Dichotomous Scoring System Research Articles

Intraoperative in vivo confocal endomicroscopy of the glioma margin: performance assessment of image interpretation by neurosurgeon users.

Confocal laser endomicroscopy (CLE) is an intraoperative real-time cellular resolution imaging technology that images brain tumor histoarchitecture. Previously, we demonstrated that CLE images may be interpreted by neuropathologists to determine the presence of tumor infiltration at glioma margins. In this study, we assessed neurosurgeons' ability to interpret CLE images from glioma margins and compared their assessments to those of neuropathologists. In vivo CLE images acquired at the glioma margins that were previously reviewed by CLE-experienced neuropathologists were interpreted by four CLE-experienced neurosurgeons. A numerical scoring system from 0 to 5 and a dichotomous scoring system based on pathological features were used. Scores from assessments of hematoxylin and eosin (H&E)-stained sections and CLE images by neuropathologists from a previous study were used for comparison. Neurosurgeons' scores were compared to the H&E findings. The inter-rater agreement and diagnostic performance based on neurosurgeons' scores were calculated. The concordance between dichotomous and numerical scores was determined. In all, 4275 images from 56 glioma margin regions of interest (ROIs) were included in the analysis. With the numerical scoring system, the inter-rater agreement for neurosurgeons interpreting CLE images was moderate for all ROIs (mean agreement, 61%), which was significantly better than the inter-rater agreement for the neuropathologists (mean agreement, 48%) (p < 0.01). The inter-rater agreement for neurosurgeons using the dichotomous scoring system was 83%. The concordance between the numerical and dichotomous scoring systems was 93%. The overall sensitivity, specificity, positive predictive value, and negative predictive value were 78%, 32%, 62%, and 50%, respectively, using the numerical scoring system and 80%, 27%, 61%, and 48%, respectively, using the dichotomous scoring system. No statistically significant differences in diagnostic performance were found between the neurosurgeons and neuropathologists. Neurosurgeons' performance in interpreting CLE images was comparable to that of neuropathologists. These results suggest that CLE could be used as an intraoperative guidance tool with neurosurgeons interpreting the images with or without assistance of the neuropathologists. The dichotomous scoring system is robust yet simple and may streamline rapid, simultaneous interpretation of CLE images during imaging.

Development, validation, and psychometric analysis of Foot and Ankle Flexibility Index (FAFI)

AimTo develop a new tool for identifying joint hypermobility of the paediatric foot and ankle, based on a dichotomous scoring system utilising the Lower Limb Assessment Score (LLAS), to separate the foot and ankle items. Material and methodsA total of 205 children, aged between 5 and 10 years, participated in a cross-sectional study. The new tool Foot and Ankle Flexibility Index (FAFI) was predicated upon the last 7 items of LLAS, which are specific to the foot and ankle. The internal consistency was measured with Cronbach's test. Kappa statistics with 95% CI were calculated to verify the level of inter-rater and intra-rater agreement for the FAFI. ResultsCronbach's alpha returned 0.82. The correlations between items returned a mean of 0.59 (range: 0.43–0.74). The discrimination score on the ROC curve (4 points) showed that the model can be used to identify children with joint hypermobility of the foot and ankle. Inter-rater reliability was largely good (ICC = 0.89). Excellent intra-rater reliability was found (ICC = 0.96) ConclusionsThis study identified high reliability between evaluators, and high sensitivity and specificity, for a new reliable and valid tool for the identification of foot and ankle joint hypermobility.

Reliability and Measurement Error of the Qualitative Analysis of Single Leg Loading (QASLS) Tool For Unilateral Tasks.

