scholarly journals Toward Understanding Normal Craniocervical Rotation Occurring During the Rotation Stress Test for the Alar Ligaments

2013 ◽  
Vol 93 (7) ◽  
pp. 986-992 ◽  
Author(s):  
Peter Grant Osmotherly ◽  
Darren Rivett ◽  
Lindsay J. Rowe
Keyword(s):  
Stress Testing ◽  
Stress Test ◽  
Intraclass Correlation ◽  
Reference Plane ◽  
Neutral Position ◽  
Alar Ligament ◽  
Alar Ligaments ◽  
Measurement Protocol ◽  
Test Position ◽  
Rotation Stress

Background The rotation stress test is recommended for assessing alar ligament integrity. Although some authors, in the literature regarding the rotation stress test, accept that rotation will occur during testing, estimates of range occurring with a normal test response vary between 20 and 40 degrees. None of these estimates are based on formal examination of the test. Objective The purposes of this study were: (1) to examine the range of craniocervical rotation occurring during rotation stress testing for the alar ligaments in individuals who are healthy and (2) to investigate a measurement protocol for quantifying rotation. Design A within-subject experimental study was conducted. Methods Sixteen participants underwent magnetic resonance imaging in neutral and end-range rotation stress test positions. Measurements followed a standardized protocol relative to the position of the axis. A line connecting the transverse foramena of the axis created a reference plane. The position of the occiput in the head-neutral position was calculated as the angle formed between a line joining the foramena lacerum and the reference plane. Measurements were repeated at the end-range test position. Total rotation of the occiput was calculated as the difference in angles measured in neutral and test positions. Measurement was performed on 4 occasions, and reliability of measurements was assessed using the standard error of measurement (SEM) and the intraclass correlation coefficient (ICC). Results Measurement of rotation of the occiput relative to a stabilized axis ranged between 1.7 and 21.5 degrees (X̅=10.6, SD=5.1, SEM=1.14, ICC=.96, 95% confidence interval=.90–.98). Limitations Sustaining the test position for imaging increased the potential for loss of end-range position and image quality. Testing could be performed only in the neutral position, not in 3 planes as commonly described. Conclusions The range of craniocervical rotation during rotation stress testing of intact alar ligaments should typically be 21 degrees or less. Rotation may be quantified using the method protocol outlined.

The effect of alar ligament transection on the rotation stress test: A cadaveric study

2020 ◽  
Vol 80 ◽  
pp. 105185
Author(s):  
César Hidalgo-García ◽  
Ana I. Lorente ◽  
Orosia Lucha-López ◽  
José Manuel Auría-Apilluelo ◽  
Miguel Malo-Urriés ◽  
...  
Keyword(s):  
Stress Test ◽  
Cadaveric Study ◽  
Alar Ligament ◽  
Rotation Stress

scholarly journals Construct Validity of Clinical Tests for Alar Ligament Integrity: An Evaluation Using Magnetic Resonance Imaging

2012 ◽  
Vol 92 (5) ◽  
pp. 718-725 ◽  
Author(s):  
Peter G. Osmotherly ◽  
Darren A. Rivett ◽  
Lindsay J. Rowe
Keyword(s):  
Magnetic Resonance Imaging ◽  
Cervical Spine ◽  
Magnetic Resonance ◽  
Ligament Length ◽  
Stress Tests ◽  
Resonance Imaging ◽  
Alar Ligament ◽  
Alar Ligaments ◽  
Side Bending ◽  
Rotation Stress

Background The alar ligaments are integral to limiting occipito-atlanto-axial rotation and lateral flexion and enhancing craniocervical stability. Clinical testing of these ligaments is advocated prior to the application of some cervical spine manual therapy procedures. Given the absence of validation of these tests and the potential consequences if manipulation is applied to an unstable upper cervical spine segment, exploration of these tests is necessary. Objective The purpose of this study was to examine the direct effect of the side-bending and rotation stress tests on alar ligaments using magnetic resonance imaging (MRI). Design This was a within-participant experimental study. Methods Sixteen participants underwent MRI in neutral and end-range stress test positions using proton density-weighted sequences in a 3-Tesla system. Measurements followed a standardized protocol relative to the position of the axis. Distances were measured from dens tip to the inferior margin of the foramen magnum and from midsubstance of the dental attachment of the ligament to its occipital insertion. Between-side differences were calculated for each measurement to account for inherent asymmetries in morphology. Differences were compared between the test and neutral positions using a Wilcoxon signed rank test. Results Side-bending stress tests produced a median between-side difference in ligament length of +1.15 mm. Rotation stress tests produced a median between-side difference in ligament length of +2.08 mm. Both results indicate increased measurement of the contralateral alar ligament. Limitations Assessment could be made only in the neutral position due to imaging limitations. Clinical texts state that tests should be performed in 3 positions: neutral, flexion, and extension. Conclusions Both side-bending and rotation stress testing result in a measurable increase in length of the contralateral alar ligament. This finding is consistent with mechanisms that have been described to support their use in clinical practice.

