Fair Reliability Research Articles

Test-retest reliability of exercise blood pressure and the workload-indexed systolic blood pressure slope in healthy males and females.

The reliability of blood pressure (BP) measured during submaximal and maximal exercise, and confounding effects of biological sex, remain to be fully established but have implications for using exercise BP as a cardiovascular risk factor. We hypothesize that exercise BP test-retest reliability will not differ between sexes but will be higher during submaximal compared to maximal exercise. Eighty-four participants (22±5 years; 36 females) completed two maximal treadmill tests (modified Bruce protocol) separated by ≥2 days. Exercise BP was measured every 90-seconds using automated auscultation (Tango M2 monitor). Breath-by-breath oxygen uptake was analyzed. Test-retest reliability was assessed using two-way, mixed effects, consistency, single-rater intraclass correlation coefficient (ICC) analysis on the total group and separated by sex at submaximal and maximal exercise. Systolic BP during submaximal (ICC=0.65 [0.49-0.76], p<0.01) and maximal (ICC=0.66 [0.52-0.77], p<0.01) exercise both displayed substantial reliability between visits. In contrast, the SBP/MET slope showed poor submaximal (ICC=0.12 [-0.09-0.33], p=0.13) but substantial maximal (ICC=0.63 [0.48-0.75], p<0.01) exercise reliability. Females showed substantial reliability in submaximal systolic BP (ICC=0.73 [0.53-0.85], p<0.01), and peak systolic BP (ICC=0.74 [0.54-0.87], p<0.01) and SBP/MET slope (ICC=0.78 [0.60-0.88], p<0.01); the submaximal SBP/MET slope had fair reliability (ICC=0.28 [-0.06-0.56], p=0.05). Males showed moderate reliability in submaximal systolic BP (ICC=0.53 [0.26-0.72], p<0.01), and peak systolic BP (ICC=0.41 [0.15-0.62], p<0.01) and SBP/MET slope (ICC=0.48 [0.22-0.67], p<0.01); the submaximal SBP/MET slope had poor reliability (ICC=0.06 [-0.18-0.31], p=0.32). Systolic BP showed similar reliability during submaximal and maximal exercise, with females demonstrating higher reliability in exercise systolic BP compared to males.

A Cross-Sectional Investigation on Drug-Drug Interactions in Prescriptions of Pediatric Outpatient Clinics at a Referral Center in Southern Iran

Background: Drug interactions can lead to treatment failure, the occurrence of side effects, complicate the clinical course and severity of the disease, and prolong hospitalization duration. Pediatrics are particularly vulnerable to drug interactions. Objectives: This study aims to evaluate prescribed medications and the incidence of drug interactions in pediatric patients. Methods: This study was conducted as a cross-sectional investigation. Over nine months, we evaluated pediatric patients referred to Bandar Abbas Children’s Hospital, affiliated with Hormozgan University of Medical Sciences, who received outpatient treatment services. The medications these patients received were assessed for drug interactions. Only interactions with clinical importance (i.e., category C-D-X) were considered. Using the Lexi-Interact online database, the prescribed drugs were evaluated in terms of the number and type of potential drug-drug interactions. Results: A total of 1011 patients were included in the study based on the determined criteria. The mean age was 4.52 ± 0.11 years, and the male-to-female ratio was 1.2:1. More than two-thirds of the patients were seen by general physicians. Among all participants, 26.7% had at least one clinically significant interaction in their prescriptions. Furthermore, 309 interactions were identified, of which 6.39% were of significant severity, and 93.61% were of moderate severity. The risk rating of C was the most common interaction, followed by X and D (87.7%, 7.4%, and 4.8%, respectively). Regarding reliability, 0.30% had fair reliability, 64.20% had good reliability, and 35.50% had excellent reliability ratings. Patients with underlying conditions were at increased risk of interaction occurrence (OR = 1.8, P = 0.008). Conclusions: Drug interactions with high clinical significance were identified at a high prevalence rate. These interactions can have significant consequences. Pharmacists and physicians play an important role in identifying and managing drug-drug interactions.

