Bone Material Strength Index as Measured by Impact Microindentation is Low in Patients with Primary Hyperparathyroidism.

CONTEXT: In primary hyperparathyroidism (PHPT) bone mineral density (BMD) is typically decreased in cortical bone and relatively preserved in trabecular bone. An increased fracture rate is observed however not only at peripheral sites but also at the spine, and fractures occur at higher BMD values than expected. We hypothesized that components of bone quality other than BMD are affected in PHPT as well. OBJECTIVE: To evaluate bone material properties using impact microindentation (IMI) in PHPT patients. METHODS: In this cross-sectional study, the Bone Material Strength index (BMSi) was measured by IMI at the midshaft of the tibia in 37 patients with PHPT (28 women), 11 of whom had prevalent fragility fractures, and 37 euparathyroid controls (28 women) matched for age, gender, and fragility fracture status. RESULTS: Mean age of PHPT patients and controls was 61.8 ±â€…13.3 and 61.0 ±â€…11.8 years, respectively, P = .77. Calcium and PTH levels were significantly higher in PHPT patients but BMD at the lumbar spine (0.92 ±â€…0.15 vs 0.89 ±â€…0.11, P = .37) and the femoral neck (0.70 ±â€…0.11 vs 0.67 ±â€…0.07, P = .15) were comparable between groups. BMSi however was significantly lower in PHPT patients than in controls (78.2 ±â€…5.7 vs 82.8 ±â€…4.5, P < .001). In addition, BMSi was significantly lower in 11 PHPT patients with fragility fractures than in the 26 PHPT patients without fragility fractures (74.7 ±â€…6.0 vs 79.6 ±â€…5.0, P = .015). CONCLUSION: Our data indicate that bone material properties are altered in PHPT patients and most affected in those with prevalent fractures. IMI might be a valuable additional tool in the evaluation of bone fragility in patients with PHPT.

Precision and reliability of tape measurements in the assessment of head and neck lymphedema.

OBJECTIVES: Tape measurement is a commonly used method in the clinical assessment of lymphedema. However, few studies have assessed the precision and reliability of tape measurement in assessing head and neck lymphedema. This study aimed to evaluate the reliability and precision of using tape measurement, performed by different evaluators, for the assessment of head and neck lymphedema. METHODS: This study was conducted at a tertiary care cancer hospital. Between January and December 2019, 50 patients with head and neck cancers and 50 normal subjects were enrolled. Each subject was examined using tape measurements for 7 point-to-point distances of facial landmarks, 3 circumferences of the neck (upper, middle, and lower), and 2 circumferences of the face (vertical and oblique) by 3 random examiners. Test precision and reliability were assessed with the within-subject standard deviation (Sw) and intra-class correlation coefficient (ICC), respectively. RESULTS: Overall, the standard deviation of the tape measurements varied in the range of 4.6 mm to 18.3 mm. The measurement of distance between the tragus and mouth angle (Sw: 4.6 mm) yielded the highest precision, but the reliability (ICC: 0.66) was moderate. The reliabilities of neck circumference measurements (ICC: 0.90-0.95) were good to excellent, but the precisions (Sw: 8.3-12.3 mm) were lower than those of point-to-point facial measurements (Sw: 4.6-8.8 mm). CONCLUSIONS: The different methods of tape measurements varied in precision and reliability. Thus, clinicians should not rely on a single measurement when evaluating head and neck lymphedema.

Accuracy of weight estimation by the Broselow tape is substantially improved by including a visual assessment of body habitus.

BackgroundThe Broselow tape (BT) has been shown to estimate weight poorly primarily because of variations in body habitus. The manufacturers have suggested that a visual assessment of habitus may be used to increase its performance. This study evaluated the ability of habitus-modified models to improve the accuracy thereof.MethodsA post hoc analysis of prospectively collected data from four hospitals in Johannesburg, South Africa, on a population of 1,085 children. Sixteen a priori models generated a modified weight estimation or drug dose based on the BT weight and a gestalt assessment of habitus.ResultsThe habitus-modified method suggested by the manufacturer did not improve the accuracy of the BT. Five dosing and four weight-estimation models were identified that markedly improved dosing and weight estimation accuracy, respectively. The best dosing model improved dosing accuracy (doses within 10% of correct dose) from 52.0 to 69.6% and reduced critical dosing errors from 16.5 to 4.3%. The best weight-estimation model improved accuracy from 59.4 to 81.9% and reduced critical errors from 11.8 to 1.9%.ConclusionThe accuracy of the BT as a drug-dosing and weight-estimation device can be substantially improved by including an appraisal of body habitus in the methodology.

