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A standardised, national, 160-item FFQ, the FFQ-NL 1.0, was recently developed for Dutch epidemiological studies. The objective was to validate the FFQ-NL 1.0 against multiple 24-h recalls (24hR) and recovery and concentration biomarkers. The FFQ-NL 1.0 was filled out by 383 participants (25-69 years) from the Nutrition Questionnaires plus study. For each participant, one to two urinary and blood samples and one to five (mean 2·7) telephone-based 24hR were available. Group-level bias, correlation coefficients, attenuation factors, de-attenuated correlation coefficients and ranking agreement were assessed. Compared with the 24hR, the FFQ-NL 1.0 estimated the intake of energy and macronutrients well. However, it underestimated intakes of SFA and trans-fatty acids and alcohol and overestimated intakes of most vitamins by >5 %. The median correlation coefficient was 0·39 for energy and macronutrients, 0·30 for micronutrients and 0·30 for food groups. The FFQ underestimated protein intake by an average of 16 % and K by 5 %, relative to their urinary recovery biomarkers. Attenuation factors were 0·44 and 0·46 for protein and K, respectively. Correlation coefficients were 0·43-0·47 between (fatty) fish intake and plasma EPA and DHA and 0·24-0·43 between fruit and vegetable intakes and plasma carotenoids. In conclusion, the overall validity of the newly developed FFQ-NL 1.0 was acceptable to good. The FFQ-NL 1.0 is well suited for future use within Dutch cohort studies among adults.
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Encuestas sobre Dietas , Recuerdo Mental , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Países Bajos , Reproducibilidad de los Resultados , Factores de TiempoRESUMEN
Assessing energy requirements is a fundamental activity in clinical dietetic practice. The aim of this study was to investigate which resting energy expenditure (REE) predictive equations are the best alternatives to indirect calorimetry before and after an interdisciplinary therapy in Brazilian obese women. In all, twelve equations based on weight, height, sex, age, fat-free mass and fat mass were tested. REE was measured by indirect calorimetry. The interdisciplinary therapy consisted of nutritional, physical exercise, psychological and physiotherapy support during the course of 1 year. The average differences between measured and predicted REE, as well as the accuracy at the ±10 % level, were evaluated. Statistical analysis included paired t tests, intraclass correlation coefficients and Bland-Altman plots. Validation was based on forty obese women (BMI 30-39·9 kg/m2). Our major findings demonstrated a wide variation in the accuracy of REE predictive equations before and after weight loss in non-morbid, obese women. The equations reported by Harris-Benedict and FAO/WHO/United Nations University (UNU) were the only ones that did not show significant differences compared with indirect calorimetry and presented a bias <5 %. The Harris-Benedict equation provided 40 and 47·5 % accurate predictions before and after therapy, respectively. The FAO equation provided 35 and 47·5 % accurate predictions. However, the Bland-Altman analysis did not show good agreement between these equations and indirect calorimetry. Therefore, the Harris-Benedict and FAO/WHO/UNU equations should be used with caution for obese women. The need to critically re-assess REE data and generate regional and more homogeneous REE databases for the target population is reinforced.
