There is limited evidence on how much and on which days accelerometry monitoring should be performed to obtain a representative measurement of physical activity (PA) in young children. We measured 76 children (40 M and 36 F, mean age 5.6 years ([SD ± 0.4]) on 7 days using Actigraph accelerometers. Mean daily PA was expressed in counts per min (cpm). Reliability increased as the number of days and hours of monitoring increased, but only to 10 hr per day. At 7 days of monitoring for 10 hr per day, reliability was 80% (95% CI [70%, 86%]). The number of days was more important to reliability than the number of hours. The inclusion or exclusion of weekend days made relatively little difference. A monitoring period of 7 days for 10 hr per day produced the highest reliability. Surprisingly short monitoring periods may provide adequate reliability in young children.

OBJECTIVE. To investigate whether it was possible to promote placental blood transfer to infants at preterm delivery by (1) delaying cord clamping, (2) holding the infant below the placenta, and (3) administering an oxytocic agent to the mother, we measured the infants' blood volumes. DESIGN. Randomized study. METHODS. Forty-six preterm infants (gestational age: 24[0/7] to 32[6/7] weeks) were assigned randomly to either placental blood transfer promotion (delayed cord clamping [DCC] group, ie, ≥30 seconds from moment of delivery) or early cord clamping (ECC) with conventional management (ECC group). Eleven of 23 and 9 of 23 infants assigned randomly to DCC and ECC, respectively, were delivered through the vaginal route. The study was conducted at a tertiary perinatal center, the Queen Mother's Hospital (Glasgow, United Kingdom). RESULTS. The infants' mean blood volume in the DCC group (74.4 mL/kg) was significantly greater than that in the ECC group (62.7 mL/kg; 95% confidence interval for advantage: 5.8–17.5). The blood volume was significantly increased by DCC for infants delivered vaginally. The infants in the DCC group delivered through cesarean section had greater blood volumes (mean: 70.4 mL/kg; range: 45–83 mL/kg), compared with the ECC group (mean: 64.0 mL/kg; range: 48–77 mL/kg), but this was not significant. Additional analyses confirmed the effect of DCC (at least 30 seconds) to increase average blood volumes across the full range of gestational ages studied. CONCLUSIONS. The blood volume was, on average, increased in the DCC group after at least a 30-second delay for both vaginal and cesarean deliveries. However, on average, euvolemia was not attained with the third stage management methods outlined above.

The aim of this study was to compare sprint performance over 10 and 20 in 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 in using a Latin rectangular design. The times were recorded at 10 and 20 in 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 in at 0% body mass and 1.33 +/- 0.13 in 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.

A physiological sickness scoring system (SS), based on the APACHE II score, has been used to assess outcome from critical illness in 128 patients admitted to a general intensive care unit. Physiological data were collected on each patient from admission until death or discharge from the unit, and survival was recorded as survival to home. The admission SS correctly classified 80.6% of survivors, and 70.4% of non-survivors. Predictive power did not improve with time using the daily SS. However, when the proporxonal change in SS over time was included in the analysis, predictive power improved; and at day 4, 87.1% of survivors and 75% of non-survivors were correctly classified. At intermediate levels of sickness severity (admission score of 13–18), a reduction in SS of 30% by day 4 reduced the risk of death by 32%; at higher levels (>18) a similar reduction in SS was associated with a 47% reduction in death-risk. Failure to obtain a reduction in score by day 4 was associated with increased risk of death. Survivors consistently showed a greater fall in SS by day 4 than non-survivors. The APACHE score and its modifications provide an accurate, unitary measure of physiological disturbance. Correction of abnormal physiology, and the measurement of responsiveness to therapy are important components in the prediction of outcome from critical illness.

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 to17%, 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.

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, Mood 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. (C) 2004 The Royal Institute of Public Health. Published by Elsevier Ltd. All rights reserved.

