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Reproducibility of relaxation and spin-density parameters in phantoms and the human brain measured by MR imaging at 1.5 T.

The reproducibility of T1, T2, and proton density, measured in phantoms and the human brain was evaluated by proton imaging techniques. The sequence used to derive T1 and density values was a multiple-saturation recovery which consists of four pairs of 90 degrees pulses, followed by a 180 degrees phase reversal pulse, generating four T1-weighted images. T2 was derived from a multiple-echo sequence, generating four T2-weighted images. The data were analyzed by fitting the pixel intensities to the respective equations by means of nonlinear multiparameter least-squares analysis. Short-term reproducibility between four consecutive scans was evaluated to be 1-4% depending on location with a phantom covering the entire span of physiologic T1 and T2 values. A second phantom containing a series of identical samples served to study the dependence of the apparent T1 and T2 on position, both radially and axially, with respect to magnet isocenter. Reproducibility across the field of view was found to be better than 7% (T1 and T2). This phantom was further used to evaluate effects of long-term reproducibility, which at each location varied from 5-14% (T1) and 2-10% (T2). Finally, interinstrument reproducibility, tested by means of the same protocol on three different instruments, all operating at the same magnetic field and using largely identical hardware for each location, was found to be 1-14% (T1) and 2-10% (T2). The positional dependence of the apparent relaxation times appears to be systematic and may be due to variations in the effective field, caused by magnet and rf inhomogeneity. Finally, brain tissue relaxation and spin-density data were determined using the same protocol in 37 scans performed on 27 normal volunteers. The tissues analyzed were putamen, thalamus, caudate nucleus, centrum semiovale, internal capsule, and corpus callosum. Excellent accordance was further obtained between left and right hemispheres.

Brain

Ambulatory 24-hour esophageal pH monitoring. Reproducibility and variability of pH parameters.

If 24-hour esophageal pH monitoring is to be a useful diagnostic tool, it must reliably discriminate gastroesophageal reflux patients despite daily variations in distal esophageal acid exposure. To address this issue, we studied 53 subjects (14 healthy normals, 14 esophagitis patients, and 25 patients with atypical symptoms) with two ambulatory pH tests performed within 10 days of each other. Intrasubject reproducibility of 12 pH parameters to discriminate the presence of abnormal acid reflux was determined. As a group, the parameters of percent time with pH less than 4 (total, upright, recumbent) were most reproducible (80%). Therefore, a subject was defined as having gastroesophageal reflux disease if at least one of these three values were abnormal. Intrasubject reproducibility for the diagnosis of reflux disease was 89% for the entire sample. Among subsets, the reproducibility was 93% for the normals and esophagitis patients and 84% for the atypical symptom patients. Total percent time with pH less than 4 was the single most discriminate pH parameter (85%) and nearly equaled that of the three combined parameters (89%). The intrasubject variability of this parameter was determined by the mean +/- 2 SD of the relative differences between the two test results for all 53 subjects. Total percent time with pH less than 4 may vary between tests by a factor of 3.2-fold or less (218% higher to 69% lower). We conclude: (1) ambulatory 24-hr esophageal monitoring is a reproducible test for the diagnosis of gastroesophageal reflux disease; and (2) the large intrastudy variability in 24-hr total acid exposure may limit this test's usefulness as a measurement of therapeutic improvement.

Adult

Reproducibility of incremental maximal cycle ergometer tests in patients with mild to moderate obstructive lung diseases.

This study was designed to examine the reproducibility and the learning effects of incremental maximal cycle ergometer testing in patients with obstructive lung diseases who are untrained and have never done such a test before. Eleven patients were studied on 2 consecutive days with an interval of 24 h. The reproducibility (expressed in relative duplicate error) of most of the parameters tested was good: workload (watt) 4.5%, maximal oxygen consumption (VO2max 3.5%, gas exchange ratio (R) 3.4%, and heart rate 3.7%. Moderate reproducibility was found in maximal ventilation (VEmax) 6.6%, carbon dioxide production (VCO2max 6.0%, and respiration frequency (RF) 8.3%. The reproducibility of the time between the start of the test and the minimum value of VE/VO2 and VE/VCO2 was low. We concluded that in these patients the results of incremental cycle ergometer testing showed good reproducibility in a test-retest procedure. There were no learning effects.

