Bakgrund: Det nyfödda barnet är en patient som är särskilt känslig för förändringar i kroppstemperaturen och risken är stor för både hypotermi och hypertermi. För att undvika ökad risk för sjuklighet och dödlighet är det därför viktigt att det nyfödda barnets kroppstemperaturen hålls inom gränserna 36,5–37,5 ℃. Detta är en utmaning inom neonatalvården och utmaningen blir större i och med sjunkande gestationsålder och födelsevikt. Motiv: Att med hitta en fungerande metod för beröringsfri temperaturmätning så att barnet ej störs vid kontroll av kroppstemperaturen. Syfte: Attstudera överensstämmelsen mellan beröringsfri infraröd termometer och två vedertagna metoder, axill- och rektalmätning av kroppstemperatur på nyfödda barn som vårdas på en neonatal intensivvårdsavdelning. Syftet var också att studera om överenstämmelsen mellan metoderna skiljer sig om barnet vårdas i kuvös, öppenvårdskuvös eller säng.Design: En prospektiv studie med upprepade mätningar. Metod: 35 barn inkluderades i studien och temperaturmätningar genomfördes vid tre mättillfällen med de tre olika metoderna. Datan analyserades enligt Bland-Altmans analysmetod för att bedöma överensstämmelse mellan kliniska mätmetoder. Resultat: Denna studie visade att det fanns överensstämmelsen mellan infraröd mätning och axillmätning, men att dess 95%-iga konfidensintervall var för vida för att kunna accepteras i klinisk praxis. Överensstämmelse mellan infraröd- och rektaltemperaturmätning samt mellan axill- och rektaltemperaturmätning kunde inte påvisas. Konklusion: Kroppstemperaturmätning med beröringsfri infraröd termometer är en tilltalande metod för temperaturmätning hos nyfödda barn med tanke på dess fördelar. Metodutveckling och mer forskning med större urval krävs dock för att användning av infraröd temperaturmätning inom neonatal intensivvård ska kunna etableras.

BACKGROUND: The aim was to compare the thickness of the palatal masticatory mucosa as determined on a cone-beam computerized (CBCT) scan versus thickness determined via bone-sounding. METHODS: A total of twenty patients requiring palatal surgery participated. Thickness of the palatal tissue was measured at various points radiographically and clinically. The two techniques were compared to determine the agreement of the two measurement modalities. RESULTS: Analysis of variance determined that there was no significant difference between the two methods. A small bias of the radiographic measurement being larger was found to be statistically significant (0.09 ± 0.69mm; p <0.0001). Moreover, the tissue thickness was shown to increase as the distance from the gingival margin increased and the tissue over the molars was thinner than the tissue over the premolars. CONCLUSIONS: CBCT can be used to accurately determine the soft tissue thickness of the palatal masticatory mucosa with minimal bias.

The two most common methods to measure resting metabolic rate using indirect calorimetry are steady state or time interval. Steady state is commonly defined as the first five minutes in which oxygen consumption and carbon dioxide production vary by <10%. A time interval measurement generally lasts 20-60 minutes. Using steady state criteria is often harder to achieve, but many suggest it more accurately measures resting metabolic rate. Our objective was to determine if there were differences between steady state and time interval measurements in a healthy adult population. Seventy seven subjects were measured for 45 minutes. Inclusion criteria included healthy subjects ages 18-65, excluding pregnant and lactating women. Paired t-tests analyzed differences between measures, and Bland-Altman plots evaluated bias, precision, and accuracy. Of 77 subjects, 84% achieved steady state, and 95% achieved SS by minute 30. Most differences between steady state and time intervals were statistically but not practically significant. Bland-Altman plots showed steady state measurements were generally lower indicating that steady state is more indicative of resting metabolic rate. Minutes 6-25 were most precise, accurate and fairly unbiased compared to steady state. We recommend measuring a subject for 30 minutes and using steady state criteria of <10% variation of oxygen consumption and carbon dioxide production for five minutes if a subject is able to achieve it. However, if a subject cannot achieve steady state, we recommend averaging minutes 6-25.

No description available.

No description available.

