Individual and combined effects of acute and chronic running loads on injury risk in elite Australian footballers.

A model that takes into account the current workload, and the workload the athlete has been prepared for, as an acute:chronic workload ratio has been previously used as a novel way to monitor training load and injury risk. Fifty-nine elite Australian football players from one club participated in this 2-year study. Global Positioning System technology was used to provide information on running workloads of players. An injury was defined as any non-contact "time-loss" injury. One-week (acute), along with 4-week (chronic) workloads were calculated for a range of variables. The size of the acute workload in relation to the chronic workload was calculated as an acute:chronic workload ratio. An acute:chronic workload ratio of >2.0 for total distance during the in-season was associated with a 5 to 8-fold greater injury risk in the current [relative risk (RR) = 8.65, P = 0.001] and subsequent week (RR = 5.49, P = 0.016). Players with a high-speed distance acute:chronic workload ratio of >2.0 were 5-11 times more likely to sustain an injury in the current (RR = 11.62, P = 0.006) and subsequent week (RR = 5.10, P = 0.014). These findings demonstrate that sharp increases in running workload increase the likelihood of injury in both the week the workload is performed, and the subsequent week.

How prominent are patient-reported outcomes in clinical trials of dermatological treatments?

BACKGROUND: Assessment of symptoms or disease improvement by study participants is an important aspect of assessing new dermatological therapies in clinical trials, especially for chronic skin diseases that lack objective severity markers. OBJECTIVES: We sought to determine the frequency and prominence of reporting of participants' subjective efficacy outcomes in dermatological clinical trials. Our secondary objective was to determine whether participant and physician outcomes agree in terms of direction and magnitude. METHODS: Systematic review of 125 randomized controlled trials identified from the Archives of Dermatology, British Journal of Dermatology, Clinical & Experimental Dermatology, Journal of Dermatological Treatment and Journal of the American Academy of Dermatology published between 1994 and 2001 (25 from each). Studies were retrieved in hard copy from the Cochrane Skin Group specialized register of trials and data were abstracted and summarized. RESULTS: Participant efficacy outcomes were mentioned in some form in only 32 of 125 trials (25.6%, 95% exact confidence interval 18.2-34.2%). Of these 32 studies, participant outcomes were mentioned only in the methods section in two studies, in the methods and results section without further data in nine studies and with further data in 21. Data were presented in figure format only in 12 of these studies and in tables and figures in nine. Participant efficacy outcomes were mentioned in the abstract section in just over half (53%) of the 32 trials that included participant efficacy outcomes. There was not enough information to assess agreement in direction and magnitude of participant vs. assessor outcomes. Overall, only 17 papers (13.6%) clearly declared their main outcome measures beforehand in the introduction or methods section. CONCLUSIONS: Asking study participants for their views of treatment efficacy seems like a good idea in dermatological clinical trials, yet only about a quarter of the trials examined in this review did so. Even when such information was recorded, it was often poorly and incompletely reported and given low prominence within the trial report. Our study findings call for a more comprehensive uptake for including participant efficacy outcomes alongside other assessor outcomes in clinical trials and, when included, to report those outcomes in full.

Depth of anisometropic amblyopia and difference in refraction.

Disagreement exists as to whether the depth of anisometropic amblyopia correlates with the degree of anisometropia. We reviewed the charts of 303 consecutive patients with the diagnosis of amblyopia. Thirty-five patients with untreated anisometropia without strabismus were identified. The best-corrected visual acuities, manifest refractions, and autorefractions were recorded. The differences in spherical equivalent, root mean square, and an index of anisometropia, which we defined, were calculated. The depth of amblyopia was strongly correlated to all three measures of anisometropia for both hyperopic and myopic individuals. Our new index of anisometropia was an excellent predictor of the depth of amblyopia.

Interventions for toxic epidermal necrolysis.

