Good Intraclass Correlation Research Articles

Left atrial appendage: a comparative analysis using 2D and 3D transoesophageal echocardiography

Abstract Background Percutaneous left atrial appendage (LAA) closure is an alternative intervention to anticoagulation to prevent stroke in patients with atrial fibrillation with a higher risk of bleeding. The imaging of LAA is crucial to determine the optimal ostium dimensions for safe closure and procedural outcomes. Sizing using three-dimensional transoesophageal echocardiography (3D-TOE) is likely to offer a more accurate assessment, as seen in other structural interventions such as annular measurements in transcatheter aortic valve implantation (TAVI). Aim This study aimed to evaluate the accuracy of LAA sizing using two-dimensional transesophageal echocardiography (2D-TOE) and 3D-TOE. Furthermore, we assessed the accuracy of the measurements by correlating both imaging modalities with final device size and post-device leakage. Methods Our study prospectively analysed the LAA dimensions of 63 consecutive patients undergoing transoesophageal echocardiography (TOE) with measurements using both 2D and 3D-TOE (Figure 1 & 2). The assessing clinician remained blinded to measurements that were performed retrospectively by data analysts. Additionally, we retrospectively evaluated outcomes with 25 consecutive LAA closures (Figure 3 & 4), where 2D-TOE was utilised alongside fluoroscopy for sizing in 18 (72%), and 3D-TOE was employed in 8 (32%) of patients. Results The mean age of patients was 76 ± 7 years. The LAA annulus was eccentric in 47 (75%) and circular in 16 (25%) of patients. There was a good intraclass correlation (ICC) between 2D and 3D-TOE (ICC=0.81, p <0.001) and Pearson’s correlation (r=0.84, p <0.001). Bland-Altmann analysis (Figure 5) revealed a bias of 0.19, indicating 3D-TOE LAA measurements were larger overall, with limits of agreement between -0.33cm to 0.71cm. The retrospective analysis showed that 2D-TOE underestimated the final device size by 1.86 ± 1.1 mm, while 3D-TOE underestimated by 0.6 ± 1.2 mm. Clinically, using only 2D-TOE measurements, 9 patients (36%) required upsizing, whereas 3D-TOE accurately predicted the final device size in all but one case. Additionally, in 18 cases guided solely by 2D-TOE, 9 (50%) were complicated by post-device leakage at the six-week follow-up, albeit they were all leaks were less than the guideline cut-off value of 6 mm. In contrast, for 8 patients where 3D-TOE was also used, there was only one case of post-device leak. Conclusion Our study demonstrates that while 2D and 3D-TOE values are mostly consistent, 3D-TOE measurements are larger and more accurately depict the irregular, eccentric nature of LAA orifices. 3D-TOE guidance had better correlation with true device size, resulting in lower post-device leakage and less intra-procedural upsizing. These findings align with TAVI literature, which notes that 2D echocardiography underestimates the true size of the aortic valve annulus compared to CT and 3D echocardiography techniques.

Imaging the Brainstem Raphe in Medication-Overuse Headache: Pathophysiological Insights and Implications for Personalized Care.

Background/Objectives: Medication-overuse headache (MOH) is a disabling condition affecting patients with chronic migraine resulting from excessive use of acute headache medication. It is characterized by both pain modulation and addiction-like mechanisms involving the brainstem raphe, a region critical to serotonergic signaling. This study investigates whether alterations in the brainstem raphe, assessed via transcranial sonography (TCS), are associated with MOH and independent of depressive symptoms, aiming to explore their utility as a biomarker. Methods: This prospective case-control study included 60 migraine patients (15 with MOH) and 7 healthy controls. Comprehensive clinical and psychometric assessments were performed to evaluate headache burden, medication use, and depressive symptoms. TCS was used to assess brainstem raphe echogenicity, with findings analyzed using generalized linear models adjusted for depression. Results: Non-visibility of the brainstem raphe was significantly associated with MOH, with an unadjusted odds ratio (OR) of 6.88 (95% CI: 1.32-36.01, p = 0.02). After adjusting for depressive symptoms, this association remained significant, with an adjusted OR of 1.85 (95% CI: 1.02-3.34, p = 0.041). TCS demonstrated good intraclass correlation, highlighting its reproducibility and ability to detect changes relevant to MOH pathophysiology. Conclusions: Brainstem raphe alterations are associated with MOH and may serve as a potential biomarker for its diagnosis and management. TCS offers a non-invasive, cost-effective tool for identifying MOH-specific mechanisms, which could improve clinical decision-making and support personalized care in chronic headache disorders. Further studies are needed to validate these findings and refine the clinical applications of brainstem-focused diagnostics.

Characterization of the Biological Variability of the Angiome Biomarkers over Time in Healthy Participants.

