Bland-Altman Procedure Research Articles

Pectoralis major and triceps brachii cross-sectional area measured on different planes: the effect on the muscle size-strength relationship.

Magnetic resonance imaging (MRI) is a well-used technique to assess muscle size and can be acquired on different planes. Pectoralis major (PM) and triceps brachii (TB) muscles are often acquired and analyzed on the axial plane, however it is unknown if anatomical cross-sectional area (CSA) calculated from different planes will affect the muscle size-strength relationship. Thus, the first aim of the present study was to identify if the CSA of the PM and TB measured on different planes presents a similar muscle size-strength relationship. A secondary aim was to investigate if the quantification of CSA of the PM and TB muscles are similar between sagittal and axial plane. Fifteen males underwent an MRI examination, and after that, one-repetition maximum (1RM) test was performed. There was a significant relationship between 1RM and PM CSA measured on the axial and sagittal plane (r≤0.81), while the relationship with TB CSA was only good on the axial plane (r=0.65) and not significant on the sagittal plane (r=0.27). ICC between planes was excellent for PM CSA (0.96) with Bland-Altman procedure showing agreement between planes (d=0.376; P=0.612). Contrarily, TB CSA ICC was week (0.07), with Bland-Altman procedure showing no agreement between planes (d=-24.49; P=0.022). CSA measured at axial plane from PM and TB muscles showed a significant relationship with 1RM, while only PM CSA on the sagittal plane showed a significant relationship with 1RM. Finally, it was demonstrated that PM images showed a great reliability between planes, which was not true for TB muscle.

Whole-Body Magnetic Resonance Imaging (MRI) for Staging Melanoma Patients in Direct Comparison to Computed Tomography (CT): Results from a Prospective Positron Emission Tomography (PET)/CT and PET/MRI Study.

The consideration of radiation exposure is becoming more important in metastatic melanoma due to improved prognoses. The aim of this prospective study was to investigate the diagnostic performance of whole-body (WB) magnetic resonance imaging (MRI) in comparison to computed tomography (CT) with 18F-FDG positron emission tomography (PET)/CT and 18F-PET/MRI together with a follow-up as the reference standard. Between April 2014 and April 2018, a total of 57 patients (25 females, mean age of 64 ± 12 years) underwent WB-PET/CT and WB-PET/MRI on the same day. The CT and MRI scans were independently evaluated by two radiologists who were blinded to the patients' information. The reference standard was evaluated by two nuclear medicine specialists. The findings were categorized into different regions: lymph nodes/soft tissue (I), lungs (II), abdomen/pelvis (III), and bone (IV). A comparative analysis was conducted for all the documented findings. Inter-reader reliability was assessed using Bland-Altman procedures, and McNemar's test was utilized to determine the differences between the readers and the methods. Out of the 57 patients, 50 were diagnosed with metastases in two or more regions, with the majority being found in region I. The accuracies of CT and MRI did not show significant differences, except in region II where CT detected more metastases compared to MRI (0.90 vs. 0.68, p = 0.008). On the other hand, MRI had a higher detection rate in region IV compared to CT (0.89 vs. 0.61, p > 0.05). The level of agreement between the readers varied depending on the number of metastases and the specific region, with the highest agreement observed in region III and the lowest observed in region I. In patients with advanced melanoma, WB-MRI has the potential to serve as an alternative to CT with comparable diagnostic accuracy and confidence across most regions. The observed limited sensitivity for the detection of pulmonary lesions might be improved through dedicated lung imaging sequences.

A computer vision-based mobile tool for assessing human posture: A validation study

Background and Objective: Non-invasive methods for postural assessment are tools used for tracking and monitoring the progression of postural deviations. Different computer-based methods have been used to assess human posture, including mobile applications based on images and sensors. However, such solutions still require manual identification of anatomical points. This study aims to present and validate the NLMeasurer, a mobile application for postural assessment. This application takes advantage of the PoseNet, a solution based on computer vision and machine learning used to estimate human pose and identify anatomical points. From the identified points, NLMeasurer calculates postural measures. Methods: Twenty participants were photographed in front view while using surface markers over anatomical landmarks. Then, the surface markers were removed, and new photos were taken. The photos were analyzed by two examiners, and six postural measurements were computed with NLMeasurer and a validated biophotogrammetry software. One-sample t-test and Bland Altman procedure were used to assess agreement between the methods, and Intraclass Correlation Coefficient (ICC) was used to assess inter- and intra-rater reliability. Results: Postural measurements calculated using the NLMeasurer were in agreement with the biophotogrammetry software. Furthermore, there was good inter- and intra-rater reliability for most photos without surface markers. Conclusions: NLMeasurer demonstrated to be a valid tool method to assess postural measurements in the frontal view. The use of surface markers on specific anatomical landmarks (i.e., ears, iliac spines and ankles) can facilitate the digital identification of these landmarks and improve the reliability of the postural measurements performed with NLMeasurer.

