Value of the central vein sign at 3T to differentiate MS from seropositive NMOSD

ObjectiveTo assess the value of the central vein sign (CVS) on a clinical 3T scanner to distinguish between multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD).MethodsEighteen aquaporin-4-antibody-positive patients with NMOSD, 18 patients with relapsing-remitting MS, and 25 healthy controls underwent 3T MRI. The presence of a central vein in white matter lesions on susceptibility-weighted imaging, defined as a thin hypointense line or a small dot, was recorded.ResultsThe proportion of lesions with the CVS was higher in MS than NMOSD (80% vs 32%, p < 0.001). A greater proportion of lesions with the CVS predicted the diagnosis of MS, rather than NMOSD (odds ratio 1.10, 95% confidence interval [CI] 1.04 to 1.16, p = 0.001), suggesting that each percent unit increase in the proportion of lesions with the CVS in an individual patient was associated with a 10% increase in the risk of the same patient having MS. If more than 54% of the lesions on any given scan show the CVS, then the patient can be given a diagnosis of MS with an accuracy of 94% (95% CIs 81.34, 99.32, p < 0.001, sensitivity/specificity 90%/100%).ConclusionThe clinical value of the CVS in the context of the differential diagnosis between MS and NMOSD, previously suggested using 7T scanners, is now extended to clinical 3T scanners, thereby making a step towards the use of CVS in clinical practice.Classification of evidenceThis study provides Class III evidence that the CVS on 3T MRI accurately distinguishes patients with MS from those with seropositive NMOSD.

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Questionnaire-based diagnosis of benign paroxysmal positional vertigo

Neurology ◽

10.1212/wnl.0000000000008876 ◽

2019 ◽

Vol 94 (9) ◽

pp. e942-e949 ◽

Cited By ~ 7

Author(s):

Hyo-Jung Kim ◽

Jeong-Mi Song ◽

Liqun Zhong ◽

Xu Yang ◽

Ji-Soo Kim

Keyword(s):

Confidence Interval ◽

Gold Standard ◽

Benign Paroxysmal Positional Vertigo ◽

Class Iii ◽

Positional Vertigo ◽

National University ◽

Seoul National University ◽

Sensitivity Specificity ◽

Paroxysmal Positional Vertigo

ObjectivesTo develop a simple questionnaire for self-diagnosis of benign paroxysmal positional vertigo (BPPV).MethodsWe developed a questionnaire that consisted of 6 questions, the first 3 to diagnose BPPV and the next 3 to determine the involved canal and type of BPPV. From 2016 to 2017, 578 patients with dizziness completed the questionnaire before the positional tests, a gold standard for diagnosis of BPPV, at the Dizziness Clinic of Seoul National University Bundang Hospital.ResultsOf the 578 patients, 200 were screened to have BPPV and 378 were screened to have dizziness/vertigo due to disorders other than BPPV. Of the 200 patients with a questionnaire-based diagnosis of BPPV, 160 (80%) were confirmed to have BPPV with positional tests. Of the 378 patients with a questionnaire-based diagnosis of non-BPPV, 24 (6.3%) were found to have BPPV with positional tests. Thus, the sensitivity, specificity, and precision of the questionnaires for the diagnosis of BPPV were 87.0%, 89.8%, and 80.0% (121 of 161, 95% confidence interval 74.5%–85.5%). Of the 200 patients with a questionnaire-based diagnosis of BPPV, 30 failed to respond to the questions 4 through 6 to determine the involved canal and type of BPPV. The questionnaire and positional tests showed the same results for the subtype and affected side of BPPV in 121 patients (121 of 170, 71.2%).ConclusionThe accuracy of questionnaire-based diagnosis of BPPV is acceptable.Classification of evidenceThis study provides Class III evidence that, in patients with dizziness, a questionnaire can diagnose BPPV with a sensitivity of 87.0% and a specificity of 89.8%.

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Cervical spinal cord atrophy

Neurology Neuroimmunology & Neuroinflammation ◽

10.1212/nxi.0000000000000435 ◽

2018 ◽

Vol 5 (2) ◽

pp. e435 ◽

Cited By ~ 31

Author(s):

Burcu Zeydan ◽

Xinyi Gu ◽

Elizabeth J. Atkinson ◽

B. Mark Keegan ◽

Brian G. Weinshenker ◽

...

