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Purpose: The aim of this investigation was to determine the reliability of normalizing rapid force (RF) production to peak force assessed during an isometric knee flexor assessment, and to present a novel method of classifying athletes' potential training needs within the 90–90 isometric hamstring assessment. Procedures: Twenty elite female soccer players (age: 20.7 ± 4.7 years; height: 168.2 ± 5.5 cm; body mass: 62.8 ± 7.0 kg), with no recent (>6 months) history of hamstring strain injury, volunteered to participate in the study. Following a standardized warm-up, each participant performed three maximal isometric hamstring contractions, with their heel resting on a force plate, elevated on a box, to ensure that their hips and knees were at 90° Data was analyzed to determine peak for (PF), RF was established as force expressed at 100 ms (F100) and force expressed at 200 ms (F200), with force at each time-point subsequently normalized to a percentage of PF. Findings: F100 and F200 normalized to PF demonstrated good absolute reliability (%CV = 6.12–7.62) and moderate relative reliability (ICC = 0.689–0.703). Concurrently observing PF and normalized F100 and F200 could provide clear training and monitoring goals. Conclusions: Normalizing measures of RF production, including F100 and F200, to PF can be performed reliability. Therefore, could be tracked overtime to identify changes as an effect of training or for fatigue monitoring purposes. However, further research is required to determine how knee flexor force-time characteristics change in relation to focused training and how these characteristics change in response to fatiguing activities. more...

Limited research has reported the reliability of rapid force generation characteristics during isometric assessments of the hamstrings. Therefore, the purpose of the present study was to determine the between-session reliability of rapid force generating characteristics of the hamstrings and relationship to maximal force production. Twenty-three female soccer players (age: 20.7 ± 4.7 years; height: 168.7 ± 5.9 cm; body mass: 64.4 ± 6.7 kg) performed three unilateral trials of the 90–90 isometric hamstring assessment, on two separate occasions, separated by 7 days. Peak force, force at 100- and 200 ms and average rate of force development (aRFD) over 100- and 200 ms epochs were calculated. Absolute and fair-good reliability was observed for peak force and all rapid force generating measures ( < 8.33CV%, ICC > 0.610). Significant and meaningful relationships (p < 0.001, r > 0.802) were observed for all rapid force generating measures and peak force. The 90–90 isometric assessment can be used to assess peak and rapid force generating reliably to enable practitioners to confidently track changes in performance over time as part of fatigue monitoring and management. more...

Background: ED-based trials have repeatedly failed to demonstrate superiority for antiemetic drugs over placebo,1 but the clinical significance of reported between-group differences in mean visual analogue scale (VAS) change is obscure.2 Recent research suggests that a VAS change cut-off level can reliably identify improved patients.3 This would allow more clinically meaningful between-group comparisons to be made. Objective(s): To compare intravenous (IV) droperidol 1.25 mg and ondansetron 8 mg IV with 0.9% saline placebo for adult ED patients with nausea. A VAS change cut-off level was used as the primary outcome measure. Method(s): A randomised controlled trial was conducted at Monash Health, designed to demonstrate superiority of the active drugs over placebo. The primary outcome measure of symptom improvement was defined as a VAS change of >= -8 mm from baseline at 30-minute posttreatment. Mean VAS changes per group, and percentages experiencing the desired treatment effect were also compared. Result(s): Of 215 patients, 73 (34%), 71 (33%) and 71 (33%) received droperidol, ondansetron and placebo. Symptom improvement occurred in 75%, 80% and 76% respectively; between-group differences are shown in Table 1. Mean VAS changes were -29 mm (95% CI: -36 to -23), -34 mm (95% CI: -41 to -28), and -24 mm (95% CI: -29 to -19), respectively. Desired treatment effect was experienced by 77%, 73% and 59% respectively; between-group differences are shown in Table 2. Conclusion(s): Superiority was not demonstrated for droperidol or ondansetron over placebo. The new primary outcome measure provided results which were clinically meaningful and easily understandable. (Table Presented). more...