BACKGROUND: Toxic epidermal necrolysis is a rare condition where a drug reaction induces skin loss, similar to that seen in extensive burns. It is associated with high morbidity and mortality and there is no clear agreement on effective treatment. OBJECTIVES: To assess the effects of all interventions for the treatment of toxic epidermal necrolysis. SEARCH STRATEGY: We searched the Cochrane Skin Group Specialised Register (March 2001), the Cochrane Controlled Trials Register (March 2001), MEDLINE (1966 to December 2001), EMBASE (1980 to December 2001), DARE (4th Quarter 2001) and CINAHL (1982 to October 2001). SELECTION CRITERIA: Randomised controlled trials of therapeutic and supportive interventions that included participants clinically diagnosed with toxic epidermal necrolysis were included. DATA COLLECTION AND ANALYSIS: Two independent reviewers carried out study selection and assessment of methodological quality. MAIN RESULTS: Only one randomised controlled trial of treatment was identified. This trial compared the effectiveness of thalidomide with placebo and included 22 patients, 12 in the treatment group and 10 in the placebo group. Patients on the treatment arm received thalidomide 200 mg twice daily for 5 days. The main end point was the measurement of the progression of skin detachment after 7 days. Other end points were the overall mortality and severity of the disease evaluated with the simplified acute physiology score. The study was terminated as the mortality on the treatment arm was 83% compared to 30% on the control arm (relative risk 2.78, 95% confidence interval 1.04 to 7.40). No randomised controlled trials of the most commonly used current treatments i.e. systemic steroids, cyclosporin A and intravenous immunoglobulins were found. REVIEWER'S CONCLUSIONS: Treatment with thalidomide was not shown to be effective and was associated with significantly higher mortality than placebo. There is no reliable evidence on which to base treatment for toxic epidermal necrolysis, a disease commonly associated with mortality rates of around 30%. More research is required to understand the mechanisms of toxic epidermal necrolysis. International multi-centre studies are needed in the form of randomised controlled trials, to evaluate treatments for toxic epidermal necrolysis, especially those using high doses of steroid and intravenous immunoglobulins.

Spot test for the detection of iodate in the presence of periodate application to the detection of vic-dihydroxy compounds.

Spot tests for the detection of 0.02 mug of iodate in the presence of 45 mg of periodate, and for the detection of 0.1 mug of vic-dihydroxy compounds are described. The tests are based on the iodide-iodate reaction, in the presence of periodate masked by an excess of molybdate.

Applications of enzyme-catalysed reactions in trace analysis--I. Determination of mercury and silver by their inhibition of invertase.

Procedures are described for the accurate determination of silver (2-10 x 10(-7)M) and mercury(II) (2-10 x 10(-7)M) in the presence of each other and of most other metals. The methods are based on the inhibition by these metals of invertase catalysis of the hydrolysis of sucrose.

Applications of enzyme-catalysed reactions in trace analysis-III Determination of silver and thiourea by their combined inhibition of invertase.

Thiourea has been found to enhance the inhibition of invertase by silver ions. The effect is applied to the determination of 1-5 x 10(-7)M silver and of 10(-7)-10(-8)M thiourea. A mechanism is suggested for the enhancement.

Spectrophotometric determination of some vic-diols.

Conditions have been established for the determination of mannitol and sorbitol (0.4-14 mug), mannose (3.6-18 mug), myoinositol (1.5-6 mug) and pinacol (11-70 mug) by periodate oxidation. The iodate formed is determined spectrophotometrically by reaction with iodide to form tri-iodide. Exce'ss of periodate is masked with molybdate.

Applications of enzyme-catalysed reactions in trace analysis-II Determination of cyanide, sulphide, and iodine with invertase.

Methods are described for the determination of cyanide (10(-8)-10(-5)M and sulphide (10(-7)-10(-5)M) based on the de-inhibitory effect of these ions on invertase inhibited by mercury(II) or by silver. Iodine (0.1-3 mug) may be determined by its inhibition of invertase.

Spectrophotometric determination of tartrate in the presence of citrate.

Methods are described for the determination of 5-30 mug of tartrate alone and of 15-60 mug in the presence of up to 6 mg of citrate, based on oxidation by 3 moles or 1 mole of periodate respectively. The iodate formed is determined spectrophotometrically at 350 nm as tri-iodide after reaction with iodide, the excess of periodate being masked with molybdate.

Homogeneous nucleation of some sparingly soluble salts.

