Fair Reliability Research Articles

Developing a Cantonese Version of Birmingham Cognitive Screen for Stroke Survivors in Hong Kong

The Birmingham Cognitive Screen (BCoS) is a neuropsychological battery designed to assess impairment to a variety of cognitive domains including language in patients with brain injuries. Twenty-two stroke participants and 16 gender-, age-, and education-matched controls were recruited in Hong Kong. The stroke participants were administered HK-BCoS as well as standardized batteries of cognitive and language functions validated for the Cantonese-speaking population in Hong Kong, including the Cantonese version of the Western Aphasia Battery, Cantonese Mini-Mental State Examination, and the Hong Kong–Montreal Cognitive Assessment. Results showed that HK-BCoS demonstrated good concurrent validity with all standardized batteries. HK-BCoS could discriminate between cognitive impairments in stroke patients and normal participants. Furthermore, HK-BCoS was found to have excellent intrarater and interrater reliabilities, good test–retest reliability, and fair split-half reliability as judged according to international criteria. In sum, HK-BCoS is a valid and reliable tool for assessing cognitive processing in Cantonese speakers in Hong Kong.

Reliability between online raters with varying familiarities of a region: Microscale Audit of Pedestrian Streetscapes (MAPS)

BackgroundTo test inter-rater reliability of the online Microscale Audit of Pedestrian Streetscapes (MAPS) tool between raters with varying familiarities of Phoenix, Arizona. MethodsThe online MAPS tool, based on the MAPS in-field audit tool and scoring system, was used for audits. Sixty route pairs, 141 segment pairs, and 92 crossing pairs in Phoenix were included. Each route, segment or crossing was audited by two independent raters: one rater in Phoenix and the other in San Diego, California, respectively. Item, subscale scores, and total scores reliability analyses were computed using Kappa or intra-class correlation coefficient (ICC). ResultsThe route overall score had substantial reliability (ICC: 0.832). Of the route subscale and overall scores, sixteen out of twenty had moderate to substantial reliability (ICC: 0.616–0.906), and the four subscales had fair reliability (ICC: 0.409–0.563). Sixteen out of twenty scores in segment and crossing sections demonstrated fair to substantial reliability (ICC: 0.448–0.897), and the remaining four had slight reliability (ICC: 0.348–0.364). ConclusionsMost of the online MAPS items, subscales, and overall scores demonstrated fair to substantial reliability between raters with varied familiarities of the Phoenix area. Resultssupport use of online MAPS to measure microscale elements of the built environment by raters unfamiliar with a region.

The risk of bias in systematic reviews tool showed fair reliability and good construct validity

ObjectiveThere is a movement from generic quality checklists toward a more domain-based approach in critical appraisal tools. This study aimed to report on a first experience with the newly developed risk of bias in systematic reviews (ROBIS) tool and compare it with A Measurement Tool to Assess Systematic Reviews (AMSTAR), that is, the most common used tool to assess methodological quality of systematic reviews while assessing validity, reliability, and applicability. Study Design and SettingValidation study with four reviewers based on 16 systematic reviews in the field of occupational health. ResultsInterrater reliability (IRR) of all four raters was highest for domain 2 (Fleiss' kappa κ = 0.56) and lowest for domain 4 (κ = 0.04). For ROBIS, median IRR was κ = 0.52 (range 0.13–0.88) for the experienced pair of raters compared to κ = 0.32 (range 0.12–0.76) for the less experienced pair of raters. The percentage of “yes” scores of each review of ROBIS ratings was strongly correlated with the AMSTAR ratings (rs = 0.76; P = 0.01). ConclusionROBIS has fair reliability and good construct validity to assess the risk of bias in systematic reviews. More validation studies are needed to investigate reliability and applicability, in particular.

Development and Reliability of a Preliminary Foot Osteoarthritis Magnetic Resonance Imaging Score.

