BACKGROUND: Muscle force is important for daily life and sports and can be measured with a handheld dynamometer. Reference values are employed to quantify a subject's muscle force. It is not unambiguous whether reference values can be generalized to other populations. Objectives in this study were; first to confirm the reliability of the utilization of hand-held dynamometers for isometric strength measurement; second to determine reference values for a population of Dutch workers; third to compare these values with those of a USA population.METHODS: 462 Healthy working subjects (259 male, 203 female) were included in this study. Their age ranged from 20 to 60 years with a mean (sd) of 41 (11) years. Muscle force values from elbow flexion and extension, knee flexion and extension, and shoulder abduction were measured with the break method using a MicroFet 2 hand-held dynamometer. Reliability was analyzed by calculating ICC's and limits of agreement. Muscle force expressed in Newton, means, and confidence intervals were determined for males and females in age groups ranging from twenty to sixty years old. Regression equations and explained variances were calculated from weight, height, age, and gender. The mean values and 95% CI were compared to the results from other studies.RESULTS: Reliability was good; the ICC ranged between 0.83 to 0.94. The explained variance ranged from 0.25 to 0.51. Comparison of data for the Dutch population mean muscle force values with those from the USA revealed important differences between muscle force reference values for the American and Dutch populations.CONCLUSIONS: Muscle force measurements demonstrate a sound reliability. Reference values and regressions equations are made available for the Dutch population. Comparison with other studies indicates that reference values differ between countries.
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Introduction: Reference values for cardiopulmonary exercise testing (CPET) parameters provide the comparative basis for answering important questions concerning the normalcy of exercise responses in patients, and significantly impacts the clinical decision-making process. Areas covered: The aim of this study was to provide an updated systematic review of the literature on reference values for CPET parameters in healthy subjects across the life span. A systematic search in MEDLINE, Embase, and PEDro databases were performed for articles describing reference values for CPET published between March 2014 and February 2019. Expert opinion: Compared to the review published in 2014, more data have been published in the last five years compared to the 35 years before. However, there is still a lot of progress to be made. Quality can be further improved by performing a power analysis, a good quality assurance of equipment and methodologies, and by validating the developed reference equation in an independent (sub)sample. Methodological quality of future studies can be further improved by measuring and reporting the level of physical activity, by reporting values for different racial groups within a cohort as well as by the exclusion of smokers in the sample studied. Normal reference ranges should be well defined in consensus statements.
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BACKGROUND: Visceral obesity is associated with the metabolic syndrome. The metabolic risk differs per ethnicity, but reference values for visceral obesity for body composition analyses using Computed Tomography (CT) scans in the Caucasian population are lacking. Therefore, the aim of this study was to define gender specific reference values for visceral obesity in a Caucasian cohort based upon the association between the amount of visceral adipose tissue (VAT) and markers of increased metabolic risk.METHODS: Visceral Adipose Tissue Area Index (VATI cm 2/m 2) at the level of vertebra L3 was analyzed using CT scans of 416 healthy living kidney donor candidates. The use of antihypertensive drugs and/or statins was used as an indicator for increased metabolic risk. Gender specific cut-off values for VATI with a sensitivity ≥80% were calculated using receiver operating characteristic (ROC) curves. RESULTS: In both men and women who used antihypertensive drugs, statins or both, VATI was higher than in those who did not use these drugs (p ≤ 0.013). In males and females respectively, a value of VATI of ≥38.7 cm 2/m 2 and ≥24.9 cm 2/m 2 was associated with increased metabolic risk with a sensitivity of 80%. ROC analysis showed that VATI was a better predictor of increased metabolic risk than BMI (area under ROC curve (AUC) = 0.702 vs AUC = 0.556 in males and AUC = 0.757 vs AUC = 0.630 in females). CONCLUSION: Gender and ethnicity specific cut-off values for visceral obesity are important in body composition research, although further validation is needed. This study also showed that quantification of VATI is a better predictor for metabolic risk than BMI.
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Introduction: The 6-minute walk test is a submaximal exercise test used to quantify the functional exercise capacity in clinical populations. It measures the distance walked within a period of 6-minutes. Obtaining reference values in the pediatric population is especially demanding due to factors as the development stage and age. RV provide a comparative basis for answering questions concerning the normality of health status, exercise responses and functional exercise capacity in patients. Areas covered: The aim of this review is to provide an overview of reference values and reference value prediction equations for the 6-minute walk test in the children and in adolescent pediatric population and of the methodology used to obtain them. A total of 22 studies from MEDLINE, EMBASE and Cinahl were included containing healthy participants aged ≤18 years. Reported reference values ranged from 383 m ± 41 m to 799 m ± 54 m. The prediction equation 6MWD = (4.63*height(cm))–(3.53*weight(kg))+(10.42*age)+56.32 yields the highest R2 value (0.6). Expert commentary: It is impossible to present a single best reference value. A flow-chart is presented to aid the selection of reference values or reference value prediction equations. Consensus regarding testing procedures should lead to an update and stricter application of the current guidelines.