Objective: The objective was to separately compare effectiveness of 1.25 mg of intravenous (IV) droperidol and 8 mg of IV ondansetron with 0.9% saline placebo for adult emergency department (ED) patients with nausea. A novel primary outcome measure, expected to aid clinical interpretation of reported results, was employed. Method(s): A randomized controlled trial was conducted at the three EDs of Monash Health, Melbourne, Australia. The design was to demonstrate superiority of the active drugs over placebo. The primary outcome measure of symptom improvement was defined as a visual analog scale (VAS) rating change of -8 mm or more from baseline at 30 minutes posttreatment. Mean VAS changes per group and percentages experiencing the desired treatment effect were also compared. The study was concluded after recruitment of 215 of the planned 378 patients, as interim analysis confirmed that continuation could not result in a finding of superiority. Result(s): Of 215 patients, 73 (34%), 71 (33%), and 71 (33%) received droperidol, ondansetron, and placebo. Symptom improvement occurred in 75% (95% confidence interval [CI] = 64% to 85%), 80% (95% CI = 69% to 89%), and 76% (95% CI = 64% to 85%), respectively. Mean VAS changes were -29 mm (95% CI = -36 to -23 mm), -34 mm (95% CI = -41 to -28 mm), and -24 mm (95% CI = -29 to -19 mm), respectively. Desired treatment effects were experienced by 77% (95% CI = 65% to 86%), 73% (95% CI = 61% to 83%), and 59% (95% CI = 47% to 71%), respectively. Conclusion(s): For adult ED patients with nausea, superiority was not demonstrated for droperidol or ondansetron over placebo.Copyright © 2018 by the Society for Academic Emergency Medicine more...

OBJECTIVE: The objective was to separately compare effectiveness of 1.25 mg of intravenous (IV) droperidol and 8 mg of IV ondansetron with 0.9% saline placebo for adult emergency department (ED) patients with nausea. A novel primary outcome measure, expected to aid clinical interpretation of reported results, was employed. METHODS: A randomized controlled trial was conducted at the three EDs of Monash Health, Melbourne, Australia. The design was to demonstrate superiority of the active drugs over placebo. The primary outcome measure of symptom improvement was defined as a visual analog scale (VAS) rating change of -8 mm or more from baseline at 30 minutes posttreatment. Mean VAS changes per group and percentages experiencing the desired treatment effect were also compared. The study was concluded after recruitment of 215 of the planned 378 patients, as interim analysis confirmed that continuation could not result in a finding of superiority. RESULTS: Of 215 patients, 73 (34%), 71 (33%), and 71 (33%) received droperidol, ondansetron, and placebo. Symptom improvement occurred in 75% (95% confidence interval [CI] = 64% to 85%), 80% (95% CI = 69% to 89%), and 76% (95% CI = 64% to 85%), respectively. Mean VAS changes were -29 mm (95% CI = -36 to -23 mm), -34 mm (95% CI = -41 to -28 mm), and -24 mm (95% CI = -29 to -19 mm), respectively. Desired treatment effects were experienced by 77% (95% CI = 65% to 86%), 73% (95% CI = 61% to 83%), and 59% (95% CI = 47% to 71%), respectively. CONCLUSION: For adult ED patients with nausea, superiority was not demonstrated for droperidol or ondansetron over placebo. more...

