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PubMed2006

Multivariable risk prediction can greatly enhance the statistical power of clinical trial subgroup analysis.

BACKGROUND: When subgroup analyses of a positive clinical trial are unrevealing, such findings are commonly used to argue that the treatment's benefits apply to the entire study population; however, such analyses are often limited by poor statistical power. Multivariable risk-stratified analysis has been proposed as an important advance in investigating heterogeneity in treatment benefits, yet no one has conducted a systematic statistical examination of circumstances influencing the relative merits of this approach vs. conventional subgroup analysis. METHODS: Using simulated clinical trials in which the probability of outcomes in individual patients was stochastically determined by the presence of risk factors and the effects of treatment, we examined the relative merits of a conventional vs. a "risk-stratified" subgroup analysis under a variety of circumstances in which there is a small amount of uniformly distributed treatment-related harm. The statistical power to detect treatment-effect heterogeneity was calculated for risk-stratified and conventional subgroup analysis while varying: 1) the number, prevalence and odds ratios of individual risk factors for risk in the absence of treatment, 2) the predictiveness of the multivariable risk model (including the accuracy of its weights), 3) the degree of treatment-related harm, and 5) the average untreated risk of the study population. RESULTS: Conventional subgroup analysis (in which single patient attributes are evaluated "one-at-a-time") had at best moderate statistical power (30% to 45%) to detect variation in a treatment's net relative risk reduction resulting from treatment-related harm, even under optimal circumstances (overall statistical power of the study was good and treatment-effect heterogeneity was evaluated across a major risk factor [OR = 3]). In some instances a multi-variable risk-stratified approach also had low to moderate statistical power (especially when the multivariable risk prediction tool had low discrimination). However, a multivariable risk-stratified approach can have excellent statistical power to detect heterogeneity in net treatment benefit under a wide variety of circumstances, instances under which conventional subgroup analysis has poor statistical power. CONCLUSION: These results suggest that under many likely scenarios, a multivariable risk-stratified approach will have substantially greater statistical power than conventional subgroup analysis for detecting heterogeneity in treatment benefits and safety related to previously unidentified treatment-related harm. Subgroup analyses must always be well-justified and interpreted with care, and conventional subgroup analyses can be useful under some circumstances; however, clinical trial reporting should include a multivariable risk-stratified analysis when an adequate externally-developed risk prediction tool is available.

Clinical Trials as Topic↗

PubMed2004

Maximizing power and minimizing treatment failures in clinical trials.

BACKGROUND: Response-adaptive randomization procedures have a long history in the theoretical statistics literature over the past four decades. The main idea historically was to develop randomization procedures that place fewer patients on the inferior treatment. More recent research has changed the main focus to that of usual considerations in typical clinical trials: power, sample size, expected treatment failures, maintaining randomization, among others. METHODS: We describe response-adaptive randomization procedures for simple clinical trials comparing two binomial success probabilities, including the randomized play-the-winner rule, the drop-the-loser rule, and a modification of the doubly-adaptive biased coin design. We treat as our principal goal minimizing expected treatment failures while preserving power and randomization. Based on some recent theoretical literature, the basic guidelines for selecting an appropriate procedure include targeting optimal allocation, having small variability, and preserving randomization. We use simulation to compare power and expected treatment failures according to these guidelines. RESULTS: When the two treatments had high probabilities (> 0.5) of success, the randomized play-the-winner rule was less powerful than complete randomization and the drop-the-loser rule by 1-3 percent with slightly larger expected number of treatment failures than the drop-the-loser rule. For all the success probabilities we examined, the drop-the-loser rule was within 1 percent of the power of complete randomization with a modest reduction of treatment failures. The doubly-adaptive biased coin design was as powerful or slightly more powerful than complete randomization in every case and expected treatment failures were always less, with modest reductions of the order of 0.3 percent to 8.3 percent. CONCLUSIONS: We conclude that the drop-the-loser rule and a modification of the doubly-adaptive biased coin design are the preferred procedures, and simulations show that these procedures yield a modest reduction in expected treatment failures while preserving power over complete randomization.

