High Intraclass Correlation Research Articles

Reliability and validity of the Londrina activities of daily living protocol in individuals with systemic sclerosis.

To investigate the validity and reliability of the Londrina ADL Protocol inpatients with systemic sclerosis (SSc). The study included 39 individuals with SSc and 30 healthy participants aged18-70 years. Performance-related ADL assessment was performed with the LondrinaADL Protocol which was performed twice by the same rater and energy expenditureduring the test with the Dynaport Move Monitor device. Functional capacity (6 MinuteWalk Test-6MWT), upper extremity muscle strength (hand-held dynamometer), handand finger grip strength (hand dynamometer and pinch meter), upper extremityfunctionality (Q-Dash Questionnaire and 9 Hole Peg Test), self-reported ADL (MillikenADL Scale (MAS)) and quality of life (SF-36 questionnaire) were evaluated. Upper extremity muscle strength, functional capacity, upper extremityfunctionality, and quality of life of individuals with SSc were found to be significantlylower and the time spent by individuals with SSc in the Londrina ADL Protocol was lower and the time spent by individuals with SSc in the Londrina ADL Protocol wassignificantly longer compared to the healthy group (p<0.05). Performance in the theLondrina ADL had high intraclass correlation coefficient ICC=0.813. A moderatenegative correlation was found between the time to complete the Londrina Protocoland 6MWT (p<0.05), and a weak negative correlation was found between dominantside hand grip strength (p<0.05) and MAS (p<0.05) in individuals with SSc. A moderatepositive correlation was found between the Londrina Protocol and the 9-Hole Peg Testfor the dominant side (p<0.05). The Londrina Protocol is a valid and reliable method, hence, this makes itappropriate for an objective, performance-based evaluation of ADL in SSc population. Key Points • The results obtained by reapplication the Londrina ADL Protocol under the same conditions showed that the Londrina ADL Protocol is a highly reliable assessment method in scleroderma patients. • Considering the activities and protocol content of the Londrina ADL Protocol, it is thought to show functional performance better than the Glittre ADL test and 6MWT. • The Londrina ADL Protocol is appropriate for objective and performance-based assessment of ADL in the SSc population for both research and clinical practice.

Problems of magnetic resonance diagnosis for gastric-type mucin-positive cervical lesions of the uterus and its solutions using artificial intelligence.

To reveal problems of magnetic resonance imaging (MRI) for diagnosing gastric-type mucin-positive (GMPLs) and gastric-type mucin-negative (GMNLs) cervical lesions. We selected 172 patients suspected to have lobular endocervical glandular hyperplasia; their pelvic MR images were categorised into the training (n = 132) and validation (n = 40) groups. The images of the validation group were read twice by three pairs of six readers to reveal the accuracy, area under the curve (AUC), and intraclass correlation coefficient (ICC). The readers evaluated three images (sagittal T2-weighted image [T2WI], axial T2WI, and axial T1-weighted image [T1WI]) in every patient. The pre-trained convolutional neural network (pCNN) was used to differentiate between GMPLs and GMNLs and perform four-fold cross-validation using cases in the training group. The accuracy and AUC were obtained using the MR images in the validation group. For each case, three images (sagittal T2WI and axial T2WI/T1WI) were entered into the CNN. Calculations were performed twice independently. ICC (2,1) between first- and second-time CNN was evaluated, and these results were compared with those of readers. The highest accuracy of readers was 77.50%. The highest ICC (1,1) between a pair of readers was 0.750. All ICC (2,1) values were <0.7, indicating poor agreement; the highest accuracy of CNN was 82.50%. The AUC did not differ significantly between the CNN and readers. The ICC (2,1) of CNN was 0.965. Variation in the inter-reader or intra-reader accuracy in MRI diagnosis limits differentiation between GMPL and GMNL. CNN is nearly as accurate as readers but improves the reproducibility of diagnosis.

Shortened NIHSS for Rapid Stroke Assessment in Emergency Care Settings.

