Binary Scoring System Research Articles

Comparative Accuracy of ChatGPT 4.0 and Google Gemini in Answering Pediatric Radiology Text-Based Questions.

This study evaluates the accuracy of two AI language models, ChatGPT 4.0 and Google Gemini (as of August 2024), in answering a set of 79 text-based pediatric radiology questions from "Pediatric Imaging: A Core Review."Accurate interpretation of text and images is critical in radiology, making AI tools valuable in medical education. The study involved 79 questions selected from a pediatric radiology question set, focusing solely on text-based questions. ChatGPT 4.0 and Google Gemini answered these questions, and their responses were evaluated using a binary scoring system. Statistical analyses, including chi-square tests and relative risk (RR) calculations, were performed to compare the overall and subsection accuracy of the models. ChatGPT 4.0 demonstrated superior accuracy, correctly answering 83.5% (66/79) of the questions, compared to Google Gemini's 68.4% (54/79), with a statistically significant difference (p=0.0255, RR=1.221). No statistically significant differences were found between the models within individual subsections, with p-values ranging from 0.136 to 1. ChatGPT 4.0 outperformed Google Gemini in overall accuracy for text-based pediatric radiology questions, highlighting its potential utility in medical education. However, the lack of significant differences within subsections and the exclusion of image-based questions underscore the need for further research with larger sample sizes and multimodal inputs to fully assess AI models' capabilities in radiology.

Instagram and Achilles tendon surgery: Evaluation of patients' perceptions of surgery

Background/Aim: The primary objective of this study was to conduct comprehensive research and analysis of patient-generated content related to Achilles tendon surgery on the social media platform Instagram. The aim was to gain deeper insights into patients' experiences during the perioperative period, which may contain valuable information pertinent to their condition, information of which the physicians may be unaware. Methods: A search was conducted on the Instagram database, covering a period of 78 months from February 2015 to August 2021. Posts utilizing the hashtags "#achillessurgery" and "#achillesrepair" were included in the analysis. Posts were assessed using a binary scoring system, considering variables such as tone, media format, return to work, rehabilitation or physical therapy, return to sports, images related to the ankle (e.g., scars, stitches, casts, dressings, walking boots), activities of daily living, and pain. Results: A total of 500 posts were reviewed, and a positive tone was observed in 77.8% of these. The average Instagram like ratio for these posts was computed as 9%. Statistical analysis revealed a significant relationship between post content and tone status (P=0.001). Specifically, within the positive tone group, informative content about the disease was comparatively lower and statistically significant when compared to exercise training and patient experience (P=0.001). Additionally, exercise training posts were found to be significantly lower than patient experience posts (P=0.001) within the positive tone group. In contrast, within the negative tone group, patient experience posts were significantly higher compared to informative content and exercise training posts (P=0.001). Moreover, the quantity of informative posts markedly surpassed the number of posts related to exercise training (P=0.001). Conclusion: In the positive tone category, people tended to emphasize personal experiences and participate in posts related to exercise training rather than actively seeking or exchanging information about the disorder. On the other hand, within the negative tone group, individuals were more likely to share adverse experiences, pursue support, and seek a deeper understanding from others. Their priority may also lie in sharing and gaining information specifically about the disorder. Our exploration of the use of social media platforms to delve into patient perspectives on Achilles tendon surgery provides an alternative insight into patients' experiences with the surgical process. By comprehending the content shared by patients on social media, surgeons may gain an improved opportunity to assess and address the surgical experience of their patients more effectively, ultimately contributing to enhanced patient care.

