A new statistical procedure for testing equivalence in two-group comparative bioavailability trials

Apple Watch 6 vs. Galaxy Watch 4: A Validity Study of Step-Count Estimation in Daily Activities

The purpose of this study was to examine the validity of two wearable smartwatches (the Apple Watch 6 (AW) and the Galaxy Watch 4 (GW)) and smartphone applications (Apple Health for iPhone mobiles and Samsung Health for Android mobiles) for estimating step counts in daily life. A total of 104 healthy adults (36 AW, 25 GW, and 43 smartphone application users) were engaged in daily activities for 24 h while wearing an ActivPAL accelerometer on the thigh and a smartwatch on the wrist. The validities of the smartwatch and smartphone estimates of step counts were evaluated relative to criterion values obtained from an ActivPAL accelerometer. The strongest relationship between the ActivPAL accelerometer and the devices was found for the AW (r = 0.99, p < 0.001), followed by the GW (r = 0.82, p < 0.001), and the smartphone applications (r = 0.93, p < 0.001). For overall group comparisons, the MAPE (Mean Absolute Percentage Error) values (computed as the average absolute value of the group-level errors) were 6.4%, 10.5%, and 29.6% for the AW, GW, and smartphone applications, respectively. The results of the present study indicate that the AW and GW showed strong validity in measuring steps, while the smartphone applications did not provide reliable step counts in free-living conditions.

Bland and Altman agreement method: to plot differences against means or differences against standard? An endless tale?

OBJECTIVES

In the Bland and Altman analysis of agreement studies, there is some controversy whether "to plot the differences between the Standard/actual measurement method and the test/new measurement method against their mean" or "to plot the differences against the standard method". Of course, this is not just a "graphic dispute" as a regression model is inherent in the graphical choice to test the proportional and systematic biases.

METHODS

We revised two relevant papers claiming to plot the differences against the standard and outlined their pitfalls taking into account the underlying statistical methodology. Furthermore, we have considered the conditions (correlation between the two measurement methods and ratio of their variances) leading correlation coefficient and regression slope between differences and means or differences and standard different from zero.

RESULTS

We have shown the situations in which the regression slope and the correlation coefficient calculated from the differences and means according to Bland and Altman approach or calculated from the differences and standard are closer to zero giving the minimum possible value of spurious proportional error between the two methods.

CONCLUSIONS

We highlighted how the calculation of the expected values of the correlation coefficients and, above all, of the regression slope can be very useful for choosing the statistical model in the context of an agreement study between two measurement methods. Finally, we outlined some recommendations for understanding the real possibility of carrying out agreement or calibration studies.

Verification of a digital approach for three-dimensional evaluation of marginal and internal fit

STATEMENT OF PROBLEM

Internal fit is an important aspect of indirect restorations, but methods for the 3-dimensional (3D) measurement of absolute marginal and intaglio fit are sparse.

PURPOSE

The purpose of this in vitro study was to evaluate an innovative 3D measurement method (AIXFit) based on intraoral scanning data for analyzing the fit of dental restorations.

MATERIAL AND METHODS

For the evaluation of AIXFit, 12 monolithic zirconia crowns were fabricated on typodont preparations. The fit was measured digitally with the AIXFit system and compared with the results obtained from an established 2-dimensional (2D) sectional procedure. To compare the values of both methods at identical locations, a common reference system was developed, with each die fixed in a gypsum stand with reference points. Using an intraoral scanner (True Definition), each die with its reference points and the intaglio surface of the finished crown were digitalized as standard tessellation language files. The AIXFit software program, with a specially developed best-fit algorithm, was used to match the intaglio surface of the crown with the surface of the preparation. The virtual cement gap was calculated over the entire surface and returned values for x≥0 µm. A 2D comparison method involved adhesively fixing the crown to the die and sectioning it into 4 parts with a diamond band saw. The thickness of the cement gap was determined under a light microscope at ×100 magnification at 5 defined measuring points per quarter, so that a total of 240 measurements were available for comparison. A software program (Blender Foundation) was used to superimpose the data from the AIXFit system with the data from the 2D method and to compare the cement gaps at the same locations. The agreement between these methods was verified using paired t tests and determine correlation coefficients (α=.05).

RESULTS

The mean ±standard deviation difference between the AIXFit and 2D methods was 6.7 ±29 µm). Two 1-sided tests showed statistical equivalence between the methods of measurement when considering an interval between -20 and +20 µm. The correlation coefficients showed a positive association for both methods (r=.931).

CONCLUSIONS

The AIXFit software program appeared to be accurate for the digital measurement of internal fit when using the True Definition scanner. It enabled a cast-free workflow and allowed the analysis of the entire intaglio surface.

A Case Study for Critical Reagent Qualification for Ligand Binding Assays Using Equivalence Test Methodology

Qualifying critical reagents in ligand binding assays by parallel testing of current and candidate reagent lots is recommended by regulatory agencies and industry groups, but specific guidance on the format of reagent qualification experiments is limited. Equivalence testing is a statistically sound approach that is consistent with the objective of critical reagent qualification. We present power analysis for equivalence regions ranging from 1.25- to 1.5-fold multiples of the GM ratio (centered on 1) of current and candidate lots, over a range of assay variability from 5 to 30% coefficient of variation (CV). A 1.25-fold equivalence region can be tested using 6 to 12 plates per lot for assays with up to 15% CV but is not practical for more variable assays. For these assays, wider equivalence regions are justified so long as care is taken to avoid assay drift and the assay remains suitable for the intended use. The equivalence test method is illustrated using historical data from passing and failing reagent qualification experiments. Simulation analysis was performed to support the design of qualification experiments using 6, 12, or 18 plates per lot over a broad range of assay variability. A challenge in implementing the equivalence test approach is selecting an appropriate equivalence region. Equivalence regions providing 90% power using 12 plates/lot were consistent with 1.5σ bounds, which are recommended for equivalence testing of critical quality attributes of biosimilars.

Sodium Chloride versus Lactose as a Carrier for House Dust Mite Allergen in Allergen Chamber Studies: A Clinical Study to Assess Noninferiority

INTRODUCTION

In the Fraunhofer allergen challenge chamber (ACC), a standardized, universal, good manufacturing practice-conforming technology using a spray dried solution of lactose (L) and allergen extract has been established. In this study, we investigated the noninferiority of hypertonic sodium chloride (S) versus L as a carrier for house dust mite (HDM) allergen to simplify manufacturing, reduce costs, and allow for wider use.

