Standardized Measurement Protocol Research Articles

Unpacking the Tibial Tubercle–Trochlear Groove Distance: Evaluation of Rotational Factors, Trochlear Groove and Tibial Tubercle Position, and Role of Trochlear Dysplasia

Background: The tibial tubercle to trochlear groove (TT-TG) distance is often utilized for determining the surgical treatment for patients with patellar instability (PI). It is thought to directly represent the position of the TT on the tibia. Recent work has shown that the measurement of the TT-TG distance is multifactorial. Purpose: To investigate the relationship between relative tibial external rotation (rTER) and trochlear dysplasia (TD), as well as the location of the TG and TT in patients with and without PI, and to correlate these and other anatomic measurements with the TT-TG distance. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 89 patients with PI who underwent magnetic resonance imaging were identified with 92 matched control patients. A standardized measurement protocol on axial magnetic resonance imaging determined rTER, the proximal and distal TG lateralization (pTGL and dTGL, respectively) ratios, and the TT lateralization (TTL) ratio. Other measures of interest included the lateral trochlear inclination angle, sulcus angle, and lateral patellar inclination angle. Univariate regression was used to determine the associations of TD (lateral trochlear inclination angle, sulcus angle) with rTER and the TG position, and multivariate regression was used to model associations among all the variables with the proximal and distal TT-TG distances. Results: rTER was significantly higher in the study group (P < .001), and univariate regression showed a significant association between dysplasia measures and rTER (P < .001). The pTGL ratio was lower in the study group (P = .025), but there was no difference in the dTGL ratio (P = .090) or the TTL ratio (P = .098) between the groups. There were no associations between dysplasia measures and the pTGL and dTGL ratios (P > .05). Multivariate regression showed that the proximal TT-TG distance is predicted by the sulcus angle, pTGL ratio, rTER, and TTL ratio (P < .05) and that the distal TT-TG distance is predicted by the lateral patellar inclination angle, dTGL ratio, sulcus angle, rTER, and TTL ratio (P < .05). Conclusion: rTER had a significant association with TD. The position of the proximal TG was more medial in patients with PI. There was no significant difference in the TTL ratio between patients with and without PI. The TT-TG distance was associated with multiple anatomic measures and was not solely predicated on the position of the TT.

Reliability of gender determination from paranasal sinuses and its application in forensic identification-a systematic review and meta-analysis.

This systematic review aims to determine whether linear or morphometric analysis of paranasal sinuses can be used for accurate determination of gender and to appraise which sinus can be evaluated for accurate gender determination.A comprehensive search of the specialized databases (PubMed/MEDLINE, Science Direct, Clinical Key, ProQuest, Google Scholar, Epistomonikos, LILACS, OpenGrey) and other institutional repositories was performed for including the studies which assessed paranasal sinuses for gender determination. Quality assessment was carried out with the AQUA tool. The meta-analysis was performed with the eligible study data at 95% CI and p ≤ 0.05 in the random-effects model.Forty-six studies evaluating frontal sinus (13), maxillary sinus (26), frontal and maxillary sinus (5), or three paranasal sinuses (2) were included. All the included studies assessed height, length, width, and volume, respectively, and other additional parameters (area, perimeter) if wherever applicable. Frontal sinus had significantly higher values for males compared to females except for left height (LH) and left volume (LV). Maxillary sinus measurements were significantly higher in males contrasted to females except for LH. Sub-group analyses revealed that analyses involving the population had statistically significant results for all the measured parameters for both the sinuses (p < 0.05 and p = 0.00, respectively).Measurements obtained from assessing sinuses reveal that there are variations in size, among populations in different geographic regions. Hence, more studies with improved sample sizes and standardized measurement protocols should be carried out on different populations to see the diversity and their reliability.

Bland-Altman Plot: Agreement Between Ultrasound-measured Placenta Thickness and Other Biometric Parameters in the Determination of Gestational Age.

