scholarly journals Reproducibility of global electrical heterogeneity measurements on 12-lead ECG: The Multi-Ethnic Study of Atherosclerosis.

2021 ◽  
Author(s):  
Kazi T Haq ◽  
Katherine Lutz ◽  
Kyle Peters ◽  
Natalie Craig ◽  
Evan Mitchell ◽  
...  
Keyword(s):  
Asian American ◽  
Hispanic American ◽  
Limits Of Agreement ◽  
Perfect Agreement ◽  
Ethnic Study ◽  
Normal Sinus ◽  
Before And After ◽  
Ventricular Beat ◽  
Vector Magnitude ◽  
Spatial Area

Objective: Vectorcardiographic (VCG) global electrical heterogeneity (GEH) metrics showed clinical usefulness. We aimed to assess the reproducibility of GEH metrics. Methods: GEH was measured on two 10-second 12-lead ECGs recorded on the same day in 4,316 participants of the Multi-Ethnic Study of Atherosclerosis (age 69.4 ± 9.4 y; 2317(54%) female, 1728 (40%) white, 1138(26%) African-American, 519(12%) Asian-American, 931(22%) Hispanic-American). GEH was measured on a median beat, comprised of the normal sinus (N), atrial fibrillation/flutter (S), and ventricular-paced (VP) beats. Spatial ventricular gradient's (SVG's) scalar was measured as sum absolute QRST integral (SAIQRST) and vector magnitude QT integral (VMQTi). Results: Two N ECGs with heart rate (HR) bias of -0.64 (95% limits of agreement [LOA] -5.68 to 5.21) showed spatial area QRS-T angle (aQRST) bias of -0.12 (95%LOA -14.8 to 14.5). Two S ECGs with HR bias of 0.20 (95%LOA -15.8 to 16.2) showed aQRST bias of 1.37 (95%LOA -33.2 to 35.9). Two VP ECGs with HR bias of 0.25 (95%LOA -3.0 to 3.5) showed aQRST bias of -1.03 (95%LOA -11.9 to 9.9). After excluding premature atrial or ventricular beat and two additional beats (before and after extrasystole), the number of cardiac beats included in a median beat did not affect the GEH reproducibility. Mean-centered log-transformed values of SAIQRST and VMQTi demonstrated perfect agreement (Bias 0; 95%LOA -0.092 to 0.092). Conclusion: GEH measurements on N, S, and VP median beats are reproducible. SVG's scalar can be measured as either SAIQRST or VMQTi. Significance: Satisfactory reproducibility of GEH metrics supports their implementation.

scholarly journals Comparison of Infant Test-Weighing and Hourly Breast Expression in Measuring Maternal Milk Production (P11-041-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Dayna Roznowski ◽  
Erin Wagner ◽  
Sarah Riddle ◽  
Laurie Nommsen-Rivers
Keyword(s):  
Steady State ◽  
Production Rate ◽  
Milk Production ◽  
Production Capacity ◽  
Limits Of Agreement ◽  
Term Infants ◽  
Maternal Milk ◽  
Milk Output ◽  
Before And After ◽  
The Difference

