a result of using physical activity tracking devices (Fitbit Zip) because of a lack of interest or an already active lifestyle. However, the attitude toward physical activity was altered. The family members reported an increased awareness of their activity level, introduced more conversations about active and healthy lifestyles, and changed their view of physical activity to a more positive one. The participants described the changes they were able to make and the constraining factors that stopped them from making further changes in their lifestyle., Conclusions: Technology might serve as a facilitator to participation in physical activity among families. Technology can motivate the change in attitude toward active recreation. As long-term changes in lifestyle require internal motivation, the change in the attitude might have a more long-lasting impact than the change in the immediate behavior. More longitudinal studies are needed to further explore long-term change in both behavior and attitude toward physical activity. Additional exploration of constraints to participation in physical activity among families is also an important area of exploration., (©Iryna Sharaievska, Rebecca A Battista, Jennifer Zwetsloot. Originally published in JMIR Pediatrics and Parenting (http://pediatrics.jmir.org), 20.02.2019.)

To cope with intrinsic and environmental stress, cancer cells rely on adaptive pathways more than non-transformed counterparts. Such non-oncogene addiction offers new therapeutic targets and strategies to overcome chemoresistance. In an attempt to study the role of adaptive pathways in acquired drug resistance in carcinoma cells, we devised a model of in vitro conditioning to three standard chemotherapeutic agents, cisplatin, 5-fluorouracil, and docetaxel, from the epithelial cancer cell line, HEp-2, and investigated the mechanisms underlying reduced drug sensitivity. We found that triple-resistant cells suffered from higher levels of oxidative stress, and showed heightened anti-stress responses, including the antioxidant Nrf2 pathway and autophagy, a conserved pleiotropic homeostatic strategy, mediating the clearance of aggregates marked by the adapter p62/SQSTM1. As a result, re-administration of chemotherapeutic agents failed to induce further accumulation of reactive oxygen species and p62. Moreover, autophagy proved responsible for chemoresistance through the avoidance of p62 accumulation into toxic protein aggregates. Indeed, p62 ablation was sufficient to confer resistance in parental cells, and genetic and pharmacological autophagic inhibition restored drug sensitivity in resistant cells in a p62-dependent manner. Finally, exogenous expression of mutant p62 lacking the ubiquitin- and LC3-binding domains, required for autophagic engulfment, increased chemosensitivity in TDR HEp-2 cells. Altogether, these findings offer a cellular system to investigate the bases of acquired chemoresistance of epithelial cancers and encourage challenging the prognostic and antineoplastic therapeutic potential of p62 toxicity., Competing Interests: The authors have declared that no competing interests exist.

Little evidence exists on health care provider (HCP) prescriptions for children's outdoor physical activity (PA). Semistructured interviews were conducted with 15 children's HCPs to explore perspectives on outdoor PA prescription programs for children and barriers to implementation. Thematic analytic techniques were used to analyze the data. Most participants reported an awareness of health benefits to children being in the outdoors. Ten themes emerged from the data related to 3 thematic categories: (1) current strategies that HCPs are using to promote PA among children, (2) barriers that HCPs see to prescribing outdoor PA, and (3) potential strategies for promoting outdoor PA among children. Assessment of the local outdoor PA environment and resource development must be done prior to a prescription program. HCPs should be skilled in conducting conversations and setting goals related to outdoor PA tailored to the patient. Developing a system for follow-up with patients on established goals should also be included., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Research indicates that promoting time spent in the outdoors and outdoor physical activity increases children's daily physical activity and improves health. One method showing promise is doctor prescriptions for outdoor physical activity for children; however, no empirical evidence currently exists on prescriptions for children's outdoor physical activity. A pilot study was conducted at one pediatric practice in western North Carolina during 2015 to test the feasibility and potential effectiveness of conducting an outdoor physical activity prescription program for children aged 5-13 years. Three pediatricians wrote prescriptions for children ( n  = 38), discussed benefits of outdoor physical activity, and provided information packets to parents on nearby places for physical activity. Parents of patients of five pediatricians served as control ( n  = 32). Prior to seeing a pediatrician, parents completed a baseline survey that asked height and weight, assessed their views of children's physical activity, and their personal and child's physical activity/sedentary behaviors. A nurse measured children's height and weight. Parents were emailed one-month and three-month follow-up surveys that asked the questions listed above. Changes in children's physical activity, outdoor physical activity, time spent in the outdoors, and sedentary activities were not significant between intervention and control groups. About half of parents (49%) viewed prescriptions as beneficial for their children and most used the intervention materials at home (70%). A larger study is needed to assess whether prescriptions increase children's physical activity. A critical examination of the intervention, pilot study design, and suggestions for a larger future study are provided.