The aim of this article is to evaluate the agreement of placenta thickness (PT) with other foetal biometric parameters in the determination of gestational age (GA) in normal singleton foetuses. The study was a cross-sectional descriptive study conducted among 406 consecutively recruited pregnant women with singleton foetuses at 15-40 weeks of gestation at the National Hospital, Abuja, Nigeria from October to December 2019. Biparietal diameter (BPD), femur length (FL), head circumference (HC), abdominal circumference (AC), and PT were measured using standard measurement protocols. Bland and Altman (BA) plots were used to compare PT and other foetal biometric parameters. The significant statistical level was determined at a critical value of P < 0.05. The mean age of study participants was 31.8 ± 4.8 years. The BA plot of PT and HC demonstrated a normal distribution; the mean difference was around zero (3.968) and 95% of the measurements fell within 2SD of the mean. The BA plot of HC and AC measurements also showed that the 95% limits of agreement for differences fell within 10% of the mean of the measurements (-4.236 to 15.987 with a mean difference of 5.876), indicating good agreement between the two pairs of variables. However, BA plots between PT and BPD as well as PT and FL showed no agreement. This study indicates that there is good agreement or comparability between PT and HC measurements as well as between PT and AC measurements. Hence, either HC or AC measurements may be interchangeable with PT measurements in the ultrasound determination of GA. However, PT measurements did not agree well with BPD and FL measurements, respectively.

VP.28 Psychometric properties of muscle strength assessment by hand-held dynamometry in healthy adults: A reliability study

Maximal isometric muscle strength (MIMS) assessment is a key component of physiotherapist' work. Hand-held dynamometry (HHD) is a simple and quick method to obtain quantified MIMS values. However, the lack of MIMS reference values with well-known psychometric properties in healthy adults limits the use and the interpretation of the measures obtained with HHD in clinic. To determine the intra- and inter-rater reliability, standard error of measurement (SEM) and minimal detectable changes (MDC) of MIMS values obtained with HHD. MIMS measurements of 17 muscle groups were assessed by two independent raters at three different times in 30 healthy adults aged between 18 and 70 years old using a standardized HHD protocol: T1(day 1: rater 1), T2 (day 5: rater 2) and T3 (day 14: rater 1). Intra- and inter-rater reliability were measured using intra-class correlation coefficients (ICC: 95% confidence interval) and the SEM and MDC were calculated from these reliability data. Intra-rater reliability and inter-rater reliability were good to excellent with ICC (95% confidence interval) varying from 0,90 to 0,99 (0,85-0,99) and 0,89 to 0,99 (0,55-0,995) respectively, except for the wrist flexors and the internal hip rotators, which showed moderate to excellent inter-rater reliability. Relative and absolute SEM and MDC for intra-rater reliability ranged from 0.14 to 3.20 Nm and 0.50 to 3.45 % for the SEM and 0.38 to 8.87 Nm and 1.38 to 7.88% for the MDC, respectively for all muscle groups. Relative and absolute SEM and MDC for inter-rater reliability ranged from 0.17 to 5.80 Nm and 0.49 to 3.25 % for the SEM and 0.47 to 16.06 Nm and 1.35 to 9.02% for the MDC, respectively. The good to excellent intra- and inter-rater reliability of the standardized HHD protocol make of the HHD protocol used a method of choice in clinical or research setting. Knowing the psychometric properties of MIMS values obtained with HHD standardized measurement protocols will allow an optimal use of the reference values established. Hand-held dynamometry, muscle strength, psychometric properties, quantitative evaluation.

A Standardized Protocol for Measuring Bioelectrical Impedance in Green Turtles (Chelonia mydas).

AbstractBioelectrical impedance analysis (BIA) is gaining popularity in wildlife studies as a portable technology for immediate and nondestructive predictions of body composition components, such as fat-free and fat masses. Successful application of BIA for field-based research requires the identification and control of potential sources of error, as well as the creation of and adherence to a standardized protocol for measurement. The aim of our study was to determine sources of error and to provide a standardization protocol to improve measurement precision of BIA on juvenile green turtles (Chelonia mydas; ). We assessed the effects of altered environmental temperature (20°C-30°C), postprandial state (2-72 h), and time out of the water (2 h) on five impedance parameters (resistance at infinite frequency [Rinf], resistance at zero frequency [R0], resistance at 50 kHz [R50], phase angle at 50 kHz [PhA50], and intracellular resistance [Ri]) using a bioimpedance spectroscopy device. Technical reproducibility of measurements and interanimal variability were also assessed. We found an inverse exponential relationship between change in environmental temperature and impedance parameters Rinf, R0, and R50. Postprandial state significantly increased Rinf and Ri 72 h after feeding. BIA measurements were reproducible within individual juvenile green turtles at temperatures from 20°C to 30°C. Significant variation in impedance values was found between animals at all temperatures, sampling times, and postprandial states, but the relative differences (%) were small in magnitude. Our study suggests that measurement precision is improved by measuring animals at consistent environmental temperatures close to their preferred thermal range. We propose a standardized protocol of measurement conditions to facilitate laboratory and field use of BIA for body composition assessment studies in turtles.