The homogeneous nucleation of barium, strontium and lead sulphates and lead carbonate has been studied by particle counting, and values for the interfacial tension and radius of each critical nucleus calculated. The changes in crystal size and shape that occur near S(crit) are reported.

A comparative study of methods for precipitating calcium oxalate from homogeneous solution.

A PFHS of calcium oxalate has been examined and the optimum conditions for the precipitation established. This method, and two other methods employing PFHS for the gravimetric determination of calcium as the oxalate are compared with the conventional and acetic acid-medium methods. All the methods work well in the absence of magnesium, but the urea hydrolysis procedure, in the absence of an initial precipitate, is recommended as the best method when magnesium is present. Crystal sizes have been measured by microscopy.

On homogeneous nucleation in barium sulphate precipitation from homogeneous solution.

Unsuccessful attempts to induce homogeneous nucleation of barium sulphate by a PFHS technique in which potential hetero-nuclei are removed by a preliminary precipitation are described. In all instances, only heterogeneous nucleation was observed.

Applications of enzyme-catalysed reactions in trace analysis-V Determination of zinc and calcium by their activation of the apo-enzyme of calf-intestinal alkaline phosphatase.

The activation of the apo-enzyme of calf-intestinal alkaline phosphatase by zinc in the presence and absence of magnesium 4 x 10(-4)M) is applied to the determination of 6-65 ng and 65-650 ng of zinc, respectively. The activation of the apo-enzyme by calcium in the presence of 1.4 x 10(-7)M zinc is used to determine 1-4 mug of calcium. The mechanism of the re-activation effects is discussed.

Applications of enzyme-catalysed reactions in trace analysis-VI Determination of mercury and silver by their inhibition of yeast alcohol dehydrogenase.

The inhibition of yeast alcohol dehydrogenase is applied to the determination of 2-200 ng of mercury(II) and 1-100 ng of silver. The enzyme, when used to catalyse the oxidation of ethanol, or the reverse reaction, is equally sensitive to inhibitors.

Indirect polarographic determination of tripolyphosphate ions in the presence of other polyphosphates, with octyltin chloride.

Tripolyphosphate ions form a soluble complex with mono-octyltin cations, thus reducing the polarographic wave height ofthe octyltin. This provides a method for the determination of 2 x 10(-4)-4 x 10(-3)M tripolyphosphate in the presence of 2 x 10(-3)M ortho-, pyro-, trimeta-, and 10(-3)M tetrametaphosphate, together, or in any combination. The method is also insensitive to less than 2 x 10(-3)M magnesium or calcium and less than 10(-2)M sulphate.

Applications of enzyme-catalysed reactions in trace analysis-IV Determination of beryllium and zinc by their inhibition of calf-intestinal alkaline phosphatase.

Methods are described for the determination of beryllium (18-90 ng) and zinc (0.6-6 mug), based on their inhibition of calf-intestinal alkaline phosphatase.

Titrimetric determination of microgram amounts of bismuth after precipitation as Bi[Cr(SCN)(6)] followed by thiocyanate amplification.

Bismuth (10-100 mug) is precipitated as Bi[Cr(SCN)(6)]. After filtration, the precipitate is treated with bicarbonate solution, and the thiocyanate dissolved is oxidized by iodine in alkaline medium to sulphate. After acidification, the excess of iodine is extracted into chloroform, and the iodide in the aqueous solution is amplified by bromine oxidation and subsequent treatment with more iodide. The titrimetric procedure provides 228 iodine atoms for each original bismuth ion. Only Hg(2+)(2), Hg(2+) and AsO(3-)(4) interfere seriously.

Candoluminescence-a new flame technique for trace analysis-II Determination of nanogram amounts of manganese.

The yellow candoluminescence of manganese stimulated in a 8:1 w w calcium oxide-calcium sulphate matrix at the edge of a hydrogen-nitrogen-air flame is used to determine 0.1-3.0 ng of manganese in 1-mul samples. Large amounts of chloride ions enhance the emission, and many transition metals suppress it.

Determination of manganese(II) by a chemiluminescence reaction.

Manganese(II) ( 1.5 ng/ml) is determined by measuring either of the two emission peaks given by alkaline oxidation of luminol. Several other metal ions, which enhance both emission peaks, are masked by cyanide ions.