Design and validation of a low cost, high-capacity weighing device for wheelchair users and bariatrics.

Accessible high-capacity weighing scales are scarce in healthcare facilities, in part due to high device cost and weight. This shortage impairs weight monitoring and health maintenance for people with disabilities and/or morbid obesity. We conducted this study to design and validate a lighter, lower cost, high-capacity accessible weighing device. A prototype featuring 360 kg (800 lbs) of weight capacity, a wheelchair-accessible ramp, and wireless data transmission was fabricated. Forty-five participants (20 standing, 20 manual wheelchair users, and five power wheelchair users) were weighed using the prototype and a calibrated scale. Participants were surveyed to assess perception of each weighing device and the weighing procedure. Weight measurements between devices demonstrated a strong linear correlation (R2 = 0.997) with absolute differences of 1.4 ± 2.0% (mean±SD). Participant preference ratings showed no difference between devices. The prototype weighed 11 kg (38%) less than the next lightest high-capacity commercial device found by author survey. The prototype's estimated commercial price range, $500-$600, is approximately half the price of the least expensive commercial device found by author survey. Such low cost weighing devices may improve access to weighing instrumentation, which may in turn help eliminate current health disparities. Future work is needed to determine the feasibility of market transition.

Portable A-Mode Ultrasound for Body Composition Assessment in Adolescents.

OBJECTIVES: Ultrasound (US) imaging is a low-cost, highly feasible alternative method for monitoring the nutritional status of a population; however, only a few studies have tested the body composition agreement between US and reference standard methods, especially in adolescents. The purposes of this study were to assess the agreement of portable US with a reference standard method, dual-energy x-ray absorptiometry (DXA), for body fat percentage (BF%) in adolescents and to verify whether the use of a new mathematical model, based on the anatomic thickness obtained by US, is capable of improving BF% prediction. METHODS: This research was a descriptive study. Measures of total body mass, BF% on DXA, and BF% on US were collected from 105 adolescents. RESULTS: The participants included 71 male adolescents (median age ± interquartile range, 14.0 ± 2.0 years) and 34 female adolescents (13.0 ± 2.3 years). Ultrasound yielded significantly lower BF% values than DXA for male (mean ± SD, US, 9.6% ± 6.6%; DXA, 20.0% ± 7.2%; R= 0.848; P< .05) and female (US, 22.5% ± 5.7%; DXA, 30.3% ± 4.9%; R = 0.495; P < .05) participants. In addition, Bland-Altman analysis showed low concordance. When a multivariate regression was tested, the results improved for both sexes (US, 20.3% ± 4.6%; R= 0.848; P= .503) and female participants (US, 29.0% ± 5.7%; R = 0.712; P = .993) with a standard estimate of error of 1.57%. CONCLUSIONS: This study has shown that US applied in a specific regression for BF% prediction in adolescents has a strong correlation with DXA as well as concordance with Bland-Altman analysis.

Assessment of Lumbar Spine Height Following Sustained Lumbar Extension Posture: Comparison Between Musculoskeletal Ultrasonography and Stadiometry.

OBJECTIVES: The purpose of this study was to correlate sitting height measured by stadiometry with lumbar spine height (LSH) modifications measured by musculoskeletal ultrasonography (MSU). METHODS: Eighteen healthy young adults were recruited for this study (mean age: 21.5 ± 1.5 years). All subjects were tested in the following sequence: (1) lying supine for 10 minutes, (2) sitting under loaded (9.5 kg) and unloaded conditions for 5 minutes each, (3) lying supine for 15 minutes with passive lumbar extension, and (4) sitting unloaded for 5 minutes. Both stadiometry and MSU measurements were taken after each step of the testing sequence. RESULTS: Following the loaded sitting step, sitting height (measured by stadiometry) decreased by 3.4 ± 1.6 mm, whereas following sustained lumbar extension, sitting height increased by 5.4 ± 3.5 mm (P < .05). Following loaded sitting and sustained lumbar extension, LSH decreased by 3.8 ± 1.7 mm and increased by 6.2 ± 4.1 mm, respectively (P < .05). On the basis of the mean differences (between the different steps of the testing sequence), the mean correlation coefficient and the mean coefficient of determination between stadiometry and MSU measurements were calculated at 0.93 ± 0.07 and 0.88 ± 0.13, respectively, and no statistical differences were observed (P > .05). CONCLUSIONS: In vivo measurements of sitting height changes, measured using stadiometry, were strongly correlated with LSH changes, measured using ultrasonography.

