Physiological determinants of climbing-specific finger endurance and sport rock climbing performance.

The aim of the study was to examine several physiological responses to a climbing-specific task to identify determinants of endurance in sport rock climbing. Finger strength and endurance of intermediate rock climbers (n = 11) and non-climbers (n = 9) were compared using climbing-specific apparatus. After maximum voluntary contraction (MVC) trials, two isometric endurance tests were performed at 40% (s = 2.5%) MVC until volitional exhaustion (continuous contractions and intermittent contractions of 10 s, with 3 s rest between contractions). Changes in muscle blood oxygenation and muscle blood volume were recorded in the flexor digitorum superficialis using near infra-red spectroscopy. Statistical significance was set at P < 0.05. Climbers had a higher mean MVC (climbers: 485 N, s = 65; non-climbers 375 N, s = 91) (P = 0.009). The group mean endurance test times were similar. The force-time integral, used as a measure of climbing-specific endurance, was greater for climbers in the intermittent test (climbers: 51,769 N x s, s = 12,229; non-climbers: 35,325 N x s, s = 9724) but not in the continuous test (climbers: 21,043 N x s, s = 4474; non-climbers: 15,816 N x s, s = 6263). Recovery of forearm oxygenation during rest phases (intermittent test) explained 41.1% of the variability in the force-time integral. Change in total haemoglobin was significantly greater in non-climbers (continuous test) than climbers (P = 0.023--40% test timepoint, P = 0.014--60% test timepoint). Pressor responses were similar between groups and not related to the force-time integral for either test. We conclude that muscle re-oxygenation during rest phases is a predictor of endurance performance.

Survival ratio plots with permutation envelopes in survival data problems.

A new method is proposed, based on a simple ratio plot, which is useful for identifying time intervals or regions in which survival prospects differ between two distinct populations or treatments. In order to investigate whether any observed difference or trend is due to sampling variation or is due to a possible real effect, resampling techniques are used to generate permutation envelopes as reference bands. The method is applicable to the comparison of survival in two populations for both independent and paired survival problems and also to the assessment of the symmetry of a bivariate survival function.

Factors affecting a climber's ability to ascend Mont Blanc.

The aim of the study was to determine the factors affecting a climber's ability to ascend Mont Blanc using a number of variables collected at the Gouter Hut (3,817 m) before and after an attempted ascent on the Mont Blanc summit. Subjects (n=285) were tested at 3,817 m prior to their ascent of Mont Blanc. Maximum height ascended in the last 14 days was recorded. End tidal CO2, arterial oxygen saturation (SaO2), heart rate and respiratory rate were measured using a Capnograph (Nellcor Patrick NPB75). Acute mountain sickness (AMS) was assessed using the Lake Louise scoring system. Summit information is available for 216 subjects. None of the subjects who attained 4,000 m in the previous 14 days failed to reach the summit (P=0.04). Previous recent exposure to an altitude of 4,000 m resulted in faster ascent times to the summit than those who had not been above 3,000 m in the previous 14 days (4.02+/-0.6 vs. 4.46+/-0.8 h, P=0.009), higher SaO2 on arrival at the Gouter Hut on day 1 (88.6+/-5 vs. 86.3+/-6%, P=0.004) and lower AMS scores upon arrival at the Gouter Hut after the attempted ascent to the summit 2.5+/-1.8 versus 4.7+/-2.5 U (P=0.001), respectively. It is concluded that recent exposure to 4,000 m confers an advantage to those who wish to ascend a 4,800 m peak.

The effect of towing a range of relative resistances on sprint performance.