Methods to Assess Fat Mass in Infants and Young Children: A Comparative Study Using Skinfold Thickness and Air-Displacement Plethysmography.

Background: Traditionally, fat mass is estimated using anthropometric models. Air-displacement plethysmography (ADP) is a relatively new technique for determining fat mass. There is limited information on the agreement between these methods in infants and young children. Therefore we aimed to longitudinally compare fat mass percentage values predicted from skinfold thicknesses (SFTs) and ADP in healthy infants and young children. Methods: Anthropometry and body composition were determined at the ages of 1, 4, and 6 months and 2 years. We quantified the agreement between the two methods using the Bland–Altman procedure, linear mixed-model analysis, and intra-class correlation coefficients (ICC). Results: During the first 6 months of life, fat mass% predicted with SFT was significantly different from that measured with ADP in healthy, term-born infants (n = 245). ICCs ranged from 0.33 (at 2 years of age) and 0.47 (at 4 months of age). Although the mean difference (bias) between the methods was low, the Bland–Altman plots showed proportional differences at all ages with wide limits of agreement. Conclusions: There is poor agreement between ADP and SFTs for estimating fat mass in infancy or early childhood. The amount of body fat was found to influence the agreement between the methods.

Feasibility in the echocardiographic estimation of parameters of the right ventricle in prone position.

Echocardiographic cardiac parameters in the prone position are usually obtained with an esophageal probe. The feasibility of obtaining them by means of a transthoracic approach is unknown. Estimating the feasibility to obtain parameters of the right ventricle by transthoracic echocardiography in prone position on the subject. Pilot design of consecutive case series without cardiopulmonary disease. Demographic, vital signs and echocardiographic variables were defined in the ventral initial, prone and ventral final decubitus positions. The data are shown with averages and standard deviations, and frequencies and percentages according to the variable. The differences between the positions were calculated with ANOVA of repeated samples and adjustment of Bonferroni test. Intra-subject variability was obtained by the Bland-Altman procedure and its 95% confidence interval. We studied 50 subjects, 44 (88%) males, age 30 ± 6 years and body mass index 25.65 ± 2.71 kg/m2. Tricuspid annular plane systolic excursion (TAPSE) and S'-wave were measured 100% of the time. The vital signs and echocardiographic variables according to the position had differences in: heart rate (74 ± 9 vs. 77 ± 9 vs. 75 ± 8 beats/min), partial oxygen saturation (94.40 ± 1.70 vs. 96.64 ± 1.79 vs. 95.32 ± 1.36%) and mean systemic blood pressure (65.33 ± 5.38 vs. 67.69 ± 6.31 vs. 65.29 ± 5.62 mmHg); TAPSE (19.74 ± 3.24 vs. 21.60 ± 2.97 vs. 19.44 ± 2.84 mm), mean difference (bias) 0 (2, -2.0) and S'-wave (13.52 ± 1.87 vs. 15.02 ± 2.09 vs. 13.46 ± 1.55 cm/s), mean difference (bias) -0.46 (1.21, -2.14) respectively. Obtaining right ventricle parameters by transthoracic ecocardiopraphy is feasible in the prone position.

Feasibility in the echocardiographic estimation of parameters of the right ventricle in prone position.