Accelerometry is a popular objective method to measure physical activity (PA) in children. Currently there is limited evidence on how long (number of days) and which days (weekdays/weekends) monitoring should be carried out to be confident of a representative PA measurement. Previous work has addressed some of these questions in certain populations of children (Trost et al, 2000). Further research is required to verify these findings in other populations of children. PURPOSE To determine the number of days of monitoring required to obtain a representative measurement of daily PA in young children and which days of the week should be included in this monitoring period. METHODS CSA 7164 uniaxial accelerometers were worn by 76 healthy children (40 male(M) and 36 female(F)), mean age 5.8 years(SD 0.5), for a minimum of 7 consecutive days. The daily total physical activity for each child was expressed as counts per minute (cpm) averaged over the entire daily monitoring period. RESULTS Logarithms of the daily cpm were used to reduce the effect of increasing within child day-to-day variability with increasing daily activity. Using Spearman-Brown Prophecy Formula, reliability co-efficients and 95% Confidence Intervals for 1, 4 and 7 days of monitoring were established as 0.35 (0.26,0.46), 0.69 (0.58,0.77) and 0.79 (0.71,0.86) respectively. Repeated Measures Analysis of Variance showed that the children were slightly and significantly more active on weekends (M mean = 900.2cpm, F mean = 833.0cpm) than weekdays (M mean = 858.2cpm, F mean = 747.2cpm) (p = 0.02). Boys were slightly and significantly more active than girls on both weekdays and weekends (p = 0.011). CONCLUSION Consistent with previous work, these results show that when using accelerometers, adoption of a monitoring period of around 7 days will ensure a representative measurement of habitual PA of young children. This monitoring period will allow for the effect of greater PA of 5-year-old children at weekends than weekdays. This work is funded by SPARKS 0GLW/O1

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.

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.

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.

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.

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 ≤−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∼2931 kJ for E , ∼1675 kJ for M , and ∼837 kJ increase over the 6 months for the S group. For the 18-month-old cohort the changes were ∼2512 kJ for E ∼1675 for the M group and ∼1047 for the S group. Sponsorship: Nestlé Foundation. European Journal of Clinical Nutrition (2000) 54 , Suppl 2, S43–S51

ABSTRACT 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.

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 ≤−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. Sponsorship: Nestlé Foundation. European Journal of Clinical Nutrition (2000) 54 , Suppl 2, S69–S73

AIM:To investigate risk factors, visual outcome, and graft survival for traumatic wound rupture after penetrating keratoplasty. METHODS:A retrospective analysis of 336 patients who underwent penetrating keratoplasty from 1988 to 1995. RESULTS:19 patients (5.7%) suffered traumatic postoperative wound rupture requiring surgical repair. They were younger (mean age 16.6 years, 95% CI 13.2-20.6) and more frequently keratoconic (p = 0.01) than other patients (mean age 28.9 years, 95% CI 26.-31.0). Mean postoperative follow up was 37.7 (SD 22.9) months and 24.5 (18.9) months for the rupture and non-rupture patients. Mean interval between keratoplasty and rupture was 18 (21) weeks. The lens was damaged and removed in 37% of ruptured eyes. For keratoconics, the probability of graft survival at 5 years was lower (p = 0.03) in the ruptured eyes (75%) than in the non-ruptured eyes (90%). Endothelial failure was a more common (p <0.05) cause of graft opacification in ruptured grafts than in intact grafts. Of the ruptured eyes, 53% achieved a final corrected acuity of at least 6/18 and 63% achieved at least 6/60 compared with 48% and 71% of the intact eyes respectively (both p >0.1). The proportion of keratoconic eyes which achieved at least 6/60 was lower (p = 0.02) in the ruptured eyes (67%) than the non-ruptured eyes (87%). Eyes with wound ruptures of 5 clock hours or greater were less likely (p <0.05) to achieve an acuity of 6/18 and were more likely (p <0.05) to have an associated lens injury. CONCLUSIONS:Graft rupture is relatively common in African practice, particularly in young keratoconics. Visual outcome and graft survival are not significantly worse than for other grafted eyes, but are significantly worse than for other grafted keratoconic eyes.

AIMSThe coefficient of variation is a popular measure for describing the amount of repeat variability present in ECG measurements from recording to recording. However, it can be misleading. The aim of the present study was to assess repeat variation (reclassification) in computer measured ECG criteria, i.e. positive to negative or vice versa, and compare this with the coefficient of variability.METHODS AND RESULTSTwo ECGs were obtained from each of 295 patients, one day apart, and separately from a further 364 patients, several minutes apart. All patients were considered to be in a stable condition. Estimates of the coefficients of variation were obtained for a number of ECG parameters used in the diagnosis of left ventricular hypertrophy. Corresponding reclassification rates of relevant ECG criteria were also calculated. Large coefficients of variation were observed in voltage parameters, e.g. R in V5 (20% for day-to-day recordings and 6% for minute-to-minute recordings) while the corresponding reclassification rates were 8% and 0% respectively. The repeat variation in the diagnosis of left ventricular hypertrophy was up to 5% for day-to-day recordings and up to 3% for minute-to-minute recordings based on several different criteria.CONCLUSIONA large coefficient of variation in a particular variable does not necessarily correspond to a high reclassification rate. A better measure of the impact of ECG variability for a particular measurement is obtained from its reclassification rate. In turn, this may have a minimal effect on the overall diagnosis of a particular abnormality.