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Learning by creating qualitative representations is a valuable approach to learning. However, modelling is challenging for students, especially in secondary education. Support is needed to make this approach effective. To address this issue, we explore automated support provided to students while they create their qualitative representation. This support is generated form a reference model that functions as a norm. However, the construction of a reference models is still a challenge. In this paper, we present the reference model that we have created to support students in learning about the melatonin regulation in the context of the biological clock.
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Peak oxygen uptake (V'O2peak) is recognised as the best expression of aerobic fitness. Therefore, it is essential that V'O2peak reference values are accurate for interpreting a cardiopulmonary exercise test (CPET). These values are country specific and influenced by underlying biological ageing processes. They are normally stratified per paediatric and adult population, resulting in a discontinuity at the transition point between prediction equations. There are currently no age-related reference values available for the lifespan of individuals in the Dutch population. The aim of this study is to determine the best-fitting regression model for V'O2peak in the healthy Dutch paediatric and adult populations in relation to age. In this retrospective study, CPET cycle ergometry results of 4477 subjects without reported somatic diseases were included (907 females, age 7.9-65.0 years). Generalised additive models were employed to determine the best-fitting regression model. Cross-validation was performed against an independent dataset consisting of 3518 subjects (170 females, age 6.8-59.0 years). An additive model was the best fitting with the largest predictive accuracy in both the primary (adjusted R2=0.57, standard error of the estimate (see)=556.50 mL·min-1) and cross-validation (adjusted R2=0.57, see=473.15 mL·min-1) dataset. This study provides a robust additive regression model for V'O2peak in the Dutch population.
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INTRODUCTION: In the Netherlands, hospitals have difficulty in implementing the formal procedure of comparing radiation dose values to Diagnostic Reference Levels (DRLs).METHODS: To support the hospitals, train radiography students, and carry out a nationwide dose survey, diagnostic radiography students performed 125 DRL comparisons for nine different procedures in 29 radiology departments. Students were instructed at three Dutch Universities of Applied Sciences with a radiography programme and supervised by medical physicists from the participating hospitals.RESULTS: After a pilot study in the western part of the country in eight hospitals, this study was enlarged to involve 21 hospitals from all over the Netherlands. The 86 obtained dose comparisons fall below the DRLs in 97% of all cases. This very high compliance may have been enhanced by the voluntary participation of hospitals that are confident about their performance.CONCLUSION: The results indicate that the current DRLs that were not based on a national survey, may need to be updated, sometimes to half their current value. For chest and pelvis examinations the DRLs could be lowered from 12 and 300 μGy·m 2 to the 75-percentile values found in this study of 5,9 and 188 μGy·m 2, respectively.
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The growing prevalence of AI systems in society, has also prompted a growth of AI systems in the public sector. There are however ethical concerns over the impact of AI on society and how this technology can impact public values. Previous works do not connect public values and the development of AI. To address this, a method is required to ensure that developers and public servants can signal possible ethical implications of an AI system and are assisted in creating systems that adhere to public values. Using the Research pathway model and Value Sensitive Design, we will develop a toolbox to assist in these challenges and gain insight into how public values can be embedded throughout the development of AI systems.
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This research investigates the integration of stakeholders' values into the digital frameworks of Collective Management Organizations (CMOs) within the Dutch music copyright system. Utilizing Q methodology, the study captures diverse perspectives from composers, lyricists, publishers, and CMO representatives on values, value tensions, norms, and system requirements. A pilot study with four experts tested data collection methods and refined the study design for a larger, follow-up study involving 30 participants. Preliminary findings, based on factor analysis of participant rankings of 30 statements, reveal two distinct perspectives: one focused on "Fairness and Accountability," emphasizing trust-building and equitable treatment, and the other on "Technological Efficiency and Transparency," prioritizing clear information, verification mechanisms, and advanced IT systems. Qualitative insights from participant interviews provide nuanced understanding, highlighting the importance of transparency in royalty processes, balanced application of technology, and equitable royalty distribution in the digital age. This research contributes to the modernization of copyright management systems offering a conceptual model adaptable to other creative (Intellectual Property) industries
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Introduction In the Netherlands, hospitals have difficulty in implementing the formal procedure of comparing radiation dose values to Diagnostic Reference Levels (DRLs).
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