Abstract Objectives Measuring maternal milk production is cumbersome. Our objectives were to: 1) confirm that milk production rate reaches steady state at hour 2 of hourly breast emptying; and 2) compare agreement in milk production when measured using the well-established test-weighing method versus the more efficient hourly breast emptying method (Lai, et al., Breastfeeding Medicine, 2010). Methods Eligible mothers were 4–10 weeks postpartum and exclusively breastfeeding their healthy, singleton, term infants. A subset of mothers test-weighed (TW) their infant (± 2 g) before and after breastfeeding for 48h. Within 1 week of TW, mothers had a morning visit at the research clinic for hourly breast expression measurements. Mothers emptied both breasts at baseline (h0), and 1, 2, and 3 hours after baseline (h1, h2, h3) using a hospital-grade pump. We recorded hourly milk output ± 1 g and adjusted production rate (g/h) to exact interval (minutes from end of previous to end of current expression). We used paired t-test to compare g/h at h3 versus h0, h1, and h2. We estimated mother's steady-state milk production rate (MPR, g/h) as mean (h2, h3). We used the Bland-Altman method for determining the 95% limits of agreement in measuring milk production (g/24h) using TW versus MPRx24. Results 23 mothers (65% primiparous) were 54 ± 14 days postpartum. Milk output was 185 ± 55 g at h0 and 60 ± 26, 47 ± 13, 44 ± 13 g/h at h1, h2, and h3, respectively. Mean paired difference (vs. h3) was significant at h0 and h1 (P < 0.05), but not at h2 (P > 0.05, h3 - h2 = 3 ± 10 g/h). In the subset with TW data (n = 16), mean TW milk output was 717 ± 119 g/24h, and mean MPRx24 was 1085 ± 300 g/24h. Mean difference, MPRx24 - TW [± 95% limits of agreement], was 368 [± 468] g/24h; and mean ratio, MPRx24/TW, was 1.5 [± 0.4]. Both difference and ratio significantly increased as MPR increased (P < 0.05). Conclusions Hourly milk production reaches steady state at h2; thus, mean (h2, h3) is a valid measure of current maternal milk production capacity. However, there was not homogeneous agreement between MPR and TW, and the 95% limits of agreement were very wide: -91 to 459 g/24h when expressed as the difference, and 0.9 to 1.9-fold as a ratio. Thus, MPR is feasible for researching variation in maternal milk production but not for researching variation in infant intake. Funding Sources None. Supporting Tables, Images and/or Graphs

Asian American Graphic Narrative

2018 ◽  
Author(s):  
Monica Chiu ◽  
Jeanette Roan
Keyword(s):  
United States ◽  
Asian Americans ◽  
Asian American ◽  
Graphic Novels ◽  
The United States ◽  
Comic Strips ◽  
Graphic Narrative ◽  
Award Winning ◽  
Graphic Narratives ◽  
Before And After

Asian American graphic narratives typically produce meaning through arrangements of images, words, and sequences, though some forgo words completely and others offer an imagined “before” and “after” within the confines of a single panel. Created by or featuring Asian Americans or Asians in a US or Canadian context, they have appeared in a broad spectrum of formats, including the familiar mainstream genre comics, such as superhero serials from DC or Marvel Comics; comic strips; self-published minicomics; and critically acclaimed, award-winning graphic novels. Some of these works have explicitly explored Asian American issues, such as anti-Asian racism, representations of history, questions of identity, and transnationalism; others may feature Asian or Asian American characters or settings without necessarily addressing established or familiar Asian American issues. Indeed, many works made by Asian American creators have little or no obvious or explicit Asian American content at all, and some non-Asian American creators have produced works with Asian American representations, including racist stereotypes and caricatures. The earliest representations of Asians in comics form in the United States were racist representations in the popular press, generally in single-panel caricatures that participated in anti-immigration discourses. However, some Asian immigrants in the early to mid-20th century also used graphic narratives to show and critique the treatment of Asians in the United States. In the realm of mainstream genre comics, Asian Americans have participated in the industry in a variety of different ways. As employees for hire, they created many well-known series and characters, generally not drawing, writing, or editing content that is recognizably Asian American. Since the 2010s, though, Asian American creators have reimagined Asian or Asian American versions of legacy characters like Superman and the Hulk and created new heroes like Ms. Marvel. In the wake of an explosion of general and scholarly interest in graphic novels in the 1990s, many independent Asian American cartoonists have become significant presences in the contemporary graphic narrative world.

scholarly journals Occupational Attributes With The Highest Minority Domination: Variables Narrowing Or Increasing Interethnic Occupational Differences

2011 ◽  
Vol 1 (9) ◽  
Author(s):  
Annabel Droussiotis
Keyword(s):  
African American ◽  
Asian American ◽  
Capital Accumulation ◽  
Minority Group ◽  
The United States ◽  
Hispanic American ◽  
Font Size ◽  
Explanatory Variables ◽  
Occupational Differences ◽  
Males And Females

