Altman Test Research Articles

Validation of Scolioscan Air-Portable Radiation-Free Three-Dimensional Ultrasound Imaging Assessment System for Scoliosis.

To diagnose scoliosis, the standing radiograph with Cobb’s method is the gold standard for clinical practice. Recently, three-dimensional (3D) ultrasound imaging, which is radiation-free and inexpensive, has been demonstrated to be reliable for the assessment of scoliosis and validated by several groups. A portable 3D ultrasound system for scoliosis assessment is very much demanded, as it can further extend its potential applications for scoliosis screening, diagnosis, monitoring, treatment outcome measurement, and progress prediction. The aim of this study was to investigate the reliability of a newly developed portable 3D ultrasound imaging system, Scolioscan Air, for scoliosis assessment using coronal images it generated. The system was comprised of a handheld probe and tablet PC linking with a USB cable, and the probe further included a palm-sized ultrasound module together with a low-profile optical spatial sensor. A plastic phantom with three different angle structures built-in was used to evaluate the accuracy of measurement by positioning in 10 different orientations. Then, 19 volunteers with scoliosis (13F and 6M; Age: 13.6 ± 3.2 years) with different severity of scoliosis were assessed. Each subject underwent scanning by a commercially available 3D ultrasound imaging system, Scolioscan, and the portable 3D ultrasound imaging system, with the same posture on the same date. The spinal process angles (SPA) were measured in the coronal images formed by both systems and compared with each other. The angle phantom measurement showed the measured angles well agreed with the designed values, 59.7 ± 2.9 vs. 60 degrees, 40.8 ± 1.9 vs. 40 degrees, and 20.9 ± 2.1 vs. 20 degrees. For the subject tests, results demonstrated that there was a very good agreement between the angles obtained by the two systems, with a strong correlation (R2 = 0.78) for the 29 curves measured. The absolute difference between the two data sets was 2.9 ± 1.8 degrees. In addition, there was a small mean difference of 1.2 degrees, and the differences were symmetrically distributed around the mean difference according to the Bland–Altman test. Scolioscan Air was sufficiently comparable to Scolioscan in scoliosis assessment, overcoming the space limitation of Scolioscan and thus providing wider applications. Further studies involving a larger number of subjects are worthwhile to demonstrate its potential clinical values for the management of scoliosis.

Dried blood spots for the quantitative evaluation of IgG isotypes and correlation with serum samples in HIV-exposed uninfected (HEU) infants

BackgroundThe determination of IgG levels and their subclasses can provide clinically relevant information on the status of the immune system. Here we determined the sensitivity and reproducibility of the quantification of IgG subclasses from Dried Blood Spots (DBS) in Malawian uninfected infants exposed to HIV (HEU). MethodsSixty paired samples of serum and DBS from HEU infants were used. Samples were collected from 1, 6, and 24-month old infants. IgGs concentrations from both serum and DBS were analyzed by BN ProSpec Siemens assay, using a different setting for sample dilutions. The reproducibility of the DBS method was tested on 10 samples run twice, starting from the DBS extraction process. To assess the systematic, proportional, and random differences, we computed the Passing-Bablok regression, and the Bland-Altman analysis to estimate the total mean bias between the two tests. ResultsThe IgG isotypes concentrations from serum and DBS showed significant differences in all the comparisons. Generally, the DBS method underestimated IgG subclasses' values showing a recovery range between 51.2% and 77.6%. Passing Bablok regression on age-based groups showed agreement for IgG, IgG1, and IgG2, but not for IgG3 and IgG4. The mean bias obtained with the Bland Altman test varied largely depending on IgG isotypes (−0.02–2.21 g/l) Coefficient of variation <7.0% was found in the repeated tests for IgG, IgG1, IgG3, and IgG4, while it was 12.4% for IgG2. ConclusionsVarying degrees of differences were seen in the IgGs measurement in the two different matrices. In IgGs analysis, the DBS method offers promise for population-based research, but the results should be carefully evaluated and considered as a relative value since they are not equivalent to the serum concentrations.