Reliability of task-based fMRI in the dorsal horn of the human spinal cord

Abstract The application of functional magnetic resonance imaging (fMRI) to the human spinal cord is still a relatively small field of research and faces many challenges. Here we aimed to probe the limitations of task-based spinal fMRI at 3T by investigating the reliability of spinal cord blood oxygen level dependent (BOLD) responses to repeated nociceptive stimulation across 2 consecutive days in 40 healthy volunteers. We assessed the test–retest reliability of subjective ratings, autonomic responses, and spinal cord BOLD responses to short heat-pain stimuli (1 s duration) using the intraclass correlation coefficient (ICC). At the group level, we observed robust autonomic responses as well as spatially specific spinal cord BOLD responses at the expected location, but no spatial overlap in BOLD response patterns across days. While autonomic indicators of pain processing showed good-to-excellent reliability, both β-estimates and z-scores of task-related BOLD responses showed poor reliability across days in the target region (gray matter of the ipsilateral dorsal horn). When taking into account the sensitivity of gradient-echo echo planar imaging (GE-EPI) to draining vein signals by including the venous plexus in the analysis, we observed BOLD responses with fair reliability across days. Taken together, these results demonstrate that heat-pain stimuli as short as 1 s are able to evoke a robust and spatially specific BOLD response, which is, however, strongly variable within participants across time, resulting in low reliability in the dorsal horn gray matter. Further improvements in data acquisition and analysis techniques are thus necessary before event-related spinal cord fMRI as used here can be reliably employed in longitudinal designs or clinical settings.

Reliability of Intestinal Ultrasound for Evaluating Crohn’s Disease Activity Using Point-of-care and Central Reading

Intestinal ultrasound (IUS) is increasingly used to assess Crohn's disease (CD) activity in clinical practice. However, application in clinical trials has been limited by heterogeneous scoring methods and concerns about reliability. We aimed to determine the inter- and intra-rater reliability of locally and centrally read IUS parameters for evaluating CD using prospectively performed scans. Twenty-four participants with CD and 6 gastroenterologists participated in a 2-day workshop where each participant underwent 6 IUS scans in total. Eight IUS parameters (bowel wall thickness [BWT], bowel wall stratification [BWS], color Doppler signal [CDS], inflammatory mesenteric fat [i-fat], submucosal prominence, submucosal layer thickness, haustra coli/peristalsis, and affected segment length) and an overall measure of sonographic disease activity were blindly assessed by the 6 local readers and 4 central gastroenterologist-sonographers. Reliability was quantified using intraclass correlation coefficients (ICCs). Institutional review board approval was granted for this study (12938). Five IUS parameters demonstrated at least moderate (ICC ≥0.41) inter- and intra-rater reliability when local and central reading was performed (BWT, CDS, i-fat, submucosal prominence, and affected segment length). Reliability was generally better with central, in distinction to local, reading. ICCs for BWS and i-fat were highest when evaluated as binary outcomes. Sensitivity analyses demonstrated that IUS parameters are most reliable when evaluated in the worst affected segment. Fair reliability was observed when local readers identified the worst affected segment. Local and central reading of IUS demonstrated at least moderate inter- and intra-rater reliability for several parameters. This study supports refining existing activity indices and incorporating IUS central reading into clinical trials.

Reliability and validity of belt-stabilized and tension dynamometry for assessing hip strength and power in uninjured adults