<p class="MsoNormal" style="text-align: justify; margin: 0in 48.1pt 0pt 0.5in; mso-pagination: none;"><span style="font-family: Times New Roman;"><span style="font-size: 10pt; mso-bidi-font-style: italic;">The occupational profile of the various ethnic groups varies in the United States. The occupational stratification is sometimes based on one&rsquo;s ethnicity rather than ability. When interethnic occupational differences are attributed to discrimination the result is inefficiency in the labor market. The purpose of this study is to determine the occupations in which ethnic minorities are dominant and the factors which are most significant in either increasing or reducing this dominance. The data consist of 183 Economic Areas (as defined by the Bureau of Economic Analysis). Explanatory variables reflect educational levels, human capital accumulation, social status, government action, and general area characteristic for each groups. Occupational attributes are used to aggregate all occupations, reflecting prestige and satisfaction levels. African-American, Hispanic-American and Asian-American groups are compared to non-Hispanic whites. Males and females are tested separately. The results show that African American and Hispanic males and females are influenced by similar variables. The level of higher education assists the labor position of African and Hispanic American males reducing interethnic occupational differences. The density of the minority group in the area improves the position of their female counterparts. The Asian American group is very different</span><span style="font-size: 10pt;">.<span style="mso-bidi-font-style: italic;"></span></span></span></p>

scholarly journals Comparison of clinical data based on limits of agreement

2012 ◽  
Vol 49 (1) ◽  
pp. 45-56 ◽  
Author(s):  
Luís M. Grilo ◽  
Helena L. Grilo
Keyword(s):  
Reference Method ◽  
Serum Levels ◽  
Measurement Methods ◽  
Statistical Techniques ◽  
Appropriate Use ◽  
Limits Of Agreement ◽  
Nonparametric Approach ◽  
Medical Researchers ◽  
Before And After ◽  
Medical Measurement

Summary Two different medical measurement methods, which usually do not produce exactly the same results, are used to analyse the serum levels of folic acid in a blood sample. We assess the (dis)agreement of the available data in order to replace the old method (the reference method, which involves a lot of human intervention) with the new one (which uses mostly machines), without causing problems in clinical interpretation. The 95% limits of agreement are estimated, before and after a logarithmic transformation, and an appropriate use of regression and a nonparametric approach are also considered. The application of these different statistical techniques is very useful and easily interpreted by medical researchers, but the results obtained do not provide confidence that the new method can be used in place of the old one for clinical purposes.

scholarly journals NT-proBNP, race and endothelial function in the Multi-Ethnic Study of Atherosclerosis

Heart ◽  
2019 ◽  
Vol 105 (20) ◽  
pp. 1590-1596 ◽  
Author(s):  
Sushan Yang ◽  
Shi Huang ◽  
Lori B Daniels ◽  
Joseph Yeboah ◽  
Joao A C Lima ◽  
...  
Keyword(s):  
African American ◽  
African Americans ◽  
Endothelial Function ◽  
Racial Differences ◽  
Asian American ◽  
Vascular Function ◽  
Chinese Americans ◽  
Mediation Effect ◽  
Linear Regression Models ◽  
Ethnic Study

ObjectiveNatriuretic peptides (NPs) are hormones with cardioprotective effects. NP levels vary by race; however, the pathophysiological consequences of lower NP levels are not well understood. We aimed to quantify the association between NPs and endothelial function as measured by flow-mediated dilation (FMD) and the contribution of NP levels to racial differences in endothelial function.MethodsIn this cross-sectional study of 2938 Multi-Ethnic Study of Atherosclerosis participants (34% Caucasian, 20% African-American, 20% Asian-American and 26% Hispanic) without cardiovascular disease at baseline, multivariable linear regression models were used to examine the association between serum N-terminal pro-B-type NP (NT-proBNP) and natural log-transformed FMD. We also tested whether NT-proBNP mediated the relationship between race and FMD using the product of coefficients method.ResultsAmong African-American and Chinese-American individuals, lower NT-proBNP levels were associated with lower FMD, β=0.06 (95% CI: 0.03 to 0.09; p<0.001) and β=0.06 (95% CI: 0.02 to 0.09; p=0.002), respectively. Non-significant associations between NT-proBNP and FMD were found in Hispanic and Caucasian individuals. In multivariable models, endothelial function differed by race, with African-American individuals having the lowest FMD compared with Caucasians, p<0.001. Racial differences in FMD among African-Americans and Chinese-Americans were mediated in part by NT-proBNP levels (African-Americans, mediation effect: −0.03(95% CI: −0.05 to −0.01); Chinese-Americans, mediation effect: −0.03(95% CI: −0.05 to −0.01)).ConclusionsLower NP levels are associated with worse endothelial function among African-Americans and Chinese-Americans. A relative NP deficiency in some racial/ethnic groups may contribute to differences in vascular function.