Echocardiographic cardiac parameters in the prone position are usually obtained with an esophageal probe. The feasibility of obtaining them by means of a transthoracic approach is unknown. Estimating the feasibility to obtain parameters of the right ventricle by transthoracic echocardiography in prone position on the subject. Pilot design of consecutive case series without cardiopulmonary disease. Demographic, vital signs and echocardiographic variables were defined in the ventral initial, prone and ventral final decubitus positions. The data are shown with averages and standard deviations, and frequencies and percentages according to the variable. The differences between the positions were calculated with ANOVA of repeated samples and adjustment of Bonferroni test. Intra-subject variability was obtained by the Bland-Altman procedure and its 95% confidence interval. We studied 50 subjects, 44 (88%) males, age 30 ± 6 years and body mass index 25.65 ± 2.71 kg/m2. Tricuspid annular plane systolic excursion (TAPSE) and S'-wave were measured 100% of the time. The vital signs and echocardiographic variables according to the position had differences in: heart rate (74 ± 9 vs. 77 ± 9 vs. 75 ± 8 beats/min), partial oxygen saturation (94.40 ± 1.70 vs. 96.64 ± 1.79 vs. 95.32 ± 1.36%) and mean systemic blood pressure (65.33 ± 5.38 vs. 67.69 ± 6.31 vs. 65.29 ± 5.62 mmHg); TAPSE (19.74 ± 3.24 vs. 21.60 ± 2.97 vs. 19.44 ± 2.84 mm), mean difference (bias) 0 (2, -2.0) and S'-wave (13.52 ± 1.87 vs. 15.02 ± 2.09 vs. 13.46 ± 1.55 cm/s), mean difference (bias) -0.46 (1.21, -2.14) respectively. Obtaining right ventricle parameters by transthoracic ecocardiopraphy is feasible in the prone position.

Validation of an app-based portable spirometer in adolescents with asthma

Objectives Objective measurements of asthma impairment could aid teens in recognition of changes in asthma status over time. Ready access to a conventional spirometer is not realistic outside of the clinical setting. In this proof-of-concept study, we compared the performance of the VitalFlo mobile spirometer to the nSpire KoKo® sx1000 spirometer for accuracy in measuring Forced Expiratory Volume in one second (FEV1) and Forced Vital Capacity (FVC) in adolescents with asthma. Methods Two hundred forty pulmonary function measurements were collected from 48 adolescents with persistent asthma from the University of North Carolina’s pediatric allergy and pulmonology subspecialty clinics. Participants performed spirometry with the nSpireKoKo® sx1000 spirometer and the VitalFlo spirometer during their clinic visits. 119 simulated FVC maneuvers were conducted on both devices to standardize measurements. Pearson correlations, Bland-Altman procedure, and two-sample comparison tests were performed to assess the relationship between the two spirometers. Results VitalFlo measurements were significantly highly correlated with nSpireKoKo® spirometer values for FEV1, (r 2=0.721, [95% CI, 0.749 ± 0.120], P < 0.001) and moderately for FVC (r 2= 0.617, [95% CI, 0.640 ± 0.130], P < 0.001) measurements. There were no statistically significant differences of the mean FEV1 (M = 0.00764, SD = 0.364, t(59)=0.16, P = 0.87) and FVC measurements (M = 0.00261, SD = 0.565, t(59)=0.036, P = 0.97.) between the VitalFlo and nSpireKoKo® systems. Both devices demonstrated significantly high correlation when comparing the automated FVC (r 2 = 0.997, [95% CI, 1.00 ± 0.00974], P < 0.001) measurements. Bland-Altman plots did not demonstrate significant bias between devices for both FEV1 (0.00764 L) and FVC (0.00261 L) measurements. Conclusions Lung function measurements from the VitalFlo mobile spirometer were comparable to a commercially-available spirometer commonly used in clinical settings. This validated app-based spirometer for home use has the potential to improve asthma self-management.

Cooper Test Provides Better Half-Marathon Performance Prediction in Recreational Runners Than Laboratory Tests.