Binomial Distribution↗

PubMed1992

Statistical power and the Rorschach: 1975-1991.

The Rorschach Inkblot Test has been the source of long-standing controversies as to its nature and its psychometric properties. Consistent with behavioral science research in general, the concept of statistical power has been entirely ignored by Rorschach researchers. The concept of power is introduced and discussed, and a power survey of the Rorschach literature published between 1975 and 1991 in the Journal of Personality Assessment, Journal of Consulting and Clinical Psychology, Journal of Abnormal Psychology, Journal of Clinical Psychology, Journal of Personality, Psychological Bulletin, American Journal of Psychiatry, and Journal of Personality and Social Psychology was undertaken. Power was calculated for 2,300 statistical tests in 158 journal articles. Power to detect small, medium, and large effect sizes was .13, .56, and .85, respectively. Similar to the findings in other power surveys conducted on behavioral science research, we concluded that Rorschach research is underpowered to detect the differences under investigation. This undoubtedly contributes to the inconsistency of research findings which has been a source of controversy and criticism over the decades. It appears that research conducted according to the Comprehensive System for the Rorschach is more powerful. Recommendations are offered for improving power and strengthening the design sensitivity of Rorschach research, including increasing sample sizes, use of parametric statistics, reduction of error variance, more accurate reporting of findings, and editorial policies reflecting concern about the magnitude of relationships beyond an exclusive focus on levels of statistical significance.

Journal Article↗

PubMed2003

Testosterone dose-dependently increases maximal voluntary strength and leg power, but does not affect fatigability or specific tension.

Testosterone supplementation in men increases fat-free mass, but whether measures of muscle performance, such as maximal voluntary strength, power, fatigability, or specific tension, are improved has not been determined. Furthermore, the extent to which these measures of muscle performance are related to testosterone dose or circulating concentration is unknown. To examine the relationship between testosterone dose and muscle performance, 61 healthy, eugonadal young men (aged 18-35 yr) were randomized to 1 of 5 groups, each receiving a long-acting GnRH agonist to suppress endogenous testosterone production plus weekly injections of 25, 50, 125, 300, or 600 mg testosterone enanthate for 20 wk. These doses produced mean nadir testosterone concentrations of 253, 306, 542, 1345, and 2370 ng/dl, respectively. Maximal voluntary muscle strength and fatigability were determined by a seated leg press exercise. Leg power was measured using a validated leg power instrument. Specific tension was estimated by the ratio of one repetition maximum muscle strength to thigh muscle volume determined by magnetic resonance imaging. Testosterone administration was associated with a dose-dependent increase in leg press strength and leg power, but muscle fatigability did not change significantly during treatment. Changes in leg press strength were significantly correlated with total (r = 0.46; P = 0.0005) and free (r = 0.38; P = 0.006) testosterone as was leg power (total testosterone: r = 0.38; P = 0.007; free testosterone: r = 0.35; P = 0.015), but not muscle fatigability. Serum IGF-I concentrations were not significantly correlated with leg strength, power, or fatigability. Specific tension did not change significantly at any dose. We conclude that the effects of testosterone on muscle performance are specific; it increases maximal voluntary strength and leg power, but does not affect fatigability or specific tension. The changes in leg strength and power are dependent on testosterone dose and circulating testosterone concentrations and exhibit a log-linear relationship with serum total and free testosterone. Failure to observe a significant testosterone dose relationship with fatigability suggests that testosterone does not affect this component of muscle performance and that different components of muscle performance are regulated by different mechanisms.

Adolescent↗

PubMed2003

Aerodynamic force generation and power requirements in forward flight in a fruit fly with modeled wing motion.