METHODS

Using a participant-blinded, sham exposure-controlled, single-arm, sequential intervention study, we challenged adults with HDM allergic rhinitis five times in the ACC. Participants were first exposed to S, L, and clean air (block 1), followed by S + HDM and L + HDM (block 2). Primary endpoints were mean total nasal symptom score (TNSS) and mean nasal secretion weight.

RESULTS

19 participants were enrolled in the study (10 females; mean age 32 years [22-49], 4 with mild allergic asthma). The safety profile of S + HDM and L + HDM was similar; eight participants experienced mild procedure-related adverse events including tiredness, cough, and dyspnea. Due to dropouts, 13 participants completed the study and were evaluated. Mean TNSS and nasal secretion were as follows: S 0.98, 0.28 g; L 1.1, 0.20 g; clean air 1.1, 0.23 g; S + HDM 5.7, 4.8 g; L + HDM 5.1, 5.1 g. Separate block 1/block 2 MANOVAs with TNSS and nasal secretion as dependent variables revealed no significant differences between the carriers, neither alone and compared with clean air (p = 0.2059, Wilk's λ = 0.78) nor combined with HDM (p = 0.3474, Wilk's λ = 0.89). Noninferiority of S was established using a meta-analysis-based minimal clinical important difference of -0.55: mean TNSS difference between S + HDM and L + HDM was 0.62 (90% CI: -0.51 to 1.74).

CONCLUSION

S as an HDM carrier was safe and well tolerated. It was noninferior to L which makes it an adequate and easy-to-use carrier substitute.

Equivalence tests before end of follow-up under the class of log transformation model

One important topic in clinical trials is to show that the effects of new and standard treatments are equivalent in terms of clinical relevance. In literature, many equivalence tests based on the maximal difference between two survival functions for the two treatments over the whole time axis have been proposed. However, since survival times can only be observed until the end of follow-up, an equivalence test should be based on a comparison only in the observed time-window dictated by the end of follow-up. In this article, under the class of log transformation model, we propose an asymptotical α-level equivalence test for the difference between two survival functions that only addresses equivalence until the end of follow-up. We demonstrate that the hypothesis of equivalence of two survival functions before the end of follow-up can be formulated as interval-based hypothesis testing which involves the treatment effect parameter. Simulation results indicate that when sample size is sufficiently large the proposed test controls the type I error effectively and performs well at detecting the equivalence. The proposed test is applied to a dataset from veteran's administration lung cancer trial.

Towards fully automated segmentation of rat cardiac MRI by leveraging deep learning frameworks

Automated segmentation of human cardiac magnetic resonance datasets has been steadily improving during recent years. Similar applications would be highly useful to improve and speed up the studies of cardiac function in rodents in the preclinical context. However, the transfer of such segmentation methods to the preclinical research is compounded by the limited number of datasets and lower image resolution. In this paper we present a successful application of deep architectures 3D cardiac segmentation for rats in preclinical contexts which to our knowledge has not yet been reported. We developed segmentation models that expand on the standard U-Net architecture and evaluated models separately trained for systole and diastole phases (2MSA) and a single model trained for all phases (1MSA). Furthermore, we calibrated model outputs using a Gaussian process (GP)-based prior to improve phase selection. The resulting models approach human performance in terms of left ventricular segmentation quality and ejection fraction (EF) estimation in both 1MSA and 2MSA settings (Sørensen-Dice score 0.91 ± 0.072 and 0.93 ± 0.032, respectively). 2MSA achieved a mean absolute difference between estimated and reference EF of 3.5 ± 2.5%, while 1MSA resulted in 4.1 ± 3.0%. Applying GPs to 1MSA enabled automating systole and diastole phase selection. Both segmentation approaches (1MSA and 2MSA) were statistically equivalent. Combined with a proposed cardiac phase selection strategy, our work presents an important first step towards a fully automated segmentation pipeline in the context of rat cardiac analysis.

B-value and empirical equivalence bound: A new procedure of hypothesis testing

In this study, we propose a two-stage procedure for hypothesis testing, where the first stage is conventional hypothesis testing and the second is an equivalence testing procedure using an introduced empirical equivalence bound (EEB). In 2016, the American Statistical Association released a policy statement on P-values to clarify the proper use and interpretation in response to the criticism of reproducibility and replicability in scientific findings. A recent solution to improve reproducibility and transparency in statistical hypothesis testing is to integrate P-values (or confidence intervals) with practical or scientific significance. Similar ideas have been proposed via the equivalence test, where the goal is to infer equality under a presumption (null) of inequality of parameters. However, the definition of scientific significance/equivalence can sometimes be ill-justified and subjective. To circumvent this drawback, we introduce the B-value and the EEB, which are both estimated from the data. Performing a second-stage equivalence test, our procedure offers an opportunity to improve the reproducibility of findings across studies.

Is 'Not Different' Enough to Conclude Similar Cardiovascular Responses Across Sexes?

The number of research studies investigating whether similar or different cardiovascular responses or adaptations exist between males and females are increasing. Traditionally, difference-based statistical methods (e.g., t-test, ANOVA, etc.) have been implemented to compare cardiovascular function between males and females, with a P-value >0.05 used to denote similarity between sexes. However, an absence of evidence (i.e., large P-value) is not evidence of absence (i.e., no sex differences). Equivalence testing determines whether two measures or groups provide statistically equivalent outcomes, in that they differ by less than an 'ideally prespecified' smallest effect size of interest. Our perspective discusses the applicability and utility of integrating equivalence testing when conducting sex comparisons in cardiovascular research. An emphasis is placed on how cardiovascular researchers may conduct equivalence testing across multiple study designs (e.g., cross-sectional comparisons, repeated measures intervention, etc.). The strengths and weaknesses of this statistical tool are discussed. Equivalence analyses are relatively simple to conduct, may be used in conjunction with traditional hypothesis testing to interpret findings, and permits the determination of statistically equivalent responses between sexes. We recommend that cardiovascular researchers consider implementing equivalence testing to better our understanding of similar and different cardiovascular processes between sexes.