Simulation-based optimization of a near-infrared spectroscopic subcutaneous fat thickness measuring device.

Using Monte Carlo simulations we optimized the wavelength and source-detector distance (SDD) of a reflectance-based spectroscopic device used for measuring subcutaneous fat thickness. As the optical properties of muscle, fat and dermis are wavelength dependent, it is necessary to choose a wavelength that is highly sensitive to fat but insensitive to water and melanin. The SDD is important since it determines average photon penetration depth. With a tissue optics plug-in for the GEANT4/GAMOS system and published ex vivo tissue optical properties we were able to predict the behavior of different device configurations when used with varying thicknesses of fat, melanin concentrations or hydration levels. Our results indicate that the ideal wavelengths for fat measurement are 630-650 nm with an SDD of 2.6-29 cm. We also examined the potential of using near infrared (NIR) spectroscopy to determine tissue hydration levels, but concluded that this wavelength range was not ideal.

Biomechanical assessment of varus-valgus range of motion of normal elbow joint using prototype measuring device.

INTRODUCTION: Elbow joint stability is provided by the medial and lateral collateral ligaments, joint surface alignment, and the joint capsule. The contribution of the joint capsule is relatively minor and varies with the position of the joint. The normal range of forearm abduction and adduction in the elbow joint is estimated to be between 5 and 10°. The aim of the paper was to determine precisely the physiological range of elbow joint motion in the frontal plane (laxity), which, apart from the knowledge gained, will provide a means to assess the effect of the surgical treatment of elbow joint contractures by comparing the stability of operated and healthy joints. MATERIAL AND METHODS: The measurements were carried out using UB-01, a prototype device produced by ANT Polska, in a group of 52 healthy volunteers. RESULTS: The mean valgus and varus deviation of the elbow joint was 11.2° (6.4° 16.1°) and 6.6° (3° 10.7°), respectively. The mean degree of elbow joint laxity was 17.8° (10.6° 26.5°). The difference in laxity between two opposite elbow joints in the same person was, on average, 1.2° (0.1° 3.8°). In healthy persons, the amplitude of deviation for both elbows is significantly smaller than 2°. CONCLUSIONS: 1. There are major differences in elbow joint laxity between individuals. 2. Nevertheless, laxity values of two elbow joints in the same individual are very similar. This observation allows for the healthy elbow to be treated as a reference while assessing the affected joint's stability in a patient following conventional surgery for elbow joint contracture.

Intra- and interobserver repeatability of the assessment of anteroposterior curvatures of the spine using Saunders digital inclinometer.

INTRODUCTION: According to the requirements of Evidence Based Medicine, every research tool and method should be subjected to reliability evaluation. A variety of inclinometers are used for the assessment of sagittal plane spinal curvatures in clinical practice. The aim of the study was to evaluate the intra- and interobserver repeatability of measurements of the anterior-posterior spinal curvatures taken with Saunders digital inclinometer. MATERIAL AND METHODS: The study involved 30 healthy subjects (5 males, 25 females) aged 20 to 35 years. The anteroposterior curvatures of the spine were measured in all subjects using a Saunders digital inclinometer. In order to evaluate the intraobserver repeatability of measurements, the results obtained by one investigator were compared. To evaluate interobserver repeatability, the results obtained by three investigators were compared. Additionally, the levels of reliability and measurement error were determined. RESULTS: The measurements conducted by one investigator showed good repeatability for sacral slope, lumbar lordosis, and thoracic kyphosis, including the angle of proximal (Th1-Th6) and distal (Th6-Th12) thoracic kyphosis (p>0.05). For measurements taken by three investigators, interobserver repeatability was achieved for thoracic kyphosis (p>0.05). The reliability of the measurements was good (Cronbach's alpha was 0.9> α ≥0.8), and the measurement error was between 2.8°-3.8°. CONCLUSIONS: The assessment of anteroposterior curvatures of the spine by one investigator provided good repeatability and reliability of measurements. Measurements performed by more than one investigator displayed partial repeatability. The value of the observational error should be taken into account in the interpretation of results of measurements performed with the Saunders inclinometer. The assessment of anteroposterior curvatures of the spine should be preceded by a verification of measurement reliability.