Foot osteoarthritis (OA) is very common but underinvestigated musculoskeletal condition and there is little consensus as to common magnetic resonance imaging (MRI) features. The aim of this study was to develop a preliminary foot OA MRI score (FOAMRIS) and evaluate its reliability. This preliminary semiquantitative score included the hindfoot, midfoot, and metatarsophalangeal joints. Joints were scored for joint space narrowing (JSN; 0-3), osteophytes (0-3), joint effusion/synovitis, and bone cysts (present/absent). Erosions and bone marrow lesions (BML) were scored (0-3) and BML were evaluated adjacent to entheses and at sub-tendon sites (present/absent). Additionally, tenosynovitis (0-3) and midfoot ligament pathology (present/absent) were scored. Reliability was evaluated in 15 people with foot pain and MRI-detected OA using 3.0T MRI multi-sequence protocols, and assessed using ICC as an overall score and per anatomical site. Intrareader agreement (ICC) was generally good to excellent across the foot in joint features (JSN 0.90, osteophytes 0.90, effusion/synovitis 0.46, cysts 0.87), bone features (BML 0.83, erosion 0.66, BML entheses 0.66, BML sub-tendon 0.60) and soft tissue features (tenosynovitis 0.83, ligaments 0.77). Interreader agreement was lower for joint features (JSN 0.43, osteophytes 0.27, effusion/synovitis 0.02, cysts 0.48), bone features (BML 0.68, erosion 0.00, BML entheses 0.34, BML sub-tendon 0.13), and soft tissue features (tenosynovitis 0.35, ligaments 0.33). This preliminary FOAMRIS demonstrated good intrareader reliability and fair interreader reliability when assessing the total feature scores. Further development is required in cohorts with a range of pathologies and to assess the psychometric measurement properties.

Assessment of Intra- and Inter-Rater Reliability of Three Methods for Measuring Atopic Dermatitis Severity: EASI, Objective SCORAD, and IGA

Background: Numerous different scoring systems have been proposed for assessing the severity of atopic dermatitis (AD). Many of these methods did not undergo proper validation and reliability testing. Objective: The aim of our study was to compare the reliability and reproducibility of the Eczema Area and Severity Index (EASI), objective Scoring Atopic Dermatitis (oSCORAD), and Investigator Global Assessment (IGA). Methods: On the scoring day, 10 trained dermatologists evaluated 10 adult patients with AD using the EASI, oSCORAD, and IGA. All subjects were assessed twice by each physician. Correlations between measures were analysed using the Pearson correlation coefficient. The intra-class correlation coefficient (ICC) was calculated to assess intra-rater reliability; the coefficient of variation (CV) was used to assess inter-rater variability. Results: Significant positive correlations were observed between each scale in both assessments. The ICCs for the EASI and oSCORAD were 0.71 and 0.66, respectively, indicating good reliability, while the ICC for the IGA (0.54) indicated only fair reliability. The CVs for the oSCORAD and IGA were 28.1 and 33.0, respectively, indicating moderate variability. The CV for the EASI was 66.5, indicating high variability. Conclusion: Among the 3 compared scales, the oSCORAD had the highest inter-rater reliability, whereas the EASI had the highest intra-rater reliability. None of the 3 scoring methods showed a significant advantage over the other. Thus, a reliable assessment of AD severity requires the use of at least 2 independent measurements simultaneously.

Validation of Adapted Dartmouth Operative Conditions Scale for sedation during pediatric esophagogastroduodenoscopy.

