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PROBLEM BEING ADDRESSED: The Geriatric Day Program (GDP) of the Capital Health Region in Victoria, BC, is concerned with effective team processes, accountability for health service outcomes, and improving the quality of programs. The GDP identified a need to improve its interdisciplinary processes and generate useful patient outcome data. OBJECTIVE OF PROGRAM: To determine whether Goal Attainment Scaling (GAS) could be introduced to facilitate interdisciplinary processes and to generate useful health outcome data. MAIN COMPONENTS OF PROGRAM: The GAS procedures were incorporated into clinical routines based on published guidelines. The authors determined GAS outcome scores for patients who completed the program and developed outcome scores for specific geriatric problem areas requiring intervention. Outcome scores were made available to the clinical care team and to program managers for continuous quality improvement purposes. CONCLUSIONS: The GAS process was successfully implemented and was acceptable to clinicians and managers at the GDP. Team processes were thought to be improved by focusing on patient goals in a structured way. The GAS provided data on both patient outcomes and outcomes of interventions in specific problem areas. Accountability for patient care increased. Goal Attainment Scaling provided indicators of care for which clinicians could develop program quality improvements.

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The aim of this research was to determine if circadian rhythms have an effect on time trial cycling performance of 15 min duration. Seven males (Mean+/-SD): age, 22.3+/-4.9 yr; height 179.0+/-7.9 cm, body mass 74.5+/-15.5 kg; VO2max 68.0+/-5.7 ml x kg(-1) x min(-1) who were all competitive cyclists or triathletes with previous experience in laboratory testing procedures volunteered to participate in this study. Each of the seven subjects underwent a series of four tests; one VO2 max test, and three 15 min maximal performance tests, at varying times during a 24 hr period. Testing times were at 08.00-10.00; 14.00-16.00 and 20.00-22.00 hours. Heart rate was recorded during the last 10-15 seconds of each minute and blood lactate levels were taken at 5 and 10 min during exercise and again immediately post-exercise. O2 consumption was measured continuously using open circuit spirometry. RPE was measured using the Borg scale at 5 and 10 min during, and again immediately following the completion of testing. Resting oral temperature was the only variable to show a significant time of day effect (p<0.05). Oral temperature during the afternoon was higher than both morning and evening results by 0.76 degrees C and 0.09 degrees C respectively. Total work (kJ) and average power output (W) were recorded at their highest during the morning session and reached a trough during the afternoon session, but these differences were not significant (p = 0.9997 and 0.9972 respectively). The results obtained in this study indicate that while certain biological rhythms are present, they appear to have no effect on this type of cycling performance. Although athletic performance may be enhanced by training programs that are compatible with an individuals body clock, the ability to perform and train at various times has an adaptive response which appears to over-ride these naturally inherent rhythms.

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Eight highly trained male kayakers were studied to determine the relationship between critical power (CP) and the onset of blood lactate accumulation (OBLA). Four exercise sessions of 90 s, 240 s, 600 s, and 1200 s were used to identify the CP of each kayaker. Each individual CP was obtained from the line of best fit (LBFCP) obtained from the progressive work output/time relationships. The OBLA was identified by the 4 mmol.l-1 blood lactate concentration and the work output at this level was determined using a lactate curve test. This consisted of paddling at 50 W for 5 min after which a 1-min rest was taken during which a 25-microliters blood sample was taken to analyse for lactate. Exercise was increased by 50 W every 5 min until exhaustion, with the blood sample being taken in the 1-min rest period. The exercise intensity at the OBLA for each subject was then calculated and this was compared to the exercise intensity at the LBFCP. The intensity at LBFCP was found to be significantly higher (t = 2.115, P < 0.05) than that at the OBLA of 4 mmol.l-1. These results were further confirmed by significant differences being obtained in blood lactate concentration (t = 8.063, P < 0.05) and heart rate values (t = 2.90, P < 0.05) obtained from the exercise intensity at LBFCP over a 20-min period and that of the anaerobic threshold (Th(an)) parameters obtained from the lactate/heart rate curve.(ABSTRACT TRUNCATED AT 250 WORDS)

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Eight highly trained male kayakers were studied in an attempt to examine whether critical power (CP), based upon four tests, could be determined from a combination of any two tests. The mean age of the subjects was 26.3 (SEM 3.8) years, mean height was 180.9 (SEM 5.1) cm, and mean body mass was 81.7 (SEM 8.3) kg. Four exercise sessions of 90 s, 240 s, 600 s, and 1200 s duration were used. For each subject the total work output was plotted against the duration of each test, the CP being obtained from the line of best fit. The CP obtained from this relationship was then compared to the CP derived from six combinations (90/240, 90/600, 90/1200, 240/600, 240/1200 and 600 00 s) of various performance times. A repeated measures analysis of variance found a significant difference between the exercise intensity obtained from the line of best fit and that obtained for the combination of exercise times of 90/240 s, F(7,1) = 11.12 (P < 0.05). No other significant differences were found between the CP from the line of best fit and that from any of the other possible exercise combinations. This would suggest that any combination of time intervals except 90/240 s may be used to determine the CP of elite kayakers.

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A case of proximal 3p deletion is reported in tumor cells from a patient with renal cell carcinoma and von Hippel-Lindau disease. This is the first report of this deletion with renal cell carcinoma. With the previously detected translocations at the same breakpoint, this report confirms the 3p14 breakpoint as critical in this neoplasm. This strongly suggests that renal cell carcinoma results from a change in the genetic material in the proximal short arm of chromosome #3.

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