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Comparison of training activities and game demands in the Australian Football League.

his paper serves as a companion to our recent study of the movement patterns and game activities of players (from five different positions) during matches in the 2000 Australian Football League season. Using lapsed-time video analysis, the same individual players (n= 11) as filmed in matches were also monitored during 21 in-season, main training sessions conducted by their clubs in order to assess the degree to which training activities matched game demands. In general, the training sessions did not involve physical pressure; therefore there were very few contested marks and ground balls or tackles, shepherds and spoils, thereby not matching these game demands. Players typically had more possessions (kicks and handballs) at training than in games. They also spent a greater percentage of total time standing and less time walking at training than in games. Fast-running and sprinting efforts at training were almost all for durations of <6 secs, which matched game demands, as did changes of direction when sprinting, which were almost all in a 0-90 degrees arc. However, across all players filmed, high intensity (fast-running and sprinting) movements were not performed as frequently at training (one every 76 secs) as in games (one every 51 secs). Therefore, while some game demands were adequately replicated at training, others were not closely simulated, suggesting that, after careful interpretation of these results, some improvements in training practices could be made.

Australia↗

Electrocardiographic examination of dental patients with systemic lupus erythematosus.

Cardiac complications and abnormalities associated with systemic lupus erythematosus (SLE) have been well described. The most well-recognized cardiac myopathies in SLE are pericarditis and valvular problems such as verrucous endocarditis. Electrocardiogram (EKG) abnormalities and arrhythmias have also occurred and such individuals may have persistent tachycardia. To determine the prevalence of dental patients with SLE who have these EKG changes, a pilot study was designed in which a group of 13 subjects with SLE underwent EKG monitoring in the clinic. Most of these were patients referred to the oral medicine clinic. A randomly selected group of age-gender matched controls were monitored in an identical manner. All subjects first completed a cardiac screening questionnaire, were comfortably seated, and then monitored. The results indicated that the overall prevalence of EKG abnormalities among the subjects with SLE was 61.5% (n = 8). The most common arrhythmia was supraventricular extrasystoles. These were compared with a control group with a prevalence of 23% (n = 3). Of the 76.9% of the subjects with SLE who reported a positive history of cardiac abnormalities, 80% demonstrated EKG abnormalities as compared with 50% of the control group. Of the subjects with SLE who did not report a previous history, none demonstrated EKG abnormalities as was the same for the control group. These results indicate a high prevalence of EKG abnormalities in dental patients with SLE, especially those with a positive cardiac history.

Adult↗

Recording soccer players' heart rates during matches.

The aim of this study was to examine the possibility of obtaining information about the heart rate and physiological load imposed on soccer players during a game. The study was conducted on 27 soccer players, 9 each from semi-professional, university and recreational soccer teams. Players from all positions (attack, midfield and defence) were selected for the study. Each subject's heart rate was monitored during a match using a short-range radio telemetry (Sport Tester PE3000), and was sampled at 5-s intervals. The results indicate that it is possible to monitor successfully the heart rate of players with such equipment. The mean heart rate and standard deviation for each player during match play were: semi-professional players (172 +/- 12, 176 +/- 9 and 166 +/- 15 for forwards, midfielders and defenders, respectively); university players (171 +/- 13, 173 +/- 10 and 156 +/- 13 for forwards, midfielders and defenders, respectively); and recreational players (173 +/- 13, 170 +/- 12 and 162 +/- 13 for forwards, midfielders and defenders, respectively). Analysis by playing position revealed that midfield and forward players has a greater mean heart rate during a game than defensive players. To examine the suitability and accuracy of the two methods of obtaining objective data on heart rate, comparisons were made between the Sport Tester PE3000 and a standard electrocardiograph (ECG) telemetry technique. The results show that both techniques produce similar results; the former was the more convenient.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Serum carbamazepine concentrations in elderly patients: a case-matched pharmacokinetic evaluation based on therapeutic drug monitoring data.