Aerodynamic force generation and power requirements in forward flight in a fruit fly with modeled wing motion were studied using the method of computational fluid dynamics. The Navier-Stokes equations were solved numerically. The solution provided the flow velocity and pressure fields, from which the vorticity wake structure and the unsteady aerodynamic forces and torques were obtained (the inertial torques due to the acceleration of the wing-mass were computed analytically). From the flow-structure and force information, insights were gained into the unsteady aerodynamic force generation. On the basis of the aerodynamic and inertial torques, the mechanical power was obtained, and its properties were investigated. The unsteady force mechanisms revealed previously for hovering (i.e. delayed stall, rapid acceleration at the beginning of the strokes and fast pitching-up rotation at the end of the strokes) apply to forward flight. Even at high advance ratios, e.g. J=0.53-0.66 (J is the advance ratio), the leading edge vortex does not shed (at such advance ratios, the wing travels approximately 6.5 chord lengths during the downstroke). At low speeds (J approximately equal to 0.13), the lift (vertical force) for weight support is produced during both the down- and upstrokes (the downstroke producing approximately 80% and the upstroke producing approximately 20% of the mean lift), and the lift is contributed mainly by the wing lift; the thrust that overcomes the body drag is produced during the upstroke, and it is contributed mainly by the wing drag. At medium speeds (J approximately equal to 0.27), the lift is mainly produced during the downstroke and the thrust mainly during the upstroke; both of them are contributed almost equally by the wing lift and wing drag. At high speeds (J approximately equal to 0.53), the lift is mainly produced during the downstroke and is mainly contributed by the wing drag; the thrust is produced during both the down- and upstrokes, and in the downstroke, is contributed by the wing lift and in the upstroke, by the wing drag. In forward flight, especially at medium and high flight speeds, the work done during the downstroke is significantly greater than during the upstroke. At advance ratios J approximately equal to 0.13, 0.27 and 0.53, the work done during the downstroke is approximately 1.6, 2.8 and 4.2 times as much as that during the upstroke, respectively. At J=0 (hovering), the body-mass-specific power is approximately 29 W kg(-1); at J=0.13 and 0.27, the power is approximately 10% less than that of hovering; at J=0.40, the power is approximately the same as that of hovering; when J is further increased, the power increases sharply. The graph of power against flying speeds is approximately J-shaped. From the graph of power against flying speeds, it is predicted that the insect usually flies at advance ratios between zero and 0.4, and for fast flight, it would fly at an advance ratio between 0.4 and 0.53.

Animals↗

PubMed2004

Moments and power generated by the horse (Equus caballus) hind limb during jumping.

The ability to jump over an obstacle depends upon the generation of work across the joints of the propelling limb(s). The total work generated by one hind limb of a horse and the contribution to the total work by four joints of the hind limb were determined for a jump. It was hypothesized that the hip and ankle joints would have extensor moments performing positive work, while the knee would have a flexor moment and perform negative work during the jump. Ground reaction forces and sagittal plane kinematics were simultaneously recorded during each jumping trial. Joint moment, power and work were determined for the metatarsophalangeal (MP), tarsal (ankle), tibiofemoral (knee) and coxofemoral (hip) joints. The hip, knee and ankle all flexed and then extended and the MP extended and then flexed during ground contact. Consistent with our hypothesis, large extensor moments were observed at the hip and ankle joints and large flexor moments at the knee and MP joints throughout ground contact of the hind limb. Peak moments tended to occur earlier in stance in the proximal joints but peak power generation of the hind limb joints occurred at similar times except for the MP joint, with the hip and ankle peaking first followed by the MP joint. During the first portion of ground contact (approximately 40%), the net result of the joint powers was the absorption of power. During the remainder of the contact period, the hind limb generated power. This pattern of power absorption followed by power generation paralleled the power profiles of the hip, ankle and MP joints. The total work performed by one hind limb was 0.71 J kg(-1). Surprisingly, the knee produced 85% of the work (0.60 J kg(-1)) done by the hind limb, and the positive work performed by the knee occurred during the first 40% of the take-off. There is little net work generated by the other three joints over the entire take-off. Velocity of the tuber coxae (a landmark on the pelvis of the animal) was negative (downward) during the first 40% of stance, which perhaps reflects the negative work performed to decrease the potential energy during the first 40% of contact. During the final 60% of contact, the hip, ankle and MP joints generate positive work, which is reflected in the increase of the animal's potential energy.