The aim of this study was to compare sprint performance over 10 and 20 m when participants ran while towing resistances, weighing between 0 and 30% of body mass. The sample of 33 participants consisted of male rugby and soccer players (age 21.1 +/- 1.8 years, body mass 83.6 +/- 13.1 kg, height 1.82 +/- 0.1 m; mean +/- s). Each participant performed two sets of seven sprints over 20 m using a Latin rectangular design. The times were recorded at 10 and 20 m using electronic speed gates. The sprints of 13 players were video-recorded to allow calculation of stride length and frequency. For both sprints, a quadratic relationship was observed between sprint time and resistance as sprint time increased from 2.94 s to 3.80 s from 0 to 30% resistance. This relationship was statistically significant but considered not to be meaningful for performance because, over the range of resistances used in this study, the quadratic model was never more than 1% (in terms of sprint time) from the linear model. As resistance increased, the stride length shortened, with mean values of 1.63 +/- 0.13 m at 0% body mass and 1.33 +/- 0.13 m at 30% of body mass. There was no significant change in stride frequency with increasing resistance. The results show that in general there is an increase in sprint time with an increase in resistance. No particular resistance in the range tested (0 - 30%) can be recommended for practice.

Is it possible to predict the blood volume of a sick preterm infant?

OBJECTIVE: To investigate the relation between the measured intravascular blood volume (BV) and current methods of indirectly assessing BV status in sick preterm infants on the first day of life. METHODS: Thirty eight preterm infants of gestation 24-32 weeks (median 30) and weight 480-2060 g (median 1220) were studied. Red cell volume was measured by the fetal haemoglobin dilution method in six infants and by the biotin labelled autologous red cell dilution method in the remaining 32. Total BV was calculated by dividing red cell volume by packed cell volume. Indirect assessments of BV status using heart rate (HR), core-peripheral temperature difference, mean arterial pressure, base excess, and packed cell volume were recorded. RESULTS: The mean (SD) initial measured BV was 71 (12) ml/kg (range 53-105). The mean HR was 148 beats/min (range 130-180), which correlated positively (r = 0.39, p = 0.02) with BV (higher HR was associated with higher BV). The mean base excess was -3.19 mmol/l (range -18 to +6.2). The negative base excess correlated significantly positively (r = 0.41, p < 0.01) with BV (more acidotic babies tended to have higher BV). There was no significant correlation between core-peripheral temperature difference, mean arterial pressure, or packed cell volume and BV. Regression analysis showed that base excess and HR were significantly related to BV; base excess alone can predict variability in BV only to 17%, and base excess with HR can predict variability in BV to 29%. CONCLUSION: The conventional clinical and laboratory indices are poor predictors of measured blood volume.

The effects of a 12-week group exercise programme on physiological and psychological variables and function in overweight women.

OBJECTIVES: The aim of this study was to investigate the effect of a 12-week functional exercise programme on overweight women. METHODS: Twenty-six subjects (n=13 exercisers, n=13 controls) aged (mean+/-SD) 63 (+/-4) years completed the study. The exercise sessions were carried out twice each week for 12 weeks. The variables measured were body mass, body mass index, skin-fold thickness, resting blood pressure, total blood cholesterol, chair rise, timed 'up and go' test, 20-m walk,lifting a 1- and a 2-kg bag on to a shelf, stair walking, 'sit and reach' flexibility test, Life Satisfaction Index and Physical Self-perception Profile for Older Adults. The exercise sessions consisted of 40-min sessions during which the subjects performed aerobic and strength exercises. RESULTS: Paired analyses showed that body mass, body mass index, blood pressure (systolic and diastolic values), 'up and go' time, time to complete a 20-m walk, time to lift a 1- and a 2-kg bag with both the right and left arms onto a shelf, and stair climbing-total time and ascent time-decreased significantly in the exercise group. Also, the exercise group improved their Life Satisfaction Index score significantly compared with the control group. CONCLUSIONS: The results indicate that a functional exercise programme has the potential to improve performance in a number of physiological variables and functional activities in overweight women. The exercise programme enhanced life satisfaction.

Precordial electrode placement in women.