The effects of surface electrical stimulation plus voice therapy in Parkinson's disease.

This study aimed to assess the effects of surface electrical stimulation plus voice therapy on voice in dysphonic patients with idiopathic Parkinson's disease. Patients were assigned to 3 treatment groups (n = 28 per group) and received daily treatment for 3 weeks on 5 days a week. All three groups received voice therapy (usual care). In addition, two groups received surface electrical stimulation, either motor-level or sensory-level stimulation. A standardised measurement protocol to evaluate therapeutic effects included the Voice Handicap Index and videolaryngostroboscopy. Voice Handicap Index and videolaryngostroboscopic assessment showed statistically significant differences between baseline and post-treatment across all groups, without any post-treatment differences between the three groups. Intensive voice therapy (usual care) improved idiopathic Parkinson's disease patients' self-assessment of voice impairment and the videolaryngostroboscopic outcome score. However, surface electrical stimulation used as an add-on to usual care did not improve idiopathic Parkinson's disease patients' self-assessment of voice impairment or the videolaryngostroboscopic outcome scores any further.

Low Concordance Between Blood Pressures Measured in Periodic Health Examinations and in a Workplace-Based Hypertension Management Program.

The online version contains supplementary material available at 10.1007/s43657-022-00067-w.

Does Moringa stenopetala based diet consumption decrease burden of under nutrition in under-five children, Southern Ethiopia?

BackgroundMoringa stenopetala is used for medicinal and nutritional purposes. This study was, therefore, conducted to assess the contribution of Moringa stenopetala based diet in reducing under nutrition in under-five children in four districts of Southern Ethiopia. MethodA community-based comparative cross-sectional study design was employed from August to September 2016 in randomly selected comparative sites among 732 under five children. Anthropometric measurements of weight and height of children were measured based on the standard measurement protocol. Regarding moringa stenopetala diet, the consumption habit was collected by using a seven days food frequency questionnaire. Amount of moringa stenopetala leaf biomass portion size consumption was measured with local measurement and converted to kilograms. Anthropometric data were analyzed using WHO Anthro software to determine the nutritional status of the child. An independent t-test was conducted to compare the mean difference of WHO-Z score of child nutritional index. Statistical mean significance difference was measured based on p-value less than 0.05 with 95% confidence level. In addition chi-square test with a p-value, less than 0.05 with a 95% confidence level was used to compare the prevalence of stunting, wasting, and underweight in moringa stenopetala based diet and non-moringa stenopetala based diet consuming area. ResultThe prevalence of stunting was 19% vs. 28.8%, wasting 4.7% vs. 9.6%, and underweight 12.19% vs 13.71% in moringa stenopetala based diet consuming and non-consuming participants respectively. There was a significant difference in stunting and wasting (p < 0.05) among moringa stenopetala based diet-consuming and non-consuming participants. Conclusion: The present study showed that moringa stenopetala based diet consumption had a significant contribution in reducing under-nutrition in under-five children.