Animals↗

PubMed1997

Why do tuna maintain elevated slow muscle temperatures? Power output of muscle isolated from endothermic and ectothermic fish.

It has been hypothesised that regional endothermy has evolved in the muscle of some tunas to enhance the locomotory performance of the fish by increasing muscle power output. Using the work loop technique, we have determined the relationship between cycle frequency and power output, over a range of temperatures, in isolated bundles of slow muscle fibres from the endothermic yellowfin tuna (Thunnus albacares) and its ectothermic relative the bonito (Sarda chiliensis). Power output in all preparations was highly temperature-dependent. A counter-current heat exchanger which could maintain a 10 degrees C temperature differential would typically double maximum muscle power output and the frequency at which maximum power is generated (fopt). The deep slow muscle of the tuna was able to operate at higher temperatures than slow muscle from the bonito, but was more sensitive to temperature change than more superficially located slow fibres from both tuna and bonito. This suggests that it has undergone some evolutionary specialisation for operation at higher, but relatively stable, temperatures. fopt of slow muscle was higher than the tailbeat frequency of undisturbed cruising tuna and, together with the high intrinsic power output of the slow muscle mass, suggests that cruising fish have a substantial slow muscle power reserve. This reserve should be sufficient to power significantly higher sustainable swimming speeds, presumably at lower energetic cost than if intrinsically less efficient fast fibres were recruited.

Animals↗

PubMed1997

Work and power output in the hindlimb muscles of Cuban tree frogs Osteopilus septentrionalis during jumping.

It has been suggested that small frogs use a catapult mechanism to amplify muscle power production during the takeoff phase of jumping. This conclusion was based on an apparent discrepancy between the power available from the hindlimb muscles and that required during takeoff. The present study provides integrated data on muscle contractile properties, morphology and jumping performance that support this conclusion. We show here that the predicted power output during takeoff in Cuban tree frogs Osteopilus septentrionalis exceeds that available from the muscles by at least sevenfold. We consider the sartorius muscle as representative of the bulk of the hindlimb muscles of these animals, because this muscle has properties typical of other hindlimb muscles of small frogs. At 25 degrees C, this muscle has a maximum shortening velocity (Vmax) of 8.77 +/- 0.62 L0 s-1 (where L0 is the muscle length yielding maximum isometric force), a maximum isometric force (P0) of 24.1 +/- 2.3 N cm-2 and a maximum isotonic power output of 230 +/- 9.2 W kg-1 of muscle (mean +/- S.E.M.). In contrast, the power required to accelerate the animal in the longest jumps measured (approximately 1.4 m) is more than 800 W kg-1 of total hindlimb muscle. The peak instantaneous power is expected to be twice this value. These estimates are probably conservative because the muscles that probably power jumping make up only 85% of the total hindlimb muscle mass. The total mechanical work required of the muscles is high (up to 60 J kg-1), but is within the work capacities predicted for vertebrate skeletal muscle. Clearly, a substantial portion of this work must be performed and stored prior to takeoff to account for the high power output during jumping. Interestingly, muscle work output during jumping is temperature-dependent, with greater work being produced at higher temperatures. The thermal dependence of work does not follow from simple muscle properties and instead must reflect the interaction between these properties and the other components of the skeletomuscular system during the propulsive phase of the jump.

Animals↗

PubMed2000

The influence of temperature on power production during swimming. I. In vivo length change and stimulation pattern.

