Interrater Reliability Correlation Research Articles

Consulting “Dr. YouTube”: an objective evaluation of hypospadias videos on a popular video-sharing website

Parents who make decisions about hypospadias repair for their child may seek information from online platforms such as YouTube. The purpose of this study is to evaluate the health literacy demand of hypospadias videos on YouTube using the Patient Education Materials Assessment Tool for Audiovisual Materials (PEMAT-A/V). We performed a YouTube search using the term "hypospadias," limiting results to the first 100 videos. We excluded videos that were <1min or >20min and videos that were not in English or did not include subtitles. Two evaluators independently examined videos and determined PEMAT-A/V scores for understandability and actionability (i.e., ability to identify actions the viewer can take). Videos with scores >70% are understandable or actionable. The inter-rater reliability (kappa) and intraclass correlation coefficient (ICC) of PEMAT scores were calculated. Bivariate and multivariable linear regression models assessed the association of video characteristics with respective scores. Of the 100 videos that were identified on YouTube, 47 (47%) were excluded leaving 53 for analysis: 14 were >20min, 14 were <1min, 9 had no audio or subtitles, 7 were not in English, 1 was a duplicate, 1 was unrelated to hypospadias, and 1 was deleted at the time of data analysis. Three (5.6%) were understandable (mean score 54.5%, standard deviation (SD) 14.9) and eight (15.1%) were actionable (mean score 21.8%, SD 16.6) (Extended Summary Figure). Kappa values ranged from 0.4 to 1. The ICC's were 0.55 and 0.33 for understandability and actionability, respectively. In the bivariate analysis, mean understandability scores were significantly higher for English language videos (p=0.04), videos with animation (p=0.002), and those produced by industry (p=0.02). In the multivariable analysis, mean understandability scores were significantly higher for "expert testimonial" or "other" video types after adjusting for graphics type and overall tone (p=0.04). Mean understandability scores were also significantly higher for videos with animation after adjusting for video type and overall tone (p=0.01). Mean actionability scores were significantly higher for videos with a negative tone (p=0.01). The vast majority of hypospadias-related YouTube content is not appropriate for users with low health literacy although certain types of videos, such those with animation and expert testimonials, scored higher on understandability than other types. Due to the lack of sufficient online informational content regarding hypospadias, we plan to engage parents of sons with hypospadias in the development of high-quality patient educational materials about hypospadias.

The Muscle Cross-sectional Area on MRI of the Shoulder Can Predict Muscle Volume: An MRI Study in Cadavers.

Muscle volume is important in shoulder function. It can be used to estimate shoulder muscle balance in health, pathology, and repair and is indicative of strength based on muscle size. Although prior studies have shown that muscle area on two-dimensional (2-D) images correlates with three-dimensional (3-D) muscle volume, they have not provided equations to predict muscle volume from imaging nor validation of the measurements. We wished to create an algorithm that quickly, accurately, and reliably estimates the volume of the shoulder muscles using cross-sectional area on MR images with low error. Specifically, we wished to (1) determine which MR imaging planes provide the highest correlation between shoulder muscle cross-sectional area and volume; (2) derive equations to predict muscle volume from cross-sectional area and validate their predictive capability; and (3) quantify the reliability of muscle cross-sectional area measurement. Three-dimensional MRI was performed on 10 cadaver shoulders, with sample size chosen for comparison to prior studies of shoulder muscle volume and in consideration of the cost of comprehensive analysis, followed by dissection for muscle volume measurement via water displacement. From each MR series, 3-D models of the rotator cuff and deltoid muscles were generated, and 2-D slices of these muscle models were selected at defined anatomic landmarks. Linear regression equations were generated to predict muscle volume at the plane(s) with the highest correlation between volume and area and for planes identified in prior studies of muscle volume and area. Volume predictions from MR scans of six different cadaver shoulders were also made, after which they were dissected to quantify muscle volume. This validation population allowed the calculation of the predictive error compared with actual muscle volume. Finally, reliability of measuring muscle areas on MR images was calculated using intraclass correlation coefficients for inter-rater reliability, as measured between two observers at a single time point. The rotator cuff planes with the highest correlation between volume and area were the sum of the glenoid face and the midpoint of the scapula, and for the deltoid, it was the transverse plane at the top of the greater tuberosity. Water and digital muscle volumes were highly correlated (r ≥ 0.993, error < 4%), and muscle areas correlated highly with volumes (r ≥ 0.992, error < 2%). All correlations had p < 0.001. Muscle volume was predicted with low mean error (< 10%). All intraclass correlation coefficients were > 0.925, suggesting high inter-rater reliability in determining muscle areas from MR images. Deltoid and rotator cuff muscle cross-sectional areas can be reliably measured on MRI and predict muscle volumes with low error. Using simple linear equations, 2-D muscle area measurements from common clinical image analysis software can be used to estimate 3-D muscle volumes from MR image data. Future studies should determine if these muscle volume estimations can be used in the evaluation of patient function, changes in shoulder health, and in populations with muscle atrophy. Additionally, these muscle volume estimation techniques can be used as inputs to musculoskeletal models examining kinetics and kinematics of humans that rely on subject-specific muscle architecture.