Pediatric esophagogastroduodenoscopy requires deep sedation as it involves stimulation of the airway. Frequency of adverse events is higher with esophagogastroduodenoscopy. Hence, monitoring needs sedation scales like the Dartmouth Operative Condition Scale that identifies safe states of sedation. This study aims at validating the Adapted Dartmouth Operative Condition Scale for sedation rating by pediatricians during pediatric esophagogastroduodenoscopy. Items in the Dartmouth Operating Conditions Scale were adapted for pediatric esophagogastroduodenoscopy. Videos of 35 procedures were recorded. The recording started 10 min before sedation and continued till recovery. The videos were split into preprocedure videos, intraprocedure videos, and recovery videos, and further split into 30-s clips. Twenty representative intraprocedure videos clips were selected. Ten raters scored the videos with the Adapted Dartmouth Operating Conditions Scale and modified-COMFORT score. The Adapted Dartmouth Operating Conditions Scale scoring was repeated after a month. The preprocedure videos, intraprocedure videos, and recovery videos of ten patients (six clips each) were scored by one rater to assess responsiveness. The Adapted Dartmouth Operating Conditions Scale detected nonoptimal sedation states including laryngospasm due to undersedated states. It showed fair interrater reliability at timeline-1 (intraclass correlation coefficient = 0.45) and timeline-2 (intraclass correlation coefficient = 0.65) but poor intrarater reliability (intraclass correlation coefficient = 0.32). There was significant positive correlation with modified-COMFORT (Spearman's rank order correlation, r = 0.150). Responsiveness was demonstrated by the difference in the preprocedure videos, intraprocedure videos, and recovery videos scores (F = 126.50). The Adapted Dartmouth Operating Conditions Scale detects nonoptimal sedation states during pediatric-esophagogastroduodenoscopy. It shows good criterion validity, interrater reliability, and responsiveness. Poor intrarater reliability seen in our study could be due to item ambiguity arising from the mode of training of the raters in the Dartmouth Operating Conditions Scale.

The reliability of commonly used arthroscopic classifications of ligamentum teres pathology.

The importance of the ligamentum teres (LT) in the hip is increasingly being recognized. However, the incidence of LT tears in the literature is extremely variable. Although classification systems exist their reliability in classifying LT pathology arthroscopically has not been well defined. To determine the inter- and intra-observer reliability of two existing classifications systems for the diagnosis of LT pathology at hip arthroscopy. Second, to identify key pathological findings currently not included. Four experienced hip-arthroscopists reviewed 40 standardized arthroscopic videos. Arthroscopic findings of the LT were classified using the Gray and Villar (G&V) and descriptive classification (DC). Reviewers were asked to record other relevant pathology encountered. Inter- and intra-observer reliability was defined using Fleiss-Kappa and Cohen-Kappa statistics. Both classifications demonstrated fair inter-observer reliability. The intra-observer reliability for G&V was moderate-to-substantial and for DC was slight-to-moderate. An absolute agreement rate of 10% (G&V) and 37.5% (DC) was found. Differentiation between normal, and partial or low-grade tears was a common source of disagreement. The prevalence of LT pathology was 90%. Synovitis was the most common diagnostic finding that was not included in either classification system used in this study. Arthroscopic classification of LT pathology using the G&V and the DC demonstrated only fair inter-observer reliability. The major discrepancy in interpretation was between normal, and partial or low-grade tears. The presence of synovitis was not in either classification but was considered an important arthroscopic finding. Thorough arthroscopic scrutiny reveals the prevalence of LT pathology is higher than previously reported.

Inter- and intra- observer reliability of risk assessment of repetitive work without an explicit method

A common way to conduct practical risk assessments is to observe a job and report the observed long term risks for musculoskeletal disorders. The aim of this study was to evaluate the inter- and intra-observer reliability of ergonomists' risk assessments without the support of an explicit risk assessment method. Twenty-one experienced ergonomists assessed the risk level (low, moderate, high risk) of eight upper body regions, as well as the global risk of 10 video recorded work tasks. Intra-observer reliability was assessed by having nine of the ergonomists repeat the procedure at least three weeks after the first assessment. The ergonomists made their risk assessment based on his/her experience and knowledge. The statistical parameters of reliability included agreement in %, kappa, linearly weighted kappa, intraclass correlation and Kendall's coefficient of concordance. The average inter-observer agreement of the global risk was 53% and the corresponding weighted kappa (Kw) was 0.32, indicating fair reliability. The intra-observer agreement was 61% and 0.41 (Kw). This study indicates that risk assessments of the upper body, without the use of an explicit observational method, have non-acceptable reliability. It is therefore recommended to use systematic risk assessment methods to a higher degree.

