Interobserver Reliability Testing Research Articles

Reliability assessment of new radiographic scales to evaluate radiolucency and bony in-between fin growth of partially cemented all-polyethylene glenoid components

Current methods available for assessment of radiolucency and in-between fin (IBF) growth of a glenoid component have not undergone interobserver reliability testing for an all-polyethylene fluted central peg (FCP) glenoid. The purpose of this study was to evaluate anteroposterior radiographs of an FCP glenoid component at ≥48 months comparing commonly used scales to a new method adapted to the FCP. Our hypothesis was that the new method would result in acceptable intra- and interobserver agreement and a more accurate description of radiographic findings. We reviewed ≥48-month follow-up radiographs of patients treated with a primary aTSA using an FCP glenoid. Eighty-three patients were included in the review. Radiographs were evaluated by 5 reviewers using novel IBF radiodensity and radiolucency assessments and the Wirth and Lazarus methods. To assess intraobserver reliability, a subset of 40 images was reviewed. Kappa statistics were calculated to determine intra- and interobserver reliability; correlations were assessed using Pearson correlation. Interobserver agreement (κ score) was as follows: IBF 0.71, radiolucency 0.68, Wirth 0.48, and Lazarus 0.22. Intraobserver agreement ranges were as follows: IBF radiodensity 0.36-0.67, radiolucency 0.55-0.62, Wirth 0.11-0.73, and Lazarus 0.04-0.46. Correlation analysis revealed the following: IBF to Wirth r=0.93, radiolucency to Lazarus r=0.92 (P value <.001 for all). This study introduces a radiographic assessment method developed specifically for an FCP glenoid component. Results show high interobserver and acceptable intraobserver reliability for the method presented in this study. The new scales provide a more accurate description of radiographic findings, helping to identify glenoid components that may be at risk for loosening.

Comparisons of diagnostic performance and the reliability in identifying ACL injury between two measuring protocols of anterior tibial subluxation on MR images.

To evaluate the diagnostic performance in identifying an anterior cruciate ligament (ACL) injury and the reliability between two measuring protocols of anterior tibial subluxation (ATS). A total of 165 patients with ACL injury and 157 ACL-intact patients were included in this study. Two different measuring protocols of ATS were performed on sagittal MR images, including the modified protocol using the longitudinal tibial axis (axis protocol) and the established protocol using a line perpendicular to the tibial plateau (plateau protocol). Receiver-operating characteristic (ROC) curves were calculated to evaluate the diagnostic performance in identifying an ACL injury, and areas under the curves (AUCs) were compared between the two protocols. Intra- and interobserver reliability tests were performed to evaluate the reliability of the measurements. Lateral ATS (P < 0.001) and medial ATS (P < 0.001) were increased in patients with ACL injury under both protocols. To identify an ACL injury, ATS measured under the axis protocol showed higher AUC values than the plateau protocol, including lateral ATS (AUC 0.828 vs. 0.688, P < 0.001), medial ATS (AUC 0.829 vs. 0.789, P = 0.013), and the combined indicator of lateral and medial ATS (AUC 0.885 vs. 0.810, P < 0.001). Reliability tests showed that both protocols were reliable. ATS measured under the modified protocol using the longitudinal tibial axis showed superior diagnostic performance in identifying an ACL injury compared to the established protocol, indicating that the modified protocol may better reflect the characteristics of an ACL-deficient knee.

Deep learning based liquid level extraction from video observations of gas–liquid flows

The slug flow pattern is one of the most common gas–liquid flow patterns in multiphase transportation pipelines, particularly in the oil and gas industry. This flow pattern can cause severe problems for industrial processes. Hence, a detailed description of the spatial distribution of the different phases in the pipe is needed for automated process control and calibration of predictive models. In this paper, a deep-learning based image processing technique is presented that extracts the gas–liquid interface from video observations of multiphase flows in horizontal pipes. The supervised deep learning model consists of a convolutional neural network, which was trained and tested with video data from slug flow experiments. The consistency of the hand-labelled data and the predictions of the trained model have been evaluated in an inter-observer reliability test. The model was further tested with other data sets, which also included recordings of a different flow pattern. It is shown that the presented method provides accurate and reliable predictions of the gas–liquid interface for slug flow as well as for other separate flow patterns. Moreover, it is demonstrated how flow characteristics can be obtained from the results of the deep-learning based image processing technique.