Poster 111: Poor Inter-observer Reliability of TT-TG Measurement Among Orthopaedic Sports Medicine Surgeons Regardless of Measurement Technique

Objectives:Tibial tubercle-trochlear groove distance (TT-TG) is an important radiologic parameter in the diagnosis and treatment of patellar instability. However, there is substantial heterogeneity in the literature regarding the most appropriate measurement protocol for assessing TT-TG distance. The objective of this study was to evaluate the inter- and intra-observer reliability of TT-TG distance measurement in healthy knees performed by fellowship-trained orthopaedic sports medicine surgeons.Methods:A convenience sample of 29 magnetic resonance imaging scans (MRIs) of the knee was assembled after screening to ensure there was no ligamentous rupture, meniscal pathology, cartilage injury, subchondral edema, or abnormal masses in the bone or muscle. An a priori power analysis determined that this number of MRIs would provide greater than 90% power to detect a statistically significant difference in intraclass correlation of 0.95 (a < 0.05). Three fellowship-trained orthopaedic sports medicine surgeons read the MRIs and recorded the TT-TG distance using their method of choice. After a minimum of 5 months, the MRIs were read again, this time using a standardized evidence-based method to measure the TT-TG distance. Kappa statistics were calculated to evaluate inter- and intra-observer reliability.Results:Among the initial TT-TG distance measurements, kappa was equal to -0.006 (P = 0.690) when assessing inter-observer reliability. Introduction of the standardized measurement protocol was associated with no significant change in inter-observer reliability (kappa = 0.124, P = 0.070). The individual TT slice that was selected for TT-TG distance measurement demonstrated a kappa statistic of 0.192 (P < 0.001) for the surgeons’ method of choice and a kappa statistic of 0.037 (P = 0.455) for the standardized method. Similarly, TG slice selection using the surgeons’ method of choice yielded a kappa statistic of -0.005 (P = 0.949) and a kappa statistic of -0.102 (P = 0.140) for the standardized method.Conclusions:Our findings demonstrate poor inter-observer reliability of TT-TG distance measurement in healthy knees that was not improved with the application of a standardized evidence-based measurement protocol. TT and TG slices selected by surgeons varied widely. Future research should focus on comparing TT-TG distance measurements across a wider variety of knees (ranging from healthy to those with patellar instability), as this may improve the inter-observer reliability of TT-TG measurement.Table I.Variation in TT-TG Distance Measurement and MRI Slice Selection Between Surgeons

Changes in Metabolism as a Diagnostic Tool for Lung Cancer: Systematic Review.

Lung cancer is the leading cause of cancer-related mortality worldwide, with five-year survival rates varying from 3–62%. Screening aims at early detection, but half of the patients are diagnosed in advanced stages, limiting therapeutic possibilities. Positron emission tomography-computed tomography (PET-CT) is an essential technique in lung cancer detection and staging, with a sensitivity reaching 96%. However, since elevated 18F-fluorodeoxyglucose (18F-FDG) uptake is not cancer-specific, PET-CT often fails to discriminate between malignant and non-malignant PET-positive hypermetabolic lesions, with a specificity of only 23%. Furthermore, discrimination between lung cancer types is still impossible without invasive procedures. High mortality and morbidity, low survival rates, and difficulties in early detection, staging, and typing of lung cancer motivate the search for biomarkers to improve the diagnostic process and life expectancy. Metabolomics has emerged as a valuable technique for these pitfalls. Over 150 metabolites have been associated with lung cancer, and several are consistent in their findings of alterations in specific metabolite concentrations. However, there is still more variability than consistency due to the lack of standardized patient cohorts and measurement protocols. This review summarizes the identified metabolic biomarkers for early diagnosis, staging, and typing and reinforces the need for biomarkers to predict disease progression and survival and to support treatment follow-up.