Biomarker analyses are an integral part of cancer research. Despite the intense efforts to identify and characterize biomarkers in patients with cancer, little is known regarding the natural variation of biomarkers in healthy populations. Here we conducted a clinical study to evaluate the natural variability of biomarkers over time in healthy participants. The angiome multiplex array, a panel of 25 circulating protein biomarkers, was assessed in 28 healthy participants across eight timepoints over the span of 60 days. We utilized the intraclass correlation coefficient (ICC) to quantify the reliability of the biomarkers. Adjusted ICC values were calculated under the framework of a linear mixed-effects model, taking into consideration age, sex, body mass index, fasting status, and sampling factors. ICC was calculated to determine the reliability of each biomarker. Hepatocyte growth factor was the most stable marker (ICC = 0.973), while platelet-derived growth factor (PDGF)-BB was the most variable marker (ICC = 0.167). In total, ICC analyses revealed that 22 out of 25 measured biomarkers display good (≥0.4) to excellent (>0.75) ICC values. Three markers (PDGF-BB, TGFβ1, PDGF-AA) had ICC values <0.4. Greater age was associated with higher IL6 (P = 0.0114). Higher body mass index was associated with higher levels of IL6 (P = 0.0003) and VEGF-R3 (P = 0.0045). Of the 25 protein biomarkers measured over this short time period, 22 markers were found to have good or excellent ICC values, providing additional validation for this biomarker assay. These data further support the validation of the angiome biomarker assay and its application as an integrated biomarker in clinical trial testing.

Reliability of a novel neck external loading dynamometer

Cervistab is an electro-pneumatic device that produces flexion push-loading events in an ecological rugby position (i.e. similar to on-pitch position) to assess neck extensors muscle response to a flexion perturbation. This response is important for preventing head/neck injuries in Rugby, however there is a clear lack of validated devices in the literature.This study tested the reliability of this new device designed to investigate the extensor neck muscle response to flexion head push-loading event. Twelve healthy volunteers were tested with Cervistab in a test/retest protocol. Participants experienced push-loading events with preloading on extensors muscles at 50 % and 20 % of their maximum voluntary isometric extension strength. Muscle mechanical latency, non-reflex and reflex rates of force development were measured twice, 7 days apart. Reliability was assessed by intraclass correlation coefficient (ICC), coefficient of variation (CV), and the Bland and Altman graphical approach.For both preloading conditions, muscle mechanical latency showed good ICC values from 0.81 to 0.88 and good CV (3.5%). Non-reflex and reflex rates of force development showed good reliability with ICC ranging from 0.78 to 0.89, and moderate CV values ranging from 8.5% to 14.5%, depending on the preloading condition (20% and 50% of maximal isometric extension contraction respectively). Bland and Altman plots showed no significant fixed or proportional bias.Overall, the reliability of measurements obtained with Cervistab is good. Cervistab can be used in practice to improve our understanding of the neuromechanical factors that influence neck stability, to help prevent head/neck injuries and to guide the decision to return to play after a head or neck injury.

Development and testing of a tool to assess parental care for children with mental illness (PCCMI).

Involving parents in mental health treatment services can empower parents to manage their child's illness. We conducted this study to develop a tool to assess parental care for children with mental illness. The present study was conducted in five phases that included in-depth interviews with parents in the outpatient department (OPD), focus group discussions (FGDs) with parents in an in-patient setting, and with a multidisciplinary team, item development, and the assessment of psychometric properties of the tool. Parental care for children with mental illness (PCCMI) has 50 items derived from a thematic analysis of in-depth interviews of 31 parents and 2 FGDs with eight parents admitted at CPC and eight mental health professionals experienced in child and adolescent psychiatry. It is a 5-point Likert scale. The tool showed a high item-level Content Validity Index (I-CVI range: 0.8-1.0) and a high Scale Content Validity Index (S-CVI = 0.91). The test-retest method was used to calculate reliability. A total of 38 parents were included in the test-retest method. The mother and father's mean age and standard deviation (SD) scores were 39.7 ± 5.8 and 45.1 ± 4.9, respectively. Most parents' education level is above graduation (mothers: 86.8% and fathers: 86%). Around 63% of mothers were housewives and had normal pregnancies. The single measure two-way mixed absolute agreement intraclass correlation coefficient (ICC) value for 38 subjects was 0.96 with a 95% confidence interval (CI: 0.90-0.95), indicating high reliability. PCCMI has high I-CVI and S-CVI and good ICC test-retest reliability. This tool will help mental health professionals in the formal assessment of parental care for children with mental illness and provide the intervention to address issues related to the same.

Evaluating the Reliability and Model Fit of the 13-Item and 10-Item Big Five Inventory (Malay Version) among Malaysian Firefighters.

