Search

Background: Manually segmenting cardiac structures is time‐consuming and produces variability in MRI assessments. Automated segmentation could solve this. However, current software is developed for adults without congenital heart defects (CHD). Purpose: To evaluate automated segmentation of left ventricle (LV) and right ventricle (RV) for pediatric MRI studies. Study Type: Retrospective comparative study. Population: Twenty children per group of: healthy children, LV‐CHD, tetralogy of Fallot (ToF), and univentricular CHD, aged 11.7 [8.9–16.0], 14.2 [10.6–15.7], 14.6 [11.6–16.4], and 12.2 [10.2–14.9] years, respectively. Sequence/Field Strength: Balanced steady‐state free precession at 1.5 T. Assessment: Biventricular volumes and masses were calculated from a short‐axis stack of images, which were segmented manually and using two fully automated software suites (Medis Suite 3.2, Medis, Leiden, the Netherlands and SuiteHeart 5.0, Neosoft LLC, Pewaukee, USA). Fully automated segmentations were manually adjusted to provide two further sets of segmentations. Fully automated and adjusted automated segmentation were compared to manual segmentation. Segmentation times and reproducibility for each method were assessed. Statistical Tests: Bland Altman analysis and intraclass correlation coefficients (ICC) were used to compare volumes and masses between methods. Postprocessing times were compared by paired t‐tests. Results: Fully automated methods provided good segmentation (ICC > 0.90 compared to manual segmentation) for the LV in the healthy and left‐sided CHD groups (eg LV‐EDV difference for healthy children 1.4 ± 11.5 mL, ICC: 0.97, for Medis and 3.0 ± 12.2 mL, ICC: 0.96 for SuiteHeart). Both automated methods gave larger errors (ICC: 0.62–0.94) for the RV in these populations, and for all structures in the ToF and univentricular CHD groups. Adjusted automated segmentation agreed well with manual segmentation (ICC: 0.71–1.00), improved reproducibility and reduced segmentation time in all patient groups, compared to manual segmentation. Data Conclusion: Fully automated segmentation eliminates observer variability but may produce large errors compared to manual segmentation. Manual adjustments reduce these errors, improve reproducibility, and reduce postprocessing times compared to manual segmentation. Adjusted automated segmentation is reasonable in children with and without CHD. Evidence Level: 3. Technical Efficacy: Stage 2. [ABSTRACT FROM AUTHOR]

The Eetscore FFQ was developed to score the Dutch Healthy Diet index 2015 (DHD2015-index) representing the Dutch food-based dietary guidelines of 2015. This paper describes the development of the Eetscore FFQ, a short screener assessing diet quality, examines associations between diet quality and participants' characteristics, and evaluates the relative validity and reproducibility of the Eetscore FFQ in a cross-sectional study with Dutch adults. The study sample consisted of 751 participants, aged 19–91 years, recruited from the EetMeetWeet research panel. The mean DHD2015-index score based on the Eetscore FFQ of the total sample was 111 (sd 17·5) out of a maximum score of 160 points and was significantly higher in women than in men, positively associated with age and education level, and inversely associated with BMI. The Kendall's tau-b coefficient of the DHD2015-index between the Eetscore FFQ and the full-length FFQ (on average 1·7-month interval, n 565) was 0·51 (95 % CI 0·47, 0·55), indicating an acceptable ranking ability. The intraclass correlation coefficient between DHD2015-index scores derived from two repeated Eetscore FFQ (on average 3·8-month interval, n 343) was 0·91 (95 % CI 0·89, 0·93) suggesting a very good reproducibility. In conclusion, the Eetscore FFQ was considered acceptable in ranking participants according to their diet quality compared with the full-length FFQ and showed good to excellent reproducibility. [ABSTRACT FROM AUTHOR]