EFFECT OF MENTAL RELAXATION ON OFFICE BLOOD PRESSURE MEASUREMENT BY OSCILLOMETRY

Objective: Automated office Blood pressure (AOBP) has become the standard of care method of measuring blood pressure. ESC/ESH Clinical Practice Guidelines for the management of arterial hypertension 2018 specifies that Patients should be seated comfortably in a quiet environment for 5 min before beginning BP measurements. However, a variety of visual and auditory stimuli during this period can still result in higher BP recordings. Mental Relaxation induced by reducing visual stimuli and soothing sounds can potentially have an effect on the AOBP recordings. The study aims to evaluate this effect and compare it to the standard protocol of BP measurement. Design and method: 198 consecutive patients were evaluated in the outpatient department. BP was measured by oscillometric method using Microlife BP device following the ESC/ESH guidelines. Patients were seated in a comfortable posture with back and feet supported for a period of 15 minutes before BP measurement. Mental relaxation was induced by reducing visual stimuli using eye shades and ear phones playing soft natural sounds and second set of BP and pulse recordings were done at the end of 5 minutes of relaxation time. Unpaired t test and Chi-Square test were utilized for the statistical analysis. Results: There were 96 males and 102 females with mean age of 53.13 ± 13.95 yrs History of hypertension was present in 105 subjects Using standard BP measurement protocol the mean systolic BP was 142.33 ± 18.85 mm hg, mean diastolic BP was 83.22 ± 8.5 mm hg and mean pulse rate was 84.55 ± 15.27 per minute. The mean change after Mental relaxation augmented period was 6.71 ± 13.66 mm hg in systolic BP (p value 0.0001), 2.85 ± 7.67 mm hg in diastolic BP (p value 0.0001) and 2.81 ± 8.71 per minute in pulse rate (p value 0.0001) Conclusions: Mental relaxation augmented physical rest before measurement of BP by oscillometric method in outpatient clinic results in significant reduction in BP (both systolic and diastolic) and pulse rate compared to standard BP measurement protocol. These values may be more realistic as they are likely to have reduced white coat effect and environmental influences.

Subclinical carotid artery atherosclerosis and cognitive function in older adults

BackgroundThe combined effects of increased life expectancy and the considerable number of persons reaching old age will magnify the dementia epidemic in the USA. Demonstration that subclinical atherosclerosis precedes and is associated with cognitive impairment suggests a modifiable risk factor for age-associated cognitive impairment and dementia. The purpose of this study is to determine whether subclinical atherosclerosis as measured by carotid artery intima-media thickness (CIMT) is associated with changes in cognitive function over time in older adults.MethodsThis study combined longitudinal data from three clinical trials conducted between 2000 and 2013: the B-Vitamin Atherosclerosis Intervention Trial (BVAIT), the Women’s Isoflavone Soy Health (WISH) trial, and the Early versus Late Intervention Trial with Estradiol (ELITE). Participants were recruited from the general population in the Greater Los Angeles area and were free of cardiovascular disease and diabetes; no cognitive or psychiatric exclusion criteria were specified. The same standardized protocol for ultrasound image acquisition and measurement of CIMT was used in all trials. CIMT measurements performed at baseline and 2.5 years were used in these analyses. Cognitive function was assessed at baseline and 2.5 years using a battery of 14 standardized cognitive tests. All clinical trials were conducted at the University of Southern California Atherosclerosis Research Unit, Los Angeles, and had at least 2.5 years of cognitive follow-up.ResultsA total of 308 men and 1187 women, mean age of 61 years, were included in the combined longitudinal dataset for the primary analysis. No associations were found between CIMT and cognitive function at baseline or at 2.5 years. There was a weak inverse association between CIMT measured at baseline and change in global cognition assessed over 2.5 years (β (SE) = − 0.056 (0.028) units per 0.1 mm CIMT, 95% CI − 0.110, − 0.001, p = 0.046). No associations between CIMT at baseline and changes in executive function, verbal memory, or visual memory were found.ConclusionsIn this sample of healthy older adults, our findings suggest an association between subclinical atherosclerosis and change in global cognitive function over 2.5 years. Stronger associations were observed longitudinally over 2.5 years than cross-sectionally. When analysis was stratified by age group (<65 and ≥65 years old), the inverse association remained statistically significant for participants in the older age group. Subclinical atherosclerosis of the carotid artery may be a modifiable correlate of cognitive decline in middle and older age.Trial registrationBVAIT, NCT00114400. WISH, NCT00118846. ELITE, NCT00114517.

Hypertension Prevalence, Awareness, and Control Among Parents of School-Aged Children in the United Arab Emirates.

