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Factors that affect the reproducibility of measurements of left ventricular function from first-pass radionuclide ventriculograms.

To examine which factors affect the reproducibility of ejection fraction (EF), pulmonary transit time (PTT) and segmental wall motion assessed from first-pass radionuclide angiograms (FPRA), 32 patients who had FPRA were randomized for site of injection of isotope (right or left arm) and projection (right or left anterior oblique [RAO or LAO]). The quality of injected bolus was measured from the full width at half maximum (FWHM) of the bolus time-activity curve in the superior vena cava. All patients had two sequential studies on each of two consecutive days, and each study was analyzed independently by two observers. For EF, inter- and intraobserver correlations ranged from 0.94-0.98. EF was higher in the RAO than the LAO projection (mean 47.4% vs 40.3%, p less than 0.001), but neither injection site nor bolus FWHM affected the results. For PTT, interobserver correlations ranged from 0.75-0.93 and intraobserver correlations from 0.61-0.85. Variability in PTT was large, and inter- and intraobserver variabilities were directly related to bolus FWHM (mean 0.60 +/- 0.21 second for interobserver differences in PTT of less than 2.0 seconds, mean 1.55 +/- 0.86 seconds for interobserver differences in PTT of greater than 2 seconds [p less than 0.005]). Differences in FWHM between sequential studies were 0.28 +/- 0.29 second when intraobserver differences in PTT were less than 2 seconds and 1.04 +/- 0.67 seconds when differences in PTT were greater than 2.0 seconds (p less than 0.005). Variations in PTT were not related to differences in projection or injection site. Wall motion was highly reproducible for both projections. In the RAO projection, one of 116 anterior segments (0.9%), one of 116 apical segments (0.9%), and four of 116 inferior segments (3%) were judged normal from one observer's images and abnormal from another. In the LAO view, discrepancies occurred in one of 126 septal segments (0.8%), two of 126 apical segments (1.6%) and four of 126 posterolateral segments (3%). This study shows that EF and wall motion are highly reproducible in any projection, but the choice of projection significantly affects the values for EF from FPRA. PTT measurements are less reliable, highly bolus dependent, and their use in clinical practice depends on quality control of the bolus of injected radionuclide.

Adult↗

Digital angiographic impulse response analysis of regional myocardial perfusion: linearity, reproducibility, accuracy, and comparison with conventional indicator dilution curve parameters in phantom and canine models.

The system mean transit time (Tsys) of the impulse response function describing contrast material transit through the coronary circulation was determined from serial digital angiographic images. The linearity, reproducibility, and relations with regional myocardial perfusion and conventional time-density curve parameters, time to peak concentration (TPC), and exponential washout rate (k) were assessed in a dynamic flow x-ray phantom (n = 46) and in six open-chest dogs (n = 102) while coronary flow was altered by stenosis and/or hyperemic stimuli. In the phantom studies, the inverse of the system mean transit time (Tsys-1) closely predicted flow/volume (r = 0.99, slope = 0.99). In dogs, Tsys-1 was independent of the shape of the contrast bolus injection (single or double-peaked), class of contrast agent (ionic or nonionic), the type of hyperemic stimulus (dipyridamole, dipyridamole plus norepinephrine, transient total occlusion, or ionic contrast media), and was highly reproducible between adjacent myocardial regions served by the same artery (r = 0.98 +/- 0.01). There was a strong correlation between Tsys-1 and regional coronary flow for stenotic and/or hyperemic vessels (r = 0.94, distribution volume = 14.9 ml/100 g) over a wide range (0-514 ml/min/100 g). Tsys-1 performed better than conventional time-density curve parameters TPC-1 and k for predicting phantom flow/volume ratios and regional myocardial blood flow in the dog. These data suggest that both digital coronary angiography and coronary contrast transit can be modeled as linear systems and that impulse response analysis may provide accurate and reproducible estimates of regional myocardial blood flow.

Algorithms↗

Reproducibility of carotid artery Doppler frequency measurements.