ObjectivesTo investigate the intra-rater reliability and validity of belt-stabilized and tension dynamometry to assess hip muscle strength and power. DesignRepeated measures. SettingBiomechanics laboratory. ParticipantsSeventeen uninjured adults (age = 22.0 ± 2.3y; 13 females). Main outcomes measuresPeak torque (strength) and rate of torque development (RTD; power) were measured for hip abduction, internal rotation, external rotation and extension using an isokinetic dynamometer, and belt-stabilized and tension dynamometry. ResultsFor peak torque assessment, belt-stabilized and tension dynamometry showed good (Intraclass Correlation Coefficient [ICC] = 0.848–0.899) and good-to-excellent (ICC = 0.848–0.942) reliability, respectively. For RTD, belt-stabilized dynamometry showed fair reliability for abduction (ICC = 0.524) and good reliability for hip internal rotation, external rotation, and extension (ICC = 0.702–0.899). Tension dynamometry showed good reliability for all motions when measuring RTD (ICC = 0.737–0.897). Compared to isokinetic dynamometry, belt-stabilized and tension dynamometry showed good-to-excellent correlations for peak torque assessment (r = 0.503–0.870), and fair-to-good correlations for RTD (r = 0.438–0.674). Bland-Altman analysis showed that measures from belt-stabilized and tension dynamometry had clinically meaningful disagreement with isokinetic dynamometry. ConclusionTension dynamometry is reliable for assessing hip strength and power in all assessed motions. Belt-stabilized dynamometry is reliable for assessing internal rotation, external rotation, and extension. Validity of both methods is questionable, considering the lack of agreement with isokinetic dynamometry.

Test-Retest Reliability of EEG Aperiodic Components in Resting and Mental Task States.

Aperiodic activity is derived from the electroencephalography (EEG) power spectrum and reflects changes in the slope and shifts of the broadband spectrum. Studies have shown inconsistent test-retest reliability of the aperiodic components. This study systematically measured how the test-retest reliability of the aperiodic components was affected by data duration (1, 2, 3, 4, and 5min), states (resting with eyes closed, resting with eyes open, performing mental arithmetic, recalling the events of the day, and mentally singing songs), and methods (the Fitting Oscillations and One-Over-F (FOOOF) and Linear Mixed-Effects Regression (LMER)) at both short (90-min) and long (one-month) intervals. The results showed that aperiodic components had fair, good, or excellent test-retest reliability (ranging from 0.53 to 0.91) at both short and long intervals. It is recommended that better reliability of the aperiodic components be obtained using data durations longer than 3min, the resting state with eyes closed, the mental arithmetic task state, and the LMER method.

Diagnosing popliteofibular ligament injuries in anterior cruciate ligament-injured knees: A prospective magnetic resonance imaging study investigating the inter- and intraobserver reliability of identification of the popliteofibular ligament.

The aim of our study was to investigate the intra- and interobserver reliability for the identification of the popliteofibular ligament (PFL) in magnetic resonance imaging (MRI) scans in patients with an anterior cruciate ligament (ACL) injury and ascertain the prevalence of PFL tears in ACL-injured knees without clinically high-grade posterolateral corner injury. MRI readings were performed retrospectively by two surgeons on 84 patients who underwent ACL reconstruction in our department. The presence of the PFL on both sagittal and coronal images as well as the presence of PFL tears was noted. Readings were repeated 6 weeks later for one observer. The κ value was calculated to determine the intra- and interobserver reliability for identification of the PFL and the prevalence of PFL tears was ascertained. The PFL was visualized in 90.5%-91.7% of MRI scans. The intra- and interobserver reliability of visualizing the PFL on MRI had an κ value of 0.63 and 0.66 (substantially reliable), respectively. The intraobserver reliability for identification of PFL tears had an κ value of 0.26 (fair reliability). We found a 4.8% prevalence of PFL tears in ACL-injured knees. There is substantially reliable intra- and interobserver reliability for the identification of the PFL on MRI scans but only fair reliability for the identification of PFL tears. A 4.8% prevalence of PFL tears in ACL-injured knees without clinically confirmed high-grade posterolateral corner injury can be observed in our series. Level IV.

The Use of Narco SS Score in Predicting Adverse Events in Children Undergoing Major Elective Abdominal Surgery at The University Teaching Hospital, Lusaka, Zambia.

