Excellent Degree Of Agreement Research Articles

Intraday repeatability of macular layers measurements in glaucomatous and non-glaucomatous patients using spectral-domain optical coherence tomography

PurposeTo assess the intraday repeatability of macular architecture measurements in glaucomatous and non-glaucomatous patients using spectral-domain optical coherence tomography (SD-OCT) and to evaluate the independence from intraindividual intraocular pressure (IOP) fluctuations.MethodsIn this single-center, time-point comparison study, 88 eyes with glaucoma, 53 eyes with ocular hypertension (OHT), and 253 healthy eyes underwent two standardized SD-OCT and intraocular pressure (IOP) measurements on the same day with a 5-h time gap. Bland–Altman plots, intraclass correlation coefficients (ICC), and random-effects model were used to analyze repeatability of entire retinal thickness, retinal nerve fiber layer, ganglion cell layer, inner plexiform layer, and inner nuclear layer measurements.ResultsIntraday measurements were highly reproducible in all 3 groups. ICC were greater than 0.90, respectively. The pairwise comparisons of morphometric parameters showed a statistically significant difference (P < 0.001, respectively) between groups (glaucoma vs. control, glaucoma vs. OHT) and a significant influence of time points. No correlation was found between IOP fluctuations and morphometric parameters (P > 0.05, respectively), except for a weak positive correlation with GCL (rho = 0.109, P = 0.031).ConclusionsThe evaluation of macular morphometric parameters of SD-OCT showed a high intraday repeatability and an excellent degree of agreement in glaucoma, ocular hypertension, and healthy groups. The fixed effects of time points were statistically significant. Except for a weak positive correlation of ganglion cell layer, variability did not appear to be affected by intraday IOP changes. Additional research is required to fully understand the impact of IOP fluctuations on macular morphometric parameters, considering the small observed IOP changes.

Fully automated evaluation of paraspinal muscle morphology and composition in patients with low back pain

Chronic Low Back Pain (LBP) is one of the most prevalent musculoskeletal conditions and is the leading cause of disability worldwide. The morphology and composition of lumbar paraspinal muscles, in terms of infiltrated adipose tissue, constitute important guidelines for diagnosis and treatment choice but still require manual procedures to be assessed. We developed a fully automated artificial intelligence based algorithm both to segment paraspinal muscles from MRI scans through a U-Net architecture and to estimate the amount of fatty infiltrations by a home-made intensity- and region-based processing; we further validated our results by statistical assessment of the accuracy and agreement between our automated measures and the clinically reported values, achieving dice scores greater than 95 % on the preliminary segmentation task, as well as an excellent degree of agreement on the following area estimates (ICC2,1 = 0.89). Furthermore, we employed an external public dataset to validate our model generalization abilities, reaching dice scores greater than 94 % with an average processing time of 21.92s(±3.38s) per subject. Hence, a deterministic and reliable measuring tool is proposed, without any manual confounding effect, to efficiently support daily clinical practice in LBP management.

Content Validity of the Spanish Adaptation of the Premature Infant Pain Profile Revised

BackgroundTo the best of our knowledge, there are no validated neonatal pain assessment scales in Spanish. Given the need for such a scale, a study was undertaken to adapt and validate the Premature Infant Pain Profile-Revised (PIPP-R) scale. After translation and back-translation, content validity was addressed, a crucial phase in validation studies, in which researchers examine whether the items that make up the scale represent the content that the scale is intended to assess. AimsThe aim was to provide evidence for the content validity of the Spanish adaptation of the PIPP-R scale. MethodThe study used the Delphi technique with 10 experts. Data collection was anonymous and was conducted through an online platform. It was an ad hoc survey consisting of four questions, with a five-point Likert scale for each item on the scale and for the instruction table. An item-content validity index (I-CVI) and a scale-content validity index (S-CVI) were calculated for the analysis. ResultsAfter two rounds of the survey, all items exceeded an I-CVI of 0.9. The S-CVI value was 0.98 (±0.03) for the scale, and 1 for its instruction table. The kappa index yielded values indicating an excellent degree of agreement. ConclusionsThe Spanish version of the PIPP-R obtained a high degree of content validity according to the expert group and the Delphi technique.