Multiparametric vs. Inferior Vena Cava-Based Estimation of Right Atrial Pressure.

Background: Right atrial pressure (RAP) can be estimated by echocardiography from inferior vena cava diameter and collapsibility (eRAPIVC), tricuspid E/e′ ratio (), or hepatic vein flow (eRAPHV). The mean of these estimates (eRAPmean) might be more accurate than single assessments.Methods and Results: eRAPIVC, , eRAPHV (categorized in 5, 10, 15, or 20 mmHg), eRAPmean (continuous values) and invasive RAP (iRAP) were obtained in 43 consecutive patients undergoing right heart catheterization [median age 69 (58–75) years, 49% males]. There was a positive correlation between eRAPmean and iRAP (Spearman test r = 0.66, P < 0.001), with Bland–Altman test showing the best agreement for values <10 mmHg. There was also a trend for decreased concordance between eRAPIVC, , eRAPHV, and iRAP across the 5- to 20-mmHg categories, and iRAP was significantly different from and eRAPHV for the 20-mmHg category (Wilcoxon signed-rank test P = 0.02 and P < 0.001, respectively). The areas under the curve in predicting iRAP were nonsignificantly better for eRAPmean than for eRAPIVC at both 5-mmHg [0.64, 95% confidence interval (CI) 0.49–0.80 vs. 0.70, 95% CI 0.53–0.87; Wald test P = 0.41] and 10-mmHg (0.76, 95% CI 0.60–0.92 vs. 0.81, 95% CI 0.67–0.96; P = 0.43) thresholds.Conclusions: Our data suggest that multiparametric eRAPmean does not provide advantage over eRAPIVC, despite being more complex and time-consuming.

To Study the Correlation between Estimated Ultrasound Depth and Actual Needle Depth of Epidural Space in Transverse Plane in Parturients Undergoing Cesarean Section

Background and aim: During pregnancy, edema and obesity obscure the anatomical landmark and because of this epidural space identification become difficult by conventional methods. Loose connective tissue also causes false loss of resistance and responsible for failed block and complications. This study was planned for USG (ultrasonography) guided puncture point detection and epidural space depth assessment and its correlation with actual needle insertion depth in obstetric patients. Methods: Sixty four patients of ASA I and II for elective caesarean sections were included in this study. Lumbar space was identified by USG in which ligamentum-flavum with dura mater complex was taken as key structure for assessment of Ultrasound Depth (UD). This was followed by epidural needle insertion at the same marked point and measurement of epidural space Needle Depth (ND) taken. Concordance correlation coefficient and Bland Altman test were used to compare UD and ND. Results: Mean ND and UD were respectively 3.63 ± 043 cm and 3.61 ± 0.17 and these distances were not significantly different (P>0.0001). Bland Altman analysis showed mean of difference between UD and ND to be insignificant (0.02). Significant concordance correlation r=0.96 (95% CI-0.94-0.9, p>0.0001) was observed between ND and UD. Conclusion: In obstetric population pre puncture ultrasound scanning of lumbar spine helps in approximate assessment of epidural space depth and its correlate precisely with actual needle depth.

A comparison between panoramic radiography and dental study model for space maintainer

Background: A space maintainer is an appliance used to maintain the jaw space due to the premature loss of deciduous teeth. Moyer’s method is used to determine the need for a space maintainer by measuring the discrepancy. Objective: The aim of this article is to determine the difference between measurements using Moyer’s method on a dental study model and on panoramic radiographs. Methods: Researchers measured the available space in 60 dental study models using two methods—the segmental method and contouring of the jaw arch using a 0.6 mm diameter arch wire. Moyer’s prediction table was used to predict the mesial-distal width of the permanent canines and premolars. Software ImageJ (SIJ) was used to measure the available space and required space on panoramic radiographs. We performed image calibration so that the measurement results could be presented in millimeters. Results: There was no significant difference (P = 0.935) in the discrepancy prediction between the panoramic radiographs and the dental study model. The Bland—Altman test result showed no significant difference, and the conformity between the panoramic radiographs and the dental study model was 0.02770. The sensitivity and specificity values of the panoramic radiographs and dental study model were above the 50% line. The area under curve values of the panoramic radiographs and dental study model were considered to be very good. Conclusion: Application of Moyer’s method to panoramic radiographs using SIJ to determine space maintainer requirements can be performed on pediatric patients to predict special discrepancies.