Postural assessment software (PAS/SAPO): Validation and reliabiliy.

OBJECTIVE: This study was designed to estimate the accuracy of the postural assessment software (PAS/SAPO) for measurement of corporal angles and distances as well as the inter- and intra-rater reliabilities. INTRODUCTION: Postural assessment software was developed as a subsidiary tool for postural assessment. It is easy to use and available in the public domain. Nonetheless, validation studies are lacking. METHODS: The study sample consisted of 88 pictures from 22 subjects, and each subject was assessed twice (1 week interval) by 5 blinded raters. Inter- and intra-rater reliabilities were estimated using the intraclass correlation coefficient. To estimate the accuracy of the software, an inanimate object was marked with hallmarks using pre-established parameters. Pictures of the object were rated, and values were checked against the known parameters. RESULTS: Inter-rater reliability was excellent for 41% of the variables and very good for 35%. Ten percent of the variables had acceptable reliability, and 14% were defined as non-acceptable. For intra-rater reliability, 44.8% of the measurements were considered to be excellent, 23.5% were very good, 12.4% were acceptable and 19.3% were considered non-acceptable. Angular measurements had a mean error analisys of 0.11 degrees , and the mean error analisys for distance was 1.8 mm. DISCUSSION: Unacceptable intraclass correlation coefficient values typically used the vertical line as a reference, and this may have increased the inaccuracy of the estimates. Increased accuracies were obtained by younger raters with more sophisticated computer skills, suggesting that past experience influenced results. CONCLUSION: The postural assessment software was accurate for measuring corporal angles and distances and should be considered as a reliable tool for postural assessment.

Gingival biotype assessment in the esthetic zone: visual versus direct measurement.

This study evaluated the reliability of assessing visually the facial gingival biotype of maxillary anterior teeth with and without the use of a periodontal probe in comparison with direct measurements. Forty-eight patients (20 men, 28 women) with a single failing maxillary anterior tooth participated in this study. Three methods were used to evaluate the thickness of the gingival biotype of the failing tooth: visual, periodontal probing, and direct measurement. Prior to extraction, the gingival biotype was identified as either thick or thin via visual assessment and assessment with a periodontal probe. After tooth extraction, direct measurement of the gingival thickness was performed to the nearest 0.1 mm using a tension-free caliper. The gingival biotype was considered thin if the measurement was =or<1.0 mm and thick if it measured>1.0 mm. The assessment methods were compared using the McNemar test at a significance level of a=.05. The mean gingival thickness obtained from direct measurements was 1.06+/-0.27 mm, with an equal distribution (50%) of sites with gingival thicknesses of =or<1 mm and >1 mm. The McNemar test showed a statistically significant difference when comparing the visual assessment with assessment using a periodontal probe (P=.0117) and direct measurement (P=.0001). However, there was no statistically significant difference when comparing assessment with a periodontal probe and direct measurement (P=.146). Assessment with a periodontal probe is an adequately reliable and objective method in evaluating gingival biotype, whereas visual assessment of the gingival biotype by itself is not sufficiently reliable compared to direct measurement.