Keyword(s):

Spinal Cord ◽

Cervical Spinal Cord ◽

Intraclass Correlation ◽

Disease Course ◽

Class Iii ◽

Spinal Cord Lesions ◽

Spinal Cord Atrophy ◽

Spine Length ◽

Relapsing Remitting

ObjectiveTo assess whether cervical spinal cord atrophy heralds the onset of progressive MS.MethodsWe studied 34 individuals with radiologically isolated syndrome (RIS) and 31 patients with relapsing-remitting MS (RRMS) age matched to 25 patients within a year of onset of secondary progressive MS (SPMS). Two raters independently measured (twice per rater) the cervical spinal cord average segmental area (CASA) (mm2) of axial T2-weighted images between C2 and C7 landmarks. The midsagittal T2-weighted image from the end of C2 to the end of C7 vertebra was used to measure the cervical spine (c-spine) length (mm). Sex, age at cervical MRI, number and location of cervical spinal cord lesions, c-spine length, and diagnoses were analyzed against the outcome measures of CASA and C2 and C7 slice segmental areas.ResultsIntrarater and interrater agreement was excellent (intraclass correlation coefficient >0.97). The CASA area (p = 0.03) and C7 area (p = 0.002) were smaller in SPMS compared with RRMS. The C2 area (p = 0.027), CASA (p = 0.004), and C7 area (p = 0.003) were smaller in SPMS compared with RIS. The C2 area did not differ between SPMS and RRMS (p = 0.09). The C2 area (p = 0.349), CASA (p = 0.136), and C7 area (p = 0.228) did not differ between RIS and MS (SPMS and RRMS combined). In the multivariable model, ≥2 cervical spinal cord lesions were associated with the C2 area (p = 0.008), CASA (p = 0.009), and C7 area independent of disease course (p = 0.017). Progressive disease course was associated with the C7 area independent of the cervical spinal cord lesion number (p = 0.004).ConclusionCervical spinal cord atrophy is evident at the onset of progressive MS and seems partially independent of the number of cervical spinal cord lesions.Classification of evidenceThis study provides Class III evidence that MRI cervical spinal cord atrophy distinguishes patients at the onset of progressive MS from those with RIS and RRMS.

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In vivo distribution of α-synuclein in multiple tissues and biofluids in Parkinson disease

Neurology ◽

10.1212/wnl.0000000000010404 ◽

2020 ◽

Vol 95 (9) ◽

pp. e1267-e1284 ◽

Cited By ~ 3

Author(s):

Lana M. Chahine ◽

Thomas G. Beach ◽

Michael C. Brumm ◽

Charles H. Adler ◽

Christopher S. Coffey ◽

...

Keyword(s):

Monoclonal Antibody ◽

Parkinson Disease ◽

Class Iii ◽

Cross Sectional ◽

Antibody Staining ◽

Significant Relationships ◽

Sensitivity Specificity ◽

Final Cohort

ObjectiveThe Systemic Synuclein Sampling Study (S4) measured α-synuclein in multiple tissues and biofluids within the same patients with Parkinson disease (PD) vs healthy controls (HCs).MethodsS4 was a 6-site cross-sectional observational study of participants with early, moderate, or advanced PD and HCs. Motor and nonmotor measures and dopamine transporter SPECT were obtained. Biopsies of skin, colon, submandibular gland (SMG), CSF, saliva, and blood were collected. Tissue biopsy sections were stained with 5C12 monoclonal antibody against pathologic α-synuclein; digital images were interpreted by neuropathologists blinded to diagnosis. Biofluid total α-synuclein was quantified using ELISA.ResultsThe final cohort included 59 patients with PD and 21 HCs. CSF α-synuclein was lower in patients with PD vs HCs; sensitivity/specificity of CSF α-synuclein for PD diagnosis was 87.0%/63.2%, respectively. Sensitivity of α-synuclein immunoreactivity for PD diagnosis was 56.1% for SMG and 24.1% for skin; specificity was 92.9% and 100%, respectively. There were no significant relationships between different measures of α-synuclein within participants.ConclusionsS4 confirms lower total α-synuclein levels in CSF in patients with PD compared to HCs, but specificity is low. In contrast, α-synuclein immunoreactivity in skin and SMG is specific for PD but sensitivity is low. Relationships within participants across different tissues and biofluids could not be demonstrated. Measures of pathologic forms of α-synuclein with higher accuracy are critically needed.Classification of evidenceThis study provides Class III evidence that total CSF α-synuclein does not accurately distinguish patients with PD from HCs, and that monoclonal antibody staining for SMG and skin total α-synuclein is specific but not sensitive for PD diagnosis.