Purpose Chronic musculoskeletal pain can have a major impact on ability to work. The work ability score is a commonly used single-item question to assess work ability but has not been fully validated yet. The aim of the present study was to evaluate test–retest reliability, agreement, construct validity, and responsiveness of the work ability score among sick-listed workers with chronic musculoskeletal pain. Methods Data of sick-listed workers with chronic musculoskeletal pain was routinely collected at seven rehabilitation centres in the Netherlands. Assessments included a set of questionnaires, administered at admission and discharge from a fifteen-week vocational rehabilitation program. Test–retest reliability was determined with the intraclass correlation coefficient. For agreement, the standard error of measurement and smallest detectable changes were calculated. Construct validity was assessed by testing hypotheses regarding Spearman rank correlation coefficient. Area under the curve obtained from the receiver operating characteristic curve and minimal clinically important change were determined for the total sample and work ability score baseline tertile groups to assess responsiveness. Results In total, 34 workers were analyzed for reliability and agreement, 1291 workers for construct validity, and 590 responded to the responsiveness questionnaire. Reliability reached an intraclass correlation coefficient of 0.89; 95% CI 0.77–0.94, a standard error of measurement of 0.69 points, and the smallest detectable change of 1.92 points. For construct validity, six of the seven predefined hypotheses were not refuted. The area under the curve was 0.76 (95% CI 0.71–0.81) allowing for discrimination between stable and improved workers, with a minimal clinically important change of 2.0 points for the total sample. Conclusion The work ability score showed good measurement properties among sick-listed workers with chronic musculoskeletal pain. [ABSTRACT FROM AUTHOR]

Objective Clinicians are recommended to use the clinical reasoning framework developed by the International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) to provide guidance regarding assessment of the cervical spine and potential for cervical artery dysfunction prior to manual therapy and exercise. However, the interexaminer agreement and reliability of this framework is unknown. This study aimed to estimate the interexaminer agreement and reliability of the IFOMPT framework among physical therapists in primary care. Methods Ninety-six patients who consulted a physical therapist for neck pain or headache were included in the study. Each patient was tested independently by 2 physical therapists, from a group of 17 physical therapists (10 pairs) across The Netherlands. Patients and examiners were blinded to the test results. The overall interexaminer agreement, specific agreement per risk category (high-, intermediate-, and low-risk), and interexaminer reliability (weighted κ) were calculated. Results Overall agreement was 71% (specific agreement in high-risk category = 63%; specific agreement in intermediate-risk category = 38%; specific agreement in low-risk category = 84%). Overall reliability was moderate (weighted κ = 0.39; 95% CI = 0.21–0.57) and varied considerably between pairs of physical therapists (κ = 0.14–1.00). Conclusion The IFOMPT framework showed an insufficient interexaminer agreement and fair interexaminer reliability among physical therapists when screening the increased risks for vascular complications following manual therapy and exercise prior to treatment. Impact The IFOMPT framework contributes to the safety of manual therapy and exercise. It is widely adopted in clinical practice and educational programs, but the measurement properties are unknown. This project describes the agreement and reliability of the IFOMPT framework. [ABSTRACT FROM AUTHOR]

Purpose: Assessment of the blood--brain barrier (BBB) permeability without the need for contrast agent is desirable, and the ability to measure the permeability to small molecules such as water may further increase the sensitivity in detecting diseases. This study proposed a time-efficient, noncontrast method to measure BBB permeability to water, evaluated its test--retest reproducibility, and compared it with a contrast agent--based method. Methods: A single-delay water extraction with phase-contrast arterial spin tagging (WEPCAST) method was devised in which spatial profile of the signal along the superior sagittal sinus was used to estimate bolus arrival time, and the WEPCAST signal at the corresponding location was used to compute water extraction fraction, which was combined with global cerebral blood flow to estimate BBB permeability surface area product to water. The reliability of WEPCAST sequence was examined in terms of intrasession, intersession, and inter-vendor (Philips [Ingenia, Best, the Netherlands] and Siemens [Prisma, Erlangen, Germany]) reproducibility. Finally, we compared this new technique to a contrast agent--based method. Results: Single-delay WEPCAST reduced the scan duration from approximately 20 min to 5 min. Extract fraction values estimated from single-delay WEPCAST showed good consistency with the multi-delay method (R = 0.82, P = .004). Group-averaged permeability surface area product values were found to be 137.5 ± 9.3 mL/100 g/min. Intrasession, intersession, and inter-vendor coefficient of variation of the permeability surface area product values were 6.6 ± 4.5%, 6.9 ± 3.7%, and 8.9 ± 3.0%, respectively. Finally, permeability surface area product obtained from WEPCAST MRI showed a significant correlation with that from the contrast-based method (R = .73, P = .02). Conclusion: Single-delay WEPCAST MRI can measure BBB permeability to water within 5 min with an intrasession, intersession, and inter-vendor test--retest reproducibility of 6% to 9%. This method may provide a useful marker of BBB breakdown in clinical studies. [ABSTRACT FROM AUTHOR]