Preoperative MRI-based vertebral bone quality (VBQ) score assessment in patients undergoing lumbar spinal fusion

BACKGROUND CONTEXTThe importance of bone status assessment in spine surgery is well recognized. The current gold standard for assessing bone mineral density is dual-energy X-ray absorptiometry (DEXA). However, DEXA has been shown to overestimate BMD in patients with spinal degenerative disease and obesity. Consequently, alternative radiographic measurements using data routinely gathered during preoperative evaluation have been explored for the evaluation of bone quality and fracture risk. Opportunistic quantitative computed tomography (QCT) and more recently, the MRI-based vertebral bone quality (VBQ) score, have both been shown to correlate with DEXA T-scores and predict osteoporotic fractures. However, to date the direct association between VBQ and QCT has not been studied. PURPOSEThe objective of this study was to evaluate the correlation between VBQ and spine QCT BMD measurements and assess whether the recently described novel VBQ score can predict the presence of osteopenia/osteoporosis diagnosed with QCT. STUDY DESIGN/SETTINGCross-sectional study using retrospectively collected data. PATIENT SAMPLEPatients undergoing lumbar fusion from 2014-2019 at a single, academic institution with available preoperative lumbar CT and T1-weighted MRIs were included. OUTCOME MEASURESCorrelation of the VBQ score with BMD measured by QCT, and association between VBQ score and presence of osteopenia/osteoporosis. METHODSAsynchronous QCT measurements were performed. The average L1-L2 BMD was calculated and patients were categorized as either normal BMD (>120 mg/cm3) or osteopenic/osteoporotic (≤120 mg/cm3). The VBQ score was calculated by dividing the median signal intensity of the L1-L4 vertebral bodies by the signal intensity of the cerebrospinal fluid on midsagittal T1-weighted MRI images. Inter-observer reliability testing of the VBQ measurements was performed. Demographic data and the VBQ score were compared between the normal and osteopenic/osteoporotic group. To determine the area-under-curve (AUC) of the VBQ score as a predictor of osteopenia/osteoporosis receiver operating characteristic (ROC) analysis was performed. VBQ scores were compared with QCT BMD using the Pearson's correlation. RESULTSA total of 198 patients (53% female) were included. The mean age was 62 years and the mean BMI was 28.2 kg/m2. The inter-observer reliability of the VBQ measurements was excellent (ICC of 0.90). When comparing the patients with normal QCT BMD to those with osteopenia/osteoporosis, the patients with osteopenia/osteoporosis were significantly older (64.9 vs. 56.7 years, p<.0001). The osteopenic/osteoporotic group had significantly higher VBQ scores (2.6 vs. 2.2, p<.0001). The VBQ score showed a statistically significant negative correlation with QCT BMD (correlation coefficient = -0.358, 95% CI -0.473 - -0.23, p<.001). Using a VBQ score cutoff value of 2.388, the categorical VBQ score yielded a sensitivity of 74.3% and a specificity of 57.0% with an AUC of 0.7079 to differentiate patients with osteopenia/osteoporosis and with normal BMD. CONCLUSIONSWe found that the VBQ score showed moderate diagnostic ability to differentiate patients with normal BMD versus osteopenic/osteoporotic BMD based on QCT. VBQ may be an interesting adjunct to clinically performed bone density measurements in the future.

Benchmarking Based on Regularly Recorded Claw Health Data of Austrian Dairy Cattle for Implementation in the Cattle Data Network (RDV).

Simple SummaryBenchmarking is an assessment process that compares an individual entity to their peer group and the ‘best in class’. The goal is to motivate for improvement, e.g., claw health in dairy farms. We describe the pre-requisites necessary for establishing a benchmarking system for claw health. Data were transmitted by hoof trimmers, who recorded claw lesions of dairy cows in 512 herds during each trimming visit. National dairy herd improvement organisations provided animal and herd information, such as milk performance and culling data, and scoring of cows for lameness at regular milk performance tests for 99 herds. Appropriate key performance indicators for describing claw health in dairy cattle are the incidences of risk of lameness, 13 common claw lesions, and the annual culling risk directly related to claw and limb disorders. All data sets were for 2020. These key performance indicators were arranged in a benchmarking system using six classes (mean, median, 10th, 25th, 75th, and 90th percentiles) where farms in the 10th percentile represented the ‘best in class’.While benchmarking is already used for the assessment of performance gaps in cattle herd management and welfare concerns, its application to quantifying claw health performance is relatively new. The goal here was to establish a benchmarking system for claw health in Austrian dairy cattle. We used electronically registered claw health data of cows from 512 dairy herds documented by professional hoof trimmers, culling data from the same herds, and locomotion scores taken at regular milk performance testings in 99 dairy herds during 2020. Mean, median and the 10th, 25th, 75th, and 90th percentiles of the incidences of risk of lameness, 13 common claw lesions, and the annual culling risk directly related to claw and limb disorders were used as key performance indicators. Only validated data sets were used and participating trimmers and locomotion scorers had to pass interobserver reliability tests with weighted Cohen’s kappa values ≥ 0.61 indicating substantial interobserver agreement. This claw health benchmarking system is intended to be used henceforth in the transnational cattle data network (RDV) by all participating farmers and is also available for veterinarians and consultants, with the agreement of respective farmers.