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Central Vein Sign Profile of Newly Developing Lesions in Multiple Sclerosis

Neurology Neuroimmunology & Neuroinflammation ◽

10.1212/nxi.0000000000001120 ◽

2022 ◽

Vol 9 (2) ◽

pp. e1120

Author(s):

Omar Al-Louzi ◽

Vijay Letchuman ◽

Sargis Manukyan ◽

Erin S. Beck ◽

Snehashis Roy ◽

...

Keyword(s):

Multiple Sclerosis ◽

White Matter Lesions ◽

Trial Registration ◽

Central Vein ◽

Class Iii ◽

Lesion Development ◽

Clinical Trial Registration ◽

Link Type ◽

Younger Age

Background and ObjectivesThe central vein sign (CVS), a central linear hypointensity within lesions on T2*-weighted imaging, has been established as a sensitive and specific biomarker for the diagnosis of multiple sclerosis (MS). However, the CVS has not yet been comprehensively studied in newly developing MS lesions. We aimed to identify the CVS profiles of new white matter lesions in patients with MS followed over time and investigate demographic and clinical risk factors associated with new CVS+ or CVS− lesion development.MethodsIn this retrospective longitudinal cohort study, adults from the NIH MS Natural History Study were considered for inclusion. Participants with new T2 or enhancing lesions were identified through review of the radiology report and/or longitudinal subtraction imaging. Each new lesion was evaluated for the CVS. Clinical characteristics were identified through chart review.ResultsA total of 153 adults (95 relapsing-remitting MS, 27 secondary progressive MS, 16 primary progressive MS, 5 clinically isolated syndrome, and 10 healthy; 67% female) were included. Of this cohort, 96 had at least 1 new T2 or contrast-enhancing lesion during median 3.1 years (Q1–Q3: 0.7–6.3) of follow-up; lesions eligible for CVS evaluation were found in 62 (65%). Of 233 new CVS-eligible lesions, 159 (68%) were CVS+, with 30 (48%) individuals having only CVS+, 12 (19%) only CVS−, and 20 (32%) both CVS+ and CVS− lesions. In gadolinium-enhancing (Gd+) lesions, the CVS+ percentage increased from 102/152 (67%) at the first time point where the lesion was observed, to 92/114 (82%) after a median follow-up of 2.8 years. Younger age (OR = 0.5 per 10-year increase, 95% CI = 0.3–0.8) and higher CVS+ percentage at baseline (OR = 1.4 per 10% increase, 95% CI = 1.1–1.9) were associated with increased likelihood of new CVS+ lesion development.DiscussionIn a cohort of adults with MS followed over a median duration of 3 years, most newly developing T2 or enhancing lesions were CVS+ (68%), and nearly half (48%) developed new CVS+ lesions only. Importantly, the effects of edema and T2 signal changes can obscure small veins in Gd+ lesions; therefore, caution and follow-up is necessary when determining their CVS status.Trial Registration InformationClinical trial registration number NCT00001248.Classification of EvidenceThis study provides Class III evidence that younger age and higher CVS+ percentage at baseline are associated with new CVS+ lesion development.

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Validation of Michigan risk score and D-dimer to predict peripherally inserted central catheter-related thrombosis: A study of 206,132 catheter days

The Journal of Vascular Access ◽

10.1177/11297298211008772 ◽

2021 ◽

pp. 112972982110087

Author(s):

Junren Kang ◽

Wenyan Sun ◽

Hailong Li ◽

En ling Ma ◽

Wei Chen

Keyword(s):