Auditory-perceptual evaluation with visual analogue scale: feasibility and preliminary evidence of ultrasound visual feedback treatment of Finnish [r

ABSTRACT Accumulating evidence suggests that ultrasound visual feedback increases the treatment efficacy for persistent speech sound errors. However, the available evidence is mostly from English. This is a feasibility study of ultrasound visual feedback for treating distortion of Finnish [r]. We developed a web-based application for auditory-perceptual judgement. We investigated the impact of listener’s experience on perceptual judgement and the intra-rater reliability of listeners. Four boys (10–11 years) with distortion of [r], otherwise typical development, partook in eight ultrasound treatment sessions. In total, 117 [r] samples collected at pre- and post-intervention were judged with visual analogue scale (VAS) by two listener groups: five speech and language therapists (SLTs) and six SLT students. We constructed a linear mixed-effects model with fixed effects for time and listener group and several random effects. Our findings indicate that measurement time had a significant main effect on judgement results, χ2 = 78.82, p < 0.001. Effect of listener group was non-significant, but a significant main effect of interaction of group × time, χ2 = 6.33, p < 0.012 was observed. We further explored the effect of group with nested models, and results revealed a non-significant effect of group. The average intra-rater correlation of the 11 listeners was 0.83 for the pre-intervention samples and 0.92 for post-intervention showing a good or excellent degree of agreement. Finnish [r] sound can be evaluated with VAS and ultrasound visual feedback is a feasible and promising method in treatment for distortion of [r], and its efficacy should be further assessed.

Diagnostic accuracy of cardiac computed tomographic angiography and transesophageal echocardiography in evaluation of patients with prosthetic paravalvular leakage.

Computed Tomography (CT) scan has been well addressed to provide diagnostic information for patients with prosthetic heart valve (PHV) dysfunction. However, its role in the assessment of patients with prosthetic paravalvular leakage (PVL) has not been studied thoroughly. So, this study was conducted to assess the feasibility, reproducibility, and accuracy of CT for diagnosis of prosthetic PVL using surgical findings as the reference standard. This was a prospective cohort study that was conducted on 26 consecutive patients with suspected prosthetic PVL who underwent both transesophageal echocardiography (TEE) and 64-slice ECG-gated CT. The gold standard was the intraoperative findings. Surgery was performed on 26 patients. There was an excellent degree of agreement between CT and intraoperative findings for diagnosis, localization of prosthetic PVL. The perimeter of prosthetic PVL measured by CT was strongly correlated with echocardiographic severity of PVL by TEE (Spearman's Correlation Coefficient, r=.83, p=.0014). This study demonstrates that cardiac CT showed comparable diagnostic accuracy to TEE and intraoperative findings for the detection, localization, and assessment of severity of prosthetic PVL. Moreover, CT was shown to be useful in detection of other findings related to prosthetic cardiac valves.

Comparison of Radiovisiography, an Apex Locator and an Integrated Endomotor-inbuilt Apex Locator in Primary Teeth Endometrics.

Aim and objectiveTo compare the accuracy of radiovisiography (RVG), Root ZX mini Apex locator, and Endo radar's inbuilt Apex Locator during working length determination determination in primary teeth with the actual/direct canal length.Materials and methods58 primary teeth indicated for extraction in children of age group 4-12 years were selected. RVG, Root ZX mini Apex Locator, and Endo radar's Apex Locator were used to determine the working length intraorally. Following extraction of the teeth, the actual working length was determined with magnifying loupes (2.5×) using a K-file and an endodontic ruler. The data was tabulated and statistically analyzed.Results84 canals (58 teeth) were evaluated and Root ZX mini Electronic Apex Locator (EAL) showed no statistically significant difference with the actual measurement (p = 0.18) whereas Endo radar and RVG showed statistically significant difference. Endo radar underestimated, while RVG overestimated the working length. The most accurate method for working length measurements of the root canals in primary teeth was Root ZX mini EAL, followed by Endo radar and the least accurate was RVG.ConclusionThe Root ZX mini Apex Locator showed the most promising results and had an excellent degree of agreement with actual working length, followed by Endo radar and RVG.How to cite this articleKhan SA, Khanna R, Navit S, et al. Comparison of Radiovisiography, an Apex Locator and an Integrated Endomotor-inbuilt Apex Locator in Primary Teeth Endometrics. Int J Clin Pediatr Dent. 2022;15(S-1):S18-S21.