This study compared the ability to predict performance in half-marathon races through physiological variables obtained in a laboratory test and performance variables obtained in the Cooper field test. Twenty-three participants (age: 41.6 ± 7.6 years, weight: 70.4 ± 8.1 kg, and height: 172.5 ± 6.3 cm) underwent body composition assessment and performed a maximum incremental graded exercise laboratory test to evaluate maximum aerobic power and associated cardiorespiratory and metabolic variables. Cooper’s original protocol was performed on an athletic track and the variables recorded were covered distance, rating of perceived exertion, and maximum heart rate. The week following the Cooper test, all participants completed a half-marathon race at the maximum possible speed. The associations between the laboratory and field tests and the final time of the test were used to select the predictive variables included in a stepwise multiple regression analysis, which used the race time in the half marathon as the dependent variable and the laboratory variables or field tests as independent variables. Subsequently, a concordance analysis was carried out between the estimated and actual times through the Bland-Altman procedure. Significant correlations were found between the time in the half marathon and the distance in the Cooper test (r = −0.93; p < 0.001), body weight (r = 0.40; p < 0.04), velocity at ventilatory threshold 1, (r = −0.72; p < 0.0001), speed reached at maximum oxygen consumption (vVO2max), (r = −0.84; p < 0.0001), oxygen consumption at ventilatory threshold 2 (VO2VT2) (r = −0.79; p < 0.0001), and VO2max (r = −0.64; p < 0.05). The distance covered in the Cooper test was the best predictor of time in the half-marathon, and might predicted by the equation: Race time (min) = 201.26 – 0.03433 (Cooper test in m) (R2 = 0.873, SEE: 3.78 min). In the laboratory model, vVO2max, and body weight presented an R2 = 0.77, SEE 5.28 min. predicted by equation: Race time (min) = 156.7177 – 4.7194 (vVO2max) – 0.3435 (Weight). Concordance analysis showed no differences between the times predicted in the models the and actual times. The data indicated a high predictive power of half marathon race time both from the distance in the Cooper test and vVO2max in the laboratory. However, the variable associated with the Cooper test had better predictive ability than the treadmill test variables. Finally, it is important to note that these data may only be extrapolated to recreational male runners.

Predictive validity of body fat percentage by bioimpedance compared with deuterium oxide dilution in Costa Rican schoolchildren

The purpose of this study was to verify the validity of body fat percentage (BF%) by bioelectrical impedance analysis (BIA) in a sample of Costa Rican schoolchildren. The sample consisted of 52 male (mean age 8.1 ± 0.9 years) and 49 female (mean age 7.5 ± 1.0 years) schoolchildren. Deuterium oxide dilution was the reference method used as the "gold standard" to determine the fat mass (FM) expressed as BF%. Linear regression analyses and paired sample t-tests were used to test the association and mean differences between BIA and deuterium oxide dilution BF%. Concordance between BIA and deuterium oxide dilution BF% was determined by Lin's concordance correlation coefficient. Measurement of agreement between the two methods was analyzed using the Bland-Altman procedure. Significant associations between BIA and deuterium oxide dilution BF% were found in males (R = 0.97, R2 = 0.95, P < .0001) and in females (R = 0.98, R2 = .96, P < .0001). The measurements of BF% (mean ± SD) were not significantly different between males (BIA 31.1 ± 7.6% vs. deuterium oxide dilution 31.0 ± 7.4%) and females (BIA 25.9 ± 7.9% vs. deuterium oxide dilution 26.3 ± 7.8%) by t-test. Lin's concordance correlation coefficient identified an almost perfect strength of agreement between males and females. Bland-Altman plots showed that the Bodystat measured similar BF% compared to the deuterium oxide dilution in both males and females. BIA Bodystat presented high agreement with BF% measured by deuterium oxide dilution; therefore BIA Bodystat is recommended for estimating BF% in Costa Rican schoolchildren.

Wrist Accelerometer Cut Points for Classifying Sedentary Behavior in Children.

