The Harris Benedict equation reevaluated: resting energy requirements and the body cell mass13

Size: px
Start display at page:

Download "The Harris Benedict equation reevaluated: resting energy requirements and the body cell mass13"

Transcription

1 Secial Article The Harris Benedict equation reevaluated: resting energy requirements and the body cell mass13 Allan M Roza, MD and Harry M Shizgal, MD, FRCS(C), FACS Introduction ABSTRACT The Harris Benedict equations (HBE) were derived from indirect calorimetric data obtained in 239 normal subjects. Using these data and additonal data ublished by Benedict, which were obtained from subjects sanning a wider age range (n = 98), the resent study evaluated the relationshi between measured resting energy exenditure and age, sex, and redicted body cell mass (BCM). When the additional subjects from the subsequently ublished series are included, the regression equations, standard error ofthe estimate, and 95% confidence limits are similar to the original equations. The HBE estimate resting energy exenditure of a normal subject with a recision of 14%. Resting energy exenditure is directly related to the size of the 8CM and is indeendent of age and sex. The variables of height, weight, age, and sex in the HBE reflect the relationshi between body weight and the BCM. Indirect calorimetry and body comosition measurements were erformed in both normally nourished and malnourished atients (n = 74) to assess the accuracy of the HBE in malnourished atients. Malnutrition is associated with an increase in resting oxygen consumtion (V2) which becomes aarent only when V2 is exressed as a function of the BCM. There is no difference in resting VO2 between the sexes when exressed as a function of BCM. A regression equation was derived from the Harris Benedict data to redict resting V2 from age, height, weight, and sex. Predicted VO2 was not significantly different from measured VO2 for the normally nourished atients (n = 33) whereas in the malnourished (n = 41) redicted VO2 underestimated the measured value. The HBE accurately redict resting energy exenditure in normally nourished individuals with a recision of ±14%, but are unreliable in the malnourished atient. Am J Clin Nuir 1984;4: KEY WORDS Basal metabolism, body comosition, energy, malnutrition, metabolism Malnutrition is common in the hositalized atient, develoing as a comlication of the disease rocess and/or as a result of diagnostic and theraeutic maneuvers. Aggressive nutritional suort will both revent and treat the malnourished state. The success of nutritional suort deends on the delivery ofadequate calories and rotein by either the enteral or arenteral route. Two methods are commonly used to determine the caloric or energy requirements of the individual atient. The first uses the Harris Benedict equations which give an estimate of resting energy exenditure (REE). The second method involves measurement of REE, by indirect calorimetry. In 1919, Harris and Benedict ublished their classic monograh on basal metabolism in normal subjects (1). Metabolic arameters were determined by indirect calorimetry on 136 men and 13 women. From these measurements they derived regression I From the Deartment of Surgery, McGill University and Royal Victoria Hosital, Montreal, Canada. 2 Suorted by Medical Research Council of Canada. 3 Address rerint requests to: Harry M Shizgal, MD, Deartment of Surgery, Royal Victoria Hosital, 687 Pine Avenue West, Montreal, Quebec, Canada H3A 1A1. Downloaded from at Academisch Ziekenhuis Vrije Universiteit, Medical Library on January 27, The American Journal ofclinical Nutrition 4: JULY 1984, Printed in USA 1984 American Society for Clinical Nutrition

2 HARRIS BENEDICT EQUATION 169 formulae which estimated REE from height, weight, age, and sex. Total energy exenditure is estimated by adding the additional energy cost associated with activity, fever, trauma, and malnutrition (2). Indirect calorimetry, which involves the measurement of metabolic gas exchange, is simle to erform and results in a reliable measurement of REE (3, 4). In the resting, ostabsortive subject, the rate of oxygen consumtion is a measure of REE, because for all classes of nutrients, a direct relationshi exits between the energy generated and the volume of oxygen consumed. The body cell mass (BCM), is the total mass of metabolically active cells, and is therefore that comonent of body comosition which is resonsible for all ofthe oxygen consumtion, carbon dioxide roduction, and the work erformed by the body. Moore (5), demonstrated that total exchangeable otassium (Ic), which is equivalent to total body otassium, is a measure of the BCM. An excellent correlation has been demonstrated between K and both the intracellular water volume (5) and REE (6). According to the Harris Benedict equations there is a decrease in REE with aging. In addition, searate equations were derived for male and female subjects imlying a difference in energy exenditure related to sex. In the resent study we examined the original Harris Benedict data in order to investigate the relationshi between REE and both sex and age, and the relationshi between the BCM and REE. In addition, the accuracy of the Harris Benedict equation in redicting REE was evaluated in both normally nourished and malnourished atients. Materials and methods The Harris Benedict equation The Hams Benedict monograh reorted for each subject the age, height, weight, body surface area, ulse rate, carbon dioxide roduction and oxygen consumtion er minute, and heat roduction er 24 h, cxressed as calories. In the original monograh, the ublished data were obtained in 239 subjects, 136 men and 13 women. Two further series were ublished subsequently by Benedict in 1928 and 1935 with similar data on additional subjects (7, 8). This resulted in a total series of 337 subjects, 168 men and 169 women. The two latter series included subjects with a wider age range (Table 1). TABLE 1 Age data for Harris Benedict subjects Meanage Men n Meanage women Seriesl(l919) 27± ±14 13 Seriesll(1928) 34± ±12 33 SeriesIII(l935) 81±7 5 76±6 33 Total 3 ± ± S SD. TABLE 2 Body comosition regressions4 Men TBW =.7945 (wt) -.24 (wt) (age) (wt) ICW =.623 (TBW) -.16 (age) (TBW) ECW = TBW - ICW K = 15 (ICW) + 4 (ECW) BCM =.833 (I) Women TBW = (wt) -.26 (wt) -.12 (age) (wt) ICW =.553 (TBW) -.7 (age) (TBW) ECW = TBW - ICW Ic= l5(icw)+4(ecw) BCM =.833 (I) 4 TBW, total body water(l); ICW, intracellular water (I); ECW, extracellular water (I); K, total exchangeable otassium (meq); BCM, body cell mass (kg). n In the resent study the Harris Benedict data were used to correlate REE (kcal/day), as the deendent variable, with age, height, and weight athe indeendent variables by means of multile linear regression. Searate equations were derived for both men and women. This was carried out searately for the original grou of 239 subjects and for the combined grou of 337 subjects. The significance ofeach regression was determined by an analysis of variance. The 95% confidence limits about the regression were calculated as 1.96 times the SE of the estimate. In addition, for each regression the multile correlation coefficient was calculated and the statistical significance ofeach regression coefficient was evaluated (9). All of the calculations were carried out with a Digital PDP/1 I comuter (Digital Equiment Cor, Maynard, MA). The BCM for each of the 337 Harris Benedict subjects was calculated using the regression equations develoed by Moore et al (1) (Table 2). The relationshi between REE and the BCM was evaluated by correlatingthe calculated BCM with REE. Searate correlations were erformed for the 168 men and the 169 women. To evaluate the effect of age, sex, and the BCM on REE, multile linear regression was used to correlate REE as the deendent variable with age and the BCM as indeendent variables. Searate equations were derived for men and women. Age was also correlated with BCM exressed as a fraction of body weight for both men and women, to establish the relationshi between the BCM and aging. Finally, to evaluate the relationshi between REE and sex, REE and the BCM were corre- Downloaded from at Academisch Ziekenhuis Vrije Universiteit, Medical Library on January 27, 26

3 17 ROZA AND SHIZGAL lated searately for men and women. The significance of the difference between the regression lines determined from the resultant equations was determined by analysis of variance. Refrrence entityfor energy exchange Body comosition was determined by multile isotoe dilution in 74 nonsetic, afebrile general surgical atients before the onset of nutritional theray with total arenteral nutrition. None of the atients was receiving medication that would significantly alter metabolic gas exchange. A multile isotoe dilution technique was used to measure total body water and total exchangeable sodium (Na,)as reviously described (1 1). An indirect method was used to calculate total K from TBW, Nat, and the ratio in whole blood ofthe sodium lus otassium content divided by the water content (12). Na, rovides an estimate ofthe extracellular mass (ECM) and I rovides an estimate of the BCM. The ratio of Na to K was used to define the resence or absence of malnutrition (1, 15). In 25 normal volunteers the mean Na,/K was.98 ±.2 with an uer 95% confidence limit of As a result, malnutrition is defined by a ratio of more than 1.22 while a atient with a ratio of less than 1.22 is considered to be normally nourished. All studies were erformed after ohtaming written informed consent. In all atients oxygen consumtion and carbon dioxide roduction were measured on the day of the body comosition measurement. The measurements were erformed with the atient resting and in the suine osition. All atients were receiving a small amount of glucose calories as 5% dextrose in water intravenously but were otherwise fasting. Measurements of gas cxchange were erformed by the oen circuit method of indirect calorimetry. To minimize hyerventilation during gas collection, all atients underwent a eriod of acclimatization to breathing through a mouthiece with adisosable Hans-Rudolh tye valve(oem Medical Inc, Richmond, VA) with the nasal airway occluded. This eriod of acclimatization was continued until the atients were all breathing normally. There was no obvious difference in breathing atterns between the malnourished and normally nourished atients. Exired gas was collected in a Douglas bag for four eriods of 2 mm each. The concentration of oxygen and carbon dioxide in insired air and mixed exired gas were measured, within 1 h, using a mass sectrometer (Perkin Elmer 1 1, Perkin-Elmer Medical Instruments, Pomona, CA). Exired gas volume was measured with a dry gas meter (JH Emerson & Co, Cambridge, MA) which was accurate to within.25 1 in 2 1. Oxygen consumtion was determined from the mmute volume and gas concentration corrected for standard temerature and ressure and exressed as ml/min (13). For all atients, including those on a resirator, the accuracy of the oxygen consumtion measurement was estimated at less than 5%. However, measurements were not erformed on atients who were on resirators with an insired oxygen that exceeded 4%. Body weight and height for each atient was recorded and body surface area was calculated for each subject according to the formula develoed by Dubois and Dubois(l4): S = W#{176}425 x L#{176}#{149}725 where S is body surface area in cm2, W is body weight in kg, and L is height in cm. Mean oxygen consumtion for the normally nourished and the malnourished atients was exressed in ml/min as a function of body weight [ml. min (kg)], as a function of body surface area [ml. min (m2)], and as a function of BCM [ml.min.(kg BCM) ]. The significance ofthe difference between the means was determined by unaired Student s t test. Predicted versus measured oxygen consumtion Equations to redict the resting oxygen consumtion er minute from height, weight, and age were derived, for men and women, using the total combined Harris Benedict data (n = 337). Resting oxygen consumtion as the deendent variable was correlated with height, weight, and age as the indeendent variables by means of multile linear regression. Searate equations were derived for both men and women. These regression equations were used to redict resting oxygen consumtion for the 74 atients. Patients were divided into two grous based on the resence or absence of malnutrition, as determined by the Na,/K ratio. For this analysis the data from men and women were combined. The correlation between redicted resting oxygen consumtion and measured oxygen consumtion was erformed by standard linear correlation for both the normally nourished and the malnourished atients. Predicted oxygen consumtion, as a function of the BCM (ie oxygen consumtion er kg of BCM), was calculated for each of the 74 atients. Moore s regression equations and the equations derived from the Harris Benedict data were used to redict body comosition and oxygen consumtion, resectively. These values were comared to the measured oxygen consumtion er kg of measured BCM for the normally nourished and the malnourished atients. Values are reorted as the mean ± the SEM. Significance of the difference between the means for the four grous was determined by analysis of variance and Scheffe s test. Results The Harris Benedict equation The correlation of REE as the deendent variable with height, weight, and age by means of multile linear regression reresents a recalculation of the Harris Benedict equation. Table 3 lists the ublished Harris Benedict equations for males and females (equations 1 and 3) with the recalculated regression formulas for men and women (equations 2 and 4, Table 3). A similar regression analysis was erformed with the additional subjects from the two subsequent series which san a wider age range, ie, the total series of 168 men and 169 women (equations 3 and 6, Table 3). All of the Downloaded from at Academisch Ziekenhuis Vrije Universiteit, Medical Library on January 27, 26