Postural assessment software (PAS/SAPO): validation and reliabiliy

OBJECTIVE: This study was designed to estimate the accuracy of the postural assessment software (PAS/SAPO) for measurement of corporal angles and distances as well as the inter- and intra-rater reliabilities. INTRODUCTION: Postural assessment software was developed as a subsidiary tool for postural assessment. It is easy to use and available in the public domain. Nonetheless, validation studies are lacking. METHODS: The study sample consisted of 88 pictures from 22 subjects, and each subject was assessed twice (1 week interval) by 5 blinded raters. Inter- and intra-rater reliabilities were estimated using the intraclass correlation coefficient. To estimate the accuracy of the software, an inanimate object was marked with hallmarks using pre-established parameters. Pictures of the object were rated, and values were checked against the known parameters. RESULTS: Inter-rater reliability was excellent for 41 percent of the variables and very good for 35 percent. Ten percent of the variables had acceptable reliability, and 14 percent were defined as non-acceptable. For intra-rater reliability, 44.8 percent of the measurements were considered to be excellent, 23.5 percent were very good, 12.4 percent were acceptable and 19.3 percent were considered non-acceptable. Angular measurements had a mean error analisys of 0.11°, and the mean error analisys for distance was 1.8 mm. DISCUSSION: Unacceptable intraclass correlation coefficient values typically used the vertical line as a reference, and this may have increased the inaccuracy of the estimates. Increased accuracies were obtained by younger raters with more sophisticated computer skills, suggesting that past experience influenced results. CONCLUSION: The postural assessment software was accurate for measuring corporal angles and distances and should be considered as a reliable tool for postural assessment.

Improved assessment of child nutritional status using target weights and a novel, low-cost, weight-for-height slide chart.

Correctly identifying malnourished or at-risk children is the critical first step towards appropriate nutritional interventions. To improve weight-for-height assessment and classification of nutritional status, we present a novel, low-cost, weight-for-height slide chart. We also describe a target weight system for monitoring children's progress towards nutritional recovery.

Medidas clínicas da coxa e da perna por meio de reparos anatômicos e correlação com o comprimento radiográfico em crianças entre 7 a 12 anos da cidade de Londrina/Paraná, Brasil / Clinical assessment of the thigh and leg with the use of anatomic repairs and correlation with the radiographic evaluation in children between 7 and 12 years of age in the city of Londrina, state of Parana, Brazil

Assimetrias de comprimento dos MMII são comuns na população, porém apenas quando maiores que 1,5 cm deixam deser um problema estético e podem levar a alterações funcionais. Objetivo: Estabelecer uma correlação entre as medidas clínicas e radiográficasda coxa e da perna em crianças entre 7-12 anos, sendo esta obtida através da escanometria. Material e Método: Avaliaçãoprospectiva do comprimento da coxa e perna de 300 crianças entre 7-12 anos, de ambos os sexos, através da medida clínica com fitamilimetrada e radiográfica pela escanometria. A correlação entre as medidas foi feita através da regressão linear simples. Resultadoe discussão: Através da análise estatística verificou-se que há diferença estatisticamente significativa entre as medidas clínicas e radiográficasde coxa e perna (p<0,05). Por este motivo foi feita a regressão linear simples entre os valores encontrados e verificou-se aexistência de correlação entre elas e definiu-se uma equação de correlação. Com base nesta equação é possível que a medida radiográficaseja pressuposta a partir da medida clínica. Conclusão: As medidas clínicas e radiográficas são estatisticamente diferentes, porém existeuma correlação entre elas, permitindo que seja estabelecida uma fórmula que possibilita a predição das medidas radiográficas a partirdos valores obtidos clinicamente.

Limb length discrepancies are common in the general population, but they only cause functional problems when they areover 1.5 cm. Objective: To make a correlation between clinical and radiological assessments of children´s thigh and leg lengths between7-12 yrs, through slit scanogram measurement. Method: Prospective study of limb length in 300 children between 7-12 yrs, of bothsexes, through clinical measurement using a measuring tape and radiographic assessment using the supine slit scanogram technique. Thecorrelation between the assessments was made by simple linear regression. Results and discussion: The statistical analysis showed thatthere are differences between the clinical and the radiographic assessments (p<0.05). The simple linear regression was used to verifythe correlation and to define the correlation equation. Using this equation, it is possible to define the radiographic values based on theclinical assessment. Conclusion: The clinical and radiographic assessments are statistically different; however, there is

[Precision and accuracy of body weight assessment in hospitalized adults]. / Precisão e acurácia na aferição do peso corporal em adultos hospitalizados.