This study aimed to examine the validity and accuracy of wrist accelerometers for classifying sedentary behavior (SB) in children. Fifty-seven children (5-8 and 9-12 yr) completed an ~170-min protocol, including 15 semistructured activities and transitions. Nine ActiGraph (GT3X+) and two GENEActiv wrist cut points were evaluated. Direct observation was the criterion measure. The accuracy of wrist cut points was compared with that achieved by the ActiGraph hip cut point (≤25 counts per 15 s) and the thigh-mounted activPAL3. Analyses included equivalence testing, Bland-Altman procedures, and area under the receiver operating curve (ROC-AUC). The most accurate ActiGraph wrist cut points (Kim; vector magnitude, ≤3958 counts per 60 s; vertical axis, ≤1756 counts per 60 s) demonstrated good classification accuracy (ROC-AUC = 0.85-0.86) and accurately estimated SB time in 5-8 yr (equivalence P = 0.02; mean bias = 4.1%, limits of agreement = -20.1% to 28.4%) and 9-12 yr (equivalence P < 0.01; -2.5%, -27.9% to 22.9%). The mean bias of SB time estimates from Kim were smaller than ActiGraph hip (5-8 yr: 15.8%, -5.7% to 37.2%; 9-12 yr: 17.8%, -3.9% to 39.5%) and similar to or smaller than activPAL3 (5-8 yr: 12.6%, -39.8% to 14.7%; 9-12 yr: -1.4%, -13.9% to 11.0%), although classification accuracy was similar to ActiGraph hip (ROC-AUC = 0.85) but lower than activPAL3 (ROC-AUC = 0.92-0.97). Mean bias (5-8 yr: 6.5%, -16.1% to 29.1%; 9-12 yr: 10.5%, -13.6% to 34.6%) for the most accurate GENEActiv wrist cut point (Schaefer: ≤0.19 g) was smaller than ActiGraph hip, and activPAL3 in 5-8 yr, but larger than activPAL3 in 9-12 yr. However, SB time estimates from Schaefer were not equivalent to direct observation (equivalence P > 0.05) and classification accuracy (ROC-AUC = 0.79-0.80) was lower than for ActiGraph hip and activPAL3. The most accurate SB ActiGraph (Kim) and GENEActiv (Schaefer) wrist cut points can be applied in children with similar confidence as the ActiGraph hip cut point (≤25 counts per 15 s), although activPAL3 was generally more accurate.

Validation of thigh-based accelerometer estimates of postural allocation in 5-12 year-olds.

ObjectivesTo validate activPAL3™ (AP3) for classifying postural allocation, estimating time spent in postures and examining the number of breaks in sedentary behaviour (SB) in 5–12 year-olds.DesignLaboratory-based validation study.MethodsFifty-seven children completed 15 sedentary, light- and moderate-to-vigorous intensity activities. Direct observation (DO) was used as the criterion measure. The accuracy of AP3 was examined using a confusion matrix, equivalence testing, Bland–Altman procedures and a paired t-test for 5–8y and 9–12y.ResultsSensitivity of AP3 was 86.8%, 82.5% and 85.3% for sitting/lying, standing, and stepping, respectively, in 5–8y and 95.3%, 81.5% and 85.1%, respectively, in 9–12y. Time estimates of AP3 were equivalent to DO for sitting/lying in 9–12y and stepping in all ages, but not for sitting/lying in 5–12y and standing in all ages. Underestimation of sitting/lying time was smaller in 9–12y (1.4%, limits of agreement [LoA]: −13.8 to 11.1%) compared to 5–8y (12.6%, LoA: −39.8 to 14.7%). Underestimation for stepping time was small (5–8y: 6.5%, LoA: −18.3 to 5.3%; 9–12y: 7.6%, LoA: −16.8 to 1.6%). Considerable overestimation was found for standing (5–8y: 36.8%, LoA: −16.3 to 89.8%; 9–12y: 19.3%, LoA: −1.6 to 36.9%). SB breaks were significantly overestimated (5–8y: 53.2%, 9–12y: 28.3%, p < 0.001).ConclusionsAP3 showed acceptable accuracy for classifying postures, however estimates of time spent standing were consistently overestimated and individual error was considerable. Estimates of sitting/lying were more accurate for 9–12y. Stepping time was accurately estimated for all ages. SB breaks were significantly overestimated, although the absolute difference was larger in 5–8y. Surveillance applications of AP3 would be acceptable, however, individual level applications might be less accurate.

Predictive Validity of a Thigh-Worn Accelerometer METs Algorithm in 5- to 12-Year-old Children.