The determinants of work position among Gen X:a case of UiTM graduate

The purpose of this preliminary research is to identify corporate talents’ positioning of the UiTM graduates especially the Generation X, within the industries. At the same time, there is also the need to ascertain the factors that contributed to the success of the UiTM Generation X graduates. Majority of the research which have been conducted on the graduates involved the employability rate. However, none has been carried out in identifying the graduates’ career accomplishment. The sample of this research consisted of 191 UiTM graduates who are born between 1965 until 1985 (known as the Generation X). The responses were obtained via an online survey sent to random groups in UiTM emails. In addition, Facebook was also used as a medium in dissemininating the survey forms to random individuals whom has connections with the Generation X alumni. Rasch Measurement Model was employed by using the software WINSTEP 3.72.3, to measure the reliability and validity of the instrument. SPSS version 21 was used to answer the research objective of the study. The result has produced a fair person reliability at +0.66 while the Cronbach Alpha reliability value was at 0.72 and an excellent item reliability of 0.99. In terms of career positioning, 60% of the Generation- falls within the middle management position. This reflects the success of the Gen-X where most of them were able to obtain posts like lecturers, engineers and managers. As for the factors which contributed to the success of the alumni, it was found that involvement in clubs, soft skills and orientation towards religion play important roles in determining the career position of GenX. These findings validate past research and demonstrate that the pattern continues into the present. Surprisingly, it was found that academic achievement, hard skills and personality traits hardly had any influence on the career positions of the Gen-X. It was also discovered that the success of the Gen-X could be due to other factors which is beyond the horizon of this research. Therefore, it was recommended that students should be encouraged to be actively involved in clubs. This must be balanced with religious values exposure so that they know the limit of their involvement.

Reliability and reproducibility analysis of the AOSpine thoracolumbar spine injury classification system by Chinese spinal surgeons.

The objective of this study was to analyze the interobserver reliability and intraobserver reproducibility of the new AOSpine thoracolumbar spine injury classification system in young Chinese orthopedic surgeons with different levels of experience in spinal trauma. Previous reports suggest that the new AOSpine thoracolumbar spine injury classification system demonstrates acceptable interobserver reliability and intraobserver reproducibility. However, there are few studies in Asia, especially in China. The AOSpine thoracolumbar spine injury classification system was applied to 109 patients with acute, traumatic thoracolumbar spinal injuries by two groups of spinal surgeons with different levels of clinical experience. The Kappa coefficient was used to determine interobserver reliability and intraobserver reproducibility. The overall Kappa coefficient for all cases was 0.362, which represents fair reliability. The Kappa statistic was 0.385 for A-type injuries and 0.292 for B-type injuries, which represents fair reliability, and 0.552 for C-type injuries, which represents moderate reliability. The Kappa coefficient for intraobserver reproducibility was 0.442 for A-type injuries, 0.485 for B-type injuries, and 0.412 for C-type injuries. These values represent moderate reproducibility for all injury types. The raters in Group A provided significantly better interobserver reliability than Group B (P<0.05). There were no between-group differences in intraobserver reproducibility. This study suggests that the new AO spine injury classification system may be applied in day-to-day clinical practice in China following extensive training of healthcare providers. Further prospective studies in different healthcare providers and clinical settings are essential for validation of this classification system and to assess its utility.