O estudo de concordância ou coincidência entre os resultados obtidos por dois métodos ou modelos é amplo e abrange diversos índices e abordagens distintas, havendo divergências nas escolhas das técnicas usadas na estimativa da evapotranspiração. Dentre os índices usados para esta finalidade destacam-se: o coeficiente de correlação linear, o coeficiente de determinação, os índices de concordância de Willmott (WILLMOTT, 1981; WILLMOTT et al., 2012) e os índices de desempenho (CAMARGO & SENTELHAS, 1997; ALVARES et al., 2013). Também são utilizados o método de Bland-Altman (BLAND & ALTMAN, 1986) e testes sobre os coeficientes de regressão linear simples, com ou sem intercepto. O Irrigâmetro é um aparelho evapopluviométrico utilizado no manejo da irrigação, visando a otimizar o uso da água na agricultura irrigada e que pode ser usado para estimar a evapotranspiração de referência (ET0). Este aparelho apresenta grande potencial de uso na agricultura, pois além de ser um equipamento simples, de fácil manuseio e economicamente viável, fornece informações de quando e quanto irrigar, sem que o irrigante tenha conhecimentos técnicos especializados sobre irrigação (OLIVEIRA et al., 2008b) ou acesso a inúmeros dados meteorológicos. Neste contexto é interessante saber se a evapotranspiração de referência obtida com o uso do Irrigâmetro (ETI) concorda com a Evapotranspiração de referência obtida pelo método padrão de Penman Monteith FAO 56 (ET0). Diante do exposto os objetivos deste trabalho foram: (i) apresentar e avaliar diferentes técnicas utilizadas no estudo de concordância entre dois métodos para a obtenção da ET0 por meio de um estudo com dados simulados; (ii) implementar computacionalmente os cálculos no software computacional R e (iii) aplicar as técnicas aos dados de Evapotranspiração de referência obtidos com o uso do Irrigâmetro (ETI), em um experimento conduzido no Campus Universitário de Gurupi da Universidade Federal do Tocantins (UFT). Os resultados das simulações indicaram que nenhum índice ou técnica conseguiu sozinho identificar a real concordância entre os dados simulados. Dentre os índices estudados, o índice de Willmott refinado foi o mais eficiente para avaliar a concordância entre dois métodos usados na obtenção da ET. O teste para os parâmetros da reta de regressão e o método de Bland-Altman devem ser utilizados em conjunto com outros índices de concordância. A aplicação dos métodos de concordância aos dados do estudo com o Irrigâmetro indicou que a altura de água no evaporatório, que melhor estima a ET0 foi de 3 cm. O índice de Willmott indicou uma concordância boa (d = 0; 74), mas o índice refinado de Willmott indicou uma concordância fraca (dr = 0; 34) entre ETI e ET0. Em trabalhos futuros com o Irrigâmetro, além do nível de água no interior do evaporatório, outras medidas deverão ser consideradas, como a área de água exposta na superfície e, consequentemente, o volume de água no evaporatório, a espessura e o tipo de material do evaporatório. / The agreement or coincidence between the results obtained by two methods or models is extensive and comprises several indexes and different approaches, with differences in the choices of the techniques used to estimate evapotranspiration. Among the indices used for this purpose are: correlation coefficient, determination coefficient, Willmott\'s concordance indexes (WILLMOTT, 1981; WILLMOTT et al., 2012) and performance indices (CAMARGO & SENTELHAS, 1997; ALVARES et al., 2013). The Bland-Altman method and tests on the coefficients of simple linear regression, with or without the intercept term, are also used in this kind of study. The Irrigameter is an evapo-pluviometric apparatus to be used in irrigation water management, aiming to optimize the use of water in irrigated agriculture and that can be used to estimate the reference evapotranspiration (ET0). This apparatus has great potential for use in agriculture, because besides being simple apparatus, easy handling and economically feasible, gives information of when and how much to irrigate, without the irrigator has technical expertise on irrigation (OLIVEIRA et al., 2008b) or access to numerous meteorological data. In this context it is interesting to know whether the reference evapotranspiration obtained with the use of Irrigameter (ETI) agrees with the reference evapotranspiration obtained by the standard method of Penman Monteith FAO 56 (ET0). Given the above the objectives of this study were: (i) present and evaluate the different techniques used in the study of agreement between two methods for obtaining the ET0 through an analysis of simulated data, (ii) implement the calculations in the computer software R and (iii) apply the techniques to the evapotranspiration (ET0) data obtained with the use of an Irrigameter (ETI) in an experiment conducted at the Federal University of Tocantins (UFT), Gurupi-TO/Brazil. The simulation study concluded that none of the discussed methodologies can be used, isolated, to conclude on the agreement between two models or methods. Among the studied indices, the Willmott\'s refined index was the most efficient to evaluate the agreement between the two methods used in obtaining the ET. The test for the regression line parameters and the Bland-Altman\'s chart should be used together with other concordance indices. The application of the methods of agreement to study data with the Irrigameter indicated that the water level in the evaporatory that better estimated ET0 was 3 cm. The index of Willmott indicated a good agreement (d = 0:74), but the refined Willmott\'s index indicated a weak agreement (dr = 0:34) between (ETI e ET0). In future studies, beyond the water level inside the evaporatory other measures could be considered, such as the exposed area of water on the surface and, consequently, the water volume in the evaporatory, the thickness and type of the evaporatory\'s material.