Adult

Reproducibility of exercise-induced ventricular arrhythmia after myocardial infarction.

To evaluate the reproducibility of exercise-induced ventricular arrhythmia, 155 men with a mean age of 53 +/- 8 years underwent serial exercise testing 3 to 52 weeks after myocardial infarction. The reproducibility of categorical test responses, that is, the presence or absence of ventricular arrhythmia, was evaluated with the kappa coefficient, which considers negative as well as possible test responses and expresses reproducibility above the chance level. Reproducibility was highest at an intertest interval of 1 to 5 days and was not enhanced by further categorizing premature ventricular complexes as simple or complex based on their frequency or configuration. Continuous response measures such as frequency of premature ventricular complexes yielded higher reproducibility than categorical responses. Continuous response measures appear preferable to categorical responses for evaluating the clinical significance and response to antiarrhythmic therapy of ventricular arrhythmias.

Arrhythmias, Cardiac

Effects of occlusal therapy on pantographic reproducibility of mandibular border movements.

A clinical experiment was undertaken to study the relationship between occlusal therapy and pantographic reproducibility. Twenty-six subjects were categorized according to their ability to reproduce pantographic border movements and were put into either a control nonreproducible, control reproducible, or experimental nonreproducible group. From each subject a sequence of five pantographic surveys consisting of two morning and two afternoon pantographic recordings was taken. Each survey period lasted a minimum of 30 days. The experimental subjects alone were given occlusal splint therapy and occlusal adjustment therapy during the sequence of recall periods. The relationship between the effect caused by occlusal therapy and pantographic reproducibility was analyzed. For the purpose of analysis, the pantographic recordings were assessed a numerical score using a pantographic reproducibility index. A double-blind technique was used until all data were collected.

Adult

Allergen bronchial challenge tests: variability and reproducibility of the early response.

We evaluated allergen bronchial challenge tests (ABCTs) variability and reproducibility during 2-week intervals, respectively, in 28 and 14 Dermatophagoides pteronyssinus-sensitized patients. Increasing doses of Dpt (1.25 to 160 X 10(-3) mg) of lyophilized Dpt extract were administered at 20-minute intervals by doubling the previous dose. Dose-response curves (D-RC) were constructed for each test with the logarithm (base 2) of the allergen dose and the FEV1 in milliliters as ordinate. We analyzed different indices: the allergen doses causing a 15% decrease in FEV1 (PD15) and a 20% decrease in FEV1 (PD20), the slope of the curve beyond PD15, the overall slope, and the area under the parabolic curve. We found considerable intersubject variability in early asthmatic responses to Dpt ABCTs. Bronchoconstriction induced by allergen produced a specific D-RC for each individual. PD20 was significantly correlated with all the indices representing the whole D-RC (i.e., overall slope and area); moreover, PD20 was found on the steepest portion of the curve in 24 of 28 D-RCs. With the methodology used, we obtained a satisfactory reproducibility in a 2-week interval: the linear slope obtained by log base 2 transformation of doses was highly reproducible (p less than 0.001), as was area p under the parabolic curve. PD20 is significantly reproducible in a range of one doubling dose (twofold variation). The reproducibility of ABCTs over a short period permits solid arguments for their use in the evaluation of prophylactic treatment and in clinical research.

Adult

Late asthmatic responses after exercise challenge are reproducible.

In this study the reproducibility of a late asthmatic reaction (LAR) after exercise challenge (EC) has been documented. Eighty-three hospitalized patients with asthma were challenged with exercise. The patients were examined according to a standardized protocol that comprised 8 minutes of bicycling at 90% of predicted heart rate. An LAR after EC was considered to have occurred when there was a fall in peak expiratory flow rate greater than or equal to 20% on three or more time points on the exercise day compared to corresponding clock time on a control day. According to these criteria, 11 patients (13.3%) experienced an LAR. Those patients were rechallenged 21 to 150 days after the first EC, without changing the therapy regimen of the patients, to study its reproducibility. Eight patients (73%) demonstrated a reproducible LAR after EC based on the criteria for a positive LAR. Although the LAR after EC was reproducible, the time points at which the LAR took place after the second EC differed from LARs after the first EC. Our results indicate that the LAR after EC occurs in a considerable number of patients with bronchial asthma and is quite reproducible.