Stress-testing Russian Banking System: Will Banks Need Government Assistance Again?

2010 ◽  
pp. 61-81 ◽  
Author(s):  
O. Solntsev ◽  
A. Pestova ◽  
M. Mamonov
Keyword(s):  
Stress Testing ◽  
Banking Sector ◽  
Stress Test ◽  
Banking System ◽  
Government Assistance ◽  
Methodological Issues ◽  
Loan Portfolio ◽  
Macroeconomic Indicators ◽  
Remote Stress ◽  
Capital Injections

The article analyzes factors that affect growth of the share of non-performing loans in the loan portfolio of Russian banks and proposes approaches for this share forecasting on the basis of dynamics of macroeconomic indicators. It also deals with methodological issues of remote stress-test of lending agencies. Using the results of conducted stress-test of Russian banks the authors assess their perspective capital needs in 2010 and estimate the share of government assistance in capital injections. Furthermore, the authors define the scale of vulnerable banks groups in the Russian banking sector.

scholarly journals Quality control stress test for deep learning-based diagnostic model in digital pathology

2021 ◽  
Author(s):  
Birgid Schömig-Markiefka ◽  
Alexey Pryalukhin ◽  
Wolfgang Hulla ◽  
Andrey Bychkov ◽  
Junya Fukuoka ◽  
...  
Keyword(s):  
Deep Learning ◽  
Cancer Detection ◽  
Stress Testing ◽  
Computational Analysis ◽  
Stress Test ◽  
Digital Pathology ◽  
Model Performance ◽  
Diagnostic Model ◽  
Model Accuracy ◽  
Diagnostic Models

AbstractDigital pathology provides a possibility for computational analysis of histological slides and automatization of routine pathological tasks. Histological slides are very heterogeneous concerning staining, sections’ thickness, and artifacts arising during tissue processing, cutting, staining, and digitization. In this study, we digitally reproduce major types of artifacts. Using six datasets from four different institutions digitized by different scanner systems, we systematically explore artifacts’ influence on the accuracy of the pre-trained, validated, deep learning-based model for prostate cancer detection in histological slides. We provide evidence that any histological artifact dependent on severity can lead to a substantial loss in model performance. Strategies for the prevention of diagnostic model accuracy losses in the context of artifacts are warranted. Stress-testing of diagnostic models using synthetically generated artifacts might be an essential step during clinical validation of deep learning-based algorithms.

scholarly journals Reproducibility of Skin Temperature Response after Cold Stress Test Using the Game Ready System: Preliminary Study

2021 ◽  
Vol 18 (16) ◽  
pp. 8295
Author(s):  
Jose Ignacio Priego-Quesada ◽  
Alexis Gandia-Soriano ◽  
Maria Teresa Pellicer-Chenoll ◽  
Ignacio Catalá-Vilaplana ◽  
Jose Luis Bermejo-Ruiz ◽  
...  
Keyword(s):  
Cold Stress ◽  
Skin Temperature ◽  
Stress Test ◽  
Intraclass Correlation ◽  
Temperature Response ◽  
Lower Limbs ◽  
Good Reproducibility ◽  
Preliminary Study ◽  
Logarithmic Equation ◽  
Cold Stress Test