Palatal Motion After Primary and Secondary Furlow Palatoplasty

Indications for Furlow palatoplasty include primary repair of cleft palate as well as secondary repair, or secondary palatoplasty for treatment of velopharyngeal insufficiency. Speculation exists surrounding the benefit of secondary Furlow palatoplasty in cases of a previously well-reconstructed palate or a short but otherwise anatomically normal soft palate because it has been theorized that reorientation of a previously reconstructed or normal muscular levator sling should in fact worsen palatal motion. To compare palatal motion following primary and secondary Furlow palatoplasty using footage from postoperative nasopharyngoscopy videos. In this retrospective case series, medical records in a database of an urban academic pediatric otolaryngology practice was used to identify patients who had undergone either primary or secondary Furlow palatoplasty. Subjects with adequate postoperative nasopharyngoscopy footage were randomized, and 2 blinded reviewers assessed soft palate motion in each video using an abbreviated version of the Golding-Kushner scale. Reviewers' blinded ratings of soft palate motion were quantified using a modified Golding-Kushner scale to generate a mean palatal motion score for each subject (range, 0.0-2.0). Scores of primary and secondary Furlow palatoplasty patients were compared. Over a 4-year period, 20 patients with adequate postoperative nasopharyngoscopy footage were identified (12 primary Furlow palatoplasty patients and 8 secondary Furlow palatoplasty patients). Patients consisted of 8 males and 12 females and ranged in age from 12 months to 22 years at the time of postoperative nasopharyngoscopy. Modified Golding-Kushner scores were similar between groups: mean primary group, 1.61 (range, 0.5-2.0); mean secondary group, 1.53 (range, 0.75-2.0); absolute difference in mean, 0.08 (95% CI, 0.00-0.43); effect size, Hedges g, 0.18. There was fair interrater reliability (interclass coefficient, R = 0.45), consistent with prior reports using this scale. No significant difference in postoperative palatal motion scores was identified between primary and secondary palatoplasty groups in this study. When examined in isolation, postoperative motion of the soft palate appears similar following both primary and secondary Furlow palatoplasty procedures, suggesting that there are no major deleterious effects on palatal motion following secondary Furlow palatoplasty.

Does Computed Tomography Change our Observation and Management of Fracture Non-Unions?

The purpose of this study was to determine whether Multi-Detector Computed Tomography (MDCT) in addition to plain radiographs influences radiologists' and orthopedic surgeons' diagnosis and treatment plans for delayed unions and non-unions. A retrospective database of 32 non-unions was reviewed by 20 observers. On a scale of 1 to 5, observers rated on X-Ray and a subsequent Multi Detector Helical Computer Tomography (MDCT) scan was performed to determine the following categories: "healed", "bridging callus present", "persistent fracture line" or "surgery advised". Interobserver reliability in each category was calculated using the Interclass Correlation Coefficient (ICC). The influence of the MDCT scan on the raters' observations was determined in each case by subtracting the two scores of both time points. All four categories show fair interobserver reliability when using plain radiographs. MDCT showed no improvement, the reliability was poor for the categories "bridging callus present" and "persistent fracture line", and fair for "healed" and "surgery advised". In none of the cases, MDCT led to a change of management from nonoperative to operative treatment or vice versa. For 18 out of 32 cases, the treatment plans did not alter. In seven cases MDCT led to operative treatment while on X-ray the treatment plan was undecided. In this study, the interobserver reliability of MDCT scan is not greater than conventional radiographs for determining non-union. However, a MDCT scan did lead to a more invasive approach in equivocal cases. Therefore a MDCT is only recommended for making treatment strategies in those cases.

Derivation of Two Critical Appraisal Scores for Trainees to Evaluate Online Educational Resources: A METRIQ Study

IntroductionOnline education resources (OERs), like blogs and podcasts, increasingly augment or replace traditional medical education resources such as textbooks and lectures. Trainees’ ability to evaluate these resources is poor, and few quality assessment aids have been developed to assist them. This study aimed to derive a quality evaluation instrument for this purpose.MethodsWe used a three-phase methodology. In Phase 1, a previously derived list of 151 OER quality indicators was reduced to 13 items using data from published consensus-building studies (of medical educators, expert podcasters, and expert bloggers) and subsequent evaluation by our team. In Phase 2, these 13 items were converted to seven-point Likert scales used by trainee raters (n=40) to evaluate 39 OERs. The reliability and usability of these 13 rating items was determined using responses from trainee raters, and top items were used to create two OER quality evaluation instruments. In Phase 3, these instruments were compared to an external certification process (the ALiEM AIR certification) and the gestalt evaluation of the same 39 blog posts by 20 faculty educators.ResultsTwo quality-evaluation instruments were derived with fair inter-rater reliability: the METRIQ-8 Score (Inter class correlation coefficient [ICC]=0.30, p<0.001) and the METRIQ-5 Score (ICC=0.22, p<0.001). Both scores, when calculated using the derivation data, correlated with educator gestalt (Pearson’s r=0.35, p=0.03 and r=0.41, p<0.01, respectively) and were related to increased odds of receiving an ALiEM AIR certification (odds ratio=1.28, p=0.03; OR=1.5, p=0.004, respectively).ConclusionTwo novel scoring instruments with adequate psychometric properties were derived to assist trainees in evaluating OER quality and correlated favourably with gestalt ratings of online educational resources by faculty educators. Further testing is needed to ensure these instruments are accurate when applied by trainees.