Lengthy instruments for assessing personality traits may not be applicable in certain research settings. In situations where time is scarce, a briefer measurement is preferable. However, the reliability of a briefer measurement of the Big Five Inventory (BFI) among firefighters in Malaysia has not been reported. This study aimed to investigate the reliability and model fit of the Malay version of the BFI with 13 items (BFI-13) and 10 items (BFI-10) among Malaysian firefighters. A cross-sectional study using cluster sampling was conducted in a state in Malaysia. Each respondent completed BFI-10 and BFI-13 using an online survey with a 1-month interval between each response. Reliability testing was evaluated using internal consistency and a 2-week interval test-retest. The model fit of these two BFI questionnaires was evaluated via confirmatory factor analysis (CFA). A total of 124 firefighters participated in the study, with a zero-dropout rate. The Malay version of BFI-13 exhibited higher reliability by displaying good internal consistency with Cronbach's alpha of 0.919, 0.838, 0.871 and 0.896 for the domains conscientiousness, neuroticism, agreeableness and extraversion, respectively, and acceptable test-retest reliability with moderate to good intraclass correlation (0.588-0.806). The CFA model also indicated that BFI-13 has a better model fit (comparative fit index [CFI] = 0.993; Tucker-Lewis index [TLI] = 0.991; standardised root mean squared residual [SRMR] = 0.029; root mean square error of approximation [RMSEA] = 0.035). The Malay version of BFI-13 is reliable and applicable enough to be supplementarily used in surveys among Malaysian firefighters. By using a brief personality assessment, it will reduce the cognitive and emotional burden on respondents.

Persistent inward currents in tibialis anterior motoneurons can be reliably estimated within the same session

The response of spinal motoneurons to synaptic input greatly depends on the activation of persistent inward currents (PICs), the contribution of which can be estimated through the paired motor unit technique. Yet, the intra-session test–retest reliability of this measurement remains to be fully established. Twenty males performed isometric triangular dorsiflexion contractions to 20 and 50 % of maximal torque at baseline and after a 15-min resting period. High-density electromyographic signals (HD-EMG) of the tibialis anterior were recorded with a 64-electrode matrix. HD-EMG signals were decomposed, and motor units tracked across time points to estimate the contribution of PICs to motoneuron firing through quantification of motor unit recruitment-derecruitment hysteresis (ΔF). A good intraclass correlation coefficient (ICC = 0.75 [0.63, 0.83]) and a large repeated measures correlation coefficient (rrm = 0.65 [0.49, 0.77]; p < 0.001) were found between ΔF values obtained at both time points for 20 % MVC ramps. For 50 % MVC ramps, a good ICC (0.77 [0.65, 0.85]) and a very large repeated measures correlation coefficient (rrm = 0.73 [0.63, 0.80]; p < 0.001) were observed. Our data suggest that ΔF scores can be reliably investigated in tibialis anterior motor units during both low- and moderate-intensity contractions within a single experimental session.

Reproducibility of freehand vs. foam cast as well as the intrarater reliability of foam cast ultrasound scans assessing the muscle architecture and tissue organization of the gastrocnemius medialis and vastus lateralis muscles.

This study compares the reproducibility of freehand (FH) vs. foam cast (FC) scans and investigates the intrarater reliability of the ultrasound FC muscle architecture and tissue organization measurements of the gastrocnemius medialis (GM) and vastus lateralis (VL) muscles with fixed and repositioning FC scans. Thirteen young adults (22 ± 3 years) underwent repeated sagittal B-mode ultrasound measurements of GM and VL. FH, FC, and repositioned FC scans were conducted. Muscle architecture measurements included muscle thickness (MT), pennation angle (PA), and fascicle length (FL). Spatial frequency analysis assessed muscle tissue organization. MT decreased from 2.1 to 1.8 cm in GM and from 2.4 to 2.2 cm in VL with the FC compared with the FH. Reproducibility between the FH and the FC showed poor to good intraclass correlation coefficients (ICCs) for MT (0.46-0.77) and PA (0.09-0.86) as well as poor to moderate ICCs for FL (0.41), with very low to moderate test-retest variability (TRV) (4%-18%). Tissue organization indicated low to good ICCs (0.21-0.80) with low to moderate TRV (4%-19.5%). The re-scanning results of fixed FC indicated excellent ICCs for MT (0.95-0.996), good for PA (0.77-0.90), and moderate for FL (0.73-0.76), with low TRV (5%-10%) for both muscles. Tissue organization displayed moderate to good ICCs (0.61-0.87) with very low to low TRV (4%-9%). For repositioned FC scans in GM and VL, MT showed good to excellent ICCs (0.86-0.98) with very low to low TRV (2%-8%). PA and FL demonstrated moderate to good ICCs (0.57-0.75), with very low to moderate TRV (2%-13%). Tissue organization revealed ICCs ranging from poor to good (0.13-0.87) for both muscles, with low to moderate TRV (5%-18%). The FC systematically reduced MT by 2-3 mm. Furthermore, reproducibility revealed low ICCs and high data variability for several muscle architecture and tissue organization parameters. Thus, switching methods within a single study is not recommended. Nevertheless, FC ultrasound scans demonstrated excellent intrarater reliability for assessing MT. In the case of fixed FC scans particularly, moderate to excellent ICCs were observed for all muscle architecture and tissue organization parameters, accompanied by very low to low variability. Therefore, FC scans are recommended for investigating acute effects on muscle architecture and tissue organization when the FC remains on the leg throughout the period of measurements.