73 Computed Tomography Imaging to Determine Reduction in Intracrainal Pressure Before &amp; After Posterior Vault Expansion in Apert Syndrome

Abstract Introduction Apert syndrome is an autosomal dominant malformation syndrome, accounting for 4.5% of all craniosynostoses. Raised intracranial pressure (ICP) in Apert syndrome has a multifactorial aetiology, with an incidence of up to 45% if left untreated [1, 2]. Raised ICP can be determined clinically, with non-invasive and invasive methods. In this study, we want to assess whether the use of CT scans is reliable in identifying changes in ICP. Method Pre and postoperative CT scans for 13 Apert syndrome patients who had posterior vault expansion were assessed and graded for severity of intracranial pressure (ICP). The grading system used was departmental specific and the assessment was carried out by a single clinician on different brain structures. This process was repeated on the same patients, using the same CT scans, 4 months later to determine consistency and repeatability. The relationship between the pre and postoperative scans was explored using the chi squared test. Intra-observer variability was assessed using Kappa statistics [SS1]. Results There was no statistically significant difference between the pre and postoperative CT scan grading. Across instances, only one assessed structure had a p-value &amp;lt;0.05. The Kappa interobserver reliability test did not identify a strong agreement in the comparison of the two instances of data analysis. Conclusions Assessment of CT scans is not a reliable method to determine changes in intracranial pressure in Apert syndrome patients who have had a posterior vault expansion.

Reliability of cerebral edema interpretation on head computed tomography scan in mild and moderate traumatic brain injury

Introduction: Cerebral edema could be caused by mild or moderate traumatic brain injury. The primary modality for cerebral edema is head computed tomography (CT), however the interpretation could be different between radiologists which could be due to subjectivity. The purpose of this study is to determine the radiologist interobserver and intraobserver reliability in the interpretation of cerebral edema on head CT of mild and moderate traumatic brain injury in Sanglah General Hospital, Denpasar, Bali.Methods: Retrospective study design with interobserver and intraobserver reliability test of two radiologists in interpreting cerebral edema on head CT of patients with mild and moderate traumatic brain injuryResults: 35 head CT scans of patients with clinical history of mild or moderate traumatic brain injury, shows that significant differences (bias) intraobserver and interobserver in the interpretation of cerebral edema.Conclusion: Head CT scan could not be reliable to determine cerebral edema in patients with mild and moderate traumatic brain injury due to high subjectivity between radiologists.

Extraocular Muscle Volumetry for Assessment of Thyroid Eye Disease.

In this study we evaluate the diagnostic accuracy of extraocular muscle volumetry in detecting thyroid eye disease and to compare the results with simple measurements of maximal medial rectus (MR) diameter. Cross-sectional study that included 47 eyes of 47 patients with thyroid eye disease and 47 healthy controls. Patients underwent slitlamp examination and imaging consisting of computed tomography scans. Image segmentation and volume measurements were performed by 2 independent researchers. Intraobserver and interobserver reliability testing was also conducted. Total extraocular muscle volume was 7.31 ± 1.88 cm3 and medial volume was 2.38 ± 0.73 cm3 in the study group. In this group, the maximum measured diameter of the MR was 6.67 ± 0.35 mm. MR volume was statistically associated with maximum MR diameter (r = 9.78; P < 0.001). Both MR volume and maximum MR diameter measurements showed good predictive efficacy as shown using receiver operator characteristic curve analysis. Complications of thyroid eye disease are often sight threatening, and timely diagnosis is crucial for the management of the entity and its sequelae. The results of this study imply that simple measurements of maximum MR diameter are sensitive enough to establish diagnosis.