Comparison of Cgmanalysis, a Free Open-Source Continuous Glucose Monitoring Data Management and Analysis Software, with Commercially Available CGM Platforms: Data Standardization for Diabetes Technology Research

Background: Cgmanalysis is an open-source software based on the R programming language for data management and descriptive analysis of data from continuous glucose monitoring (CGM). We sought to validate the summary measures calculated by cgmanalysis against the results from proprietary software associated with four CGM commercially available models. Methods: Two weeks of data from 188 patients with type 1 diabetes using commercially available CGMs. Freestyle Libre Gen 1 (n = 53), Medtronic Guardian 3 (n = 52), Dexcom G6 reported by Dexcom Clarity (n = 48), and Dexcom G6 reported by Tandem (n = 35) were analyzed using proprietary software and cgmanalysis. Agreement was assessed using scatterplots, Bland-Altman plots, and equivalence tests. Results: Good agreement was obtained for all glycemic summary measures for all CGMs assessed. None of the differences between the cgmanalysis package and the manufacturers' software were outside the prespecified bounds of equivalence. Conclusions: Cgmanalysis is a validated open-source software to analyze commercially available CGM data and can be used to standardize diabetes technology research.

Bayesian Hodges-Lehmann tests for statistical equivalence in the two-sample setting: Power analysis, type I error rates and equivalence boundary selection in biomedical research

BACKGROUND

Null hypothesis significance testing (NHST) is among the most frequently employed methods in the biomedical sciences. However, the problems of NHST and p-values have been discussed widely and various Bayesian alternatives have been proposed. Some proposals focus on equivalence testing, which aims at testing an interval hypothesis instead of a precise hypothesis. An interval hypothesis includes a small range of parameter values instead of a single null value and the idea goes back to Hodges and Lehmann. As researchers can always expect to observe some (although often negligibly small) effect size, interval hypotheses are more realistic for biomedical research. However, the selection of an equivalence region (the interval boundaries) often seems arbitrary and several Bayesian approaches to equivalence testing coexist.

METHODS

A new proposal is made how to determine the equivalence region for Bayesian equivalence tests based on objective criteria like type I error rate and power. Existing approaches to Bayesian equivalence testing in the two-sample setting are discussed with a focus on the Bayes factor and the region of practical equivalence (ROPE). A simulation study derives the necessary results to make use of the new method in the two-sample setting, which is among the most frequently carried out procedures in biomedical research.

RESULTS

Bayesian Hodges-Lehmann tests for statistical equivalence differ in their sensitivity to the prior modeling, power, and the associated type I error rates. The relationship between type I error rates, power and sample sizes for existing Bayesian equivalence tests is identified in the two-sample setting. Results allow to determine the equivalence region based on the new method by incorporating such objective criteria. Importantly, results show that not only can prior selection influence the type I error rate and power, but the relationship is even reverse for the Bayes factor and ROPE based equivalence tests.

CONCLUSION

Based on the results, researchers can select between the existing Bayesian Hodges-Lehmann tests for statistical equivalence and determine the equivalence region based on objective criteria, thus improving the reproducibility of biomedical research.

Using historical control data in bioassays for regulatory toxicology

Historical control data (HCD) consist of pooled control group responses from bioassays. These data must be collected and are often used or reported in regulatory toxicology studies for multiple purposes: as quality assurance for the test system, to help identify toxicological effects and their effect-size relevance and to address the statistical multiple comparison problem. The current manuscript reviews the various classical and potential new approaches for using HCD. Issues in current practice are identified and recommendations for improved use and discussion are provided. Furthermore, stakeholders are invited to discuss whether it is necessary to consider uncertainty when using HCD formally and statistically in toxicological discussions and whether binary inclusion/exclusion criteria for HCD should be revised to a tiered information contribution to assessments. Overall, the critical value of HCD in toxicological bioassays is highlighted when used in a weight-of-evidence assessment.

Comprehensive Profiling of Hypoxia-Related miRNAs Identifies miR-23a-3p Overexpression as a Marker of Platinum Resistance and Poor Prognosis in High-Grade Serous Ovarian Cancer

Simple Summary

In the present paper, we identified miR-23a-3p, a hypoxia regulated-microRNA (miRNA), as a potential biomarker of chemoresistance and poor outcome in two independent cohorts of high-grade serous ovarian carcinoma (HGSOC) patients. Then, we predicted the involvement of miR-23a-3p in the platinum resistance pathway, together with its target APAF-1 gene, and validated their anticorrelation and association with platinum response in HGSOC patients and cell lines. We propose that the evaluation of miR-23a-3p expression may provide important clinical indications on patients not responding to platinum treatment and that the miR23a-3p/APAF1 axis could be considered a possible target for personalized medicine in HGSOC patients.

Abstract

The onset of chemo-resistant recurrence represents the principal cause of high-grade serous ovarian carcinoma (HGSOC) death. HGSOC masses are characterized by a hypoxic microenvironment, which contributes to the development of this chemo-resistant phenotype. Hypoxia regulated-miRNAs (HRMs) represent a molecular response of cancer cells to hypoxia and are involved in tumor progression. We investigated the expression of HRMs using miRNA expression data from a total of 273 advanced-stage HGSOC samples. The miRNAs associated with chemoresistance and survival were validated by RT-qPCR and target prediction, and comparative pathway analysis was conducted for target gene identification. Analysis of miRNA expression profiles indicated miR-23a-3p and miR-181c-5p over-expression as associated with chemoresistance and poor PFS. RT-qPCR data confirmed upregulation of miR-23a-3p in tumors from chemoresistant HGSOC patients and its significant association with shorter PFS. In silico miR-23a-3p target prediction and comparative pathway analysis identified platinum drug resistance as the pathway with the highest number of miR-23a-3p target genes. Among them, APAF-1 emerged as the most promising, being downregulated in platinum-resistant patients and in HGSOC chemo-resistant cells. These results highlight miR-23a-3p as a potential biomarker for HGSOC platinum response and prognosis and the miR23a-3p/APAF1 axis as a possible target to overcome platinum-resistance.