University Libraries play a crucial role in moving towards Open Science, contributing to more transparent, reproducible and reusable research. The Center for Digital Scholarship (CDS) at Leiden University (LU) library is a scholarly lab that promotes open science literacy among Leiden's scholars by two complementary strategies: existing top-down structures are used to provide training and services, while bottom-up initiatives from the research community are actively supported by offering the CDS's expertise and facilities. An example of how bottom-up initiatives can blossom with the help of library structures such as the CDS is ReproHack. ReproHack -- a reproducibility hackathon -- is a grass-root initiative by young scholars with the goal of improving research reproducibility in three ways. First, hackathon attendees learn about reproducibility tools and challenges by reproducing published results and providing feedback to authors on their attempt. Second, authors can nominate their work and receive feedback on their reproducibility efforts. Third, the collaborative atmosphere helps building a community interested in making their own research reproducible. A first ReproHack in the Netherlands took place on November 30th, 2019, co-organised by the CDS at the LU Library with 44 participants from the fields of psychology, engineering, biomedicine, and computer science. For 19 papers, 24 feedback forms were returned and five papers were reported as successfully reproduced. Besides the researchers' learning experience, the event led to recommendations on how to enhance research reproducibility. The ReproHack format therefore provides an opportunity for libraries to improve scientific reproducibility through community engagement. [ABSTRACT FROM AUTHOR]

Introduction: It is crucial to understand the factors that introduce variability before applying metabolomics to clinical and biomarker research. Objectives: We quantified technical and biological variability of both fasting and postprandial metabolite concentrations measured using 1H NMR spectroscopy in plasma samples. Methods: In the Netherlands Epidemiology of Obesity study (n = 6,671), 148 metabolite concentrations (101 metabolites belonging to lipoprotein subclasses) were measured under fasting and postprandial states (150 minutes after a mixed liquid meal). Technical variability was evaluated among 265 fasting and 851 postprandial samples, with the identical blood plasma sample being measured twice by the same laboratory protocol. Biological reproducibility was assessed by measuring 165 individuals twice across time for evaluation of short- (<6 months) and long-term (>3 years) biological variability. Intra-class coefficients (ICCs) were used to assess variability. The ICCs of the fasting metabolites were compared with the postprandial metabolites using two-sided paired Wilcoxon test separately for short- and long-term measurements. Results: Both fasting and postprandial metabolite concentrations showed high technical reproducibility using 1H NMR spectroscopy (median ICC = 0.99). Postprandial metabolite concentrations revealed slightly higher ICC scores than fasting ones in short-term repeat measures (median ICC in postprandial and fasting metabolite concentrations 0.72 versus 0.67, Wilcoxon p-value = 8.0×10−14). Variability did not increase further in a long-term repeat measure, with median ICC in postprandial of 0.64 and in fasting metabolite concentrations 0.66. Conclusion: Technical reproducibility is excellent. Biological reproducibility of postprandial metabolite concentrations showed a less or equal variability than fasting metabolite concentrations over time. [ABSTRACT FROM AUTHOR]

Introduction: Although experienced raters show good reproducibility1 of Pressure Pain Thresholds (PPT) in most body locations2, it is unknown if inexperienced physiotherapy students perform comparably. Recruiting students as raters would increase opportunities for the student's development and the design of studies. Methods: A total of 175 participants were measured by ten undergraduate students using either a Wagner (n = 87) or Somedic (n = 88) digital algometer on four body locations; the lower leg, upper leg, arm and neck. Each student measured a subsample of ~9 participants. Agreement (reported as a coefficient of variance; standard error of measurement divided by the average threshold) and reliability (intraclass correlation (ICC)) were measured for both the individual rater and the total group. Results: Agreement ranged from 9-17% per body location, whereas individual raters differed from the group result from -7.9% up to +6.6%. Reliability was good to excellent, ICCs (1,1) ranging from 0.88 to 0.95. Individual ICCs (2,1) were between 0.00 to 0.99. Discussion: Reproducibility of the total group was good; however, it varies per student. Even though reliability is affected by group variance differences, agreement parameters also show individual differences. PPTs seem rater dependent, which may explain different findings in the literature. Consequently, using reproducibility values of other studies/raters should be done cautiously. Students may be recruited as research assistants to perform PPTs. Process evaluation: Organising raters and participants together is challenging. Using parallel rooms with observational tools helped. Dependency on raters was a threat, resulting in an excluded rater due to sickness. [ABSTRACT FROM AUTHOR]