Evolution of word production errors after typicality-based semantic naming treatment in individuals with aphasia

ABSTRACT Background The Complexity Account for Treatment Efficacy (CATE) has been applied to semantic typicality in aphasia naming therapy, i.e. training atypical items of a category would improve naming of typical untrained-related items. However, most aphasia treatment studies have implemented a binary scoring system to measure response accuracy, which may not thoroughly reveal linguistic mechanisms underlying aphasia recovery. Aims The current study investigated the evolution of error patterns following typicality-based Semantic Features Analysis (SFA) treatment in individuals with post-stroke aphasia. Methods & Procedures Thirty individuals with chronic aphasia participated in a typicality-based SFA treatment, and ten individuals with chronic aphasia served as controls. The treatment participants and controls completed a naming screener before and after either a treatment period or a no-treatment period, respectively. Responses were coded using an error coding scale and analyzed with mixed-effects models. Outcomes & Results Treatment participants demonstrated significant treatment and generalization effects, as captured by significant improvements on the error coding system for both trained and untrained items. However, the group-level analysis did not reveal significant generalization from training atypical items to untrained typical items. Subgroup analyses based on participants’ performance in treatment showed significant gains in naming untrained typical items from training atypical items in responders, but improved naming of untrained atypical items from training typical items in nonresponders. Conclusions These findings suggest different linguistic mechanisms underlying aphasia recovery and highlight the importance of investigating treatment and generalization effects using a fine-grained error coding system as a complement to a binary scoring system.

Pollen foraging preferences in honey bees and the nutrient profiles of the pollen

Honey bees are important insect pollinators that provide critical pollination services to fruit and nut crops in the US. They face challenges likely due to pressures associated with agricultural intensification related habitat loss. To better understand this, pollen preferences of foraging bees and the nutritional profile of pollen brought into hives by foraging bees in crop fields and nut orchards can provide valuable information. We trained bees to forage on bee-collected pollen from hives placed for pollination services in almond orchards, sunflower fields, or mixed species from inter-row plantings. Using bees trained to a certain kind of hive pollen, we applied a binary scoring system, to test preferences of these preconditioned foragers. We also performed metabolomic analyses of the hive pollen used for training and testing to elucidate their nutritional content. Irrespective of preconditioning, bees collected all the available choice pollen types, predominantly choosing hive-collected mixed species pollen (MSP), followed by almond orchard pollen. The hive-collected MSP was chemically diverse, richest in cholesterol, vitamins, and phytochemicals quercetin, kaempferol, coumarin, and quinine, but was not consistently high for essential amino acids and polyunsaturated fatty acids. Although diversity in chemical profiles may not directly relate to plant species diversity, our results suggest that foragers collect a variety of pollen types when available reiterating the importance of diverse floral resources.

An evaluation tool for assessing coral restoration efforts

The ever-increasing need for coral restoration as a tool available to mitigate reef declines and aid in the recovery of lost ecosystem services requires improving restoration performance over time through an adaptive management framework to evaluate the status of restoration programs using uniform, consistent metrics. An evaluation tool, presented herein, allows restoration practitioners and managers to self-evaluate the robustness of each project and identify successful metrics, those metrics that need special attention, and changes to restoration strategies that can improve performance and aid recovery. This tool is designed to allow programs to track the progress of each key metric over time to assist in improving upon successes and learning from failures. The metrics within this restoration evaluation tool focus on published best-management practices and have resulted from extensive research conducted by restoration experts over the past 20 years. Common metrics of growth and survival are included, in addition to parameters vital to the operational success of restoration programs, such as coral reproduction, recruitment of associated reef taxa, increasing habitat for reef fisheries, and improving overall reef habitat. Five Caribbean restoration programs, each with at least 15 years of restoration experience, are presented as case studies. Each program was evaluated based on six restoration categories including: field-based nurseries, outplantings, programmatic management, education and outreach, event-driven restoration, and socioeconomic restoration. Category-specific metrics were scored with a binary scoring system and summarized using a stop-light indicator framework, where the resulting color/score indicates the operations tatus of the different program components (Scores >75% = green/successful; 50–74.9% = light green > yellow > orange/intermediate; <49.9% = red/sub-optimal). Composite scores may be used to evaluate individual projects, overall restoration programs, or even large-scale state of regional restoration plans. Overall, four of the five programs scored >75% indicating most of these programs are performing well, are versatile, well managed, and sustainable. Outside of environmental factors and large-scale disturbance events, many programs described resource limitations, including funding and staffing, as reasons for scoring low on some metrics. A holistic evaluation rubric incorporated into programmatic self-assessment can ensure that restoration projects and programs are working towards success and sustainability.