BACKGROUND: Precordial ECG electrode positioning was standardised in the early 1940s. However, it has been customary for the V3 to V6 electrodes to be placed under the left breast in women rather than in the correct anatomical positions relating to the 4th and 5th interspaces. For this reason, a comparison between the two approaches to chest electrode positioning in women was undertaken. METHODS: In total 84 women were recruited and ECGs recorded with electrodes in the correct anatomical position and also in the more commonly used positions under the breast. As a separate study, 299 healthy women were recruited to study normal limits of leads V3 to V6 recorded with electrodes in the correct anatomical positions and compare them with published normal limits with electrodes in the more commonly used locations. RESULTS: It was shown that there was less variability with electrodes in the correct anatomical positions and that there were significant differences between the new limits of normality compared with the old established limits. CONCLUSION: Expansion of the database and further analysis of the data is required to make a definitive recommendation with respect to precordial electrode placement in women.

A comparison of physiological responses and rating of perceived exertion in two modes of aerobic exercise in men and women over 50 years of age.

OBJECTIVES: To compare the physiological responses and ratings of perceived exertion to aerobic dance and walking sessions completed at a self selected pace. METHODS: Six women and six men with a sample mean (SD) age of 68 (7) years completed aerobic dance and walking sessions in random order. A treadmill test was performed by each subject from which peak oxygen uptake (.VO(2)) and maximum heart rates (HRmax) were determined. During the aerobic dance and walking sessions, heart rate and .VO(2) were measured continuously throughout. Rate of perceived exertion (RPE) was measured every three minutes throughout the session. RESULTS: The sample means (SD) for %peak .VO(2) were 67 (17)% for the aerobic dance sessions and 52 (10)% for the walking sessions, and the %HRmax sample means (SD) were 74 (12)% for the aerobic dance sessions and 60(8)% for walking sessions. The sample mean (SD) RPE for the aerobic dance sessions was 11(2), and for the walking sessions it was 10(2). CONCLUSIONS: %peak .VO(2), %HRmax, and RPE were significantly higher for aerobic dance than for walking. However, both the aerobic dance and walking sessions were of adequate intensity to improve aerobic fitness in most subjects. Further investigation into the relation between RPE and %peak .VO(2) in a field setting over representative exercise time periods would be useful.

Assessing restorative dental materials: 2. Questions for a dental sales representative.

Many methodologies are used during the testing of dental materials, although different tests are suitable for different materials and clinical situations. This paper discusses factors relevant to the choice of a dental material, and suggests questions that a practitioner would find helpful to ask a dental sales representative, such as ease of use, effect on the environment and the relevance of fluoride release.

Assessing restorative dental materials: I. Test methods and assessment of results.

Many methodologies are used during the testing of dental materials. Among these are compressive, tensile and flexural strengths, and fracture toughness. However, different tests are relevant to different materials and clinical situations. This paper describes different test methodologies and discusses the substantiation of research claims in publications and advertising.

"Walk in to Work Out": a randomised controlled trial of a self help intervention to promote active commuting.

STUDY OBJECTIVE: To determine if a self help intervention, delivered via written interactive materials (the "Walk in to Work Out" pack), could increase active commuting behaviour (walking and cycling). DESIGN: Randomised controlled trial. The intervention group received the "Walk in to Work Out" pack, which contained written interactive materials based on the transtheoretical model of behaviour change, local information about distances and routes, and safety information. The control group received the pack six months later. Focus groups were also conducted after six months. SETTING: Three workplaces in the city of Glasgow, Scotland, UK. PARTICIPANTS: 295 employees who had been identified as thinking about, or doing some irregular, walking or cycling to work. MAIN RESULTS: The intervention group was almost twice as likely to increase walking to work as the control group at six months (odds ratio of 1.93, 95% confidence intervals 1.06 to 3.52). The intervention was not successful at increasing cycling. There were no distance travelled to work, gender, or age influences on the results. Twenty five per cent (95% confidence intervals 17% to 32%) of the intervention group, who received the pack at baseline, were regularly actively commuting at the 12 month follow up. CONCLUSION: The "Walk in to Work Out" pack was successful in increasing walking but not cycling. The environment for cycling must be improved before cycling will become a popular option.

A comparison of the anthropometric, strength, endurance and flexibility characteristics of female elite and recreational climbers and non-climbers.