The objective of this preliminary study was to determine the reproducibility of lower limbs skin temperature after cold stress test using the Game Ready system. Skin temperature of fourteen participants was measured before and after cold stress test using the Game Ready system and it was repeated the protocol in four times: at 9:00, at 11:00, at 19:00, and at 9:00 h of the posterior day. To assess skin temperature recovery after cold stress test, a logarithmic equation for each region was calculated, and constant (β0) and slope (β1) coefficients were obtained. Intraclass correlation coefficient (ICC), standard error (SE), and within-subject coefficient of variation (CV) were determined. No differences were observed between measurement times in any of the regions for the logarithmic coefficients (p > 0.38). Anterior thigh (β0 ICC 0.33–0.47; β1 ICC 0.31–0.43) and posterior knee (β0 ICC 0.42–0.58; β1 ICC 0.28–0.57) were the regions with the lower ICCs, and the other regions presented values with a fair and good reproducibility (ICC > 0.41). Posterior leg was the region with the better reproducibility (β0 ICC 0.68–0.78; β1 ICC 0.59–0.74; SE 3–4%; within-subject CV 7–12%). In conclusion, cold stress test using Game Ready system showed a fair and good reproducibility, especially when the posterior leg was the region assessed.

Abstract 363: Chest Pain Observation Unit: Does Post-Discharge Stress Testing Influence Physician Management Decisions?

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Yasser Khalil ◽  
Martin E Matsumura ◽  
Maida Abdul-Latif ◽  
Prasant Pandey ◽  
Melvin Schwartz
Keyword(s):  
Chest Pain ◽  
Risk Stratification ◽  
Stress Testing ◽  
Stress Test ◽  
Multivariate Regression Analysis ◽  
The United States ◽  
Observation Unit ◽  
Management Decisions ◽  
Post Discharge ◽  
Effective Manner

Background: Chest pain (CP) accounts for approximately 6 million emergency visits per year in the United States. There is growing interest in strategies to effectively risk stratify pts for coronary artery disease (CAD) related events in a cost-effective manner. The use of chest pain observation units followed by early stress testing is frequently employed in these pts. However the utility of stress testing in this population is not well defined, and the effect of stress test results on subsequent management decisions is a topic of controversy. In the present study we examined the relationship of stress myocardial perfusion imaging (MPI) results to physician decisions regarding ccath in a single community teaching hospital. Methods: Retrospective study of 426 pts undergoing a chest pain observation strategy over a 24 month period. Pt eligible for the program had CP deemed possibly related to CAD but no diagnostic ECG changes and negative TnI measurements x2. All pts underwent outpt. stress MPI within 72 hours of discharge. Pts saw a cardiologist the day of stress MPI who reviewed the CP history, MPI results, and made decisions regarding further risk stratification. Demographic and medical history was collected from the pts chest pain observation unit record. Multivariate regression analysis was used to determine significant independent variables related to physician decisions regarding further risk stratification. Results: Of 426 pts who underwent outpt stress MPI, 71(16.7%) were positive for ischemia, and 16 (22.5% of +MPI) underwent cath with reperfusion performed in 8 (5PCI, 3 CABG, 11.3% of +MPI). Of the 355 pts with negative stress MPI, 5(1.4% of -MPI) underwent cath with reperfusion performed in 2 (2PCI, 0 CABG, 0.5% of -MPI). A MLR model suggested only stress MPI results were independently predictive of the use of ccath for risk stratification. Conclusion: Stress MPI was an important factor in physician decision-making regarding the need for ccath in pts managed in a chest pain observation unit. The rate of +MPI and subsequent use of ccath in our institution supports MPI as an appropriate step in risk stratification of low to moderate risk CP pts triaged through a CP observation unit.

scholarly journals Comparison of Preoperative Assessment of Patient’s Metabolic Equivalents (METs) Estimated from History versus Measured by Exercise Cardiac Stress Testing

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Adam S. Weinstein ◽  
Martin I. Sigurdsson ◽  
Angela M. Bader
Keyword(s):  
Cardiac Failure ◽  
Stress Testing ◽  
Stress Test ◽  
Preoperative Evaluation ◽  
Preoperative Assessment ◽  
Exercise Stress ◽  
Cardiac Stress ◽  
Metabolic Equivalents ◽  
Cardiac Stress Testing ◽  
Cardiac Stress Test