Sensitivity And Specificity ◽

Risk Score ◽

Primary Objective ◽

Class Iii ◽

Operating Characteristics ◽

Central Venous ◽

Sensitivity Specificity ◽

Catheter Related Thrombosis ◽

D Dimer ◽

Independent Cohort

Background: The Michigan Risk Score (MRS) was the only predicted score for peripherally inserted central venous catheters (PICC) associated upper extremity venous thrombosis (UEVT). Age-adjusted D-dimer increased the efficiency for UEVT. There were no external validations in an independent cohort. Method: A retrospective study of adult patients with PICC insertion was performed. The primary objective was to evaluate the performance of the MRS and age-adjusted D-dimer in estimating risk of PICC-related symptomatic UEVT. The sensitivity, specificity and areas under the receiver operating characteristics (ROC) of MRS and age-adjusted D-dimer were calculated. Results: Two thousand one hundred sixty-three patients were included for a total of 206,132 catheter days. Fifty-six (2.6%) developed PICC-UEVT. The incidences of PICC-UEVT were 4.9% for class I, 7.5% for class II, 2.2% for class III, 0% for class IV of MRS ( p = 0.011). The incidences of PICC-UEVT were 4.5% for D-dimer above the age-adjusted threshold and 1.5% for below the threshold ( p = 0.001). The areas under ROC of MRS and age-adjusted D-dimer were 0.405 (95% confidence interval (CI) 0.303–0.508) and 0.639 (95% CI 0.547–0.731). The sensitivity and specificity of MRS were 0.82 (95% CI, 0.69–0.91), 0.09 (95% CI, 0.08–0.11), respectively. The sensitivity and specificity of age-adjusted D-dimer were 0.64 (95% CI, 0.46–0.79) and 0.64 (95% CI, 0.61–0.66), respectively. Conclusions: MRS and age-adjusted D-dimer have low accuracy to predict PICC-UEVT. Further studies are needed.

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Lost in Classification: Lower Cognitive Functioning in Apparently Cognitive Normal Newly Diagnosed RRMS Patients

Brain Sciences ◽

10.3390/brainsci9110321 ◽

2019 ◽

Vol 9 (11) ◽

pp. 321 ◽

Cited By ~ 4

Author(s):

Marco Pitteri ◽

Stefano Ziccardi ◽

Caterina Dapor ◽

Maddalena Guandalini ◽

Massimiliano Calabrese

Keyword(s):

Cognitive Functioning ◽

Neuropsychological Tests ◽

Continuous Variable ◽

Newly Diagnosed ◽

Cognitively Normal ◽

Relapsing Remitting ◽

Current Classification ◽

Z Scores ◽

Score Index

Cognitive functioning in multiple sclerosis (MS) patients is usually related to the classic, dichotomic classification of impaired vs. unimpaired cognition. However, this approach is far from mirroring the real efficiency of cognitive functioning. Applying a different approach in which cognitive functioning is considered as a continuous variable, we aimed at showing that even newly diagnosed relapsing–remitting MS (RRMS) patients might suffer from reduced cognitive functioning with respect to a matched group of neurologically healthy controls (HCs), even if they were classified as having no cognitive impairment (CI). Fifty newly diagnosed RRMS patients and 36 HCs were tested with an extensive battery of neuropsychological tests. By using Z-scores applied to the whole group of RRMS and HCs together, a measure of cognitive functioning (Z-score index) was calculated. Among the 50 RRMS patients tested, 36 were classified as cognitively normal (CN). Even though classified as CN, RRMS patients performed worse than HCs at a global level (p = 0.004) and, more specifically, in the domains of memory (p = 0.005) and executive functioning (p = 0.006). These results highlight that reduced cognitive functioning can be present early in the disease course, even in patients without an evident CI. The current classification criteria of CI in MS should be considered with caution.

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MRI evaluation of thalamic volume differentiates MS from common mimics

Neurology Neuroimmunology & Neuroinflammation ◽

10.1212/nxi.0000000000000387 ◽

2017 ◽

Vol 4 (5) ◽

pp. e387 ◽

Cited By ~ 23

Author(s):

Andrew J. Solomon ◽

Richard Watts ◽

Blake E. Dewey ◽

Daniel S. Reich

Keyword(s):