Are pocket sized ultrasound devices sufficient in the evaluation of lung ultrasound patterns and aeration scoring in pulmonary ICU patients?

Lung ultrasound (LUS) is a practical diagnostic tool for several lung pathologies. Pocket sized USG devices (PSUDs) are more affordable, accessible, practical, and learning to use them is easier than standard ultrasound devices (SUDs). Their capability in image quality have been found as comparable with standard USG machines. Studies have been showing that these devices can be useful as much as SUDs in the evaluation of heart, abdomen, vascular structures, diaphragm and optic nerve. The aim of this study is to compare PSUD with a standard ultrasound devices (SUD) in the evaluation of LUS patterns such as alveolar, interstitial syndromes and lung aeration score (LAS). Study performed in an University Hospital Pulmonary ICU. All patients older than 18 years old were included in this study. The sector probe of SUD (Vivid-Q) and PSUD (Vscan) were used for investigation of A lines, interstitial (B lines), alveolar syndromes (consolidation, hepatisation, air bronchograms) and pleural effusion. 33 patients were included in the study. When PSUD was compared with SUD in terms of total B2 count, and LAS in the right, left and both lung, there was an agreement without proportional bias according to Bland Altman test. There was also good inter class correlation coefficient value as greater than 0.8 and 0.7 between two physicians in terms of counting of total B1, B2, total B lines and calculating of total LAS for SUD and PSUD respectively. PSUDs is a reliable and valid method for evaluation of LUS patterns like SUDs.

A validated FFQ to determine dietary intake of vitamin D.

The aim of the present study was to develop and validate a vitamin D FFQ for assessment of dietary vitamin D intake in healthy adults in England, UK. The current study assessed the agreement between a four-day food diary (4 d-FD) and a new vitamin D FFQ to measure dietary intake of vitamin D. Dietary intake was estimated using Nutritics dietary analysis software, and Spearman's and Bland-Altman tests were utilised to assess correlation and agreement, respectively. Participants also provided a blood sample for plasma analysis of vitamin D concentrations. Home setting. Fifty participants were recruited to the study from the University of Chester and vicinity. Results showed a strong correlation between vitamin D intake recorded by the FFQ and the 4 d-FD (r = 0·609; P < 0·0001) within 95 % limits of agreement. Furthermore, a significant correlation between plasma 25(OH)D concentrations and vitamin D intake measured by the FFQ (r = 0·290, P = 0·041) and the 4 d-FD (r = 0·360, P = 0·01) was observed. Our analysis suggests this FFQ is a useful and rapid tool for researchers and health professionals to assess vitamin D dietary intakes in healthy adults in the UK.

The Effectiveness of LenshookeTM Semen Quality Analyzer X1 Pro for Human Semen Analysis

Background: LenshookeTM Semen Quality Analyzer (SQA) X1 Pro is an automated semen analysis. The accuracy of LenshookeTM SQA X1 Pro has never been analyzed with World Health Organization (WHO) standard method. Aim: This study aims to examine whether the LenshookeTM SQA X1 Pro method provides reliable results according to the WHO standard method. Methods: This study was a laboratory analytic observational study using 60 patients in Andrology clinic of Dr. Soetomo Hospital. The concentration, progressive motility (PR), total motile sperm count (TMSC), and morphology results of the LenshookeTM SQA X1 Pro and standard method were analyzed statistically using correlation, Bland Altman, and diagnostic test. Results: Significant correlation between two methods were found in all parameters (concentration: r = 0,970; PR: r = 0,781; TMSC: r = 0,952; morphology: r = 0,568). The mean difference for concentration, PR, TMSC, and morphology between the two examination methods were 1,165 million/ml, 7,05%, 7,584 million/ejaculate, and 2,25%. However, it found that the correlation and agreement were weaker in sample with low number of spermatozoa per high power field. The results revealed a sensitivity of 100%, 81%, and 59% for oligozoospermia, astenozoospermia, and teratozoospermia, respectively. The specificities were shown to be 100%, 74%, and 100% for oligozoospermia, astenozoospermia, and teratozoospermia, respectively. Conclusion: The LenshookeTM SQA X1 Pro gives a reliable result for determining oligozoospermia and asthenozoospermia, but in the situation that the clinicians need the accurate data, standard method should be used.