Background. Preoperative anesthetic evaluations of patients before surgery traditionally involves assessment of a patient’s functional capacity to estimate perioperative risk of cardiovascular complications and need for further workup. This is typically done by inquiring about the patient’s physical activity, with the goal of providing an estimate of the metabolic equivalents (METs) that the patient can perform without signs of myocardial ischemia or cardiac failure. We sought to compare estimates of patients’ METs between preoperative assessment by medical history with quantified assessment of METs via the exercise cardiac stress test. Methods. A single-center retrospective chart review from 12/1/2005 to 5/31/2015 was performed on 492 patients who had preoperative evaluations with a cardiac stress test ordered by a perioperative anesthesiologist. Of those, a total of 170 charts were identified as having a preoperative evaluation note and an exercise cardiac stress test. The METs of the patient estimated by history and the METs quantified by the exercise cardiac stress test were compared using a Bland–Altman plot and Cohen’s kappa. Results. Exercise cardiac stress test quantified METs were on average 3.3 METS higher than the METs estimated by the preoperative evaluation history. Only 9% of patients had lower METs quantified by the cardiac stress test than by history. Conclusions. The METs of a patient estimated by preoperative history often underestimates the METs measured by exercise stress testing. This demonstrates that the preoperative assessments of patients’ METs are often conservative which errs on the side of patient safety as it lowers the threshold for deciding to order further cardiac stress testing for screening for ischemia or cardiac failure.

scholarly journals Validity and reliability of inertial sensors for elbow and wrist range of motion assessment

PeerJ ◽  
2020 ◽  
Vol 8 ◽  
pp. e9687
Author(s):  
Vanina Costa ◽  
Óscar Ramírez ◽  
Abraham Otero ◽  
Daniel Muñoz-García ◽  
Sandra Uribarri ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Inertial Sensors ◽  
High Reliability ◽  
Intraclass Correlation ◽  
Active Movement ◽  
Neutral Position ◽  
Maximum Difference ◽  
Validity And Reliability ◽  
Rater Reliability ◽  
Flexion Extension

Background Elbow and wrist chronic conditions are very common among musculoskeletal problems. These painful conditions affect muscle function, which ultimately leads to a decrease in the joint’s Range Of Motion (ROM). Due to their portability and ease of use, goniometers are still the most widespread tool for measuring ROM. Inertial sensors are emerging as a digital, low-cost and accurate alternative. However, whereas inertial sensors are commonly used in research studies, due to the lack of information about their validity and reliability, they are not widely used in the clinical practice. The goal of this study is to assess the validity and intra-inter-rater reliability of inertial sensors for measuring active ROM of the elbow and wrist. Materials and Methods Measures were taken simultaneously with inertial sensors (Werium™ system) and a universal goniometer. The process involved two physiotherapists (“rater A” and “rater B”) and an engineer responsible for the technical issues. Twenty-nine asymptomatic subjects were assessed individually in two sessions separated by 48 h. The procedure was repeated by rater A followed by rater B with random order. Three repetitions of each active movement (elbow flexion, pronation, and supination; and wrist flexion, extension, radial deviation and ulnar deviation) were executed starting from the neutral position until the ROM end-feel; that is, until ROM reached its maximum due to be stopped by the anatomy. The coefficient of determination (r2) and the Intraclass Correlation Coefficient (ICC) were calculated to assess the intra-rater and inter-rater reliability. The Standard Error of the Measurement and the Minimum Detectable Change and a Bland–Altman plots were also calculated. Results Similar ROM values when measured with both instruments were obtained for the elbow (maximum difference of 3° for all the movements) and wrist (maximum difference of 1° for all the movements). These values were within the normal range when compared to literature studies. The concurrent validity analysis for all the movements yielded ICC values ≥0.78 for the elbow and ≥0.95 for the wrist. Concerning reliability, the ICC values denoted a high reliability of inertial sensors for all the different movements. In the case of the elbow, intra-rater and inter-rater reliability ICC values range from 0.83 to 0.96 and from 0.94 to 0.97, respectively. Intra-rater analysis of the wrist yielded ICC values between 0.81 and 0.93, while the ICC values for the inter-rater analysis range from 0.93 to 0.99. Conclusions Inertial sensors are a valid and reliable tool for measuring elbow and wrist active ROM. Particularly noteworthy is their high inter-rater reliability, often questioned in measurement tools. The lowest reliability is observed in elbow prono-supination, probably due to skin artifacts. Based on these results and their advantages, inertial sensors can be considered a valid assessment tool for wrist and elbow ROM.