Assessment of superior vena cava flow and cardiac output in different patterns of patent ductus arteriosus shunt

Despite the widespread use of superior vena cava (SVC) flow as a marker of systemic blood flow from the upper body, no previous studies have systematically evaluated the correlation between SVC flow and other echocardiography measures of systemic blood flow in the context of different patterns of patent ductus arteriosus (PDA) shunt direction METHODS: A retrospective cohort study of preterm infants (<30weeks,<21 days of life) who underwent comprehensive targeted neonatal echocardiography (TnECHO) was performed. Patients were categorized as follows: (i) Hemodynamically significant left-to-right shunt; (ii): Bidirectional shunt; (iii) No PDA or insignificant shunt. SVC flow, as measured by two distinct methods, was compared to left and right ventricular outputs (LVO and RVO). Intra- and inter-observer reliability testing was performed RESULTS: In total, 45 patients were included (15 in each group) with a median [IQR] weight of 720 [539, 917] grams at the time of assessment. SVC dimensions and flow measurements were not different between the groups, although patients with left-to-right shunt had higher LVO/RVO ratio. SVC flow, as estimated using the modified method, had a strong correlation with LVO (r=.63, p=0.012) and RVO (r=.635, p=0.011) in patients with no PDA. Inter- and intra-observer reliability were both stronger for LVO and RVO when compared to SVC flow measurements CONCLUSION: SVC flow was comparable across all three groups irrespective of higher LVO and LVO/RVO ratio in patients with left-to-right shunts. This may reflect poor measurement reliability or compensation for left-to-right ductal shunt by increased LVO to maintain systemic perfusion.

Gaps in Live Inter-Observer Reliability Testing of Animal Behavior: A Retrospective Analysis and Path Forward

Observational behavior research is an important activity for zoos and aquariums, often being conducted to provide insights into welfare and guide management decisions. This research relies on standardized protocols to ensure consistent data collection. Inter-observer reliability, where untrained observers are tested against the behavior identifications of an expert observer, represent a critical internal validation process. Recent software advances have made reliability testing easier and more accessible, but there is limited guidance on what constitutes a strong reliability test. In this study, we reviewed historic reliability test data from Lincoln Park Zoo’s on-going behavior monitoring program. Six representative species were chosen that included 645 live pairwise reliability tests conducted across 163 total project observers. We identified that observers were being tested on only approximately 25% of the behaviors listed and defined in the species ethograms. Observers did encounter a greater percent of the ethogram with successive reliability tests, but this gap remained large. While inactive behaviors were well-represented during reliability tests, social and other non-maintenance solitary behaviors (e.g., exploratory, scent marking, play, etc.) did not frequently occur during tests. While the ultimate implications of these gaps in testing are unclear, these results highlight the risks of live reliability testing as an inherently non-standardized process. We suggest several approaches to help address these limitations, including refining ethograms, reconsidering criteria, and supplementing live training with video. We hope this self-critique encourages others to critically examine their methods, enhance the quality of their behavioral data, and ultimately, strengthen conclusions drawn about animal behavior and welfare.

Ultrasonography to Assess the Efficacy of Osteopathic Manipulative Treatment for Lumbar Spine Asymmetry.

The effectiveness of osteopathic manipulative treatment (OMT) on the lumbar spine has been studied qualitatively, but quantitative measurement of the effects of OMT has not been thoroughly investigated. To quantitatively measure the palpated improvements of OMT on the lumbar spine using ultrasonography (US) and correlate palpatory diagnosis with US measurements of lumbar asymmetry. From September to November 2018, we recruited 20 adult participants 18 years of age or older. Lumbar somatic dysfunction (SD) was identified via osteopathic palpation. US was then performed on all participants with standard machine settings (frequency, 7 MHz; depth, 7 cm; dynamic range, 60; tissue harmonic imaging; and single-image focus). Longitudinal images of each lumbar transverse process were recorded and saved bilaterally by an experienced radiologist and a medical student. The participant's SD was then managed using OMT, including Still technique, myofascial release, muscle energy technique, high-velocity low-amplitude technique, functional positional release, balanced ligamentous tension, and counterstrain. Following OMT, US was performed again in the same method. Measurements of the saved US images were reviewed using a Digital Imaging and Communications in Medicine viewer. These measurements were obtained by 3 separate observers (J.W., A.K., S.M.), using the same computer software. Statistical analysis included a 2-tailed paired t-test to analyze rotational asymmetry pre- and posttreatment, an intraclass correlation coefficient (ICC) to test intra- and interobserver reliability, and a Pearson correlation coefficient (PCC) to analyze the correlation between US findings and OMT. The difference in soft tissue thickness before and after OMT was significant (P=.014), indicating improvements in rotational asymmetry. Side-bending asymmetry did not demonstrate statistically significant improvement. US findings correlated with the physician's palpatory rotational diagnosis (PCC=0.62, P=.004). ICC was greater than 0.9 for intra- and interobserver reliability tests of both US operation and offline image processing. The results of this study demonstrate that US is a feasible method of evaluating the efficacy of OMT. These results show good intra- and interobserver reliability of US acquisition and landmark measurement. Our study suggests that US assessment correlated closely with palpatory diagnosis. Our results also suggest that OMT can significantly improve lumbar rotational asymmetry, but did not improve side-bending asymmetry.