scholarly journals Life-threatening danger assessments of penetrating injuries in Eastern Danish clinical forensic medicine

2021 ◽  
Author(s):  
Lykke Schrøder Jakobsen ◽  
Marie Toftdahl Christensen ◽  
Sissel Banner Lundemose ◽  
Julie Munkholm ◽  
Anne Birgitte Dyhre Bugge ◽  
...  
Keyword(s):  
Clinical Forensic Medicine ◽  
Chi Square ◽  
Perfect Agreement ◽  
Moderate Severity ◽  
Protocol Implementation ◽  
Forensic Practice ◽  
Before And After ◽  
Chi Square Test ◽  
Life Threatening ◽  
Strong Agreement

AbstractClinical forensic assessments of injuries’ life-threatening danger may have an impact on the legal aftermath following a violent assault. The pursuit of evidence-based guidelines should ensure a user-independent and reproducible forensic practice. However, does it? The aim of this study was to evaluate the forensic life-threatening danger assessments after a protocol implementation in 2016. The evaluation concerned usability and reproducibility of the protocol, and its influence on assessment severity. We analyzed the level of inter- and intra-rater agreement using 169 blinded, prior-protocol cases that were reassessed by two forensic specialists. We compared assessment made the year before and after protocol implementation (n = 262), and the forensic specialists’ reassessments with the prior-protocol cases’ original assessments (n = 169). Whether to make an assessment, the levels of agreement varied between weak agreement (inter-rater, Κ = 0.43; assessor 1, Κ = 0.57) and strong agreement (assessor 2, Κ = 0.90). Regarding severity, the levels of agreement varied between strong agreement (inter-rater, Κ = 0.87; assessor 1: Κ = 0.90) and almost perfect agreement (assessor 2: Κ = 0.94). The assessments were statistically significant redistributed after the implementation (chi-square test: p < 0.0001). The proportion of cases assessed as having not been in life-threatening danger increased from 9 to 43%, and moderate severity assessments decreased from 55 to 23%. Of the moderate severity assessments, 55% were reassessed as having not been in life-threatening danger. The protocol ensured independent and reproducible assessments when the forensic specialists agreed on making one. The protocol resulted in less severe assessments. Future studies should examine the reliability of the protocol and its consequences for legal aftermaths.

Agreement Between R2 and R2* Liver Iron Estimates Is Independent of the Type of Iron Removal Therapy: Results from the Twitch Trial

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 1274-1274 ◽  
Author(s):  
John C Wood ◽  
Tim St Pierre ◽  
Banu Aygun ◽  
Nicole Mortier ◽  
William H Schultz ◽  
...  
Keyword(s):  
Research Funding ◽  
Observation Interval ◽  
Geometric Mean ◽  
Iron Concentration ◽  
Iron Removal ◽  
Secondary Outcome ◽  
Limits Of Agreement ◽  
Perfect Agreement ◽  
Liver Iron ◽  
Measurement Variability