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Metabolismo Basal , Metabolismo Energético , Obesidad/fisiopatología , Adulto , Terapia Conductista , Composición Corporal , Índice de Masa Corporal , Brasil , Calorimetría Indirecta , Dieta , Ejercicio Físico , Femenino , Humanos , Conceptos Matemáticos , Persona de Mediana Edad , Terapia Nutricional , Obesidad/psicología , Obesidad/terapia , PremenopausiaRESUMEN
myfood24 Is an online 24-h dietary assessment tool developed for use among British adolescents and adults. Limited information is available regarding the validity of using new technology in assessing nutritional intake among adolescents. Thus, a relative validation of myfood24 against a face-to-face interviewer-administered 24-h multiple-pass recall (MPR) was conducted among seventy-five British adolescents aged 11-18 years. Participants were asked to complete myfood24 and an interviewer-administered MPR on the same day for 2 non-consecutive days at school. Total energy intake (EI) and nutrients recorded by the two methods were compared using intraclass correlation coefficients (ICC), Bland-Altman plots (using between and within-individual information) and weighted κ to assess the agreement. Energy, macronutrients and other reported nutrients from myfood24 demonstrated strong agreement with the interview MPR data, and ICC ranged from 0·46 for Na to 0·88 for EI. There was no significant bias between the two methods for EI, macronutrients and most reported nutrients. The mean difference between myfood24 and the interviewer-administered MPR for EI was -230 kJ (-55 kcal) (95 % CI -490, 30 kJ (-117, 7 kcal); P=0·4) with limits of agreement ranging between 39 % (3336 kJ (-797 kcal)) lower and 34 % (2874 kJ (687 kcal)) higher than the interviewer-administered MPR. There was good agreement in terms of classifying adolescents into tertiles of EI (κ w =0·64). The agreement between day 1 and day 2 was as good for myfood24 as for the interviewer-administered MPR, reflecting the reliability of myfood24. myfood24 Has the potential to collect dietary data of comparable quality with that of an interviewer-administered MPR.
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Encuestas sobre Dietas/normas , Dieta , Internet , Evaluación Nutricional , Adolescente , Niño , Ingestión de Energía , Femenino , Humanos , Entrevistas como Asunto , Masculino , Recuerdo Mental , Reproducibilidad de los Resultados , Instituciones Académicas , Encuestas y Cuestionarios , Reino UnidoRESUMEN
Inflammatory illnesses, such as periodontitis and atherosclerotic coronary heart disease (ASCHD), trigger the production of pro-inflammatory mediators. The aim of this study was to assess the accuracy of using salivary interleukin-1ß (IL-1ß), interleukin-18 (IL-18), and gasdermin D (GSDMD) in discerning patients with periodontitis with and without ASCHD from healthy individuals, and to assess their correlation with clinical periodontal parameters and low-density lipoprotein (LDL) levels. The study involved 120 participants: 30 were healthy subjects (control group, C), 30 had generalized periodontitis (group P), 30 had ASCHD and clinically healthy periodontium (group AS-C), and 30 had ASCHD and generalized periodontitis (group AS-P). Saliva and blood samples were collected, and periodontal characteristics such as plaque index, bleeding on probing, probing pocket depth, and clinical attachment loss were examined. IL-1ß, IL-18, and GSDMD levels from saliva were determined using ELISA. LDL levels were determined from the blood samples. Groups P, AS-C, and AS-P had higher levels of salivary IL-1ß, IL-18, and GSDMD than group C. The receiver operating characteristic (ROC) curves of all biomarkers showed high diagnostic accuracy, with a significant positive correlation with the clinical parameters and LDL levels. The observed correlations between the studied pro-inflammatory mediators and disease severity suggest that these biomarkers could serve as indicators of disease progression in conditions such as periodontitis and ASCHD.
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Biomarcadores , Enfermedad Coronaria , Interleucina-18 , Interleucina-1beta , Saliva , Humanos , Biomarcadores/metabolismo , Biomarcadores/sangre , Saliva/metabolismo , Saliva/química , Interleucina-18/sangre , Interleucina-18/metabolismo , Interleucina-18/análisis , Masculino , Femenino , Interleucina-1beta/sangre , Interleucina-1beta/metabolismo , Interleucina-1beta/análisis , Persona de Mediana Edad , Enfermedad Coronaria/diagnóstico , Enfermedad Coronaria/metabolismo , Enfermedad Coronaria/sangre , Periodontitis/diagnóstico , Periodontitis/metabolismo , Periodontitis/sangre , Adulto , Proteínas de Unión a Fosfato/metabolismo , Curva ROC , Estudios de Casos y Controles , GasderminasRESUMEN
Objectives: To evaluate the impact of COVID-19 pandemic on orthodontic treatment and mental health of patients undergoing orthodontic treatment and to compare their mental health with the age-matched control group. Materials and methods: 484 orthodontic patients (245 males and 239 females) and 200 age-matched control subjects were divided into two age groups. Group 1 had 14-18 years of adolescents (N = 274) and 100 control participants (Group 2) and Group 3 comprised of 19 years above adults (N = 210) and 100 control participants (Group 4). Group 1 and 3 patients filled the 4 sections of the questionnaire related to orthodontic emergencies (Sections 1-3) and mental distress (Kessler Psychological Distress Scale-Section 4), while groups 2 and 4 were asked to fill only Section-4. The comparison of mental distress on high/low Kessler scores was made using the Chi-Square test/Fisher's exact test. The factors which came out to be significant were put to bivariate logistic regression analysis. Results: The percentage of patients with high Kessler scores among Group 1 and Group 3 were 9.9% and 17.2% respectively, and their differences with age-matched control groups were non-significant. The mean differences of Kessler score were significantly higher for Group 3 compared to group 1. The higher Kessler score was associated with age, higher education, a feeling of concern for non-availability of appointments, increased treatment duration, its effect on the quality of treatment, and sabotaging of definitive future plans. Conclusions: The orthodontic treatment and emergencies may not be a significant factor contributing to increased stress among patients during the lockdown.