Size Matters: Which Adolescent Patients Are Most Likely to Require Surgical Decompression for Lumbar Disk Herniations?

Lumbar herniated nucleus pulposis (HNP) occurs infrequently in the pediatric/adolescent population. A minority of patients with radicular symptoms fail to improve with conservative management and require discectomy. The authors hypothesize that children who ultimately require surgical intervention have an underlying lumbar stenosis predisposing them to continued symptoms. Pediatric patients with a lumbar HNP on advanced imaging were retrospectively identified at a tertiary pediatric orthopaedic institution. Patients with spondylolisthesis, fractures, previous spine surgery, or structural thoracolumbar scoliosis were excluded. On sagittal magnetic resonance imagings, measurements were taken of the L4 and L5 vertebral body diameters (VBD) and canal diameters (CD) by 2 independent reviewers. Statistical analysis was performed using 2 sample T tests followed by logistic regression analysis. This was utilized to identify significant associations between CD and need for surgical decompression. A total of 76 patients (37 males/39 females) were identified with a lumbar HNP from 2001 to 2016. Eleven patients underwent discectomy. Sixty-five patients were managed conservatively. Age at magnetic resonance imaging was not different between groups (15.1±1.7 vs. 14.9±2.2 y, P=0.82). VBD at L4 and L5 were not different between groups (P=0.2 and 0.36, respectively). The reviewers had fair to good (0.584-0.854) interrater reliability correlation coefficients. CD was decreased in the surgically treated cohort at L4 (11.6±1.6 vs. 14.2±2.1 mm, P=0.0002) and at L5 (10.1±1.3 vs. 14.2±2.2 mm, P<0.00001). The ratio of CD:VBD was lower in the surgically treated group at L4 (0.36±0.06 vs. 0.46±0.08, P=0.0002) and L5 (0.31±0.68 vs. 0.45±0.08, P<0.00001). Patients with a L4 CD<12.6 mm were 18.8× more likely to require surgical decompression. 100% of patients with a L5 CD<12.36 mm ultimately underwent surgical decompression. Adolescent patients with congenital lumbar stenosis that develop a lumbar HNP are significantly more likely to require surgical decompression to relieve persistent radicular symptoms. A L4 CD<12.6 mm and a L5 CD<12.36 mm were highly correlated with the need for decompression. Level III-prognostic study.

Buccal Cell Micronuclei among Betel Quid Chewers and Non-Betel Quid Chewers from Selected Barangays in Zamboanga City

Background. Betel quid chewing has been reported to have carcinogenic properties due to the presence of harmful compounds present in its ingredients. The oral mucosa is directly exposed to these carcinogenic compounds which could cause pathological changes and lead to malignancies. Micronucleus is a biomarker that indicates genetic alteration could form due to exposure from carcinogenic substances that can be attributed from betel quid chewing. Thus, a person’s oral health status can be gauged through the detection of micronucleus in buccal cells. Objective. A cross-sectional study was done to compare the presence of micronuclei in buccal epithelial cells between betel quid chewers and non-betel quid chewers in Zamboanga City. Methodology. Purposive sampling was used to enroll the 104 participants (52 betel quid chewers and 52 non-betel quid chewers). The demographic profiles and betel quid chewing habits of the participants were obtained using a questionnaire. Buccal cells samples were collected using clean and dry tongue depressors and were smeared directly onto pre-cleaned glass slides. Slides were processed for Papanicolaou staining by a medical technologist. For each slide, 1000 buccal cells were examined using a light microscope with an attached camera. Photomicrographs of buccal cells with micronuclei were taken. Two pathologists separately validated the results through the photomicrographs. Intraclass correlation coefficient for inter-rater reliability gave a value of 1 which indicates high reliability among observers. Results. The median of the frequency of micronuclei among betel quid chewers and non-betel quid chewers were 56.5 and 36, respectively. Mann-Whitney U test revealed a significant difference ( p =0.031) at α=0.05 in the Micronuclei frequency between the 2 groups. There were 36.5% of betel quid chewers who have Micronuclei frequency above the cut-off value and on the other hand, 15.4% among the non-betel quid chewers. Pearson’s correlation coefficient revealed that there was a very weak negative relationship (r=-0.072) between total Micronuclei frequency and length of time of betel quid exposure among the exposed group. Conclusion. Betel-quid chewers have significantly higher frequency of micronuclei compared to non-betel quid chewers which puts them at higher risk for developing oral malignancies.