BackgroundIncreased blood pressure (BP) is a major cardiovascular disease risk factor. The study aimed to determine the prevalence and predictors of hypertension and its awareness and control among parents of school-aged children in the United Arab Emirates (UAE).MethodsA total of 605 parents participated in this cross-sectional study. Information on socio-demographics, lifestyle factors, and history of chronic disease were collected through an adapted version of the World Health Organization STEPS questionnaire. Fasting blood glucose samples, BP measurements, body mass index (BMI), and waist and hip circumference were obtained using standard measurement protocols. Prevalence of hypertension was identified in the cohorts by defining hypertension using the 2017 American College of Cardiology (ACC) and the American Heart Association (AHA) guidelines (BP≥130/80 mmHg) and the World Health Organization-International Society of Hypertension Guidelines Orchid (BP≥140/90 mmHg) in association with antihypertensive medication use.ResultsThe mean age of participants was 42.9±7.9 years. The prevalence of hypertension was 37.2% (95% CI: 33.5–41.2) and 18.0% (95% CI: 15.2–21.3), using the 2017 and the previous WHO definitions, respectively. Little over half of the sample (51.5%) who were aware of having hypertension reported using antihypertensive medications. Of those reporting the use of antihypertensive medications in the past two days, 13 of 33 patients (39.4%) had their hypertension under control (<140/90 mmHg). The independent correlates of hypertension included age [(adjusted odds ratio (AOR): 1.09 (1.05–1.13], male sex [AOR: 2.48 (1.41–4.34], college or higher education [AOR: 0.22 (0.09–0.56)], family history of hypertension [AOR: 2.03 (1.17–3.53)], obesity [AOR: 3.15 (1.24–7.12)], and moderate or vigorous physical activity [AOR: 0.50 (0.26–0.98)].ConclusionHypertension is prevalent among parents of school-going children. Improving lifestyle, health literacy, and introducing innovative models to raise awareness and education about hypertension are essential to achieve sustainable development goals (SDGs).

Improving Blood Pressure Screening in Neonatal Follow-up Clinic: A Quality Improvement Initiative.

Introduction:The American Academy of Pediatrics recommends blood pressure screening at every health care encounter in children younger than 3 years if they have a history of prematurity or other neonatal complications requiring intensive care because these children have an increased risk for hypertension.Methods:A multidisciplinary team conducted a quality improvement initiative to improve blood pressure screening at a single-center outpatient neonatal follow-up clinic. We developed a focused intervention program including a standardized blood pressure measurement protocol, staff training and education, and streamlined documentation. We conducted two Plan-Do-Study-Act cycles from November 2019 to January 2021. The outcome measure was the percentage of patients with a blood pressure measurement. Process measures included the percentage of medical assistants educated on the new protocol, percentage of patients 3 years, and younger old with the first blood pressure measurement taken from the right arm, and the percentage of patients 1 year and younger with 3 documented blood pressures. The balancing measure was staff satisfaction with time to obtain vital signs. We used statistical process control charts and Wilcoxon rank-sum test.Results:At baseline, only 15.3% of patients had documented blood pressure. During the 10-month intervention period, there were 954 patient visits. Overall, blood pressure measurement increased to 54.7% with study interventions. The balancing measure was not negatively impacted.Conclusions:After implementing a program of focused interventions, we substantially improved the frequency of blood pressure measurements and increased adherence to American Academy of Pediatrics screening guidelines. Improved blood pressure screening allows us to identify and evaluate at-risk infants after hospital discharge.

Analysis of the Active Measurement Systems of the Thoracic Range of Movements of the Spine: A Systematic Review and a Meta-Analysis.

(1) Objective: to analyze current active noninvasive measurement systems of the thoracic range of movements of the spine. (2) Methods: A systematic review and meta-analysis were performed that included observational or clinical trial studies published in English or Spanish, whose subjects were healthy human males or females ≥18 years of age with reported measurements of thoracic range of motion measured with an active system in either flexion, extension, lateral bending, or axial rotation. All studies that passed the screening had a low risk of bias and good methodological results, according to the PEDro and MINORS scales. The mean values and 95% confidence interval of the reported measures were calculated for different types of device groups. To calculate the differences between the type of device measures, studies were pooled for different types of device groups using Review Manager software. (3) Results: 48 studies were included in the review; all had scores higher than 7.5 over 10 on the PEDro and MINORs methodological rating scales, collecting a total of 2365 healthy subjects, 1053 males and 1312 females; they were 39.24 ± 20.64 years old and had 24.44 ± 3.81 kg/m2 body mass indexes on average. We summarized and analyzed a total of 11,892 measurements: 1298 of flexoextension, 1394 of flexion, 1021 of extension, 491 of side-to-side lateral flexion, 637 of right lateral flexion, 607 of left lateral flexion, 2170 of side-to-side rotation, 2152 of right rotation and 2122 of left rotation. (4) Conclusions: All collected and analyzed measurements of physiological movements of the dorsal spine had very disparate results from each other, the cause of the reason for such analysis is that the measurement protocols of the different types of measurement tools used in these measurements are different and cause measurement biases. To solve this, it is proposed to establish a standardized measurement protocol for all tools.