Functional echocardiography training in the neonatal intensive care unit: comparing measurements and results with the pediatric cardiologist

ObjectivesFunctional echocardiography is a valuable tool in the neonatal intensive care unit, but training programs are not standardized. The aim was to report an functional echocardiography training program for neonatologists and to describe the agreement of their measurements with the pediatric cardiologist. MethodsFunctional echocardiography training lasted 32h. After training program, the neonatologists performed functional echocardiography in the neonatal intensive care unit and were required to measure left cardiac chambers dimensions, left ventricle systolic function, right and left ventricular output, ductus arteriosus diameter, and flow pattern. Images were recorded by the equipment and reviewed offline by the pediatric cardiologist. The Bland–Altman test was used for quantitative variables and the kappa test, for qualitative variables. ResultsTwenty‐two trained neonatologists performed 100 functional echocardiography exams. Ductus arteriosus identification and flow pattern had substantial agreement (kappa=0.91 and 0.88, respectively), as well as its diameter (mean difference=0.04mm). The mean difference for the aortic root was −1.2mm; left atrium, 0.60mm; left ventricle diastolic diameter, −0.90mm; left ventricle systolic diameter, −0.30mm. Shortening fraction and ejection fraction correlated well with broad limits of agreement, −2.96% (14.88; −20.82%) and −‐3.43% (15.54; −22.40%), respectively. Right and left ventricular output had broad limits of agreement, 16.69mL/kg/min (222.76; −189.37) and 23.57mL/kg/min (157.88; −110), respectively. There was good agreement between interpretations of normal or low cardiac output (76.7% for right ventricular output; 75.7% for left ventricular output). ConclusionThis functional echocardiography training program enabled neonatologists to obtain adequate skills in performing the images, obtaining good agreement with the cardiologist in simple hemodynamic measurements and ductus arteriosus evaluation.

Assessing mandibular body changes in growing subjects: a comparison of CBCT and reconstructed lateral cephalogram measurements

The aim of this study is to compare cone-beam computed tomography (CBCT) and bi-dimensional reconstructed lateral cephalograms (RLCs) in assessing mandibular body length and growth and to evaluate how mandibular reshaping influences the error in measuring mandibular body growth in bi-dimensional radiographs. Twenty-five patients with two CBCT scans taken at a mean distance of 2.21 ± 0.5 years were selected. The following measurements were performed: right and left mandibular body length at each point in time, mandibular growth, inter-gonial distance and mandibular symphyseal angle. From each CBCT, an RLC was obtained, and mandibular body length and growth were measured. Data analysis revealed a statistically and clinically significant difference in CBCT and RLC regarding the mandibular length of each patient at each point in time. However, mandibular growth was almost identical. A linear regression was performed to predict growth distortion between RLCs and CBCT depending on the ratio between transverse and sagittal mandibular growth. The expected maximum and minimum distortion, however, appeared not to be significant. In fact, a second linear regression model and a Bland–Altman test revealed a strong correlation between measurements of average mandibular body growth by CBCT and RLCs. As the same distortion occurs in the first and second RLCs, bi-dimensional radiographs remain the method of choice in evaluating mandibular body growth.

Validation of a Food Propensity Questionnaire for the Hellenic National Nutrition and Health Survey (HNNHS) and Results on This Population's Adherence to Key Food-Group Nutritional Guidelines.