The neurological, airway, respiratory, cardiovascular and other, with a subscore of surgical severity (NARCO-SS) is a scoring system which assesses the presence of systemic disease and the risk the operation poses to the patient. A number of patients that undergo major abdominal surgery suffer adverse events. The aim of the study was to determine the reliability of NARCO-SS in predicting peri-operative adverse events and to determine the risk factors for peri-operative adverse events in paediatric patients undergoing elective abdominal surgery. Prospective cohort study. Consecutively sampled patients from December 2019 to December 2020 were used. Patients scheduled for elective abdominal surgery were scored pre-operatively and end points were; when an adverse event occurred or up to day 30. Analysis of the reliability of the tool, bivariate and multivariate logistics regression was done. One hundred and nineteen patients were enrolled and 49% of them had adverse events. Both bivariate and multivariate analyses showed no significant association between the NARCO-SS score and the occurrence of adverse events. The area under the receiver operating characteristics curve (area under the curve) of the NARCO-SS for adverse events was 0.518; there was a significant correlation between high scores and mortality. Longer duration of surgery and complex surgery were the risk factors for adverse events. The NARCO-SS score was found to be a poor predictor of adverse events with a fair inter-rater reliability as a scoring tool. Future research could evaluate a modification of neurological and airway categories.

Test-retest reliability of intrahemispheric dorsal premotor and primary motor cortex dual-site TMS connectivity measures

ObjectiveInvestigating the optimal interstimulus interval (ISI) and the 24-hour test–retest reliability for intrahemispheric dorsal premotor cortex (PMd) – primary motor cortex (M1) connectivity using dual-site transcranial magnetic stimulation (dsTMS). MethodsIn 21 right-handed adults, left intrahemispheric PMd–M1 connectivity has been investigated with a stacked-coil dsTMS setup (conditioning stimulus: 75% of resting motor threshold; test stimulus: eliciting MEPs of 1–1.5 mV) at ISIs of 3, 5–8, and 10 ms. Additionally, M1–M1 short-interval intracortical inhibition (SICI) and intracortical facilitation (ICF) were investigated to assess comparability to standard paired-pulse setups. ResultsConditioning PMd led to significant inhibition of M1 output at ISIs of 3 and 5 ms, whereas 10 ms resulted in facilitation (all, p < 0.001), with a fair test–retest reliability for 3 (ICC: 0.47) and 6 ms (ICC: 0.44) ISIs. Replication of SICI (p < 0.001) and ICF (p = 0.017) was successful, with excellent test–retest reliability for SICI (ICC: 0.81). ConclusionThis dsTMS setup can probe the inhibitory and facilitatory PMd–M1 connections, as well as reliably replicate SICI and ICF paradigms. SignificanceThe stacked-coil dsTMS setup for investigating intrahemispheric PMd–M1 connectivity offers promising possibilities to better understand motor control.

Inter- and Intrarater Reliability of the Gap-Kalamazoo Communication Skills Assessment Form Among Occupational Therapy Interns.

Effective communication skills (CS) are essential for occupational therapists. The Gap-Kalamazoo Communication Skills Assessment Form (GKCSAF) is a standard tool for assessing the CS of medical residents. However, the interrater reliability for the nine CS domain scores ranges from poor to good. The intrarater reliability remains unclear. To examine the inter- and intrarater reliability of the GKCSAF's nine domain scores and total score among occupational therapy interns. Repeated assessments with the GKCSAF. Medical center psychiatry department. Twenty-five interns and 49 clients with mental illness, recruited from August 2020 to December 2021. The transcripts of 50 evaluation interviews between clients and interns were used. Three independent raters assessed each transcript twice, at least 3 mo apart. The GKCSAF demonstrated poor interrater reliability for the nine domain scores (weighted κ = .08-.30) and the total score (intraclass correlation coefficient [ICC] = .22, 95% confidence interval [CI] [.10, .35]). The GKCSAF showed poor to intermediate intrarater reliability for the nine domain scores (weighted κ = .27-.73) and fair reliability for the total score (ICC = .69, 95% CI [.60, .77]). The GKCSAF demonstrates poor interrater reliability and poor to intermediate intrarater reliability for the nine domain scores. However, it demonstrates fair intrarater reliability in assessing the overall CS performance of occupational therapy interns. Significant variations were observed when different raters assessed the same interns' CS, indicating inconsistencies in ratings. Consequently, it is advisable to conservatively interpret the CS ratings obtained with the GKCSAF. Plain-Language Summary: It is essential for occupational therapists to effectively communicate with clients. The Gap-Kalamazoo Communication Skills Assessment Form (GKCSAF) is a standard tool that is used to assess the communication skills of medical residents. The study authors used the GKCSAF with occupational therapy interns in a medical center psychiatry department to assess how effectively they interviewed clients with mental illness. This study aids occupational therapy personnel in the interpretation of GKCSAF results. The study findings also highlight the importance of developing reliable and standardized measures to assess communications skills in the field of occupational therapy.