Exploring the Potential of Mobile Laser Scanning to Quantify Forest Structural Complexity

Today, creating or maintaining forest structural complexity is a management paradigm in many countries due to the positive relationships between structural complexity and several forest functions and services. In this study, we tested whether the box-dimension (Db), a holistic and objective measure to describe the structural complexity of trees or forests, can be used to quantify the structural complexity of 14 European beech (Fagus sylvatica L.) dominated forest plots by means of mobile laser scanning (MLS). The goal of this study was to explore the potential of this approach for quantifying the effect of leaves (summer vs winter) and management (lately unmanaged vs managed) on forest structural complexity. The findings suggest that repeated measurements on the same site and at the same time yielded consistent results if the measuring scheme is standardized. The results also showed that standardized measurement protocols allowed quantifying differences in forest structural complexity due to season. The highest stand structural complexity was found in leaf-on condition during summer, with the complexity being significantly higher than in winter condition. Also, in case of our beech-dominated plots, managed forests were more complex in structure than formerly managed but now unmanaged forests. This study illustrates the potential of MLS for monitoring the changes in forest structural complexity and allows correcting stand structural information for seasonality.

How to accurately measure blood pressure

One very important clinical skill for every veterinary nurse is the accurate measurement of arterial blood pressure in both conscious and anaesthetised patients. These readings are useful for a wide variety of monitoring as well as diagnostic purposes. It is critical to produce accurate results so that patients may receive the best care and treatment as soon as possible. If blood pressure measurement is not performed correctly there is the possibility of an error, which can negatively impact patient management. Blood pressure measurements are sensitive: their accuracy can be affected by the environment the patient is in, the patient's behaviour, measurement procedures, devices used for the measurement and the nurse or clinician carrying out the measurement. To minimise errors in blood pressure measurement, a detailed, standardised measurement protocol is necessary with adequate training. This allows for accurate, repeatable and reliable measurement of blood pressure to be achieved each time.

Inter-Rater Reliability of Total Cardiac Volume Measurement for Heart Transplantation: An ACTION Collaborative Study

<h3>Purpose</h3> There is increasing evidence that size-matching pediatric donor hearts by direct measurement of total cardiac volume (TCV) is superior to traditional methods based on body size. Currently, there are no standardized protocols for assessing TCV or studies evaluating the inter-rater reliability of such measurements, both critical requirements to support a national TCV-based size-matching system. We sought to evaluate the inter-rater reliability of a standardized TCV measurement protocol across multiple pediatric transplant centers. <h3>Methods</h3> A total of nine pediatric transplant centers within the Advanced Cardiac Therapies Improving Outcomes Network (ACTION) performed TCV assessments in 12 test subjects. TCV was assessed from computed tomography (CT) or magnetic resonance imaging (MRI) files using a standard TCV measurement protocol that was reviewed with each center. Interclass correlation coefficients (ICC) were calculated between all centers and each center in relation to the primary center. <h3>Results</h3> Of the 12 test subjects, the median age was 9.5 years (range 18 days to 30 years), the median weight was 28 (2.5 to 89) kg; 3 had no heart disease (donors), 3 had cardiomyopathy (CMP); 6 had congenital heart disease (CHD) including 4 single-ventricle CHD (1 shunted newborn, 2 Glenns, and 2 Fontans) and 2 biventricular CHD (aortic stenosis, tetralogy of Fallot/pulmonary atresia). Imaging modalities included 7 contrast CTs (CCT), 3 non-contrast CT (NCT), and 2 MRI. TCV was performed by 7 cardiologists, 1 radiologists, and 1 biomedical engineer. Overall compared to the primary center, the ICC across all 8 centers for all 12 scans was 0.99 (95% CI 0.98-0.99), including in normal hearts 0.98 (0.95-1.0), in CMP 0.99 (0.96-1.0), in CHD 0.99 (95% CI 0.99-0.99) and single ventricle CHD 0.99 (95% CI 0.97-0.99). By imaging modality, ICC for NCT was 0.98 (0.94-1.0), CCT 0.99 (0.99-0.99), and MRI 0.79 (0.32-1.0). By age, infants ICC was 0.99 (0.95-1.0), children 0.99 (0.98-0.99), and adults 0.97 (0.81-1.0). <h3>Conclusion</h3> The inter-rater reliability for total cardiac volume assessment in healthy and diseased hearts appears excellent across a variety of age groups and diagnoses. ICC for MRI was modest compared to CT imaging albeit the small sample size. Further validation of a standardized TCV measurement protocol among ACTION transplant centers is warranted.