Doppler sonography of 29 extracranial carotid arteries was performed twice within three days or less. Angiography revealed stenoses with from 10 to 95% diameter reduction in 25 internal carotid arteries whereas four vessels were found to be normal. The systolic peak frequency of the internal carotid artery read from the Doppler spectrum (n = 29) could be reproduced very well. This was shown by a linear regression nearest the line of identical values with a coefficient of correlation r = 0.97 (p less than 0.001). Other values derived from the spectral analysis of the Doppler shift signal were not so well reproduced including the peak frequency ratio (systolic peak frequency of the internal carotid artery/systolic peak of the common carotid artery) (n = 22; r = 0.81; p less than 0.001). The mean frequencies read from the zero-crossing detector recordings (n = 20) could not be reproduced as demonstrated by a linear regression far away from the line of identical measurements with a coefficient of correlation r = 0.43 (p less than 0.05).

Arterial Occlusive Diseases↗

A reproducible model of middle cerebral infarcts, compatible with long-term survival, in aged rats.

BACKGROUND AND PURPOSE: Stroke is a disease associated with aging, but experimental stroke studies are generally done in young male animals. Because there are numerous differences associated with aging, such as an altered immune system and altered neurochemistry, that could affect the outcome of these experiments, a model of reproducible cerebral infarction in aged rats is needed. METHODS: We attempted to produce middle cerebral artery (MCA) infarcts in aged (22 months of age) rats using two standard methods. A nylon suture with a heat-induced bulb was passed through the external carotid artery in seven animals, with an attempt to place the tip at the origin of the MCA. The MCA was ligated through a craniotomy just proximal to the internal cerebral vein in 14 rats. Survival potential was tested by attempting 2-week survival in four rats and 2-month survival in one rat. RESULTS: The suture model failed to produce MCA infarcts, even when the bulb of the suture was properly placed in the MCA. The intracranial MCA occlusion resulted in reproducible MCA infarcts. There were no deaths, including the animals allowed to survive 2 weeks and 2 months. CONCLUSIONS: We conclude that reproducible MCA infarcts can be produced in aged rats by craniotomy and that these lesions may be compatible with long-term survival. This should be a useful technique for studying therapeutic interventions and rehabilitation strategies in an animal model that immunologically and neurochemically more closely resembles humans at risk for stroke.

Aging↗

Precision and reproducibility of quantitative coronary angiography with applications to controlled clinical trials. A sampling study.

Most computer methods that quantify coronary artery disease from angiograms are designed to analyze frames recorded during the end-diastolic portion of the cardiac cycle. The purpose of this study was to determine if end diastole is the best portion of the cardiac cycle to sample, or if other sampling schemes produce more precise and/or reproducible estimates of coronary disease. 20 cinecoronary angiograms were selected at random from a controlled clinical trial testing the effects of plasma lipid lowering on atherosclerosis. Sampling schemes included sequential and random sampling of two to five frames within the complete cardiac cycle, systole, and diastole. Three vessel measures and percent stenosis were evaluated for each sampling scheme. From the sampling experiment, it was determined that sampling sequentially end diastole yielded the most precise estimates (i.e., exhibiting minimum variability within a cycle) of the vessel measures. With regard to reproducibility (i.e., similar values across cycles), sampling randomly within the cycle was best. Overall, the average diameter of a vessel segment was the most precise and the most reproducible of the measures. Sample size calculations are given for each of these measures under the best sampling scheme.

Algorithms↗

Reproducibility of a commercial enzyme-linked immunosorbent assay for bovine paratuberculosis among eight laboratories.

Interlaboratory reproducibility of an absorbed enzyme-linked immunosorbent assay (ELISA) kit for detection of bovine serum antibodies to Mycobacterium paratuberculosis was evaluated. A panel of 30 bovine sera (15 positives and 15 negatives) was tested in triplicate microtiter wells on each of 2 days at 8 different laboratories. One laboratory had invalid results because of positive or negative serum control optical density (OD) readings beyond the acceptable range specified by the kit. The coefficient of variation (CV) for mean OD values was influenced by low ODs on test negative sera at 2 laboratories, thus the CVs on positive sera were considered a more representative measure of kit reproducibility. Between-well CVs averaged 6.7% +/- 2.8% (mean +/- standard deviation), and between-day CVs averaged 14.5% +/- 9.8% among the 7 laboratories with valid assays on the 15 positive sera. The OD values were converted to positive or negative classifications for each assay well, and the results were compared. Among 1,392 assays in 7 laboratories, 98.6% were in agreement. Eleven of 18 discrepant results were due to a sample that consistently gave OD values near the cutoff for a positive test. Exclusion of that serum from the analysis resulted in a 99.8% rate of agreement among laboratories. Results indicated that the absorbed ELISA kit provided reproducible results within and between laboratories.