Adrenal Cortex Hormones

Self-reproducing systems: structure, niche relations and evolution.

A formal definition of a self-reproducing system is proposed using Petri nets. A potential self-reproducing system is a set of places in the Petri net such that the number of tokens in each place increases due to some sequence of internal transitions (a transition is called internal to the marked subset of places if at least one of its starting places and one of its terminating places belongs to that subset). An actual self-reproducing system is a system that compensates the outflow of its components by reproduction. In a suitable environment every potential self-reproducing system becomes an actual one. Each Petri net can be considered as an ecosystem with the web of ecological niches bound together with trophic and other relations. The stationary dynamics of the ecosystem is characterized by the set of filled niches. The process of evolution is described in terms of niche composition change. Perspectives of the theory of self-reproducing systems in biology are discussed.

Biological Evolution

The reproducibility of natural head posture: a methodological study.

Current clinical interest in natural head posture (NHP) derives from studies correlating NHP to craniofacial morphology, future growth trends, and to respiratory needs. It has also been argued that NHP is the logical reference and orientation position for craniofacial analysis and the publication of illustrations. The individual or group is presented as they naturally appear in life. Hence, lateral cephalometric radiographs recorded routinely in NHP would be more meaningful for the clinician. Underpinning all these potential clinical benefits is the incompletely answered question of the clinical reproducibility of NHP. In this study a natural head posture, the orthoposition, was defined and standardized for clinical use. The effects of ear posts, an external source of eye reference (a wall mirror), sex and time were evaluated in relation to the reproducibility of recording lateral cephalometric radiographs in this natural head posture. The sample comprised 217 randomly selected 12-year-old Chinese children in Hong Kong. Boys looked up more when changing from the self-balance position to the mirror eye reference position (mean change 2 degrees, P less than or equal to 0.001). No other significant male-versus-female differences were detected. NHP reproducibility was better with a mirror (with mirror, method error = 1.9 degrees, without mirror, method error = 2.7 degrees). No significant differences in reproducibility were detected between NHP recordings taken with and without ear posts. However, without ear posts the radiographs tended to be of poor quality. The reproducibility of same-day repeat radiographs recorded with ear posts and with a mirror (after 4 to 10 minutes and 1 to 2 hours) was 1.9 degrees.(ABSTRACT TRUNCATED AT 250 WORDS)

Cephalometry

The influence of age, relative weight, smoking, and alcohol intake on the reproducibility of a dietary questionnaire.

To evaluate factors that affect the reproducibility of a semi-quantitative food frequency questionnaire used in a large prospective study we compared an extended 99-item questionnaire with a shorter, 61-item form completed by 1497 women with an interval of nine months between. Correlation coefficients for individual items assessed by the two questionnaires were highest for beverages (Spearman r = 0.70). For other foods, coefficients ranged from 0.60 to 0.70 for items eaten frequently (or habitually), to values between 0.34 and 0.45 for foods, such as sweet potatoes and ready made pie, that were eaten less frequently. For food items, the correlation between mean frequency of consumption and the reproducibility coefficient (Spearman r) was 0.51 (p less than 0.01), formally confirming that the reproducibility of measurements was positively associated with frequency of use. Pearson correlation coefficients for calorie-adjusted intakes of nutrients between the two questionnaires ranged from 0.40 for trans-fatty acids to 0.71 for vitamin E (including supplements). These correlation coefficients did not vary materially between subjects in different categories of smoking status or tertiles of age or relative weight. Moderate alcohol use had minimal effect on correlation coefficients, but reproducibility was slightly reduced among heavier drinkers. These data indicate that this self-administered dietary questionnaire can provide reproducible information about individual food and nutrient intakes which is not altered materially by age and a number of important health habits.

Adult

Measurement of hemagglutination-inhibiting antibody to influenza virus in the 1976 influenza vaccine program: methods and test reproducibility.