Background: Food propensity questionnaires (FPQs) are means of dietary assessment in nutritional epidemiology, which provide valuable information for long term intakes and food group consumption. These tools, however, may be subjected to misreporting and need to be validated against standard quantitative methods. Aim: The aim of this study was to examine the validity of the qualitative FPQ developed to assess the dietary habits of the general population in Greece during the Hellenic National Nutrition and Health Survey (HNNHS) and to assess the population’s intake of specific food groups in relation to guidelines. Methods: Validation analysis was based on 3796 [1543 men (42.82%) and 2253 women (57.18%)] participants of the HNNHS in relation to two interviewer-administered 24 h recalls (24 hR). Participants were asked to report the frequency of their dietary intake, using the FPQ provided. Correlations and significance between methods were assessed via Spearman correlation and a Two-sample Wilcoxon rank-sum (Mann-Whitney) test, respectively. Agreement between the FPQ and the 24 hR was performed using the Bland–Altman test and differences between the FPQ’s shown intakes and the recommended intakes by the Dietary Guidelines for Greek Adults were calculated. Results: Medium to weak correlations, but statistically significant (p < 0.05), were observed for most food groups between 24 hR and the FPQ; medium for fruits, dairy products, drinks, and spirits (ranging from ρ = 0.371 to ρ = 0.461; highest for drinks and spirits) and weak for vegetables, meat, fish, eggs, starch foods, sweets, nuts, fats and oils, and fast food (ρ = 0.111 to ρ = 0.290; lowest for starch foods). A non-significant correlation was found for legumes (ρ = 0.070). The mean intake agreement (Bland–Altman analysis) between the FPQ and the 24 hR was 96.08% and ranged from 94.43 to 99.34% for the 14 food groups under examination. When food group intakes were compared to guidelines, results showed that the population’s dietary intake was below the guidelines for fruits, vegetables, whole grains, fish, and legumes. On the other hand, it was above the guidelines for most of the “unhealthy” food groups, in particular, fast food, sweets, drinks and spirits, red meat, and sweets. Conclusions: The specific FPQ provides valid information on major food groups and can be used to examine long term dietary patterns in nutritional studies. Ιn addition, dietary intakes of Greek adults are problematic and initiatives at the public health level are necessary.

Reproducibility of Ablated Volume Measurement Is Higher with Contrast-Enhanced Ultrasound than with B-Mode Ultrasound after Benign Thyroid Nodule Radiofrequency Ablation-A Preliminary Study.

The reproducibility of contrast-enhanced ultrasound (CEUS) and standard B-mode ultrasound in the assessment of radiofrequency-ablated volume of benign thyroid nodules was compared. A preliminary study was conducted on consecutive patients who underwent radiofrequency ablation (RFA) of benign thyroid nodules between 2014 and 2016, with available CEUS and B-mode post-ablation checks. CEUS and B-mode images were retrospectively evaluated by two radiologists to assess inter- and intra-observer agreement in the assessment of ablated volume (Bland–Altman test). For CEUS, the mean inter-observer difference (95% limits of agreement) was 0.219 mL (-0.372–0.809 mL); for B-mode, the mean difference was 0.880 mL (-1.655–3.414 mL). Reproducibility was significantly higher for CEUS (85%) than for B-mode (27%). Mean intra-observer differences (95% limits of agreement) were 0.013 mL (0.803–4.097 mL) for Reader 1 and 0.031 mL (0.763–3.931 mL) for Reader 2 using CEUS, while they were 0.567 mL (-2.180–4.317 mL, Reader 1) and 0.759 mL (-2.584–4.290 mL, Reader 2) for B-mode. Intra-observer reproducibility was significantly higher for CEUS (96% and 95%, for the two readers) than for B-mode (21% and 23%). In conclusion, CEUS had higher reproducibility and inter- and intra-observer agreement compared to conventional B-mode in the assessment of radiofrequency-ablated volume of benign thyroid nodules.