Analysis of Variance↗

Reproducibility of gene expression across generations of Affymetrix microarrays.

BACKGROUND: The development of large-scale gene expression profiling technologies is rapidly changing the norms of biological investigation. But the rapid pace of change itself presents challenges. Commercial microarrays are regularly modified to incorporate new genes and improved target sequences. Although the ability to compare datasets across generations is crucial for any long-term research project, to date no means to allow such comparisons have been developed. In this study the reproducibility of gene expression levels across two generations of Affymetrix GeneChips (HuGeneFL and HG-U95A) was measured. RESULTS: Correlation coefficients were computed for gene expression values across chip generations based on different measures of similarity. Comparing the absolute calls assigned to the individual probe sets across the generations found them to be largely unchanged. CONCLUSION: We show that experimental replicates are highly reproducible, but that reproducibility across generations depends on the degree of similarity of the probe sets and the expression level of the corresponding transcript.

Calibration↗

Reproducibility of the STARD checklist: an instrument to assess the quality of reporting of diagnostic accuracy studies.

BACKGROUND: In January 2003, STAndards for the Reporting of Diagnostic accuracy studies (STARD) were published in a number of journals, to improve the quality of reporting in diagnostic accuracy studies. We designed a study to investigate the inter-assessment reproducibility, and intra- and inter-observer reproducibility of the items in the STARD statement. METHODS: Thirty-two diagnostic accuracy studies published in 2000 in medical journals with an impact factor of at least 4 were included. Two reviewers independently evaluated the quality of reporting of these studies using the 25 items of the STARD statement. A consensus evaluation was obtained by discussing and resolving disagreements between reviewers. Almost two years later, the same studies were evaluated by the same reviewers. For each item, percentages agreement and Cohen's kappa between first and second consensus assessments (inter-assessment) were calculated. Intraclass Correlation coefficients (ICC) were calculated to evaluate its reliability. RESULTS: The overall inter-assessment agreement for all items of the STARD statement was 85% (Cohen's kappa 0.70) and varied from 63% to 100% for individual items. The largest differences between the two assessments were found for the reporting of the rationale of the reference standard (kappa 0.37), number of included participants that underwent tests (kappa 0.28), distribution of the severity of the disease (kappa 0.23), a cross tabulation of the results of the index test by the results of the reference standard (kappa 0.33) and how indeterminate results, missing data and outliers were handled (kappa 0.25). Within and between reviewers, also large differences were observed for these items. The inter-assessment reliability of the STARD checklist was satisfactory (ICC = 0.79 [95% CI: 0.62 to 0.89]). CONCLUSION: Although the overall reproducibility of the quality of reporting on diagnostic accuracy studies using the STARD statement was found to be good, substantial disagreements were found for specific items. These disagreements were not so much caused by differences in interpretation of the items by the reviewers but rather by difficulties in assessing the reporting of these items due to lack of clarity within the articles. Including a flow diagram in all reports on diagnostic accuracy studies would be very helpful in reducing confusion between readers and among reviewers.

Advisory Committees↗

Reproducibility of the serum lipid response to coffee oil in healthy volunteers.

BACKGROUND: Humans and animals show a certain consistency in the response of their serum lipids to fat-modified diets. This may indicate a genetic basis underlying this response. Coffee oil might be used as a model substance to investigate which genes determine differences in the serum lipid response. Before carrying out such studies our objective was to investigate to what extent the effect of coffee oil on serum lipid concentrations is reproducible within subjects. METHODS: The serum lipid response of 32 healthy volunteers was measured twice in separate five-week periods in which coffee oil was administered (69 mg cafestol/day). RESULTS: Total cholesterol levels increased by 24% in period 1 (range: 0;52%) and 18% in period 2 (1;48%), LDL cholesterol by 29 % (-9;71%) and 20% (-12;57%), triglycerides by 66% (16;175%) and 58% (-13;202%), and HDL cholesterol did not change significantly: The range of the HDL response was -19;25% in period 1 and -20;33% in period 2. The correlation between the two responses was 0.20 (95% CI -0.16, 0.51) for total cholesterol, 0.16 (95% CI -0.20, 0.48) for LDL, 0.67 (95% CI 0.42, 0.83) for HDL, and 0.77 (95% CI 0.56, 0.88) for triglycerides. CONCLUSIONS: The responses of total and LDL cholesterol to coffee oil were poorly reproducible within subjects. The responses of HDL and triglycerides, however, appeared to be highly reproducible. Therefore, investigating the genetic sources of the variation in the serum-lipid response to coffee oil is more promising for HDL and triglycerides.