4 HARRIS BENEDICT EQUATION 171 TABLE 3 Harris Benedict regression equations Men Equation 1. Harris Benedict equation based on l9l9data(n= 136) REE = (ht) (wt) (age) Equation 2. Original 1919 data recalculated (n = 136) REE = (ht) (wt) (age) r =.86 F = <.1 95% CL = ±21.5 kcal Equation 3. Total data (n = 168) REE = (ht) (wt) (age) r=.88 F= <.l 95% CL = ±213. kcal Women Equation 4. Harris Benedict equation based on l9l9data(n= 13) REE = (ht) (wt) (age) Equation 5. Original 1919 data recalculated (n = 13) REE = (ht) (wt) (age) r=.77 F=37.8 <.1 95% CL = ± kcal Equation 6. Total data (n = 169) REE = (ht) (wt) (age) r=.83 F= <.1 95% CL = ±21. kcal TABLE 4 Resting energy exenditure for 7-kg man Ht= 17 cm Wt = 7 kg Age = 5 yr Equation 1-Table 3 REE = (ht) (wt) (age) = 1542 kcal/day Equation 2-Table 3 REE = (ht) (wt) (age) = I 54 kcal/day 95% Confidence limits = I329 to 175 kcal/day Equation 3-Table 3 REE = (ht) (wt) (age) = 1558 kcal/day 95% Confidence limits = 1348 to 1769 kcal/day equations are similar. A samle calculation for a 7-kg man is resented in Table 4 using equations 2 and 3, ie, the recalculated Harris Benedict equation and the equation generated from the larger series of men, resectively. The estimated values for REE using either equation are virtually identical. In the resent study the multile correlation coefficients and the SE of the estimate were also determined (Table 3). For the original series of 136 men the multile correlation coefficient is.86 which is highly significant, ( <.1, F ratio = 122.4). The 95% confidence limits are ±21.5 kcal/day. The multile correlation coefficient for the regression obtained for men using data from all three ublished series (n = 168), is.88 ( <.1, F ratio = 192.3). The 95% confidence limits are ±2 13. kcal/day. For the original series of 13 women the multiie correlation coefficient is.77 ( <.1, F ratio = 37.8), with 95% confidence limits of± kcal/day. For the combined series of 169 women the correlation coefficient is.83 ( <.1, F = ) and the 95% confidence limits are ±21. kcal/ day. The 95% confidence limits estimate the recision of the calculated REE. In the examle resented in Table 4, the 95% confidence limits reresent 1 3.7% of the estimated REE. To examine the relationshi between REE and the BCM in the Harris Benedict subjects, the BCM for each of the 337 subjects was calculated using the regression equations develoed by ED Moore. The calculated BCM was correlated with REE as measured in each Harris Benedict subject. Searate correlations were erformed for men and women. There was a highly significant ( <.1) correlation between REE and BCM for both men and women (Fig 1). The REE as the deendent variable was correlated with age and BCM as the indeendent variables. The following highly significant ( <.1) multile linear regression equations were obtained: Men(n= 168): REE = (age) (BCM) Women (n = 169): r=.86 REE = (age) (BCM) r=.82 <O.1 <.1 Downloaded from at Academisch Ziekenhuis Vrije Universiteit, Medical Library on January 27, 26

5 172 ROZA AND SHIZGAL 25 MO1Gs 2 BODY CELL MASS >,....% 15 w w ci:: > ,. 15 U. 1 1 LJ 5 Fema 1 s HARRIS BENEDICT :-::-::-:--: BODY CELL MASS HARRIS BENEDICT BO 1 Age (Years) FIG 1. The regression and 95% confidence limits for the calculated BCM on the measured REE for the Harris Benedict males and females. For both sexes there was a highly significant correlation ( <.1) with correlation coefficients of.86 and.8 for the men and women resectively. The regression coefficient associated with the BCM was statistically significant in both equations ( <.1), while the coefficient associated with age was statistically significant ( <.5) for women only. However, in both sexes the magnitude ofthe regression coefficients associated with age was small, indicating that age minimally affected the REE. Because these regression equations contain more than one indeendent variable, they can only be lotted in a multidimensional sace. However, by holding one or more indeendent variables constant, the relationshi between the deendent variable and a single indeendent variable can be lotted on a two-dimensional grah. With the Harris Benedict equation, height and weight are held constant and in the second equation, the BCM is held constant. In this way the effect due to aging inherent in each equation can be demonstrated (Fig 2). With the Harris Benedict equation, where REE is redicted from height, weight, age, and sex there is an aarent reduction in REE with Downloaded from at Academisch Ziekenhuis Vrije Universiteit, Medical Library on January 27, 26

6 HARRIS BENEDICT EQUATION Harris Benedict Males % 2 U >.. 2 U Harris Benedict Females Body Cell Mass (Kg) N N R -.86 P.1 FIG 2. The relationshi between age and the REE, when determined from the BCM and age (solid line), which was derived by setting the BCM constant at 3 kg for men and 22 kg for women. The broken line reresents the aging effect inherent in the Harris Benedict equation with height held constant at 18 cm for men and 16 cm for women and weight held constant at 7 kg for men and 6 kg for women. R-.8 P < advancing age when height and weight remain constant. However, when REE is redicted from age and BCM, REE does not change with advancing age, with a constant BCM. The relationshi between the BCM and body weight as a function of advancing age was examined using the Harris Benedict data. In both men and women body weight did not change with age (Fig 3). However, the BCM as a fraction of body weight decreased significantly with age for both men and women (Fig 4). In both sexes there is a constant decline in the roortion of body weight due to the BCM with aging. To examine the influence ofsex on energy requirements, REE for all Harris Benedict subjects, men and women, was lotted against their calculated BCM. The results are shown in Figure 5. It is evident from this lot that the data oints for both men and women are clustered about the same regres- Downloaded from at Academisch Ziekenhuis Vrije Universiteit, Medical Library on January 27, 26

7 174 ROZA AND SHIZGAL 1 Harris Benedict Males 8 #, 6 4).i:., 4 cs ik..!::.ffT-7,) 6 4.) -C a, Harris Benedict Females I. ;;:#{149} Age (Years) N R -. 6 FIG 3. The correlation between body weight and age for both the Harris Benedict men and women. The body weight did not change significantly with advancing age. sion line. The REE of the women is lower than that of the men rimarily because the BCM of the women tends to be smaller. Furthermore, the regression of REE on BCM in the men was not significantly different from the regression obtained for the women by analysis of variance (t =. 13). Men (n = 168): REE=l7l+5l.7(BCM) r=.86 <.1 Women (n = 169): REE = (BCM) r =.8 <.1 1. N R -. 8 Reftrence entityfor energy exchange The body comosition data of the 74 atients studied before nutritional theray with total arenteral nutrition are tabulated in Table 5 and comared to similar data ohtamed from 25 normally nourished volunteers. In these atients 33 were normally nourished while 41 were malnourished. Patients were classified as malnourished on the basis of a Na<jK > The Na/K ratio is a senstitive index of the nutritional state (15), as it is a measure of the (ECM), ex- Downloaded from at Academisch Ziekenhuis Vrije Universiteit, Medical Library on January 27, 26

8 HARRIS BENEDICT EQUATION 175 I Harris Benedict Males 4) Ii 4) I Ii Harris Benedict Females N R--.B1 P.1 N R--.81 P < Age FIG 4. The correlation between BCM, exressed as a ercentage of body weight with advancing age for both the Hams Benedict men and women. With aging there is a significant ( <.1) decline in the roortion of body weight due to the BCM, with correlation coefficients of -.81 for both sexes. ressed as a function of the BCM. With malnutrition, the ECM increases, while the BCM contracts, resulting in an increased Na/K. The malnourished atients in the resent study show a statistically significant ( <.5) exansion of the ECM with a significant ( <.5) erosion of the BCM when comared to both the normal volunteers and the normally nourished atients. These changes are reflected by the Na/K ratios. In the malnourished grou the mean (Years) ratio is significantly greater ( <.5) at 1.77 ±.9 than that ofthe normally nourished atients with a ratio of 1.8 ±.2. The mean ratio of the normal controls (.98 ±.2) does not differ significantly from the ratio of the normally nourished atients. As illustrated in Table 5, mean oxygen consumtion exressed in ml/min was significantly greater ( <.5) in the normally nourished as comared to the malnourished grous (214 ± 1 and 185 ± 7 ml. min ). Downloaded from at Academisch Ziekenhuis Vrije Universiteit, Medical Library on January 27, 26