Intracapsular neck of femur fractures secondary to civilian gunshot injuries: an inter- and intra-observer agreement study on classification and treatment using the AO/OTA classification

PurposeNumerous classification systems have been developed for neck of femur fractures, but none have been tested for reliability in gunshot injuries. Our primary objective was to assess the inter-observer and intra-observer reliability of the AO/OTA classification system when applied to intracapsular neck of femur fractures secondary to low-velocity civilian gunshots wounds (GSWs). Our secondary objective was to test the reliability of the AO/OTA classification system in guiding surgeon treatment choices for these fractures.Patients and methodsEighteen reviewers (six orthopaedic traumatologists, six general orthopaedic surgeons and six junior orthopaedic fellows) were given a set of 25 plain radiographs and CT scans of femur neck fractures secondary to GSW. For each clinical case, all reviewers selected a classification as well as treatment option from a list of given options. Inter-observer reliability was measured at the initial classification. The exercise was repeated 10–12 weeks later by the same 18 reviewers to test intra-observer reliability.ResultsThe Fleiss kappa values indicate only slight agreement amongst raters, across all experience levels, for both injury classification and treatment. Intra-observer agreement was fair across all experience levels for both injury classification and treatment.ConclusionThe AO/OTA classification showed only slight reliability in classification of gunshot fractures of the femur neck. With only fair reliability, it also failed to guide surgical treatment thus rendering its routine use in daily clinical practice of questionable value.

A Comparison of the Psychometric Properties of the EQ-5D-Y-3L and EQ-5D-Y-5L Using Paediatric Multi-Instrument Comparison (P-MIC) Study Data.

The EQ-5D-Y is a generic health-related quality of life (HRQoL) measure suitable for children and adolescents. There are two versions of the instrument, which differ in response levels: the three- (Y-3L) and five-level (Y-5L) versions. The Y-5L has been developed to improve the psychometric performance of the Y-3L. This study aims to assess the psychometric properties of Y-5L and to compare the performance of Y-5L with Y-3L in separate self- and proxy-reported samples. Both versions of the instrument were administered to children/adolescents (self-report) or caregivers (proxy-report) of Australian children aged 5-18 years. The data were gathered as part of the Australian Paediatric Multi-Instrument Comparison (P-MIC) study. The Y-5L and Y-3L were evaluated in terms of ceiling effects, criterion validity, inconsistency, informativity, and test-retest reliability in both proxy and self-complete populations. Overall, 5945 respondents completed both the Y-3L and Y-5L, with 2083 proxy and 3862 self-completed responses. Ceiling effects were lower in the Y-5L than the Y-3L. Items from the samedomains show the strongest correlation for both samples. Regarding informativity, the Y-5L demonstrated more discriminatory power, indicated by having a higher Shannon diversity index in all domains of the Y-5L compared with the Y-3L. Test-retest showed fair agreement between responses at baseline and follow-up. The Y-5L has demonstrated moderate validity and fair reliability for use in measuring HRQoL in children and adolescents, both when self-reported by children or proxy reported. Overall, Y-5L is a dependable and valid extension from the Y-3L.

Development and initial psychometric properties of the Research Complexity Index.