Movement quality assessment is popular within clinical and sporting practice, due to the contribution diminished or suboptimal movement quality is believed to have on musculoskeletal (MSK) injury risk. Various movement quality assessments exist, many are limited to bilateral or jumping movements evaluation. Qualitative analysis of single leg loading (QASLS) is a new clinical assessment tool for unilateral tasks that utilizes a dichotomous scoring system of ten questions relating to the segmental body regions of the trunk, lower and upper limb. To determine the intra and inter-rater, within- and between-session reliability of the QASLS tool during two unilateral movement tasks, and provide insight to measurement error and smallest detectable difference (SDD). Reliability Study. Fifteen healthy females (mean age 19 years SD2; height 167 cm, +/- 6; weight 56 kg, +/- 6) completed two unilateral tasks, single leg squat (SLS) and single leg landing (SLL), within session data collection occurred on the same day, with between session data collection occurring seven days later. Tasks were scored with the QASLS tool via video playback. Intra-Class correlation coefficients (ICCk,3) were used to measure within and between session reliability, and Kappa coefficients and percentage of exact agreement (PEA%) were used to determine intra and inter-rater reliability. Standard error of measurement (SEM) and the SDD for the compound score of each limb was calculated. Within session reliability of QASLS scores was good (ICC = 0.82-0.86) for SLS and moderate (ICC = 0.67-0.87) for SLL. Between session reliability was moderate (ICC = 0.69-0.87) for SLS and excellent (ICC = 0.92-0.93) for SLL. SEM was less than 1 point, and SDD for compound score ranging from 1.0-2.5 points. Intra-rater agreement of compound QASLS score was near perfect (k = 0.85-100; PEA% 90-100%) and agreement of individual components was substantial- near perfect (k = 0.13-0.74; PEA% 78-100%). Inter-rater agreement for compound QASLS scores ranged from non-substantial (k = 0.13-0.74; PEA% 43.3-90%) for SLS and non-slight (k =0.03-0.17; PEA% 43.3-60%) for SLL. The QASLS movement analysis tool can be used to analyze movement quality during two unilateral loading tasks with moderate to excellent within and between session reliability. PEA% was acceptable for inter-rater agreement, however rater education training is recommended to develop more acceptable levels of reliability. 3.

Development and reliability of the AOSpine CROST (Clinician Reported Outcome Spine Trauma): a tool to evaluate and predict outcomes from clinician\u2019s perspective

PurposeTo report on the development of AOSpine CROST (Clinician Reported Outcome Spine Trauma) and results of an initial reliability study.MethodsThe AOSpine CROST was developed using an iterative approach of multiple cycles of development, review, and revision including an expert clinician panel. Subsequently, a reliability study was performed among an expert panel who were provided with 20 spine trauma cases, administered twice with 4-week interval. The results of the developmental process were analyzed using descriptive statistics, the reliability per parameter using Kappa statistics, inter-rater rater agreement using intraclass correlation coefficient (ICC), and internal consistency using Cronbach’s α.ResultsThe AOSpine CROST was developed and consisted of 10 parameters, 2 of which are only applicable for surgically treated patents (‘Wound healing’ and ‘Implants’). A dichotomous scoring system (‘yes’ or ‘no’ response) was incorporated to express expected problems for the short term and long term. In the reliability study, 16 (84.2%) participated in the first round and 14 (73.7%) in the second. Intra-rater reliability was fair to good for both time points (κ = 0.40–0.80 and κ = 0.31–0.67). Results of inter-rater reliability were lower (κ = 0.18–0.60 and κ = 0.16–0.46). Inter-rater agreement for total scores showed moderate results (ICC = 0.52–0.60), and the internal consistency was acceptable (α = 0.76–0.82).ConclusionsThe AOSpine CROST, an outcome tool for the surgeons, was developed using an iterative process. An initial reliability analysis showed fair to moderate results and acceptable internal consistency. Further clinical validation studies will be performed to further validate the tool.

Evaluation of agreement among digital dermatitis scoring methods in the milking parlor, pen, and hoof trimming chute