Colonic Stool Burden a Useful Surrogate for Slow Transit Constipation as Determined by a Radiopaque Transit Study.

Plain film abdominal x-ray (AXR) is frequently used in the evaluation of constipation, but studies assessing the association between stool burden on AXR and colonic transit have been limited. We sought to investigate the relationship between colonic stool burden and slow transit constipation, as determined by a radiopaque marker (ROM) transit study. A retrospective cohort population was assembled, consisting of adult patients with chronic constipation who underwent testing with both a ROM study and anorectal manometry at 2 tertiary care centers over 5 years. Stool burden was graded by 2 independent observers, with colonic transit being assessed by the Hinton method. Of 361 patients, 145 (40.3%) had slow transit constipation, and women were more likely than men to have slow transit constipation (42.3% vs 26.5%, P = 0.04). The mean stool burden scores by observer 1 and observer 2 for patients with slow transit constipation were significantly higher than the mean stool burden scores for patients with normal transit constipation (8.1 ± 1.6 vs 6.9 ± 1.9, P < 0.0001; 8.5 ± 1.5 vs 5.8 ± 1.6, P < 0.0001). The Pearson correlation coefficient for the stool burden score and number of remaining ROMs was 0.31 (moderate) for observer 1 (P < 0.0001) and 0.62 (strong) for observer 2 (P < 0.0001), whereas the Pearson correlation coefficient for interrater reliability of the stool burden score was 0.58 (P < 0.0001), indicating a strong correlation. The ideal score cutoff for both observers was 7, with moderate agreement by Cohen's kappa (0.43, P < 0.0001). Stool burden assessment on AXR may be a reliable alternative ROM study in the assessment of colonic transit.

A Teaching Intervention Increases the Performance of Handheld Ultrasound Devices for Assessment of Left Ventricular Ejection Fraction.

Background:Few studies have demonstrated the utility of a teaching program for evaluation of left ventricular ejection fraction (LVEF) of echocardiographic images acquired with high-end machines. No study to date explored the value of similar programs when a handheld ultrasound device is used. The aim of this study was to determine whether a teaching intervention could improve the accuracy and the reliability of LVEF visual assessment of echocardiographic images acquired with HUD.Materials and Methods:Twenty echocardiograms acquired with a hand-held ultrasound device with a spectrum of LVEF were presented to 26 participants with varying experience in echocardiography (range 2-12 years) for single-point LVEF visual estimates. After this baseline assessment, participants underwent three training sessions which included analysis of the individual baseline results and review and interpretation of additional 60 cases from the same platform. After 2 months, 20 new echocardiograms were presented to the same 26 participants for visual LVEF assessment. For each participant, the visual LVEF for each case was compared with the reference LVEF (quantitative measurements by experts), and a difference of > ±5% was considered a misclassification.Results:The misclassification rate was 61% preintervention and decreased to 41% after intervention (P < 0.0001). The mean absolute differences in LVEF between visual estimates and reference before and after intervention for all readers were −7.9 ± 9.6 and −1.2 ± 7.8, respectively (P < 0.0001). Inter-rater repeatability analysis was performed using the intraclass correlation coefficient. The intraclass correlation coefficient for inter-rater reliability was fair preintervention (0.65, 95% confidence interval [CI] 0.59 0.71) and good after intervention (0.80, 95% CI 0.73 0.87), and there were no differences when categorized according to the level of experience.Conclusions:A teaching intervention can improve the accuracy and the reliability in the visual LVEF assessment of images acquired with handheld ultrasound device.