We investigated the validity and reproducibility of the FFQ used in the Dutch European Investigation of Cancer and Nutrition cohort, in order to rank subjects according to intakes of fatty acid classes and individual fatty acids. In total, 121 men and women (23-72 years) filled out three FFQ at 6-month intervals between 1991 and 1992. As a reference method, they filled out twelve monthly 24-h dietary recalls (24HDR) during the same year. Intra-class correlation coefficients for the FFQ showed moderate to good reproducibility across all fatty acids (classes and individual) in men (0.56-0.81) and women (0.57-0.83). In men, Spearman's correlation coefficients (rs) for the FFQ compared with the 24HDR indicated moderate to good relative validity (rs =0.45-0.71) for all fatty acids, except for arachidonic acid and marine PUFA (rs<0.40). In women, relative validity was moderate to good for MUFA and trans-fatty acids (TFA) and the majority of SFA (rs =0.40-0.66), was fair for the short-chain SFA and lauric acid (rs=0.30-0.33) and was fair to moderate for PUFA (rs=0.22-0.47). Bland-Altman plots showed good agreement between the FFQ and 24HDR, and proportional bias for fatty acids with very low intakes. In conclusion, the FFQ showed good reproducibility for subject ranking based on intakes of fatty acids (classes and individual). The relative validity measures indicated that the FFQ is an adequate tool to rank subjects according to intakes of high-abundant fatty acids, but less for low-abundant fatty acids. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The aim of this study was to assess the reproducibility (i.e., agreement and inter-rater reliability) of two task-specific functional capacity evaluation protocols meant to simulate the daily workload of collectors using either two-wheeled waste containers or bags. METHODS: A within-subjects design was used to assess reproducibility in terms of agreement and reliability. Twenty-one household waste collectors were assessed twice with both task-specific protocols with a time interval of seven days. Agreement was assessed using the Standard Error of Measurement (SEM), and inter-rater reliability was assessed using the Intra-Class Correlation Coefficient (ICC). RESULTS: For the task-specific protocol for waste collection using two-wheeled containers, agreement was excellent (SEM = 0.9 points; 0-340 scale; mean score 339), but inter-rater reliability was poor (ICC = 0.22). For the task-specific protocol for bag collection, agreement was acceptable (SEM = 53 s; continuous scale; mean time 779 s), and inter-rater reliability was good (ICC = 0.79). CONCLUSIONS: Reproducibility of the task-specific protocol for bag collection is acceptable to good, while the task-specific protocol for waste collection using two-wheeled containers has an excellent agreement but a poor reliability. Although face and content validity have been covered within the development of both protocols, further studies should evaluate the construct and criterion-related validity of both task-specific protocols. [ABSTRACT FROM AUTHOR]

The article describes an experiment which assessed the reliability and validity of the steep ramp test (SRT) using a cycle ergometer to evaluate maximal aerobic capacity in seventy-five healthy children and adolescents in the Netherlands. The SRTs were compared with cardiopulmonary exercise tests (CPET) with respiratory gas analysis. The results were analyzed with correlation coefficients and linear regression statistics. It suggested that the SRT can be a reliable and valid test to estimate maximum oxygen consumption in children and adolescents.