Critical Shoulder Angle Assessment in Radiographies and Magnetic Resonance Imaging (MRI): Measurement of Intra and Inter-Observer Agreement

Objective: to evaluate the critical shoulder angle by comparing the results of measurements performed by radiography and magnetic resonance imaging, considering the intra and interobserver perspectives. Methods: we evaluated radiographic and magnetic resonance images of 74 shoulders (71 patients) submitted to these exams between 2017 and 2020, regardless of the acquired pathology. We ran a statistical analysis comparing the mean values of the data obtained by the student's t-test, and the analysis of intra and interobserver agreement used the Interclass Correlation Coefficient (ICC), with bidirectional mixed models and a confidence interval of 95%. Results: the patients had a mean age of 51.7 years, with a predominance of men (51.9%) and the most affected shoulder was the right-sided one (57.9%). There were no significant differences between the measurements made by radiography and those by magnetic resonance, both by intra and interobserver views, and the ICC showed a satisfactory level of agreement in relation to these aspects. Conclusion: there was an excellent degree of agreement between the examiners, in all the situations compared (intra and interobserver, radiography and MRI), considering the two periods of analysis.

Usefulness of novel martin/hopkins and sampson equations over friedewald equation in cardiology outpatient: CVSCORE-TR substudy

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf CVSCORE-TR study group Background Friedewald equation (LDL-Cf) is known to produce inaccurate estimations of low-density lipoprotein cholesterol (LDL-C) when triglycerides are high (&amp;gt;400 mg/dl) or LDL-C is low (&amp;lt;70 mg/dl). Martin/Hopkins (LDL-Cmh) and Sampson (LDL-Cs) equations were developed to overcome these limitations, but few data are available whether these equations offer incremental usefulness over LDL-Cf. Purpose In this pragmatic study, we aimed to evaluate the agreement between LDL-C calculated using LDL-Cmh, LDL-Cs and LDL-Cf equations and to understand whether using LDL-Cmh or LDL-Cs instead of LDL-Cf leads to significant changes on the clinical decision-making Methods 4196 cardiology outpatient cases that were included in a multicenter registry database were analyzed. Each case was assigned into a cardiovascular risk class using web-based SCORE (Systematic COronary Risk Evaluation) algorithm calibrated for high-risk European countries, and relevant European guidelines were used to assess LDL-C targets. LDL-Cf, LDL-Cs and LDL-Cmh were calculated as previously described. Results Compared to LDL-Cmh and LDL-Cs, LDL-Cf was able to correctly identify 96.9%-98.08% of cases as within or out of LDL-C target, respectively, while 1.95%-2.8% of cases were falsely identified as within LDL-C target. Kappa coefficients for agreement between LDL-Cf vs. LDL-Cmh and LDL-Cf vs. LDL-Cs were 0.868 and 0.918 (p &amp;lt; 0.001 for both). For patients not on anticholesterolemic drugs, decision to initiate treatment would be different in 1.2%-1.8% of cases if LDL-Cs or LDL-Cmh were used, respectively. For those already on anticholesterolemic drugs, decisions regarding to treatment intensification would be different in 1.5%-2.4% of cases if LDL-Cs or LDL-Cmh were used. Conclusions Friedewald equation had an excellent degree of agreement with the novel Martin/Hopkins and Sampson formulas in most cardiology outpatients, especially those within the lower end of the cardiovascular risk spectrum. In selected patients, especially those with high or very high risk in whom LDL-Cf &amp;lt; 70 mg/dl or those with a TG &amp;gt; 400 mg/dl, agreement was far worse and thus novel equations might have an incremental usefulness for clinical decision making. Table 1 Reference Comparison Correct estimation Underestimation Overestimation Kappa (p value) All patients that were not on cholesterol-lowering treatment LDL-Cmh LDL-Cf 2785 (98.1%) 51 (1.8%) 3 (0.1%) 0.962 (&amp;lt;0.001) LDL-Cs LDL-Cf 2804 (98.8%) 35 (1.2%) 0 (0.0%) 0.975 (&amp;lt;0.001) Agreement for the indication of cholesterol-lowering treatment for patients not already on cholesterol-lowering drugs. Leftmost column shows the reference method, and the second row shows equation which is compared to the reference method. Abstract Figure