O estudo de concordância ou coincidência entre os resultados obtidos por dois métodos ou modelos é amplo e abrange diversos índices e abordagens distintas, havendo divergências nas escolhas das técnicas usadas na estimativa da evapotranspiração. Dentre os índices usados para esta finalidade destacam-se: o coeficiente de correlação linear, o coeficiente de determinação, os índices de concordância de Willmott (WILLMOTT, 1981; WILLMOTT et al., 2012) e os índices de desempenho (CAMARGO & SENTELHAS, 1997; ALVARES et al., 2013). Também são utilizados o método de Bland-Altman (BLAND & ALTMAN, 1986) e testes sobre os coeficientes de regressão linear simples, com ou sem intercepto. O Irrigâmetro é um aparelho evapopluviométrico utilizado no manejo da irrigação, visando a otimizar o uso da água na agricultura irrigada e que pode ser usado para estimar a evapotranspiração de referência (ET0). Este aparelho apresenta grande potencial de uso na agricultura, pois além de ser um equipamento simples, de fácil manuseio e economicamente viável, fornece informações de quando e quanto irrigar, sem que o irrigante tenha conhecimentos técnicos especializados sobre irrigação (OLIVEIRA et al., 2008b) ou acesso a inúmeros dados meteorológicos. Neste contexto é interessante saber se a evapotranspiração de referência obtida com o uso do Irrigâmetro (ETI) concorda com a Evapotranspiração de referência obtida pelo método padrão de Penman Monteith FAO 56 (ET0). Diante do exposto os objetivos deste trabalho foram: (i) apresentar e avaliar diferentes técnicas utilizadas no estudo de concordância entre dois métodos para a obtenção da ET0 por meio de um estudo com dados simulados; (ii) implementar computacionalmente os cálculos no software computacional R e (iii) aplicar as técnicas aos dados de Evapotranspiração de referência obtidos com o uso do Irrigâmetro (ETI), em um experimento conduzido no Campus Universitário de Gurupi da Universidade Federal do Tocantins (UFT). Os resultados das simulações indicaram que nenhum índice ou técnica conseguiu sozinho identificar a real concordância entre os dados simulados. Dentre os índices estudados, o índice de Willmott refinado foi o mais eficiente para avaliar a concordância entre dois métodos usados na obtenção da ET. O teste para os parâmetros da reta de regressão e o método de Bland-Altman devem ser utilizados em conjunto com outros índices de concordância. A aplicação dos métodos de concordância aos dados do estudo com o Irrigâmetro indicou que a altura de água no evaporatório, que melhor estima a ET0 foi de 3 cm. O índice de Willmott indicou uma concordância boa (d = 0; 74), mas o índice refinado de Willmott indicou uma concordância fraca (dr = 0; 34) entre ETI e ET0. Em trabalhos futuros com o Irrigâmetro, além do nível de água no interior do evaporatório, outras medidas deverão ser consideradas, como a área de água exposta na superfície e, consequentemente, o volume de água no evaporatório, a espessura e o tipo de material do evaporatório. / The agreement or coincidence between the results obtained by two methods or models is extensive and comprises several indexes and different approaches, with differences in the choices of the techniques used to estimate evapotranspiration. Among the indices used for this purpose are: correlation coefficient, determination coefficient, Willmott\'s concordance indexes (WILLMOTT, 1981; WILLMOTT et al., 2012) and performance indices (CAMARGO & SENTELHAS, 1997; ALVARES et al., 2013). The Bland-Altman method and tests on the coefficients of simple linear regression, with or without the intercept term, are also used in this kind of study. The Irrigameter is an evapo-pluviometric apparatus to be used in irrigation water management, aiming to optimize the use of water in irrigated agriculture and that can be used to estimate the reference evapotranspiration (ET0). This apparatus has great potential for use in agriculture, because besides being simple apparatus, easy handling and economically feasible, gives information of when and how much to irrigate, without the irrigator has technical expertise on irrigation (OLIVEIRA et al., 2008b) or access to numerous meteorological data. In this context it is interesting to know whether the reference evapotranspiration obtained with the use of Irrigameter (ETI) agrees with the reference evapotranspiration obtained by the standard method of Penman Monteith FAO 56 (ET0). Given the above the objectives of this study were: (i) present and evaluate the different techniques used in the study of agreement between two methods for obtaining the ET0 through an analysis of simulated data, (ii) implement the calculations in the computer software R and (iii) apply the techniques to the evapotranspiration (ET0) data obtained with the use of an Irrigameter (ETI) in an experiment conducted at the Federal University of Tocantins (UFT), Gurupi-TO/Brazil. The simulation study concluded that none of the discussed methodologies can be used, isolated, to conclude on the agreement between two models or methods. Among the studied indices, the Willmott\'s refined index was the most efficient to evaluate the agreement between the two methods used in obtaining the ET. The test for the regression line parameters and the Bland-Altman\'s chart should be used together with other concordance indices. The application of the methods of agreement to study data with the Irrigameter indicated that the water level in the evaporatory that better estimated ET0 was 3 cm. The index of Willmott indicated a good agreement (d = 0:74), but the refined Willmott\'s index indicated a weak agreement (dr = 0:34) between (ETI e ET0). In future studies, beyond the water level inside the evaporatory other measures could be considered, such as the exposed area of water on the surface and, consequently, the water volume in the evaporatory, the thickness and type of the evaporatory\'s material.