Reliability and validity of the new portable Nordic hamstring test device (IVMES H-Bord)

The aim of this study is to determine the reliability and validity of the IVMES H-Bord eccentric hamstring strength measurement device. Thirty-eight healthy male athletes (age: 20.9 ± 2.11 years, height: 1.79 ± 0.03 m, body weight: 76.6 kg, body mass index: 22.6 ± 0.69 kg/m2) participated in this study. Each test protocol was applied in eccentric mode and isometric mode respectively. Between-session test-retest reliability of the IVMES H-Bord was analyzed for the intraclass correlation coefficient (ICC) with 95% coefficient intervals (CI). Validity of the IVMES H-Bord was examined for eccentric mode (NHTecc), and isometric mode (NHTiso) using Pearson’s correlation coefficient with 95% CI and limits of agreement. Bland-Altman plots were also created to provide a representation of the agreement between two test devices. Strong correlations, good ICC values and acceptable typical errors of the estimate were observed between the NHT and isokinetic strength testing (IST) during both limbs with no proportional bias for validity analysis. In conclusion, the “IVMES H-Bord” is a reliable and valid measurement device for eccentric hamstring muscle strength and it provides important advantages for medical staff, fitness coaches and practitioners because it is portable, low cost, and field-based assessment.

Validation of machine learning models for estimation of left ventricular ejection fraction on point-of-care ultrasound: insights on features that impact performance

BackgroundMachine learning (ML) algorithms can accurately estimate left ventricular ejection fraction (LVEF) from echocardiography, but their performance on cardiac point-of-care ultrasound (POCUS) is not well understood.ObjectivesWe evaluate the performance of an ML model for estimation of LVEF on cardiac POCUS compared with Level III echocardiographers’ interpretation and formal echo reported LVEF.MethodsClinicians at a tertiary care heart failure clinic prospectively scanned 138 participants using hand-carried devices. Video data were analyzed offline by an ML model for LVEF. We compared the ML model's performance with Level III echocardiographers' interpretation and echo reported LVEF.ResultsThere were 138 participants scanned, yielding 1257 videos. The ML model generated LVEF predictions on 341 videos. We observed a good intraclass correlation (ICC) between the ML model's predictions and the reference standards (ICC = 0.77–0.84). When comparing LVEF estimates for randomized single POCUS videos, the ICC between the ML model and Level III echocardiographers' estimates was 0.772, and it was 0.778 for videos where quantitative LVEF was feasible. When the Level III echocardiographer reviewed all POCUS videos for a participant, the ICC improved to 0.794 and 0.843 when only accounting for studies that could be segmented. The ML model's LVEF estimates also correlated well with LVEF derived from formal echocardiogram reports (ICC = 0.798).ConclusionOur results suggest that clinician-driven cardiac POCUS produces ML model LVEF estimates that correlate well with expert interpretation and echo reported LVEF.

Validation of Air Storage System for Hypoxia Exposure During Exercise.

Norberto, Matheus S., João Victor G. Torini, Matheus S. Firmino, and Marcelo Papoti. Validation of air storage system for hypoxia exposure during exercise. High Alt Med Biol. 00:000-000, 2024.-Considering the importance of optimizing normobaric hypoxia exposure (i.e., higher delivery capacity), the current study aims to validate a hypoxic air storage system. The study has a cross-over, one-blind randomized design. The air storage is composed of a piping system that directs hypoxic air from a hypoxia generator into nylon bags. Sixteen men (age, 25.4 ± 4.8 years; height, 174.9 ± 9.4 cm; weight, 77.1 ± 17.2 kg) performed three incremental treadmill tests until exhaustion on different days. For test-retest, the subjects repeated two tests in similar hypoxia conditions (H1 and H2; fraction of inspired O2 [FIO2] = ∼0.13; reliability analysis), and one time in normoxia (FIO2 = ∼0.20; condition comparison). Subjects' performance, blood lactate concentration ([La-]), arterial oxygen saturation (SpO2), oxygen consumption (VO2), heart rate (HR), and several respiratory-derived variables were evaluated. A comparison was made between the rest, moderate intensity, and exhaustion stages. All variables were compared using the Friedman test with Durbin-Conover post hoc (p < 0.05). The hypoxia test-retest showed no statistical differences for any variable. Time analysis showed similar behavior for SpO2, HR, and cardiorespiratory variables (p < 0.01) for both conditions. The mean FIO2 at rest and during the incremental treadmill test was higher for normoxia (20.6 ± 0.2%) than for H1 (13.8 ± 0.8%) and H2 (13.7 ± 0.3%) (p < 0.001). The VO2 response was higher in normoxia than during hypoxia exposure at moderate intensity (Normoxia = 43.1 ± 8.1; H1 = 38.7 ± 5.7; H2 = 35.8 ± 8.8 ml.kg-1.min-1) and at the exhaustion stage (Normoxia = 52.7 ± 12.5; H1 = 41.9 ± 8.8; H2 = 40.5 ± 8.9 ml.kg-1.min-1) (p < 0.01). SpO2 and HR showed excellent intraclass correlation coefficient (ICC) during all moments, whereas VO2, SpO2, ratio between ventilation and CO2 production (VE/VCO2), ratio between oxygen consumption and ventilation (VE/VO2), and HR showed moderate or good ICC and coefficient of variation <9% during hypoxia test-retest exercises. Thus, the air storage system showed validity for its application and reliability in the measurements associated.