PURPOSE: To assess the influence of aging on the steady-state pharmacokinetics of carbamazepine (CBZ) in a large population of patients evaluated in a therapeutic drug monitoring (TDM) setting. METHODS: The database of a large TDM service was used to identify retrospectively steady-state serum CBZ concentrations in 157 elderly patients with epilepsy (65 years and older) treated with CBZ alone or in combination with phenobarbital (PB). CBZ apparent oral clearance (CL/F) values were calculated and compared with those determined in an equal number of controls aged 20 to 50 years, and matched for gender, body weight, and comedication. RESULTS: Compared with corresponding controls, mean CBZ CL/F values were 23% and 24% lower, respectively, in the groups of elderly patients receiving monotherapy (57.1 +/- 20.6 vs. 74.6 +/- 28.3 ml/h/kg; p < 0.0001) and PB comedication (74.7 +/- 25.5 vs. 98.7 +/- 34.9 ml/h/kg; p < 0.01). Within each age group, patients comedicated with PB showed significantly higher CBZ CL/F values than those on monotherapy. A negative correlation between CL/F and age was found both within the monotherapy and the PB comedicated groups. In addition, CL/F values showed a positive relation with the administered daily dosage, which persisted within subgroups homogeneous for age and comedication. The independent influence of age, CBZ dosage, and comedication on CBZ CL/F was confirmed by multiple regression analysis. CONCLUSIONS: CBZ CL/F is decreased in an age-dependent manner in elderly patients compared with younger subjects, presumably because a reduction in the rate of CYP3A4-mediated drug metabolism. Elderly patients retain their sensitivity to dose-dependent autoinduction and to heteroinduction by enzyme-inducing AEDs, but their metabolic rates remain considerably below those observed in matched controls. As a result of this, patients in old age will require lower CBZ dosages to achieve serum concentrations comparable with those found in nonelderly adults.

Adult↗

Hormonal and metabolic changes during a strenuous tennis match. Effect of ageing.

The effect of a strenuous tennis match was studied in 9 young (21.2 +/- 1.9 yr) and 10 veteran women players (46.5 +/- 1.3 yr) of equivalent skill. Each match was carried out during the summer (ambient temperature 27 +/- 1 degree C), as an official competition, under conditions as similar as possible. Heart rate (HR) was monitored throughout the match, weight loss was evaluated and pre- and post-match values of haematocrit, plasma lactate, free fatty acid (FFA), glycemia, ionogram, norepinephrine (NOR), epinephrine, arginine vasopressin (AV) concentrations and plasma renin activity (PRA) were measured. Plasma volume was calculated. While mean HR remained steady in young players, it increased progressively in veteran players as the match went on and reached a very high level towards the end of the match. When post-match values were compared to pre-match values, the mean results were: no substantial changes in plasma lactate and electrolyte concentrations, a large increase in FFA, no increase in epinephrine, a moderate rise in NOR and a large increase in PRA and AV. Despite a similar weight loss, a large drop in plasma volume occurred only in veteran players, who also showed FFA and AV values greater than in young players. During these strenuous matches the large response of hormones which control body fluid probably contributed to the limiting of changes in water and electrolyte balances. However, under similar conditions marked differences occurred as a function of ageing concerning the control of plasma volume.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

Serum sCD30 in monitoring of alloresponse in well HLA-matched cadaveric kidney transplantations.

In kidney transplantation, pretransplant serum sCD30 testing has been proposed in immunological risk estimation together with anti-HLA antibodies. We evaluated the risks associated with high pretransplant serum sCD30 in well HLA-matched cadaveric kidney recipients recruited in a clinical study comparing different immunosuppressive regimens. Rejection rate was similar in 37 recipients with high pretransplant serum sCD30 compared to 117 recipients with low serum sCD30 (16% vs. 15%, P=NS). Compared to pretransplant levels, the posttransplant sCD30 levels generally decreased, also in patients with rejection, although on day 21 posttransplant, rejecting patients had significantly higher relative sCD30 than nonrejecting patients (P<0.01). However, steroid-resistant rejection was associated with increasing posttransplant sCD30 levels. High pretransplant sCD30 values were associated with tubulointerstitial rejection. There was no correlation of sCD30 with delayed graft function. Good HLA matching seems to be effective in neutralizing the negative effect of a high pretransplant serum sCD30.