Digital dermatitis (DD) is the most common infectious foot lesion affecting welfare and productivity of dairy cattle. The key to DD control programs is routine and frequent identification of DD lesions. The objective was to evaluate accuracy of detecting and scoring DD lesions in 3 milking parlor designs and in 3 alternative settings compared with scoring in the hoof trimming chute as reference. A total of 552 cows and 1,104 hind feet from 17 freestall farms were scored by 1 observer in the milking parlor and in 1 other setting: pen, headlocks, or management rail. After being scored in the milking parlor and at least 1 other setting, cows were examined in the hoof trimming chute, considered the gold standard. In every setting, all hind feet were inspected visually using a flashlight and without prior washing of feet. Agreement of the scoring settings was assessed using the 5 M-stage scoring system and a dichotomous absence (M0 or M0/M1) or presence (M1 to M4.1 or M2 to M4.1) system. At trimming chute inspection, 44% of feet had a DD lesion, with estimates of 11, 5, 2, 10, and 16% for M1, M2, M3, M4, and M4.1 lesions, respectively. Apparent DD foot-level prevalence at the milking parlor, pen, management rail, and headlocks was 28, 22, 16, and 22%, respectively. M-stages were less discernible in the pen, management rail, and headlocks (apparent prevalence of M1, M2, M3, and M4.1 was ≤1%) compared with the trimming chute and milking parlor. Agreement beyond chance between any scoring setting and trimming chute scoring ranged from 0.48 to 0.70 for the dichotomous scoring system (absence = M0/M1 vs. presence = M2 to M4.1). Diagnostic test performance varied greatly among DD scoring settings but, in general, it had low sensitivity (<70%) and high specificity (>93%) for detecting any DD lesion. Agreement and test characteristics were not affected by the type of milking parlor. Although the milking parlor and headlocks were the most reliable settings in which to detect DD, none of the settings were reliable enough to replace inspection of feet in the trimming chute. However, scoring the presence or absence of DD in the milking parlor, pen, management rail, and headlocks could be used to estimate within-herd DD prevalence, to improve DD surveillance through routine monitoring, and to evaluate effects of interventions at the farm level.

Dichotomous versus semi-quantitative scoring of ultrasound joint inflammation in rheumatoid arthritis using novel individualized joint selection methods.

The aim of the study is to compare the responsiveness of two joint inflammation scoring systems (dichotomous scoring (DS) versus semi-quantitative scoring (SQS)) using novel individualized ultrasound joint selection methods and existing ultrasound joint selection methods. Responsiveness measured by the standardized response means (SRMs) using the DS and the SQS system (for both the novel and existing ultrasound joint selection methods) was derived using the baseline and the 3-month total inflammatory scores from 20 rheumatoid arthritis patients. The relative SRM gain ratios (SRM-Gains) for both scoring system (DS and SQS) comparing the novel to the existing methods were computed. Both scoring systems (DS and SQS) demonstrated substantial SRM-Gains (ranged from 3.31 to 5.67 for the DS system and ranged from 1.82 to 3.26 for the SQS system). The SRMs using the novel methods ranged from 0.94 to 1.36 for the DS system and ranged from 0.89 to 1.11 for the SQS system. The SRMs using the existing methods ranged from 0.24 to 0.32 for the DS system and ranged from 0.34 to 0.49 for the SQS system. The DS system appears to achieve high responsiveness comparable to SQS for the novel individualized ultrasound joint selection methods.

A validated protocol to quantify severity of male urogenital feminization using the MOUSE (Mouse objective urethral severity evaluation).

Congenital abnormalities vary in presentation, yet studies using model organisms tend to focus on occurrence rather than severity of the defect. Scoring severity of abnormalities in model systems allows explicit hypothesis testing during basic, translational, and reverse translational studies. We developed and validated a protocol to quantify severity of male urogenital feminization (hypospadias) in the mouse model. Hypospadias is one of the most common birth defects in the world. To induce genital feminization, pregnant mice were exposed to different concentrations of the antiandrogen vinclozolin. Genitalia were photographed at gestational age 18.5. A dichotomous scoring system to evaluate genital feminization was developed, and validated against histological measurements of urethral length. A training protocol was developed for novice scorers, and criteria were defined to evaluate precision and accuracy of scores. Vinclozolin induced variation in hypospadias severity. Severity scores were tightly correlated with histologically determined urethral length and both techniques showed similar dose-response relationships. Novice observers were trained to precisely and accurately score hypospadias severity. This standardized scoring system advances the mouse as a model to study urogenital development, and will facilitate research on the mechanisms driving genital feminization in males, and aid translational hypospadias research.

AB1002 Do Foot Posture and the Age-Related Variations Led to Sonographic Abnormalities in the Paediatric Healthy Foot?

BackgroundAs ultrasonography has proven to be a helpfulness tool for detecting articular and periarticular foot disease in juvenile idiopathic arthritis, the interpretation of some findings such as effusion or power...

Abstract 1167: Aberrant expression of trefoil factor 3 (TFF3) is associated with tumor progression and an unfavorable prognosis in patients with colorectal cancer .