Reproducibility assessment of brain responses to visual food stimuli in adults with overweight and obesity.

The brain's reward system influences ingestive behavior and subsequently obesity risk. Functional magnetic resonance imaging (fMRI) is a common method for investigating brain reward function. This study sought to assess the reproducibility of fasting-state brain responses to visual food stimuli using BOLD fMRI. A priori brain regions of interest included bilateral insula, amygdala, orbitofrontal cortex, caudate, and putamen. Fasting-state fMRI and appetite assessments were completed by 28 women (n = 16) and men (n = 12) with overweight or obesity on 2 days. Reproducibility was assessed by comparing mean fasting-state brain responses and measuring test-retest reliability of these responses on the two testing days. Mean fasting-state brain responses on day 2 were reduced compared with day 1 in the left insula and right amygdala, but mean day 1 and day 2 responses were not different in the other regions of interest. With the exception of the left orbitofrontal cortex response (fair reliability), test-retest reliabilities of brain responses were poor or unreliable. fMRI-measured responses to visual food cues in adults with overweight or obesity show relatively good mean-level reproducibility but considerable within-subject variability. Poor test-retest reliability reduces the likelihood of observing true correlations and increases the necessary sample sizes for studies.

Noninvasive Assessment of Liver Fibrosis By Transient Elastography and FIB4/APRI for Prediction of Treatment Response in Chronic Hepatitis C—An Experience from a Tertiary Care Hospital

Liver fibrosis and its sequel cirrhosis represent a major health care burden, and assessment of fibrosis by biopsy is gradually being replaced by noninvasive methods. In clinical practice, the determination of fibrosis stage is important, since patients with advanced fibrosis have faster progression to cirrhosis and antiviral therapy is indicated in these patients. To assess the role of transient elastography (TE) and compare it with APRI and FIB4 for predicting liver fibrosis and assessing the effect of host and viral factors on fibrosis and treatment outcome in CHC patients. In a retrospective analysis, 330 CHC patients underwent liver stiffness measurement (LSM) by TE and tests needed for calculating APRI and FIB4 scores at baseline. 228 patients received a combination of Pegylated IFN-based antiviral therapy and were analyzed for therapeutic response. The study included 330 patients (median age 39 years [range 18-67]), predominantly males (n=227, 68.8%) with baseline LSMs. The median liver stiffness was 7.8kPa (range 3.2-69.1kPa). LSMs and its thresholds for severe fibrosis progression (≥9.5kPa) and cirrhosis (≥12.5kPa) were significantly higher in patients with age ≥40 years, diabetes mellitus, and patients with significant alcohol intake (P=0.003 to P<0.001). By taking TE as a reference, the diagnostic accuracy of FIB4 scores for predicting cirrhosis (AUROC 0.896) was good (+LR 13.4) compared to APRI (AUROC 0.823) with moderate likelihood ratio (+LR 6.9). Among 228 treated patients the SVR rate in genotype 3 was 70% versus 57.8% in genotype 1. Fibrosis score F4 (P=0.023) and HCV genotype (P=0.008) were independent predictors of SVR. The study shows that LSM by TE and fibrosis assessment by FIB4/APRI scores can be used with fair reliability to predict fibrosis and treatment response in patients with CHC infection.