Antigens, CD↗

Inspiratory pressure generation: comparison of subjects with COPD and age-matched normals.

We continuously monitored esophageal (Pes) and gastric (Pga) pressures and used these measurements in a three-component model to estimate instantaneous diaphragmatic (DIA), inspiratory accessory muscle (IAM), and postexpiratory recoil (PER) pressures at various times during inspiration. We validated our model both by volume-pressure relationships of the respiratory system (Vrc-Pga and Vab-Pga, where Vrc and Vab are the rib cage and abdominal volumes, respectively) as well as electromyography of the respiratory muscles. Measurements were carried out at rest and during graded treadmill exercise in 11 subjects with chronic obstructive pulmonary disease (COPDs) and 8 age-matched normal subjects (AMNs). AMNs were 59 +/- 2 (SE) yr and had a forced expiratory volume at 1 s (FEV1.0) of 3.6 +/- 0.2 liters; COPDs were 66 +/- 2 yr and had a FEV1.0 of 1.0 +/- 0.1 liters. We noted the following. At rest, both AMNs and COPDs exhibited an increasing DIA pressure (PDIA) across inspiratory time (TI) at rest. As expired minute ventilation increased with exercise intensity, AMNs continued to maintain this PDIA ramp across inspiration; in contrast, COPDs exhibited higher values of PDIA during the first half of TI than during the second half. At all intensities of exercise, COPDs exhibited higher IAM and PER pressures than the AMNs.

Age Factors↗

Leukemia risk associated with low-level benzene exposure.

BACKGROUND: Men who were part of an Australian petroleum industry cohort had previously been found to have an excess of lympho-hematopoietic cancer. Occupational benzene exposure is a possible cause of this excess. METHODS: We conducted a case-control study of lympho-hematopoietic cancer nested within the existing cohort study to examine the role of benzene exposure. Cases identified between 1981 and 1999 (N = 79) were age-matched to 5 control subjects from the cohort. We estimated each subject's benzene exposure using occupational histories, local site-specific information, and an algorithm using Australian petroleum industry monitoring data. RESULTS: Matched analyses showed that the risk of leukemia was increased at cumulative exposures above 2 ppm-years and with intensity of exposure of highest exposed job over 0.8 ppm. Risk increased with higher exposures; for the 13 case-sets with greater than 8 ppm-years cumulative exposure, the odds ratio was 11.3 (95% confidence interval = 2.85-45.1). The risk of leukemia was not associated with start date or duration of employment. The association with type of workplace was explained by cumulative exposure. There is limited evidence that short-term high exposures carry more risk than the same amount of exposure spread over a longer period. The risks for acute nonlymphocytic leukemia and chronic lymphocytic leukemia were raised for the highest exposed workers. No association was found between non-Hodgkin lymphoma or multiple myeloma and benzene exposure, nor between tobacco or alcohol consumption and any of the cancers. CONCLUSIONS: We found an excess risk of leukemia associated with cumulative benzene exposures and benzene exposure intensities that were considerably lower than reported in previous studies. No evidence was found of a threshold cumulative exposure below which there was no risk.

Adult↗

Ambulatory 24 hour sleep-wake monitoring in narcolepsy-cataplexy compared to matched controls.

Twenty-four hour ambulatory sleep-wake recordings were made in 10 untreated patients with narcolepsy-cataplexy and 10 matched controls. Nocturnal sleep of narcoleptics was similar to descriptions of laboratory based recordings and was characterized by frequent sleep onset REM periods, high variability of REM latency, increased amounts of wakefulness after sleep onset, and low sleep efficiencies. Daytime portions in narcoleptics showed greater drowsiness and sleep than in controls with significantly higher amounts of stages 1A, 1B, 3, 4 and REM, more sleep episodes longer than 1 and longer than 10 min in duration, and high intersubject variability. On average, only 1.2 daytime sleep episodes began with sleep onset REM periods. There was a strong tendency in both groups towards a long mid-afternoon sleep episode often containing slow wave sleep (SWS) and which was significantly longer in narcoleptics. The mean interval between the onset of nocturnal SWS and the main daytime SWS peak was 14.1 h for narcoleptics and 13.6 h for controls. Daytime waking portions in narcoleptics showed significantly less 'active wakefulness' than in controls. There was no correlation between MSLT measures of sleepiness and amount of daytime sleep in ambulant recordings.