PET/CT reading for relapse in non-small cell lung cancer after chemoradiotherapy in the PET-Plan trial cohort

BackgroundCurrent studies indicate that fluorine-18-fluorodeoxyglucose positron emission tomography/ computed tomography ([18F]FDG PET/CT) is the most accurate imaging modality for the detection of relapsed locally advanced non-small cell lung cancer (NSCLC) after curatively intended chemoradiotherapy. To this day, there is no objective and reproducible definition for the diagnosis of disease recurrence in PET/CT, the reading of which is relevantly influenced by post radiation inflammatory processes. The aim of this study was to evaluate and compare visual and threshold-based semi-automated evaluation criteria for the assessment of suspected tumor recurrence in a well-defined study population investigated during the randomized clinical PET-Plan trial.MethodsThis retrospective analysis comprises 114 PET/CT data sets of 82 patients from the PET-Plan multi-center study cohort who underwent [18F]FDG PET/CT imaging at different timepoints for relapse, as suspected by CT. Scans were first analyzed visually by four blinded readers using a binary scoring system for each possible localization and the associated reader certainty of the evaluation. Visual evaluations were conducted repeatedly without and with additional knowledge of the initial staging PET and radiotherapy delineation volumes. In a second step, uptake was measured quantitatively using maximum standardized uptake value (SUVmax), peak standardized uptake value corrected for lean body mass (SULpeak), and a liver threshold-based quantitative assessment model. Resulting sensitivity and specificity for relapse detection were compared to the findings in the visual assessment. The gold standard of recurrence was independently defined by prospective study routine including external reviewers using CT, PET, biopsies and clinical course of the disease.ResultsOverall interobserver agreement (IOA) of the visual assessment was moderate with a high difference between secure (ĸ = 0.66) and insecure (ĸ = 0.24) evaluations. Additional knowledge of the initial staging PET and radiotherapy delineation volumes improved the sensitivity (0.85 vs 0.92) but did not show significant impact on the specificity (0.86 vs 0.89). PET parameters SUVmax and SULpeak showed lower accuracy compared to the visual assessment, whereas threshold-based reading showed similar sensitivity (0.86) and higher specificity (0.97).ConclusionVisual assessment especially if associated with high reader certainty shows very high interobserver agreement and high accuracy that can be further increased by baseline PET/CT information. The implementation of a patient individual liver threshold value definition, similar to the threshold definition in PERCIST, offers a more standardized method matching the accuracy of experienced readers albeit not providing further improvement of accuracy.

The USMLE Step 1 Transitions to Pass/Fail Scoring: Perceptions of Dermatology Residents

Background: The USMLE Step 1 exam has been a critical objective tool for residency applications, and given the recent score change to a binary pass/fail system it is essential for programs and future residency applicants to understand the implications of this score change.
 Methods: A survey containing 21 items was dispensed through REDCap utilizing an established email list of all dermatology program directors (PDs) who then distributed the survey to residents in their programs in December 2021. 132 residents completed the survey. Perceptions regarding the USMLE Step 1 scoring change were probed.
 Results: Out of the 132 residents surveyed, the highest proportion of respondents were PGY2 (36.4% [48/132]) and PGY3 (25.8% [34/132]). Of that group, most of them (74.2% [98/132]) achieved a self-reported score of 240 or higher on their USMLE Step 1 exam and most (69.7% [92/132]) disagreed with Step 1 changing to a pass/fail scoring system. Similarly, 65% (86/131) opposed Step 2 CK also going pass/fail. The majority of respondents agreed that there will be increased emphasis placed on research (90.0% [118/131]), extracurricular involvement (76.5% [101/132]) and the Step 2 CK score (96.21% [127/132]). Further, 82.3% (107/130) of respondents agreed that more students pursuing a dermatology residency will need to take a gap year.
 Conclusion: According to current dermatology residents, the USMLE Step 1 exam score change to a binary scoring system will lead to more emphasis being placed on the Step 2CK exam, research, and extracurricular activities.