Abstract Introduction: TCD with Transfusions Changing toHydroxyurea (TWiTCH Clinical Trials.gov NCT01425307), an NHLBI-sponsored multicenter trial, compared transfusion pluschelation (Standard Arm) tohydroxyurea (HU) plus phlebotomy (Alternative Arm) in children with sickle cell disease at high risk for stroke. Alternative arm patients underwent serial phlebotomy (10mL/kg, maximum 500mL) every 4 weeks after reaching maximal tolerated dose (MTD) of HU and discontinuing transfusions. Changes in liver iron concentration (dLIC), measured as mg Fe per gram dry weight liver, by both MRI R2 (FerriScan) and R2* were key secondary outcome measures. R2 and R2* are two, different MRI techniques that exploit the magnetic properties of tissue iron to estimate iron concentration. We previously reported significant differences between the two approaches at the baselinetimepoint. The purpose of this investigation was to determine the limits of agreement between measurements ofdLIC over a period of one year by R2 and R2* methods in both arms of the study. Methods: MRI R2 and R2* data were collected prior to randomization, and after 1 year (midpoint) and 2 years of therapy (study exit). dLIC between baseline to midpoint and midpoint to study completion was calculated for both R2 and R2* LIC values. Since LIC measurement variability increases with iron burden, each dLIC pair (R2 and R2*) were normalized to the patients iron burden at the start of the observation interval. That is, dLIC from baseline to midpoint was normalized to baseline LIC, while dLIC from midpoint to study end was normalized to midpoint LIC. The geometric mean of LICR2 and LICR2* was used to represent the baseline and midpoint LIC. Bland Altman analysis was performed on measurements of the percent change of dLICR2 and dLICR2* to determine the limits of agreement between the two techniques. Results: R2 measurements were performed in 104 patients at baseline, 94 at midpoint and 99 at study end, while R2* measurements were performed in 101, 87, and 89 patients, respectively. However, missing data limited Bland Altman comparisons ofdLIC to 74 patients between baseline to midpoint and 69 patients from midpoint to study end. Figure 1 (left) plots the measureddLIC using R2 (vertical axis) against the measureddLIC change by R2* (horizontal axis) for the Standard Arm participants. Dots represent LIC change over the first year and open circles represent LIC changes over the second year. The dotted line represents perfect agreement. Figure 1 (right) demonstrates the corresponding relationship for the patients in the Alternative Arm. Although the alternative arm appears to have greater disagreement, this represents an artifactcause by the transient increases in LIC that occurred as patients bridged from standard to alternative therapy. Iron chelationwas stopped when patients began hydroxyureabut patients required an overlap period of transfusions for stroke prophylaxis. Figure 2 demonstrates the difference in dLIC measured by R2 and R2*, expressed as a percentage of starting LIC, plotted against the starting LIC value. The standard arm (open circles) and alternative arms (dots) completely overlap. 95% limits of agreement between the two measures ofdLIC were -45.7% to 63.7% (light lines). At LIC values > 8.3 mg/g,dLIC predicted by R2 was larger than predicted by R2*, while the converse was true for LIC values below 8.3 mg/g, similar to our published baseline findings for LIC measurements. Conclusions: LIC by R2 and R2* tracked one another closely over time in patients in both study arms. These data indicate that either technique can be used with confidence to monitor patients on iron removal therapy (chelation or phlebotomy), but that the techniques should not be interchanged. Figure 1 Figure 1. Figure 2 Figure 2. Disclosures Wood: Vifor: Consultancy; Ionis Pharmaceuticals: Consultancy; Vifor: Consultancy; Biomed Informatics: Consultancy; World Care Clinical: Consultancy; Ionis Pharmaceuticals: Consultancy; World Care Clinical: Consultancy; AMAG: Consultancy; AMAG: Consultancy; Celgene: Consultancy; Celgene: Consultancy; Biomed Informatics: Consultancy; Apopharma: Consultancy; Apopharma: Consultancy. St Pierre:Resonance Health: Consultancy, Equity Ownership. Piccone:Novartis: Other: Speaker. Hankins:Novartis: Research Funding. Rogers:Apopharma: Consultancy. Ware:Bayer Pharmaceuticals: Consultancy; Global Blood Therapeutics: Consultancy; Biomedomics: Research Funding; Addmedica: Research Funding; Nova Laboratories: Consultancy; Bristol Myers Squibb: Research Funding.

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