Generation of High-Quality Pharmacokinetic Data From Parallel Tail Vein Dosing And Bleeding in Non-cannulated Rats

It is common practice to use cannulated rats for pharmacokinetic (PK) in-life studies as it yields high quality PK parameter estimation. While offering many benefits, cannulation requires surgery, post-surgical care, and cannula maintenance. As an alternative approach, the strategy of dosing and bleeding rats via the tail vein in a single experiment is technically feasible and theoretically offers many benefits. Unfortunately, however, as reported by F Tse et al. in 1984 (J Pharm Sci 73: https://doi.org/10.1002/jps.2600731128), parallel tail dosing and bleeding is scientifically flawed and yields inaccurate estimation of PK parameters following intravenous administration. The underlying causality of poor data quality has not been addressed in over 35 years. To overcome the technical flaws associated with parallel tail dosing and bleeding, we have developed a Tail-Dose-Bleed (TDB) method as a substitute for use of cannulated rats. Specifically, the method introduces a flush procedure after dosing, uses separate tail veins for dosing and bleeding, and adjusts dosing and sampling to the proximal and distal portions of the tail, respectively. To demonstrate the proof of principle for this TDB technique, several cassette dosing studies were conducted. The performance of the TDB technique is compared in both stand alone and animal crossover studies employing conventional jugular/femoral bleeding and dosing. The poor data via tail dosing and bleeding previously described by Tse et al. are also recapitulated using their described approach. To ensure broad applicability of the TDB technique, data were generated utilizing compounds of diverse physical chemical properties manifesting a range of clearance and/or volume of distribution characteristics. These data demonstrate that the TDB approach yields comparable PK profiles and parameters as compared to conventional femoral dosing / jugular bleeding. Using this newly described TDB procedure, we demonstrate the ability to overcome documented data quality issues when dosing and bleeding via the tail. The TDB technique has numerous operational advantages of reduced study turnaround time and improved cost effectiveness, but most importantly, addresses key animal welfare concerns relevant to institutional animal care and use committees (IACUC). The notable advantage here is reduced animal stress and discomfort by eliminating the need for surgery and recovery. And by consequence, allows for animals to be group housed and re-used without concern for loss of cannula patency. The tail dose and bleed method is simple and appears readily transferable to other laboratories.

Comparison of two human infant urine collection methods for measuring estrone-3-glucuronide

OBJECTIVES

Current human infant urine collection methods for the field are problematic for the researcher and potentially uncomfortable for the infant. In this study, we compared two minimally invasive methods for collecting infant urine: organic cotton balls and filter paper.

MATERIALS AND METHODS

We first collected urine from infants using the clean catch method. We then used those samples to compare the performance of filter paper and cotton ball collection protocols. We analyzed the clean catch and cotton samples using commercial estrone-3-glucuronide (E1G) kits and tried two different extraction methods for the filter paper. Using a paired t-test (n = 10), we compared clean catch and cotton samples. We also compared effect sizes within and between methods.

RESULTS

We were unable to extract enough urine from the filter paper to successfully assay the samples for E1G. The paired t-test revealed a statistically significant difference between the clean catch and cotton methods (t = 2.63, p-value = 0.03). However, the effect size was small (5.91 μg/ml, n = 10, 95% CI = 3.80, 8.02) and similar to or larger than the difference seen between duplicate wells for clean catch and cotton values.

DISCUSSION

While this study is limited by sample size, our results indicate that filter paper is not a field-friendly method for collecting infant urine. However, we found that organic cotton balls showed similar values to the clean catch method, and we propose this method as an alternative, minimally invasive method for study of E1G in human infant urine.

Multimodal Neuroimaging of Suicidal Thoughts and Behaviors in a U.S. Population-Based Sample of School-Age Children

OBJECTIVE

Suicide deaths and suicidal thoughts and behaviors are considered a public health emergency, yet their underpinnings in the brain remain elusive. The authors examined the classification accuracy of individual, environmental, and clinical characteristics, as well as multimodal brain imaging correlates, of suicidal thoughts and behaviors in a U.S. population-based sample of school-age children.

METHODS

Children ages 9-10 years (N=7,994) from a population-based sample from the Adolescent Brain Cognitive Development study were assessed for lifetime suicidal thoughts and behaviors. After quality control procedures, structural MRI (N=6,238), resting-state functional MRI (N=4,134), and task-based functional MRI (range, N=4,075-4,608) were examined. Differences with Welch's t test and equivalence tests, with observed effect sizes (Cohen's d) and their 90% confidence intervals <|0.15|, were examined. Classification accuracy was examined with area under precision-recall curves (AUPRCs).

RESULTS

Among the 7,994 unrelated children (females, N=3,757, 47.0%), those with lifetime suicidal thoughts and behaviors based on child (N=684, 8.6%), caregiver (N=654, 8.2%), and concordant (N=198, 2.5%) reports had higher levels of social adversity and psychopathology, among themselves and their caregivers, compared with never-suicidal children (N=6,854, 85.7%). Only one imaging test survived statistical correction: caregiver-reported suicidal thoughts and behaviors were associated with a thinner left bank of the superior temporal sulcus. On the basis of the prespecified bounds of |0.15|, approximately 48% of the group mean differences for child-reported suicidal thoughts and behaviors comparisons and approximately 22% for caregiver-reported suicidal thoughts and behaviors comparisons were considered equivalent. All observed effect sizes were relatively small (d≤|0.30|), and both non-imaging and imaging correlates had low classification accuracy (AUPRC ≤0.10).

CONCLUSIONS

Commonly applied neuroimaging measures did not reveal a discrete brain signature related to suicidal thoughts and behaviors in youths. Improved approaches to the neurobiology of suicide are critically needed.

Transformational Leadership across Cultures: Follower Perception and Satisfaction

Leading people from diverse cultures is centrally important in organizations. This study investigates the extent to which transformational leadership behaviors are universal: by examining if leaders and followers perceive transformational leadership behaviors the same way across cultures; and by determining if the magnitude of satisfaction that followers derive from transformational leadership behavior is the same across cultures. Survey data from 71,537 leaders and their direct reports (n = 203,027) from 77 countries were analyzed. Respondents represented hundreds of different organizations, 12 functional areas, 26 industries, and all management levels. Cultural universality was examined by comparing internal reliability scores and using multilevel mixed coefficient models to assess the similarity of effect sizes in across cultures. Regardless of culture, when interacting with leaders from their own culture, followers were universally alike in their perceptions of transformational leadership behavior and in their satisfaction with such behavior.

T-MoCA: A valid phone screen for cognitive impairment in diverse community samples

INTRODUCTION

There is an urgent need to validate telephone versions of widely used general cognitive measures, such as the Montreal Cognitive Assessment (T-MoCA), for remote assessments.

METHODS

In the Einstein Aging Study, a diverse community cohort (n = 428; mean age = 78.1; 66% female; 54% non-White), equivalence testing was used to examine concordance between the T-MoCA and the corresponding in-person MoCA assessment. Receiver operating characteristic analyses examined the diagnostic ability to discriminate between mild cognitive impairment and normal cognition. Conversion methods from T-MoCA to the MoCA are presented.