The National Institutes of Health Stroke Scale (NIHSS) is widely used to assess ischemic stroke severity, but its full 11-item version can be time-consuming. This study evaluates the NIHSS-8, a shortened version, for its efficacy compared with NIHSS-11 in an emergency department setting. A cohort study was conducted from May 2018 to May 2019 at Imam Reza Hospital, Tabriz, Iran. Patients with suspected acute stroke were assessed using both NIHSS-11 and NIHSS-8. The modified Rankin Scale (mRS) was used to evaluate patient outcomes at discharge. Correlations between NIHSS-8, NIHSS-11, and mRS were analyzed, and diagnostic performance metrics were calculated. The study included 292 patients with a mean age of 70.40 years. Approximately 68.5% of patients were categorized as having moderate stroke severity using NIHSS-11, with a similar 67.1% using NIHSS-8. The correlation between NIHSS-11 and NIHSS-8 scores was high (intraclass correlation coefficient of 0.970). Both scales showed strong relationships with mRS at discharge but were not significantly correlated with long-term outcomes. NIHSS-8 demonstrated a sensitivity of 97.5% and specificity of 96.9%, while NIHSS-11 showed 100% sensitivity and 96.9% specificity. NIHSS-8 is a reliable and efficient alternative to NIHSS-11 for assessing stroke severity in emergency departments. It provides high sensitivity and specificity while being less time-consuming, making it suitable for rapid stroke assessment and triage.

Quantitative Neuroanatomical measurement on Photogrammetric model: Validation study.

To scrutinize and compare the accuracy of measurements obtained from photogrammetric models against direct measurements taken on dry skulls, with the aim to verify the feasibility of photogrammetry for quantitative analysis in microsurgical neuroanatomy. Two dry human skulls were used. Each was scanned using the dual camera system of a smartphone The selected photos were separately processed two different software to create 3D models. Subsequently, 41 anatomical measures (both linear and curvilinear) based on common anatomical landmarks, were taken both directly on dry skulls and on photogrammetric models and compared. Analyzed factors included measurement error, intra- and inter-rater reliability and, the intermodality agreement. Four photogrammetric models were created. Our analysis revealed similar errors when comparing the photogrammetric and direct measurements. Measurements from digital models exhibited robust reliability among repeated measures and different observers, supported by very high Intraclass Correlation Coefficient (ICC) values. Mean measurement difference between Agisoft Metashape software-generated models and direct measurement was 0.01 cm with no systematic bias observed. Conversely, the Metascan app-derived models showed a mean measurement difference of -0.35 cm compared to direct measurement, displaying good agreement for smaller measurements and a systematic proportional bias with increasing measurement size. The role of two photogrammetric models is validated as quantitative analysis technique for laboratory neuroanatomical studies showing acceptable measurement error, high intra- and inter-rater reliability as well as good to very good agreement compared to direct measurement on dry skulls, replacing the expensive and time-consuming methods like CT scans and neuronavigation system.

Reliability and Validity Study of the Turkish Version of the Motivation and Attitude to Change Health (MATCH) Scale.

This study aims to culturally adapt the 'Motivation and Attitudes Towards Changing Health (MATCH)' scale into Turkish and assess its reliability and validity within the Turkish population. The Turkish version of the MATCH questionnaire, designed to gauge patient motivation for initiating or sustaining behaviour changes, was created through translation and adaptation. A total of 305 patients diagnosed with chronic illnesses completed the questionnaire and scale to evaluate its validity and reliability. The Turkish version of MATCH demonstrated strong internal consistency and reliability. The Cronbach's alpha coefficient for the entire scale was 0.737, with subdimensions ranging between 0.69 and 0.75. Notably, no item displayed a total correlation value below 0.40. Furthermore, test-retest analysis indicated high intraclass correlation coefficients. Consequently, no items were removed due to their consistently high reliability values among all nine items. The Turkish-adapted MATCH scale proves to be a valid and reliable instrument for assessing motivational status within the Turkish population.

Inter-rater and Intra-rater Reliability of Glottal Image Capture: A Mobile Application to Quantify Vocal Fold Bowing.

Age-related vocal atrophy (ARVA) causes vocal fold bowing, impacting communication and quality of life. The assessment of vocal fold bowing is largely subjective. Glottal Image Capture (GlottIC) is a new mobile application that helps quantify vocal fold bowing. We aim through this study to assess its reliability, compare it to manual calculation method, and compare differences between visual-perceptual bowing severity ratings. Ten raters independently quantified Bowing Index (BI) using GlottIC from 10 videostroboscopic images among individuals with ARVA. There was 100% duplication of images to facilitate intra-rater reliability analyses using Pearson's correlation. Inter-rater reliability was quantified using Intraclass Correlation Coefficient (ICC) for experienced and novice raters. The correlation between manual calculations using ImageJ and GlottIC was analyzed. The intra-rater reliability for total BI was strong (r = 0.822, p < 0.001). The inter-rater reliability for BI, calculated using ICC, was (ICC = 0.720; 95% CI: 0.579-0.852), indicating good consistency among the raters. Experts had higher ICC (ICC = 0.808; 95% CI: 0.678-0.906) compared to novice raters (ICC = 0.651; 95% CI: 0.468-0.816). There was a positive correlation between GlottIC and manual BI (r = 0.811, p < 0.001). As the BI increased, the bowing severity, based on visual-perceptual ratings, also increased (p < 0.001). GlottIC is a reliable mobile application that can quantify vocal fold bowing in patients with ARVA with high intra- and inter-rater reliability. GlottIC BI measurments are highly correlated with manual BI and visual-perceptual ratings of bowing severity. Further improvements in reliability may be achieved with more robust rater training and automated technologies. Level 3 Laryngoscope, 2024.