Proposition of a corrected measure of the Lawton instrumental activities of daily living score

BackgroundWe aimed to propose a correction of the Lawton instrumental activity of daily living (IADL) score to take into account the possibility to have never done some activities, and measured its agreement and reliability with the usual IADL score.MethodsA cross-sectional study was conducted in outpatients attending French memory clinics between 2014 and 2017. Lawton IADL, cognitive performance, diagnosis, neuropsychiatric symptoms, and sociodemographics characteristics were collected. A corrected IADL was calculated and its agreement with the usual IADL was assessed.ResultsThe study included of 2391 patients (79.9 years old, 61.7% female). Based on the usual IADL, 36.9% of patients had never carried out at least one of the activities. This proportion reached 68.8% for men and 17.7% for women. Women had a mean IADL higher than men: 4.72 vs 3.49, this difference decreased when considering the corrected IADL: 4.82 vs 4.26 respectively. Based on Bland-Altman method, 93.5% of observations lied within the limits agreement. The ICC between the 2 scores was 0.98. The relationships between patients’ characteristics and the IADL scores were similar, regardless the usual or corrected version.ConclusionsThis corrected IADL score had an excellent degree of agreement with the usual version based the ICC. This simple correction could benefit both for the clinical practice by providing a more accurate description of the real clinical state of the patients allowing to manage them more precisely, and for research involving the evaluation of the functional abilities of patients.

Tecnologia educativa para cuidadores de crianças e adolescentes dependentes de cuidados especiais no domicílio

Materiais educativos podem promover resultados expressivos na promoção da saúde. No entanto, a contribuição desses materiais depende do processo de elaboração e das formas de comunicação utilizadas para transmitir as informações. O estudo teve como objetivo desenvolver uma tecnologia educativa para cuidadores de crianças e adolescentes dependentes de cuidados especiais no domicílio. Estudo metodológico realizado em cinco fases: sistematização de conteúdo, escolha das ilustrações, composição da cartilha, validação da cartilha por juízes e pelos cuidadores. A cartilha foi elaborada com base em revisão integrativa da literatura e por entrevistas com 19 cuidadores. O índice de validade de conteúdo entre os juízes foi de 0,99, indicando ótimo grau de concordância. A validação semântica pelos cuidadores obteve-se um percentual de concordância de 100%. Diante dos resultados conclui-se que a tecnologia educativa teve excelente aceitação, podendo contribuir para o cuidado de crianças e adolescentes acamados em domicílio.

Construction and validation of an educational technology on human papillomavirus vaccine for adolescents

ABSTRACT Objective: To construct and validate a comic-type educational technology on the human papillomavirus vaccine. Methods: A methodological study developed based on the manuals, informative notes of the Ministry of Health and with the suggestions of the target audience. Content validation was performed with 11 expert judges and the validation of appearance, with 32 adolescents. For the judges, the Content Validity Index was used and for the target audience the proportion of agreement was considered. Results: The comic book obtained a content validation index total of 0.95, a validation index considered adequate. It was identified a concordance greater than 0.80 in the validation of appearance with the target public, indicating an excellent degree of agreement. Conclusion: The technology was considered valid by the judges and the target audience, and can be used as an educational tool to guide the practice in the acceptability scenario of the vaccine. Implications for practice: The technology may contribute to the stimulation of adhesion to the human papillomavirus vaccine, since, in Brazil, the rates of adhesion to this vaccine are still low.

Current voltage perspective of an organic electronic device

Nonlinearity in current (I) – voltage (V) measurement is a well-known attribute of two-terminal organic device, irrespective of the geometrical or structural arrangement of the device. Most of the existing theories that are developed for interpretation of I–V data, either focus current-voltage relationship of charge injection mechanism across the electrode-organic material interface or charge transport mechanism through the organic active material. On the contrary, both the mechanisms work in tandem charge conduction through the device. The transport mechanism is further complicated by incoherent scattering from scattering centres/charge traps that are located at the electrode-organic material interface and in the bulk of organic material. In the present communication, a collective expression has been formulated that comprises of all the transport mechanisms that are occurring at various locations of a planar organic device. The model has been fitted to experimental I–V data of Au/P3HT/Au device with excellent degree of agreement. Certain physical parameters such as the effective area of cross-section and resistance due to charge traps have been extracted from the fit.