Research study complexity refers to variables that contribute to the difficulty of a clinical trial or study. This includes variables such as intervention type, design, sample, and data management. High complexity often requires more resources, advanced planning, and specialized expertise to execute studies effectively. However, there are limited instruments that scale study complexity across research designs. The purpose of this study was to develop and establish initial psychometric properties of an instrument that scales research study complexity. Technical and grammatical principles were followed to produce clear, concise items using language familiar to researchers. Items underwent face, content, and cognitive validity testing through quantitative surveys and qualitative interviews. Content validity indices were calculated, and iterative scale revision was performed. The instrument underwent pilot testing using 2 exemplar protocols, asking participants (n = 31) to score 25 items (e.g., study arms, data collection procedures). The instrument (Research Complexity Index) demonstrated face, content, and cognitive validity. Item mean and standard deviation ranged from 1.0 to 2.75 (Protocol 1) and 1.31 to 2.86 (Protocol 2). Corrected item-total correlations ranged from .030 to .618. Eight elements appear to be under correlated to other elements. Cronbach's alpha was 0.586 (Protocol 1) and 0.764 (Protocol 2). Inter-rater reliability was fair (kappa = 0.338). Initial pilot testing demonstrates face, content, and cognitive validity, moderate internal consistency reliability and fair inter-rater reliability. Further refinement of the instrument may increase reliability thus providing a comprehensive method to assess study complexity and related resource quantification (e.g., staffing requirements).

Translation and validation of traditional Chinese version of the pediatric eating assessment Tool-10

Translation and validation of traditional Chinese version of the pediatric eating assessment Tool-10

The Global Track Concept for Assessment of Engaging Hill-Sachs Defects in Anterior Shoulder Instability

Background: The glenoid track concept is used to determine preoperatively whether a Hill-Sachs defect is engaging or not. Currently, the glenoid track concept relies on measurements of bony structures as well as on the confines and elasticity of the rotator cuff as a reference point, which varies extensively among individuals and therefore limits the reliability and accuracy of this concept. Purpose: To evaluate the reliability of the global track concept, which determines the angular distance of the Hill-Sachs defect from the center of the articular surface of the humeral head as a new reference point with the help of an automated image analysis software and 3-dimensional analysis of the humeral head. Study Design: Controlled laboratory study. Methods: Computed tomography scans of 100 patients treated for anterior shoulder instability with different sizes of Hill-Sachs defects were evaluated manually by 2 orthopaedic surgeons independently using the software OsiriX as well as automatically by using a dedicated prototype software (ImFusion). Obtained manual and automated measurements included the Hill-Sachs length, Hill-Sachs width, and Hill-Sachs depth of the defect; the Hill-Sachs interval (HSI); and the glenoid width for the glenoid track concept, as well as the angular distance of the Hill-Sachs defect from the center of the articular surface of the humeral head (global track concept). The reliability of the different measurement techniques was compared by calculating intraclass correlation coefficients (ICCs). Results: There was a significant difference for all obtained parameters comparing manual and automatic measurements. For manually obtained parameters, measurements referring to bony boundaries (glenoid width, Hill-Sachs length, and Hill-Sachs width) showed good to excellent agreement (ICC, 0.86, 0.82, and 0.62, respectively), while measurements referring to soft tissue boundaries (HSI and glenoid track; ICC, 0.56 and 0.53, respectively) or not directly identifiable reference points (center of articular surface and global track) only showed fair reliability (ICC middle excursion, 0.42). When the same parameters were measured with the help of an automated software, good reliability for the glenoid track concept and excellent reliability for the global track concept in the middle excursion were achieved. Conclusion: The present study showed that the more complex global track measurements of humeral defects are more reliable than the current standard HSI and glenoid track measurements. However, this is only true when automated software is used to perform the measurements. Clinical Relevance: Future studies using the new proposed method in combination with an automated software need to be conducted to determine critical threshold values for defects prone to engagement.

Gender differences in concussion-related knowledge, attitudes and reporting behaviors of varsity athletes.