Validation of the Hungarian Version of the International Consultation on Incontinence Modular Questionnaire on Female Lower Urinary Tract Symptoms (ICIQ-FLUTS).

Objectives: Urinary incontinence (UI) is a prevalent condition that significantly impacts the quality of life. This study aimed to validate the Hungarian version of the International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) and assess its psychometric properties in the context of the Hungarian population. Study design: A cross-sectional study involved 215 Hungarian-speaking women with a mean age of 67.6 ± 11.9 years. Main outcome measure: Participants were administered both the ICIQ-FLUTS and the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). The psychometric analysis included test-retest reliability, convergent validity, and internal consistency. Results: The Hungarian version of ICIQ-FLUTS demonstrated strong psychometric properties. The test-retest reliability analysis showed a high intraclass correlation coefficient (ICC = 0.921), indicating excellent agreement between measurements over a 14-day interval. Convergent validity was supported by a strong positive correlation between the total scores of ICIQ-FLUTS and ICIQ-SF (ρ = 0.686, p < 0.001), emphasizing shared underlying constructs. Furthermore, the ICIQ-FLUTS questionnaire exhibited good internal consistency, with a Cronbach's α coefficient of 0.862. Conclusions: This study successfully validated the Hungarian version of the ICIQ-FLUTS questionnaire and demonstrated its robust psychometric properties. This tool will enable healthcare practitioners and researchers to effectively assess and address UI's impact on their quality of life.

Core Laboratory Versus Center-Reported Echocardiographic Assessment of the Native and Bioprosthetic Aortic Valve.

Insights into quantitative differences between core laboratory and center-reported echocardiographic assessment of the native and bioprosthetic aortic valve are lacking. We aimed to explore clinically relevant differences between these evaluations. Data were used from the PERIcardial SurGical AOrtic Valve ReplacemeNt (PERIGON) Pivotal Trial for the Avalus valve. In this trial, patients with an indication for surgical aortic valve replacement (SAVR) due to aortic stenosis or regurgitation (AR) were enrolled. Serial echocardiographic examinations were performed at each center and blindly reanalyzed by an independent echocardiographic core laboratory (ECL). For the bioprosthetic valve analysis, postoperative data throughout the 5-year follow-up were pooled. Differences between the ECL and the centers in continuous parameters were quantified in mean differences and intraclass correlation coefficients (ICCs). Agreement on AR, paravalvular leak (PVL), and prosthesis-patient mismatch (PPM) classification was investigated using Cohen's kappa coefficients. The analysis on the native aortic valve was performed on 1118 echocardiograms. The relative mean difference was largest for the left ventricular outflow tract (LVOT) area, followed by stroke volume and effective orifice area (index), with center-reported values being 11%-7% higher. High ICCs of around 0.90 were observed for the parameters peak aortic jet velocity, mean pressure gradient, and the velocity-time integral across the aortic valve. Over 5000 echocardiograms were available for the bioprosthetic valve analysis. Therein, comparable results were observed. The kappa coefficient was 0.59 (95% confidence interval [CI] 0.56, 0.63) for agreement on native AR, 0.28 (95% CI 0.18, 0.37) for PVL, and 0.42 (95% CI 0.40, 0.44) for PPM. There is high agreement between the ECL and clinical centers on continuous-wave Doppler-related measurements. In contrast, agreement is low for parameters that involve measurement of the LVOT diameter. These results provide important context for the interpretation of aortic valve performance in studies that lack central ECL evaluation. ClinicalTrials.gov identifier: NCT02088554.

Cross-cultural adaptation, validation, and establishment of the minimal clinicallyimportant change score of the European Portuguese Core Outcome Measures Index in patients with cervical degenerative spine disease.