Background Mid-upper arm circumference ( MUAC) is used as an alternative measure for body mass index to determine thinness in older persons. However, there are limited data on the reproducibility of this measurement in an older population. The present study examined the reproducibility of MUAC measurements in older persons, as well as the influence of different body positions and clothing. Methods A cross-sectional reproducibility study was performed in a nursing home ( n = 43; age 65-96 years) and swimming pool facilities ( n = 107; age 65-88 years). A different pair of observers independently measured the MUAC of each participant in the upright position on two occasions within 1 week. In the nursing home, measurements were also performed for each participant in the laying position and with clothes covering the upper arm. Results Mean differences and the 95% limit of agreement for inter-observer reproducibility of MUAC were 0.0 cm (−2.6 to 2.5 cm) for the swimming pool facilities and 0.3 cm (−0.6 to 1.3 cm) for the nursing home. Intra-class correlation coefficients ( ICCs) were 0.89 and 0.92, respectively. Mean differences between laying and upright positions were 0.1 cm (−2.0 to 2.2 cm) and 0.0 cm (−1.9 to 2.0 cm) for each observer, respectively ( ICC 0.96-0.97). Mean differences between clothes versus bare upper arm were −2.7 cm (−6.2 to 0.7) and −2.4 (−5.6 to 0.9 cm) ( ICC 0.75 and 0.78). Conclusions The reproducibility of the MUAC measurement in older persons is acceptable for group comparisons and, although borderline for the swimming pool facilities, remains acceptable for clinical purposes. The measurement can also be performed in the laying position but not with clothes covering the upper arm. [ABSTRACT FROM AUTHOR]

Introduction In general practice, dizziness is one of the most frequently reported complaints. Dizziness, as a part of other clinical syndromes, is found in 16% of patients and is frequently associated with whiplash-associated disorders (WAD). In manual/musculoskeletal medicine the Hautant procedure has been advocated as a test for disturbed neck proprioception. The main aim of the present study was to evaluate in a quantitative way the reproducibility of Hautant's procedure in normal subjects. Patients and methods Ten healthy subjects, all women, participated in the reproducibility study with a mean age of 23.3 (range 18-28, SD 3.3). Nine subjects, who were diagnosed with WAD grade II, were included with a mean age of 33 (range 17-42, SD 15.6) and contained four male and five female subjects. Arm motion patterns in combination with a particular head movement were registered with a 3 Space Inside Track HP. A neutral-positioned receiver was attached to the ceiling, which quantified arm motion in the frontal sagittal and transversal planes, y, z, and yaw values, respectively. Results Of the 42 absolute differences in the y, z, and yaw values, 40 were reproducible. No particular motion pattern in combination with a particular head movement was seen, either in normal subjects or WAD II patients. Conclusions Based on our results, the Hautant test, as we performed it, is reproducible. In the original paper, Hautant used his test as a vestibular one and made no relation at all with cervical propriocepsis. Since no differences were found between normal subjects and WAD II patients, in clinical practice the diagnostic value of the Hautant test is very low. [ABSTRACT FROM AUTHOR]

Objective: To determine the precise degree of variability that is represented by the reproducibility and reliability of semen analysis. The general assumption is that semen analyses need to be repeated because of a high degree of within-individual variability. However, the precise degree of variability is not well established in male partners of subfertile couples. Design: Retrospective cohort study. Setting: Two university hospitals in the Netherlands, which routinely perform two semen analyses in the male partner of subfertile couples. Patient(s): Male partners of subfertile couples. Interventions: None. Main Outcome Measure(s): We assessed the test-retest reproducibility, by calculating the coefficient of variation (CVw) for five semen parameters. The CVw expresses, on a relative scale, the degree of closeness of repeated measurements taken in the same subject. We also estimated the reliability of these semen parameters, in terms of the intraclass correlation coefficient, which expresses the ratio of the between-subject variability over the total variability. Result(s): We analyzed the data of 5,240 men and found that the CVw of all semen parameters ranged from 28% to 34%. The intraclass correlation coefficients of these semen parameters were moderate to high: volume: 0.70; concentration: 0.89; motility: 0.58; morphology: 0.60; total motile count: 0.73. Conclusion(s): This study affirmed the presumed large within-subject variability and the limited reproducibility of semen analyses in subfertile men. Whether this degree of variability within men justifies one or more repetitions of the semen analysis in view of consequences for clinical management should be the topic of future studies. Until then it seems reasonable to perform two semen analyses. [ABSTRACT FROM AUTHOR]