Dementia disorders are difficult to detect in the early stages of the disease. Therefore, it is of importance to develop new methods in early diagnostics. The Uppsala Dalarna Dementia and Gait Study has established a new method in diagnosing early stages of cognitive impairments. The new method Timed-Up-and-Go (TUG) dual-task, combines a gait test with a verbal task. This thesis analyses nine TUG variables for healthy controls and discusses differences between two age groups, subjects younger than 72 years and subjects 72 years or older. Reliability of the new method is the primary focus point and is assessed using Intraclass Correlation Coefficients (ICC) and Bland-Altman plots. Normative reference values for the continuous variables are estimated with the help of bootstrap confidence intervals for the 2.5 and 97.5 percentiles. The results show that the three variables measuring the time to complete the test have good to excellent reliability, while variables that measure combinations of gait and verbal tasks show poor to moderate reliability. The lower reliability for these variables could be explained by them being ratios or differences of other variables. Differences in reliability can be seen between the age groups, where younger subjects have lower reliability partly due to homogeneity. Results show that the reference values of healthy controls are different for the two age groups.

The evaluation of shoulder abduction and flexion strength is important in the rehabilitation after rotator cuff tear. The purpose of this work is to assess the intra and inter-rater reliability of measurement data from an isokinetic dynamometer used to evaluate shoulder abduction and flexion strength, with the aim to identify sources of measurement errors and suggest improvements. The measurement data was collected by a research group at Karolinska Institute and contained load and torque data from thirteen healthy subjects in the ages of 25 to 87 years. The measurements were carried out on two occasions, one week apart. Systematic differences between occasions are analyzed using the Shapiro Wilk test, the paired t-test, and Wilcoxon signed rank test. The agreement of the measurements is analyzed quantitatively using the coefficient of variation and the Bland Altman plot, and quantitively, using the intraclass correlation coefficient. A significant systematic difference in shoulder abduction and flexion load measurements was found, and the recommendation to prevent this is that components should be calibrated in a standardized way. The measurements showed varying reliability within and between measurement occasions and that after familiarization with the isokinetic dynamometer, repeatability improved. The findings indicate a need of a standardized protocol for patient education and placement. Measurements from the position sensor contributed to more random torque values. To improve the repeatability in measurements from the position sensor, axis of rotation should be kept aligned. An increasing variability in measurements with increasing load and torque was found. The recommendation is to use a preload for patients using more force in the movement, to make sure a preset speed is not exceeded, which contributes to more reliable measurements. / Utvärderingen av axelabduktion och flexionsstyrka är viktig i rehabiliteringen efter skada i axelleden. Syftet med det här arbetet är att bedöma intra- och