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Rationale and objectives: Selecting region of interest (ROI) for left atrial appendage (LAA) filling defects assessment can be time consuming and prone to subjectivity. This study aimed to develop and validate a novel artificial intelligence (AI), deep learning (DL) based framework for automatic filling defects assessment on CT images for clinical and subclinical atrial fibrillation (AF) patients. Materials and methods: A total of 443,053 CT images were used for DL model development and testing. Images were analyzed by the AI framework and expert cardiologists/radiologists. The LAA segmentation performance was evaluated using Dice coefficient. The agreement between manual and automatic LAA ROI selections was evaluated using intraclass correlation coefficient (ICC) analysis. Receiver operating characteristic (ROC) curve analysis was used to assess filling defects based on the computed LAA to ascending aorta Hounsfield unit (HU) ratios. Results: A total of 210 patients (Group 1: subclinical AF, n = 105; Group 2: clinical AF with stroke, n = 35; Group 3: AF for catheter ablation, n = 70) were enrolled. The LAA volume segmentation achieved 0.931-0.945 Dice scores. The LAA ROI selection demonstrated excellent agreement (ICC ≥0.895, p < 0.001) with manual selection on the test sets. The automatic framework achieved an excellent AUC score of 0.979 in filling defects assessment. The ROC-derived optimal HU ratio threshold for filling defects detection was 0.561. Conclusion: The novel AI-based framework could accurately segment the LAA region and select ROIs while effectively avoiding trabeculae for filling defects assessment, achieving close-to-expert performance. This technique may help preemptively detect the potential thromboembolic risk for AF patients.
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Organized activity participation has been linked to children's emotional wellbeing. However, a scarcity of literature considers the role of immigrant background. This study's primary objective was to measure the association between organized activity participation and emotional wellbeing among a population-based sample of Grade 7 children in British Columbia, Canada. We also examined whether this relationship depended on immigration background. Our sample included 14,406 children (47.8% female; mean age = 12.0 years). 9,393 (65.2%) children were of non-immigrant origin (48.9% female; mean age = 12.1 years). 5,013 children (34.8%) were of immigrant origin (45.8% female; mean age = 12.0 years; 40.8% first-generation). Participants completed the Middle Years Development Instrument, a self-report survey measuring children's wellbeing and assets. We used odds ratios and the χ2 test to compare the organized activity participation of non-immigrant and immigrant-origin children. We used multiple linear regression to measure associations between participation and indicators of emotional wellbeing and assessed whether associations varied based on immigrant background, controlling for demographic factors and peer belonging. Participation in any activity was similar among non-immigrant and immigrant-origin children (OR1st-gen=1.06, p=0.37; OR2nd-gen=0.97, p=0.62). Immigrant generation status modified the relationship between participation and emotional wellbeing (χSWL 2=3.69, p=0.03; χDep 2=12.31, p<0.01). Beneficial associations between participation and both life satisfaction and depressive symptoms were observed among non-immigrant children only, although associations were small. We conclude that immigrant background modestly modified the association between organized activity participation and emotional wellbeing.