Concussion is a pathophysiological process that occurs due to a traumatic biomechanical force. Concussions are an "invisible" and common traumatic brain injury with symptoms that may be underestimated. This necessitates fundamental improvements in public knowledge specifically addressing young university athletes and different genders. This cross-sectional study aimed to explore the possibility of gender differences with respect to university student athletes' concussion knowledge, attitude and reporting behaviors. We hypothesized that there should be no significant difference in concussion knowledge among male and female student athletes; however, females would show a more positive attitude and more reporting behaviors than male student athletes. Overall, 115 university athlete students completed a survey questionnaire; we eliminated some participants based on required inclusion criteria of Rosenbaum Concussion Knowledge and Attitude Survey-student version (RoCKAS-ST). Our final analysis consisted of 96 participants: 20 males (mean age 21.15 years) and 75 females (mean age 22.36 years). This study included questions about the athletes' given reasons for reporting or not reporting a concussion. Additionally, 33 RoCKAS-ST questions on Concussion Knowledge Index (CKI) with fair test-retest reliability (r=0.67) and 15 items on Concussion Attitude Index (CAI) with satisfactory test-retest reliability (r=0.79) were provided. Males reported more sources for learning about concussions and more sport-related reasons for reporting a concussion than females (P<0.05). Both genders provided equal numbers of reasons for neglecting a concussion report or not disclosing a concussion for the sake of others (i.e., family, teammates or the coach). Out of 16 given reasons for not reporting a concussion, males significantly chose sport-related reasons over female athletes (P<0.05). Additionally, by looking at the two components of RoCKAS-ST, the independent t-test results showed no significant gender-based differences in concussion knowledge and attitude indices (P>0.05). Nevertheless, females were less optimistic about evaluating other athletes' attitude over concussion reporting (P<0.05). Our study indicated that concussion knowledge is not gender biased among Canadian university athletes; however, more investigation is required to learn how safe environments for concussion disclosure could encourage reporting the symptoms in varsity athletes, especially in males who are more susceptible to not reporting a concussion to not miss their sport-related goals.

Vestibular evoked myogenic potential (VEMP) test-retest reliability in adults.

The technique of measuring ocular vestibular evoked myogenic potentials (oVEMP) in response to Mini-shaker vibration is relatively new, there is a limited normative data to define the presence or absence of a response in the literature. To determine the test-retest reliability of cervical and ocular VEMPs (cVEMP and oVEMP, respectively) to air-conducted sound (ACS) and bone-conducted vibration (BCV) stimulation and to determine normative ranges for the responses. Twenty normal-hearing individuals (40 ears) and 20 hearing impaired volunteers with normal balance function (40 ears) were examined in this study. ACS cVEMP and BCV oVEMP (using a Mini-shaker) were recorded from both groups to assess the test-retest reliability and to collect normative VEMP data for P1/N1 latencies and amplitudes from 20 normal hearing individuals. To test reliability, VEMP recordings were repeated within the same session. The test-retest reliability for all the cVEMP parameters showed excellent reliability whereas oVEMP parameters showed between fair and excellent reliability depending on the parameter tested. Normative data for VEMP P1/N1 latencies and amplitudes were established. Normative data and test-retest reliability for BCV oVEMP using the Mini-shaker at 100 Hz were established in our study for the first time in the literature. Responses appear reliable.

Recommendations for initial diabetic retinopathy screening of diabetic patients using large language model-based artificial intelligence in real-life case scenarios

PurposeTo study the role of artificial intelligence (AI) to identify key risk factors for diabetic retinopathy (DR) screening and develop recommendations based on clinician and large language model (LLM) based AI platform opinions for newly detected diabetes mellitus (DM) cases.MethodsFive clinicians and three AI applications were given 20 AI-generated hypothetical case scenarios to assess DR screening timing. We calculated inter-rater agreements between clinicians, AI-platforms, and the “majority clinician response” (defined as the maximum number of identical responses provided by the clinicians) and “majority AI-platform” (defined as the maximum number of identical responses among the 3 distinct AI). Scoring was used to identify risk factors of different severity. Three, two, and one points were given to risk factors requiring screening immediately, within a year, and within five years, respectively. After calculating a cumulative screening score, categories were assigned.ResultsClinicians, AI platforms, and the “majority clinician response” and “majority AI response” had fair inter-rater reliability (k value: 0.21–0.40). Uncontrolled DM and systemic co-morbidities required immediate screening, while family history of DM and a co-existing pregnancy required screening within a year. The absence of these risk factors required screening within 5 years of DM diagnosis. Screening scores in this study were between 0 and 10. Cases with screening scores of 0–2 needed screening within 5 years, 3–5 within 1 year, and 6–12 immediately.ConclusionBased on the findings of this study, AI could play a critical role in DR screening of newly diagnosed DM patients by developing a novel DR screening score. Future studies would be required to validate the DR screening score before it could be used as a reference in real-life clinical situations.Clinical trial registrationNot applicable.