Unilateral cleft nose deformities at adulthood

Secondary rhinoplasty is a challenging procedure, requiring a precise preoperative diagnosis of nasal deformities before correcting them. As there is currently no accepted outcome measurement tool available to assess unilateral cleft lip and palate (UCLP) nose sequelae before secondary rhinoplasty. The goal of this retrospective study is to identify the nose deformities and rate them in an evaluation scale that allows collecting and analyzing cleft nose data. Our retrospective cohort is composed of 29 patients with UCLP, who underwent secondary rhinoplasty between 2010 and 2021 in a cleft center, with a mean age of 23years old. Evaluation of deformities is made from preoperative two-dimensional photography. The assessment photographic tool is a custom-designed scale of 16 items. A binary scoring system is used by two experts to assess nasolabial deformities. The most encountered sequelaes are the alar foot displacement (93%), the enlarged tip (90%) and the nostril horizontalization (86%). The inter-examiner ICC for total rating was calculated at 0.911 and indicated a strong level of reliability that was highly significant (P<0.05). The simplicity, reliability and reproducibility of the proposed assessment system could be interesting for clinicians, in order to diagnose the nasal deformities before surgery, but also to assess postoperative success of a secondary rhinoplasty and thus to compare several surgical techniques.

T2/T2-FLAIR mismatch sign as a predictive biomarker for anaplastic astrocytoma genetic profile

T2/T2-FLAIR mismatch sign as a predictive biomarker for anaplastic astrocytoma genetic profile

Reduction of hypoglycaemia, lifestyle modifications and psychological distress during lockdown following SARS-CoV-2 outbreak in type 1 diabetes.

To assess changes in glucose metrics and their association with psychological distress and lifestyle changes in patients with type 1 diabetes (T1D) using flash glucose monitoring (FGM) during lockdown following severe acute respiratory syndrome coronavirus 2 outbreak. Single-centre, observational, retrospective study enrolling T1D patients who attended a remote visit on April 2020 at the Endocrinology division of the University Hospital Policlinico Consorziale, Bari, Italy. Lockdown-related changes in physical activity level and dietary habits were assessed on a semi-quantitative basis. Changes in general well-being were assessed by the General Health Questionnaire-12 items with a binary scoring system. Glucose metrics were obtained from the Libreview platform for the first 2 weeks of February 2020 (T0) and the last 2 weeks before the phone visit (T1). Out of 84 patients assessed for eligibility, 48 had sufficient FGM data to be included in the analysis. FGM data analysis revealed significant reductions in coefficient of variation, number of hypoglycaemic events, and time below range, while no changes were found in time in range, time above range, mean sensor glucose, and glucose management indicator. Moreover, the frequency of sweets consumption was inversely related to the occurrence of hypoglycaemic events during lockdown. Lockdown-related lifestyle changes, albeit unhealthy, may lead to reduction in FGM-derived measures of hypoglycaemia and glycaemic variability in patients with T1D.

Identifying New Frontiers for Social Media Engagement in Global Surgery: An Observational Study