Ectothermal animals are able to locomote effectively over a wide range of temperatures despite low temperature reducing the power output of their muscles. It has been suggested that animals recruit more muscle fibres and faster fibre types to compensate for the reduced power output at low temperature, but it is not known how much low temperature actually reduces power output in vivo. 'Optimized' work-loop measurements, which are thought to approximate muscle function in vivo, give a Q(10) of approximately 2.3 for power output of scup (Stenotomus chrysops) red muscle between 10 degrees C and 20 degrees C. However, because of the slower muscle relaxation rate at low temperatures, 'optimizing' work loops requires stimulation duration to be reduced and oscillation frequency to be decreased to obtain maximal power output. Previous fish swimming experiments suggest that similar optimization may not occur in vivo, and this may have substantial consequences in terms of muscle power generation and swimming at low temperatures. To assess more precisely the effects of temperature on muscle performance and swimming, in the present study, we measured the length change, stimulation duration and stimulus phase of red muscle at various positions along scup swimming at several speeds at 10 degrees C and 20 degrees C. In a companion study, we determined the effects of temperature on in vivo power generation by driving muscle fibre bundles through these in vivo length changes and stimulation conditions, and measuring the resulting power output. The most significant finding from the present study is that, despite large differences in the in vivo parameters along the length of the fish (a decrease in stimulus duration, an increase in strain and a negative shift in phase) moving posteriorly, these parameters do not change with temperature. Thus, although the nervous system of fish could, in theory, compensate for slow muscle relaxation by greatly reducing muscle stimulation duration at low temperatures, it does not. This lack of compensation to low temperatures might reflect a potential limitation in neural control.

Animals↗

PubMed2002

Lift and power requirements of hovering flight in Drosophila virilis.

The lift and power requirements for hovering flight in Drosophila virilis were studied using the method of computational fluid dynamics. The Navier-Stokes equations were solved numerically. The solution provided the flow velocity and pressure fields, from which the unsteady aerodynamic forces and moments were obtained. The inertial torques due to the acceleration of the wing mass were computed analytically. On the basis of the aerodynamic forces and moments and the inertial torques, the lift and power requirements for hovering flight were obtained. For the fruit fly Drosophila virilis in hovering flight (with symmetrical rotation), a midstroke angle of attack of approximately 37 degrees was needed for the mean lift to balance the insect weight, which agreed with observations. The mean drag on the wings over an up- or downstroke was approximately 1.27 times the mean lift or insect weight (i.e. the wings of this tiny insect must overcome a drag that is approximately 27% larger than its weight to produce a lift equal to its weight). The body-mass-specific power was 28.7 W kg(-1), the muscle-mass-specific power was 95.7 W kg(-1) and the muscle efficiency was 17%. With advanced rotation, larger lift was produced than with symmetrical rotation, but it was more energy-demanding, i.e. the power required per unit lift was much larger. With delayed rotation, much less lift was produced than with symmetrical rotation at almost the same power expenditure; again, the power required per unit lift was much larger. On the basis of the calculated results for power expenditure, symmetrical rotation should be used for balanced, long-duration flight and advanced rotation and delayed rotation should be used for flight control and manoeuvring. This agrees with observations.

Animals↗

PubMed2003

Effects of pseudoephedrine on maximal cycling power and submaximal cycling efficiency.