To validate the activPAL3 algorithm for predicting metabolic equivalents (TAMETs) and classifying MVPA in 5- to 12-year-old children. Fifty-seven children (9.2 ± 2.3y, 49.1% boys) completed 14 activities including sedentary behaviors (SB), light (LPA) and moderate-to-vigorous physical activities (MVPA). Indirect calorimetry (IC) was used as the criterion measure. Analyses included equivalence testing, Bland-Altman procedures and area under the receiver operating curve (ROC-AUC). At the group level, TAMETs were significantly equivalent to IC for handheld e-game, writing/coloring, and standing class activity (P < .05). Overall, TAMETs were overestimated for SB (7.9 ± 6.7%) and LPA (1.9 ± 20.2%) and underestimated for MVPA (27.7 ± 26.6%); however, classification accuracy of MVPA was good (ROC-AUC = 0.86). Limits of agreement were wide for all activities, indicating large individual error (SB: -27.6% to 44.7%; LPA: -47.1% to 51.0%; MVPA: -88.8% to 33.9%). TAMETs were accurate for some SB and standing, but were overestimated for overall SB and LPA, and underestimated for MVPA. Accuracy for classifying MVPA was, however, acceptable.

Differences in Central Corneal Thickness between Spectral Domain-Optical Coherence Tomography and Ultrasound Pachymetry in Patients with Dry Eye Disease.

Purpose. To compare central corneal thickness (CCT) values via Spectral Domain-Optical Coherence Tomography (SD-OCT) and ultrasonic pachymetry in patients with severe dry eye disease (DED) to determine the level of agreement between these 2 methods. Methods. The paired samples t-test was used to compare CCT values in severe DED patients. Matching analysis between methods was performed using intraclass correlation coefficient (ICC). Intrasession reliability of the measurement methods was calculated via the concordance correlation coefficient (CCC), variation equivalent, and Pearson's correlation coefficient. The Bland-Altman procedure was used to graphically represent the differences between CCT values. Results. The study included 56 eyes of 24 female and 4 male patients. Mean age of the patients was 50.9 ± 11.3 years. Mean CCT via Cirrus SD-OCT was 523.82 ± 30.98 μm versus 530.050 ± 31.85 μm via ultrasonic pachymetry (paired samples t-test, P < 0.001). The Bland-Altman plot showed good agreement between the examiners. The ICC for repeatability was 0.974. The CCC between the 2 methods' CCT values was 0.973. The variation equivalent was 0.976 and Pearson's correlation coefficient was 99.3%, which also indicated high correlation between the 2 methods' measurements. Conclusions. The present findings show that in patients with severe DED Cirrus SD-OCT provides reliable intraobserver CCT values.

Motor unit number in a small facial muscle, dilator naris.

A loss of functioning motor units underlies many neuromuscular disorders. The facial nerve innervates the muscles of facial expression, including nasal muscles, which also play an important role in the regulation of airflow resistance. It is difficult to accurately assess motor unit number in the facial muscles, because the muscles are difficult to activate in isolation. Here, we apply the manual McComas method to estimate the number of motor units in a nasal dilator muscle. EMG of the dilator naris was recorded during graded stimulation of the zygomatic branch of the facial nerve in 26 subjects (12 males and 14 females), aged 20-41 years. Each subject was studied twice, on separate days, to estimate method reproducibility. As a check on our use of the McComas method, we also estimated motor unit number in the first dorsal interosseus muscle (FDI) of six subjects, as the muscle is also small and has been studied with the McComas method. Reproducibility was evaluated with a rigorous statistical approach, the Bland-Altman procedure. We estimate that dilator naris is composed of 75 ± 15.6 (SD) motor units, compared to 144 ± 35.5 in FDI. The coefficient of variation for test-retest reproducibility of dilator naris motor unit estimates was 29.6 %, similar to separate-day reproducibility reported for other muscles. Recording and stimulation were done with surface electrodes, and the recordings were of high quality and reproducible. This simple technique could be applied clinically to track motor neuron loss and to monitor facial nerve integrity.

A new mobile phone-based tool for assessing energy and certain food intakes in young children: a validation study.