BackgroundThe purpose of this observational study is to characterize the use of social media content pertaining to global surgery.MethodsA search for public posts on social media related to global surgery was performed over a 3-month window, from January 1st, 2019, to March 31st, 2019. Two public domains were included in the search: Instagram and Twitter. Posts were selected by filtering for one hashtag: #GlobalSurgery. A binary scoring system was used for media format, perspective of the poster, timing of the post, tone, and post content. Data were analyzed using Chi-squared tests with significance set to p < 0.05.ResultsOverall, 2633 posts with the hashtag #GlobalSurgery were publicly shared on these two social media platforms over the 3-month period. Of these, 2272 (86.3%) referenced content related to global surgery and were original posts. Physicians and other health professionals authored a majority (60.5%, 1083/1788) of posts on Twitter, whereas organizations comprised a majority of the posts on Instagram (59.9%, 290/484). Posts either had a positive (50.2%, 1140/2272) or neutral (49.6%, 1126/2272) tone, with only 0.3% or 6/2272 of posts being explicitly negative. The content of the posts varied, but most frequently (43.4%, 986/2272) focused on promoting communication and engagement within the community, followed by educational content (21.3%, 486/2272), advertisements (18.8%, 427/2272), and published research (13.2%, 299/2272). The majority of global surgery posts originated from the USA, UK, or Canada (67.6%, 1537/2272), followed by international organizations (11.5%, 261/2272). Chi-squared analysis comparing Instagram with Twitter performed examining media content, tone, perspective, and content, finding statistically significant differences (p < 0.001) the two platforms for each of the categories.ConclusionThe online social media community with respect to global surgery engagement is predominantly composed of surgeons and health care professionals, focused primarily on promoting dialogue within the online community. Social media platforms may provide a scalable tool that can augment engagement between global surgeons, with remaining opportunity to foster global collaboration, community engagement, education and awareness.

Learning and Conceptual Change in Thermal Physics Concepts: An Examination by Gender

Students enter physics classes often having an understanding of basic concepts which is incomplete or incorrect. In this study, we investigate the performance difference between males and females on one particular question of the Thermodynamics Concept Survey (TCS). The question evaluates student understanding of the heat (energy) that is transferred during change of state and change of temperature. We find that males outperform females, in the pre-and post-instruction tests. However, using transition matrices with the hierarchy of answer choices, reveals that females are more likely than males to improve their understanding from an incorrect answer to a better incorrect answer. This improvement is not captured in the facilities, or normalised learning gains. Hence while the gap in conceptual understanding is reduced after the instruction, this is not rewarded in the usual binary multiple-choice scoring system.

Chimpanzees demonstrate individual differences in social information use

Studies of transmission biases in social learning have greatly informed our understanding of how behaviour patterns may diffuse through animal populations, yet within-species inter-individual variation in social information use has received little attention and remains poorly understood. We have addressed this question by examining individual performances across multiple experiments with the same population of primates. We compiled a dataset spanning 16 social learning studies (26 experimental conditions) carried out at the same study site over a 12-year period, incorporating a total of 167 chimpanzees. We applied a binary scoring system to code each participant’s performance in each study according to whether they demonstrated evidence of using social information from conspecifics to solve the experimental task or not (Social Information Score—‘SIS’). Bayesian binomial mixed effects models were then used to estimate the extent to which individual differences influenced SIS, together with any effects of sex, rearing history, age, prior involvement in research and task type on SIS. An estimate of repeatability found that approximately half of the variance in SIS was accounted for by individual identity, indicating that individual differences play a critical role in the social learning behaviour of chimpanzees. According to the model that best fit the data, females were, depending on their rearing history, 15–24% more likely to use social information to solve experimental tasks than males. However, there was no strong evidence of an effect of age or research experience, and pedigree records indicated that SIS was not a strongly heritable trait. Our study offers a novel, transferable method for the study of individual differences in social learning.

Abstract P1-06-04: Simplified histological grading of breast carcinoma – potential for improved concordance and consistency in breast cancer grading?