We aimed to validate and cross-culturally adapt the Core Outcome Measures Index (COMI) neck for use in Portuguese patients with cervical spine degenerative disease and define the minimal clinically important change score (MCIC) for this questionnaire and population. The COMI translation and cross-cultural adaptation was done following published guidelines. Patients awaiting surgery in a neurosurgical centre completed the COMI, Neck Disability Index (NDI) and EQ-5D questionnaires, a pain visual analog scale (VAS) twice within a 5-to-15-day period, and a Global Treatment Outcome (GTO) question evaluating whether a clinical status change had occurred during that period. The MCIC was obtained through an anchor method by analysis of changes in pre- to postoperative total COMI scores and GTO dichotomized answers. The COMI first assessment was completed by 101 patients and 72 patients completed both assessments. The questionnaire showed good construct validity (n = 72 patients) as predefined hypotheses were confirmed: scores on each COMI domain correlated with a Spearman ρ > 0.4 with scores for the corresponding domain on other questionnaires and COMI total score displayed good correlation with total NDI score (ρ = 0.67) and EQ-5D total score (ρ = 0.55). Test-retest reliability (n = 72 patients) was confirmed through high intraclass correlation coefficients. The MCIC (n = 76 patients) was calculated as 2 points. The COMI (neck) psychometric qualities were confirmed, such that it can be considered a valid and reliable questionnaire to be applied in the European Portuguese population with surgical cervical spine degenerative disease, with an MCIC of 2 points.

Reliability and validity of the Turkish version of the Aging Voice Index

Purpose The Ageing Voice Index is a valid and reliable tool for assessing the impact of changes in the voice of older adults. Our aim is to adapt the Aging Voice Index with Turkish older adults and test its reliability and validity to create the Turkish Aging Voice Index. Method A total of 206 participants were included in the study. Construct validity, criterion validity, test-retest reliability, internal consistency, and confirmatory factor analysis were investigated. Finally, the sensitivity and specificity of the Turkish Aging Voice Index were calculated using receiver operating characteristics curve analysis. Result The Turkish Aging Voice Index has excellent internal consistency (Cronbach’s alpha= 0.971). A high intraclass correlation for test-retest reliability was found (ICC = 0.953, p < 0.001). Construct validity of the Turkish Aging Voice Index was found to be statistically significant (p < 0.001) by comparing the mean Turkish Aging Voice Index scores between the study and control groups. For criterion validity, a statistically positive high correlation was found between the mean scores of the Turkish Aging Voice Index and the Turkish version of the Voice Handicap Index-10 (r = 0.854, p < 0.001). The cut-off value of the Turkish Aging Voice Index was 15.50 with a sensitivity of 85.01% and a specificity of 84.8%. Conclusion The Turkish Aging Voice Index is a valid and reliable tool for elderly patients with voice disorders. A score >15.50 is an indicator of voice problems in the older population.

Age-Related Differences and Reliability of a Field-Based Fitness Test Battery in Young Trained Footballers: The Role of Biological Age.

the purpose of this study was to analyze the reliability of a field-based fitness test battery in young trained football players, according to biological age. 197 young trained football players (12-19 years old) participated in the study. We measured anthropometric measurements (i.e., height, sitting height, length leg, and body mass), a bilateral vertical jumping test (CMJ), a progressive loading test of squats and hip thrust, acceleration and speed tests (10 m and 30 m sprint tests), a change-of-direction ability test (V-cut test), and a cardiorespiratory fitness test (30-15 intermittent fitness test). Statistical data are shown as the mean ± standard deviation by PHV group in tests and retests. Test reliability was assessed through the intraclass correlation coefficient (ICC), with an ICC above 0.9 being considered high. To evaluate accuracy and repeatability, standard error of measurement, coefficient of variation, and minimum detectable change at 90% were determined and Bland-Altman diagrams were used, establishing a statistical significance of p < 0.05. All of the tests showed non-significant differences between the test and retest in the pooled sample (p > 0.05). Furthermore, all of them presented a trivial effect size (<0.2) and high intraclass correlation coefficients (>0.9), which indicates the high reproducibility of the tests, despite some of them presenting a significant difference between trials (i.e., the CMJ, 10 m sprint, V-cut, and squat tests). Low measurement errors were found for all tests (coefficient of variation [CV] = 4.39-9.39), except for the CMJ and the progressive loading test for squat and hip thrust exercises (CV = 12.2-21.11). Similar results were found irrespective of biological age group. All tests were reliable for the pooled sample as well as for the biological age groups.

Stability of Blood DNA Methylation Across Two Timepoints in Three Cohorts.