The purpose of this investigation was to compare external work and net energy expenditure during a bout of repetitive stretch-shortening cycles between competitive and recreational long-distance runners. Participants were divided into either competitive or recreational runners based on their maximal oxygen consumption and self-reported 1600 m times. The stretch-shortening cycle involved a repetitive hopping protocol on a force plate while measuring oxygen consumption and lactate accumulation for a total of 10 min. External work and net energy expenditure were calculated for 3 min after steady state was achieved and the ratio between these variables was utilised as an index of mechanical efficiency. Lower extremity stiffness was calculated during this interval as well. Net energy expenditure was significantly lower in competitive runners (152.6 ± 33.3 kJ) in comparison to recreational runners (200.6 ± 41.4 kJ) (P = 0.02) given similar amounts of external work performed in both groups (competitive runners = 65.6 ± 20.1 kJ, recreational runners = 68.8 ± 12.1 kJ) (P = 0.67). Index of mechanical efficiency was significantly different between competitive runners (43.2 ± 9.0%) and recreational runners (34.8 ± 5.3%) (P = 0.03). No significant differences were found in lower extremity stiffness (P = 0.64). Competitive distance runners can perform similar levels of external work with lower net energy expenditure and thus a higher index of mechanical efficiency during repetitive stretch-shortening cycles in comparison to recreational runners with similar values of lower extremity stiffness. This ability could possibly be due differences in muscle-tendon length changes, muscle pre-activation, cross-bridge potentiation and short-latency reflex responses as a result of training which should be considered for future investigation.

Objective: To determine if child care centers in rural, Western North Carolina met recommendations for nutrition and physical activity, if focusing on nutrition and physical activity practices and policies was effective in improving the center environment, and if differences existed between centers affiliated or unaffiliated with schools., Methods: Of 33 child care centers in three counties, 29 submitted mini-grant requests and participated in a pre-post evaluation using Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC). NAP SACC assesses compliance for nutrition and physical activity recommendations and standards. Between October 2011 and April 2012, centers participated in workshops and goal setting specific to nutrition and physical activity., Results: At baseline, over 95% of the centers met all recommendations. However, post-intervention, Wilcoxon Signed Ranks Test (p<0.05) indicated significant improvement across center types in five out of 37 nutrition and seven out of 17 physical activity standards following the intervention. Centers unaffiliated with schools made significant changes in ten nutrition standards, while those affiliated with schools improved in only two standards and decreased on one standard., Conclusion: Overall, rural child care centers in Western North Carolina were meeting standards, they were still able to strengthen policies and practices by following NAP SACC. This was especially true for centers unaffiliated with schools. Continued financial support may assist centers in sustaining increased physical activity in children., (Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: To compare short- and long-term hearing results following stapedectomy using 3 different oval window grafting materials with the same stapes prosthesis., Study Design: Database review., Setting: Tertiary referral private practice., Subjects and Methods: Subjects were ears that underwent stapedectomy for otosclerosis, with placement of fat, fascia, or vein as an oval window seal and reconstruction with a titanium bucket handle prosthesis. A total of 365 procedures met these inclusion criteria: 98 fat grafts, 135 fascia grafts, and 132 vein grafts. Outcome measures included short-term (<1 year) and long-term follow-up air-bone gap. We compared the preoperative and postoperative amount of change in air-bone gap and preoperative and postoperative amount of change in the high-frequency bone conduction average., Results: Overall median times to short-term and long-term follow-ups were 2.2 months and 36.1 months, respectively. There were no statistically significant differences between the 3 tissue seal groups in the amount of change in air-bone gap. There was no significant difference in amount of change in high-frequency bone conduction (representing sensorineural hearing level) between the 3 tissue seal groups. Most patients in all 3 groups had an air-bone gap at long-term follow-up of ≤ 10 dB (fat, 79.5%; fascia, 78.8%; and vein, 75.6%), with 90.3% of all patients at ≤ 20 dB., Conclusions: In both the short-term postoperative period and long-term follow-up, there were no significant differences in hearing results among 3 types of tissue seals of the oval window in stapes surgery. Fat, fascia, and vein grafts all provide satisfactory hearing outcomes in stapedectomy.