The purpose of the present study was to evaluate the anthropometric and physical characteristics of English academy rugby league players by annual-age category (under 16s-under 20s) and between backs and forwards. Data were collected on 133 academy players over a 6-year period (resulting in a total of 257 assessments). Player assessments comprised of anthropometric (height, body mass, sum of 4 skinfolds) and physical (vertical jump, 10- and 20-m sprint, estimated V[Combining Dot Above]O2max via the yo-yo intermittent recovery test level 1, absolute 1 repetition maximum [1RM], and relative squat, bench press, and prone row) measures. Univariate analysis of variance demonstrated significant (p ≤ 0.05) increases in height, body mass, vertical jump, absolute, and relative strength measures across the 5 annual-age categories (e.g., body mass: under 16s = 75.2 ± 11.1, under 20s = 88.9 ± 8.5 kg; vertical jump: under 16s = 45.7 ± 5.2, under 20s = 52.8 ± 5.4 cm; 1RM bench press: under 16s = 73.9 ± 13.2, under 20s = 114.3 ± 15.3 kg). Independent t-tests identified significant (p ≤ 0.05) differences between backs and forwards for anthropometric (e.g., under 16s body mass: backs = 68.4 ± 8.6, forwards = 80.9 ± 9.7 kg) and physical (e.g., under 19s 20-m sprint: backs = 3.04 ± 0.08, forwards = 3.14 ± 0.12s; under 18s relative squat: backs = 1.65 ± 0.18, forwards = 1.51 ± 0.17 kg·kg) characteristics that were dependent on the age category and measure assessed. Findings highlight that anthropometric and physical characteristics develop across annual-age categories and between backs and forwards in academy rugby league players. These findings provide comparative data for such populations and support the need to monitor player development in junior rugby league players. more...

Prescription opioid (PO)-dependent treatment presentations are becoming increasingly common; however, most research on the treatment of opioid-dependent populations has been conducted in heroin users. The aim of this secondary data analysis was to compare the buprenorphine induction experience of 167 heroin and 61 PO users. Results demonstrate that although the groups differed on some baseline characteristics, many of the key induction experience variables were comparable between the groups. Heroin users were found to have significantly higher preinduction Clinical Opiate Withdrawal Scale (COWS) scores (p = 014) and postinduction COWS score (p = 008) compared with the PO users. No differences between groups were found for self-reported craving and withdrawal scores, mean buprenorphine dose on Day 1, or retention at the end of the first week. The findings of this study suggest that existing buprenorphine induction practices developed for heroin users appear to be equally effective with PO users. © 2012 Elsevier Inc. more...

BACKGROUND: The catalytically active 66-kDa subunit of the human immunodeficiency virus type 1 (HIV-1) reverse transcriptase (RT) consists of DNA polymerase, connection, and ribonuclease H (RNase H) domains. Almost all known RT inhibitor resistance mutations identified to date map to the polymerase domain of the enzyme. However, the connection and RNase H domains are not routinely analysed in clinical samples and none of the genotyping assays available for patient management sequence the entire RT coding region. The British Columbia Centre for Excellence in HIV/AIDS (the Centre) genotypes clinical isolates up to codon 400 in RT, and our retrospective statistical analyses of the Centre's database have identified an N348I mutation in the RT connection domain in treatment-experienced individuals. The objective of this multidisciplinary study was to establish the in vivo relevance of this mutation and its role in drug resistance. METHODS AND FINDINGS: The prevalence of N348I in clinical isolates, the time taken for it to emerge under selective drug pressure, and its association with changes in viral load, specific drug treatment, and known drug resistance mutations was analysed from genotypes, viral loads, and treatment histories from the Centre's database. N348I increased in prevalence from below 1% in 368 treatment-naïve individuals to 12.1% in 1,009 treatment-experienced patients (p = 7.7 x 10(-12)). N348I appeared early in therapy and was highly associated with thymidine analogue mutations (TAMs) M41L and T215Y/F (p < 0.001), the lamivudine resistance mutations M184V/I (p < 0.001), and non-nucleoside RTI (NNRTI) resistance mutations K103N and Y181C/I (p < 0.001). The association with TAMs and NNRTI resistance mutations was consistent with the selection of N348I in patients treated with regimens that included both zidovudine and nevirapine (odds ratio 2.62, 95% confidence interval 1.43-4.81). The appearance of N348I was associated with a significant increase in viral more...