The test–retest reliability of physiological and perceptual responses during treadmill load carriage

PurposeUnderstanding the test–retest reliability of physiological responses to load carriage influences the interpretation of those results. The aim of this study was to determine the test–retest reliability of physiological measures during loaded treadmill walking at 5.5 km h−1 using the MetaMax 3B.MethodsFifteen Australian Army soldiers (9 male, 6 female) repeated two 12-min bouts of treadmill walking at 5.5 km h−1 in both a 7.2 kg Control condition (MetaMax 3B, replica rifle) and a 23.2 kg Patrol condition (Control condition plus vest) across three sessions, separated by one week. Expired respiratory gases and heart rate were continuously collected, with the final 3 min of data analysed. Ratings of Perceived Exertion and Omnibus-Resistance Exercise Scale were taken following each trial. Reliability was quantified by coefficient of variation (CV), intra-class correlation coefficients (ICC), smallest worthwhile change (SWC), and standard error of the measurement.ResultsMetabolic and cardiovascular variables were highly reliable (≤ 5% CV; excellent-moderate ICC), while the respiratory variables demonstrated moderate reliability (< 8% CV; good-moderate ICC) across both conditions. Perceptual ratings had poorer reliability during the Control condition (12–45% CV; poor ICC) than the Patrol condition (7–16% CV; good ICC).ConclusionsThe test–retest reliability of metabolic and cardiovascular variables was high and relatively consistent during load carriage. Respiratory responses demonstrated moderate test–retest reliability; however, as the SWC differed with load carriage tasks, such data should be interpreted independently across loads. Perceptual measures demonstrated poor to moderate reliability during load carriage, and it is recommended that they only be employed as secondary measures.Graphical abstract

Reliability of assessing skeletal muscle architecture and tissue organization of the gastrocnemius medialis and vastus lateralis muscle using ultrasound and spatial frequency analysis.

The purpose of this study was to investigate inter- and intra-rater reliability as well as the inter-rater interpretation error of ultrasound measurements assessing skeletal muscle architecture and tissue organization of the gastrocnemius medialis (GM) and vastus lateralis (VL) muscle. The GM and VL of 13 healthy adults (22 ± 3 years) were examined thrice with sagittal B-mode ultrasound: intraday test-retest examination by one investigator (intra-rater) and separate examinations by two investigators (inter-rater). Additionally, images from one investigator were analysed by two interpretators (interpretation error). Muscle architecture was assessed by muscle thickness [MT], fascicle length [FL], as well as superior and inferior pennation angle [PA]. Muscle tissue organization was determined by spatial frequency analysis (SFA: peak spatial frequency radius, peak -6 dB width, PSFR/P6, normalized peak value of amplitude spectrum [Amax], power within peak [PWP], peak power percent). Reliability of ultrasound examination and image interpretation are presented as intraclass correlation coefficient (ICC), test-retest variability, standard error of measurement as well as bias and limits of agreement. GM and VL demonstrated excellent ICCs for inter- and intra-rater reliability, along with excellent ICCs for interpretation error of MT (0.91-0.99), showing minimal variability (<5%) and SEM% (<5%). Systematic bias for MT was less than 1 mm. For PA and FL poor to good ICCs for inter- and intra-rater reliability were revealed (0.41-0.90), with moderate variability (<12%), low SEM% (<10%) and systematic bias between 0.1-1.4°. Tissue organization analysis indicated moderate to good ICCs for inter- and intra-rater reliability. Notably, Amax and PWP consistently held the highest ICC values (0.77-0.87) across all analyses but with higher variability (<24%) and SEM% (<18%), compared to lower variability (<9%) and SEM% (<8%) in other tissue organization parameters. Interpretation error of all muscle tissue organization parameters showed excellent ICCs (0.96-0.999) with very low variability (≤1%) and SEM% (<2%), except Amax & PWP (TRV%: <6%; SEM%: <7%). Our findings demonstrated excellent inter- and intra-rater reliability for MT. However, agreement for PA, FL, and SFA parameters was not as strong. Additionally, MT and all SFA parameters exhibited excellent agreement for inter-rater interpretation error. Therefore, the SFA seems to offer the possibility of objectively and reliably evaluating ultrasound images.