Is there an alternative to the Delbet-Colonna classification? Introduction and reliability assessment of a new classification system for paediatric femoral neck fractures: preliminary results.

The purpose of this study was to introduce a new classification system for paediatric femoral neck fractures (PFNFs) and to evaluate its reliability. Two hundred and eight unilateral PFNFs (mean patient age: 9.0 ± 4.8years) were included. Based on preoperative radiographs, the new classification system distinguished PFNFs without anterior or posterior translation (Type I), PFNFs with anterior (Type II) or posterior (Type III) translation, PFNFs with a comminuted medial or posterior column (Type IV), and subtrochanteric femoral fractures (SFFs; Type V). Radiographs were evaluated twice with an interval of two weeks by 19 raters with different specialties, experiences and geographical origins. The results were compared with a selection of 50 patient age-matched unilateral PFNFs and SFFs (mean patient age: 9.1 ± 4.9years). These were graded twice by the same graders according to the Delbet-Colonna (D-C) classification. Four radiologists and 15 paediatric orthopaedic surgeons from Europe and Asia graded the radiographs. Fair agreement was found between radiologists (κ = 0.296 ± 0.01) and surgeons (κ = 0.3 ± 0.005) (P = 0.17), although more experienced surgeons performed better than less experienced ones; a similar fair assessment was found for raters from Europe (κ = 0.309 ± 0.021) and Asia (κ = 0.3 ± 0.006) and for type II, III and IV fractures; the κ value in the first evaluation (0.309) was similar to that in the second evaluation (0.298). The overall κ value of the D-C classification subtypes was significantly higher (0.599 ± 0.217) than that of the new classification, 0.326 ± 0.162 (t = 3.190 P = 0.005). The new classification system showed fair reliability relative to the D-C classification. The reliability of the new classification system was not affected by the specialty or geographic origin of the rater or the evaluation round, only by rater experience level. The concordance was worse for PFNFs with anterior or posterior translation or with a comminuted medial or posterior columns.

Reproducibility of the Mayo and Schatzker classification systems in proximal ulna fractures

IntroductionA fracture classification system should provide a reliable and reproducible means of communication between different parties. It should be logical and understandable, with few categories to memorize. The aim of this study was to determine the intra- and interobserver reliability of the Schatzker and Mayo classification systems for the assessment of proximal ulna fractures. Materials and methodsIntra- and interobserver reliability studies were conducted on 39 X-rays of injured elbows drawn randomly from 74 cases previously used in a series on predictors of ulnohumeral osteoarthritis in proximal ulna fractures. Ten observers independently reviewed these X-rays on 2 separate occasions 3 months apart. The fracture type was assessed according to the Schatzker and Mayo classification systems during each reading session. Cohen's and Fleiss’ kappa were used to measure the intra- and interobserver reliability. ResultsThe Schatzker classification had a fair interobserver reliability for the first (Schatzker R1, Fleiss’ κ: 0.394) and second (Schatzker R2, Fleiss’ κ: 0.351) readings. The mean intraobserver reliability value between the 10 reviewers for the Schatzker classification was rated as substantial (0.61). The Mayo classification had a fair interobserver reliability for the first (Mayo R1, Fleiss’ κ: 0.278) and second (Mayo R2, Fleiss’ κ: 0.292) readings. The mean intraobserver reliability value between the 10 reviewers for the Mayo classification was rated as fair (0.52). DiscussionThe classification systems for proximal ulna fractures showed poor reproducibility between the different observers since they had low interobserver agreement values. Nevertheless, their use remained reliable since the measured intraobserver agreement value was deemed substantial. Level of evidenceIV; retrospective.