PURPOSE: To study the effects of a therapeutic dose of pseudoephedrine on anaerobic cycling power and aerobic cycling efficiency. METHODS: Eleven healthy moderately trained males (VO (2peak) 4.4 +/- 0.8 L x min(-1) participated in a double-blinded crossover design. Subjects underwent baseline (B) tests for anaerobic (Wingate test) and aerobic (VO (2peak) test) cycling power. Subjects ingested either 60 mg of pseudoephedrine hydrochloride (D) or a placebo (P) and, after 90 min of rest, a Wingate and a cycling efficiency test were performed. During the cycling efficiency test, heart rate (HR) and VO(2) were averaged for the last 5 min of a 10-min cycle at 40% and 60% of the peak power achieved during the VO (2peak) test. RESULTS: There were no significant differences in peak power (B = 860 +/- 154, D = 926 +/- 124, P = 908 +/- 118 W), total work (B = 20 +/- 3, D = 21 +/- 3, P = 21 +/- 3 kJ), or fatigue index (B = 39 +/- 8, D = 45 +/- 5, P = 43 +/- 5%). There were no significant differences in HR at 40% power (D = 138 +/- 10, P = 137 +/- 10 beats.min-1) or 60% power (D = 161 +/- 11, P = 160 +/- 11 beats x min(-1). There were no significant differences in cycling efficiency at 40% power (D = 18.8 +/- 1.8, P = 18.5 +/- 1.8%) or 60% power (D = 20.3 +/- 2.0, P = 20.1 +/- 2.1%). CONCLUSION: A therapeutic dose of pseudoephedrine hydrochloride does not affect anaerobic cycling performance or aerobic cycling efficiency.

Adult↗

PubMed2005

Consequences of ankle joint fixation on FES cycling power output: a simulation study.

INTRODUCTION: During fixed-ankle FES cycling in paraplegics, in which the leg position is completely determined by the crank angle, mechanical power output is low. This low power output limits the cardiovascular load that could be realized during FES ergometer cycling, and limits possibilities for FES cycling as a means of locomotion. Stimulation of ankle musculature in a released-ankle setup might increase power output. However, releasing the ankle joint introduces a degree of freedom in the leg that has to be controlled, which imposes constraints on the stimulation pattern. METHODS: In this study, a forward dynamics modeling/simulation approach was used to assess the potential effect of releasing the ankle on the maximal mechanical power output. RESULTS: For the released-ankle setup, the optimal stimulation pattern was found to be less tightly related to muscle shortening/lengthening than for the fixed-ankle setup, which indicates the importance of the constraints introduced by releasing the ankle. As a result, the maximal power output for 45-RPM cycling in the released-ankle setup was found to be about 10% lower than with a fixed ankle, despite the additional muscle mass available for stimulation. Power output for the released-ankle setup can be improved by tuning the point of contact between the foot and pedal to the relative strength of the ankle plantar flexors. For the model used, power output was 14% higher than for the fixed-ankle setup when this point of contact was moved posteriorly by 0.075 m. CONCLUSION: Releasing the ankle joint and stimulating the triceps surae and tibialis anterior is expected to result in a modest increase in power output at best.

Acceleration↗

PubMed1993

EEG power spectrum changes due to listening to pleasant music and their relation to relaxation effects.

Electroencephalogram (EEG) power spectrum changes induced by pleasant music (2-min. fractions of 6 samples of music [famous classical and commercially available "alpha music" at 10-sec. intervals]) were investigated in relation to changes in 16 kinds of psychosomatic feelings. Subjects were 42 healthy young people aged 18-25 yrs. Two major components, "pleasant & relaxed" and "calm", were extracted through principal component analysis of the feeling changes, both of which were related to the "relaxation effects" of the music. These component scores were not related to the changes of EEG powers in the delta, theta, alpha and beta frequency components in 6 regions (frontal, parietal and occipital regions of the left and right hemispheres), when examined separately. However, the change of the total delta power for all the regions was significantly associated with both the "pleasant & relaxed" and "calm" component scores. The association between the total theta power change and "calm" score was found to be insignificant if the type-A personality variable was added to their regression model. On the other hand, the alpha-peak frequency was inversely related to the decrease of the "calm" score in the left occipital region (LO). The reduction of the alpha-peak power in the LO was also significant, and was associated not with the alpha-peak frequency changes but inversely with the "calm" score, although these alpha-component changes were not shown to be modified by the personality. Thus, the present study suggests, as a preliminary finding, that the "relaxation effects" of pleasant music can be associated with the EEG power spectrum component changes, especially with the change in the total theta power and possibly with that in the alpha power in the occipital, and the frequency shift of the peak in the alpha-range. Some of the associations were also shown to vary for the type-A personality, suggesting a clue to relating the personality to a differential stress-related psychosomatic trait, although the physiological significance of the changes in the low-frequency component range as well as those in the alpha-frequency component, which are obtained through FFT, should be further clarified.