Validation of a food frequency questionnaire as a tool for assessing dietary intake in cardiovascular disease research and surveillance in Bangladesh

BackgroundCardiovascular disease (CVD) has emerged as a major public health concern in Bangladesh. Diet is an established risk factor for CVD but a tool to assess dietary intake in Bangladesh is lacking. This study aimed to validate a food frequency questionnaire (FFQ) using the 24-h dietary recall method and corresponding nutritional biological markers among rural and urban populations of Bangladesh.MethodParticipants of both genders aged 18–60 years were included in the analysis (total n = 146, rural n = 94 and urban n = 52). Two FFQs of 166 items were administered three-months apart, during which time three 24-h dietary recalls were also completed. Participants were asked to recall their frequency of consumption over the preceding 3 months. Urine and blood samples were collected for comparison between FFQ-estimates of nutrients and their corresponding biomarkers. Methods were compared using unadjusted, energy-adjusted, de-attenuated correlation coefficients, 95% limits of agreement (LOA) and quartile classification.ResultsFair to moderate agreement for ranking energy, macro and micronutrients into quartiles was observed (weighted k value ranged from 0.22 to 0.58; p < 0.001 for unadjusted data) except for vitamin D (weighted k − 0.05) and zinc (weighted k 0.09). Correlation coefficients of crude energy, macronutrients and common micronutrients including vitamin E, thiamine, riboflavin, niacin, pyridoxine, folate, iron, magnesium, phosphorus, potassium, and sodium were moderately good, ranging from 0.42 to 0.78; p < 0.001 but only fair for vitamin A, β carotene and calcium (0.31 to 0.38; p < 0.001) and poor for vitamin D and zinc (0.02 and 0.16; p = ns, respectively). Energy-adjusted correlations were generally lower except for fat and vitamin E, and in range of − 0.017 (for calcium) to 0.686 (for fat). De-attenuated correlations were higher than unadjusted and energy- adjusted, and significant for all nutrients except for vitamin D (0.017) to 0.801 (for carbohydrate). The Bland Altman tests demonstrated that most of the coefficients were positive which indicated that FFQ provided a greater overestimation at higher intakes. More than one in three participants appeared to overestimate their food consumption based on the ratio of energy intake to basal metabolic rate cut points suggested by Goldberg. Absolute intake of macronutrients was 1.5 times higher and for micronutrients it ranged from 1.07 (sodium) to 26 times (Zinc). FFQ estimates correlated well for sodium (0.32; p < 0.001), and vitamin D (0.20; p = 0.017) with their corresponding biomarkers and iron (0.25; p = 0.003) with serum ferritin for unadjusted data. Folate, iron (with haemoglobin) and total protein showed inverse association; and fat and potassium showed poor correlation with their corresponding biomarkers for unadjusted data. However, folate showed significant positive correlation (0.189; p = 0.025) with biomarker after energy adjustment.ConclusionAlthough FFQ showed overestimation for absolute intake in comparison with 24-h recalls, the validation study demonstrated acceptable agreement for ranking dietary intakes from FFQ with 24-h recall methods and some biomarkers and therefore could be considered as a tool to measure dietary intake for research and CVD risk factors surveillance in Bangladesh. The instrument may not be appropriate for monitoring population adherence to recommended intakes because of the overestimation.

Differences of tear film osmolarity between two time-points of the day in healthy subjects

Purpose: Tear film hyperosmolarity is considered one the core mechanism of the dry eye along with the tear film stability. Many tear physiological variables oscillate during the day. This study was designed to assess the differences in tear film osmolarity between morning and afternoon in a group of healthy subjects.&#x0D; Materials and methods: A total of 25 healthy subjects who fulfilled the study’s inclusion criteria were enrolled for the study. Tear osmolarity was measured using the TearLab™ system in two separated sessions, at 9.30 am and 6.30 pm. A paired t-test and a Bland–Altman test were used to assess the differences between sessions.&#x0D; Results: Tear osmolarity (mean ± SD) was 309.96 ± 9.00 and 296.48 ± 12.98 mOsm/l at 9.30 am and 6.30 pm, respectively, being significantly lower at 6.30 pm than at 9.30 am (mean difference ± SD = 13.48 ± 8.69 mOsm/l; paired t-test; p &lt; 0.001).&#x0D; Conclusions: Tear film osmolarity does appear to have some influence by the time of day in healthy patients.