9 176 ROZA AND SHIZGAL 3 Harris Benedict Males & FGmalGs. >, a C) w Li ci:: 2 1 N = 337 R =. 89 P < Body Cell Mass (Kg) MALES (168). FEMALES (169) FIG 5. The REE for all 337 Harris Benedict subjects, men (squares) and women (dots) lotted against their calculated 8CM, demonstrating that both sexes cluster about the same regression line. The REE for women is lower than that of the men because of the smaller size of the BCM in women. TABLE 5 Body comosition and oxygen consumtion data of atient oulation Normal volunteers Normally nourished Malnourished n Wt (kg) 7.4 ± ± ± 2.l Bodyfat(kg) 2.1± ±2.3 l2.5±l.7 TBW (I) 36.8 ± ± ± 1.2 ECM(kg) 25.8± ± ±1.2 BCM(kg) 24.6± ± l.ot 16.±.6 K,JFBW (meqjl) 8. ± ±.6t 55.7 ± l.5 NaJTBW (meqjl) 77.5 ± ± ± l.8 NaJK,.97 ± ± ±.9 VO2(ml.min) 214±1 185±7t VCO2 (ml/min) 2 ± ± 7 R/Q.9 ±.3.89 ±.2 VO/body wt (ml. min1. kg) 3.2 ± ±.1 VO,Jsurface area [ml.min.(m2)] 122 ± ± 4 VOZ/BCM (ml.min.kg ) 9.9 ± ±.6t 4 Significantly different ( <.5) from the normal volunteers and the normally nourished by analysis of variance and Scheffe s test. t Significantly different ( <.5) from the normal volunteers and the malnourished by analysis of variance and Scheffe s test. :t Significantly different ( <.5) from normally nourished by unaired Student s t test. All values reorted as mean ± SEM. VO, resting oxygen consumtion; VCO, resting carbon dioxide roduct; R/Q, resiratory quotient. Downloaded from at Academisch Ziekenhuis Vrije Universiteit, Medical Library on January 27, 26

10 HARRIS BENEDICT EQUATION 177 Mean oxygen consumtion when exressed as either ml/kg body weight (3.2 ±.2 and 3. 1 ±. 1 ml. min.(kg body weight) or as ml/m2 of body surface area (1 22 ± 5 and 11 ± 4 ml.min.(m2)) was not significantly different in the two grous. However, there was a difference in the mean oxygen consumtion when exressed as ml/kg BCM with the malnourished grou having a significantly ( <.5) higher mean oxygen consumtion, ±.6 comared to 9.9 ±.3 ml.min.(kg BCM) in the normally nourished atients. Predicted versus measured oxygen consumtion The Harris Benedict equation redicts REE in kcal/ day. Since this measurement was unavailable to us in our laboratory, REE was estimated by measuring oxygen consumtion. The relationshi between resting oxygen consumtion and weight, height, age, and sex was determined from the original Harris Benedict data. For both men and women, the oxygen consumtion, cxressed as ml/min, was correlated, as the deendent variable, with height, weight, age, and sex as the mdcendent variables. The resultant regression equations can thus be used to redict resting oxygen consumtion in ml/min from height, weight, age, and sex (Table 6). The correlation coefficients, SE ofthe estimate, and the 95% confidence limits were similar to those obtained with REE as the deendent variable (Table 3). Using the regression equations listed in Table 6, the resting oxygen consumtion was redicted for each of the 74 atients studied. In the normally nourished atients a highly significant correlation ( <. 1) existed between measured and redicted resting oxygen consumtion, with a correlation coefficient of.76 and a regression line which aroximated the line of identity (Fig 6). In the malnourished grou, although a significant ( <.1) correlation existed between the measured and redicted resting oxygen consumtion, the correlation coefficient was only.43 and the regression line was quite different from the line of identity (Fig 6). Ideally oxygen consumtion data should be cxressed as a function of the BCM, the oxygen consuming, work erforming comonent ofbody comosition. As a result the above analysis was reeated with the resting oxygen consumtion exressed as a function of the BCM. The redicted oxygen consumtion exressed as ml/kg BCM was calculated for the normally nour- TABLE 6 Resting oxygen consumtion Men VO (ht) (wt) -.82 (age) n= 168 r=.88 F= <.1 Women V (ht) (wt) (age) n=169 r=.82 F=114 <.1 VO2, resting oxygen consumtion in ml/min. ished and the malnourished atients using the regression equation derived from the Harris Benedict data (Table 6). The BCM was calculated using the regression equations of Moore (Table 2). The measured oxygen consumtion was exressed as a function of the mesured BCM. The redicted and measured oxygen consumtions were comared by an analysis of variance and Scheffe s test (Table 7). In the normally nourished grou there was no difference between the measured and redicted oxygen consumtion, when exressed as a function of the BCM. The mean measured oxygen consumtion er kg BCM for the malnourished grou was, however, significantly higher ( <.5) than the redicted value for the same grou. Furthermore the measured V2, er unit 8CM in the malnourished atients was significantly( <.5) different from both the redicted and measured values for the normally nourished grou. In contrast the redicted V2/kg BCM for the malnourished grou was similar to that in the normally nourished grou. Discussion In their original monograh Harris and Benedict exressed reservations concerning the alicabilty of their redictive formulae to elderly individuals. This concern romted them to carry out similar measurements in two additional grous of subjects with a wider age range. These data were ublished in 1928 and However, no revision of the regression equations aeared in the literature desite the availability of the additional subjects sanning a wider age range. This was due undoubtedly to the enormous task involved in erforming the required comutation without the aid of modern digital comuters. In the resent study we derived the Harris Benedict equation by using the original 1919 Harris Benedict data to correlate REE, as the deendent variable, with height, weight, age, and sex as the indeendent variables. This task was simlified by using a modern comuter. The data from the two additional series that used identical methodology ermitted us to erform a similar calculation with larger numbers of male and female subjects across a wider age range. The regression equations derived using the original data (equations 2 and 5, Table 3) are virtually identical to the equations obtained with the data from the larger number of subjects (equations 3 and 6, Table 3). The REE obtained with both of these equations is identical to the estimate obtained with the equation ublished in the original Downloaded from at Academisch Ziekenhuis Vrije Universiteit, Medical Library on January 27, 26

11 178 ROZA AND SHIZGAL 4 Normal ly Nourished,, 3 -a I L, I , P P,,, P P P 1 Malnourished : a 2 3 a:_ s,., #{149} D a a P. N - 33 R P <.1 N - 41 R P Prod FIG 6. The correlation between measured VO and redicted VO (ml/min) for both normally nourished (NaJK < 1.22) and malnourished atients (Na/K > 1,22). A statistically significant relationshi existed between the two arameters. However, in the normally nourished grou the regression line was almost identical to the line of identity (broken line) whereas in the malnourished atients the regression line was different from the line of identity. Harris Benedict monograh. The correlation coefficients, SE ofthe estimate, and the 95% confidence limits are similar for all the equations listed in Table 3. The Harris Benedict equation is therefore equally valid for both younger and older individuals. The 95% confidence limits of both the original equation and that derived from the larger grou of subjects reresent ±14% of the estimated i cted 4 REE. The Harris Benedict regression thus estimates REE of a normal individual with a recision of 14%. Multile linear regression was used to derive the regression equations, and therefore they are based on the assumtion that a linear relationshi exists between REE and the indeendent arameters that were used to derive the regression. However, the rela- Downloaded from at Academisch Ziekenhuis Vrije Universiteit, Medical Library on January 27, 26

12 HARRIS BENEDICT EQUATION 179 TABLE 7 Predicted versus measured oxygen consumtion Measured Predicted Normally nourished 9.93 ± ±.11 NajK< 1.22 Malnourished ±.6w 9.26 ±.12 Na,/K> Significantly different ( <.5) from other values by analysis of variance and Scheffe s test. All values reorted as mean ± SEM. Units are ml. min kg BCM. tionshi may not be truly linear and therefore at the extremes of age the resultant estimates may be in error. Benedict (8) reorted that in elderly women (age range 66 to 88 yr) basal metabolism was constant irresective of age when body weight exceeded 74 kg. Dubois (16), however, concluded that the linear relationshi of the Harris Benedict equations actually overestimated energy requirements in the elderly. The BCM reresents the total mass of living cells. It includes the cellular comonents of muscle and viscera and in addition the cellular fraction of adiose tissue, bone, cartilage, and tendon. The BCM is, therefore, that comonent of body comosition that is resonsible for all of the metabolic gas exchange, ie, oxygen consumtion and carbon dioxide roduction. All ofthe energy exchange and work erformed within the body occurs within the BCM, whereas no work is erformed by the extracellular suorting comonent of body comosition. The rimary function ofthe ECM is suort and transort. Therefore, the BCM is the ideal reference oint for energy exenditure. In the resent study the BCM was estimated from K. K is linearly related to the size ofthe BCM as 98 to 99% ofk is within the intracellular comartment, and the otassium concentration within this comartment varies within a narrow range. A small, and as yet undetermined, fraction of K is related to glycogen stores. The otassium associated with body glycogen reflects changes in BCM that occur as a result of changes in intracellular glycogen stores. K is not a measure of either total body rotein or total body nitrogen, as there is no otassium associated with the 3% of total body nitrogen which in the normal individual is located in the extracellular comartment. The regression equations develoed by Moore et al were used to calculate the BCM for each of the Harris Benedict subjects. These regression equations were derived from data obtained from a grou of normal volunteers and have been demonstrated to redict accurately the body comosition of the normal adult. Thus, it is valid to use these regression equations to calculate the BCM of the Harris Benedict subjects, who were a reresentative samle of the normal oulation. For both the men and women there was an excellent correlation between the calculated BCM and REE (Fig 1). The regression was highly significant ( <.1) with narrow 95% confidence limits about the regression. In order to examine the indeendent contribution of both age and BCM on REE a multile linear regression was carried out with REE as the deendent variable and age and BCM as the indeendent variables. The magnitude of the regression coefficient associated with each indeendent variable indicates their relative influence on REE. Thus, the small regression coefficients associated with age for both men and women indicate that age lays an insignificant role in both sexes as a determinant of REE. This was demonstrated grahically in Figure 2, where age was lotted against REE, for a constant BCM It is aarent that age negligibly affects the REE. In contrast, when lotting age against REE for the Harris Benedict equation, with all of the indeendent arameters excet for age held constant, age exerts a significant effect on REE (Fig 2). This arises because the indeendent variables in the Harris Benedict equation, namely weight, height, age, and sex, rovide an estimate ofthe BCM. In the normally nourished individual, the BCM is directly related to body size. However, this relationshi between the BCM and body weight is not a constant one throughout life. In the Harris Benedict subjects, body weight did not change significantly with advancing age (Fig 3). However, the BCM, as a fraction ofthe body weight did decrease significantly with increasing age for both men and women (Fig 4). It is aarent that age is a factor in the original Harris Benedict equation not because of a decline in REE associated with and secondary to the aging ro- Downloaded from at Academisch Ziekenhuis Vrije Universiteit, Medical Library on January 27, 26