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Sensitive, objective, and easily applied methods for evaluating skin lesions are needed to improve diagnostic accuracy. In this study, we evaluated whether a developed noninvasive electrical impedance dermography device URSKIN could serve this purpose. In this pilot study, 17 subjects with subsequently confirmed basal cell carcinoma underwent four-electrode electrical impedance dermography measurements to assess the electrical properties of basal cell carcinoma and adjacent normal skin. A linear mixed-effects model with random intercept and slope terms was used for the analysis of multifrequency values in longitudinal and transverse directions. A significant difference in the intercept of frequency trajectories was observed for the longitudinal conductivity of 0.13 siemens/m (P < 0.001, 95% confidence interval = 0.10-0.16), transverse conductivity of 0.06 siemens/m (P < 0.001, 95% confidence interval = 0.05-0.07), longitudinal relative permittivity (dimensionless) of 203,742 (P < 0.001, 95% confidence interval = 180,292-227,191), and transverse relative permittivity (dimensionless) of 86,894 (P < 0.001, 95% confidence interval = 81,549 - 92,238). Thus, our device detected significant electrical differences between basal cell carcinoma and adjacent normal skin. Given these preliminary performance metrics and the ease of use, this technology merits further study to establish its value in facilitating the clinical diagnosis of skin cancers.
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Assessing the severity of atopic dermatitis (AD, or eczema) traditionally relies on a face-to-face assessment by healthcare professionals and may suffer from inter- and intra-rater variability. With the expanding role of telemedicine, several machine learning algorithms have been proposed to automatically assess AD severity from digital images. Those algorithms usually detect and then delineate (segment) AD lesions before assessing lesional severity and are trained using the data of AD areas detected by healthcare professionals. To evaluate the reliability of such data, we estimated the inter-rater reliability of AD segmentation in digital images. Four dermatologists independently segmented AD lesions in 80 digital images collected in a published clinical trial. We estimated the inter-rater reliability of the AD segmentation using the intraclass correlation coefficient at the pixel and the area levels for different resolutions of the images. The average intraclass correlation coefficient was 0.45 ( standard error = 0.04 ) corresponding to a poor agreement between raters, whereas the degree of agreement for AD segmentation varied from image to image. The AD segmentation in digital images is highly rater dependent even among dermatologists. Such limitations need to be taken into consideration when AD segmentation data are used to train machine learning algorithms that assess eczema severity.
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Introduction: When unanticipated neonatal asphyxia occurs, it may be necessary for a single resuscitator to commence advanced resuscitation before others arrive. We hypothesised that a single rescuer can provide positive pressure ventilations and chest compressions using higher inflation pressures and better adherence to the recommended compression rate with an i-gel supraglottic airway than with a face mask. Method: A manikin-based cross-over study was conducted. Twenty-one midwives performed both positive pressure ventilation using a T-piece and chest compressions with the two-finger technique on a newborn manikin alone. They performed ventilation with a face mask or an i-gel. The peak inspiratory pressure (PIP) was set to 30 cmH2O. The actual PIPs were evaluated based on the values displayed on the manometer. The total amount of time taken to complete 30 cycles of three compressions and one ventilation was also evaluated. Results: The mean of the average PIP for each participant was significantly lower with a face mask than with an i-gel (17.3 ± 4.4 vs 28.2 ± 2.0 cmH2O, p < 0.00001). The amount of time taken to complete 30 cycles was significantly longer with a face mask than with an i-gel (66.2 ± 6.1 vs 60.6 ± 3.4 seconds, p < 0.0001). Conclusion: During one-rescuer newborn resuscitation using a T-piece and the two-finger technique, the PIPs are consistently high and 30 cycles of CPR are better adhered to 60 seconds using an i-gel.