Adolescent↗

PubMed2003

360-W average power operation with a single-stage diode-pumped Nd:YAG amplifier at a 1-kHz repetition rate.

We report a high-average-power laser-diode-pumped Nd:YAG master oscillator power amplifier system that has a minimum number of elements in the single multipass zigzag-slab amplifier stage and is used to pump a high-peak-power and high-average-power Ti:sapphire laser system. This phase-conjugated system produces an average power of 362 W at 1 kHz in a 30-ns pulse with an optical-to-optical conversion efficiency of 14%. With an external KTP doubler this system generates 132 W of green average output power at 1 kHz with a conversion efficiency of 60% when pumped at a power level of 222 W. To the best of our knowledge these results represent the highest average output power at both infrared and green wavelengths achieved in a single amplifier stage.

Journal Article↗

PubMedDate not supplied

South American rattlesnake venom: its hemolytic power.

The hemolytic power of rattlesnake venom (Crotalus durissus terrificus) was studied. A high percentage of sample with negative hemolytic power was detected when sheep red blood cells were used. A large number of venoms with hemolytic power, though with a low hemolysis percentage, were detected when liquid, recently extracted venom was used. When crystallized venom was used under the same experimental conditions, a higher percentage of positivity for hemolysis was obtained. When the results obtained on agar plates were compared to those obtained in test tubes, a large number of animals with a higher percentage of hemolysis were detected, though this value was not proportional to the number of animals showing positive plate hemolysis. When the hemolytic power of these venoms was tested on human red blood cells, a large percentage of animals with venoms having a low hemolytic power was also detected. Hemolytic power was much greater when human red blood cells were tested with crystallized venom. The preparation of red blood cells also had an important effect and the use of red blood cells from defibrinated blood is recommended. We conclude that rattlesnake venom has hemolytic power that increases when the venom is crystallized. Red blood cells should be properly prepared for the lysis reactions. We suggest that the lytic power of the venom is related to venom concentration and to the purity of its fractions.

Animals↗

PubMed1995

Effect of instrument power setting during ultrasonic scaling upon treatment outcome.

Ultrasonic scalers may be operated at different power settings which may influence the final therapeutic result. The displacement amplitude of the scaling tip may affect scaling efficiency or the degree of root surface damage. This investigation aimed to determine whether there was any difference in periodontal healing, as assessed by standard clinical methods, when an ultrasonic scaler was operated at full or half power in patients suffering from mild to moderate adult periodontitis. Seventeen patients with chronic adult periodontitis were entered into the study and a split mouth design utilized. Quadrant allocation was randomized, 2 quadrants being treated at full power and 2 at half power. At baseline, probing attachment levels, bleeding and plaque indices (BI and PI) were recorded and oral hygiene instruction given. Two weeks later all measurements were repeated and further recordings made at 1, 3, and 6 months post-therapy. Statistical analysis demonstrated no differences between groups at baseline (P > 0.3) for all parameters. At the post-oral hygiene stage, there were significant attachment gains for both experimental groups (P < 0.04), but no differences were found between the groups (P > 0.6). At 6 months, mean attachment gains for the half power and full power groups over baseline measures were 0.5 +/- 0.5 mm and 0.4 +/- 0.3 mm, respectively (P < 0.002), and there were no significant differences between the groups (P > 0.5). The results show that the use of the half power setting was as effective as using the ultrasonic scaler at full power.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed2003

Possible factors determining the non-linearity in the VO2-power output relationship in humans: theoretical studies.