Objective: To evaluate the sound localization capabilities of patients with unilateral, profound sensorineural hearing loss who had been treated with either a bone-anchored hearing device (Baha BP100) or a TransEar 380-HF bone-conduction hearing device., Study Design: Nonrandomized, prospective study. SETTING Tertiary referral private practice., Patients: Patients with unilateral, profound sensorineural hearing loss treated with a BP100 (n = 10) or a TransEar (n = 10) device. Patients wore the hearing device for at least 1 month and had normal hearing in the contralateral ear. Ten patients with normal, bilateral hearing were used for control., Interventions: Sound localization of a 3-second recorded sound with and without a TransEar or Baha device was assessed using an array of 7 speakers at head level separated by approximately 45 degrees. The recorded sounds were that of a barking dog or a police siren. Randomized trials of 4 presentations per speaker were given for each hearing condition., Main Outcome Measures: Sound localization was assessed by the accuracy in response and the generalized laterality of response., Results: The mean accuracy of speaker localization was 24% and 26% for the aided condition using the BP100 and TransEar devices, respectively. The mean accuracy of laterality judgment was 59% and 69% for the aided condition using the BP100 and TransEar devices, respectively. These results were only slightly better than chance. There was no statistical difference in localization accuracy or laterality judgment between the BP100 and TransEar groups., Conclusion: Neither the BP100 nor the TransEar device improved sound localization accuracy or laterality judgment ability in patients with unilateral, profound sensorineural hearing loss compared with performance in the unaided condition.

Background: The pattern of energy expenditure during sustained high-intensity exercise is influenced by several variables. Data from athletic populations suggest that a pre-exercise conceptual model, or template, is a central variable relative to controlling energy expenditure., Aims: The aim of this study was to make systematic observations regarding how the performance template develops in fit individuals who have limited specific experience with sustained high-intensity exercise (eg, time trials)., Methods: The study was conducted in four parts and involved measuring performance (time and power output) during: (A) six 3 km cycle time trials, (B) three 2 km rowing time trials, (C) four 2 km rowing time trials with a training period between trials 2 and 3, and (D) three 10 km cycle time trials. All time trials were self-paced with feedback to the subjects regarding previous performances and momentary pace., Results: In all four series of time trials there was a progressive pattern of improved performance averaging 6% over the first three trials and 10% over six trials. In all studies improvement was associated with increased power output during the early and middle portions of the time trial and a progressively greater terminal rating of perceived exertion. Despite the change in the pattern of energy expenditure, the subjects did not achieve the pattern usually displayed by athletes during comparable events., Conclusions: This study concludes that the pattern of learning the performance template is primarily related to increased confidence that the trial can be completed without unreasonable levels of exertion or injury, but that the process takes more than six trials to be complete.

In 1951, Dr. Lars Leksell from Sweden conceived of what is now known as gamma knife radiosurgery (GKRS). Since Leksell first treated a patient who had a vestibular schwannoma in 1967, there has been a year-to-year increase in the number of patients treated with the gamma knife for vestibular schwannoma. This article outlines the technique of GKRS and discusses the current results of its use to treat vestibular schwannomas. Other topics discussed include tumor control, treatment of recurrent/residual and cystic vestibular schwannomas, and the results of treatment of neurofibromatosis type 2.

The ability to modify power output (PO) in response to a changing stimulus during exercise is crucial for optimizing performance involving an integration system involving a performance template and feedback from peripheral receptors. The rapidity with which PO is modified has not been established, but would be of interest relative to understanding how PO is regulated. The objective is to determine the rapidity of changes in PO in response to a hypoxic challenge, and if change in PO is linked to changes in arterial O(2) saturation (S (a)O(2)). Well-trained cyclists performed randomly ordered 5-km time trials. Subjects began the trials breathing room air and switched to hypoxic (HYPOXIC, F(I)O(2) = 0.15) or room (CONTROL, F(I)O(2) = 0.21) air at 2 km, then to room air at 4 km. The time delay to begin decreasing S (a)O(2) and PO and to recover S (a)O(2) and PO on to room air was compared, along with the half time (t (1/2)) during the HYPOXIC trial. Mean S (a)O(2) and PO between 2 and 4 km were significantly different between CONTROL and HYPOXIC (94 +/- 2 vs. 83 +/- 2% and 285 +/- 16 vs. 245 +/- 19 W, respectively). There was no difference between the time delay for S (a)O(2) (31.5 +/- 12.8 s) and in PO (25.8 +/- 14.4 s) or the recovery of S (a)O(2) (29.0 +/- 7.7 s) and PO (21.5 +/- 12.4 s). The half time for decreases in S (a)O(2) (56.6 +/- 14.4 s) and in PO (62.7 +/- 20.8 s) was not significantly different. Modifications of PO due to the abrupt administration of hypoxic air are related to the development of arterial hypoxemia, and begin within approximately 30 s.