Reliability of ultrasonic diaphragm thickness measurement in mechanically ventilated infants and children: A pilot study

Background. Diaphragmatic atrophy in mechanically ventilated infants and children may be due to ventilator-induced diaphragmatic dysfunction, which could lead to extubation failure. Ultrasound may be used as a means by which diaphragmatic atrophy can be reliably identified. There are currently no data reporting on the use of ultrasound to monitor diaphragm atrophy in the paediatric population. Objectives. To assess the inter- and intra-rater reliability of using ultrasound to measure diaphragm thickness in mechanically ventilated infants and children. Method. Diaphragm thickness measurements were compared between two individual researchers for inter-rater reliability and between multiple measurements from a single researcher for intra-rater reliability. Measurements were compared using Intraclass correlation coefficients and Bland- Altman plots. Results. Results indicated excellent reliability between measurements for both inter-and intra-rater reliability, with slightly better reliability for intra-rater compared with inter-rater reliability. Intraclass correlation coefficients for inter-rater reliability were between 0.77 and 0.98, and 0.94 for intra-rater reliability. Conclusion. Ultrasound measurements of diaphragm thickness can be used to reliably measure diaphragm thickness in mechanically ventilated infants and children. This modality could therefore be used as a reliable outcome measure for future clinical research studies to establish the relationship between ventilator-induced diaphragmatic atrophy and children who are at risk for extubation failure.

Nutrition Environment Food Pantry Assessment Tool (NEFPAT): Development and Evaluation

ObjectiveTo develop and evaluate a nutrition environment assessment tool to assess the consumer nutrition environment and use of recommended practices in food pantries. MethodsThe Nutrition Environment Food Pantry Assessment Tool (NEFPAT) was developed based on a literature review and guidance from professionals working with food pantries. The tool was pilot-tested at 9 food pantries, an expert panel assessed content validity, and interrater reliability was evaluated by pairs in 3 pantries. After revisions, the NEFPAT was used in 27 pantries. ResultsPilot tests indicated positive appraisal for the NEFPAT and recommendations were addressed. The NEFPAT's 6 objectives and the overall tool were rated as content valid by experts, with an average section rating of 3.85 ± 0.10. Intraclass correlation coefficients for interrater reliability were >0.90. Conclusions and ImplicationsThe NEFPAT is content valid with high interrater reliability. It provides baseline data that could be valuable for interventions within the nutrition environment of food pantries.

Validity and reliability of a Malay version of the Lawton instrumental activities of daily living scale among the Malay speaking elderly in Malaysia

The Lawton Instrumental Activities of Daily Living Scale is a tool often used to assess independence among elderly at home. Its suitability to be used with the elderly population in Malaysia has not been validated. This current study aimed to assess the validity and reliability of the Lawton Instrumental Activities of Daily Living Scale - Malay Version to Malay speaking elderly in Malaysia. This study was divided into three phases: (1) translation and linguistic validity involving both forward and backward translations; (2) establishment of face validity and content validity; and (3) establishment of reliability involving inter-rater, test-retest and internal consistency analyses. Data used for these analyses were obtained by interviewing 65 elderly respondents. Percentages of Content Validity Index for 4 criteria were from 88.89 to 100.0. The Cronbach α coefficient for internal consistency was 0.838. Intra-class Correlation Coefficient of inter-rater reliability and test-retest reliability was 0.957 and 0.950 respectively. The result shows that the Lawton Instrumental Activities of Daily Living Scale - Malay Version has excellent reliability and validity for use with the Malay speaking elderly people in Malaysia. This scale could be used by professionals to assess functional ability of elderly who live independently in community.

The Montreal Augmentation Mammaplasty Operation (MAMO) Simulator: An Alternative Method to Train and Assess Competence in Breast Augmentation Procedures.

Surgical residents' exposure to aesthetic procedures remains limited in residency training. The development of the Montreal augmentation mammaplasty operation (MAMO) simulator aims to provide an adjunctive training method and assessment tool to complement the evolving competency-based surgical curriculum. To perform face, content, and construct validations of the MAMO simulator for subpectoral breast augmentation procedures and assess the reliability of the assessment scales used. Plastic surgery staff and residents were recruited to perform a subpectoral breast augmentation on the simulator. Video recordings of their performance were blindly evaluated using the objective structured assessment of technical skills (OSATS) system consisting of the global rating scale (GRS), mammaplasty objective assessment tool (MOAT), and a surgery-specific Checklist score. Fourteen plastic surgery residents and seven expert plastic surgeons were enrolled. Experts' performance was significantly higher than residents' according to each of GRS, MOAT, and Checklist scores. Mean values of residents and experts were 23.4 (2.5) vs 36.9 (3.1) (P < 0.0001) for GRS score, 30.4 (2.2) vs 40 (3.2) (P < 0.0001) for MOAT scores, and 9.7 (1.5) vs 12 (1) (P < 0.001) for Checklist scores, respectively. Face and content validations showed excellent results among parameters evaluated, with an overall mean score of 4.8 (0.3) on 5. Cronbach's alpha was 0.96 and 0.83 for GRS and MOAT scores, respectively. Intraclass correlation coefficients for interrater reliability were excellent at 0.93, 0.92, and 0.89 for the GRS, MOAT, and Checklist scores, respectively. This study proves the construct simulator to be valid and the assessment scales to be reliable.