At low power output exercise (below lactate threshold), the oxygen uptake increases linearly with power output, but at high power output exercise (above lactate threshold) some additional oxygen consumption causes a non-linearity in the overall VO(2) (oxygen uptake rate)-power output relationship. The functional significance of this phenomenon for human exercise tolerance is very important, but the mechanisms underlying it remain unknown. In the present work, a computer model of oxidative phosphorylation in intact skeletal muscle developed previously is used to examine the background of this relationship in different modes of exercise. Our simulations demonstrate that the non-linearity in the VO(2)-power output relationship and the difference in the magnitude of this non-linearity between incremental exercise mode and square-wave exercise mode (constant power output exercise) can be generated by introducing into the model some hypothetical factor F (group of associated factors) that accumulate(s) in time during exercise. The performed computer simulations, based on this assumption, give proper time courses of changes in VO(2) and [PCr] after an onset of work of different intensities, including the slow component in VO(2), well matching the experimental results. Moreover, if it is assumed that the exercise terminates because of fatigue when the amount/intensity of F exceed some threshold value, the model allows the generation of a proper shape of the well-known power-duration curve. This fact suggests that the phenomenon of the non-linearity of the VO(2)-power output relationship and the magnitude of this non-linearity in different modes of exercise is determined by some factor(s) responsible for muscle fatigue.

Energy Metabolism↗

PubMed1998

Transjugular intrahepatic portosystemic shunts: improved evaluation with echo-enhanced color Doppler sonography, power Doppler sonography, and spectral duplex sonography.

OBJECTIVE: We assessed the feasibility of contrast-enhanced color Doppler, power Doppler, and spectral duplex sonography for visualization and quantification of flow through transjugular intrahepatic portosystemic shunts (TIPS) in patients in whom the baseline sonographic evaluation was unsatisfactory. SUBJECTS AND METHODS: Thirty-three patients underwent color Doppler, power Doppler, and spectral duplex sonography after TIPS insertion or before TIPS revision (mean time interval +/- SD, 1 +/- 1 day). All sonograms were obtained before and after patients received echo-enhancing contrast material. Sonography was evaluated with regard to presence or absence of flow in the mid portion, portal segment, and hepatic segment of the shunt. The maximal peak velocity was measured in the mid portion of the shunt. For identifying and quantifying stenoses, the percentage of luminal diameter reduction was calculated at the tightest part of the shunt. Shunt angiography and measurements of portosystemic pressure gradients were independently evaluated and compared with the sonographic findings. RESULTS: Flow visualization on unenhanced color Doppler sonography was significantly improved through the use of power Doppler sonography and contrast-enhanced color Doppler and power Doppler sonography (p < .01). Between contrast-enhanced power Doppler and contrast-enhanced color Doppler sonography, a significant difference was found in the portal and hepatic segments (p < .05). All shunt stenoses (n = 8) and occlusions (n = 3) were revealed by power Doppler sonography, whereas color Doppler sonography failed to reveal six of eight stenoses. Compared with unenhanced sonography, the quality of spectral duplex sonography was improved in eight patients after contrast enhancement (p < .05). Maximal peak velocity ranged from 54 to 252 cm/sec (mean +/- SD, 132.7 +/- 52.1 cm/sec) in normal shunts and from 24.5 to 70.0 cm/sec (mean +/- SD, 45.0 +/- 18.9 cm/sec) in stenosed shunts. No correlation was found between maximal peak velocity and portosystemic pressure gradients (r = .28). CONCLUSION: Unenhanced power Doppler and contrast-enhanced color and power Doppler sonography can be helpful in the assessment of TIPS status in patients who previously underwent unsatisfactory sonography. These techniques may allow anatomic evaluation and quantification of shunt stenosis in most patients. Contrast enhancement may also considerably improve the quality of spectral duplex sonography.

Adult↗