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Objective: Isolated coronary artery bypass grafting and aortic valve replacement are common cardiac operations performed in the United States and serve as platforms for benchmarking. The present national study characterized hospital-level variation in costs and value for coronary artery bypass grafting and aortic valve replacement. Methods: Adults undergoing elective, isolated coronary artery bypass grafting or aortic valve replacement were identified in the 2016-2018 Nationwide Readmissions Database. Center quality was defined by the proportion of patients without an adverse outcome (death, stroke, respiratory failure, pneumonia, sepsis, acute kidney injury, and reoperation). High-value hospitals were defined as those with observed-to-expected ratios less than 1 for costs and greater than 1 for quality, whereas the converse defined low-value centers. Results: Of 318,194 patients meeting study criteria, 71.9% underwent isolated coronary artery bypass grafting and 28.1% underwent aortic valve replacement. Variation in hospital-level costs was evident, with median center-level cost of $36,400 (interquartile range, 29,500-46,700) for isolated coronary artery bypass grafting and $38,400 (interquartile range, 32,300-47,700) for aortic valve replacement. Observed-to-expected ratios for quality ranged from 0.2 to 10.9 for isolated coronary artery bypass grafting and 0.1 to 11.7 for isolated aortic valve replacement. Hospital factors, including volume and quality, contributed to approximately 9.9% and 11.2% of initial cost variation for isolated coronary artery bypass grafting and aortic valve replacement. High-value centers had greater cardiac surgery operative volume and were more commonly teaching hospitals compared to low-value centers, but had similar patient risk profiles. Conclusions: Significant variation in hospital costs, quality, and value exists for 2 common cardiac operations. Center volume was associated with value and partly accounts for variation in costs. Our findings suggest the need for value-based care paradigms to reduce expenditures and optimize outcomes.
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Background & Aims: Magnetic resonance cholangiopancreatography (MRCP) is used for the diagnosis and follow-up of individuals with primary sclerosing cholangitis (PSC). The aim of our study is to develop an MRCP-score based on cholangiographic findings previously associated with outcomes and assess its reproducibility and prognostic value in PSC. Methods: The score (DiStrict score) was developed based on the extent and severity of cholangiographic changes of intrahepatic and extrahepatic bile ducts (range 0-8) on 3D-MRCP. In this retrospective, multicentre study, three pairs of radiologists with different levels of expertise from three tertiary centres applied the score independently. MRCP examinations of 220 consecutive individuals with PSC from a prospectively collected PSC-cohort, with median follow-up of 7.4 years, were reviewed. Inter-reader and intrareader agreements were assessed via intraclass correlation coefficient (ICC). After consensus, the prognostic value of the score was assessed using Cox-regression and outcome-free survival rates were assessed via Kaplan-Meier estimates. Harrell's C-statistic was calculated. Results: Forty patients developed outcomes (liver transplantation or liver-related death). Inter-reader agreement between experienced radiologists was good (ICC 0.82; 95% CI 0.74-0.87, and ICC 0.81; 95% CI 0.70-0.87, respectively) and better than the agreement for the pair of experienced/less-experienced radiologists (ICC 0.48; 95% CI 0.05-0.72). Agreement between radiologists from the three centres was good (ICC 0.76; 95% CI 0.57-0.89). Intrareader agreement was good to excellent (ICC 0.85-0.93). Harrell's C was 0.78. Patients with a DiStrict score of 5-8 had 8.2-fold higher risk (hazard ratio 8.2; 95% CI 2.97-22.65) of developing outcomes, and significantly worse survival (p <0.001), compared to those with a DiStrict score of 1-4. Conclusions: The novel DiStrict score is reproducible and strongly associated with outcomes, indicating its prognostic value for individuals with PSC in clinical practice. Impact and implications: The diagnosis of primary sclerosing cholangitis (PSC) is based on magnetic resonance cholangiopancreatography (MRCP). However, the role of MRCP in the prognostication of PSC is still unclear. We developed a novel, simple, and reproducible risk-score, based on MRCP findings, that showed a strong association with prognosis in individuals with PSC (DiStrict score). This score can be easily used in clinical practice and thus has the potential to be useful in clinical trials and in patient counselling and management.