13 18 ROZA AND SHIZGAL cess. Rather, age is a factor to account for the changing relationshi between the BCM and body weight with advancing age. Different regressions are required for men and women when relating REE to weight, height, and age. However, when REE is correlated with BCM searately for men and women, the resultant regression lines are not significantly different by an analysis of variance. This was demonstrated by Figure 5 where REE is lotted against BCM for all 337 Harris Benedict subjects, both men and women. The women and men distribute evenly about the regression line, demonstrating that REE is similar in the two sexes. The different Harris Benedict equations for the two sexes arise because of the different relationshi between body weight and BCM in the two sexes. Generally, in women as oosed to men, body fat occuies a larger roortion of the body weight, while the BCM is a smaller fraction of body weight. Dubois and Benedict (16, 17) introduced the concet of the oxidizing rotolasmic mass as a reference entity in studies of energy exchange. Rubner in 192 (18) in the German literature had roosed the concet of the active tissue mass. Behnke et al (19) later oularized the concet of the lean body mass. Moore et al defined the BCM as the oxygen consuming, metabolically active comonent of body comosition and develo_ a multile isotoe dilution technique that rovided an accurate, reliable, and reroducible measure of the BCM. Oxygen consumtion is usually exressed as a function of either body wieght or body surface area. In the resent study oxygen consumtion and body comosition were determined in 74 atients. When oxygen consumtion was exressed as either a function of body weight or as a function of the body surface area, there was no difference between the normally nourished and malnourished atients. However, when oxygen consumtion was exressed as a function of the BCM there was a significant elevation in the malnourished grou. This is consistent with revious data from our laboratory (2) and in shar contrast to the generally held view that malnutrition is associated with a decreased or unchanged oxygen consumtion. All atients were receiving minimal caloric infusions and therefore any increase in oxygen consumtion secondary to large glucose and rotein infusion was avoided. All of the atients studied were clinically stable, afebrile, and none had undergone recent oeration. The BCM, in gross anatomic terms can be subdivided into the skeletal muscle and the visceral comonents, with the skeletal ortion occuying a much larger roortion of the BCM. It has been estimated that the visceral organs, liver, brain, heart, and kidney are resonsible for 6 to 7% of basal oxygen consumtion and that skeletal muscle consumes 16 to 3% (2 1). Malnutrition results in a greater relative loss ofthe skeletal comonent. Thus the rise in oxygen consumtion with malnutrition, when exressed as a function of the BCM, may be due to the changing relationshi within the BCM of its two main comonents. Malnutrition most robably results in a reonderance of the visceral subdivision with its higher oxygen consumtion. Malnutrition results in a loss of body fat, a loss of the BCM, and an exansion of the ECM. The sum of these changes is reflected in the change in body weight. Because of the exansion in the ECM and the variable loss of body fat that occurs in malnutrition, the loss of body weight is not an accurate reflection of the loss of BCM. Since REE is directly related to the size of the BCM, the use of body weight as the reference entity for metabolic gas exchange is unreliable, esecially in the malnourished atient. Relating REE to body weight assumes a normal body comosition. In malnutrition this assumtion is not valid. Body surface area as a reference entity introduces similar errors because weight and height are used in calculating surface area. Furthermore, classification of atients into such catergories as normometabolic or hyermetabolic on the basis of energy exenditure normalized for body weight or body surface area may not in fact be valid. The Harris Benedict equation is frequently used to determine energy requirements from weight, height, age, and sex. These indeendent arameters are used to estimate the BCM. The estimate obtained is valid in the normally nourished atient but Downloaded from at Academisch Ziekenhuis Vrije Universiteit, Medical Library on January 27, 26

14 HARRIS BENEDICT EQUATION 181 robably invalid in the malnourished atient. To evaluate the validity of the Harris Benedict equation in malnourished individuals, studies were carried out in 74 atients. Because we lacked the facilities to determine REE, we measured instead oxygen consumtion and carbon dioxide roduction. Body comosition was measured at the same time. A relationshi between oxygen consumtion and weight, height, age, and sex was obtained using the Harris Benedict data. The equation obtained is analogous to the Harris Benedict equation. In the normally nourished atients, the resting oxygen consumtion redicted by this equation was similar to the measured values. There was an excellent correlation between the two, with the resultant regression aroximating the line of identity (Fig 6). However, in the malnourished atients, the regression equation did not accurately redict the resting oxygen consumtion. Rather, it tended to underestimate the resting oxygen consumtion. Although a statistically significant correlation existed between the redicted and measured resting oxygen consumtion, the resultant regression was significantly different from the line of identity (Fig 6). Similar results were obtained when the resting oxygen consumtion was exressed as a function of the BCM, the oxygen consuming comonent ofbody comosition. In the normally nourished atients there was no difference in the measured and redicted oxygen consumtion whereas in the malnourished atients the redicted and measured means were significantly different. In the malnourished atients, the redicted mean was 22% less than the mean measured oxygen consumtion. In 2 cancer atients Knox et al (22) comared measured REE, determined by bedside indirect calorimetry, with that redicted by the Harris Benedict equation. In 82 atients there was no difference between redicted and measured REE, normalized for metabolic body size (body weight#{176}75) (23). These atients were defined as normometabolic. In 52 atients, redicted REE normalized for metabolic body size underestimated the measured REE by 18%. These atients were defined as hyermetabolic. It could be argued that the hyermetabolic atients were malnourished. As comared to the normometabolic atients, the hyermetabolic atients were older, had their disease for a longer eriod of time, and had a significantly smaller mean body weight, ercentage ideal body weight and serum albumm. Stewart et al (24) found a similar relationshi in critically ill ventilated atients and in normal controls. Estimated energy exenditure was redicted using the Harris Benedict equation. Indirect calorimetry using the Douglas bag technique was used to measure energy exenditure. In 2 normal controls, there was no difference in the redicted and measured energy exenditure. However, in 1 critically ill ventilated atients, redicted energy exenditure significantly underestimated the measured value by 18%. The data in this study and others therefore seriously question the reliability of the Harris Benedict equation in malnourished atients. Equations for redicting REE were derived from a normal, healthy oulation and thus are best alied to similar oulations. To assess REE accurately in the ill and malnourished atient, direct measurement is referable to the use of the Harris Benedict equations. El References 1. Harris JA, Benedict FG. A biometric study of basal metabolism in man. Washington, DC: Carnegie Institute ofwashington, Publication no 279, Long CL. Energy balance and carbohydrate metabolism in infection and sesis. Am J Gin Nutr l977;3: Kinney JM. The alication ofindirect calorimetry to clinical studies. In Kinney JM ed. Assessment of energy metabolism in health and disease. Reort of the First Ross Conference on Medical Research. Columbus, OH: Ross Laboratories, 198: Swift RW, Barron GP, Fisher KH, et al. Relative dynamic effects of high versus low rotein diets of equicaloric content. Deartment of Animal Nutrition. Pennsylvania State University Publication, no 232, Moore FD. Energy and the maintenance of the body cell mass. JPEN 198;4: Kinney JM, Lister J, Moore H). Relationshi of energy exenditure to total exchangeable otassium. Ann NY Acad Sci l963;1 1: Benedict FG. Basal metabolism data on normal men and women (series II) with some considerations on the use of rediction standards. Am J Physiol 1928;85:67-2. Downloaded from at Academisch Ziekenhuis Vrije Universiteit, Medical Library on January 27, 26

15 182 ROZA AND SHIZGAL 8. Benedict FG. Old age and basal metabolism. N Engl J Med l935;212:l I Armitage P. Statistical methods in medical research. New York, NY: John Wiley and Sons, Moore FD, Oleson KH, McMurhy JD, Parker HV, Bell MR, Boyden CM. The body cell mass and its suorting environment. In: Body comosition in health and disease. Philadelhia, PA: WB Saunders and Co, Shizgal HM. The effect of malnutrition on body comosition. Surg Gynecol Obstet 198 l;152: Shizgal HM, Sanier AM, Humes J, Wood CD. Indirect measurement of total exchangeable otassium. Am J Physiol l977;233:f Field 5, Kelly SM, Macklem PT. The oxygen cost ofbreathing in atients with cardioresiratory disease. Am Rev Resir Dis l982;l26:9-l Dubois D, Dubois EF. Clinical calorimetry. a formula to estimate the aroximate surface area if height and wieght be known. Arch Intern Med l916;l7: Forse RA, Shizgal HM. The Na/K ratio: a redictor of malnutrition. Surg Forum 198;3l: Dubois EF. Basal metabolism in health and disease. Philadelhia, PA: Lea and Febiger, Benedict FG. A study of rolonged fasting. Washington DC: Carnegie Institute ofwashington, Publication no 23, Rubner M. Die Gesetze des Energieverbrauchs bei der Ernahrung. Leizig: Deuticke, Behnke AR, Osserman EF, Welham WC. Lean body mass. Its clinical significance and estimation from excess fat and total body water determinations. Arch Intern Med 1953;9l: Forse RA, Coughlin M, Shizgal HM. Effect of malnutrition on oxygen consumtion. Surg Forum 198 l;32: Grande F. Energy exenditure oftissue and organs. In: Kinney JM, ed. Assessment of energy metabolism in health and disease. Reort ofthe First Ross Conference on Medical Research. Columbus, OH: Ross Laboratories, 198: Knox LS, Crosby LO, Feurer ID, Buzby GP, Miller CL, Mullen JL. Energy exenditure in malnourished cancer atients. Ann Surg 1983;197: Klieber M. The fire of life: an introduction to animal energetics. Huntingdon: Robert E Krieger Publishing, Stewart S, Baker J, Jeejeebhoy KN. Energy exenditure in the critically ill ventilated atient. JPEN 198 1;5:562(abstr). Downloaded from at Academisch Ziekenhuis Vrije Universiteit, Medical Library on January 27, 26