BACKGROUND: Body weight (BW) is widely used to evaluate and manage clinical situations therefore assessment errors can influence the ichosen therapies. OBJECTIVE: To assess the variability in values of BW obtained by using different equipment (weight scales). METHODS: A cross sectional study was performed to assess BW of 360 adult patients in eight units including clinical and surgical specialties Three types of scales were used: a portable domestic model and a fixed platform model, both from the units and a portable digital model previously calibrated and used as standard reference equipment. Self-reported weight (SRW) was also compared to weight assessed with the reference equipment. The values were compared trough paired-samples t-test using SPSS software. RESULTS: The difference between weights assessed by the reference equipment and SRW was 445+/-3.359 g (P=0.015), it was -182+/-2.323 g (P=0.140) for portable domestic scales and 137+/-2.412 g (P=0.218) for platform fixed scales. Values obtained from SRW, portable domestic scales and fixed platform scales were strongly correlated to the mean value of weight assessed by the reference equipment (r=0.973, r=0.987 and r=0.986, respectively). Nevertheless, considering analyses of each patient, errors of magnitude greater than 500 g occurred in 78.8% of SRW, 80.6% of the portable domestic scales and 40% of the fixed platform scales. CONCLUSION: In general, the scales tested were neither accurate nor precise for measuring BW, considering the percentage of error in the evaluation of each patient and the variability observed.

Precisão e acurácia na aferição do peso corporal em adultos hospitalizados / Precision and accuracy of body weight assessment in hospitalized adults

OBJETIVO: Verificar a variabilidade entre valores de peso corporal (PC) obtidos por meio de diferentes instrumentos de aferição (balanças). MÉTODOS: Foi realizado estudo transversal que avaliou o PC de 360 adultos, em oito unidades de internação (UI) de especialidades clínicas e cirúrgicas, utilizando três tipos de balanças: portátil doméstica e fixa de plataforma, das UI de origem, e portátil digital, sendo a última previamente calibrada e adotada como padrão de referência. O peso informado (PI) pelos pacientes também foi comparado à balança de referência. Os valores foram comparados através de teste t para amostras pareadas no software estatístico SPSS. RESULTADOS: A diferença entre a balança de referência e o PI foi de 445±3.359g (p=0,015), de -182±2.323g (p=0,140) nas balanças portáteis domésticas e de 137±2.412g (p=0,218) com as de plataforma. Tanto PI quanto peso aferido por balança portátil doméstica e de plataforma apresentaram forte correlação com o valor médio de peso aferido na balança digital (r=0,973, r=0,987 e r=0,986), respectivamente. Entretanto, considerando a análise de cada paciente, a ocorrência de erros superiores a 500 g, para mais ou para menos, foi de 78,8 por cento dos pesos informados, 80,6 por cento para as balanças portáteis e 40 por cento para as balanças de plataforma. CONCLUSAO: De modo geral, as balanças testadas não foram acuradas e precisas em estimar o PC dos pacientes avaliados, dado o percentual de erro nas avaliações para cada sujeito e a variabilidade observada.

Quantitative assessment of airway remodeling using high-resolution CT.

Asthma and COPD are the most prevalent of lung diseases and contribute an enormous burden of morbidity in North America and globally. In both conditions, inflammation leads to airway remodeling, which contributes to airway narrowing. To date, airway remodeling has only been assessed using histological examination of airways. However, it may now be possible to assess and quantify the extent of airway remodeling in vivo using high-resolution CT (HRCT). The aim of this article is to review the use of HRCT in the investigation of airway remodeling. A number of investigators have reported techniques to make measurements of airway dimensions using CT and an increasing number of quantitative methods are being developed. Using these techniques, airway dimensions have been examined in patients with asthma and COPD. In patients with asthma, the airway wall area was increased without a decrease in luminal area, whereas in patients with COPD, the airway luminal area was decreased and airway wall area was increased. The different pattern of remodeling may reflect fundamental differences in the inflammatory processes in asthma and COPD and could influence the reversibility of the narrowing. It has also been shown that, by quantifying both the extent of emphysema and of airway remodeling, CT is useful in differentiating COPD patients who have primarily parenchymal disease from those who have primarily airway pathology. With additional advances in technology, it is likely that quantitative assessment of airway wall dimensions will ultimately provide a valuable tool for the study of airway disease.