The Montreal Augmentation Mammoplasty Operation (MAMO) Simulator: An Alternative Method to Train and Assess Competence in Breast Augmentation Procedures

Surgical residents' exposure to aesthetic procedures remains limited in residency training. The development of the Montreal Augmentation Mammoplasty Operation (MAMO) simulator aims to provide an adjunctive training method and assessment tool to complement the evolving competency-based surgical curriculum. To perform face, content and construct validations of the MAMO simulator for subpectoral breast augmentation procedures and assess the reliability of the assessment scales used. Plastic surgery staff and residents were recruited to perform a subpectoral breast augmentation on the simulator. Video recordings of their performance were blindly evaluated using the Objective Structured Assessment of Technical Skills (OSATS) system consisting of the Global Rating Scale (GRS), Mammoplasty Objective Assessment Tool (MOAT) and a surgery-specific Checklist score. Fourteen plastic surgery residents and seven expert plastic surgeons were enrolled. Experts' performance was significantly higher than residents' according to each of GRS, MOAT and Checklist scores. Mean values of residents and experts were 23.4 (2.5) vs. 36.9 (3.1) (p<0.0001) for GRS score, 30.4 (2.2) vs. 40 (3.2) (p<0.0001) for MOAT scores and 9.7 (1.5) vs. 12 (1) (p<0.001) for Checklist scores, respectively. Face and content validations showed excellent results among parameters evaluated, with an overall mean score of 4.8 (0.3) on 5. Cronbach's alpha was 0.96 and 0.83 for GRS and MOAT scores, respectively. Intraclass Correlation Coefficients for interrater reliability were excellent at 0.93, 0.92, and 0.89 for the GRS, MOAT, and Checklist scores, respectively. This study proves the construct simulator to be valid and the assessment scales to be reliable.

Psychometric Properties of the MyotonPRO in Dementia Patients with Paratonia

Background: Paratonia is a distinctive form of hypertonia, causing loss of functional mobility in early stages of dementia to severe high muscle tone and pain in the late stages. For assessing and evaluating therapeutic interventions, objective instruments are required. Objective: Determine the psychometric properties of the MyotonPRO, a portable device that objectively measures muscle properties, in dementia patients with paratonia. Methods: Muscle properties were assessed with the MyotonPRO by 2 assessors within one session and repeated by the main researcher after 30 min and again after 6 months. Receiver operating characteristic curves were constructed for all MyotonPRO outcomes to discriminate between participants with (n = 70) and without paratonia (n = 82). In the participants with paratonia, correlation coefficients were established between the MyotonPRO outcomes and the Modified Ashworth Scale for paratonia (MAS-P) and muscle palpation. In participants with paratonia, reliability (intraclass correlation coefficient) and agreement values (standard error of measurement and minimal detectable change) were established. Longitudinal outcome from participants with paratonia throughout the study (n = 48) was used to establish the sensitivity for change (correlation coefficient) and responsiveness (minimal clinical important difference). Results: Included were 152 participants with dementia (mean [standard deviation] age of 83.5 [98.2]). The area under the curve ranged from 0.60 to 0.67 indicating the MyotonPRO is able to differentiate between participants with and without paratonia. The MyotonPRO explained 10-18% of the MAS-P score and 8-14% of the palpation score. Interclass correlation coefficients for interrater reliability ranged from 0.57 to 0.75 and from 0.54 to 0.71 for intrarater. The best agreement values were found for tone, elasticity, and stiffness. The change between baseline and 6 months in the MyotonPRO outcomes explained 8-13% of the change in the MAS-P scores. The minimal clinically important difference values were all smaller than the measurement error. Conclusion: The MyotonPRO is potentially applicable for cross-sectional studies between groups of paratonia patients and appears less suitable to measure intraindividual changes in paratonia. Because of the inherent variability in movement resistance in paratonia, the outcomes from the MyotonPRO should be interpreted with care; therefore, future research should focus on additional guidelines to increase the clinical interpretation and improving reproducibility.