Variation in the preferred movement path while walking barefoot and with minimal shoes on a cross-sloped surface

Document reliability and normative data for a novel device measuring weight-bearing ankle range of motion after ankle injury.Cross-sectional Cohort, two occasions one day apart.Sports medicine hospital.87 ankle-injured male athletes at a late stage of their rehabilitation and 25 uninjured subjects. The injured athletes had met all criteria to return to functional, on-field rehabilitation.Reliability (Intra-Class correlation Coefficient (ICC), and Minimum Detectable Change as a percent of the grand mean), weight-bearing range of motion (degrees) of dorsiflexion, plantarflexion, inversion, and eversion.Good (dorsiflexion = 0.82[0.76–0.87] and inversion = 0.81[0.75–0.86]) and excellent (plantarflexion = 0.93[0.90–0.95]) reliability was documented, however reliability for the eversion measure showed only fair reliability (0.61[0.49–0.70]). Reduced range of motion in the injured leg was seen in all 4 directions, however with different magnitudes: Large differences were plantarflexion (−8.5°, ES = 0.80), medium for dorsiflexion (−5.2°, 0.57), small for inversion (−4.8°, 0.36), and trivial for eversion (−1.7°, 0.15).The device demonstrated clinically useful reliability for measuring these ranges of motion in a functional, weight-bearing position. PF ROM showed the greatest reduction in range in these athletes at a late stage of their rehabilitation.

Evaluation of milk cathelicidin for detection of bovine mastitis.

Mastitis due to intramammary infection is one of the most economically relevant diseases in dairy cows, causing reductions in milk quality and quantity. Currently, mastitis monitoring is based on somatic cell count (SCC) and bacteriologic culture (BC) of milk. Nevertheless, inflammation-specific protein markers might provide more sensitive and reliable assays, enabling immunoassay-based screening strategies. Cathelicidin is an inflammatory protein released in milk that has recently demonstrated fair reliability and diagnostic potential for ewe mastitis. To assess its performance in cows, 531 quarter milk samples from 2 herds were tested using cathelicidin ELISA, SCC, and BC. We found that 29.0% of samples were positive for cathelicidin, 18.8% had SCC >200,000 cells/mL, and 13.7% were BC-positive. Cathelicidin showed a strong positive correlation with SCC as demonstrated by receiver operating characteristics curve analysis and by the clustering of cathelicidin-negative and cathelicidin-positive samples in association with low and high SCC values, respectively. For evaluating the diagnostic performance of a novel test, BC cannot be considered a reliable gold standard for true disease status because of its known limitations. Therefore, we assessed the sensitivity (Se) and specificity (Sp) of the milk cathelicidin ELISA using a latent class analysis approach together with BC and SCC by considering different diagnostic thresholds to identify the preferred Se/Sp combination. We modeled conditional dependence of cathelicidin and SCC to account for their close association. The cathelicidin ELISA showed higher Se than SCC and BC for almost all threshold combinations. In fact, at the best-performing threshold combination, the Se of cathelicidin was 80.6%, 6.2 percentage points higher than that of SCC >200,000 cells/mL (74.4%) and similar to that of SCC >100,000 cells/mL (80.2%). Most importantly, this Se was obtained with a loss in Sp of only 1.4 percentage points compared with SCC >200,000 cells/mL (94.9% Sp for cathelicidin vs. 96.3% for SCC >200,000). The limited Se of BC (38.8%) was also confirmed in this study, and BC showed a slightly lower Sp than both cathelicidin and SCC for most of threshold combinations. This study confirmed that cathelicidin is released in the milk of cows with mastitis and that its presence is highly correlated with SCC. The measurement of cathelicidin by ELISA may hold significant potential for improving the sensitivity of mastitis detection in dairy cows while maintaining high specificity.

Reliable and Rapid Robotic Assessment of Wrist Proprioception Using a Gauge Position Matching Paradigm.