Journal Article↗

An accurate and reproducible absorptiometric technique for determining bone mineral content in newborn infants.

At the Bone Mineral Laboratory of the University of Wisconsin a microcomputer-based digital read-out system was designed specifically for determining bone mineral content (BMC) and bone width (BW) in newborn infants with the following features: (1) high accuracy and precision; (2) high reproducibility in vivo; (3) direct read-out of BMC and BW; (4) automatic data calibration; and (5) use of a low activity [125I] source (less than 50 mCi). BMC and BW were determined on the left radius on a series of 114 newborn infants of all gestational ages and a curve for intrauterine bone mineral content extrapolated from the data. Accuracy of the photon absorptiometric system was assessed by measuring BMC on a series of nine small bone sections (29-212 mg/cm) and confirmed by subsequent ashing of these bone sections (r = 0.99). Short-term precision (weekly, coefficient of variation 1.7%) and long-term precision (monthly, coefficient of variation 2.1%) for measuring BMC were determined by multiple determinations on a four-chambered bone phantom calibrated with the bone sections. Immediate reproducibility (without repositioning the arm) for the 4-6 scans performed for each determination of BMC and BW was good with a mean coefficient of variation of 3.9% for BMC and 3.6% for BW. In 84 infants, repositioning error was determined by repeating the measurement of BMC and BW after repositioning the arm. The correlation coefficients between measurements before and after repositioning the arm were 0.97 for BMC and 0.95 for BW. BMC correlated well with gestational age (r = 0.92), birth weight (r = 0.89) and bone width (r = 0.92). BW also correlated with gestational age (r = 0.84) and birth weight (r = 0.85). A multiple linear regression analysis of BMC versus BW, gestational age, and birth weight was done. The correlation coefficient between the predicted BMC from these variables and measured BMC was 0.95. Photon absorptiometry can be used with high accuracy, precision, and reproducibility in vivo in newborn infants. BMC correlates with gestational age, birth weight, and bone width.

Birth Weight↗

Interobserver reproducibility of criteria for vertebral body exclusion.

UNLABELLED: We studied reproducibility of the ISCD vertebral exclusion criteria among four interpreters. Surprisingly, agreement among interpreters was only moderate, because of differences in threshold for diagnosing focal structural defects and choice of which vertebra among a pair discordant for T-score, area, or BMC to exclude. Our results suggest that reproducibility may be improved by specifically addressing the sources of interobserver disagreement. INTRODUCTION: Although DXA is widely used to measure vertebral BMD, its interpretation is subject to multiple confounders including osteoarthritis, aortic calcification, and scoliosis. In an attempt to standardize interpretation and minimize the impact of artifacts, the International Society for Clinical Densitometry (ISCD) established criteria for vertebral exclusion, including the presence of a focal structural defect (FSD), discrepancy of >1 SD in T-score between adjacent vertebrae, and a lack of increase in BMC or area from L1 to L4. Whereas the efforts of the ISCD represent an important advance in BMD interpretation, the interobserver reproducibility with application of these criteria is unknown. We hypothesized that there would be substantial agreement among four interpreters regarding application of the exclusion criteria and the final lumbar spine T-score. MATERIALS AND METHODS: Each interpreter read a set of 200 lumbar DXA scans obtained on male veterans, applying the ISCD vertebral body exclusion criteria. RESULTS: Surprisingly, agreement among interpreters was only moderate. Differences in interpretation resulted from differing thresholds for recognition of FSD and the choice of excluding the upper or lower vertebral body for the criteria requiring comparison between adjacent vertebrae. CONCLUSIONS: Despite their apparent simplicity, the ISCD vertebral exclusion criteria are difficult to apply consistently. In principle, appropriate refinement of the exclusion criteria may significantly improve interobserver agreement.

Absorptiometry, Photon↗

Reproducibility of echocardiography. A study evaluating the variability of serial echocardiographic measurements.