Development and Testing of the First-Episode Psychosis Services Fidelity Scale.

The purpose of this study was to test the reliability and validity of the First-Episode Psychosis Services Fidelity Scale (FEPS-FS) and compare it with similar scales. A fidelity scale was developed from previously identified essential components of first-episode psychosis services. The scale was tested in six programs in two countries and compared with three existing scales. Program data collection from multiple sources indicated the feasibility and reliability of the FEPS-FS (intraclass correlation coefficient for interrater reliability=.842; 95% confidence interval=.795-.882). Satisfactory programs scored an average of 86% of the maximum total score; the single unsatisfactory program scored 70%. Compared with the other scales, the FEPS-FS has fewer items, but it has the highest proportion of items common to all scales. The FEPS-FS is a feasible, compact, reliable, and valid measure of adherence to evidence-based practices for first-episode psychosis services that can be applied to any first-episode psychosis service.

NovoTTF™-100A System (Tumor Treating Fields) transducer array layout planning for glioblastoma: a NovoTAL™ system user study.

BackgroundOptune™, previously known as the NovoTTF-100A System™, generates Tumor Treating Fields (TTFields), an effective anti-mitotic therapy for glioblastoma. The system delivers intermediate frequency, alternating electric fields to the supratentorial brain. Patient therapy is personalized by configuring transducer array layout placement on the scalp to the tumor site using MRI measurements and the NovoTAL System. Transducer array layout mapping optimizes therapy by maximizing electric field intensity to the tumor site. This study evaluated physician performance in conducting transducer array layout mapping using the NovoTAL System compared with mapping performed by the Novocure in-house clinical team.MethodsFourteen physicians (7 neuro-oncologists, 4 medical oncologists, and 3 neurosurgeons) evaluated five blinded cases of recurrent glioblastoma and performed head size and tumor location measurements using a standard Digital Imaging and Communications in Medicine reader. Concordance with Novocure measurement and intra- and inter-rater reliability were assessed using relevant correlation coefficients. The study criterion for success was a concordance correlation coefficient (CCC) >0.80.ResultsCCC for each physician versus Novocure on 20 MRI measurements was 0.96 (standard deviation, SD ± 0.03, range 0.90–1.00), indicating very high agreement between the two groups. Intra- and inter-rater reliability correlation coefficients were similarly high: 0.83 (SD ±0.15, range 0.54–1.00) and 0.80 (SD ±0.18, range 0.48–1.00), respectively.ConclusionsThis user study demonstrated an excellent level of concordance between prescribing physicians and Novocure in-house clinical teams in performing transducer array layout planning. Intra-rater reliability was very high, indicating reproducible performance. Physicians prescribing TTFields, when trained on the NovoTAL System, can independently perform transducer array layout mapping required for the initiation and maintenance of patients on TTFields therapy.

NovoTTFTM-100A System (Tumor Treating Fields) Transducer Array Layout Planning for Recurrent Glioblastoma: Results of a NovoTALTM System User Study

The NovoTTF-100A System (OptuneTM) generates Tumor Treating Fields (TTFields), an effective anti-mitotic therapy, significantly prolonging overall survival when added to standard of care in patients with newly diagnosed glioblastoma. The system locally delivers intermediate-frequency, alternating electric fields to the supratentorial brain. Patient therapy is personalized by configuring transducer array layout placement on the scalp to the tumor site using MRI measurements and the NovoTAL System. Transducer array layout mapping optimizes TTFields therapy by maximizing electric field intensity to the tumor site. This study evaluated physician performance in conducting transducer array layout mapping using the NovoTAL System compared with gold-standard mapping performed by the Novocure in-house clinical team. Fourteen physicians (7 neuro-oncologists, 4 medical oncologists, and 3 neurosurgeons) evaluated 5 blinded MRI cases of glioblastoma and performed head size and tumor location measurements using a standard Digital Imaging and Communications in Medicine reader. Concordance with Novocure measurement and intra- and inter-rater reliability were assessed using relevant correlation coefficients. The study criterion for success was a concordance correlation coefficient (CCC) >0.80. CCC for each physician versus Novocure on 20 MRI measurements was 0.96 (SD ± 0.03, range 0.90-1.00), indicating very high agreement between the 2 groups. Intra- and inter-rater reliability correlation coefficients were similarly high: 0.83 (SD This user study demonstrated an excellent level of concordance between prescribing physicians and Novocure in-house clinical teams in performing transducer array layout planning. Intra-rater reliability was very high, indicating reproducible performance. Physicians prescribing TTFields, when trained on the NovoTAL System, can independently perform transducer array layout mapping required for the optimal initiation and maintenance of patients on TTFields therapy.