There is limited information on the anthropometry, strength, endurance and flexibility of female rock climbers. The aim of this study was to compare these characteristics in three groups of females: Group 1 comprised 10 elite climbers aged 31.3 +/- 5.0 years (mean +/- s) who had led to a standard of 'hard very severe'; Group 2 consisted of 10 recreational climbers aged 24.1 +/- 4.0 years who had led to a standard of 'severe'; and Group 3 comprised 10 physically active individuals aged 28.5 +/- 5.0 years who had not previously rock-climbed. The tests included finger strength (grip strength, finger strength measured on climbing-specific apparatus), flexibility, bent arm hang and pull-ups. Regression procedures (analysis of covariance) were used to examine the influence of body mass, leg length, height and age. For finger strength, the elite climbers recorded significantly higher values (P < 0.05) than the recreational climbers and non-climbers (four fingers, right hand: elite 321 +/- 18 N, recreational 251 +/- 14 N, non-climbers 256 +/- 15 N; four fingers, left hand: elite 307 +/- 14 N, recreational 248 +/- 12 N, non-climbers 243 +/- 11 N). For grip strength of the right hand, the elite climbers recorded significantly higher values than the recreational climbers only (elite 338 +/- 12 N, recreational 289 +/- 10 N, non-climbers 307 +/- 11 N). The results suggest that elite climbers have greater finger strength than recreational climbers and non-climbers.

A comparison of mobility assessments in a geriatric day hospital.

OBJECTIVE: To assess the sensitivity of the Elderly Mobility Scale (EMS) to detect improvements in mobility after physiotherapy in comparison with the Barthel Index (BI) and Functional Ambulation Category (FAC) in routine clinical day hospital practice. SUBJECTS: Eighty-three patients who completed a course of physiotherapy were studied. METHODS: Each was assessed by an independent physiotherapist before and after a programme of physiotherapy, using the EMS, BI and FAC. RESULTS: The mean age was 79 years (SD 7.7). Fifty-three out of 83 (64%) patients were female and 92% were community dwelling. The median number of physiotherapy sessions undergone by each patient was 9 (range 3-51). All three scales detected an improvement in mobility with physiotherapy (p < 0.001). However, using the EMS, 68 out of 82 (83%) patients had a detectable improvement in mobility compared with only 34 out of 80 (42%) using the BI and 28 out of 81 (35%) using the FAC. Using a matched-pairs comparison, the EMS was significantly more likely to detect an improvement in mobility following physiotherapy within the study group than the BI (p < 0.001) or the FAC (p < 0.001). CONCLUSION: Although all three scales detected improvements in mobility, the EMS detected mobility improvements in a significantly greater number of patients.

Randomised controlled trial of homoeopathy versus placebo in perennial allergic rhinitis with overview of four trial series.

OBJECTIVE: To test the hypothesis that homoeopathy is a placebo by examining its effect in patients with allergic rhinitis and so contest the evidence from three previous trials in this series. DESIGN: Randomised, double blind, placebo controlled, parallel group, multicentre study. SETTING: Four general practices and a hospital ear, nose, and throat outpatient department. PARTICIPANTS: 51 patients with perennial allergic rhinitis. INTERVENTION: Random assignment to an oral 30c homoeopathic preparation of principal inhalant allergen or to placebo. MAIN OUTCOME MEASURES: Changes from baseline in nasal inspiratory peak flow and symptom visual analogue scale score over third and fourth weeks after randomisation. RESULTS: Fifty patients completed the study. The homoeopathy group had a significant objective improvement in nasal airflow compared with the placebo group (mean difference 19.8 l/min, 95% confidence interval 10.4 to 29.1, P=0.0001). Both groups reported improvement in symptoms, with patients taking homoeopathy reporting more improvement in all but one of the centres, which had more patients with aggravations. On average no significant difference between the groups was seen on visual analogue scale scores. Initial aggravations of rhinitis symptoms were more common with homoeopathy than placebo (7 (30%) v 2 (7%), P=0.04). Addition of these results to those of three previous trials (n=253) showed a mean symptom reduction on visual analogue scores of 28% (10.9 mm) for homoeopathy compared with 3% (1.1 mm) for placebo (95% confidence interval 4.2 to 15.4, P=0.0007). CONCLUSION: The objective results reinforce earlier evidence that homoeopathic dilutions differ from placebo.