The self-administered Food Allergy Quality of Life Questionnaire-Child Form (FAQLQ-CF), -Teenager Form (FAQLQ-TF) and -Adult Form (FAQLQ-AF) were recently developed within EuroPrevall, a multi-centred study of food allergy in Europe. The primary aim of this study was to evaluate the test-retest reliability of the FAQLQ-CF, -TF and -AF. One hundred and one Dutch patients (31 children, 34 adolescents and 36 adults) completed the FAQLQ twice with a 10–14 day interval. The intraclass correlation coefficient (ICC), Lin’s concordance correlation coefficient (CCC) and Bland-Altman plots were used to assess test-retest reliability. Test-retest reliability was excellent with ICCs and CCCs above 0.907, 0.975 and 0.951 for the FAQLQ-CF, -TF and -AF, respectively. Bland-Altman plots showed that the mean differences of the test and re-test were all close to zero for the FAQLQs. The FAQLQs are reliable over a short time interval. The FAQLQs are not only excellent tools for group comparison studies, but also for monitoring individual patients. [ABSTRACT FROM AUTHOR]

We give a short international history of econometric software development, with an emphasis on the origin of the main existing econometric packages. We provide a Dutch perspective on this development. We identify the characteristics of econometric software in comparison with mathematical and statistical software. Finally, a number of recent developments connected with the reuse of code across econometric softwares are discussed. [ABSTRACT FROM AUTHOR]

In 1996/1997, a 14C-AMS system (model 4130-AMS) manufactured by High Voltage Engineering Europe (HVEE), B.V., The Netherlands, was installed at the Center for Chronological Research (CCR), Nagoya University. The system provides highly precise and accurate 14C determinations as well as δ13C values for graphite targets (1.5 mg carbon and 3 mg iron powder) prepared from standards and samples. One sigma errors in 14C ages typically range from ±20 to ±40 yr for materials younger than 8000 BP, depending on absolute 14C ages or 14C counting uncertainties. Standard deviations of 13C/12C ratios range from ±0.1‰ to ±0.9‰. For relatively young samples, accuracies of less than 10‰ are obtained using IAEA reference materials and FIRI test samples. Background levels on the 4C-AMS system range from 52 to 54 ka BP for a pure graphite powder. The HVEE 14C-AMS system at the CCR has been used routinely to date samples with a variety of research applications. [Copyright &y& Elsevier]

In this paper, we propose a class of locally dependent latent trait models for responses to psychological and educational tests. Typically, item response models treat an individual's multiple response to stimuli as conditional independent given the individual's latent trait. In this paper, instead the focus is on models based on a family of conditional distributions, or kernel, that describes joint multiple item responses as a function of student latent trait, not assuming conditional independence. Specifically, we examine a hybrid kernel which comprises a component for one-way item response functions and a component for conditional associations between items given latent traits. The class of models allows the extension of item response theory to cover some new and innovative applications in psychological and educational research. An EM algorithm for marginal maximum likelihood of the hybrid kernel model is proposed. Furthermore, we delineate the relationship of the class of locally dependent models and the log-linear model by revisiting the Dutch identity (Holland, 1990). [ABSTRACT FROM AUTHOR]

Objective: To validate a newly introduced classification system for the registration of perinatal mortality. Design: Descriptive. Setting: Dutch Healthcare region Delft-Westland-Oostland (DWO). Material and methods: In a 10-years period (1983–1992), all cases of perinatal death with a birthweight above 500 g (n=239) were included into the study. Six assessors: four gynaecologists and two paediatricians were asked to classify all cases using a classification model proposed by the authors. This model is based on the underlying cause of death using simple principles of obstetrical and neonatal pathology: birth trauma, infection, placenta or cord pathology, pathology of immune tolerance of mother and fetus, congenital malformation of the fetus and complications of a pre-viable delivery. Therefore, we used the term fundamental classification. The six assessors worked independently of each other in classifying all cases of perinatal death, were not involved in the original development of the system and were unaware of the results of the classification of their colleagues. Agreement beyond chance between assessors was calculated using kappa’s coefficient for multiple observers and multiple test results. Results: Overall kappa was 0.70 (95% confidence interval (C.I.) 0.68–0.72). Reproducibility was poor for the categories trauma and unclassifiable, fair for the categories infections and placental/cord pathology, and very good to excellent for the categories maternal immune system pathology, congenital malformations and complications of prematurity. Conclusions: The proposed system showed a good level of agreement and appeared to be simply applicable. It offers a good insight in the underlying cause of death with the possibility for recognising preventive factors in future pregnancies and will enable (inter)national comparisons in causes of perinatal death. A reliable uniform registration of perinatal death based on the underlying causes should be the basis for improvement of the quality of perinatal care. [Copyright &y& Elsevier]