Chapter 4: One Compartment Open Model: Intravenous Bolus Administration

Chapter 4: One Compartment Open Model: Intravenous Bolus Administration Home Readings Search AccessPharmacy Adv. Search Alied Bioharmaceutics & Pharmacokinetics, 7e > Chater 4 Chater 4: One Comartment Oen Model: Intravenous Bolus Administration avid S.H. Lee CHAPTER OBJECTIVES

More information

Decision Analysis Rates, Proportions, and Odds Decision Table Statistics Receiver Operating Characteristic (ROC) Analysis

Decision Analysis Rates, Proportions, and Odds Decision Table Statistics Receiver Operating Characteristic (ROC) Analysis Decision Analysis Rates, Proortions, and Odds Decision Table Statistics Receiver Oerating Characteristic (ROC) Analysis Paul Paul Barrett Barrett email: email:.barrett@liv.ac.uk htt://www.liv.ac.uk/~barrett/aulhome.htm

More information

A Note on False Positives and Power in G 3 E Modelling of Twin Data

A Note on False Positives and Power in G 3 E Modelling of Twin Data Behav Genet (01) 4:10 18 DOI 10.100/s10519-011-9480- ORIGINAL RESEARCH A Note on False Positives and Power in G E Modelling of Twin Data Sohie van der Sluis Danielle Posthuma Conor V. Dolan Received: 1

More information

Since its introduction in 1975, extracorporeal membrane

Since its introduction in 1975, extracorporeal membrane Results of Extracororeal Membrane Oxygenation in Children With Sesis Dan M. Meyer, MD, Michael E. Jessen, MD, and the Extracororeal Life Suort Organization University of Texas Southwestern Medical Center,

More information

Induced Mild Hypothermia for Ischemic Stroke Patients

Induced Mild Hypothermia for Ischemic Stroke Patients Med. J. Cairo Univ., Vol. 82, No. 2, December: 179-186, 2014 www.medicaljournalofcairouniversity.net Induced Mild Hyothermia for Ischemic Stroke Patients AHMED E.S. ELNAHRAWY, M.Sc.; MERVAT M. KHALEF,

More information

Bayesian design using adult data to augment pediatric trials

Bayesian design using adult data to augment pediatric trials ARTICLE Clinical Trials 2009; 6: 297 304 Bayesian design using adult data to augment ediatric trials David A Schoenfeld, Hui Zheng and Dianne M Finkelstein Background It can be difficult to conduct ediatric

More information

COPD is a common disease. Over the prolonged, Pneumonic vs Nonpneumonic Acute Exacerbations of COPD*

COPD is a common disease. Over the prolonged, Pneumonic vs Nonpneumonic Acute Exacerbations of COPD* vs Acute Exacerbations of COPD* David Lieberman, MD; Devora Lieberman, MD; Yevgenia Gelfer, MD; Raiesa Varshavsky, MD; Bella Dvoskin, MD, PhD; Maija Leinonen, PhD; and Maureen G. Friedman, PhD Study objective:

More information

Author's personal copy

Author's personal copy Vision Research 48 (2008) 1837 1851 Contents lists available at ScienceDirect Vision Research journal homeage: www.elsevier.com/locate/visres Bias and sensitivity in two-interval forced choice rocedures:

More information

Comparison of Water Seal and Suction After Pulmonary Lobectomy: A Prospective, Randomized Trial

Comparison of Water Seal and Suction After Pulmonary Lobectomy: A Prospective, Randomized Trial GENERAL THORACIC Comarison of Water Seal and Suction After Pulmonary Lobectomy: A Prosective, Randomized Trial Alessandro Brunelli, MD, Marco Monteverde, MD, Alessandro Borri, MD, Michele Salati, MD, Rita

More information

Citation for published version (APA): Lutgers, H. L. (2008). Skin autofluorescence in diabetes mellitus Groningen: s.n.

Citation for published version (APA): Lutgers, H. L. (2008). Skin autofluorescence in diabetes mellitus Groningen: s.n. University of Groningen Skin autofluorescence in diabetes mellitus Lutgers, H.L. IMPORTANT NOTE: You are advised to consult the ublisher's version (ublisher's PDF) if you wish to cite from it. Please check

More information

carinzz prophylactic regimens

carinzz prophylactic regimens Genitourin Med 1997;73:139-143 Continuing medical education HIV Eidemiology Unit, Chelsea and Westminster Hosital, 369 Fulham Road, London SW10 9TH, UK P J Easterbrook Acceted for ublication 8 October

More information

Severe Psychiatric Disorders in Mid-Life and Risk of Dementia in Late- Life (Age Years): A Population Based Case-Control Study

Severe Psychiatric Disorders in Mid-Life and Risk of Dementia in Late- Life (Age Years): A Population Based Case-Control Study Send Orders for Rerints to rerints@benthamscience.net Current Alzheimer Research, 2014, 11, 681-693 681 Severe Psychiatric Disorders in Mid-Life and Risk of Dementia in Late- Life (Age 65-84 Years): A

More information

Application of a score system to evaluate the risk of malnutrition in a multiple hospital setting

Application of a score system to evaluate the risk of malnutrition in a multiple hospital setting Sagnuolo et al. Italian Journal of Pediatrics 2013, 39:81 ITALIAN JOURNAL OF PEDIATRICS RESEARCH Oen Access Alication of a score system to evaluate the risk of malnutrition in a multile hosital setting

More information

Reinforcing Visual Grouping Cues to Communicate Complex Informational Structure

Reinforcing Visual Grouping Cues to Communicate Complex Informational Structure 8 IEEE TRANSACTIONS ON VISUALIZATION AND COMPUTER GRAPHICS, VOL. 20, NO. 12, DECEMBER 2014 1973 Reinforcing Visual Grouing Cues to Communicate Comlex Informational Structure Juhee Bae and Benjamin Watson

More information

Automatic System for Retinal Disease Screening

Automatic System for Retinal Disease Screening Automatic System for Retinal Disease Screening Arathy.T College Of Engineering Karunagaally Abstract This work investigates discrimination caabilities in the texture of fundus images to differentiate between

More information

Yavuz M. Bilgin, MD; Leo M. G. van de Watering, MD, PhD; Michel I. M. Versteegh, MD; Marinus H. J. van Oers, MD, PhD; Anneke Brand, MD, PhD

Yavuz M. Bilgin, MD; Leo M. G. van de Watering, MD, PhD; Michel I. M. Versteegh, MD; Marinus H. J. van Oers, MD, PhD; Anneke Brand, MD, PhD Effects of allogeneic leukocytes in blood transfusions during cardiac surgery on inflammatory mediators and ostoerative comlications* Yavuz M. Bilgin, MD; Leo M. G. van de Watering, MD, PhD; Michel I.

More information

Presymptomatic Risk Assessment for Chronic Non- Communicable Diseases

Presymptomatic Risk Assessment for Chronic Non- Communicable Diseases Presymtomatic Risk Assessment for Chronic Non- Communicable Diseases Badri Padhukasahasram 1 *. a, Eran Halerin 1. b c, Jennifer Wessel 1 d, Daryl J. Thomas 1 e, Elana Silver 1, Heather Trumbower 1, Michele

More information

Risk factors for post-colectomy adhesive small bowel obstruction

Risk factors for post-colectomy adhesive small bowel obstruction Original article Acta Medica Academica 2016;45(2):121-127 DOI: 10.5644/ama2006-124.167 Risk factors for ost-colectomy adhesive small bowel obstruction Edin Husarić 1, Šefik Hasukić 1, Nešad Hotić 1, Amir

More information

Polymorbidity in diabetes in older people: consequences for care and vocational training

Polymorbidity in diabetes in older people: consequences for care and vocational training 763 ORIGINAL ARTICLE Polymorbidity in diabetes in older eole: consequences for care and vocational training B van Bussel, E Pijers, I Ferreira, P Castermans, A Nieuwenhuijzen Kruseman... See end of article

More information

Prognostic Significance of Peripheral Monocytosis After Reperfused Acute Myocardial Infarction: A Possible Role for Left Ventricular Remodeling

Prognostic Significance of Peripheral Monocytosis After Reperfused Acute Myocardial Infarction: A Possible Role for Left Ventricular Remodeling Journal of the American College of Cardiology Vol. 39, No. 2, 2002 2002 by the American College of Cardiology ISSN 0735-1097/02/$22.00 Published by Elsevier Science Inc. PII S0735-1097(01)01721-1 Prognostic

More information

Child attention to pain and pain tolerance are dependent upon anxiety and attention

Child attention to pain and pain tolerance are dependent upon anxiety and attention Child attention to ain and ain tolerance are deendent uon anxiety and attention control: An eye-tracking study Running Head: Child anxiety, attention control, and ain Heathcote, L.C. 1, MSc, Lau, J.Y.F.,

More information

Protocol: Influence of Budesonide and Budesonide/ Formoterol on Asthma Control in Smoking Asthmatic Adults

Protocol: Influence of Budesonide and Budesonide/ Formoterol on Asthma Control in Smoking Asthmatic Adults The Oen Resiratory Medicine Journal, 2010, 4, 51-57 51 Protocol: Influence of and / Formoterol on Asthma Control in Smoking Asthmatic Adults Oen Access Louis-Philie Boulet *,1, Francine Deschesnes 1, Simone

More information

Amino acids in retinitis pigmentosa

Amino acids in retinitis pigmentosa British Journal of Ohthalmology, 1981, 65, 626-630 Amino acids in retinitis igmentosa STEVE A. ARSHINOFF,' J. CLEMENT McCULLOCH,' WILLIAM MACRAE,2 ARTHUR N. STEIN,3 AND ERROL B. MARLISS3 From the Deartments

More information

Assessment of Growth Using Mandibular Canine Calcification Stages and Its Correlation with Modified MP3 Stages

Assessment of Growth Using Mandibular Canine Calcification Stages and Its Correlation with Modified MP3 Stages 10.5005/j-journals-10005-1050 IJCPD Assessment of Growth Using Mandibular Canine Calcification Stages and Its Correlation with Modified MP3 Stages ORIGINAL ARTICLE Assessment of Growth Using Mandibular

More information

Differences in the local and national prevalences of chronic kidney disease based on annual health check program data

Differences in the local and national prevalences of chronic kidney disease based on annual health check program data Clin Ex Nehrol (202) 6:749 754 DOI 0.007/s057-02-0628-0 ORIGINAL ARTICLE Differences in the local and national revalences of chronic kidney disease based on annual health check rogram data Minako Wakasugi