Nutritional intake of an undernourished infant population receiving an energy and micronutrient supplement in Indonesia.

OBJECTIVES: This paper reports the dietary intake (home, day care centers, supplement and breast milk) of the children in the clinical trial in Pangalengan. DESIGN: Two cohorts of children were randomly assigned to three treatments: E = 1171 kJ + 12 mg iron; M = 209 kJ + 12 mg iron; S = 104 kJ. Supplementation was given for 12 months. SETTING: The sites were six tea plantations in Pangalengan, West Java. SUBJECTS: A 12-month-old (n = 53) and an 18-month-old (n = 83) cohort were recruited from day-care-centers. Twenty children who received S belong to the 12- and 18-month-old cohorts. Inclusion criteria were: no chronic disease; length-for-age < or = -1 standard deviation (s.d.) and weight-for-length between -1 and -2 s.d. of the median of the reference of the World Health Organization. METHODS: E = 1171 kJ + 12 mg iron; M = 209 kJ + 12 mg iron; S = 104 kJ. Supplementation was given for 12 months. Evaluations of intake were made at baseline and every 2 months thereafter. RESULTS: For the 12-month-old cohort the mean increase in daily energy intake approximately 2931 kJ for E, approximately 1675 kJ for M, and approximately 837 kJ increase over the 6 months for the S group. For the 18-month-old cohort the changes were approximately 2512 kJ for E approximately 1675 for the M group and approximately 1047 for the S group.

Effects of an energy and micronutrient supplement on growth and activity, correcting for non-supplemental sources of energy input in undernourished children in Indonesia.

OBJECTIVES: This paper investigates simultaneously the growth and activity of children that received an early energy and micronutrient supplement, adjusting for all non-supplemental energy intakes. Any additional change in growth and activity after this adjustment was then compared across supplements at three points felt to be representative of the study. DESIGN: Two cohorts of children were randomly assigned to three treatments: E = 1171 kJ + 12 mg iron; M = 209 kJ + 12 mg iron; S = 104 kJ. Supplementation was given for 12 months. SETTING: The sites were six tea plantations in Pangalengan, West Java. SUBJECTS: A 12-month-old (n = 53) and an 18-month-old (n = 83) cohort were recruited from day-care-centers. Twenty children that received S belonged to the 12- and 18-month-old cohorts. Inclusion criteria were: no chronic disease; length-for-age < or = -1 standard deviation (s.d.) and weight-for-length between -1 and -2 s.d. of the median of the reference of the World Health Organization. METHODS: Length was measured with a portable measuring board; a Detecto scale with an accuracy of 0.1 kg was used for the measurement of body weight. Arm and head circumferences were measured using similar fiberglass tapes. Motor activity was assessed through continuous 4 h observations at home and at day care centers. Anthropometry and activity were measured every two months over 12 months. RESULTS: After correcting for non-supplemental sources of energy intake, the effects of the supplement on weight and activity were observed at 2 months; effects on length and activity were observed at 6 months; and effects on weight alone were observed at 12 months.

Effects of an energy and micronutrient supplement on anthropometry in undernourished children in Indonesia.