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Objective: To prospectively evaluate the image quality and diagnostic performance of a compact flat-panel detector (FD) scanner for thoracic diseases compared to a clinical CT scanner. Materials and methods: The institutional review board approved this single-center prospective study, and all participants provided informed consent. From December 2020 to May 2021, 30 patients (mean age, 67.1 ± 8.3 years) underwent two same-day low-dose chest CT scans using clinical state-of-art and compact FDCT scanners. Image quality was assessed visually and quantitatively. Two readers evaluated the diagnostic performance for nodules, parenchymal opacifications, bronchiectasis, linear opacities, and pleural abnormalities in 40 paired CT scans. The other 20 paired CT scans were used to examine the agreement of semi-quantitative CT scoring regarding bronchiectasis, bronchiolitis, nodules, airspace consolidations, and cavities. Results: FDCT images had significantly lower visual image quality than clinical CT images (all p < 0.001). The two CT image sets showed no significant differences in signal-to-noise and contrast-to-noise ratios (56.8 ± 12.5 vs. 57.3 ± 15.2; p = 0.985 and 62.9 ± 11.7 vs. 60.7 ± 16.9; p = 0.615). The pooled sensitivity was comparable for nodules, parenchymal opacifications, linear opacities, and pleural abnormalities (p = 0.065-0.625), whereas the sensitivity was significantly lower in FDCT images than in clinical CT images for micronodules (p = 0.007) and bronchiectasis (p = 0.004). The specificity was mostly 1.0. Semi-quantitative CT scores were similar between the CT image sets (p > 0.05), and intraclass correlation coefficients were around 0.950 or higher, except for bronchiectasis (0.869). Conclusion: Compact FDCT images provided lower image quality but comparable diagnostic performance to clinical CT images for nodules, parenchymal opacifications, linear opacities, and pleural abnormalities.
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Purpose: To compare temporal evolution of imaging features of coronavirus disease 2019 (COVID-19) and influenza in computed tomography and evaluate their predictive value for distinction. Methods: In this retrospective, multicenter study 179 CT examinations of 52 COVID-19 and 44 influenza critically ill patients were included. Lung involvement, main pattern (ground glass opacity, crazy paving, consolidation) and additional lung and chest findings were evaluated by two independent observers. Additional findings and clinical data were compared patient-wise. A decision tree analysis was performed to identify imaging features with predictive value in distinguishing both entities. Results: In contrast to influenza patients, lung involvement remains high in COVID-19 patients > 14 days after the diagnosis. The predominant pattern in COVID-19 evolves from ground glass at the beginning to consolidation in later disease. In influenza there is more consolidation at the beginning and overall less ground glass opacity (p = 0.002). Decision tree analysis yielded the following: Earlier in disease course, pleural effusion is a typical feature of influenza (p = 0.007) whereas ground glass opacities indicate COVID-19 (p = 0.04). In later disease, particularly more lung involvement (p < 0.001), but also less pleural (p = 0.005) and pericardial (p = 0.003) effusion favor COVID-19 over influenza. Regardless of time point, less lung involvement (p < 0.001), tree-in-bud (p = 0.002) and pericardial effusion (p = 0.01) make influenza more likely than COVID-19. Conclusions: This study identified differences in temporal evolution of imaging features between COVID-19 and influenza. These findings may help to distinguish both diseases in critically ill patients when laboratory findings are delayed or inconclusive.
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OBJECTIVE: To determine the impact of an operator's experience on transcranial magnetic stimulation (TMS) measurement. METHODS: Operator B (beginner), operator E (expert), and 30 healthy participants joined the study consisting of two experiments. In each experiment, each operator performed a TMS protocol on each participant in a random order. RESULTS: Compared with operator E, operator B exhibited higher resting motor threshold (RMT) in experiment I (60.1⯱â¯13.0 vs. 57.4⯱â¯10.9% maximal stimulation output, pâ¯=â¯0.017) and the difference disappeared in experiment II (pâ¯=â¯0.816). In 1-mV motor evoked potential (MEP) measurement, operator B exhibited higher standard deviation indicating lower consistency in experiment I compared with experiment II (1.05⯱â¯0.40 vs. 1.05⯱â¯0.16â¯mV with unequal variances, pâ¯=â¯0.001) and had poor intrarater reliability between the experiments (intraclass correlation coefficientâ¯=â¯-0.130). There was no difference in the results of active motor threshold, silent period, paired-pulse stimulation, or continuous theta burst stimulation between the operators. CONCLUSIONS: An operator's experience in TMS may affect the results of RMT measurement. With practice, a beginner may choose a more precise stimulation location and have higher consistency in 1-mV MEP measurement. SIGNIFICANCE: We recommend that a beginner needs to practice for precise stimulation locations before conducting a trial or clinical practice.