P89 Grocery Store Observations Using the CX3 Tool in Underserved Neighborhoods in Tampa, FL

<h3>Background</h3> Consumers' food choices can be influenced by food availability, marketing/advertisements, and interior/exterior infrastructure of food retail stores. Furthermore, there is a lack of representation of diverse population groups in previous retail store studies, especially studies conducted in low-income, ethnic minority communities. <h3>Objective</h3> To assess food availability, quality, price, and interior/exterior marketing of healthy and unhealthy foods in neighborhood stores using systematic observations. <h3>Study Design, Setting, Participants</h3> A cross-sectional observation study. Trained research staff visited 4 food retail stores identified in low-income, predominantly African American neighborhoods in Tampa, Florida. <h3>Measurable Outcome/Analysis</h3> Two observers conducted an inter-observer reliability test. The store observation was rated on a 100-point scale based on the CX3 (Communities of Excellence in Nutrition, Physical Activity, and Obesity Prevention) observation form developed and validated by the California Department of Health. Food availability, quality, price, interior and exterior marketing/advertisements were measured. To meet healthy retail store standards, the total score should be equal to or greater than 75. Descriptive statistics were used for data analysis. <h3>Results</h3> The mean total score was 71.6, which did not meet the healthy retail store standard score of 75. Two stores reached over 75 points (76.5 and 77.5) and the other 2 stores received a score of 63.0 and 69.5 points. All 4 stores met the standard for providing a wide range and quality of good fruit and vegetables, but 2 stores did not meet the standard for price of fruit and vegetables based on <10% of the county average. Two stores met the standard for availability of other healthy foods and exterior marketing/advertisements. No store met the standard for interior marketing/advertisement. <h3>Conclusions</h3> Although a variety of fruit and vegetables was available, the prices of fresh produce was relatively expensive. Each store had its strengths and weaknesses as a healthy food retail store. Tailored intervention strategies can be recommended for each store including healthy food marketing/advertisements within and outside of the store.

Best implant choice for coracoid graft fixation during the Latarjet procedure depends on patients\u2019 morphometric considerations

PurposeTo assess the anthropometric dimensions of the coracoid process and the glenoid articular surface and to determine possible implications with the different commercially available Latarjet fixation techniques.MethodsIn a total of 101 skeletal scapulae the glenoid length (GL), the glenoid width (GW), the coracoid length (CL), the coracoid width (CW) and the coracoid thickness (CTh) were measured. In order to assess the ability of the transferred coracoid to restore the glenoid anatomy we created a hypothetical model of 10%, 15%, 20%, 25% and 30% glenoid bone loss. We analyzed four common surgical fixation techniques for the Latarjet procedure (4.5 mm screws, 3.75 mm screws, 3.5 mm screws, and 2.8 mm button). The distances from the superior-inferior and medio-lateral limits of the coracoid using the four different fixation methods were calculated. We hypothesized that the “safe distance” between the implant and the coracoid osteotomy should be at least equal to the diameter of the implant.ResultsThe intra and inter-observer reliability tests were almost perfect for all measurements. The mean GH was 36.8 ± 2.5 mm, the GW 26.4 ± 2.2 mm, the CL 23.9 ± 3 mm, the CW 13.6 ± 2.mm, and the mean CTh was 8.7 ± 1.3 mm. The CL was < 25 mm in 46% of the cases. In cases with 25% and 30% bone loss, the coracoid graft restored the glenoid anatomy in 96% and 79.2% of the cases. With the use of the 4.5 mm screws the “safe distance” was present in 56% of the cases, with the 3.75 mm screws in 85%, with the 3.5 mm screws in 87%, and with the 2.8 mm button in 98% of the cases. The distance from the medio-lateral limit of the coracoid could be significantly increased (up to 9 mm) when smaller-button implants are used.ConclusionsThe coracoid graft could not always restore glenoid defects of 30%. Larger implants could be positioned too close to the osteotomy and the “medio-lateral offset” of the coracoid could be increased with smaller implants.