BackgroundChildhood obesity is an increasing health problem globally. Obesity may be established already at pre-school age. Further research in this area requires accurate and easy-to-use methods for assessing the intake of energy and foods. Traditional methods have limited accuracy, and place large demands on the study participants and researchers. Mobile phones offer possibilities for methodological advancements in this area since they are readily available, enable instant digitalization of collected data, and also contain a camera to photograph pre- and post-meal food items. We have recently developed a new tool for assessing energy and food intake in children using mobile phones called the Tool for Energy Balance in Children (TECH).ObjectiveThe main aims of our study are to (1) compare energy intake by means of TECH with total energy expenditure (TEE) measured using a criterion method, the doubly labeled water (DLW) method, and (2) to compare intakes of fruits and berries, vegetables, juice, and sweetened beverages assessed by means of TECH with intakes obtained using a Web-based food frequency questionnaire (KidMeal-Q) in 3 year olds.MethodsIn this study, 30 Swedish 3 year olds were included. Energy intake using TECH was compared to TEE measured using the DLW method. Intakes of vegetables, fruits and berries, juice, as well as sweetened beverages were assessed using TECH and compared to the corresponding intakes assessed using KidMeal-Q. Wilcoxon matched pairs test, Spearman rank order correlations, and the Bland-Altman procedure were applied.ResultsThe mean energy intake, assessed by TECH, was 5400 kJ/24h (SD 1500). This value was not significantly different (P=.23) from TEE (5070 kJ/24h, SD 600). However, the limits of agreement (2 standard deviations) in the Bland-Altman plot for energy intake estimated using TECH compared to TEE were wide (2990 kJ/24h), and TECH overestimated high and underestimated low energy intakes. The Bland-Altman plots for foods showed similar patterns. The mean intakes of vegetables, fruits and berries, juice, and sweetened beverages estimated using TECH were not significantly different from the corresponding intakes estimated using KidMeal-Q. Moderate but statistically significant correlations (ρ=.42-.46, P=.01-.02) between TECH and KidMeal-Q were observed for intakes of vegetables, fruits and berries, and juice, but not for sweetened beverages.ConclusionWe found that one day of recordings using TECH was not able to accurately estimate intakes of energy or certain foods in 3 year old children.

Reproducibility of peak power output during a 10-s cycling maximal effort using different sampling rates.

The study was aimed to investigate the reproducibility of performance parameters obtained from 10-s maximal cycling effort against different braking forces in young adult athletes. The sample (n = 48) included male athletes aged 18.9-29.9 years (175.5 ± 6.9 cm, 76.2 ± 10.1 kg). The exercise protocol was performed in a cycle-ergometer against a random braking force (4% to 11% of body mass). Intra-individual variation was examined from repeated tests within one week. Descriptive statistics were computed and differences between sessions were tested using paired t-test. The coefficient of correlation between repeated measures, technical error of measurement (TEM), coefficient of variation and ICC were calculated. Agreement between trials was examined using the Bland-Altman procedure. Mean values of peak power were relatively stable when obtained from sampling rates of 50 Hz and ranged between 1068 watt and 1082 watt (t(47) = 1.149, p = 0.256, ES-r = 0.165) or while corresponding to a sampling rate of 1 Hz (t(47) = 0.742, p = 0.462, ES-r = 0.107). Correlations between repeated measures were high (+0.907, 95% CI: +0.839 to +0.947) and TEM about 59.3 watt (%CV = 5.52%; ICC = 0.951, 95% CI: 0.912 to 0.972). The present study suggests that reproducibility of peak power in male adult athletes tended to be acceptable and within individual error appeared unrelated to braking force.

Quality of life and self-reported lower extremity function in adults with HIV-related distal sensory polyneuropathy.

Distal sensory polyneuropathy (DSP) is a common complication of HIV disease. Its effects on quality of life (QOL) and function have not been well described. The study objectives were: (1) to compare QOL and lower extremity function in people with HIV-related DSP and people with HIV disease who do not have DSP, (2) to determine the extent to which function predicts QOL, (3) to evaluate the agreement of 2 function scales, and (4) to describe the use of pain management resources. This was a cross-sectional survey study with predictive modeling and measurement tool concordant validation. A demographic questionnaire, the Medical Outcomes Study HIV Health Survey, the Lower Extremity Functional Scale (LEFS), the Lower Limb Functional Index (LLFI), and a review of medical records were used. General linear modeling was used to assess group differences in QOL and the relationship between function and QOL. Bland-Altman procedures were used to assess the agreement of the LEFS and the LLFI. Usable data for analyses were available for 82 of the 94 participants enrolled. The 67% of participants who reported DSP symptoms tended to be older, had HIV disease longer, and were more likely to receive disability benefits. Participants without DSP had better LLFI, LEFS, and physical health summary scores. In multivariate models, lower limb function predicted physical and mental health summary scores. The LLFI identified participants with a lower level of function more often than the LEFS. Participants with DSP were more likely to use medical treatment, physical therapy, and complementary or alternative treatments. A sample of convenience was used; the sample size resulted in a low power for the mental health summary score of the Medical Outcomes Study HIV Health Survey. Quality of life and function were more impaired in participants with HIV disease and DSP. The LLFI was more likely to capture limitations in function than the LEFS. Participants with DSP reported more frequent use of pain management resources.