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Background: Sleep disordered breathing (SDB) may trigger nocturnal cardiac arrhythmias (NCA) in patients with heart failure with reduced ejection fraction (HFrEF). The NCA ancillary study of the ADVENT-HF trial will test whether, in HFrEF-patients with SDB, peak-flow-triggered adaptive servo-ventilation (ASVpf) reduces NCA. To this end, accurate scoring of NCA from polysomnography (PSG) is required. Objective: To develop a method to detect NCA accurately from a single-lead electrocardiogram (ECG) recorded during PSG and assess inter-observer agreement for NCA detection. Methods: Quality assurance of ECG analysis included training of the investigators, development of standardized technical quality, guideline-conforming semi-automated NCA-scoring via Holter-ECG software and implementation of an arrhythmia adjudication committee. To assess inter-observer agreement, the ECG was analysed by two independent investigators and compared for agreement on premature ventricular complexes (PVC) /h, premature atrial complexes/h (PAC) as well as for other NCA in 62 patients from two centers of the ADVENT-HF trial. Results: The intraclass correlation coefficients for PVC/h and PAC/h were excellent: 0.99 (95%- confidence interval [CI]: 0.99-0.99) and 0.99 (95%-CI: 0.97-0.99), respectively. No clinically relevant difference in inter-observer classification of other NCA was found. The detection of non-sustained ventricular tachycardia (18% versus 19%) and atrial fibrillation (10% versus 11%) was similar between the two investigators. No sustained ventricular tachycardia was detected. Conclusion: These findings indicate that our methods are very reliable for scoring NCAs and are adequate to apply for the entire PSG data set of the ADVENT-HF trial.
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Background and purpose: Glioblastoma (GBM) patients have a dismal prognosis. Tumours typically recur within months of surgical resection and post-operative chemoradiation. Multiparametric magnetic resonance imaging (mpMRI) biomarkers promise to improve GBM outcomes by identifying likely regions of infiltrative tumour in tumour probability (TP) maps. These regions could be treated with escalated dose via dose-painting radiotherapy to achieve higher rates of tumour control. Crucial to the technical validation of dose-painting using imaging biomarkers is the repeatability of the derived dose prescriptions. Here, we quantify repeatability of dose-painting prescriptions derived from mpMRI. Materials and methods: TP maps were calculated with a clinically validated model that linearly combined apparent diffusion coefficient (ADC) and relative cerebral blood volume (rBV) or ADC and relative cerebral blood flow (rBF) data. Maps were developed for 11 GBM patients who received two mpMRI scans separated by a short interval prior to chemoradiation treatment. A linear dose mapping function was applied to obtain dose-painting prescription (DP) maps for each session. Voxel-wise and group-wise repeatability metrics were calculated for parametric, TP and DP maps within radiotherapy margins. Results: DP maps derived from mpMRI were repeatable between imaging sessions (ICC > 0.85). ADC maps showed higher repeatability than rBV and rBF maps (Wilcoxon test, p = 0.001). TP maps obtained from the combination of ADC and rBF were the most stable (median ICC: 0.89). Conclusions: Dose-painting prescriptions derived from a mpMRI model of tumour infiltration have a good level of repeatability and can be used to generate reliable dose-painting plans for GBM patients.