Lower Limb Torque Prediction for Sit-To-Walk Strategies Using Long Short-Term Memory Neural Networks.

Joint torque prediction is crucial when investigating biomechanics, evaluating treatments, and designing powered assistive devices. Controllers in assistive technology require reference torque trajectories to set the level of assistance for a patient during rehabilitation or when aiding essential daily tasks such as sit-to-walk (STW). STW itself can be generalized into strategies based on individual needs and movement patterns. In this study, three long short-term memory (LSTM) neural networks were empirically trained for hip and knee torque prediction considering these STW strategies and subject anthropometry. The hip and knee are the drivers of STW, while the network architectures were selected for recognizing temporal and spatial relationships. Performance of the LSTMs were compared and evaluated against the STW strategies to accurately generate strategy-specific and user-oriented torque. As such, train and test STW data were obtained from 65 subjects across three age groups: young, middle-aged, and older adults (19-73 years). Model inputs were hip and knee angles with horizontal center of mass velocity, while windowing allowed the LSTMs to dynamically adapt to real-time changes in STW transitions. The encoder-decoder LSTM showcased optimal performance with robust recognition of temporal features. It produced significantly ( [Formula: see text]) low hip and knee root mean square error ( 0.24 ± 0.07 and 0.15 ± 0.02 Nm/kg), strong Spearman's correlation ( 93.43 ± 2.86 and 84.83 ± 2.96 %) and good intraclass correlation coefficients (greater than 0.75), demonstrating model reliability. Hence, this network predicts strategy and user oriented reference torques for personalized controllers in assistive devices, with more natural application of assistance.

Relationship between Acceleration in a Sit-To-Stand Movement and Physical Function in Older Adults.

Acceleration parameters in sit-to-stand (STS) movements are useful for measuring lower-limb function in older adults. The purpose of this study was to examine the relationship between acceleration in STS movements and physical function and the test-retest reliability of acceleration parameters in older adults. We performed cross-sectional analyses on 244 older adults including 107 men (mean age: 77.4 ± 4.7) and 137 women (mean age: 75.6 ± 5.3). Four acceleration parameters were measured in STS movements: maximum acceleration (MA), maximum velocity (MV), maximum power (MP), and stand-up time (ST). Good intraclass correlation coefficients (ICC > 0.70) were observed for all parameters. For the acceleration parameters, MA, MV, and MP were relatively strongly associated with the 5-time STS test (men: r = -0.36~-0.47; women: r = -0.37~-0.45) and the timed up and go test (men: r = -0.39~0.47, women: r = -0.43~-0.51): MP was also strongly associated with grip strength (men: r = 0.48, women: r = 0.43). All acceleration parameters were poorer in participants reporting mobility limitations than in those reporting no mobility limitations. These findings support the usefulness of sensor-based STS measurement. The system is expected to be useful in various settings where care prevention is addressed.

A new home‐based cognitive test using phone calls in mild cognitive impairment

AbstractBackgroundMild cognitive impairment (MCI) is a risk group of dementia. Despite of plethora of hospital‐based neuropsychological tests, assessment tools that can be performed at home to detect cognitive progression are lacking. We thought that a home‐based cognitive test (HCT) is useful for regular cognitive monitoring without visiting the hospital. Our study aimed to validate the HCT by assessing relationships with existing hospital‐based neuropsychological tests scores.MethodThis pilot study was conducted in a university‐affiliated dementia clinic from July 2019 to December 2021. We had developed a new HCT that can be examined using phone calls without visiting the hospital. The newly developed HCT is composed of 20 questions (score ranges 0‐30), a higher score indicates better general cognition. Participants with MCI were enrolled and underwent regular HCT during 6 months. Brain MRI, plasma amyloid, baseline and endpoint neuropsychological tests, and assessment for clinical progression were performed. Associations between HCT scores and in‐person neuropsychological tests were investigated. We additionally assessed whether the HCT scores are correlated with Alzheimer’s disease (AD)‐related biomarkers including plasma amyloid values and regional brain volumes. To assess relevance, partial correlation coefficient adjusted by age, sex, and education was performed.ResultHCT had good intraclass correlation coefficient values (test‐retest Cronbach’s alpha 0.839 &amp; inter‐rater reliability Cronbach’s alpha 0.627). Totally 38 participants were enrolled and 32 completed the endpoint evaluations at 6 months. Seven participants progressed to mild dementia. Baseline HCT score showed good correlations with Mini‐Mental State Examination (MMSE) score, verbal memory delayed recall scores, and stroop test scores after adjustment for age, sex, and education. However, HCT scores did not show significant associations with AD‐biomarkers. MCI with higher risk of progression (APOE4 carrier or positivity in plasma amyloid values) showed numerical trends of faster HCT declines compared with MCI with lower risk of progression, although it did not reach statistical significance (p&gt;0.05).ConclusionWe demonstrated good reliability and correlations of the newly developed HCT with existing in‐person neuropsychological tests. It also showed good applicability on the elderly with MCI. Hence, HCT could be a promising and alternative option to monitor cognitive declines without visiting the hospital.