RESULTS

Education, race/ethnicity, gender, age, self-reported cognitive concerns, and telephone administration difficulties were associated with both modes of administration; however, when examining the difference between modalities, these factors were not significant. Sensitivity and specificity for the T-MoCA (using Youden's index optimal cut) were 72% and 59%, respectively.

DISCUSSION

The T-MoCA demonstrated sufficient psychometric properties to be useful for screening of MCI, especially when clinic visits are not feasible.

Assessing the efficacy of tablet-based simulations for learning pseudo-surgical instrumentation

Nurses and surgeons must identify and handle specialized instruments with high temporal and spatial precision. It is crucial that they are trained effectively. Traditional training methods include supervised practices and text-based study, which may expose patients to undue risk during practice procedures and lack motor/haptic training respectively. Tablet-based simulations have been proposed to mediate some of these limitations. We implemented a learning task that simulates surgical instrumentation nomenclature encountered by novice perioperative nurses. Learning was assessed following training in three distinct conditions: tablet-based simulations, text-based study, and real-world practice. Immediately following a 30-minute training period, instrument identification was performed with comparable accuracy and response times following tablet-based versus text-based training, with both being inferior to real-world practice. Following a week without practice, response times were equivalent between real-world and tablet-based practice. While tablet-based training does not achieve equivalent results in instrument identification accuracy as real-world practice, more practice repetitions in simulated environments may help reduce performance decline. This project has established a technological framework to assess how we can implement simulated educational environments in a maximally beneficial manner.

Bioequivalence and switchability of generic antiseizure medications (ASMs): A re-appraisal based on analysis of generic ASM products approved in Europe

The safety of switching between generic products of antiseizure medications (ASMs) continues to be a hot topic in epilepsy management. The main reason for concern relates to the uncertainty on whether, and when, two generics found to be bioequivalent to the same brand (reference) product are bioequivalent to each other, and the risk of a switch between generics resulting in clinically significant changes in plasma ASM concentrations. This article addresses these concerns by discussing the distinction between bioequivalence and statistical testing for significant difference, the importance of intra-subject variability in interpreting bioequivalence studies, the stricter regulatory bioequivalence requirements applicable to narrow-therapeutic-index (NTI) drugs, and the extent by which currently available generic products of ASMs comply with such criteria. Data for 117 oral generic products of second-generation ASMs approved in Europe by the centralized, mutual recognition or decentralized procedure were analyzed based on a review of publicly accessible regulatory assessment reports. The analysis showed that for 99% of generic products assessed (after exclusion of gabapentin products), the 90% confidence intervals (90% CIs) of geometric mean ratios (test/reference) for AUC (area under the drug concentration vs time curve) were narrow and wholly contained within the acceptance interval (90%-111%) applied to NTI drugs. Intra-subject variability for AUC was <10% for 53 (88%) of the 60 products for which this measure was reported. Many gabapentin generics showed broader, 90% CIs for bioequivalence estimates, and greater intra-subject variability, compared with generics of other ASMs. When interpreted within the context of other available data, these results suggest that any risk of non-bioequivalence between these individual generic products is small, and that switches across these products are not likely to result in clinically relevant changes in plasma drug exposure. The potential for variability in exposure when switching across generics is likely to be greatest for gabapentin.

Asymptotic properties of the two one-sided t-tests – new insights and the Schuirmann-constant

The two one-sided t-tests (TOST) method is the most popular statistical equivalence test with many areas of application, i.e., in the pharmaceutical industry. Proper sample size calculation is needed in order to show equivalence with a certain power. Here, the crucial problem of choosing a suitable mean-difference in TOST sample size calculations is addressed. As an alternative concept, it is assumed that the mean-difference follows an a-priori distribution. Special interest is given to the uniform and some centered triangle a-priori distributions. Using a newly developed asymptotical theory a helpful analogy principle is found: every a-priori distribution corresponds to a point mean-difference, which we call its Schuirmann-constant. This constant does not depend on the standard deviation and aims to support the investigator in finding a well-considered mean-difference for proper sample size calculations in complex data situations. In addition to the proposed concept, we demonstrate that well-known sample size approximation formulas in the literature are in fact biased and state their unbiased corrections as well. Moreover, an R package is provided for a right away application of our newly developed concepts.

Validity of Tools to Measure Physical Activity in Older Adults Following Total Knee Arthroplasty

Few validated tools exist for measuring physical activity following total knee arthroplasty (TKA) despite the importance of returning to sufficient levels of physical activity post-TKA to achieve health benefits. This study examined the validity of two clinical measures-the Fitbit, a commercially available personal activity monitor, and the Community Healthy Activities Model Program for Seniors (CHAMPS), a self-report questionnaire-compared with a reference standard accelerometer, the SenseWearTM Armband (SWA). At 6-month post-TKA, 47 participants wore the Fitbit and SWA for 4 days and then completed the CHAMPS. Moderate-to-good correlation was observed between the Fitbit and SWA for steps (intraclass correlation coefficient [ICC] = .79), energy expenditure (ICC = .78), and energy expenditure <3 METS (ICC = .79). Poor-to-moderate correlation was observed between the CHAMPS and SWA (ICC = .43) with the questionnaire reporting lower daily energy expenditures than the SWA. Results showed that Fitbit may be a reasonable measurement tool to measure steps and energy expenditures in older adults following TKA.

Improving the precision of intranasal oxytocin research

The neuropeptide oxytocin has been popularized for its role in social behaviour and nominated as a candidate treatment for several psychiatric illnesses due to promising preclinical results. However, these results so far have failed to reliably translate from animal models to human research. In response, there have been justified calls to improve intranasal oxytocin delivery methodology in terms of verifying that intranasal administration increases central levels of oxytocin. Nonetheless, improved methodology needs to be coupled with a robust theory of the role of oxytocin in behaviour and physiology to ask meaningful research questions. Moreover, stringent methodology based on robust theory may yield interesting results, but such findings will have limited utility if they are not reproducible. We outline how the precision of intranasal oxytocin research can be improved by the complementary consideration of methodology, theory and reproducibility.