Reliability, Validity, and Sensitivity to Change Overtime of the Modified Melasma Area and Severity Index Score.

The new modified Melasma Area and Severity Index (mMASI) score, the recently used outcome measure for melasma, has not been tested to determine its sensitivity to change in melasma. To determine the reliability, validity, and sensitivity to change overtime of the mMASI score in assessment of the severity of melasma. Pearson correlation, Cronbach alpha, and intraclass correlation coefficient were calculated to assess the reliability of the mMASI score. Validity of the mMASI scale was carried out using Spearman correlation between mMASI total score (before and after treatment), clinical data, and patient's responses. The mMASI score showed excellent reliability and good validity for assessment of the severity of melasma. The authors also determined that the mMASI score demonstrated sensitivity to change over time. An excellent degree of agreement between the mMSAI and MASI scores was revealed. The mMASI score is reliable, valid, and responsive to change in the assessment of severity of melasma. Moreover, the mMASI score was found to be easier to learn and perform and simpler in calculation compared with the MASI score. Overall, the mMASI score can effectively replace the MASI score.

Kinemyography (KMG) versus Electromyography (EMG) neuromuscular monitoring in pediatric patients receiving cisatracurium during general anesthesia

Aim of the workTo compare KMG versus EMG neuromuscular monitoring in pediatric patients receiving cisatracurium during general anesthesia.MethodsAfter approval of the protocol by Ethics Committee 24 pediatric patients of both sexes aged 2–6 years, with a maximum weight 20 kg, were included in the study. Monitoring equipments (Datex-Ohmeda A/S 5™) were attached to the patient. The electromyogram was attached to one hand, while, KMG was attached to the other hand for simultaneous monitoring. Induction of anesthesia with fentanyl 2 μg/kg and propofol 2 mg/kg followed by endotracheal intubation. Anesthesia was maintained by end-tidal isoflurane 1.2%. Ventilation was kept by 50% oxygen in air and was adjusted to maintain end-tidal CO2 in the range of 35–40 mm Hg. After a stable baseline period of at least 3 min, the 24 patients were received 0.1 mg/kg cisatracurium twice the 95% effective dose (2 × ED95). The following parameters were collected and compared; (1) lag time (time from start of muscle relaxant administration until the first measurable neuromuscular block (NMB), (2) onset time (time from start of muscle relaxant administration until maximal NMB), (3) assessing the recovery period by; train of four (TOF) 0.25, 0.50, 0.75 and 0.90 (time to reach a TOF ratio of 25%, 50%, 75% and 90%, respectively). No top-up doses of muscle relaxants were given.ResultsThere was no statistical difference between both studied groups as regard the demographic data of the patients, the lag time, the onset time, TOF 0.25, 0.5, 0.75 and 0.9 ratios using either EMG or KMG. In addition, there is excellent degree of agreement between EMG and KMG in measuring TOF ratio during both induction and recovery of muscle relaxants.ConclusionsKMG showed an excellent degree of agreement with EMG for determination of onset and recovery of NMB in children.

High‐performance liquid chromatographic phenolic compound fingerprint for authenticity assessment of honey

Phenolic compound profiles of 20 honeys of different botanical origin (eucalyptus, citrus, chestnut and linden) were obtained by high-performance liquid chromatography with ultraviolet detection after solid phase extraction, in order to evaluate the effectiveness of the fingerprint method for monofloral honey discrimination. A total of 58 peaks were detected at λ = 280 nm. Distinctive phenolic compound profiles were obtained in which both the nature and the relative amount of the detected compounds were characteristic for different botanical source honeys. In order to detect sample groupings, chromatographic peak areas were submitted to principal component analysis. Then linear discriminant analysis was carried out on the first three principal components. In addition, linear discriminant analysis was carried out on the 58 variables, allowing the selection of five variables able to discriminate honeys of different botanical origin. The chemometric evaluation of the phenolic compound profiles yielded classification models able to group honey samples according to their floral source with an excellent degree of agreement. The main advantage of the fingerprint approach with respect to traditional methods is that it does not require time-consuming identification and quantification of the analytes. The method proved to be effective for the assessment of honey authenticity.