Assessing variability of aerosols generated from e-Cigarettes

While some in vitro and in vivo experiments have studied the toxic effects of e-cigarette (e-cig) components, the typical aerosol properties released from e-cigarettes have not been well characterized. In the present study, we characterized the variability in mass concentration and particle size distribution associated with the aerosol generation of different devices and e-liquid compositions in an experimental setup. The findings of this study indicate a large inter-day variability in the experiments, likely due to poor quality control in some e-cig devices, pointing to the need for a better understanding of all the factors affecting exposures in in vitro and in vivo experiments, and the development of standardized protocols for generation and measurement of e-cig aerosols.

Novel values in the radiographic diagnosis of ligamentous Lisfranc injuries

BackgroundLigamentous Lisfranc instability is commonly missed on unilateral radiographs. However, measurement protocols for bilateral weightbearing radiographs have not been standardized. The primary aim of this study was to investigate the optimal cut-off values for diagnosing Lisfranc instability by evaluating the side-to-side differences of preoperative bilateral weightbearing radiographs among patients with surgically-confirmed ligamentous Lisfranc instability. A secondary aim was to investigate whether the midfoot measurements for detecting Lisfranc injury could also be used in patients with a pre-existing bilateral Hallux Valgus (HV) deformity by evaluating whether the Lisfranc measurements could be affected by a foot deformity as HV. Patients and methodsPatients who underwent surgical repair of ligamentous Lisfranc instability, as well as a separate cohort with bilateral hallux valgus deformity, were included in this multicenter retrospective cohort study. A standardized radiographic measurement protocol was used to assess the midfoot and a receiver operator correlation (ROC) analysis was used to identify the optimal cut-off value for measurements. Interclass Correlation (ICC) scores were calculated to assess the interrater reliability of the Lisfranc area measurement. ResultsForty-seven patients were included in the Lisfranc group with a mean age of 33 (± 15) years and 25 patients were included in the HV group with a mean age of 51 (± 15) years. For the Lisfranc group, measurements that demonstrated a significant side-to-side difference included; increased C1M2 diastasis of 2.4 mm (± 1.4, P<0.001), increased C1M2 surface area of 24 mm2 (± 15, P<0.001), C2M2 malignment by 1.7 mm (± 1.2, P<0.001), second tarsometatarsal joint dorsal step-off sign by 0.8 mm (± 0.7, P<0.001), and arch height by 2.5 mm (± 6.4, P<0.048), all greater on the injured side. In the HV group, side-to-side measurements were not significantly different. There was no significant difference comparing the M1M2 measurement in the HV group with the injured (P = 0.16) or uninjured (P = 0.08) foot in the Lisfranc group. The optimal cut-off points were between the injured and uninjured foot in the Lisfranc group were 2.1 mm for C1M2 diastasis, 0.7 mm for the C2M2 alignment, and 30 mm2 for the C1M2 surface area. The ICC-score for the second C1M2 area measurement was 0.88. ConclusionBilateral foot weightbearing radiographs can effectively diagnose ligamentous Lisfranc instability using a standardized measurement protocol. Malalignment of the medial aspect of the second metatarsal base ≥0.3 mm relatively to the intermediate cuneiform offers a high sensitivity, and distance ≥2.1 mm between the second metatarsal base and the medial cuneiform has a high specificity. Intermetatarsal distance between the first and second metatarsal base has a low sensitivity and specificity and should not be used in solitary for diagnosis. Level of evidenceLevel III, retrospective comparative study