A first study on the usability and feasibility of four subtypes of suicidality in emergency mental health care

BackgroundBased on clinical experience, a (hypothetical) four-type model of suicidality that differentiates between subtypes with a unique pathway to entrapment ((h)4ME)was developed. The subtypes are: 1) perceptual disintegration (PD), 2) primary depressive cognition (PDC), 3) psychosocial turmoil (PT) and 4) inadequate communication/coping (IC). This study was carried out to examine the usability and feasibility of the subtypes in an absolute and dimensional way with the SUICIDI-2 instrument.ObjectiveA first step was to examine the model and the SUICIDI-2 instrument for usability and feasibility in clinical practice. We aim to investigate the’real life’ practical application of the model and hope the feedback we get after practical use of the model will help us with improvements for the model and the SUICIDI-2 instrument.MethodsDischarge letters to general practitioners of 25 cases of anonymized suicidal emergency patients were independently reviewed by three psychiatrists and three nurses. Using the SUICIDI-2 instrument, describing the proposed subtypes, cases were classified by the psychiatrists and nurses. Intraclass Correlation Coefficients (ICC) for absolute/discrete and dimensional ratings were calculated to examine the model’s usability and the instrument‘s feasibility. The study was approved by the ethical board.ResultsAll raters were able to recognize and classify the cases in subtypes. We found an average measure of good reliability for absolute/(discrete) subtypes. For dimensional scores, we found excellent average measures for the subtype PDC, and good average measures for the subtypes PD, PT and IC. The reliability of dimensional score for the SUICIDI-2 was relatively lower than an alternative dimensional rating, but had good ICC values for all subtypes. After reviewing the results though, we found some inconsistently assessment between raters. This was ground to narrow down the criteria per subtype to describe the subtypes more precisely. This resulted in adjusted formulations for subtypes PD and IC and agreement was achieved about formulations in the revised SUICIDI-3.ConclusionsThe hypothetical model of entrapment leading to suicidality shows promising results for both the usability and feasibility of the SUICIDI instrument. Follow up studies with participants with a more diverse background may show consistency and validity for the model.

Repeatability and agreement of AOCT-1000 M, RTVue XR and IOL master 500 in measuring corneal thickness mapping and axial length applying principle of optical coherence tomography

PurposeTo evaluate the repeatability and agreement of Fourier-domain optical coherence tomography (AOCT-1000 M and RTVue XR) and partial coherence interferometry biometer (IOL Master 500) in measuring corneal thickness mapping and axial length respectively.MethodsCorneal thickness was measured by AOCT-1000 M and RTVue XR. Axial lengths were measured by AOCT-1000 M and IOL Master 500. The repeatability and agreement of corneal thickness and axial length were calculated in two groups of devices. The intraclass correlation coefficient (ICC) was used to verify the repeatability of the device. The 95% confidence interval of the difference compared to the set cut-off value was used to verify the agreement between the two devices.ResultsA total of 60 subjects with 58 eyes were included. The central corneal thickness measured by AOCT-1000 M and RTVue XR were 504.46 ± 42.53 μm and 504.43 ± 42.89 μm respectively. The average difference between groups was 0.03 ± 4.58 μm, and the 95% confidence interval was (-1.17, 1.24), which was far less than the set threshold value of 15 μm (P < 0.001). Both RTVue XR and AOCT-1000 M had very good ICC values of central corneal thickness (0.998 and 0.994, respectively). The average axial lengths measured by AOCT-1000 M and IOL Master 500 were 24.28 ± 1.25 mm and 24.29 ± 1.26 mm respectively and the 95% confidence interval was (-0.02, 0.01), which was less than the set threshold value of 0.15 mm (P < 0.001). The ICC for both devices were 1.000.ConclusionGood repeatability and agreement were seen in measurements of central corneal thickness and axial length by AOCT-1000 M.