Abstract Histological grade remains an independent predictor of outcome for invasive breast cancer. The internationally accepted standard grading system is the Elston and Ellis grading system based on a local hospital (Nottingham) cohort treated between 1951-1973. Histological grade, with nodal status, tumour size and receptor measurements (ER, PgR, HER2) give important information even in the context of current molecular testing for breast cancer. In 2009 we proposed a simplified approach to the EE system based on evidence from another hospital series (Thomas et al Histopathology 2009 DOI 10.1111/j.1365-2559.2009.03429.x). Here we report a second validation of this approach using a large phase III clinical trial cohort the Tamoxifen Exemestane Adjuvant multicentre Trial. A single pathologist (EM) regraded over 4200 cases using a single H&amp;E slide from the TEAM pathology study. Individual scores (1-3) were provided for tubule formation, nuclear pleomorphism and mitotic count and summed to provide the EE score (3-9) resulting in a final grade of 1, 2 or 3 for each case. As previously reported the Simplified Binary Scoring system (SBS) reorganizes this data such that each component is given a score of 1 or 2 with a sum ranging from 3-6. In the current analysis we compared the impact of this revised grading system on patient outcome. Of 4264 centrally regraded tumours in the TEAM pathology cohort, EE scores for tubular formation were 1 in 102 cases (2.4%), 2 in 503 cases (11.8%) and 3 in 3659 (85.8%). For nuclear pleomorphism only 2 cases were EE score 1 (0.05%), 3117 were score 2 (73.1%) and 1146 score 3 (26.9%). For Mitotic count 3423 (80.3%) were scored 1, 707 (16.6%) scored 2 and 134 scored 3 using the EE system. As previously observed, most/all EE categories could be captured using a simple binary system (SBS, see Table 1). Table 1 EE Grade SBS SCORE12335460043239705068217600618 GG Score EE GradeLowHigh 13327819.02%21377132248.98%35751790.07% GG Score SBS SCORELowHigh 33508419.35%4120284741.34%515947474.88%65751289.98% In a comparison between conventional grading and molecular (using a Genomic-Grade signature) we observed the predicted equal split of EE Grade 2 cases into GG high/versus low. For the SBS score the higher scores were enriched for GG High cases. We show a novel grading system can provides a potentially simple and more reproducible approach to immunohistochemical grading. Comparisons with molecular grading approaches may suggest improved concordance between novel grading approaches and molecular systems. Further comparisons with outcome and molecular signatures will be presented. Citation Format: Bartlett JMS, Thomas J, Mallon E, Piper T, Bayani J, Hasenburg A, Kieback DG, Markopoulos C, Dirix L, Seynaeve C, van de Velde CJH, Rea DW. Simplified histological grading of breast carcinoma – potential for improved concordance and consistency in breast cancer grading? [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-06-04.

Echocardiographic Image Quality Deteriorates with Age in Children and Young Adults with Duchenne Muscular Dystrophy.

Advances in medical care for patients with Duchenne muscular dystrophy (DMD) have resulted in improved survival and an increased prevalence of cardiomyopathy. Serial echocardiographic surveillance is recommended to detect early cardiac dysfunction and initiate medical therapy. Clinical anecdote suggests that echocardiographic quality diminishes over time, impeding accurate assessment of left ventricular systolic function. Furthermore, evidence-based guidelines for the use of cardiac imaging in DMD, including cardiac magnetic resonance imaging (CMR), are limited. The objective of our single-center, retrospective study was to quantify the deterioration in echocardiographic image quality with increasing patient age and identify an age at which CMR should be considered. We retrospectively reviewed and graded the image quality of serial echocardiograms obtained in young patients with DMD. The quality of 16 left ventricular segments in two echocardiographic views was visually graded using a binary scoring system. An endocardial border delineation percentage (EBDP) score was calculated by dividing the number of segments with adequate endocardial delineation in each imaging window by the total number of segments present in that window and multiplying by 100. Linear regression analysis was performed to model the relationship between the EBDP scores and patient age. Fifty-five echocardiograms from 13 patients (mean age 11.6 years, range 3.6-19.9) were systematically reviewed. By 13 years of age, 50% of the echocardiograms were classified as suboptimal with ≥30% of segments inadequately visualized, and by 15 years of age, 78% of studies were suboptimal. Linear regression analysis revealed a negative correlation between patient age and EBDP score (r = -2.49, 95% confidence intervals -4.73, -0.25; p = 0.032), with the score decreasing by 2.5% for each 1 year increase in age. Echocardiographic image quality declines with increasing age in DMD. Alternate imaging modalities may play a role in cases of poor echocardiographic image quality.