OBJECTIVES: This paper reports the effects of early supplementary feeding on body weight, length, head circumference and arm circumference among the children in the Pangalengan study. DESIGN: Two cohorts of children were randomly assigned to three treatments: E = 1171 kJ + 12 mg iron; M = 209 kJ + 12 mg iron; S = 104 kJ. Supplementation was given for 12 months. SETTING: The sites were six tea plantations in Pangalengan, West Java. SUBJECTS: A 12-month-old (n = 53) and an 18-month-old (n = 83) cohort were recruited from day-care centers. Twenty children that received S belonged to the 12- and 18-month cohorts. Inclusion criteria were: no chronic disease; length-for-age < or = -1 standard deviation (s.d.) and weight-for-length between -1 and -2 s.d. of the median of the reference of the World Health Organization. METHODS: Length was measured with a portable measuring board; a Detecto scale with an accuracy of 0.1 kg was used for the measurement of body weight. Arm and head circumferences were measured using similar fiberglass tapes. RESULTS: Body weight showed effects on both cohorts at 2, 8 and 12 months; head circumference showed effects at 4 months in the 12-month-old cohort and at 10 months among the females of the 18-month-old cohort; and arm circumference showed effects across cohorts at 2, 8 and 12 months. In general the benefits are clearer for females and for the 12-month-old cohort.

Risk factors for excess weight gain in children treated for acute lymphoblastic leukaemia.

OBJECTIVE: To test whether excess weight gain in patients treated for childhood acute lymphoblastic leukaemia (ALL) was predictable using patient characteristics at diagnosis. DESIGN AND SUBJECTS: Longitudinal study of changes in body mass index (BMI) in all 98 patients treated in Scotland on treatment protocol MRC UKALL-XI who had reached at least 3y post-diagnosis in first remission. MEASUREMENTS: The influence of the following variables on changes in BMI, expressed as a standard deviation score (SDS), was tested using variable selection techniques and classification and regression trees: BMI SDS at diagnosis; age at diagnosis; gender; socioeconomic status; treatment. RESULTS: Prevalence of obesity (BMI SDS>2.0) was <2% at diagnosis, but increased to 16% at 3y. Gain in BMI SDS was significantly inversely influenced by BMI SDS at diagnosis (P<0.01) and age at diagnosis (P<0.01). CONCLUSION: Obesity is common in ALL by the end of therapy, and is more likely in children who are younger and thinner at diagnosis. Excess weight gain was not readily predictable from routinely collected information available at diagnosis and so all children treated for ALL should be considered 'at risk' of excess weight gain and the target of obesity prevention.

Efficacy of the cyclodextrin liquid preparation of itraconazole in treatment of denture stomatitis: comparison with itraconazole capsules.

This study investigated the efficacy of a cyclodextrin solution of itraconazole in the treatment of Candida-associated denture stomatitis. It was found that the liquid and capsule preparations of itraconazole were equally effective adjuncts in the treatment of this condition. However, the side effect profile indicates that capsules are the preferred formulation.

False positive ECG reports of anterior myocardial infarction in women.

The prevalence of electrocardiographic poor R-wave progression was estimated by reviewing all electrocardiograms recorded in Glasgow Royal Infirmary over a 2-week period. It was found to be higher in women (19% vs. 11%) than in men. To investigate one possible reason, the effect of chest electrode positioning in women was thereafter examined. Eighty four women were recruited to a study in which chest electrodes were placed strictly in adherence with recommendations of using the 4th and 5th intercostal spaces as references and also using the more widely adopted technique of placing electrodes V3 to V6 under the left breast. R wave amplitudes were compared in V3 to V6 from both sets of recordings. It was found that measurements recorded on the breast by electrode V3 have a significantly smaller R wave magnitude compared to corresponding measurements below the breast, the mean difference being 34 (95% confidence interval [CI] of 7 to 60) microvolts. For V5 and V6, the reverse is true with measurements taken on the breast being larger, on average, than those taken below the breast by 119 (95% CI of 87 to 152) and 134 (95% CI of 108 to 160) microvolts respectively. For V4, there was no significant difference. Seventeen women with poor R wave progression suggestive of old anterior myocardial infarction had clinical data examined from which it was determined that 11 had a history suggestive of myocardial infarction, ie, the positive predictive value was 65% (95% CI of 42% to 87%). It was concluded that positioning of electrodes beneath rather than on top of the breast was not responsible for the increased prevalence of poor R wave progression in women and that the criterion of isolated poor R wave progression was too nonspecific to be of clinical value.