Titers of hemagglutination-inhibiting (HAI) antibody were determined for all sera obtained from participants in the 1976 Influenza Vaccine Test Program. At least eight control sera were included in each test during the vaccine trial period for the purpose of monitoring HAI test reproducibility. Estimates of day-to-day reproducibility were defined as the percentages of duplicate aliquots of the same sera, tested on two separate days, having HAI antibody titers that did not differ by more than one twofold dilution. These reproducibility estimates ranged from 89% to 97% with influenza A/New Jersey/76 and A/Mayo Clinic/74 antigens. In contrast, within-day reproducibility estimates obtained from all sets of control sera ranged from 96% to 98%. Estimates of day-to-day test reproducibility obtained with selected sera taken after vaccination that were titrated on two differen days ranged from 90% to 98%. Geometric mean titers of these sera tested weeks or months apart differed on some occasions during the test period.

Antibodies, Viral

Reproducibility of pressor response to handgrip: influence of time intervals, strength and duration of exercise.

1. The reproducibility of pressor response to handgrip performed at different time intervals and with different combinations of the product duration x strength of the exercise was evaluated in 14 normotensive subjects recording blood pressure with a noninvasive automatic device. 2. Subjects underwent five consecutive tests (30% of maximal voluntary contraction x 90 s) at 30 min, and 24 h intervals and repeated the test after 12 months. Furthermore, they underwent at 24 h intervals a randomized sequence of handgrip tests whose product strength x duration was combined in order to achieve either a constant or an increasing level of exercise. 3. Blood pressure response to exercise performed at 30 min intervals was much less reproducible than that induced by handgrip performed at time intervals greater than or equal to 24 h. 4. Increasing gradually the product strength x duration of the handgrip test there was a proportional blood pressure increase, whereas when the product was maintained constant diastolic blood pressure increase was also constant and reproducible within each subject. 5. This study shows that it is possible to obtain reproducible diastolic blood pressure responses to handgrip test measuring blood pressure with a non-invasive automatic device when the tests are performed at a time interval of at least 24 h. The choice of the strength and of the duration of the exercise is very important for the reproducibility of the test.

Adult

Inter-examiner reproducibility of probing pocket depths in molar furcation sites.

This investigation was designed to determine the reproducibility of probing pocket depths in maxillary facial and mandibular facial and lingual grade II and III molar furcation sites. 80 untreated molar teeth with 102 furcation invasions due to periodontitis were probed with a pressure-sensitive periodontal probe by 3 examiners. 8 sites per furcation were measured by each examiner at a single examination. The sequence of examiner probing was rotated in order to evaluate the effect of sequential probing. Tracings were made from radiographs of the inter-root separations in order to classify the interradicular space and to determine the effect of root separation on reproducibility. Data was analyzed by regression analysis. Pearson correlations, intraclass correlations, and the Student-Newman-Keuls test. Analysis indicated a high reproducibility of the maxillary facial and mandibular facial and lingual furcation sites in this untreated adult sample. No effect was due to probing sequence. The mid-root prominences, the line angles, and the internal surface sites of the furcation roots were recordable and reproducible, while the horizontal measurements were not consistently recordable. The reproducibility of the facial and lingual furcation sites that were probed decreased with an increase in probing pocket depth and an increased degree of root separation.

Clinical Competence

Alternative ways of estimating serological titer reproducibility.

A quantitative measure of the reproducibility of serum antibody titers has recently been proposed (R. J. Wood and T. M. Durham, J. Clin. Microbiol. 11: 541-545, 1980). The measure advocated is "the probability that the maximum ratio of two distinct (integer) titers (obtained in the blind) on the same specimen will not exceed 2." This measure of the reproducibility of serological titers is considered to be a fixed probability for any given specimen and set of test conditions. Although it is a fixed constant during the time period of a study, there are alternative methods one might use to compute an estimate of it, using laboratory data. Four such methods of estimating test reproducibility are discussed and evaluated. The estimates obtained from the two principle methods are evaluated quantitatively by means of Monte Carlo computer simulation. The simulation results show that, from a given sample of replicate integer titers, these two principal methods yield estimates that are highly correlated. In addition, with moderate numbers of replicates (sample size) these methods provide estimates that are on the average properly directed at the true reproducibility values (that is, are essentially, unbiased), particularly when the true reproducibility of the test is at least 0.9. The reliability, or stability, of the alternative estimates is studied for selected sample size.

Analysis of Variance

Reproducibility of the analytab (API 20E) system.