Acute cognitive deficits after traumatic brain injury predict Alzheimer's disease-like degradation of the human default mode network

Traumatic brain injury (TBI) and Alzheimer's disease (AD) are prominent neurological conditions whose neural and cognitive commonalities are poorly understood. The extent of TBI-related neurophysiological abnormalities has been hypothesized to reflect AD-like neurodegeneration because TBI can increase vulnerability to AD. However, it remains challenging to prognosticate AD risk partly because the functional relationship between acute posttraumatic sequelae and chronic AD-like degradation remains elusive. Here, functional magnetic resonance imaging (fMRI), network theory, and machine learning (ML) are leveraged to study the extent to which geriatric mild TBI (mTBI) can lead to AD-like alteration of resting-state activity in the default mode network (DMN). This network is found to contain modules whose extent of AD-like, posttraumatic degradation can be accurately prognosticated based on the acute cognitive deficits of geriatric mTBI patients with cerebral microbleeds. Aside from establishing a predictive physiological association between geriatric mTBI, cognitive impairment, and AD-like functional degradation, these findings advance the goal of acutely forecasting mTBI patients' chronic deviations from normality along AD-like functional trajectories. The association of geriatric mTBI with AD-like changes in functional brain connectivity as early as ~6 months post-injury carries substantial implications for public health because TBI has relatively high prevalence in the elderly.

A time-scale modification dataset with subjective quality labels

Time Scale Modification (TSM) is a well-researched field; however, no effective objective measure of quality exists. This paper details the creation, subjective evaluation, and analysis of a dataset for use in the development of an objective measure of quality for TSM. Comprised of two parts, the training component contains 88 source files processed using six TSM methods at 10 time scales, while the testing component contains 20 source files processed using three additional methods at four time scales. The source material contains speech, solo harmonic and percussive instruments, sound effects, and a range of music genres. Ratings (42 529) were collected from 633 sessions using laboratory and remote collection methods. Analysis of results shows no correlation between age and quality of rating; expert and non-expert listeners to be equivalent; minor differences between participants with and without hearing issues; and minimal differences between testing modalities. A comparison of published objective measures and subjective scores shows the objective measures to be poor indicators of subjective quality. Initial results for a retrained objective measure of quality are presented with results approaching average root mean squared error loss and Pearson correlation values of subjective sessions. The labeled dataset is available at http://ieee-dataport.org/1987.

The Risk of Going Small: Lowering GRWR and Overcoming Small-For-Size Syndrome in Adult Living Donor Liver Transplantation

OBJECTIVE

The aim of this study was to determine the outcomes of living donor liver transplantation (LDLT) according to various graft-to-recipient weight ratio (GRWR).

BACKGROUND

The standard GRWR in LDLT is >0.8%. Our center accepted predicted GRWR ≥0.6% in selected patients.

METHODS

Data from patients who underwent LDLT from 2001 to 2017 were included. Patients were stratified according to actual GRWR (Group 1:GRWR ≤0.6%; Group 2: 0.6%<GRWR≤ 0.8%; Group 3:GRWR >0.8%).

RESULTS

There were 545 LDLT (group 1 = 39; group 2 = 159; group 3 = 347) performed. Pretransplant predicted GRWR showed good correlation to actual GRWR (R = 0.834) and these figures differed within a ± 10%margin (P = 0.034) using an equivalence test. There were more left lobe grafts in group 1 (33.3%) than group 2 (10.7%) and 3 (2.9%). Median donor age was <35 years and steatosis >10% was rare.There was no difference in postoperative complication, vascular and biliary complication rate between groups. Over one-fifth (20.5%) of group 1 patients required portal flow modulation (PFM) and was higher than group 2 (3.1%) and group 3 (4%) (P = 0.001). Twenty-six patients developed small-for-size syndrome (SFSS): 5 of 39 (12.8%) in group 1 and 21 of 159 (13.2%) in group 2 and none in group 3 (P < 0.001). There were 2 hospital mortalities; otherwise, the remaining patients [24/26 (92.3%)] survive with a functional liver graft. The 5-year graft survival rates were 85.4% versus 87.8% versus 84.7% for group 1, 2, and 3, respectively (P = 0.718). GRWR did not predict worse survivals in multivariable analysis.

CONCLUSIONS

Graft size in LDLT can be lowered to 0.6% after careful recipient selection, with low incidence of SFSS and excellent outcomes. Accurate graft weight prediction, donor-recipient matching, meticulous surgical techniques, appropriate use of PFM, and vigilant perioperative care is important to the success of such approach.

Leavers and Remainers after the Brexit referendum: More united than divided after all?

Since the British 'Brexit referendum' in 2016, tensions between 'leave' and 'remain' voters have been growing. Using a novel analytical approach based on the full distribution of responses rather than their arithmetic means, Study 1 (N = 1,506) showed on average 90% of overlap among Leavers and Remainers across a range of important variables. Even on the variables that are commonly used to illustrate how Leavers and Remainers differ (e.g., prejudice against immigrants), the amount of overlap was larger than 50%. In Study 2 (N = 206), we demonstrate the importance of focusing on similarities between groups: Presenting the full distribution of responses from Leavers and Remainers rather than their mean differences caused more accurate perceptions of the actual differences and similarities between both groups and higher perceived intergroup harmony. We conclude that similarities between Leavers and Remainers are substantial and that our proposed approach may help to de-escalate tensions between these and other groups.

Clinical and pharmacokinetics equivalence of multiple doses of levodopa benserazide generic formulation vs the originator (Madopar)

AIMS

While several generic preparations of levodopa/carbidopa and levodopa/benserazide (LBD) are currently available, pharmacokinetic (PK) equivalence and therapeutic equivalence studies with levodopa generics are not available in Italy. Lack of data on generic formulations is a critical factor for their limited use in this country and often lead patients to refuse the generic version of the branded drug.

METHODS

An experimental, 2-centre, randomized, double-blind, 2-sequence, noninferiority cross-over study was designed to evaluate both the PK equivalence and clinical equivalence of multiple doses of the generic preparation of LDB, Teva Italia, compared to the originator (Madopar). Forty-three out-patients with a diagnosis of idiopathic Parkinson's disease on LDB, were recruited and randomly assigned to 1 of 2 study sequences: generic-originator or originator-generic. Clinical evaluations were performed at the end of each study period. A PK study with an LDB fixed dose (100 + 25 mg) was performed in a subpopulation of 14 subjects.

RESULTS

Clinical data showed a reduction of 0.49 and 1.54 in the mean UPDRS III scores for the LDB and the originator, respectively. The 95% CIs [-2.21: 0.11] of the mean difference original vs LDB are smaller than the clinically significant difference of 3 UPDRS III points, supporting the conclusion that the treatment with LDB is not inferior to the originator. No statistically significant differences were found with respect to area under the curve to last dose, half-life, maximum concentration, time to maximum concentration and last observed concentration.