Background: Previous studies suggest that the rating of perceived exertion (RPE) increases during steady-state, open-loop exercise in proportion to the relative time to fatigue. This suggests that RPE is scalar and integrates physiological status and homeostatic disturbances., Purpose: This study assessed the relationship between the rate of change in RPE, and relative distance in time trials at distances of 2.5, 5, and 10 km. It also assessed the rate of change in RPE during 5-km time trials while breathing hypoxic air., Methods: The subjects were well-conditioned cyclists. In part 1, each subject completed habituation time trials, and then randomly ordered time trials at each distance. The category ratio RPE was measured in 10% increments throughout each trial. In part 2, each subject completed three 5-km time trials while breathing different inspired gas mixtures (FiO2 = 0.2093 throughout the trial, FiO2 = 0.15 between 2 and 4 km, and FiO2 = 0.15 between 2.5 and 4 km). RPE was measured at 10% increments., Results: In part 1, when RPE was plotted against relative distance, there was no significant difference in the growth of RPE at proportional distances. In part 2, the decrease in power output during the hypoxic segments was sufficient that the growth of RPE was the same at each proportional distance. In both parts of the study, an RPE of 5 (hard) was achieved after 20% of the time trial distance, and an RPE of 8 was achieved after 80% distance., Conclusions: This study supports the hypothesis that RPE increases similarly in relation to relative distance, regardless of the distance performed, and it suggests that the perception of effort has scalar properties.

The concept of VO(2)max has been a defining paradigm in exercise physiology for >75 years. Within the last decade, this concept has been both challenged and defended. The purpose of this study was to test the concept of VO(2)max by comparing VO(2) during a second exercise bout following a preliminary maximal effort exercise bout. The study had two parts. In Study #1, physically active non-athletes performed incremental cycle exercise. After 1-min recovery, a second bout was performed at a higher power output. In Study #2, competitive runners performed incremental treadmill exercise and, after 3-min recovery, a second bout at a higher speed. In Study #1 the highest VO(2) (bout 1 vs. bout 2) was not significantly different (3.95 +/- 0.75 vs. 4.06 +/- 0.75 l min(-1)). Maximal heart rate was not different (179 +/- 14 vs. 180 +/- 13 bpm) although maximal V(E) was higher in the second bout (141 +/- 36 vs. 151 +/- 34 l min(-1)). In Study #2 the highest VO(2) (bout 1 vs. bout 2) was not significantly different (4.09 +/- 0.97 vs. 4.03 +/- 1.16 l min(-1)), nor was maximal heart rate (184 + 6 vs. 181 +/- 10 bpm) or maximal V(E) (126 +/- 29 vs. 126 +/- 34 l min(-1)). The results support the concept that the highest VO(2) during a maximal incremental exercise bout is unlikely to change during a subsequent exercise bout, despite higher muscular power output. As such, the results support the "classical" view of VO(2)max.

The number of healthy older individuals who are active in sports has increased significantly during the past generation. These individuals continue to perform at a high level, although there appears to be a loss in functional capacity that cannot be overcome by training. No accepted theory of aging exists, but older athletes may be limited primarily by the inability to maintain the same volume and intensity of training. Also, older athletes appear to respond more slowly to the same training load than do younger athletes. The principles of training in older athletes are similar to those in young athletes; however, additional days of recovery and cross training may be necessary to prevent orthopedic injuries. Strategies for maintaining exercise intensity, including resistance training, are advisable to prevent sarcopenia and selective loss of type II muscle fibers.

The physical characteristics and performances of female collegiate rowers were examined from two perspectives: level (novice, varsity) and years of participation (0, 1, 2, 3) in collegiate rowing. The participants were 90 female collegiate rowers from three US Division I university teams, of the National Collegiate Athletic Association (NCAA). Height, body mass, sitting height, arm span, skinfolds, limb circumferences, and skeletal breadths were measured. Leg length was estimated and Heath-Carter anthropometric somatotypes were calculated. Performance measures included lower-back flexibility, vertical jump, and 2-km time on a rowing ergometer. Descriptive statistics were calculated for the total sample and by level and years of experience. Multivariate analysis of variance and a Bonferroni-adjusted alpha level (P < 0.05) were used to test differences. Varsity rowers had significantly more rowing experience ( approximately 0.5 years) before college, higher vertical jumps ( approximately 3 cm), faster 2-km times ( approximately 25 s), and lower endomorphic characteristics than novice rowers. Anthropometric and performance differences among rowers by years of experience were negligible with the exception of slower 2-km times ( approximately 32 s) in rowers with no collegiate experience than rowers with collegiate experience. In conclusion, collegiate rowers differ to some extent in physical and performance characteristics by level and experience.