More information

SPECTRAL ENVELOPE ANALYSIS OF SNORING SIGNALS

SPECTRAL ENVELOPE ANALYSIS OF SNORING SIGNALS SPECTRAL ENVELOPE ANALYSIS OF SNORING SIGNALS Mustafa Çavuşoğlu, Mustafa Kamaşak 2, Tolga Çiloğlu 3,Yeşim Serinağaoğlu 3,Osman Eroğul 4 Max Planck Instıtute for Biological Cybernetics, High Field MR Center,

More information

Characterization of pediatric patients receiving prolonged mechanical ventilation

Characterization of pediatric patients receiving prolonged mechanical ventilation Characterization of ediatric atients receiving rolonged mechanical ventilation Ezequiel Monteverde, MD; Analía Fernández, MD; Rossana Poterala, MD; Nilda Vidal, MD; Alejandro Siaba Serrate, MD; Pablo Castelani,

More information

Inadequate treatment of ventilator-associated and hospital-acquired pneumonia: Risk factors and impact on outcomes

Inadequate treatment of ventilator-associated and hospital-acquired pneumonia: Risk factors and impact on outcomes Piskin et al. BMC Infectious Diseases 2012, 12:268 RESEARCH ARTICLE Oen Access Inadequate treatment of ventilator-associated and hosital-acquired neumonia: Risk factors and imact on outcomes Nihal Piskin

More information

Influence of Inhaled Corticosteroids on Community-acquired Pneumonia in Patients with Bronchial Asthma

Influence of Inhaled Corticosteroids on Community-acquired Pneumonia in Patients with Bronchial Asthma ORIGINAL ARTICLE Influence of Inhaled Corticosteroids on Community-acquired Pneumonia in Patients with Bronchial Asthma Masako TO, Yasuo TO, Hirokazu YAMADA, Chuhei OGAWA, Mamoru OTOMO, Naohito SUZUKI

More information

Relating mean blood glucose and glucose variability to the risk of multiple episodes of hypoglycaemia in type 1 diabetes

Relating mean blood glucose and glucose variability to the risk of multiple episodes of hypoglycaemia in type 1 diabetes Diabetologia (2007) 50:2553 2561 DOI 10.1007/s00125-007-0820-z ARTICLE Relating mean blood glucose and glucose variability to the risk of multile eisodes of hyoglycaemia in tye 1 diabetes E. S. Kilatrick

More information

Skeletal Muscle Function and Its Relation to Exercise Tolerance in Chronic Heart Failure

Skeletal Muscle Function and Its Relation to Exercise Tolerance in Chronic Heart Failure 1758 JACC Vol. 30, No. 7 Skeletal Muscle Function and Its elation to Exercise Tolerance in Chronic Heart Failure DEEK HAINGTON, MCP,* STEFAN D. ANKE, MD,* TUAN PENG CHUA, MD,* KATHAINE M. WEBB-PEPLOE,

More information

Impact of Severe Postoperative Complications after Cardiac Surgery on Mortality in Patients Aged over 80 Years

Impact of Severe Postoperative Complications after Cardiac Surgery on Mortality in Patients Aged over 80 Years Ann Thorac Cardiovasc Surg 2014; 20: 383 389 Online July 31, 2013 doi: 10.5761/atcs.oa.13-02268 Original Article Imact of Severe Postoerative Comlications after Cardiac Surgery on Mortality in Patients

More information

Chapter 2. Horm Behav Jul;60(2):

Chapter 2. Horm Behav Jul;60(2): Chater The newborn rat s stress system readily habituates to reeated and rolonged maternal searation, while continuing to resond to stressors in context deendent fashion. Nikolaos P. Daskalakis 1, Sanne

More information

Estimating shared copy number aberrations for array CGH data: the linear-median method

Estimating shared copy number aberrations for array CGH data: the linear-median method University of Wollongong Research Online Faculty of Informatics - Paers (Archive) Faculty of Engineering and Information Sciences 2010 Estimating shared coy number aberrations for array CGH data: the linear-median

More information

The Relationship Between Chronic Atrial Fibrillation and Reduced Pulmonary Function in Cases of Preserved Left Ventricular Systolic Function

The Relationship Between Chronic Atrial Fibrillation and Reduced Pulmonary Function in Cases of Preserved Left Ventricular Systolic Function ORIGINAL ARTICLE DOI 10.4070 / kcj.2009.39.9.372 Print ISSN 1738-5520 / On-line ISSN 1738-5555 Coyright c 2009 The Korean Society of Cardiology The Relationshi Between Chronic Atrial Fibrillation and Reduced

More information

PRESSURE sores (PS) are a significant problem for

PRESSURE sores (PS) are a significant problem for Journal of Gerontology: MEDICAL SCIENCES 2007, Vol. 62A, No. 3, 317 322 Coyright 2007 by The Gerontological Society of America Resting Energy Exenditure and Body Comosition in Bedridden Institutionalized

More information

Objectives. 6.3, 6.4 Quantifying the quality of hypothesis tests. Type I and II errors. Power of a test. Cautions about significance tests

Objectives. 6.3, 6.4 Quantifying the quality of hypothesis tests. Type I and II errors. Power of a test. Cautions about significance tests Objectives 6.3, 6.4 Quantifying the quality of hyothesis tests Tye I and II errors Power of a test Cautions about significance tests Further reading: htt://onlinestatbook.com/2/ower/contents.html Toics:

More information

Introducing Two-Way and Three-Way Interactions into the Cox Proportional Hazards Model Using SAS

Introducing Two-Way and Three-Way Interactions into the Cox Proportional Hazards Model Using SAS Paer SD-39 Introducing Two-Way and Three-Way Interactions into the Cox Proortional Hazards Model Using SAS Seungyoung Hwang, Johns Hokins University Bloomberg School of Public Health ABSTRACT The Cox roortional

More information

Comparing Clinical Outcomes in High-Volume and Low-Volume Off-Pump Coronary Bypass Operation Programs

Comparing Clinical Outcomes in High-Volume and Low-Volume Off-Pump Coronary Bypass Operation Programs Comaring Clinical Outcomes in High-Volume and Low-Volume Off-Pum Coronary Byass Oeration Programs Philli P. Brown, MD, Michael J. Mack, MD, Aril W. Simon, MSN, Salvatore L. Battaglia, BS, Lynn G. Tarkington,

More information

Dental X-rays and Risk of Meningioma: Anatomy of a Case-Control Study

Dental X-rays and Risk of Meningioma: Anatomy of a Case-Control Study research-article2013 JDRXXX10.1177/0022034513484338 PERSPECTIVE D. Dirksen*, C. Runte, L. Berghoff, P. Scheutzel, and L. Figgener Deartment of Prosthetic Dentistry and Biomaterials, University of Muenster,

More information

Risk Scores Do Not Predict High Mortality After Coronary Artery Bypass Surgery in the Presence of Diastolic Dysfunction

Risk Scores Do Not Predict High Mortality After Coronary Artery Bypass Surgery in the Presence of Diastolic Dysfunction Risk Scores Do Not Predict High Mortality After Coronary Artery Byass Surgery in the Presence of Diastolic Dysfunction Lorenzo Merello, MD, Erick Riesle, MD, Javier Alburquerque, MD, Humberto Torres, MD,

More information

Histopathological Parameters predicting Occult Nodal Metastases in Tongue Carcinoma Cases: An Indian Perspective

Histopathological Parameters predicting Occult Nodal Metastases in Tongue Carcinoma Cases: An Indian Perspective Tina Elizabeth Jacob et al ORIGINAL RESEARCH 10.5005/j-journals-10024-1805 Histoathological Parameters redicting Occult Nodal Metastases in Tongue Carcinoma Cases: An Indian Persective 1 Tina Elizabeth

More information

A model of HIV drug resistance driven by heterogeneities in host immunity and adherence patterns

A model of HIV drug resistance driven by heterogeneities in host immunity and adherence patterns a. Adherence attern Based on hyothesized causes and timescales Month b. Pharmacokinetics Liver TDF TFV ME ME Cell membrane c. Pharmacodynamics TDF= R relative to WT 1.8.6.4.2 WT K65R M184V TFV MP DP -4-2

More information

Association of anxiety with body mass index (BMI) and waist to hip ratio (WHR) in medical students

Association of anxiety with body mass index (BMI) and waist to hip ratio (WHR) in medical students Original Research Association of anxiety with body mass index (BMI) and waist to hi ratio (WHR) in medical students Rajeshree S. Meshram, Yogita D. Sulaxane, Snehal S. Kulkarni, Ashok H. Kale Deartment

More information

Relative Role of Factors Associated With Cerebral Infarction and Cerebral Hemorrhage

Relative Role of Factors Associated With Cerebral Infarction and Cerebral Hemorrhage STROKE VOL, No 1, JANUARY-FEBRUARY. Eklof B, Lassen NA, Nilsson L, et al: Regional cerebral blood flow in the rat, measured by the tissue samling technique. Acta hysiol Scand 1: 1-,. Nilsson B: Measurement

More information

Non-small cell lung cancer (NSCLC) is the most common

Non-small cell lung cancer (NSCLC) is the most common ORIGINAL ARTICLE Elevated Preoerative C-reactive Protein Predicts Poor Cancer Secific Survival in Patients Undergoing Resection for Non-small Cell Lung Cancer Caroline O Dowd, MBChB, MRCP,* Laura A. McRae,

More information

Journal of the American College of Cardiology Vol. 37, No. 5, by the American College of Cardiology ISSN /01/$20.