CONCLUSION

These findings prove the therapeutic clinical equivalence as well the PK equivalence of the generic LDB and the originator (Madopar).

Interaction of guidance types and the Need for Cognitive Closure in wiki-based learning

One purpose of wikis is the collaborative generation of content. During creation processes, controversies between authors emerge that they discuss on the article's talk page. Research suggests that controversies based on opposing points of view and contradictory evidence can be fruitful to trigger individual elaboration processes. However, previous research also showed that many wikis are not necessarily suited to identify relevant discussion contents and thus users need additional support as guidance. In an experimental laboratory study (N = 181) on wiki talk pages, we investigated two guidance measures in conjunction with the need for cognitive closure: (1) visual markers to highlight controversy status (implicit guidance) and (2) a collaboration script that directs users towards discussions (explicit guidance). Effects on wiki processes and learning outcomes were analysed. The results show that both guidance types can affect user behaviours, but in interaction with the individual Need for Cognitive Closure there were no meaningful effects. With respect to learning outcomes, we found an anticipated pattern for the interaction of the Need for Cognitive Closure with both guidance principles. The data provides support for differences in the learning success depending on the provided guidance type and the individual Need for Cognitive Closure.

Self-Reported Physical Activity is Not a Valid Method for Measuring Physical Activity in 15-Year-Old South African Boys and Girls

Physical activity plays an important role in the prevention of chronic lifestyle-related diseases. The development of valid instruments for the assessment of physical activity remains a challenge in field studies. The purpose of the present study was therefore to determine the level of agreement between physical activity objectively measured by the ActiHeart^® (Cambridge Neurotechnology Ltd, Cambridge, UK) device and subjectively reported physical activity by means of the International Physical Activity Questionnaire Short Form (IPAQ-SF) among adolescents attending schools in the Tlokwe Local Municipality, South Africa. A cross-sectional study design was used with a total of 63 boys and 45 girls aged 15 years who took part in the Physical Activity and Health Longitudinal Study (PHALS). Stature and weight were measured according to standard International Society for the Advancement of Kinanthropometry (ISAK) protocols. Objective physical activity (PA) was measured by a combined heart rate and accelerometer device (ActiHeart^®) for seven consecutive days. Time spent in moderate-to-vigorous intensity physical activity (MVPA) was assessed. Subjective physical activity was assessed with the self-reported IPAQ-SF. Objective PA indicated that 93% of the participants were inactive and only 6% were highly active. The IPAQ-SF showed that 24% were inactive, with 57% active. A non-significant correlation (r = 0.11; p = 0.29) between the ActiHeart^® measure of activity energy expenditure (AEE) and total physical activity (IPAQ-SF) was observed. The Bland–Altman plot showed no agreement between the two measurement instruments and also a variation in the level of equivalence. When Cohen’s kappa (κ) was run to determine the agreement between the two measurement instruments for estimated physical activity, a poor agreement (κ = 0.011, p < 0.005) between the two was found. The poor level of agreement between the objective measure of physical activity (ActiHeart^®) and the IPAQ-SF questionnaire should be interpreted cautiously. Future physical activity research using a combination of subjective and objective assessment methods in a large-scale cohort in adolescents is recommended.

Revisiting non-significant effects of intranasal oxytocin using equivalence testing

The effects of intranasal oxytocin on social cognition are mixed, with several non-significant reports casting some doubts on its efficacy. Nevertheless, drawing inferences from non-significant values is problematic as non-significant results can be indicative of either statistical equivalence or insensitive data. Equivalence tests can be used to assess evidence for statistical equivalence, which can consequently facilitate theory falsification. To improve the inference of non-significant NHST p-values, this paper reports a set of equivalence tests performed on data from a recent meta-analysis synthesizing 32 intranasal oxytocin studies. Data from 26.1% of non-significant meta-analytic effects were indicative of data insensitivity, rather than statistical equivalence. Equivalence tests were also performed on a set of previously unpublished data from one laboratory, to examine whether unpublished data yields similar outcomes. Of the 34 non-significant effects, 73.5% were due to data insensitivity. As these analyses illustrate how non-significant intranasal oxytocin results may not necessarily support the absence of an effect, researchers are encouraged to implement equivalence tests in the design of their studies. By facilitating theory falsification, the adoption of equivalence tests can advance the field by redirecting resources to more promising avenues of research.

The logic of equivalence testing and its use in laboratory medicine

Hypothesis testing is a methodological paradigm widely popularized outside the field of pure statistics, and nowadays more or less familiar to the largest part of biomedical researchers. Conversely, the equivalence testing is still somehow obscure and misunderstood, although it represents a conceptual mainstay for some biomedical fields like pharmacology. In order to appreciate the way it could suit laboratory medicine, it is necessary to understand the philosophy behind it, and in turn how it stemmed and differentiated along the history of classical hypothesis testing. Here we present the framework of equivalence testing, the various tests used to assess equivalence and discuss their applicability to laboratory medicine research and issues.

Equivalence Tests: A Practical Primer for t Tests, Correlations, and Meta-Analyses

Scientists should be able to provide support for the absence of a meaningful effect. Currently, researchers often incorrectly conclude an effect is absent based a nonsignificant result. A widely recommended approach within a frequentist framework is to test for equivalence. In equivalence tests, such as the two one-sided tests (TOST) procedure discussed in this article, an upper and lower equivalence bound is specified based on the smallest effect size of interest. The TOST procedure can be used to statistically reject the presence of effects large enough to be considered worthwhile. This practical primer with accompanying spreadsheet and R package enables psychologists to easily perform equivalence tests (and power analyses) by setting equivalence bounds based on standardized effect sizes and provides recommendations to prespecify equivalence bounds. Extending your statistical tool kit with equivalence tests is an easy way to improve your statistical and theoretical inferences.

Accuracy of inclinometer functions of the activPAL and ActiGraph GT3X+: A focus on physical activity

PURPOSE

The purpose of the study was to examine the accuracy of inclinometer functions of the ActiGraph GT3X+ (AG) (worn on the waist and wrist) and the activPAL (AP) in assessing time spent sitting, standing, and stepping.