In this study, serial reproducibility was determined on standard M-mode (M-mode) and two dimensional guided M-mode (2-D M-mode) records for ten normal volunteers and 20 patients. Overall intraobserver variability in the normal group was 518 +/- 1.8 percent (M-mode) and 3.1 +/- 0.8 percent (2-D M-mode), and in the patient group 3.1 +/- 0.6 percent (M-mode) and 4.7 +/- 0.7 percent (2-D M-mode) (P = NS). Variability on serial examination, however, was twofold to threefold greater. In the normal group, reproducibility varied by 10.8 +/- 1.6 percent (M-mode) and 9.4 +/- 1.2 percent (2-D M-mode), while in the patient group, it was 8.7 +/- 0.9 percent (M-mode) and 9.4 +/- 0.7 percent (2-D M-mode). The lowest serial variability achieved was for the diastolic LV dimension on serial M-mode examination (4 percent); the largest variability pertained to measurement of the interventricular septum (14 percent). Other structures had intermediate variation in reproducibility. This study emphasizes that establishing performance variability for an echocardiographic laboratory is an important part of the interpretation of serial records.

Echocardiography↗

Cold air as a bronchial provocation technique. Reproducibility and comparison with histamine and methacholine inhalation.

Bronchial provocation testing with cold air was carried out on 36 asthmatic and 13 normal subjects in order to assess the reproducibility and clinical relevance of the technique as a test of airways reactivity. Sixteen subjects underwent repeat testing after an interval of two to three weeks. Using a least squares linear regression analysis, the technique was highly reproducible, with a correlation of r = 0.93 (p less than 0.001). The 21 asthmatic subjects who had exercise-provoked symptoms required a significantly lower level of ventilation of cold air to produce a 35 percent drop in specific airways conductance (PD35) than did those who had no exercise-induced asthma (33.9 L min-1 vs 45.8 L min-1; p less than 0.02). Subjects requiring no regular treatment for their asthma had a geometric mean PD35 of 62.6 L min-1, significantly higher than those requiring inhaled therapy (44.9 L min-1; p less than 0.005). Subjects requiring oral in addition to inhaled treatment had the lowest PD35 (23.6 L min-1; p less than 0.02). Atopic status did not appear to influence the response. There was a strong correlation between the PD35 to cold air and to histamine (r = 0.92; p less than 0.001) and between the PD35 to cold air and to methacholine (r = 0.86; p less than 0.001). The three techniques of assessing bronchial reactivity were equally successful in separating the normal and asthmatic groups. The results indicate that cold air provocation may be reliably and reproducibly used to assess bronchial reactivity. The use of a naturally-occurring stimulus of asthma in all subjects has great potential as an investigational technique.

Adolescent↗

Reproducibility of 24-h growth hormone profiles in children.

The rate of GH secretion and the pattern of GH peaks were compared in a group of nine prepubertal children during their prepubertal period in repeated 24-h GH profiles. At investigation, the children were 6-13 years old (at first profile 6-11 years old) and of normal height (+/- 2 SD). Two profiles were obtained per child, (with a mean time interval of 1.5 years, range 0.7 to 3.5 years. The calculated GH secretions of the first and second profiles were compared. As a group, no significant differences in secreted amount of GH, when expressed as data from the second profile as a percentage of data from the first profile (93 +/- 8%), number of peaks (98 +/- 7%) or mean peak amplitudes (92 +/- 11%), were obtained. Between the repeated curves of an individual child, maximal difference in secretion, number of peaks and mean peak amplitudes ranged around +/- 30%, with a mean intraindividual cv of 12%. The reproducibility in the peak distribution for all profiles was also analysed. The relative frequencies is a percentage of the GH peak amplitudes and peak widths were virtually identical in the repeated profiles. Reproducibility of the temporal pattern of profiles was analysed using time-series analysis (Fourier analysis) and showed no difference in rhythmicity between the different occasions. In conclusion, a high reproducibility of both GH secretion and GH pattern was found for the whole group of prepubertal children.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗

Why do most tropical animals reproduce seasonally? Testing hypotheses on an Australian snake.