Communicating malapposition of flow diverters assessed with optical coherence tomography correlates with delayed aneurysm occlusion

BackgroundOptical coherence tomography (OCT) is a high resolution intravascular imaging method that allows visualization of flow diverter struts and the vessel wall. In this study, malapposition of the flow diverter...

Eye tracking to evaluate evidence recognition in crime scene investigations

Crime scene analysts are the core of criminal investigations; decisions made at the scene greatly affect the speed of analysis and the quality of conclusions, thereby directly impacting the successful resolution of a case. If an examiner fails to recognize the pertinence of an item on scene, the analyst's theory regarding the crime will be limited. Conversely, unselective evidence collection will most likely include irrelevant material, thus increasing a forensic laboratory's backlog and potentially sending the investigation into an unproductive and costly direction. Therefore, it is critical that analysts recognize and properly evaluate forensic evidence that can assess the relative support of differing hypotheses related to event reconstruction. With this in mind, the aim of this study was to determine if quantitative eye tracking data and qualitative reconstruction accuracy could be used to distinguish investigator expertise. In order to assess this, 32 participants were successfully recruited and categorized as experts or trained novices based on their practical experiences and educational backgrounds. Each volunteer then processed a mock crime scene while wearing a mobile eye tracker, wherein visual fixations, durations, search patterns, and reconstruction accuracy were evaluated. The eye tracking data (dwell time and task percentage on areas of interest or AOIs) were compared using Earth Mover's Distance (EMD) and the Needleman–Wunsch (N–W) algorithm, revealing significant group differences for both search duration (EMD), as well as search sequence (N–W). More specifically, experts exhibited greater dissimilarity in search duration, but greater similarity in search sequences than their novice counterparts. In addition to the quantitative visual assessment of examiner variability, each participant's reconstruction skill was assessed using a 22-point binary scoring system, in which significant group differences were detected as a function of total reconstruction accuracy. This result, coupled with the fact that the study failed to detect a significant difference between the groups when evaluating the total time needed to complete the investigation, indicates that experts are more efficient and effective. Finally, the results presented here provide a basis for continued research in the use of eye trackers to assess expertise in complex and distributed environments, including suggestions for future work, and cautions regarding the degree to which visual attention can infer cognitive understanding.

Integrating Social Media and Anterior Cruciate Ligament Surgery: An Analysis of Patient, Surgeon, and Hospital Use

The purpose of this observational study of social media in sports medicine was to investigate and analyze the presence and shared content of anterior cruciate ligament (ACL) patients, sports surgeons, and top orthopaedic hospitals on popular social media streams. A search of 2 public domains (Instagram and Twitter) was performed over a 6-month period. ACL surgery ("#aclsurgery") was selected for the Instagram-based patient analysis after exclusion of veterinary ACL operations. A binary scoring system was used for media format, time (preoperatively or postoperatively), perioperative period (within 1week of surgery), tone (positive or negative), return-to-work reference, return-to-play reference, rehabilitation reference, surgical-site reference, satisfaction reference, and dissatisfaction reference; perspective of the media was noted as well. A sample of 97 National Football League team surgeons was used for analysis of physician use in social media outlets and quantified by the number of posts. Hospital analysis categorized a sample of the top 50 orthopaedic hospitals by average number of posts and monthly posting rates with regard to orthopaedics, research, education, and personnel focus. In the patient analysis, 3,145 public posts of human subjects were shared on Instagram. Of these, 92% were personal recovery stories, with an emphasis on postoperative photographs (93%) with a positive tone (88%) more than 1week after surgery (73%). Posts focused on surgical site (25%), return to play (30%), and postoperative rehabilitation (37%). Of the physicians, 16% had Twitter accounts, with an average of 94posts per surgeon; none had Instagram accounts. Of the hospitals, 96% had Twitter accounts and 32% had Instagram accounts. Most of the hospital-based Instagram content in the sample was centered on patients or celebrities. Orthopaedic surgery has a large social media presence. Patients emphasize wound appearance, the rehabilitation process, and return to play. Ninety-six percent of hospitals are represented in social media outlets, whereas physicians are relatively under-represented. Social media offers a unique window into what truly matters to patients after surgery and may help us better manage expectations, enhance health care delivery, and improve marketing strategies.