TESTING VALIDITY AND RELIABILITY OF COOPERATION WITH CARE SCALE - R IN NURSING HOME MAJOR NEUROCOGNITIVE DISORDER PATIENTS SMITA U. VARSHNEY, M.D., WILLIAM V. MCCALL, M.D.

Introduction Currently 1.7 million individuals reside in 15,600 nursing homes in US ( www.cdc.gov ). These individuals often have difficulty adjusting to their new environment. They may refuse daily care, meals, and medications. Resistance-to-care behavior was reported in 9% of dementia patients in US studies and 96.9% in a Norwegian study (Konno R 2012). A definition of rejection of care and a conceptual framework of rejection of care incorporating 7 components was proposed by Ishii S. 2012). Increased caregiver stress can cause both physical and psychological injury to caregivers (Cody SJ 2001). Informant distress related to patients behavioral and psychological symptoms of dementia (BPSD) rather than symptoms themselves, were noted to be associated with higher healthcare utilization and costs (Maust D. 2017). Increased mortality and death rate are associated with use of antipsychotic medications (Tampi R 2017). Different interventions have been reported to decrease resistance to care behaviors including Music therapeutic caregiving (Hammer L 2011), simulated presence therapy (Woods p 1995), Family-generated videotapes Cohen-Mansfield J 1997), video simulated presence(VSP) (O'Conner C 2012). AlzhaTV displayed family videos to dementia patients to reorient, reassure, encourage to cooperate with care, showed decrease in NPI-NH (Neuropsychiatric inventory – Nursing home) scores by 85% by day 90 (Varshney S 2018). Noncooperation with healthcare workers to overall daily care, medications, and treatments is a major factor in increased cost of care for dementia patients in nursing homes. A Resistiveness to Care scale was developed by (Mahoney EK 1999) to measure a wide range of resistive behaviors. Some strategies can be implemented to improve cooperation. However, our literature search didn't find any study/scale to assess co-operation with care that would help compare outcomes of different studies that used different interventions to improve cooperation with care. We created and tested a scale to measure cooperation with the care (Varshney S 2018) then revised to add frequency component to obtain a comprehensive assessment on cooperation with the care. We applied Cooperation with Care Scale – Revised (CWCS-R) to nurses taking care of 15 nursing home dementia patients, in a systematic approach to test its validity and reliability. Methods We recruited 17 nurses at a single nursing home who were caring for 15 MND patients of which 10 were female and 5 male patients. The study lasted for 6 weeks. For inter-observer reliability testing: We administered CWCS-R to a nursing home patient's nurse on first and second shift, once a week for the duration of 6 weeks. For validity testing: We administered Resistiveness to Care Scale (RTC) to the same patient's nurse on first and second shift, at the beginning of the study to test for external validity against CWCS-R. The integer of 1 was given to each yes on 13 item Resistiveness to Care Scale and were summed up at the end for each patient at the beginning of the study. Results Total 17 nurses enrolled in the study. Two nurses left after one month and 14 of the 15 nurses contributed a cooperation scale rating on at least one patient at least one point in time. 100% nurses were women (16 African American and 2 White). All nurses worked at the same nursing home for 6 months or more with mean work months was 81.5 months, median work months was 65 months with standard deviation (SD) 75.76 months. Mean age for nurse was 48?years, median was 47?years, and SD was 13. The patients included 10 women and 5 men. Mean for patients age was 88?years, median was 88?years and SD was 9?years. The mean (Mini Mental Status Examination) MMSE score was 7, and median MMSE score was 2, and SD was 8.3. All were white patients. 100% of patients were diagnoses with a MND. Inter-rater agreement Cooperation scores were 41.3 +/- 7.0 on first shift of week one, and 43.4 +/- 6.6 on second shift of week one (p= n.s). The median cooperation score across both shifts was 44. Using the median score of 44 as an indicator of which patients exhibited high versus low cooperation with care, a high degree of agreement was seen between the first and second shifts at week 1 (kappa=0.70; p Conclusions Our study shows that CWCS-R for MND patients, is both reliable and valid. More studies are needed to replicate these results of CWCS -R and to compare the level of cooperation with the care against the cost of care for MND patients in nursing home setting. This research was funded by: Coop Study was not funded by any source.

Orbital volume measurements from magnetic resonance images using the techniques of manual planimetry and stereology.