Abstract Background. Trefoil factor 3 (TFF3) is predominantly expressed by goblet cells of the small intestine and colon and its expression is maintained throughout the colon adenoma-carcinoma sequence. Aberrant TFF3 expression in tumor cells has been reported to be involved in tumor progression and unfavorable prognosis of certain human malignancies. In colorectal cancer (CRC), the association between TFF3 expression and tumor progression remains uncertain. Aim. We aimed to investigate the expression of TFF3 in tumor cells using immunohistochemistry and to evaluate its clinical and prognostic values in patients with colorectal cancer (CRC). Materials and methods. Three hundred (n=300) samples of CRC patients were investigated for the expression of TFF3 in tumor cells using standard immunohistochemistry (IHC). The IHC score of TFF3 in tumor cells was determined on the basis of both staining intensity and the percentage of positive cells. The IHC score was dichotomized at the cutoff value predictive of overall survival using a non-parametric receiver operating characteristic analysis. The association between the expression of TFF3 in tumor cells and clinicopathological features was analyzed. Impact of TFF3 expression in tumor cells on overall survival (OS) was also analyzed using univariate and multivariate analyses Results. TFF3 was expressed in all goblet cells of adjacent normal tissue. In adjacent normal colonic crypt, immunoreactive TFF3 protein was localized mainly in the cytoplasm or supranuclear cytoplasm of epithelial cells. Colorectal cancer cells showed an aberrant cytoplasmic TFF3 staining. By use of our dichotomous scoring system, 110 tumors (66%) were low and 190 (34%) were high for TFF3 immunostaining. Decreased expression of TFF3 was significantly associated with larger tumor size (&amp;lt;0.05), poorly differentiated histology (&amp;lt;0.01), advanced T stage (T4) (p=0.02), synchronous liver metastasis (p=0.03), and advanced UICC stage (stage 4) (p=0.02). In univariate analysis, decreased tumoral TFF3 was significantly associated with poor prognosis [p=0.02, hazard ratio (HR)=2.13, 95 % CI, 1.15-3.97]. In multivariate analysis, decreased tumoral TFF3 showed a trend toward being an independent prognostic factor for CRC patients [p=0.09, hazard ratio (HR)=1.76, 95 % CI, 0.92-3.37]. Conclusions. Decreased TFF3 expression was associated with colorectal tumor progression. Decreased or lack of TFF3 expression in tumor cells may have a potential prognostic value in CRC patients. Citation Format: Satoru Kondo, Koji Tanaka, Susumu Saigusa, Takahito Kitajima, Tadanobu Shimura, Yuji Toiyama, Yoshinaga Okugawa, Yasuhiro Inoue, Toshimitsu Araki, Keiichi Uchida, Yasuhiko Mohri, Kenichiro Ishii, Masato Kusunoki. Aberrant expression of trefoil factor 3 (TFF3) is associated with tumor progression and an unfavorable prognosis in patients with colorectal cancer . [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 1167. doi:10.1158/1538-7445.AM2013-1167

Development and validation of Extract the Base: An English Derivational Morphology Test for third through fifth grade monolingual students and Spanish-speaking English language learners

This study describes the development and validation of the Extract the Base test (ETB), which assesses derivational morphological awareness. Scores on this test were validated for 580 monolingual students and 373 Spanish-speaking English language learners (ELLs) in third through fifth grade. As part of the validation of the internal structure, which involved using the Generalized Partial Credit Model for tests with polytomous items, items on this test were shown to provide information about students of different abilities and also discriminate amongst such heterogeneous students. As part of the validation of the test’s relationship to criterion, items were shown to correlate with measures of word identification, reading comprehension, and vocabulary measures. Differences in performances for fluent English students and ELLs, students of varied home language environments, and different grade levels were noted. Additionally, the task was validated using a dichotomous scoring system to provide reliability and validity information using this alternate scoring method.

Different models of frailty in predementia and dementia syndromes.