Adult↗

Sinus tachycardia and abnormal cardiac rate variation in schizophrenia.

The sinus rhythm resting heart rates of 138 schizophrenic patients were monitored electrocardiographically each for 30 min and were compared with those of 139 healthy controls. It was found that a significant sinus tachycardia existed in the patients. Factors of chronologic age, sex and treatment by psychotropic drugs were non-significant. A subsample of 22 process schizophrenic patients was compared with 20 healthy controls, matched for age, monitored continuously for a minimum of 120 min and analyzed by autocorrelation on a minute-by-minute basis for cardiac rate variation. Ultradian rhythms of each group revealed that the periodicity of cardiac rate variation in schizophrenia was significantly longer than that in health. Treatment by psychotropic drugs in half of the patient sample did not appear to influence the cardiac rate variation. It is suggested that the bradycardia existing between pulses of tachycardia in schizophrenia may be responsible not only for the dysplastic perception of these patients, but also for their premature death from vascular causes.

Adolescent↗

Accuracy of laboratory and portable monitor international normalized ratio determinations. Comparison with a criterion standard.

BACKGROUND: Portable instruments that measure the prothrombin time and automatically calculate the international normalized ratio (INR) with the use of a drop of whole blood have simplified the treatment of patients who are receiving warfarin therapy. The accuracy of these portable monitors has never been determined by comparing INR results with a criterion (gold) standard INR determination. METHODS: Duplicate whole-blood INR determinations were made with two commercially available portable INR monitors. Duplicate frozen-plasma samples were measured with four different thromboplastin reagents, each with a different international sensitivity index. The criterion standard INR was determined by using an international reference thromboplastin and the manual tilt-tube technique. Agreement was evaluated by determining how accurately laboratory and monitor INR determinations matched criterion standard values in designating a sample to be within or outside of currently recommended INR target ranges. RESULTS: Two of the laboratory methods, which used relatively sensitive thromboplastins, showed close agreement with the criterion standard, whereas two laboratory methods that used less sensitive thromboplastin reagents showed poor agreement. Both of the portable monitors fell between these extremes. The two best laboratory methods ere significantly better (P < .003) than both monitors, which in turn were better (P < .003) than the remaining two laboratories. CONCLUSIONS: There is large interlaboratory variation in the accuracy of INR determinations. Laboratory methods that used insensitive (high international sensitivity index) thromboplastins performed poorly. Accuracy of monitor measurements appears satisfactory.

Adult↗

Relationship of fasting and hourly blood glucose levels to HbA1c values: safety, accuracy, and improvements in glucose profiles obtained using a 7-day continuous glucose sensor.

OBJECTIVE: In this study, we evaluated the safety and efficacy of 7-day transcutaneous, real-time, continuous glucose monitoring (CGM) in subjects with insulin-requiring diabetes. RESEARCH DESIGN AND METHODS: Eighty-six subjects were enrolled at five U.S. centers. Subjects wore a sensor inserted under the skin of the abdomen for 7 days during each of three consecutive periods. Data were blinded during period 1 and unblinded during periods 2 and 3. RESULTS: Of the 6,811 matched self-monitoring of blood glucose to sensor values prospectively analyzed, 97.2% fell in the Clarke error grid zones A and B, and median absolute relative difference was 11.4%. After unblinding, subjects reduced time spent at <55 mg/dl by 0.3 h/day, reduced time spent at >240 mg/dl by 1.5 h/day, and increased time in the target zone (81-140 mg/dl) by 1.4 h/day (P < 0.05 for all three comparisons). Improvements were seen in both types 1 and 2 diabetes and with use of both multiple daily injections and continuous subcutaneous insulin infusion. Modal day graphs were generated in six groups of subjects based on HbA1c (A1C) ( 10%). Mean glucose levels from midnight to 7:00 a.m. (fasting and dawn phenomenon periods) were only normal for subjects with A1C <or=6%. All other groups were hyperglycemic during this and all periods. Reductions in overall mean glucose were achieved for the four highest A1C groupings with unblinded device use. CONCLUSIONS: This is the first report of a real-time, transcutaneous glucose sensor that functioned for 7 days. The use of CGM in the unblinded phase resulted in improvements in target-range glycemia across all A1C values.