Introduction:Current volume measurement techniques, for the orbit, are time-consuming and involve complex assessments, which prevents their routine clinical use. In this study, we evaluate the applicability and efficacy of stereology and planimetry in orbital volume measurements using magnetic resonance imaging (MRI).Materials and Methods:Prospective imaging study using MRI. Sheep craniums and human subjects were evaluated. Water-filling measurements were performed in animal skulls, as the standard validation technique. Planimetry and stereology techniques were used in each dataset. Intraobserver and interobserver reliability testing were applied.Results:In stereology customization, 1/6 systematic sampling scheme was determined as optimal with acceptable coefficient of error (3.09%) and low measurement time (1.2 min). In sheep craniums, the mean volume measured by water displacement, planimetry, and stereology was 17.81 ± 0.59 cm3, 18.53 ± 0.24 cm3, and 19.19 ± 0.17 cm3, respectively. Planimetric and stereological methods were highly correlated (r = 0.94; P ≈ 0.001). The mean difference of the orbital volume using planimetry and stereology was 0.316 ± 0.168 cm3. In human subjects, using stereology, the mean orbital volume was found to be 19.62 ± 0.2 cm3 with a CE of 3.91 ± 0.15%.Conclusions:The optimized stereological method was found superior to manual planimetry in terms of user effort and time spent. Stereology sampling of 1/6 was successfully applied in human subjects and showed strong correlation with manual planimetry. However, optimized stereological method tended to overestimate the orbital volume by about 1 cc, a considerable limitation to be taken in clinical practice.

Sequential Radiographic Evaluation During Closed Treatment of Distal Radius Fracture.

To test the null hypothesis that there is no significant change in radiographic parameters, which determines an acceptable reduction, beyond 3 weeks in distal radius fractures with closed treatment. Retrospective review of a prospectively gathered registry of distal radius fractures. Academic medical center. Patients who underwent closed treatment of distal radius fracture. Sequential radiographic evaluation. Change of radiographic measurement including radial inclination, radial height, ulnar variance, articular tilt, teardrop angle, anteroposterior distance, intra-articular gap, and step-off. We compared postreduction radiographic parameters once within 2 weeks, at the third week, at cessation of immobilization, and analyzed the interobserver reliability test. There was a statistically significant difference between radiographic measurements, which determined an acceptable reduction between radiographs performed within 2 weeks versus the third week. Radial inclination and ulnar variance were statistically different at the third week compared with the time of cessation of immobilization. Seventy-seven percent of patients who had an acceptable reduction after 2 weeks maintained acceptable alignment at cessation of immobilization. Eighty-five percent of patients with acceptable reduction after 3 weeks maintained acceptable alignment at cessation of immobilization. Radial shortening >1.8 mm at the third week predicts an unacceptable radiographic outcome at cessation of immobilization (sensitivity 94.5% and specificity 90%). Radiographic parameters that determine acceptable reduction for closed treatment of distal radius fractures change minimally after 3-week postacceptable closed reduction. Radial shortening at the third week can be used to predict an unacceptable radiographic outcome. Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Cambodian Developmental Milestone Assessment Tool (cDMAT): Performance reference charts and reliability check of a tool to assess early childhood development in Cambodian children

BackgroundChildhood development milestones are essential skills that define how children participate in their environment socially, physically, and intellectually. A culturally-sensible and environmentally-appropriate tool is needed to assess their performance and detect disabilities at an early stage. MethodThis observational study aimed to create reference charts of performances among healthy rural and semi-rural Cambodian children aged 0–83 months for each milestone using the Denver II-based Cambodian Development Milestone Assessment Tool (cDMAT). Inter-observer reliability testing yielded Kappa scores. Results and conclusion1330 children included in the analyses represented an average population sample with similar gender balance, expected poverty distribution and the illiteracy rate among their mothers (81% with no or attended <7th-grade education). While gender, poverty and the mother's education level were not found to be confounding factors, the child's school enrolment status was (p < 0.005). The performance reference charts document the PASS ratios from which age onwards <25%, 25–75%, 75–90%, 90–99% and 99–100% of the children in each monthly cohort can perform a particular milestone. The mean inter-observer reliability ranged from substantial (Kappa 0.61 for delay) to excellent (Kappa 0.84 for immediate) in all domains. The performance reference charts of a culturally-sensible and environmentally-appropriate cDMAT can be used in Cambodia with special attention given to the child's school enrolment as it was found to be a confounding factor affecting child development. Creating a small-scale pilot program linking the cDMAT to early intervention would help raise awareness and create local expertise on early childhood development.