Background: DNA methylation mediates the gene-environment interactions, with implications for health and disease. Studies with sampling at more than one timepoint revealed the considerable variability of the blood methylome, but comprehensive resources on genome-wide methylation stability are still lacking. We aimed to identify methylation sites that remain the most stable across two timepoints in human whole blood. Methods: Publicly available blood DNA methylation data from three cohorts were analysed, which included methylation profiles at two timepoints >1 year apart. The cohorts included pre-/post-pubertal children (Illumina 450k array), the elderly (Illumina 450k array), and middle-aged adults with obesity (Illumina EPIC array). Two metrics were used for the stability assessment: the mean absolute difference (MAD) of beta values between two measurements and the intraclass correlation coefficient (ICC). We searched for probes demonstrating high stability (low MAD and high ICC) across the three cohorts. Data from 51 children, 86 elderly adults, and 120 middle-aged participants were re-analysed. Results: The median interquartile range (IQR) of the maximum (from three datasets) MAD was 2.1% (1.5-2.9%), and the median of the minimum ICC agreement coefficient was 0.053 (-0.077-0.304). The Pearson's correlation coefficient for the ICC vs. maximum MAD was low (r = 0.34, p < 2.2 × 10-16). We found only 239 probes that were highly stable based on both the maximum MAD (<5th percentile, <0.01) and ICC criterion (>95th percentile, >0.74). Conclusions: The whole-blood DNA methylation profile, as measured using microarrays, is dynamic over >1 year, but contains a fraction of stable probes, most of which are related to genomic variation. A resource describing probe stability is made publicly available, with the intention to support biomarker studies and the investigation of early epigenetic programming. The absolute error and correlation are two complementary facets of probe stability that may be considered in further research, especially to determine the stability of probes in health and disease across different tissues and populations.

Radiomics Feature Stability in True and Virtual Non-Contrast Reconstructions from Cardiac Photon-Counting Detector CT Datasets.

Objectives: Virtual non-contrast (VNC) series reconstructed from contrast-enhanced cardiac scans acquired with photon counting detector CT (PCD-CT) systems have the potential to replace true non-contrast (TNC) series. However, a quantitative comparison of the image characteristics of TNC and VNC data is necessary to determine to what extent they are interchangeable. This work quantitatively evaluates the image similarity between VNC and TNC reconstructions by measuring the stability of multi-class radiomics features extracted in intra-patient TNC and VNC reconstructions. Methods: TNC and VNC series of 84 patients were retrospectively collected. For each patient, the myocardium and epicardial adipose tissue (EAT) were semi-automatically segmented in both VNC and TNC reconstructions, and 105 radiomics features were extracted in each mask. Intra-feature correlation scores were computed using the intraclass correlation coefficient (ICC). Stable features were defined with an ICC higher than 0.75. Results: In the myocardium, 41 stable features were identified, and the three with the highest ICC were glrlm_GrayLevelVariance with ICC3 of 0.98 [0.97, 0.99], ngtdm_Strength with ICC3 of 0.97 [0.95, 0.98], firstorder_Variance with ICC3 of 0.96 [0.94, 0.98]. For the epicardial fat, 40 stable features were found, and the three highest ranked are firstorder_Median with ICC3 of 0.96 [0.93, 0.97], firstorder_RootMeanSquared with ICC3 of 0.95 [0.92, 0.97], firstorder_Mean with ICC3 of 0.95 [0.92, 0.97]. A total of 24 features (22.8%; 24/105) showed stability in both anatomical structures. Conclusions: The significant differences in the correlation of radiomics features in VNC and TNC volumes of the myocardium and epicardial fat suggested that the two reconstructions may differ more than initially assumed. This indicates that they may not be interchangeable, and such differences could have clinical implications. Therefore, care should be given when selecting VNC as a substitute for TNC in radiomics research to ensure accurate and reliable analysis. Moreover, the observed variations may impact clinical workflows, where precise tissue characterization is critical for diagnosis and treatment planning.

Comparison study of quantitative susceptibility mapping with GRAPPA and wave-CAIPI: reproducibility, consistency, and microbleeds detection.