METHODS

A total of 62 adults (age: 18-40 yrs; male:37; female:25) wore three activity monitors (AG waist, and AG wrist, and AP) while completing 15 different types of activities. The 15 activities were classified into 3 different postures (sitting, standing, and stepping) based on the directly observed behaviors. Minutes estimated from the inclinometers of the three monitors were directly compared to those from direct observation (criterion method) using mean absolute percent error (MAPE) values, effect sizes (Cohen's D), and equivalence testing.

RESULTS

The AP was more accurate than the both waist- and wrist-worn AG in both sitting and standing activities, but the AG was more accurate than the AP in stepping activity when the stepping activity was determined with 0.7 step/s threshold. Equivalence testing indicated that the time measured by the waist-, wrist-worn AG, and AP showed significant equivalence to the time in the equivalence zone (90% confidence interval: 2.7 to 3.3min) for 6, 5, and 7 activities, respectively.

CONCLUSIONS

The AP was reasonably accurate for detecting sitting, standing, and stepping, and the AG was very accurate for classifying stepping when the stepping activity was determined by the formula created by 0.7 step/s threshold. It is expected that the result of the study would contribute to performing movement pattern analyses and health promotion research for classifying activities.

Validity of consumer-based physical activity monitors

BACKGROUND

Many consumer-based monitors are marketed to provide personal information on the levels of physical activity and daily energy expenditure (EE), but little or no information is available to substantiate their validity.

PURPOSE

This study aimed to examine the validity of EE estimates from a variety of consumer-based, physical activity monitors under free-living conditions.

METHODS

Sixty (26.4 ± 5.7 yr) healthy males (n = 30) and females (n = 30) wore eight different types of activity monitors simultaneously while completing a 69-min protocol. The monitors included the BodyMedia FIT armband worn on the left arm, the DirectLife monitor around the neck, the Fitbit One, the Fitbit Zip, and the ActiGraph worn on the belt, as well as the Jawbone Up and Basis B1 Band monitor on the wrist. The validity of the EE estimates from each monitor was evaluated relative to criterion values concurrently obtained from a portable metabolic system (i.e., Oxycon Mobile). Differences from criterion measures were expressed as a mean absolute percent error and were evaluated using 95% equivalence testing.

RESULTS

For overall group comparisons, the mean absolute percent error values (computed as the average absolute value of the group-level errors) were 9.3%, 10.1%, 10.4%, 12.2%, 12.6%, 12.8%, 13.0%, and 23.5% for the BodyMedia FIT, Fitbit Zip, Fitbit One, Jawbone Up, ActiGraph, DirectLife, NikeFuel Band, and Basis B1 Band, respectively. The results from the equivalence testing showed that the estimates from the BodyMedia FIT, Fitbit Zip, and NikeFuel Band (90% confidence interval = 341.1-359.4) were each within the 10% equivalence zone around the indirect calorimetry estimate.

CONCLUSIONS

The indicators of the agreement clearly favored the BodyMedia FIT armband, but promising preliminary findings were also observed with the Fitbit Zip.

Likelihood approach for evaluating bioequivalence of highly variable drugs

Bioequivalence (BE) is required for approving a generic drug. The two one-sided tests procedure (TOST, or the 90% confidence interval approach) has been used as the mainstream methodology to test average BE (ABE) on pharmacokinetic parameters such as the area under the blood concentration-time curve and the peak concentration. However, for highly variable drugs (%CV > 30%), it is difficult to demonstrate ABE in a standard cross-over study with the typical number of subjects using the TOST because of lack of power. Recently, the US Food and Drug Administration and the European Medicines Agency recommended similar but not identical reference-scaled average BE (RSABE) approaches to address this issue. Although the power is improved, the new approaches may not guarantee a high level of confidence for the true difference between two drugs at the ABE boundaries. It is also difficult for these approaches to address the issues of population BE (PBE) and individual BE (IBE). We advocate the use of a likelihood approach for representing and interpreting BE data as evidence. Using example data from a full replicate 2 × 4 cross-over study, we demonstrate how to present evidence using the profile likelihoods for the mean difference and standard deviation ratios of the two drugs for the pharmacokinetic parameters. With this approach, we present evidence for PBE and IBE as well as ABE within a unified framework. Our simulations show that the operating characteristics of the proposed likelihood approach are comparable with the RSABE approaches when the same criteria are applied.

Comment on "The effect of same-sex marriage laws on different-sex marriage: evidence from the Netherlands"

In the recent Demography article titled "The Effect of Same-Sex Marriage Laws on Different-Sex Marriage: Evidence From the Netherlands," Trandafir attempted to answer the question, Are rates of opposite sex marriage affected by legal recognition of same-sex marriages? The results of his approach to statistical inference-looking for evidence of a difference in rates of opposite-sex marriage-provide an absence of evidence of such effects. However, the validity of his conclusion of no causal relationship between same-sex marriage laws and rates of opposite-sex marriage is threatened by the fact that Trandafir did not also look for equivalence in rates of opposite-sex marriage in order to provide evidence of an absence of such an effect. Equivalence tests in combination with difference tests are introduced and presented in this article as a more valid inferential approach to the substantive question Trandafir attempted to answer.

Comparisons of prediction equations for estimating energy expenditure in youth

OBJECTIVES

The purpose of this study was to compare the validity of Actigraph 2-regression models (2RM) and 1-regression models (1RM) for estimation of EE in children.

DESIGN

The study used a cross-sectional design with criterion estimates from a metabolic cart.

METHODS

A total of 59 children (7-13yrs) performed 12 activities (randomly selected from a set of 24 activities) for 5min each, while being concurrently measured with an Actigraph GT3X and indirect calorimetry. METRMR (MET considering one's resting metabolic rate) for the GT3X was estimated applying 2RM with vector magnitude (VM2RM) and vertical axis (VA2RM), and four standard 1RMs. The validity of the 2RMs and 1RMs was evaluated using 95% equivalence testing and mean absolute percent error (MAPE).

RESULTS

For the group-level comparison, equivalence testing revealed that the 90% confidence intervals for all 2RMs and 1RMs were outside of the equivalence zone (range: 3.63, 4.43) for indirect calorimetry. When comparing the individual activities, VM2RM produced smaller MAPEs (range: 14.5-45.3%) than VA2RM (range, 15.5-58.1%) and 1RMs (range, 14.5-75.1%) for most of the light and moderate activities.

CONCLUSIONS

None of the 2RMs and 1RMs were equivalent to indirect calorimetry. The 2RMs showed smaller individual-level errors than the 1RMs.