Investigation of the dependency of the drivers’ emotional experience on different road types and driving conditions

The growing sophistication of technologies and sociological advances are major causes for the dramatic change the automotive sector is currently undergoing. To address changes from a human-centered design perspective an improved understanding of the occupants’ emotional experience and behavior is required. Facial-Expression Analysis (FEA) is an emerging tool in support of such an approach, suitable for automotive research due to its non-contact application and low intrusiveness.The research described here investigated the dependency of the occupants’ emotional experience on road types and driving conditions by investigating emotional responses and their causes through FEA and observational analysis.Twenty-one university students and staff were recruited for the real-time test on a planned road circuit covering different road types and conditions. Facial-expression data and video information from two in-car cameras were collected during an average driving time of 40 min per participant. A multi-method approach was applied for the data analysis, including both quantitative statistical analysis and qualitative observational analysis, as well as an inter-observer reliability test. Emotion frequencies were compared between the different road types, resulting in a percentage difference from the total average of emotion frequency of −6.09% below average for urban roads, +11.15% above average for major roads and +4.88% above average for rural roads.The causes most frequently assigned to the emotional responses in this dataset were poor road conditions and causes related to the navigation device. The research supported the dependency of emotional experiences on the driving condition and type of road. The study presents the first step of a human-centered design approach towards modern automotive design. The results have wide application in automotive design, applicable to the development of, for instance, an affective human-machine interaction or a personalized autonomous driving experience.

Corneo-pterygium total area measurements utilising image analysis method

PurposeTo describe an objective method to accurately quantify corneo-pterygium total area (CPTA) by utilising image analysis method and to evaluate its association with corneal astigmatism (CA). Methods120 primary pterygium participants were selected from patients who visited an ophthalmology clinic. We adopted image analysis software in calculating the size of invading pterygium to the cornea. The marking of the calculated area was done manually, and the total area size was measured in pixel. The computed area is defined as the area from the apex of pterygium to the limbal-corneal border. Then, from the pixel, it was transformed into a percentage (%), which represents the CPTA relative to the entire corneal surface area. Intra- and inter-observer reliability testing were performed by repeating the tracing process twice with a different sequence of images at least one (1) month apart. Intraclass correlation (ICC) and scatter plot were used to describe the reliability of measurement. ResultsThe overall mean (N=120) of CPTA was 45.26±13.51% (CI: 42.38–48.36). Reliability for region of interest (ROI) demarcation of CPTA were excellent with intra and inter-agreement of 0.995 (95% CI, 0.994–0.998; P<0.001) and 0.994 (95% CI, 0.992–0.997; P<0.001) respectively. The new method was positively associated with corneal astigmatism (P<0.01). This method was able to predict 37% of the variance in CA compared to 21% using standard method. ConclusionsImage analysis method is useful, reliable and practical in the clinical setting to objectively quantify actual pterygium size, shapes and its effects on the anterior corneal curvature.

Normal Atlanto-Occipital Interval in Adults of Southeast Nigeria: An Evaluation of the Effect of Age, Sex, and Race

Imaging of the craniocervical junction (CCJ) after trauma is crucial for injury detection and description. Of all the anatomic measurements of the CCJ, the normal value of atlanto-occipital interval (AOI) is not yet well established in adults. The aim of our study is to determine the normal values of the AOI in Nigerians aged between 21 and 60 years using multidetector computed tomography (MDCT) scan and to determine racial, age, and sex differences. This was a prospective observational study done at Memfys Hospital for Neurosurgery, Enugu, Nigeria, between May 2016 and April 2017. There were 240 subjects (120 men and 120 women) divided into the following age groups: 21-30, 31-40, 41-50, and 51-60 years. Non-Nigerians and those with preexisting CCJ abnormalities were excluded. Normal values were those within the 95% confidence interval. Results were analyzed for possible sex and age variations and compared with the available literature for racial differences. Ethical approval was obtained for this study. The measured normal computed tomography value of the AOI in adult Nigerians was 1.181 ± 0.018 mm. The values in the age groups of 21-30, 31-40, 41-50, and 51-60 years were 1.279 ± 0.038, 1.164 ± 0.033, 1.151 ± 0.029, and 1.133 ± 0.033 mm, respectively (P < 0.05). The average normal values in men and women were 1.188 ± 0.025 and 1.174 ± 0.026 mm, respectively. The interobserver reliability test using the Cronbach α was 0.938. AOI values in this study were higher than previous MDCT-based values in non-African populations. The AOI decreased linearly with age and did not show any sex difference.