interbedömartillförlitligheten hos mätdata från en isokinetisk dynamometer som används för att utvärdera axelabduktion och flexionsstyrka, med syftet att identifiera källor till mätfel och föreslå förbättringar. Mätdatat samlades in av en forskargrupp vid Karolinska Institutet och innehöll belastnings- och vridmomentdata från tretton friska försökspersoner i åldrarna 25 till 87 år. Mätningarna utfördes vid två tillfällen med en veckas mellanrum. Systematiska skillnader mellan tillfällena analyseras med Shapiro Wilk-testet, det parade t-testet och Wilcoxon signed rank test. Mätningarnas överensstämmelse analyseras kvantitativt med hjälp av variationskoefficienten och Bland Altman-diagrammet, samt kvalitativt med hjälp av intraklasskorrelationskoefficienten. En signifikant systematisk skillnad i axelabduktion och flexionsbelastningsmätningar hittades, och rekommendationen för att förhindra detta är att komponenter bör kalibreras på ett standardiserat sätt. Mätningarna visade på en varierande tillförlitlighet inom och mellan mättillfällen och att efter bekantskap med den isokinetiska dynamometern, förbättrades repeterbarheten. Slutsatserna indikerar ett behov av ett standardiserat protokoll för patientutbildning och placering. Mätningar från positionssensorn bidrog till mer slumpmässiga vridmomentvärden. För att förbättra repeterbarheten i mätningar från positionssensorn bör rotationsaxeln hållas i linje. En ökande variation mellan mättillfällen med ökande belastning och vridmoment hittades. Rekommendationen är att använda en förspänning för patienter som använder mer kraft i rörelsen, för att säkerställa att en förinställd hastighet inte överskrids, vilket bidrar till mer tillförlitliga mätningar.

Autosomal dominant polycystic disease (ADPKD) is the most common hereditary renal disease and is characterized by renal cyst growth and enlargement. Hypertension occurs early when renal function is normal and is characterized by decreased renal blood flow. Accordingly, the measurement of blood flow in the renal arteries can be a valuable tool in evaluating disease progression. In studies performed in conjunction with this work, blood flow was measured through the renal arteries using magnetic resonance imaging (MRI). In order to validate these in vivo measurements, a vascular phantom was created using polyvinyl alcohol (PVA) and also scanned using MRI under controlled steady flow conditions. Ranges of vessel diameters and flow velocities were used to simulate actual flow in a normal and diseased population of adults and children. With the vessel diameters studied in this experiment, minimization of field of view and an increase in spatial resolution is important in obtaining accurate data. However, a significant difference does not exist between the results when using the 160 or 200 mm FOV. An increase in the number of phase encodings provides improved results, although an increase in image acquisition time is observed. Velocity-encoding in all three orthogonal directions does not improve image data. This method of using MRI to measure flow through a vessel is shown to be both accurate and reproducible, and the protocol providing the most correct results is prescribed. Breath-hold phase-velocity encoded MRI proves to be an accurate and reproducible technique in capturing flow and has the potential to be used for the purpose of observing hemodynamic changes in the renal arteries with the progression of ADPKD.