Volume estimation of brain ventricles using Cavalieri’s principle and Atlas-based methods in Alzheimer disease: Consistency between methods

Automatic estimations of brain ventricles are needed to assess disease progression in neurodegenerative disorders such as Alzheimer Disease (AD). The objectives of this study are to evaluate the diagnostic performances of an automated volumetric assessment tool in estimating lateral ventricle volumes in AD and to compare this with Cavalieri’s principle, which is accepted as the gold standard method. This is across-sectional volumetric study including 25 Alzheimer patients and 25 healthy subjects undergoing magnetic resonance images (MRI) with a 3D turbo spin echo sequence at 1.5 Tesla. The Atlas-based method incorporated MRIStudio software to automatically measure he volumes of brain ventricles. To compare the corresponding measurements, we used manual point-counting and semi-automatic planimetry methods based on Cavalieri’s principle. Bland–Altman test results indicated an excellent agreement between Cavalieri’s principle and the Atlas-based method in all volumetric measurements (p < 0.05). We obtained a 64% sensitivity and 92% specificity for lateral ventricular volumes according to the Atlas-based method. AD subjects had significantly larger left and right lateral ventricle volume (LVV) when compared to control subjects in respect to three volumetric methods (p < 0.01). Lateral ventricle-to-brain ratio (VBR) statistically increased 49.23% in measurements done with the point-counting method, 45.12% with the planimetry method, and 45.49% with the Atlas-based method in AD patients (p < 0.01). As a result, the Atlas-based method may be used instead of manual volumetry to estimate brain volumes. Additionally, this method provides rapid and accurate estimations of brain ventricular volumes in-vivo examination of MRI.

Measurement of Resting Energy Expenditure with Indirect Calorimetry and Predictive Equations in Healthy Young Adults: A Cross-sectional Study

Introduction: Resting Energy Expenditure (REE) is the main determinant of energy requirements. An inaccurate estimation of REE can lead to the over or under-prediction of energy requirements. Indirect calorimetry is considered as the gold standard for the assessment of REE. The most of the predictive equations which are formed, are from the studies conducted on Caucasian people while on Asian population these studies are very limited. Aim: To compare the REE measured by indirect calorimetry and predictive equation in healthy young adults. Materials and Methods: A cross-sectional study was done on 100 healthy young adult participants from November 2018 to May 2019, of age group 18 to 25 years to measure REE using indirect calorimetry and predictive equations (Harris-Benedict’s, Schofield, FAO/WHO/UNU and Mifflin-St. Jeor equations). Statistical analysis was carried out using SPSS version 16.0. Unpaired student t-test for comparison of data and Bland Altman test to check for validity of predictive equations were applied. Results: The mean value of REE using Indirect calorimetry was 1994.20±577.33 and that of using four Harris-Benedict’s, Schofield, FAO/WHO/UNU and Mifflin-St.Jeor equations were 1638.15±335.64 kcal/day, 1636.21±359.85 kcal/day, 1636.93±367.59 kcal/day and 1582.41±251.29 kcal/day, respectively. Thus, the highest mean difference between values of REE obtained using predictive equation and indirect calorimetry was 411.79±326.04 kcal/day with respect to Mifflin-St.Jeorand’s and the lowest mean difference was 356.05±241.69 kcal/day with respect to Herris Benedict’s equation. Conclusion: Predictive equations underestimated the REE of young adults when compared with that measured by indirect calorimetry.

Does it make difference to measure diaphragm function with M mode (MM) or B mode (BM)?