Blood Glucose↗

Effects of continuous versus bolus infusion of enteral nutrition in critical patients.

PURPOSE: Enteral alimentation is the preferred modality of support in critical patients who have acceptable digestive function and are unable to eat orally, but the advantages of continuous versus intermittent administration are surrounded by controversy. With the purpose of identifying the benefits and complications of each technique, a prospective controlled study with matched subjects was conducted. PATIENTS AND METHODS: Twenty-eight consecutive candidates for enteral feeding were divided into 2 groups (n = 14 each) that were matched for diagnosis and APACHE II score. A commercial immune-stimulating polymeric diet was administered via nasogastric tube by electronic pump in the proportion of 25 kcal/kg/day, either as a 1-hour bolus every 3 hours (Group I), or continuously for 24 hours (Group II), over a 3-day period. Anthropometrics, biochemical measurements, recording of administered drugs and other therapies, thorax X-ray, measurement of abdominal circumference, monitoring of gastric residue, and clinical and nutritional assessments were performed at least once daily. The principal measured outcomes of this protocol were frequency of abdominal distention and pulmonary aspiration, and efficacy in supplying the desired amount of nutrients. RESULTS: Nearly half of the total population (46.4%) exhibited high gastric residues on at least 1 occasion, but only 1 confirmed episode of pulmonary aspiration occurred (3.6%). Both groups displayed a moderate number of complications, without differences. Food input during the first day was greater in Group II (approximately 20% difference), but by the third day, both groups displayed similarly small deficits in total furnished volume of about 10%, when compared with the prescribed diet. CONCLUSIONS: Both administration modalities permitted practical and effective administration of the diet with frequent registered abnormalities but few clinically significant problems. The two groups were similar in this regard, without statistical differences, probably because of meticulous technique, careful monitoring, strict patient matching, and conservative amounts of diet employed in both situations. Further studies with additional populations, diagnostic groups, and dietetic prescriptions should be performed in order to elucidate the differences between these commonly used feeding modalities.

Adolescent↗

Portable global positioning units to complement accelerometry-based physical activity monitors.

PURPOSE: This study examines the usefulness of complementing accelerometry-based physical activity measurement with spatial data from portable global positioning system (GPS) units to determine where physical activity occurs. METHODS: First, using the geographic distribution of data points and Bland-Altman plots, we examined GPS units' validity and interunit reliability by measuring the distance to a geodetic point. We also assessed interunit reliability by comparing GPS data collected in three built environment contexts. Second, we conducted a pilot study in which 35 participants wore GPS units and accelerometers in free-living conditions for 3 d. Moderate and vigorous physical activity (MVPA) bouts were matched to GPS data. We classified each bout as occurring inside or outside the participant's home neighborhood. Using unpaired t-tests and Fisher's exact tests, we compared neighborhood attributes for participants having the majority of MVPA bouts within their home neighborhood, relative to those with most bouts away from their home neighborhood. RESULTS: Average distance from each unit to the geodetic point was 3.02 m (SD 2.51). Average bias among units using Bland-Altman plots was 0.90 m, ranging from -0.22 to 1.86 m, within the limits of agreement. For interunit reliability in the built environment contexts, the mean distance difference among units ranged between 10.7 m (SD 11.9) and 20.1 m (SD 21.8). For the pilot study involving participants, GPS data were available for 59.3% of all bouts (67% of MVPA time), of which 46% were in the participants' neighborhood. Participants obtaining most of their MVPA in their neighborhoods tend to live in areas with higher population density, housing unit density, street connectivity, and more public parks. CONCLUSION: Data recorded by portable GPS units is sufficiently precise to track participants' movements. Successful matching of activity monitor and locational data suggests GPS is a promising tool for complementing accelerometry-based physical activity measures. Our pilot analysis shows evidence that the relationship between environment and activity can be clarified by examining where physical activity occurs.