Diagnosis of pulmonary embolism

The use of summed planar images generated from single-photon emission computed tomography (SPECT) ventilation/perfusion (V/Q) scintigraphy has been proposed as a substitute for planar V/Q scans in order to use the revised PIOPED interpretation criteria when only SPECT acquisition is performed in patients with suspected pulmonary embolism. The aim was to evaluate the accuracy of angular summed planar scans in comparison with true planar images. Patients included in the 'SPECT study' assessing the diagnostic performance of V/Q SPECT were analysed. Angular summed planar images were generated from SPECT acquisition data and compared with true planar scans. Angular summed planar images were successfully generated for 246 patients. Regarding interobserver variability, the interpretation result was different for 15 (6%) summed planar scans with an excellent degree of agreement (κ=0.92; 95% confidence interval 0.88-0.96). With regard to intermodality interpretation variability between conventional planar and angular summed images, the result was different for 63 (26%) of 246 patients with an intermodality degree of agreement of κ=0.66 (95% confidence interval 0.58-0.73). Planar images generated from SPECT V/Q scintigraphy are not a reliable substitute for true planar V/Q images.

Management of knee injuries: consensus-based indications from a large community of orthopaedic surgeons

To describe preferences and to quantify the amount of agreement among orthopaedic surgeons regarding treatment options for four clinical scenarios of knee pathologies. A web-based survey was developed to investigate the attitudes of members of an international association of surgeons specialised in sports traumatology and knee surgery European Society of Sports Traumatology, Knee Surgery and Arthroscopy. The response rate was 40% (412 questionnaires). An inter-rater agreement score (the Normalised Chi-square based Agreement Nomogram, NX2A) was calculated for each question. For scenario 1, 56-year-old male, degenerative medial compartment on both the femoral and tibial side, the surgical approach was preferred to the conservative approach (p<0.001). Biological procedures were not considered appropriate, and in this respect, the respondents achieved a moderate degree of agreement (NX2A=0.68). For scenario 2, 35-year-old male, early knee medial arthritis, the surgical treatment was preferred to conservative treatment (p<0.001). The traditional closed-wedge tibial osteotomy was not regarded as an appropriate treatment with an excellent degree of agreement among surgeons (NX2A=0.76). For scenario 3, 46-year-old male, ACL lesion, there was an almost disagreement, as respondents showed no preference between a surgical and conservative approach (NX2A=0.005). Among surgical treatments, an almost perfect agreement with regard to the appropriateness of arthroscopic single-bundle ACL reconstruction with a semitendinosus/gracilis graft was reached by the surgeons (NX2A=0.8). For scenario 4, 69-year-old male, diffuse knee arthritis (all the compartments), an almost perfect agreement in favour of a total knee prosthesis was obtained for the management of this scenario (NX2A=0.85). Web-based survey can help orthopaedic surgeons discuss and propose indications for clinical practice in the management of some of the most common joint diseases. Cross-sectional survey, Level V.

A semiquantitative method based on proximal convergence zone to estimate the severity of the mitral regurgitation: design and clinical application.

The analysis of the mitral regurgitation using the proximal isovelocity surface area method has not been extended to clinical practice because of its complexity. Our objective was to design and validate a simplified semi-quantitative method based on proximal isovelocity surface area to assess the severity of mitral regurgitation. We studied 58 patients with mitral regurgitation. We found a good correlation between the angiographic grade of mitral regurgitation and the parameters derived from proximal isovelocity surface area: maximal regurgitant flow, regurgitant orifice and volume (r: 0.90 to 0.92, P<0.05). The values of maximal regurgitant flow that best predicted the grades of angiographic severity (I--IV) were estimated by regurgitant orifice curves, with cut points of 16, 56 and 160ml.s(-1)kappa(p)=0.92). Considering that maximal regurgitant flow only depends on the radius of proximal isovelocity surface area and the velocity of aliasing used, we constructed a nomogram with the previously described limits. Twenty-four new patients were studied using this nomogram and angiography. An excellent degree of agreement was found (kappa(p)=0.93). The inter- and intraobserver variability showed a kappa(p)=0.89 and 0.91, respectively. This nomogram allows a fast semi-quantitative estimation of the grade of MR, feasible and highly correlative with the invasive methods.