Diaphragm dysfunction occurs in mechanically ventilated subjects. Recent literature suggests that diaphragm thickening fraction (DTF) measured by ultrasound can be useful to predict weaning outcome. However, there is no standardized approach in the measurement of diaphragm thickness (DT) and limited data exists comparing different measurement techniques of diaphragm thickness (M mode-MM or B mode-BM). The goal of this study was to compare MM with BM in the measurements of DT and excursion in the ICU subjects. DT measurements were obtained from the right diaphragm during tidal and maximal inspiratory breathing. Three measurements of the DT were taken both in MM and BM and their mean values were calculated. DT was measured during inspiration and expiration and DTF was calculated. Excursion of diaphragm was also measured with MM and BM during tidal and maximal inspiratory breathing. Bias and agreement between the two measurement methods were evaluated with Bland and Altman test. Sixty-two subjects were enrolled in the study. While 25 (40%) subjects were receiving invasive mechanical ventilation, 14 (23%) subjects ventilated noninvasively. There were no significant difference between the measurement results of MM and BM. BM and MM tidal diaphragm measurements during the inspiratory (0.3 ± 0.08 and 0.31 ± 0.08cm; P = 0.022), expiratory (0.24 ± 0.07 and 0.24 ± 0.07cm; P = 0.315) phases and tidal DTF were (27 ± 16 and 31 ± 14%, P = 0.089) respectively. Results of our study suggests that except tidal inspiratory diaphragm thickness, all thickness and excursion measurements with MM and BM are very compatible with each other. Further studies are necessarry to confirm our results and to standardize the measurements of diaphragm.

Accuracy of the non-invasive Tcore™ temperature monitoring system to measure body core temperature in abdominal surgery.

An accurate determination of body core temperature is crucial during surgery in order to avoid and treat hypothermia, which is associated with poor outcome. In a prospective observational study, we evaluated the suitability of the Tcore™ device (Drägerwerk AG & Co. KGaA, Lübeck, Germany)-a non-invasive thermometer-to accurately determine core body temperature. In patients undergoing surgery for ovarian cancer, core body temperature (CBT) was determined with the Tcore™ sensor attached to the forehead and compared with blood temperature (Tblood) as measured within the femoro-iliacal artery. Both temperatures were recorded every 10 s and the measurement error was calculated. 57,302 data pairs of CBT and Tblood were obtained in 22 patients. In a repeated-measurements version of the Bland and Altman test, a bias of - 0.02 °C and 95% limits of agreement of - 0.48 to 0.44 °C were calculated. In a population analysis, a median absolute error of 0 [- 0.1; + 0.1] °C, a bias of 0 [- 0.276; 0.271] % and an inaccuracy of 0.276 [0.274; 0.354] % was determined. Although the Tcore™ sensor was attached to the frontal skin, it provided an accurate measurement of core body temperature in the investigated intraoperative setting.

Accuracy of transcutaneous bilirubin on covered skin in preterm and term newborns receiving phototherapy using a JM-105 bilirubinometer

ObjectiveDetermine the suitability of transcutaneous bilirubin (TCB) as a tool to assess the effectiveness of phototherapy on patched skin.Study designA prospective observational study was conducted. We covered a fragment of skin (sternum) with a photo-opaque patch. Several simultaneous TCB and TSB measurements were performed with the JM-105 bilirubinometer. Bland and Altman test evaluated the agreement between bilirubin levels.ResultA total of 217 patients were studied, 48.8% were preterm. The mean difference between TSB and TCB before the start of treatment was 1.07 mg/dL. During phototherapy, differences on covered skin were 0.52, 0.27, and 0.39 mg/dL at 24, 48, and 72 h of therapy respectively. The best correlation was observed at 48 h in preterm infants.ConclusionThe measurement of TCB on patched skin (PTCB) is useful for monitoring the response to phototherapy in term and preterm infants. We use a patch with a removable flap that eases successive measures without disturbing the patients.

The Performance of Energy Firms in Greece

In this paper, we investigated empirically the financial performance of energy firms in Greece for the time period 2012-2015 with the use of the well-known Altman test. The results indicated that all firms in the energy industry are financially distressed and are characterized by lack of liquidity, low productivity and high leverage for the whole time period under examination. This means that there is a clear danger of oligopoly formation in the energy market, with its negative outcomes in prices and energy provision stability. Certain policy measures are needed in order to obtain more sustainable and consumer-friendly results.