Journal of the American College of Cardiology Vol. 37, No. 5, by the American College of Cardiology ISSN /01/$20. Journal of the American College of Cardiology Vol. 37, No. 5, 2001 2001 by the American College of Cardiology ISSN 0735-1097/01/$20.00 Published by Elsevier Science Inc. PII S0735-1097(01)01166-4 Comarative

More information

Annie Quick and Saamah Abdallah, New Economics Foundation

Annie Quick and Saamah Abdallah, New Economics Foundation Inequalities in wellbeing Annie Quick and Saamah Abdallah, New Economics Foundation Abstract: This aer exlores the nature and drivers of inequality in wellbeing across Euroe. We used the first six rounds

More information

Effects of Single Dose, Postinduction Dexamethasone on Recovery After Cardiac Surgery

Effects of Single Dose, Postinduction Dexamethasone on Recovery After Cardiac Surgery Effects of Single Dose, Postinduction on Recovery After Cardiac Surgery Jean-Pierre Yared, MD, Norman J. Starr, MD, Frederick K. Torres, MD, C. Allen Bashour, MD, Gregory Bourdakos, MD, Marion Piedmonte,

More information

IN a recent article (Iwasa and Pomiankowski 1999),

IN a recent article (Iwasa and Pomiankowski 1999), Coyright 001 by the Genetics Society of America The Evolution of X-Linked Genomic Imrinting Yoh Iwasa* and Andrew Pomiankowski *Deartment of Biology, Kyushu University, Fukuoka 81-8581, Jaan and Deartment

More information

Original Article. Kee Hyun Cho, MD and Soo Jung Kang, MD. Introduction. Korean Circulation Journal

Original Article. Kee Hyun Cho, MD and Soo Jung Kang, MD. Introduction. Korean Circulation Journal Original Article htt://dx.doi.org/10.4070/kcj.2014.44.5.328 Print ISSN 1738-5520 On-line ISSN 1738-5555 Korean Circulation Journal Clinically Useful Predictors of Resistance to Intravenous Immunoglobulin

More information

BPK 312 Nutrition for Fitness & Sport. Lecture 4 - Part 2. Measurement of Energy in Food & During Physical Activity

BPK 312 Nutrition for Fitness & Sport. Lecture 4 - Part 2. Measurement of Energy in Food & During Physical Activity BPK 312 Nutrition for Fitness & Sport Lecture 4 - Part 2 Measurement of Energy in Food & During Physical Activity 1. Heat of Combustion & Energy Value of Foods 2. Measurement of Human Energy Expenditure

More information

Inconsistencies of echocardiographic criteria for the grading of aortic valve stenosis

Inconsistencies of echocardiographic criteria for the grading of aortic valve stenosis Euroean Heart Journal (2008) 29, 1043 1048 doi:10.1093/eurheartj/ehm543 CLINICAL RESEARCH Valvular heart disease Inconsistencies of echocardiograhic criteria for the grading of aortic valve stenosis Jan

More information

SIMULATIONS OF ERROR PROPAGATION FOR PRIORITIZING DATA ACCURACY IMPROVEMENT EFFORTS (Research-in-progress)

SIMULATIONS OF ERROR PROPAGATION FOR PRIORITIZING DATA ACCURACY IMPROVEMENT EFFORTS (Research-in-progress) SIMLATIONS OF ERROR PROPAGATION FOR PRIORITIZING DATA ACCRACY IMPROEMENT EFFORTS (Research-in-rogress) Irit Askira Gelman niversity of Arizona Askirai@email.arizona.edu Abstract: Models of the association

More information

Journal of the American College of Cardiology Vol. 37, No. 3, by the American College of Cardiology ISSN /01/$20.

Journal of the American College of Cardiology Vol. 37, No. 3, by the American College of Cardiology ISSN /01/$20. Journal of the American College of Cardiology Vol. 37, No. 3, 2001 2001 by the American College of Cardiology ISSN 0735-1097/01/$20.00 Published by Elsevier Science Inc. PII S0735-1097(00)01193-1 Prerocedural

More information

Journal of the American College of Cardiology Vol. 35, No. 4, by the American College of Cardiology ISSN /00/$20.

Journal of the American College of Cardiology Vol. 35, No. 4, by the American College of Cardiology ISSN /00/$20. Journal of the American College of Cardiology Vol. 35, No. 4, 2000 2000 by the American College of Cardiology ISSN 0735-1097/00/$20.00 Published by Elsevier Science Inc. PII S0735-1097(99)00641-5 Utilization

More information

Randomized controlled trials: who fails run-in?

Randomized controlled trials: who fails run-in? Rees et al. Trials (2016) 17:374 DOI 10.1186/s13063-016-1451-9 RESEARCH Oen Access Randomized controlled trials: who fails run-in? Judy R. Rees 1, Leila A. Mott 1, Elizabeth L. Barry 1, John A. Baron 1,2,

More information

Lipoprotein Cholesterol in the Russian Lipid Research Clinics Prevalence Follow-up Study

Lipoprotein Cholesterol in the Russian Lipid Research Clinics Prevalence Follow-up Study 846 Increased Risk of Coronary Heart Disease Death in Men With Low Total and Low-Density Liorotein Cholesterol in the Russian Liid Research Clinics Prevalence Follow-u Study Dmitri B. Shestov, MD; Alexander

More information

An assessment of diabetes-dependent quality of life (ADDQoL) in women and men in Poland with type 1 and type 2 diabetes

An assessment of diabetes-dependent quality of life (ADDQoL) in women and men in Poland with type 1 and type 2 diabetes ORIGINAL ARTICLE www.aaem.l An assessment of diabetes-deendent quality of life (ADDQoL) in women and men in Poland with tye 1 and tye 2 diabetes Ewelina Bąk 1,A-F, Zofia Nowak-Kausta 2,D, Dorota Dobrzyń-Matusiak

More information

Do People s First Names Match Their Faces?

Do People s First Names Match Their Faces? First names and faces 1 Journal of Articles in Suort of the Null Hyothesis Vol. 12, No. 1 Coyright 2015 by Reysen Grou. 1539-8714 www.jasnh.com Do Peole s First Names Match Their Faces? Robin S. S. Kramer

More information

Effect of Focused Ultrasound on Abdominal Fat During Menopause

Effect of Focused Ultrasound on Abdominal Fat During Menopause International Journal of ChemTech Research CODEN (USA): IJCRGG, ISSN: 0974-4290, ISSN(Online):2455-9555 Vol.10 No.5, 379-383, 2017 Effect of Focused Ultrasound on Abdominal Fat During Menoause Noha El

More information

Correlation between pattern and mechanism of injury of free fall

Correlation between pattern and mechanism of injury of free fall Strat Traum Limb Recon (2012) 7:141 145 DOI 10.1007/s11751-012-0142-7 ORIGINAL ARTICLE Correlation between attern and mechanism of injury of free fall Ismael Auñón-Martín Pedro Caba Doussoux Jose Luís

More information

Nutritional Assessment of the Critically Ill Patient Terry L. Forrette, M.H.S., RRT

Nutritional Assessment of the Critically Ill Patient Terry L. Forrette, M.H.S., RRT Nutritional Assessment of the Critically Ill Patient Tools to understand metabolic monitoring GE Healthcare - R&S Global Training August 3, 2010 1 Metabolic Rate Fuel Sources Substrate Utilization Metabolic

More information

Respiratory changes in the E/A wave pattern can be an early sign of diastolic dysfunction: An echocardiographic long-term follow-up study

Respiratory changes in the E/A wave pattern can be an early sign of diastolic dysfunction: An echocardiographic long-term follow-up study PMID: 23018362 WWW.MEDSCIMONIT.COM Received: 2011.09.15 Acceted: 2012.05.24 Published: 2012.10.01 Resiratory changes in the E/A wave attern can be an early sign of diastolic dysfunction: An echocardiograhic

More information

RISK FACTORS FOR NOCTURIA IN TAIWANESE WOMEN AGED YEARS

RISK FACTORS FOR NOCTURIA IN TAIWANESE WOMEN AGED YEARS ORIGINAL ARTICLE RISK FACTORS FOR NOCTURIA IN TAIWANESE WOMEN AGED 20 59 YEARS Ching-Hung Hsieh*, Hsing-Yu Chen 1, Chun-Sen Hsu, Shao-Tung Chang 2, Chien-Dai Chiang 3 Deartment of Obstetrics and Gynecology,

More information

Prefrontal cortex fmri signal changes are correlated with working memory load

Prefrontal cortex fmri signal changes are correlated with working memory load Cognitive Neuroscience and Neurosychology NeuroReort 8, 545 549 (997) WE investigated whether a nonsatial working memory (WM) task would activate dorsolateral refrontal cortex (DLPFC) and whether activation

More information

This is an author-deposited version published in: Eprints ID: 15989

This is an author-deposited version published in:   Eprints ID: 15989 Oen Archive TOULOUSE Archive Ouverte (OATAO) OATAO is an oen access reository that collects the work of Toulouse researchers and makes it freely available over the web where ossible. This is an author-deosited

More information

The Usage of Emergency Contraceptive Methods of Female Students in Hawassa University: A Case Study on Natural and Computational Science

The Usage of Emergency Contraceptive Methods of Female Students in Hawassa University: A Case Study on Natural and Computational Science American Journal of Theoretical and Alied Statistics 207; 6(): 6-7 htt://www.scienceublishinggrou.com/j/ajtas doi: 0.648/j.ajtas.207060.8 ISSN: 2326-8999 (Print); ISSN: 2326-9006 (Online) The Usage of

More information

Prediction of Resistance to Standard Intravenous Immunoglobulin Therapy in Kawasaki Disease

Prediction of Resistance to Standard Intravenous Immunoglobulin Therapy in Kawasaki Disease Original Article Print ISSN 1738-5520 On-line ISSN 1738-5555 Korean Circulation Journal Prediction of Resistance to Standard Intravenous Immunoglobulin Theray in Kawasaki Disease Sang Min Lee, MD, Jeong

More information

Remaining Useful Life Prediction of Rolling Element Bearings Based On Health State Assessment

Remaining Useful Life Prediction of Rolling Element Bearings Based On Health State Assessment Remaining Useful Life Prediction of Rolling Element Bearings Based On Health State Assessment Zhiliang Liu, Ming J. Zuo,2, and Longlong Zhang School of Mechanical, Electronic, and Industrial Engineering,

More information

OBESITY is a major health problem in the United States

OBESITY is a major health problem in the United States 100 0021-972X199/$03.00/0 The Journal of Clinical Endocrinology & Metabolism Coyright 1999 by The Endocrine Society Vol. 84, No.3 Printed in U.S.A. Pubertal African-American Girls Exend Less Energy at

More information

Association of glycosylated hemoglobin (HbA1c) levels with Iinsulin resistance in obese children.