Abstract 359: Lack Of Blood Pressure Augmentation During Stress Testing Is Associated With Increased Mortality.

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Geoffrey D’Cruz ◽  
Ashish Rastogi ◽  
Neil Yager ◽  
Amarinder Bindra ◽  
Steven A Fein ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chest Pain ◽  
Stress Echocardiography ◽  
Stress Testing ◽  
Systolic Function ◽  
Stress Test ◽  
Care Center ◽  
Tertiary Care ◽  
History Of ◽  
Response To Exercise

Objective: We investigated long-term outcomes associated with hypertensive response to exercise in patients with chest pain referred for stress echocardiography. Methods: Records of 404 patients with normal baseline LV systolic function (45% females, mean age 60+/-11 years, baseline SBP 136+/-20 mmHg, 26% with CAD, 4% with CHF, 39% with hypertension, 13% with diabetes mellitus, 5% with peripheral vascular disease, 21% with history of smoking or active smoking, 43% on beta-blockers, 23% on ACE-inhibitors/ARBs) referred for chest pain evaluation with stress echocardiography at a single tertiary care center were reviewed. Demographics, clinical data, and outcomes were collected. Median length of followup was 35+/-0.3 months. Patients were divided into four groups depending on their maximum blood pressure during exercise (greater or less than 180mmHg) and whether they achieved their age-adjusted target heart rate. Results: Contrary to the expectations, hypertensive response to exercise was not associated with the increased mortality (Table). Instead, lack of blood pressure augmentation during exercise and low double product were predictive of increased mortality. History of CHF (p=0.0003) and/or PVD (p=0.001) were the strongest predictors of failure to augment blood pressure during stress testing. Conclusions: Failure to augment systolic blood pressure during exercise appears to be associated with increased mortality. Although ischemia on echocardiography and reduced exercise capacity are the stress test outcomes traditionally associated with poor prognosis, failure to augment blood pressure during exercise may be an important predictor of mortality as well. Additional studies of this subject are needed.

Abstract 17369: Addressing Missed Opportunities for Cardiometabolic Primary Prevention of Veterans Referred for Stress Testing

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ysanne Johnson ◽  
Sheila M Mattei ◽  
Matthew Burg ◽  
Judith L Meadows
Keyword(s):  
Risk Reduction ◽  
Stress Testing ◽  
Stress Test ◽  
Standard Of Care ◽  
Low Risk ◽  
Stress Tests ◽  
Missed Opportunities ◽  
Presenting Symptoms ◽  
Reduction Strategies ◽  
Risk Reduction Strategies

Introduction: Patients presenting to stress testing have a high prevalence of cardiometabolic risk factors (RF) which are not at guideline supported goals. Referral to stress testing is often a patient’s first presentation to CV care and represents a missed opportunity for delivery of risk reduction strategies. Hypothesis: Implementation of a cardiometabolic prevention initiative for cardiology-naïve patients referred to stress testing will result in improved delivery of guideline-directed prevention care. Methods: A consecutive prospective cohort of patients who underwent stress testing (12/1/2019-1/31/2020) after implementation of a linked cardiometabolic prevention referral for those with low risk stress tests was compared to a retrospective standard of care (SOC) cohort (9/1/2019-10/1/2019) from a single center Veterans Hospital. Outcomes assessed were change in CV risk reduction care at 90 days following stress test. Results: Of 181 patients, 62.5% were naïve to cardiology specialty care, had >1 CV risk factor not meeting guideline goals, 6% had typical angina as presenting symptoms, and greater than 70% of stress tests were normal or low risk. Baseline CV RF were common and failed to reach goals in SOC and intervention cohorts respectively with LDL above goal (40 vs. 33%), stage 1 or greater hypertension (67 vs 81%), Diabetes with HgA1c > 7 (48 vs. 21%), overweight or obese (68 vs. 79%), current tobacco (11 vs. 12%), and elevated mean 10-year ASCVD risk (32 vs.20%). At 90 days, 28% of SOC cohort had intensification of CV prevention care as compared to 76% of intervention cohort (X 2 26.8, p<0.05). Conclusions: A stress testing setting represents a valuable opportunity to deliver cardiometabolic prevention care. Integration of risk reduction strategies is imperative to shift from cardiac disease management to patient centered health promotion.

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