We compared quantitative susceptibility mapping (QSM) with wave-CAIPI 9 × (QSM_WC9 ×) with reference standard QSM with GRAPPA 2 × (QSM_G2 ×) in two MR scanners. We also compared detectability of microbleeds in both QSMs to demonstrate clinical feasibility of both QSMs. This prospective study was approved by the institutional review board and written informed consent was obtained from each subject. Healthy subjects were recruited to evaluate intra-scanner reproducibility, inter-scanner consistency, and inter-sequence consistency of QSM_G2 × and QSM_WC9 × at 2 MR scanners. Susceptibility values measured with volume of interests (VOIs) were evaluated. Patients who were requested for susceptibility weighted imaging were also recruited in this study to measure microbleeds on QSM_G2 × and QSM_WC9 × . The number of microbleeds was compared between two QSMs. Total 55 healthy subjects (male 34, female 21, 38.3years [23-79]) were included in this study. We investigated reproducibility and consistency of QSM_WC9 × by comparing reference standard QSM_G2 × in two MR scanners in this study, and high correlation (ρ, 0.93-0.97) and high intraclass correlation coefficient (ICC) (0.97-0.99) were obtained. Sixty patients (male 30, female 30; age, 55.4years [21-85]) were finally enrolled in this prospective study. The ICC of the detected number of microbleeds between QSM_G2 × and QSM_WC9 × was 0.99 (0.98-0.99). QSM_WC9 × and reference standard QSM_G2 × in two MR scanners showed good reproducibility and consistency in estimating magnetic susceptibilities. QSM_WC9 × and QSM_G2 × were also comparable in terms of microbleeds detection with good agreement of raters and high ICC.

Toward assessment of rupture risk predictors in abdominal aortic aneurysms including intraluminal thrombus based on 3D+t ultrasound images.

Image-based patient-specific rupture risk analysis for abdominal aortic aneurysms (AAAs) has shown considerable promise. However, clinical translation has been hampered by the use of invasive and costly imaging modalities. Despite being a promising alternative, ultrasound (US) makes a full analysis, including intraluminal thrombus (ILT), not trivial. This study explored the feasibility of assessing AAA rupture risk parameters, e.g., peak wall stress (PWS) and peak wall rupture index (PWRI), using US-based models of the AAA wall, finally including ILT. Three-dimensional US data were segmented from a group of AAA patients whose CT data were available within 30 days. The segmented vessel wall and ILT boundaries were converted into a mesh including and excluding ILT to evaluate the effect of adding ILT on the model output. US-based rupture risk parameters (PWS and PWRI) were compared to CT-based results. The US-based PWS and PWRI, including ILT, showed good agreement with CT-based results, and the model excluding ILT showed no significant bias in wall stress or rupture index. When including ILT, a lower US-based wall stress and rupture index of 7.2% and 3.8% were found, respectively. The intraclass correlation coefficient (ICC) of PWS was 0.60. The highest ICC was found for the PWRI (ICC = 0.86), indicating good absolute agreement. This study showed that PWRI can be estimated with US when including the ILT, yielding comparable results to CT, and good absolute agreement. Future work should focus on improving the contrast of ILT in US, since this will be essential to performing large-scale studies in AAA cohorts.

Core laboratory versus center-reported echocardiographic assessment of the native and bioprosthetic aortic valve

Abstract Background The use of a central echocardiographic core laboratory (ECL) is advised to minimize measurement variation and heterogeneity in clinical trials. Insights into quantitative differences between ECL and center-reported echocardiographic assessment of the native and bioprosthetic aortic valve are lacking. We aimed to explore clinically relevant differences between these evaluations. Methods Data were used from the PERIcardial SurGical AOrtic Valve ReplacemeNt (PERIGON) Pivotal Trial for the Avalus valve. In this trial, patients with an indication for surgical aortic valve replacement (SAVR) due to aortic stenosis or regurgitation (AR) were enrolled. Serial echocardiographic examinations were performed at each center and reanalyzed by an independent ECL. For the bioprosthetic valve analysis, postoperative data throughout 5-year follow-up were pooled. Differences between the ECL and the centers in continuous parameters were quantified in mean differences and intraclass correlation coefficients (ICCs). Between-center differences were illustrated by plotting standardized mean differences (SMDs) between centers and the ECL for the 10 sites that implanted the most prostheses. Agreement on AR, paravalvular leak (PVL), and prosthesis-patient mismatch (PPM) classification was investigated using Cohen’s kappa coefficients. Results The analysis on the native aortic valve was performed on 1118 patients. The relative mean difference was largest for the left ventricular outflow tract (LVOT) area, followed by stroke volume and effective orifice area (index), with center-reported values being 11-7% higher (Table 1). High ICCs of around 0.90 were observed for peak aortic jet velocity, mean pressure gradient, and the velocity-time integral across the aortic valve. More than 5000 echocardiograms were available for the bioprosthetic valve analysis. Therein, comparable results were observed. In Figure 1, differences in assessment on center level are illustrated. The SMDs for peak velocity were between 0 and 0.5 for all centers, while there was more heterogeneity between centers for other parameters. The kappa coefficient was 0.59 (95% confidence interval [CI] 0.56, 0.63) for agreement on native AR, 0.28 (95% CI 0.18, 0.37) for PVL, and 0.42 (95% CI 0.40, 0.44) for PPM. Conclusions For echocardiographic assessment of the native and bioprosthetic aortic valve, agreement between the ECL and the clinical centers varies by parameter and by center. There is high agreement on continuous-wave Doppler-related measurements. On the contrary, agreement is low for parameters that involve measurement of the LVOT diameter. These results provide important context for the interpretation of aortic valve performance in studies that lack central ECL evaluation.