Endocrine disrupting chemicals (EDCs) include non-persistent exogenous substances such as parabens, bisphenols and phthalates which have been associated with a range of metabolic disorders and disease. It is unclear if exposure remains consistent over time. We investigated change in indicators of EDC exposure between 2009 and 2016 and assessed its consistency between and within individuals over a median follow-up time of 47 months in a sample of Dutch individuals. Of 500 Dutch individuals, two 24 h urine samples were analysed for 5 parabens, 3 bisphenols and 13 metabolites of in total 8 different phthalates. We calculated per-year differences using meta-analysis and assessed temporal correlations between and within individuals using Spearman correlation coefficients, intra-class correlation coefficients (ICC) and kappa-statistics. We found a secular decrease in concentrations of methyl, ethyl, propyl and n-butyl paraben, bisphenol A, and metabolites of di-ethyl phthalate (DEP), di-butyl phthalate (DBP), di-(2-ethyl-hexyl) phthalate (DEHP), and butylbenzyl phthalate (DBzP) which varied from 8 to 96% (ethyl paraben, propyl paraben) between 2009 and 2016. Within-person temporal correlations were highest for parabens (ICC: 0.34 to 0.40) and poorest for bisphenols (ICC: 0.15 to 0.23). For phthalate metabolites, correlations decreased most between time periods (ICC < 48 months: 0.22 to 0.39; ≥48 months: 0.05 to 0.32). When categorizing EDC concentrations, 33–54% of individuals remained in the lowest or highest category and temporal correlations were similar to continuous measurements. Exposure to most EDCs decreased between 2009 and 2016 in a sample of individuals with impaired fasting glucose from the Dutch population. Temporal consistency was generally poor. The inconsistency in disease associations may be influenced by individual-level or temporal variation exhibited by EDCs. Our findings call for the need for repeated measurements of EDCs in observational studies before and during at-risk temporal windows for the disease. • Exposure to phenols and phthalates decreased between 2009 and 2016 in the Netherlands. • Some decreases coincided with the introduction of European legislation. • Temporal consistency of EDCs over 7 years was generally poor. • Categorization of EDCs did not improve consistency and should be avoided. • We call for the need for repeated measurements in disease association investigations. [ABSTRACT FROM AUTHOR]

The genetic structure of remaining black poplar (Populus nigra) trees on the banks of the Dutch Rhine branches was investigated using the AFLP technique. In total, 143 trees, including one P. deltoides and some P. x euramericana, were analysed using six AFLP primer combinations which generated 319 polymorphic bands. The AFLP patterns showed that some of the trees sampled as P. nigra were clearly different. These deviating patterns were also observed for the P. deltoides tree and all trees already identified as hybrid P. x euramericana. Hybrids between the two species are morphologically sometimes difficult to distinguish from the species itself. Two important possible source populations for recolonization of the riverbanks of the river Rhine, consisting of mature flowering P. nigra trees, appeared to consist of only a few genotypes each. In contrast, young black poplar trees growing alone or in small groups downstream of the possible source populations appeared to be predominantly generatively derived because no clones of mature trees were found among them. Therefore vegetative propagation seems a very local strategy whereas colonization of new areas appears to occur through generative propagation. Whether the genetic diversity within these black poplars is sufficient for recolonization of river banks and survival of the metapopulation is a question for further research. [ABSTRACT FROM AUTHOR]

Objective: Clinicians are recommended to use the clinical reasoning framework developed by the International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) to provide guidance regarding assessment of the cervical spine and potential for cervical artery dysfunction prior to manual therapy and exercise. However, the interexaminer agreement and reliability of this framework is unknown. This study aimed to estimate the interexaminer agreement and reliability of the IFOMPT framework among physical therapists in primary care., Methods: Ninety-six patients who consulted a physical therapist for neck pain or headache were included in the study. Each patient was tested independently by 2 physical therapists, from a group of 17 physical therapists (10 pairs) across The Netherlands. Patients and examiners were blinded to the test results. The overall interexaminer agreement, specific agreement per risk category (high-, intermediate-, and low-risk), and interexaminer reliability (weighted κ) were calculated., Results: Overall agreement was 71% (specific agreement in high-risk category = 63%; specific agreement in intermediate-risk category = 38%; specific agreement in low-risk category = 84%). Overall reliability was moderate (weighted κ = 0.39; 95% CI = 0.21-0.57) and varied considerably between pairs of physical therapists (κ = 0.14-1.00)., Conclusion: The IFOMPT framework showed an insufficient interexaminer agreement and fair interexaminer reliability among physical therapists when screening the increased risks for vascular complications following manual therapy and exercise prior to treatment., Impact: The IFOMPT framework contributes to the safety of manual therapy and exercise. It is widely adopted in clinical practice and educational programs, but the measurement properties are unknown. This project describes the agreement and reliability of the IFOMPT framework., (© The Author(s) 2021. Published by Oxford University Press on behalf of the American Physical Therapy Association.)