Acceleration↗

Effect of maximal aerobic power on match performance in elite soccer referees.

The aim of this study was to verify whether referees' maximal aerobic power could influence competitive match exercise intensity. Eight elite-level referees (mean +/- SD age, 37.6 +/- 3.4 years) were each observed during 2 Serie A matches (n = 16), and the mean of each match activity was used for analysis. Match activities were monitored with encoder-equipped cameras. .V(O)(2)max was assessed under field conditions with a portable device during a progressive multistage protocol. The .V(O)(2)max of each subject was expressed in absolute terms (.V(O)(2)max(ab), L.min(-1)), relative terms (.V(O)(2)max (rel), ml.kg(-1).min(-1)), and independent from body mass (.V(O)(2)max (ind), ml.kg(-0.75).min(-1)). Significance was set at p < or = 0.05 for all measurements. Total distance covered during the match correlated significantly with .V(O)(2)max (ind) (r = 0.77) and .V(O)(2)max (ab) (r = 0.87). .V(O)(2)max (ind), .V(O)(2)max (rel), and .V(O)(2)max (ab) correlated negatively (p < 0.05) with the time spent standing still during the match (r = -0.90, -0.85, and -0.86, respectively, p < 0.05). During the first half of the match, referees with higher levels of .V(O)(2)max (rel) (r = 0.93, p < 0.05) and .V(O)(2)max (ind) (r = 0.90, p < 0.05) were able to cover more distance at medium intensity. In the second half of the match, medium-intensity distance and low-intensity time correlated significantly (p < 0.05) with .V(O)(2)max (ab) (r = 0.76) and .V(O)(2)max (rel) (r = 0.75), respectively. The results demonstrate the positive influence of .V(O)(2)max in determining both the total amount of distance covered and the exercise intensity during a game. Higher levels of .V(O)(2)max may provide referees the opportunity to be more active and therefore closer to the action on the field during the game.

Adult↗

Actigraphic home-monitoring of the sleep patterns of in vitro fertilization children and their matched controls.

The sleep patterns of 35 in vitro fertilization (IVF) children aged 19 to 57 months and their matched controls were evaluated by actigraphic home-monitoring for three consecutive nights. Actigraphic data were analysed by an automated scoring procedure developed in the authors' laboratory. There were no significant differences in activity levels between IVF multiple-birth subjects and their matched controls or between IVF singletons and their matched controls. In contrast, multiple-birth subjects had higher activity levels during sleep and lower sleep efficiency than singletons in both IVF and control groups. Sleep measures showed night-to-night stability in all groups.

Age Factors↗

Adjustments of distributive and clinical pharmacy services to financial constraints.

The effects of hospital budget constraints on a pharmacy department's ability to provide distributive and clinical services are described, and the development and use of workload-monitoring systems to match resources with demand is discussed. In 1980, the pharmacy department at Grace Hospital, a 402-bed community hospital in Detroit, Michigan, began quantifying workload by using five drug distribution indicators. After the pharmacy began providing clinical services in 1981, workload elements were measured in a pilot program for ASHP's Hospital Pharmacy Management Information System. Hospitalwide staff reductions occurred in 1985, eliminating most clinical pharmacy services. From 1985 to 1986, drug costs increased more than expected; also, turnaround time for medication orders increased. In 1986, 1.4 full-time-equivalent positions were added, and the pharmacy instituted use of decentralized carts and a pharmacist on the patient-care units to provide first doses. The hospital's management engineering department had selected patient days as the single indicator for pharmacy workload, but pharmacy used the ASHP Pharma Trend monitoring system to present data that convinced management engineering that patient days was an inadequate indicator of pharmacy workload. Also, drug costs decreased after the drug distribution changes and the reinstitution of patient drug therapy monitoring. Pharmacy managers need workload monitoring systems that are responsive to changes and include departmental expense information; these systems should be able to interrelate to hospital cost-accounting systems.

Cost Control↗