Evaluating OSPE as a Formative Assessment Tool for Medical Students

Introduction. Objective structured practical examination (OSPE) is a globally recognized and widely implemented assessment method used for evaluating students in practical examinations. It requires examinees to complete various tasks within a set time frame, each assessed against predetermined criteria designed to measure practical skills and attitudes. This study aimed to assess the effectiveness of the OSPE as a tool for internal assessment in the subject of Anatomy for first-year MBBS students, comparing its performance against the traditional practical examination (TPE) method. Methods. In this prospective study, an OSPE tool specific to Anatomy was developed and validated for face and content to ensure that the OSPE stations were standardized and well-constructed. The part-leaving test covered the Thorax and Brain chapters using both the TPE and OSPE methods. A Bland-Altman plot was employed to assess the agreement between the quantitative assessments of both methods. Additionally, a 5-point Likert scale was utilized to gauge the perceptions of both students and faculty members regarding the assessment methods. Results. The analysis revealed a significant difference between the scores obtained from OSPE and TPE. The intraclass correlation coefficients for reliability between TPE and OSPE were 0.81 for the Thorax chapter and 0.84 for the Brain chapter. Additionally, the Bland-Altman plots illustrating the scores from both assessment methods indicated low bias and no definite pattern. While no significant outliers were identified for the Brain part, the Thorax part exhibited outliers at a rate of 6.43%, suggesting the presence of low-impact erratic variables. The Chi-square test for student perceptions yielded significant results for the entire questionnaire. In contrast, faculty perceptions showed significant results for all questions except for two. Conclusions. Due to the high intraclass correlation coefficients between TPE and OSPE and the absence of bias, systematic errors, and erratic variables, OSPE is a promising assessment tool. Students perceived that OSPE decreased the chances of failure and that the questions asked in OSPE were more relevant compared to the traditional method. Faculty members also noted that OSPE provided reasonably high transparency and decreased subjective bias compared to TPE. Considering these factors, it can be concluded that OSPE is a viable potential tool to replace TSE.

Accuracy of a Smart Diaper System for Nursing Home Residents for Automatically Detecting Voided Volume: Instrument Validation Study.

Diapers are commonly used by older patients with urination disorders. A smart diaper system (SDS) may be able to estimate the weight of urine comparably to conventional measurements made by weighing diapers. The aim of the current research is to determine the degree of accuracy of an SDS technology specifically designed for the management of urination routines and the use of incontinence pads in older adults. From January to December 2022, 97 older patients with at least 1 chronic disease from 3 nursing homes were included. In this study, the SDS was used for 1 month per patient after obtaining their consent; all patients originally used traditional diapers in the nursing home. The index test measured the change in electrical resistance of the SDS and the reference test measured the change in actual urine weight. When measuring the actual urine weight, the degree of absorption was directly confirmed with the naked eye because the expression value varied according to pressure changes caused by the user's movement or position. The Pearson correlation was used to determine the correlation between the 2 test methods, the intraclass correlation coefficient (ICC) was used to check the degree of agreement between the evaluators, and the Bland-Altman test was used to confirm whether there was a significant difference between the 2 test methods. The average age of the 97 participants was 86.48 (SD 6.26) years, with 10 men and 87 women. There were 73 patients (75%) with hypertension, 86 patients (88%) with dementia, and 86 patients (88%) with 2 or more comorbidities, accounting for the majority. The Pearson correlation coefficient and ICC were 0.971 and 0.985 (P<.001). In the Bland-Altman figure, the difference in the mean between the 2 tests was evenly scattered without showing a specific pattern, indicating that the SDS and actual urine weight were very consistent. The difference between the mean of the 2 tests was -0.045 of the standardized mean difference, and all measurements were located within the 95% CI, so this confirms that the 2 test methods are equivalent. Our study showed a fairly high correlation coefficient and ICC for all patient groups, which reveals that the 2 tests were very consistent and that the SDS can replace traditional diapers, even in a real clinical setting. This study shows the possibility that heath care professionals could be alerted by the SDS to the need for pad replacement due to incontinence, thus avoiding the development of dermatological complications.