Younger Age but Not Receptor Status May Predispose to Radiation Necrosis in Radiation Therapy for Breast Cancer Brain Metastasis

Purpose/Objective(s): The NovoTTF-100A System (Optune) generates Tumor Treating Fields (TTFields), an effective anti-mitotic therapy, significantly prolonging overall survival when added to standard of care in patients with newly diagnosed glioblastoma. The system locally delivers intermediate-frequency, alternating electric fields to the supratentorial brain. Patient therapy is personalized by configuring transducer array layout placement on the scalp to the tumor site using MRI measurements and the NovoTAL System. Transducer array layout mapping optimizes TTFields therapy by maximizing electric field intensity to the tumor site. This study evaluated physician performance in conducting transducer array layout mapping using the NovoTAL System compared with gold-standard mapping performed by the Novocure in-house clinical team. Materials/Methods: Fourteen physicians (7 neuro-oncologists, 4 medical oncologists, and 3 neurosurgeons) evaluated 5 blinded MRI cases of glioblastoma and performed head size and tumor location measurements using a standard Digital Imaging and Communications in Medicine reader. Concordance with Novocure measurement and intraand inter-rater reliability were assessed using relevant correlation coefficients. The study criterion for success was a concordance correlation coefficient (CCC) >0.80. Results: CCC for each physician versus Novocure on 20 MRI measurements was 0.96 (SD 0.03, range 0.90-1.00), indicating very high agreement between the 2 groups. Intraand inter-rater reliability correlation coefficients were similarly high: 0.83 (SD Conclusion: This user study demonstrated an excellent level of concordance between prescribing physicians and Novocure in-house clinical teams in performing transducer array layout planning. Intra-rater reliability was very high, indicating reproducible performance. Physicians prescribing TTFields, when trained on the NovoTAL System, can independently perform transducer array layout mapping required for the optimal initiation and maintenance of patients on TTFields therapy. Author Disclosure: A. Chaudhry: None. L. Benson: None. M. Varshaver: None. O. Farber: None. U. Weinberg: None. E. Kirson: None. Y. Palti: Stock; Bennet, NovelusDx. Patent/License Fees/Copyright; Multiple.

A preliminary investigation into the psychometric properties of the Dublin Extrapersonal Neglect Assessment (DENA): A novel screening tool for extrapersonal neglect

Extrapersonal neglect is one clinical manifestation that can occur following stroke. Existing neglect assessment procedures have been criticised for lengthy administration and do not assess how extrapersonal space is affected. This study investigated the psychometric properties of a new, time-efficient screening tool for extrapersonal neglect. Full ethical approval was granted and consent obtained from 50 participants with first-time stroke. Participants were screened for extrapersonal neglect on two consecutive days by two raters using the Dublin Extrapersonal Neglect Assessment (DENA) to test inter-rater reliability. Construct validity of the DENA was investigated by comparing the DENA to the Catherine Bergego Scale (CBS). Additional analyses were calculated between the DENA and the extrapersonal items of the CBS (CBS-E). The kappa statistic, intraclass correlation coefficients (ICCs) and Bland Altman analyses were calculated to determine excellent inter-rater reliability (ICC 0.971, κ = .876) and significant correlation between the DENA and the CBS and CBS-E (ICC 0.870, 0.934, κ = .793, .833, respectively). Bland Altman analyses demonstrated acceptable levels of agreement between the DENA raters, and the DENA and CBS, with no systematic differences evident. The DENA provides clinicians with a quick and psychometrically sound screening tool for extrapersonal neglect to ensure this impairment is addressed in stroke rehabilitation.