Accuracy of SenseWear Pro2 Armband to Predict Resting Energy Expenditure in Childhood Obesity

The accuracy of the SenseWear Pro2 Armband (SWA) in estimating resting energy expenditure (REE) in children and adolescents with obesity, using indirect calorimetry (IC) as a reference was evaluated. REE was assessed using both the SWA and IC in 40 obese subjects (26 M/14 F, age 11.5 ± 2.57 years, z-score BMI 3.14 ± 0.53). The agreement between methods was assessed by the Bland-Altman procedure. The relationship between REE assessments and patients' characteristics was also analyzed. SWA- and IC-derived estimates of REE showed a significant correlation (r = 0.614; P < 0.001), but the SWA overestimated mean REE by 13% (P < 0.001). Age and kilogram of fat-free mass (kg-FFM) were significantly correlated with both REE estimation by SWA (r = 0.434 and r = 0.564, respectively) and IC (r = 0.401 and r = 0.518, respectively). Only kg-FFM was demonstrated to be the main predictor factor of REE variability (r(2) 79% SWA; 75% IC). The SWA overestimated mean REE in childhood obesity, suggesting that the SWA and IC are not yet interchangeable methods. This would require improving the SWA by developing better algorithms for predicting REE and, probably, bias in each individual REE could be reduced by an adjustment for subjects' kg-FFM.

Assessment of cardiorespiratory fitness using submaximal protocol in older adults with mood disorder and Parkinson's disease

BACKGROUND: Evidence has shown benefits for mental health through aerobic training oriented in percentage of VO2max, indicating the importance of this variable for clinical practice. OBJECTIVE: To validate a method for estimating VO2max using a submaximal protocol in elderly patients with clinically diagnosis as major depressive disorder (MDD) and Parkinson's disease (PD). METHODS: The sample comprised 18 patients (64.22 ± 9.92 years) with MDD (n = 7) and with PD (n = 11). Three evaluations were performed: I) disease staging, II) direct measurement of VO2max and III) submaximal exercise test. Linear regression was performed to verify the accuracy of estimation in VO2max established in ergospirometry and the predicted VO2max from the submaximal test measurement. We also analyzed the correlation between the Bland-Altman procedures. RESULTS: The regression analysis showed that VO2max values estimated by submaximal protocol associated with the VO2max measured, both in absolute values (R² = 0.65; SEE = 0.26; p < 0.001) and the relative (R² = 0.56; SEE = 3.70; p < 0.001). The Bland-Altman plots for analysis of agreement of showed a good correlation between the two measures. DISCUSSION: The VO2max predicted by submaximal protocol demonstrated satisfactory criterion validity and simple execution compared to ergospirometry.

Greener bioanalytical approach for LC/MS–MS assay of enalapril and enalaprilat in human plasma with total replacement of acetonitrile throughout all analytical stages

Green bioanalytical approaches are oriented toward minimization or elimination of hazardous chemicals associated to bioanalytical applications. LC/MS-MS assay of enalapril and enalaprilat in human plasma was achieved by elimination of acetonitrile from both sample preparation and chromatographic separation stages. Protein precipitation (PP) by acetonitrile addition was replaced by liquid-liquid extraction (LLE) in 1-octanol followed by direct large volume injection of the organic layer in the chromatographic column operated under reversed phase (RP) separation mechanism. At the mean time, acetonitrile used as organic modifier in the mobile phase was successfully replaced by a mixture of propylene carbonate/ethanol (7/3, v/v). Three analytical alternatives ((I) acetonitrile PP+acetonitrile based chromatographic elution; (II) 1-octanol LLE+acetonitrile based chromatographic elution; (III) 1-octanol LLE+propylene carbonate/ethanol based chromatographic elution) were validated and the quality characteristics were compared. Comparison between these alternative analytical approaches was also based on results obtained on incurred samples taken during a bioequivalence study, through application of the Bland-Altman procedure.