Association of glycosylated hemoglobin (HbA1c) levels with Iinsulin resistance in obese children. Association of glycosylated hemoglobin (HbA1c) levels with Iinsulin resistance in obese children. Zehra Esra Önal, Vildan Atasayan, Tamay Gürbüz, Evrim Hekaya, Çağatay Nuhoğlu, Haydaraşa Numune Training

More information

A step-down unit transfer protocol for low-risk aneurysmal subarachnoid hemorrhage

A step-down unit transfer protocol for low-risk aneurysmal subarachnoid hemorrhage NEUROSURGICAL FOCUS Neurosurg Focus 43 (5):E15, 2017 A ste-down unit transfer rotocol for low-risk aneurysmal subarachnoid hemorrhage Alexander G. Chartrain, BS, 1 Ahmed J. Awad, MD, 1 Christoher A. Sarkiss,

More information

The Model and Analysis of Conformity in Opinion Formation

The Model and Analysis of Conformity in Opinion Formation roceedings of the 7th WSEAS International Conference on Simulation, Modelling and Otimization, Beijing, China, Setember 5-7, 2007 463 The Model and Analysis of Conformity in Oinion Formation ZHANG LI,

More information

9/17/2009. HPER 3970 Dr. Ayers. (courtesy of Dr. Cheatham)

9/17/2009. HPER 3970 Dr. Ayers. (courtesy of Dr. Cheatham) REVIEW: General Principles II What is the RDA? Level of intake for essential nutrients determined on the basis of scientific knowledge to be adequate to meet the known nutrient needs of practically all

More information

The risks of blood transfusion are well known. Aprotinin

The risks of blood transfusion are well known. Aprotinin Ultra-Low Dose Arotinin Decreases Transfusion Requirements and Is Cost Effective in Coronary Oerations Rebecca J. Dignan, MD, David W. Law, BSc, Peng W. Seah, MBBS, Con W. Manganas, MBBS, David C. Newman,

More information

Research Article ABSTRACT. Amanda Myhren-Bennett College of Nursing, University of South Carolina, Columbia, SC 29208, USA

Research Article ABSTRACT. Amanda Myhren-Bennett College of Nursing, University of South Carolina, Columbia, SC 29208, USA Quality in Primary Care (2017) 25 (3): 176-186 2017 Insight Medical Publishing Grou Research Article Research Article Adherence to Standards of Practice Treating Diabetes between Physicians and Nurse Practitioners:

More information

Anchor Selection Strategies for DIF Analysis: Review, Assessment, and New Approaches

Anchor Selection Strategies for DIF Analysis: Review, Assessment, and New Approaches Anchor Selection Strategies for DIF Analysis: Review, Assessment, and New Aroaches Julia Kof LMU München Achim Zeileis Universität Innsbruck Carolin Strobl UZH Zürich Abstract Differential item functioning

More information

Acute Effects of Ethanol Ingestion

Acute Effects of Ethanol Ingestion cute Effects of Ethanol Ingestion on the Resonse to Submaximal and Maximal Exercise in Man By GUNNR BLOMQVIST, M.D., BENGT SLTIN, M.D., ND JERE H. MrrCHELL, M.D. With the technical assistance of George

More information

The Application of a Cognitive Diagnosis Model via an. Analysis of a Large-Scale Assessment and a. Computerized Adaptive Testing Administration

The Application of a Cognitive Diagnosis Model via an. Analysis of a Large-Scale Assessment and a. Computerized Adaptive Testing Administration The Alication of a Cognitive Diagnosis Model via an Analysis of a Large-Scale Assessment and a Comuterized Adative Testing Administration by Meghan Kathleen McGlohen, B.S., M. A. Dissertation Presented

More information

The vignette, task, requirement, and option (VITRO) analyses approach to operational concept development

The vignette, task, requirement, and option (VITRO) analyses approach to operational concept development CAN UNCLASSIFIED The vignette, task, requirement, and otion (VITRO) analyses aroach to oerational concet develoment atrick W. Dooley, Yvan Gauthier DRDC Centre for Oerational Research and Analysis Journal

More information

King s Research Portal

King s Research Portal King s Research Portal Document Version Peer reviewed version Link to ublication record in King's Research Portal Citation for ublished version (APA): Murrells, T., Ball, J., Maben, J., Lee, G., Cookson,

More information

Cocktail party listening in a dynamic multitalker environment

Cocktail party listening in a dynamic multitalker environment Percetion & Psychohysics 2007, 69 (1), 79-91 Cocktail arty listening in a dynamic multitalker environment DOUGLAS S. BRUNGART AND BRIAN D. SIMPSON Air Force Research Laboratory, Wright-Patterson Air Force

More information

Breast cancer molecular profiling with single sample predictors: a retrospective analysis

Breast cancer molecular profiling with single sample predictors: a retrospective analysis Breast cancer molecular rofiling with single samle redictors: a retrosective analysis Britta Weigelt,* Alan Mackay,* Roger A hern, Rachael Natrajan, David S P Tan, Mitch Dowsett, Alan Ashworth, Jorge S

More information

Epidemiology of PRA in Pre Transplant Renal Recipients and its Relation to Different Factors

Epidemiology of PRA in Pre Transplant Renal Recipients and its Relation to Different Factors Med. J. Cairo Univ., Vol. 82, No. 1, March: 223-231, 2014 www.medicaljournalofcairouniversity.net Eidemiology of in Pre Translant Renal Reciients and its Relation to Different Factors USAMA MOHAMADY, M.D.*;

More information

Regret theory and risk attitudes

Regret theory and risk attitudes J Risk Uncertain (2017) 55:147 175 htts://doi.org/10.1007/s11166-017-9268-9 Regret theory and risk attitudes Jeeva Somasundaram 1 Enrico Diecidue 1 Published online: 5 January 2018 Sringer Science+Business

More information

The saphenous vein harvest wound is well recognized

The saphenous vein harvest wound is well recognized Occlusive Wra Dressing Reduces Infection Rate in Sahenous Vein Harvest Site Franklin L. Rosenfeldt, FRACS, Justin Negri, FRACS, Damien Holdaway, FRACS, Bruce B. Davis, FRACS, Julie Mack, BS, Michael J.

More information

Pressor Responses to Noxious Stimuli in Hypertensive Patients

Pressor Responses to Noxious Stimuli in Hypertensive Patients Downloaded from htt://ahajournals.org by on October 2, 2018 Pressor Resonses to Noxious Stimuli in Hyertensive Patients Effects of Guanethidine Sulfate and Alha Methyldoa By ALVIN P. SHAPIRO, M.D., AND

More information

Linear Theory, Dimensional Theory, and the Face-Inversion Effect

Linear Theory, Dimensional Theory, and the Face-Inversion Effect Psychological Review Coyright 2004 by the American Psychological Association, Inc. 2004 (in ress) A long list of strange numbers will aear here in the actual article Linear Theory, Dimensional Theory,

More information

Additive Beneficial Effects of Beta-Blockers to Angiotensin-Converting Enzyme Inhibitors in the Survival and Ventricular Enlargement (SAVE) Study

Additive Beneficial Effects of Beta-Blockers to Angiotensin-Converting Enzyme Inhibitors in the Survival and Ventricular Enlargement (SAVE) Study JACC Vol. 29, No. 2 February 1997:229 36 CLINICAL STUDIES 229 MYOCARDIAL INFARCTION Additive Beneficial Effects of Beta-Blockers to Angiotensin-Converting Enzyme Inhibitors in the Survival and Ventricular

More information

ESPEN Congress Prague 2007

ESPEN Congress Prague 2007 ESPEN Congress Prague 2007 Nutrition implication of obesity and Type II Diabetes Nutrition support in obese patient Claude Pichard Nutrition Support in Obese Patients Prague, 2007 C. Pichard, MD, PhD,

More information

TO help 25.8 million Americans [1] with diabetes, a growing

TO help 25.8 million Americans [1] with diabetes, a growing 3108 IEEE TRANSACTIONS ON PARALLEL AND DISTRIBUTED SYSTEMS, VOL. 26, NO. 11, NOVEMBER 2015 Patient Infusion Pattern based Access Control Schemes for Wireless Insulin Pum System Xiali Hei, Member, IEEE,

More information

Haloperidol Use in Acute Traumatic Brain Injury: A Safety Analysis

Haloperidol Use in Acute Traumatic Brain Injury: A Safety Analysis Research Article imedpub Journals htt://www.imedub.com Journal of Intensive and Critical Care ISSN 2471-8505 DOI: 10.21767/2471-8505.100023 Haloeridol Use in Acute Traumatic Brain Injury: A Safety Analysis

More information

Diathermy versus scalpel incisions in elective abdominal surgery: a comparative study

Diathermy versus scalpel incisions in elective abdominal surgery: a comparative study International Surgery Journal Nandurkar VS et al. Int Surg J. 2018 Se;5(9):3124-3128 htt://www.ijsurgery.com ISSN 2349-3305 eissn 2349-2902 Original Research Article DOI: htt://dx.doi.org/10.18203/2349-2902.isj20183734

More information

Elderly patients have an increased risk of neurologic

Elderly patients have an increased risk of neurologic Craniocervical and Aortic Atherosclerosis as Neurologic Risk Factors in Coronary Surgery Tomoko Goto, MD, Tomoko Baba, MD, Atsushi Yoshitake, MD, Yoshihiro Shibata, MD, Masashi Ura, MD, and Ryuzo Sakata,

More information

Although heart valve replacement is a safe and commonly

Although heart valve replacement is a safe and commonly Mitral Valve Relacement: Randomized Trial of St. Jude and Medtronic Hall Prostheses Andrew C. Fiore, MD, Hendrick B. Barner, MD, Marc T. Swartz, BA, Lawrence R. McBride, MD, Arthur J. Labovitz, MD, Kathy

More information

Comparative Study between Different Pulmonary Rehabilitation Programs in Patients Undergoing Coronary Artery Bypass Graft

Comparative Study between Different Pulmonary Rehabilitation Programs in Patients Undergoing Coronary Artery Bypass Graft Med. J. Cairo Univ., Vol. 82, No. 2, June: 183-189, 214 www.medicaljournalofcairouniversity.net Comarative Study between Different Pulmonary Rehabilitation Programs in Patients Undergoing Coronary Artery

More information

Cardiology & Vascular Research

Cardiology & Vascular Research Research Article Cardiology & Vascular Research ISSN 2639-8486 Correlation of Limb Bioimedance to Echocardiograhic Indicators of Congestion in Patients with NYHA Class II/III Heart Failure Accardi AJ *,

More information

Asthma is a chronic illness with several major consequences,

Asthma is a chronic illness with several major consequences, Effect of High-Dose Continuous Albuterol Nebulization on Clinical Variables in Children With Status Asthmaticus* Suwannee Phumeetham, MD 1 ; Thomas J. Bahk, MD 2 ; Shamel Abd-Allah, MD 2 ; Mudit Mathur,

More information