Dementia is an increasingly common disease in the aging population, and the numbers are expected to rise exponentially in coming years. Therefore, there is a critical need to potentially individualize new strategies able to prevent and to slow down the progression of predementia and dementia syndromes. Despite a substantial increase in the epidemiological and clinical evidence on frailty, there is no consensus on its definition or on what criteria should be used to identify older individuals with frailty. Frailty appears to be a nonspecific state of vulnerability, which reflects multisystem physiological change. In fact, current thinking is that not only physical but also psychological, cognitive and social factors contribute to this multidimensional syndrome and need to be taken into account in its definition and treatment. Cognition has already been considered as a component of frailty, and it has been demonstrated that it is associated with adverse health outcomes. In a recent population-based study, physical frail demented patients were at higher risk of all-cause mortality over 3- and 7-year follow-up periods. Several studies have also reported that physical frailty is associated with low cognitive performance, incidence of Alzheimer's disease (AD), and mild cognitive impairment, and AD pathology in older persons with and without dementia. Most frailty instruments use a dichotomous scoring system classifying a person as either frail or not frail, while a continuous or an ordinal scoring system on multiple levels would be preferable to be used as an outcome measure. Recently, a Multidimensional Prognostic Index (MPI), derived from a standardized comprehensive geriatric assessment, was effective in predicting short- and long-term mortality risk in hospitalized patients with dementia. Overall taken together these findings supported the concept that outcome measures linked to multidimensional impairment may be extremely important in making clinical decisions, especially for monitoring drug treatment in randomized clinical trials also for predementia and dementia syndromes.

Validation of a radiographic scoring system for haemochromatosis arthropathy

BackgroundArthropathy is one of the earliest and most common manifestations of hereditary haemochromatosis with a significant impact on quality of life. Although its radiographic features are well known, there is...

A revision of the Abel and Becker Cognition Scale for intellectually disabled sexual offenders.

The Abel and Becker Cognition Scale (ABCS) measures cognitive distortions supportive of sexually assaultive behavior by child molesters. Research has shown that ABCS items may be too complex to be comprehended by offenders with intellectual disabilities. A modification of the ABCS to increase its readability may be one way to facilitate the valid assessment of the cognitive distortions of intellectually disabled offenders. In addition, a dichotomous scoring system was found to be helpful in the reduction of extremity bias by such offenders. The revised items, explanation of the scoring system, and supporting data are available from the first author.

THE SUICIDE INTERVENTION RESPONSE INVENTORY: A REVISION AND VALIDATION

The Suicide Intervention Response Inventory (SIRI) was developed by Neimeyer and MacInnes (1981) to assees the ability of paraprofessional counselors to recognize appropriate responses to suicidal clients. Although several studies have supported the validity of the scale, concerns have been raised about its ceiling effect when administered to more highly trained counselors. Psychometric improvements were therefore attempted, and the original dichotomous scoring system was replaced with a Likert scale format, in the SIRI-2. Because respondents were required to make more subtle judgments concerning the appropriateness of each response as defined by a criterion group of highly expert suicidologists, the ceiling effect that limited the use of the original measure was eliminated. Construct and discriminant validity were demonstrated in both verisons of the instrument. Internal consistency and test-retest reliability showed improvement with the SIRI-2. Overall, the SIRI-2 shows promise as an index of suicide counseling effectiveness, especially among more skilled counselors.

The renal histopathology in systemic vasculitis: an international survey study of inter- and intra-observer agreement.

In order to relate histopathological findings of the kidney in systemic vasculitis to renal outcome, scoring of various morphological parameters is necessary. Therefore, we conducted a standardization study for evaluating renal biopsies from patients with systemic vasculitis. Four experienced renal pathologists from four European centres joined in the study. A scoring protocol was devised that required the observers to score an extensive number of histopathological lesions either quantitatively (as a percentage of the total number of glomeruli) or dichotomously (on a present/absent scale). Twenty renal biopsies were scored individually by all the observers, from which the inter-observer variability was analysed. Ten randomly chosen biopsies were scored again, in order to obtain the intra-observer variability. For inter-observer agreement, the evaluation of the quantitative variables was satisfactory for both rounds (0.55 < or = Kendall's W < or = 0.95 and 0.59 < or = W < or = 0.96, respectively, with all P < 0.05). However, the inter-observer agreement for the dichotomous data was poor (kappa < or = 0.30 in more than half of the parameters in both rounds). Also the data on intra-observer agreement showed more favourable results for the analysis of the quantitative data (Pearson's r > 0.45 in more than 85% of the variables in both rounds) than for the dichotomous scoring system (kappa < or = 0.30 in more than half of the variables). It is concluded that even between experienced renal pathologists discrepancies occur in scoring kidney biopsies. Inter- and intra-observer agreement is greater if a quantitative method for reviewing the biopsies is applied that requires the observers to score the tissue specimens systematically.