Reliability and validity of the Four Square Step Test in children with cerebral palsy and Down syndrome

Little is known about the measurement properties of clinical tests of stepping in different directions for children with cerebral palsy (CP) and Down syndrome (DS). The ability to step in various directions is an important balance skill for daily life. Standardized testing of this skill can yield important information for therapy planning. This observational methodological study was aimed at defining the relative and absolute reliability, minimal detectable difference, and concurrent validity with the Timed Up-&-Go (TUG) of the Four Square Step Test (FSST) for children with CP and DS. Thirty children, 16 with CP and 14 with DS, underwent repeat testing 2 weeks apart on the FSST by 3 raters. TUG was administered on the second test occasion. Intraclass correlation coefficients (ICC [1,1] and [3,1]) with 95% confidence intervals, standard error of measurement (SEM), minimal detectable difference (MDD) and the Spearman rank correlation coefficient were computed. The FSST demonstrated excellent interrater reliability (ICC=.79; 95% CI: .66, .89) and high positive correlation with the TUG (r=.74). Test–retest reliability estimates varied from moderate to excellent among the 3 raters (.54, .78 and .89 for raters 1, 2 and 3, respectively). SEM and MDD were calculated at 1.91s and 5.29s, respectively. Scores on the FSST of children with CP and DS between 5 and 12 years of age are reliable and valid.

Appraising the quality of medical education research methods: the Medical Education Research Study Quality Instrument and the Newcastle-Ottawa Scale-Education.

The Medical Education Research Study Quality Instrument (MERSQI) and the Newcastle-Ottawa Scale-Education (NOS-E) were developed to appraise methodological quality in medical education research. The study objective was to evaluate the interrater reliability, normative scores, and between-instrument correlation for these two instruments. In 2014, the authors searched PubMed and Google for articles using the MERSQI or NOS-E. They obtained or extracted data for interrater reliability-using the intraclass correlation coefficient (ICC)-and normative scores. They calculated between-scale correlation using Spearman rho. Each instrument contains items concerning sampling, controlling for confounders, and integrity of outcomes. Interrater reliability for overall scores ranged from 0.68 to 0.95. Interrater reliability was "substantial" or better (ICC > 0.60) for nearly all domain-specific items on both instruments. Most instances of low interrater reliability were associated with restriction of range, and raw agreement was usually good. Across 26 studies evaluating published research, the median overall MERSQI score was 11.3 (range 8.9-15.1, of possible 18). Across six studies, the median overall NOS-E score was 3.22 (range 2.08-3.82, of possible 6). Overall MERSQI and NOS-E scores correlated reasonably well (rho 0.49-0.72). The MERSQI and NOS-E are useful, reliable, complementary tools for appraising methodological quality of medical education research. Interpretation and use of their scores should focus on item-specific codes rather than overall scores. Normative scores should be used for relative rather than absolute judgments because different research questions require different study designs.

NovoTTF-100A system (tumor treating fields) transducer array layout planning for glioblastoma: Results of a NovoTAL system user study.

e13029 Background: The NovoTTF-100A System (Optune) generates Tumor Treating Fields (TTFields), an effective anti-mitotic therapy, significantly prolonging overall survival when added to standard of care in patients with newly diagnosed glioblastoma. The system locally delivers intermediate-frequency, alternating electric fields to the supratentorial brain. Patient therapy is personalized by configuring transducer array layout placement on the scalp to the tumor site using MRI measurements and the NovoTAL System. Transducer array layout mapping optimizes TTFields therapy by maximizing electric field intensity to the tumor site. This study evaluated physician performance in conducting transducer array layout mapping using the NovoTAL System compared with gold-standard mapping performed by the Novocure in-house clinical team. Methods: Fourteen physicians (7 neuro-oncologists, 4 medical oncologists, and 3 neurosurgeons) evaluated 5 blinded MRI cases of glioblastoma and performed head size and tumor location measurements using a standard Digital Imaging and Communications in Medicine reader. Concordance with Novocure measurement and intra- and inter-rater reliability were assessed using relevant correlation coefficients. The study criterion for success was a concordance correlation coefficient (CCC) > 0.80. Results: CCC for each physician versus Novocure on 20 MRI measurements was 0.96 (SD ± 0.03, range 0.90-1.00), indicating very high agreement between the 2 groups. Intra- and inter-rater reliability correlation coefficients were similarly high: 0.83 (SD ±0.15, range 0.54-1.00) and 0.80 (SD ±0.18, range 0.48-1.00), respectively. Conclusions: This user study demonstrated an excellent level of concordance between prescribing physicians and Novocure in-house clinical teams in performing transducer array layout planning. Intra-rater reliability was very high, indicating reproducible performance. Physicians prescribing TTFields, when trained on the NovoTAL System, can independently perform transducer array layout mapping required for the optimal initiation and maintenance of patients on TTFields therapy.