50 Remote Assessment has Minimal Effect on Test-Retest Reliability Among Older Adults with Essential Tremor

Objective:The COVID-19 pandemic increased utilization of remote assessment to allow clinicians and researchers to continue valuable work while maintaining quarantine guidelines. With guidelines relaxing, researchers have returned to in-person assessment. Information is needed regarding the effect of remote assessments on test-retest reliability. COGNET, a longitudinal study of cognition in participants with essential tremor, transitioned from in-person to remote assessments during the pandemic, and has now returned to in-person assessment. The current study investigates the extent to which remote assessment affected test-retest reliability across a range of neuropsychological assessments administered in COGNET.Participants and Methods:Participants included 27 older adults enrolled in COGNET (mean age=75.0 (9.1), education=16.2 (2.6), 67% female, and 100% white). Memory tests included: California Verbal Learning Test II, Logical Memory subtest of the Wechsler Memory Scales - Revised, and Verbal Paired? Associates. Executive function tests included: Digit Span Backwards and the Delis-Kaplan Executive Function System subtests of Verbal Fluency, Sorting, and Color-Word. Attention tests included Oral Symbol Digit Modalities Test and Digit Span Forward. Language was assessed with the Boston Naming Test. Intraclass correlation coefficients (ICCs) were calculated to examine test-retest reliability of InPerson to In-Person visits (P-P), and combination visits (e.g., In-Person to Remote (PR), and Remote to In-Person (R-P)). Following Koo &amp; Li (2016), ICCs were interpreted as: &gt;.90 excellent, .75-.90 good, .50-.74 moderate, and &lt;.50 poor reliability. The Feldt approach was used to compare ICCs from P-P visits against ICCs calculated for combination visits (P-R or R-P), with the test statistic compared to an F distribution.Results:ICCs for person-to-person assessment ranged from .51 to .89. Memory test ICCs ranged from moderate to good (.51 to .80). Executive function test ICCs ranged from moderate to good (.55 to .89). The attention domain had moderate ICCs (.67 - .68). Language ICC was moderate (.70). ICCs for person-to-remote assessment ranged from .42 to .89. Memory tests ranged from moderate to good ICCs (.59 to .83). Executive function tests ranged from poor to good ICCs (.42 to .89). Attention ICCs were moderate to good (.55 to .79). The Language ICC was moderate (.72). ICCs for remote-to-person ranged from .48 to 86. Memory ICCs ranged from moderate to good (.59 to .86). Executive function ICCs ranged from poor to good (.48 to .83). Attention ICCs were moderate to good (.56 to .79). The Language ICC was good (.78). The only test for which an ICC from a combination visit was significantly lower than a person to person visit was Digit Span Backwards.Conclusions:Test-retest reliability was moderate or better for all P-P assessments, consistent with the known psychometrics of these tests. Only one test of executive function showed lower reliability when remote assessment was introduced. From a broad standpoint, current results suggest that remote administration of neuropsychological tests can be used as a reliable substitute for in-person assessment for many measures, and suggest that caution be used when interpreting any change in Digit Span Backwards across person and remote assessments.

Effect of presbyopic correction lens on humphrey visual field testing in patients with multifocal intraocular lens.

Most previous studies on the effects of multifocal intraocular lenses (MIOL) on Humphrey visual field (HVF) used presbyopic corrective lens (PC). There has been insufficient data from patients with MIOL performing HVF with and without PC. This study aimed to determine the effect of PC on HVF testing in patients with MIOL. This was a prospective, comparative crossover study at the Department of Ophthalmology, Faculty of Medicine, Siriraj Hospital, Mahidol University between June 2015 and July 2018. Early-stage glaucomatous and non-glaucomatous pseudophakic patients with 2 models of MIOL completed HVF testing with and without PC. Mean deviation (MD), pattern standard deviation (PSD), and reliability indices (fixation losses, false positives, and false negatives) were compared. Ninety-four eyes of 59 patients were enrolled. After excluding patients with confirmed unreliable visual field, 82 eyes of 51 patients (male, 22; female, 29) with a mean age of 65.4 years were included in the study. Forty-nine eyes were non-glaucoma and 33 eyes were early-stage glaucoma. Forty-four eyes received TECNIS ZM900 and 38 eyes received Acrysof IQ ReSTOR SN6AD1. The overall MD standard deviation was -3.5 (2.1) with PC and -3.1 (2.1) without PC (P = .01). The overall PSD standard deviation was 2.8 (1.5) with PC and 2.7 (1.5) without PC (P = .93). The reliability indices were not statistically significantly different with and without PC. There was a good intraclass correlation (ICC) of MD (ICC = 0.87) and PSD (ICC = 0.88) with and without PC. Eyes with TECNIS ZM 900 had significantly better MD when performing HVF without PC (mean difference -0.7, P < .01), but not with Acrysof IQ ReSTOR SN6AD1 (mean difference -0.1, P = .74). Pseudophakic eyes with MIOL may not require PC during HVF testing regardless of the MIOL model. Although eyes with TECNIS ZM900 performed HVF without PC resulted in a significantly better MD value compared with PC, the difference was not clinically significant.