Quantitative assessments of position sense are essential for the investigation of proprioception, as well as for diagnosis, prognosis and treatment planning for patients with somatosensory deficits. Despite the development and use of various paradigms and robotic tools, their clinimetric properties are often poorly evaluated and reported. A proper evaluation of the latter is essential to compare results between different studies and to identify the influence of possible confounds on outcome measures. The aim of the present study was to perform a comprehensive evaluation of a rapid robotic assessment of wrist proprioception using a passive gauge position matching task. Thirty-two healthy subjects undertook six test-retests of proprioception of the right wrist on two different days. The constant error (CE) was 0.87°, the absolute error (AE) was 5.87°, the variable error (VE) was 4.59° and the total variability (E) was 6.83° in average for the angles presented in the range from 10° to 30°. The intraclass correlation analysis provided an excellent reliability for CE (0.75), good reliability for AE (0.68) and E (0.68), and fair reliability for VE (0.54). Tripling the assessment length had negligible effects on the reliabilities. Additional analysis revealed significant trends of larger overestimation (constant errors), as well as larger absolute and variable errors with increased flexion angles. No proprioceptive learning occurred, despite increased familiarity with the task, which was reflected in significantly decreased assessment duration by 30%. In conclusion, the proposed automated assessment can provide sensitive and reliable information on proprioceptive function of the wrist with an administration time of around 2.5 min, demonstrating the potential for its application in research or clinical settings. Moreover, this study highlights the importance of reporting the complete set of errors (CE, AE, VE, and E) in a matching experiment for the identification of trends and subsequent interpretation of results.

Test-retest reliability of a single-channel, wireless EEG system

Recording systems to acquire electroencephalogram (EEG) data are traditionally lab-based. However, there are shortcomings to this method, and the ease of use and portability of emerging wireless EEG technologies offer a promising alternative. A previous validity study demonstrated data derived from a single-channel, wireless system (NeuroSky ThinkGear, San Jose, California) is comparable to EEG recorded from conventional lab-based equipment. The current study evaluated the reliability of this portable system using test-retest and reliable change analyses. Relative power (RP) of delta, theta, alpha, and beta frequency bands was derived from EEG data obtained from a single electrode over FP1 in 19 healthy youth (10–17years old), 21 healthy adults (18–28years old), and 19 healthy older adults (55–79years old), during eyes-open, eyes-closed, auditory oddball, and visual n-back conditions. Intra-class correlations (ICCs) and Coefficients of Repeatability (CRs) were calculated from RP data re-collected one-day, one-week, and one-month later. Participants' levels of mood and attention were consistent across sessions. Eyes-closed resting EEG measurements using the portable device were reproducible (ICCs 0.76–0.85) at short and longer retest intervals in all three participant age groups. While still of at least fair reliability (ICCs 0.57–0.85), EEG obtained during eyes-open paradigms was less stable, and any change observed over time during these testing conditions can be interpreted utilizing the CR values provided. Combined with existing validity data, these findings encourage application of the portable EEG system for the study of brain function.

Profile of Current Opinion on Arthroscopic Acromioplasty: A Video Survey Study

To provide a baseline profile of current opinion on use of arthroscopic acromioplasty and evaluate the consistency of surgical decision making on whether or not to perform acromioplasty across different surgeon practices. Twenty-two fellowship-trained orthopaedic shoulder surgeons from the Association of Clinical Elbow and Shoulder Surgeons completed an Internet-based survey on practices associated with acromioplasty, including questions related to 15 arthroscopic videos. Based on video cases, interobserver and intraobserver agreement regarding clinically based decisions related to acromioplasty were assessed. Acromioplasty was uncommonly performed in isolation among this group and was most commonly performed in conjunction with repair of full-thickness rotator cuff tears. Nineteen of 22 (86%) surgeons favored an arthroscopic approach for acromioplasty. Depth of bony resection was determined most commonly based on clinical judgment and experience (68%). The video portion of the survey revealed slight interobserver agreement for classification of acromion morphology (κ= 0.099), need for acromioplasty (κ= 0.020), and adequacy of decompression (κ= 0.1). In contrast, there was fair intraobserver reliability regarding acromion morphology (κ= 0.370) and decision whether to perform acromioplasty in a given case (κ= 0.348) whereas there was moderate intraobserver reliability inthe presence of a reparable rotator cuff tear (κ= 0.507) and assessment of the adequacy of decompression (κ= 0.453). Although surgeons had similarities regarding principles of acromioplasty, including indications, surgical approach, and technique, there was lack of consensus when surgeons reviewed the video of clinical cases. Although surgeons may have similar goals in terms of treatment of pathology related to subacromial impingement, individual surgeon thresholds for the need and adequacy of decompression are varied and are not standardized. Level V, expert opinion.