The reproducibility of the Analytab (API 20E) system for identification of Enterobacteriaceae was evaluated with 110 clinical isolates. Each isolate was identified by two technologists at different times. Genus-species identification was 97.3% reproducible; however, only 55.5% of the strains gave identical reactions in all 20 of the API 20E biochemical tests on repeat testing. Of those strains which varied, 56% possessed only one variable biochemical test. The reproducibility for each biochemical test was calculated and ranged from 89 to 100%. A subset of 20 of the most variable strains was tested further under conditions of varying incubation time (15 and 22 h) and inoculum concentration (10(7), 10(5), and 10(3) colony-forming units per ml), and by having four technologists interpret the test results. The reproducibility for each biochemical test for these 20 variable strains ranged from 86 to 99%. Less variation in interpretation by technologists was seen at an incubation time of 22 h and an inoculum concentration of 10(7) colony-forming units per ml. Consideration of the reproducibility for each biochemical test can aid in determining the probability that two isolates suspected of being the same strain, but with API profiles which differ by one or more biochemical test results, are in fact the same strain. Variables such as inoculum size, incubation time, technologist interpretation, and strip variability affect the API test results and should be standardized to minimize their effects.

Bacteriological Techniques

Reproducibility of ambulatory oesophageal pH monitoring.

To evaluate the reproducibility of ambulatory 24 hour intraoesophageal pH monitoring, 20 patients were randomly selected to undergo two consecutive investigations. Fifteen patients were classified as either abnormal, or normal on both test days. The amount of acid reflux, expressed as percentage of time with oesophageal pH below 4.0 during the two 24 hour periods, showed 77% concordance. The upright and recumbent periods of measurement showed different degrees of concordance: 83% and 62%, respectively. The reproducibility during time periods of different length was found to increase with increasing length of day time pH recording. A 16 hour period during evening and night had a reproducibility of only 58%, however. It is concluded that there is fairly good reproducibility when measuring gastro-oesophageal reflux over 24 hours, but that the reproducibility is poorer at night, during the postprandial period and when daytime monitoring is shorter than 10 hours.

Adult

Reproducibility of pulmonary function tests under laboratory and field conditions.

The reproducibility of pulmonary function tests in the laboratory and in a mobile field survey vehicle has been studied. Groups of laboratory workers were studied at base and a random sample of 38 coalminers was examined in the mobile laboratory. The intra-subject variability of some newer tests of lung function, including closing volume and maximum flow at low lung volumes, has been compared with that of well-established tests, such as lung volumes and forced expiratory volume from two measurements made more than one day apart. Most measurements were slightly less reproducible in the study of coalminers than in the laboratory personnel. Conventional tests, such as forced expiratory volume in one second, lung volumes, single breath CO transfer factor, and exercise ventilation were very reproducible, the coefficients of variation (cov) being generally between 5% and 10%. The closing volume test, maximum expiratory flow at low lung volumes, and the single breath N2 index were less reproducible: cov between 15% and 39% in the miners. The forced expired time and volume of isoflow, measured only on laboratory workers, however, exhibited greater reproducibility than previously reported (cov = 10% and 15% respectively). It is suggested that, when assessing the repeatability of lung function tests, account should be taken of the circumstances in which the intra-subject variability was measured.

Adolescent

Short-term reproducibility of ergometric parameters in functional stress test after recent myocardial infarction.

In order to assess the short-term reproducibility of the most important ergometric parameters, 108 males (mean age 50.3 +/- 7.8 years) underwent a functional stress test (FST) on average 35 days after myocardial infarction. The exercise test was repeated 3 days later in the same conditions. Patients were fasting and in pharmacological washout. The following parameters were analyzed: total work performed (TWP), VO2, heart rate (HR), systolic blood pressure (SBP), arrhythmias and S-T segment depression and elevation. TWP and VO2 values did not show any significant difference during the two tests under the various workloads. HR and SBP responses proved to be well reproducible in patients with HR and SBP not exceeding the mean values obtained from 222 normal subjects who underwent the same exercise test by more than +/- 1 SD; reproducibility was significantly lower in the other patients, particularly in patients with HR and SBP exceeding normal values by more than +/- 1 SD. Therefore, in this case, further FST are necessary to obtain more reliable parameters to decide on individual pharmacological and exercise prescriptions. Arrhythmias were reproducible up to 67% (p less than 0.01) regardless of Lown's class and the presence of S-T segment depression or elevation. S-T segment depression or elevation was reproducible up to 100%.

Adult