White Matter ◽

Three Dimensional ◽

Assessment Tools ◽

Class Iii ◽

Mri Segmentation ◽

White Matter Abnormalities ◽

Volumetric Assessment ◽

Study Participants ◽

Mri Evaluation

Objective:To determine whether MRI evaluation of thalamic volume differentiates MS from other disorders that cause MRI white matter abnormalities.Methods:There were 40 study participants: 10 participants with MS without additional comorbidities for white matter abnormalities (MS − c); 10 participants with MS with additional comorbidities for white matter abnormalities (MS + c); 10 participants with migraine, MRI white matter abnormalities, and no additional comorbidities for white matter abnormalities (Mig − c); and 10 participants previously incorrectly diagnosed with MS (Misdx). T1-magnetization-prepared rapid gradient-echo and T2-weighted three-dimensional fluid attenuation inversion recovery sequences were acquired on a Phillips Achieva d-Stream 3T MRI, and scans were randomly ordered and de-identified for a blinded reviewer who performed MRI segmentation using LesionTOADS.Results:Mean normalized thalamic volume differed among the 4 cohorts (analysis of variance, p = 0.005) and was smaller in the 20 MS participants compared with the 20 non-MS participants (p < 0.001), smaller in MS − c compared with Mig − c (p = 0.03), and smaller in MS + c compared with Misdx (p = 0.006). The sensitivity and specificity were both 0.75 for diagnosis of MS with a thalamic volume <0.0077.Conclusions:MRI volumetric evaluation of the thalamus, but not other deep gray-matter structures, differentiated MS from other diseases that cause white matter abnormalities and are often mistaken for MS. Evaluation for thalamic atrophy may improve accuracy for diagnosis of MS as an adjunct to additional radiologic criteria. Thalamic volumetric assessment by MRI in larger cohorts of patients undergoing evaluation for MS is needed, along with the development of automated and easily applied volumetric assessment tools for future clinical application.Classification of evidence:This study provides Class III evidence that MRI evaluation of thalamic volume differentiates MS from other diseases that cause white matter abnormalities.

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Identification of differentially methylated genes as diagnostic and prognostic biomarkers of breast cancer

World Journal of Surgical Oncology ◽

10.1186/s12957-021-02124-6 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Xiao-hong Mao ◽

Qiang Ye ◽

Guo-bing Zhang ◽

Jin-ying Jiang ◽

Hong-ying Zhao ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Diagnosis ◽

High Sensitivity ◽

Breast Cancer Diagnosis ◽

Diagnostic Value ◽

Methylation Pattern ◽

Clinical Value ◽

Roc Curve Analysis ◽

Differentially Methylated Genes ◽

Sensitivity Specificity

Abstract Background Aberrant DNA methylation is significantly associated with breast cancer. Methods In this study, we aimed to determine novel methylation biomarkers using a bioinformatics analysis approach that could have clinical value for breast cancer diagnosis and prognosis. Firstly, differentially methylated DNA patterns were detected in breast cancer samples by comparing publicly available datasets (GSE72245 and GSE88883). Methylation levels in 7 selected methylation biomarkers were also estimated using the online tool UALCAN. Next, we evaluated the diagnostic value of these selected biomarkers in two independent cohorts, as well as in two mixed cohorts, through ROC curve analysis. Finally, prognostic value of the selected methylation biomarkers was evaluated breast cancer by the Kaplan-Meier plot analysis. Results In this study, a total of 23 significant differentially methylated sites, corresponding to 9 different genes, were identified in breast cancer datasets. Among the 9 identified genes, ADCY4, CPXM1, DNM3, GNG4, MAST1, mir129-2, PRDM14, and ZNF177 were hypermethylated. Importantly, individual value of each selected methylation gene was greater than 0.9, whereas predictive value for all genes combined was 0.9998. We also found the AUC for the combined signature of 7 genes (ADCY4, CPXM1, DNM3, GNG4, MAST1, PRDM14, ZNF177) was 0.9998 [95% CI 0.9994–1], and the AUC for the combined signature of 3 genes (MAST1, PRDM14, and ZNF177) was 0.9991 [95% CI 0.9976–1]. Results from additional validation analyses showed that MAST1, PRDM14, and ZNF177 had high sensitivity, specificity, and accuracy for breast cancer diagnosis. Lastly, patient survival analysis revealed that high expression of ADCY4, CPXM1, DNM3, PRDM14, PRKCB, and ZNF177 were significantly associated with better overall survival. Conclusions Methylation pattern of MAST1, PRDM14, and ZNF177 may represent new diagnostic biomarkers for breast cancer, while methylation of ADCY4, CPXM1, DNM3, PRDM14, PRKCB, and ZNF177 may hold prognostic potential for breast cancer.