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Purpose: The quantitative assessment of impaired lung motions and their association with the clinical characteristics of COPD patients is challenging. The aim of this study was to measure respiratory kinetics, including asynchronous movements, and to analyze the relationship between lung area and other clinical parameters. Materials and methods: This study enrolled 10 normal control participants and 21 COPD patients who underwent dynamic MRI and pulmonary function testing (PFT). The imaging program was implemented using MATLAB®. Each lung area was detected semi-automatically on a coronal image (imaging level at the aortic valve) from the inspiratory phase to the expiratory phase. The Dice index of the manual measurements was calculated, with the relationship between lung area ratio and other clinical parameters, including PFTs then evaluated. The asynchronous movements of the diaphragm were also evaluated using a sagittal image. Results: The Dice index for the lung region using the manual and semi-automatic extraction methods was high (Dice index = 0.97 ± 0.03). A significant correlation was observed between the time corrected lung area ratio and percentage of forced expiratory volume in 1 s (FEV1%pred) and residual volume percentage (RV%pred) (r = -0.54, p = 0.01, r = 0.50, p = 0.03, respectively). The correlation coefficient between each point of the diaphragm in the group with visible see-saw like movements was significantly lower than that in the group without see-saw like movements (value = -0.36 vs 0.95, p = 0.001). Conclusion: Semi-automated extraction of lung area from Cine MRI might be useful for detecting impaired respiratory kinetics in patients with COPD.
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OBJECTIVE: To determine the reliability of 3 physical performance tests performed via a telehealth visit (30-s arm curls test, 30-s chair stand test, 2-min step test) among community-dwelling older veterans. DESIGN: Cross sectional study. SETTING: Virtual. PARTICIPANTS: Veterans (N=55; mean age 75y) who enrolled in Gerofit, a virtual group exercise program. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Participants were tested by 2 different assessors at 1 time point. The intraclass correlation coefficient (ICC) with 95% confidence intervals and Bland-Altman plots were used as measures of reliability. To assess generalizability, ICCs were further evaluated by health conditions (type 2 diabetes, arthritis, obesity, depression). RESULTS: Assessments were conducted among 55 participants. The ICC was above 0.98 for all 3 tests across health conditions and Bland-Altman plots indicated that there were no significant systematic errors in the measurement. CONCLUSIONS: The virtual physical performance measures appear to have high reliability and the findings are generalizable across health conditions among veterans. Thus, they are reliable for evaluating physical performance in older veterans in virtual settings.
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OBJECTIVES: To evaluate differences in vibration perception thresholds between adults with transtibial amputation and age-matched adults without amputation and to examine associations between vibration perception thresholds and balance performance. We hypothesized that adults with transtibial amputation would demonstrate lower thresholds compared with adults without amputation and that lower thresholds would be associated with better functional balance. DESIGN: Prospective cross-sectional study. SETTING: National conference, clinical practice, and university laboratory. PARTICIPANTS: Adults (N=34) with a nondysvascular, unilateral, transtibial amputation and 43 age-matched controls without amputation. INTERVENTIONS: Participants' vibration perception thresholds were evaluated bilaterally by applying a vibration stimulus to the midpatella and recording their verbal response to conscious perception of stimulus. Functional balance was assessed with the Berg Balance Scale and the Four Square Step Test. MAIN OUTCOME MEASURES: Residual and sound limb (right and left for controls) vibration perception thresholds, Berg Balance Scale, and Four Square Step Test. RESULTS: For participants with transtibial amputation and controls, there were no significant between-group (P=.921) or interlimb (P=.540) differences in vibration perception thresholds. Overall, robust regression models explained 35.1% and 19.3% variance in Berg Balance Scale scores and Four Square Step Test times, respectively. Among adults with transtibial amputation, vibration perception thresholds were negatively associated with Berg Balance Scale scores (P=.009) and positively associated with Four Square Step Test times (P=.048). Among controls, average vibration perception thresholds were not significantly associated with functional balance (P>.050). CONCLUSIONS: Adults with nondysvascular, transtibial-level amputation demonstrated similar vibration detection compared with adults with intact limbs, indicating that vibration detection is preserved in the amputated region postamputation. These findings suggest a unique relationship between vibration perception and functional balance post-transtibial amputation.