Purpose: Assessment of the blood-brain barrier (BBB) permeability without the need for contrast agent is desirable, and the ability to measure the permeability to small molecules such as water may further increase the sensitivity in detecting diseases. This study proposed a time-efficient, noncontrast method to measure BBB permeability to water, evaluated its test-retest reproducibility, and compared it with a contrast agent-based method., Methods: A single-delay water extraction with phase-contrast arterial spin tagging (WEPCAST) method was devised in which spatial profile of the signal along the superior sagittal sinus was used to estimate bolus arrival time, and the WEPCAST signal at the corresponding location was used to compute water extraction fraction, which was combined with global cerebral blood flow to estimate BBB permeability surface area product to water. The reliability of WEPCAST sequence was examined in terms of intrasession, intersession, and inter-vendor (Philips [Ingenia, Best, the Netherlands] and Siemens [Prisma, Erlangen, Germany]) reproducibility. Finally, we compared this new technique to a contrast agent-based method., Results: Single-delay WEPCAST reduced the scan duration from approximately 20 min to 5 min. Extract fraction values estimated from single-delay WEPCAST showed good consistency with the multi-delay method (R = 0.82, P = .004). Group-averaged permeability surface area product values were found to be 137.5 ± 9.3 mL/100 g/min. Intrasession, intersession, and inter-vendor coefficient of variation of the permeability surface area product values were 6.6 ± 4.5%, 6.9 ± 3.7%, and 8.9 ± 3.0%, respectively. Finally, permeability surface area product obtained from WEPCAST MRI showed a significant correlation with that from the contrast-based method (R = .73, P = .02)., Conclusion: Single-delay WEPCAST MRI can measure BBB permeability to water within 5 min with an intrasession, intersession, and inter-vendor test-retest reproducibility of 6% to 9%. This method may provide a useful marker of BBB breakdown in clinical studies., (© 2021 International Society for Magnetic Resonance in Medicine.)

Purpose: The Ottawa ankle rules (OAR) brought about a reduction of radiographs on the Emergency Department (ED). However, still 50% of patients with ankle injuries undergo unnecessary radiography. Compared to the OAR, the Bernese ankle rule (BAR) has an acclaimed 84% reduction in radiography without loss of sensitivity. The primary aim of this study was to compare the diagnostic accuracy and reproducibility of both rules. Furthermore, the ability of triage nurses to accurately interpret the BAR was assessed., Methods: Participants were assessed by both the ED resident and the triage nurse, applying the OAR and the BAR. After standardised data collection, ankle and foot radiographs were performed in all patients. Sensitivity and specificity of both tests applied by both observers were obtained and compared by McNemar's test. Reproducibility was calculated with Cohen's kappa., Results: A total of 203 patients with ankle trauma were included. For the OAR obtained by the ED residents, the sensitivity and specificity were 0.97 and 0.29, respectively. For the BAR, the sensitivity and specificity of the ED residents were 0.69 and 0.45, respectively. For the triage nurses, the OAR sensitivity and specificity were 0.86 and 0.25, respectively. The BAR sensitivity and specificity for the nurses were 0.86 and 0.40, respectively. The reproducibility of the OAR was 0.45, and for the BAR, it was 0.48., Conclusion: Both rules showed comparable reproducibility. Although the BAR showed a superior specificity compared to the OAR, its sensitivity was too low to promote clinical use. The triage nurses demonstrated too low sensitivity on both rules to allow safe application. Therefore, the OAR remain the decision rules of choice for ankle injuries despite its modest 'ruling out' capacity., (Copyright © 2015 Elsevier Ltd. All rights reserved.)