Repeatability and Reproducibility of pseudo-Continuous Arterial Spin Labeling Measured Brain Perfusion in Healthy Volunteers and Glioblastoma Patients.

Arterial spin labeled (ASL) MRI has gained recognition as a quantitative perfusion imaging method for managing patients with brain tumors. Limited studies have so far investigated the reproducibility of ASL-derived perfusion in patients with brain tumors. This study aims to evaluate intrasession repeatability and intersession reproducibility of perfusion measurements using 3D pseudo-continuous ASL (pCASL) with Cartesian TSE (TSE-CASPR) in healthy volunteers (HV) and glioblastoma (GBM) patients at 3 Tesla and compare against 3D pCASL with GRASE. This prospective study (NCT03922984) was approved by the institutional review board and written informed consent was obtained from all subjects. HV underwent repeated pCASL evaluations 2-4 weeks apart between November 2021 and October 2022. GBM patients were recruited for longitudinal MRI from September 2019 to February 2023. Intrasession repeatability (HV and GBM) and intersession reproducibility (HV only) of pCASL were assessed using linear regression, Bland-Altman analyses, intraclass correlation coefficient (ICC) with 95% confidence interval (CI), and within-subject coefficients of variation (wsCV). Twenty HV (9 men, age: 25.1±1.7 years, range 23-30 years) and 21 GBM patients (15 men; age: 59.8±14.3 years, range 28-81 years) were enrolled. Within imaging session, 3D pCASL measured perfusion with TSE-CASPR and GRASE respectively achieved high R2 values (0.88-0.95; 0.93-0.96), minimal biases (-0.46 to 0.81; -0.08 to 0.35 mL/100g/min), high ICC [95% CI] (0.96-0.98 [0.94-0.98]; 0.96-0.98 [0.92-0.99]), and low wsCV (6.64%-9.07%; 5.20%-8.16%) in HV (N=20) and GBM patients (N=21). Across imaging session, 3D pCASL in HV (N=20) achieved high R2 values (0.71; 0.82), minimal biases (-1.2; -0.90 mL/100g/min), high ICC [95% CI] values (0.85 [0.81-0.89]; 0.90 [0.87-0.93]), and low wsCV values (13.82%; 9.98%). Our study demonstrated excellent intrasession repeatability of 3D pCASL measured cerebral perfusion in HV and GBM patients and good to excellent intersession reproducibility in HV. 3D pCASL with GRASE performed slightly better than 3D pCASL with TSE-CASPR in HV; however, in GBM patients, 3D pCASL with TSE-CASPR showed better performance in tumor regions with nearly twofold higher SNR. ASL measured perfusion could serve as a non-contrast quantitative imaging biomarker to facilitate the management of GBM patients. ASL = arterial spin labeling; pCASL = pseudo-continuous arterial spin labeling; GBM = glioblastoma; CBF = cerebral blood flow; CASPR = Cartesian acquisition with spiral profile reordering; GRASE = gradient and spin echo; NAGM = normal-appearing gray matter.

Kinetics of EBV antibody-based NPC risk scores in Taiwan NPC multiplex families.

Nasopharyngeal carcinoma (NPC) risk prediction models based on Epstein-Barr virus (EBV)-antibody testing have shown potential for screening of NPC; however, the long-term stability is unclear. Here, we investigated the kinetics of two EBV-antibody NPC risk scores within the Taiwan NPC Multiplex Family Study. Among 545 participants with multiple blood samples, we evaluated the stability of a 2-marker enzyme-linked immunosorbent assay score and 13-marker multiplex serology score using the intra-class correlation coefficient (ICC) by fitting a linear mixed model that accounted for the clustering effect of multiple measurements per subject and age. We also estimated the clustering of positive tests using Fleiss's kappa statistic. Over an average 20-year follow-up, the 2-marker score showed high stability over time, whereas the 13-marker score was more variable (p < .05). Case-control status is associated with the kinetics of the antibody response, with higher ICCs among cases. Positive tests were more likely to cluster within the same individual for the 2-marker score than the 13-marker score (p < .05). The 2-marker score had an increase in specificity from ~90% for single measurement to ~96% with repeat testing. The 13-marker score had a specificity of ~73% for a single measurement that increased to ~92% with repeat testing. Among individuals who developed NPC, none experienced score reversion. Our findings suggest that repeated testing could improve the specificity of NPC screening in high-risk NPC multiplex families. Further studies are required to determine the impact on sensitivity, establish optimal screening intervals, and generalize these findings to general population settings in high-risk regions.