926P - Reader variability of PET/CT-based response criteria in DLBCL and association to outcome

F-18-fluoro-2-deoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) is essentially recommended for monitoring response to treatment in patients with diffuse large B cell lymphoma (DLBCL) and qualitative interpretation is commonly applied in clinical practice. We aimed to evaluate interobserver agreements of qualitative PET/CT-based response criteria and evaluate predictive value of PET/CT results by each reader for outcome. FDG PET/CT images were obtained for patients with DLBCL at baseline, at interim after 3 cycles of first-line chemotherapy and after completion of chemotherapy. Two nuclear medicine physicians (with 3 and 8 years of experience with FDG PET/CT) blinded to clinical data retrospectively assessed response to chemotherapy using visual qualitative analyses from the International Working Group (IWG) criteria and Lugano classification, respectively. The associations between PET/CT results and progression-free survival (PFS) and overall survival (OS) were assessed using Cox regression analysis. Included were 112 PET/CT images from 59 patients with DLBCL (36 male, 23 female; mean age 53 ± 14 years). In interpretation using binary scoring system from IWG criteria, interobserver agreement was substantial (Cohen's ĸ = 0.76) with absolute agreement consistency of 89%. In interpretation using Deauville five-point scale from Lugano classification, interobserver agreement was moderate (Cohen's weighted ĸ = 0.54) and absolute consistency was 62%. The most common cause of disagreements was discordant interpretation of presence of residual tumor uptake. With mean follow-up period of 88 months, estimated 5-year PFS and OS were 81% and 92%, respectively. Neither interim nor post-treatment PET/CT results by both readers were significantly associated with PFS. Interim PET/CT result using Deauville scale was the only significant factor for OS. Moderate to substantial interobserver agreement was observed for response assessment according to visual analysis and interim PET/CT result could predict OS in patients with DLBCL. Further studies are necessary to validate completely PET/CT-based response criteria and further standardize and consistent PET/CT interpretation.

Development of a clinical feeding assessment scale for very young infants in South Africa

BackgroundThere is a need for validated neonatal feeding assessment instruments in South Africa. A locally developed instrument may contribute to standardised evaluation procedures of high-risk neonates and address needs in resource constrained developing settings.ObjectiveThe aim of the study was to develop and validate the content of a clinical feeding assessment scale to diagnose oropharyngeal dysphagia (OPD) in neonates.MethodThe Neonatal Feeding Assessment Scale (NFAS) was developed using the Delphi method. Five international and South African speech-language therapists (SLTs) formed the expert panel, participating in two rounds of electronic questionnaires to develop and validate the content of the NFAS.ResultsAll participants agreed on the need for the development of a valid clinical feeding assessment instrument to use with the neonatal population. The initial NFAS consisted of 240 items across 8 sections, and after the Delphi process was implemented, the final format was reduced to 211 items across 6 sections. The final format of the NFAS is scored using a binary scoring system guiding the clinician to diagnose the presence or absence of OPD. All members agreed on the format, the scoring system and the feeding constructs addressed in the revised final format of the NFAS.ConclusionThe Delphi method and the diverse clinical and research experience of participants could be integrated to develop the NFAS which may be used in clinical practice in South Africa or similar developing contexts. Because of demographically different work settings marked by developed versus developing contexts, participants did not have the same expectations of a clinical dysphagia assessment. The international participants contributed to evidence-based content development. Local participants considered the contextual challenges of South African SLTs entering the field with basic competencies in neonatal dysphagia management, thereby justifying a comprehensive clinical instrument. The NFAS is aimed at clinicians working in Neonatal Intensive Care Units where they manage large caseloads of high-risk neonates. Further validation of the NFAS is recommended to determine its criterion validity in comparison with a widely accepted standard such as the modified barium swallow study.