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ANALYSIS ON THE PATTERN OF USING THE SERVICE OF REMOVABLE PARTIAL DENTURE MAKING IN A DENTAL LABORATORY IN SURABAYA

Folia Medica Indonesiana ◽

10.20473/fmi.v52i4.5474 ◽

2017 ◽

Vol 52 (4) ◽

pp. 270

Author(s):

Okti Setyowati ◽

Endang Kusdarjanti

Keyword(s):

Dental Health ◽

Class Ii ◽

Class I ◽

Class Iii ◽

Removable Partial Denture ◽

Partial Denture ◽

Metal Framework ◽

Removable Denture ◽

Class Iv

The making of removable denture is performed by a dental laboratory. To facilitate the identification, according to Kennedy classification, classes are divided onto groups, the Kennedy class I, II, III and IV. To suit with the needs of the dental laboratory tasks commonly done, priority are necessary for common cases and should to be taught to students of Dental Health Technology Diploma. In Surabaya, research of various cases of removable partial denture with the various Kennedy classifications has never been done before. This study was to analyze the pattern of service for the removable partial denture manufacture in dental laboratory at Surabaya (2011 – 2013). The research is an observatory analytic. The population is all dental laboratories located around the campus of the Faculty of Dentistry Airlangga University Surabaya. The sample was the whole population is willing to become respondents. Sampling by total sampling. The method of collecting data using secondary data from a dental laboratory in Surabaya from 2011 until 2013. The note is cases removable denture according to the classification of Kennedy that Kennedy Class I, II, III and IV. Also of note kinds of materials used to make the denture base that is heat cured acrylic resins, thermoplastic resins and metals coherent. The data is a compilation table charting the frequency until needed, then analyzed using cross tabulation. Mostly denture type is flexible type and the least is metal framework. Most cases by classification Kennedy is followed by class II class III and class II and more recently is the fourth. In conclusion, in 2011 and 2013 the manufacture of removable partial dentures according to the classification of Kennedy Class III is the most common in both the upper arch and lower jaw, followed by Class II, Class I and Class IV. In 2012 which is the highest grade III followed by class II, class IV and class I. The denture type most used is a flexible denture, followed acrylic denture and the last is the metal framework.

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Cadence-based Classification of Minimally Moderate Intensity During Overground Walking in 21- to 40-Year-Old Adults

Journal of Physical Activity and Health ◽

10.1123/jpah.2019-0261 ◽

2019 ◽

Vol 16 (12) ◽

pp. 1092-1097

Author(s):

Elroy J. Aguiar ◽

Zachary R. Gould ◽

Scott W. Ducharme ◽

Chris C. Moore ◽

Aston K. McCullough ◽

...

Keyword(s):

Positive Predictive Value ◽

Predictive Value ◽

Classification Accuracy ◽

Moderate Intensity ◽

Overground Walking ◽

Cross Sectional ◽

Old Adults ◽

Metabolic Equivalents ◽

Sensitivity Specificity

Background: A walking cadence of ≥100 steps/min corresponds to minimally moderate intensity, absolutely defined as ≥3 metabolic equivalents (METs). This threshold has primarily been calibrated during treadmill walking. There is a need to determine the classification accuracy of this cadence threshold to predict intensity during overground walking. Methods: In this laboratory-based cross-sectional investigation, participants (N = 75, 49.3% women, age 21–40 y) performed a single 5-minute overground (hallway) walking trial at a self-selected preferred pace. Steps accumulated during each trial were hand tallied and converted to cadence (steps/min). Oxygen uptake was measured using indirect calorimetry and converted to METs. The classification accuracy (sensitivity, specificity, overall accuracy, and positive predictive value) of ≥100 steps/min to predict ≥3 METs was calculated. Results: A cadence threshold of ≥100 steps/min yielded an overall accuracy (combined sensitivity and specificity) of 73.3% for predicting minimally moderate intensity. Moreover, for individuals walking at a cadence ≥100 steps/min, the probability (positive predictive value) of achieving minimally moderate intensity was 80.3%. Conclusions: Although primarily developed using treadmill-based protocols, a cadence threshold of ≥100 steps/min for young adults appears to be a valid heuristic value (evidence-based, rounded, practical) associated with minimally moderate intensity during overground walking performed at a self-selected preferred pace.

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