Most species reproduce seasonally, even in the tropics where activity occurs year-round. Squamate reptiles provide ideal model organisms to clarify the ultimate (adaptive) reasons for the restriction of reproduction to specific times of year. Females of almost all temperate-zone reptile species produce their eggs or offspring in the warmest time of the year, thereby synchronizing embryogenesis with high ambient temperatures. However, although tropical reptiles are freed from this thermal constraint, most do not reproduce year-round. Seasonal reproduction in tropical reptiles might be driven by biotic factors (e.g., peak periods of predation on eggs or hatchlings, or food for hatchlings) or abiotic factors (e.g., seasonal availability of suitably moist incubation conditions). Keelback snakes (Tropidonophis mairii, Colubridae) in tropical Australia reproduce from April to November, but with a major peak in May-June. Our field studies falsify hypotheses that invoke biotic factors as explanations for this pattern: the timing of nesting does not minimize predation on eggs, nor maximize food availability or survival rates for hatchlings. Instead, our data implicate abiotic factors: female keelbacks nest most intensely soon after the cessation of monsoonal rains when soils are moist enough to sustain optimal embryogenesis (wetter nests produce larger hatchlings, that are more likely to survive) but are unlikely to become waterlogged (which is lethal to eggs). Thus, abiotic factors may favor seasonal reproduction in tropical as well as temperate-zone animals.

Analysis of Variance↗

The reproducibility of classification of fractures of the proximal end of the humerus.

The radiographs of ninety-five fractures of the proximal end of the humerus were classified with the Neer and the AO/ASIF systems by five orthopaedic surgeons who had a special interest in problems of the shoulder. Without access to their initial interpretations, the same five orthopaedic surgeons reevaluated the same radiographs eight weeks later. Intraobserver and intraobserver reliability were found to be fair or poor for both classification systems. Kappa values for the interobserver reliability were 0.40 for the Neer system and 0.53 for the AO/ASIF system. When the fractures were subclassified, according to the recommendations of the AO/ASIF, into groups and subgroups, reproducibility became progressively worse. Intraobserver reliability showed kappa values of 0.60 and 0.58, respectively. A so-called extended radiographic trauma series, consisting of three perpendicular radiographs, was available for thirty-five fractures; the third perpendicular projection did not significantly improve the reproducibility values for either classification compared with those obtained with only two perpendicular projections. We concluded that neither the Neer nor the AO/ASIF classification of fractures of the proximal end of the humerus is sufficiently reproducible to allow meaningful comparison of similarly classified fractures in different studies.

Humans↗

Reproducibility of beta-cell function estimates in non-insulin-dependent diabetes mellitus.

We evaluated the reproducibility of different estimates of endogenous insulin secretion in 30 patients with non-insulin-dependent diabetes mellitus (NIDDM). Fasting blood glucose concentration was similar on the 2 days of study. The coefficients of variation of fasting plasma C-peptide, plasma C-peptide 6 min after the injection of 1 mg i.v. glucagon, and the increment in plasma C-peptide after glucagon were 16.0, 14.8 and 24.1%, respectively. The coefficients of variation of the corresponding plasma insulin values were 19.2, 24.8, and 34.8%, respectively. The coefficient of variation of 24-h urinary C-peptide excretion was 22.1%. Because fasting plasma C-peptide correlated closely with plasma C-peptide 6 min after glucagon (test 1: r = .70, P less than .01; test 2: r = .76, P less than .01), it seems that these two values can be used equally well as assessment of beta-cell function in NIDDM. In conclusion, fasting plasma insulin, fasting plasma C-peptide, and plasma C-peptide 6 min after glucagon stimulation showed a similar and acceptable degree of reproducibility. Plasma insulin 6 min after glucagon and increments in plasma insulin and C-peptide, as well as urinary C-peptide, seem to be less reproducible.

Aged↗

Reproducibility of occlusal findings. A comparison between clinical and articulator analyses.

The occlusal relationship may be examined clinically in the patient's mouth and on models mounted in an articulator. For the purpose of comparing the reproducibility of the two methods, the occlusion of 10 subjects was analyzed twice with at least 1 week's interval. Certain variations were demonstrated with both methods. Overall reproducibility of tooth contact was observed more frequently in the articulator than in the mouth. The methods showed an equal degree of consistency for measurements of slide in centric. However, when subjects were classified by the extent of occlusal interference, the findings of the clinical analysis seemed to be more reproducible than those recorded by means of the articulator.

Adolescent↗