Inter-rater Reliability Agreement Research Articles

Validity and reliability of a proposed anterior implant esthetic index (AIEI)

Statement of problemPatient satisfaction and esthetic acceptance are important factors in predicting the success of implant therapy in the anterior maxilla. A standardized esthetic index to evaluate implant esthetic outcomes is still lacking. PurposeThe purposes of this study were to describe the newly developed images that correlate to the pink esthetic score and white esthetic score (PES/WES) for improved standardized documentation and to evaluate the validity and reliability of the proposed anterior implant esthetic index (AIEI) with patient satisfaction scores. Material and methodsA photograph deemed ideal (perfect score of 2) using the PES/WES criteria was acquired and digitally altered to represent scores of 1 (minor discrepancy) and 0 (major discrepancy) according to the PES/WES guidelines. A pilot study enrolled prosthodontists and periodontists to review and verify the representations. A 29-question survey was developed and distributed to 33 participants on a tablet computer to evaluate the photographs. The participants were asked about their satisfaction level with the photographs on a visual analog scale from 0 to 100. Data were extracted, and ANOVA was used to compare mean satisfaction scores. Post hoc Tukey tests were used to analyze the differences within each variable (α=.05). ResultsStandardized sets of 14 altered PES and 14 altered WES photographs were generated. The interrater reliability (n=5) of the pilot study showed moderate agreement with κ=0.453 (95% CI: 0.431–0.476) for all and individual scores. Based on the patient survey, 5 of the 14 factors of the PES/WES showed no significant difference and were eliminated when constructing the index. Using scores and percentages, the anterior implant esthetic index was developed for scores of 0, 1, and 2 for each of the remaining 9 criteria. The maximum score for the index was 20 points. ConclusionsPhotographic representation of each criterion within the PES/WES standardized the patient’s ability to evaluate anterior implant esthetics. An anterior implant esthetic index was developed, and a moderate interrater reliability agreement and good validation with patient satisfaction scores were obtained.

Should paediatric tonsillar asymmetry be an indication for tonsillectomy? A single centre experience.

Paediatric tonsillar lymphoma (TL) is a rare diagnosis. Historically, the presence of clinical features such as tonsillar asymmetry, grossly abnormal tonsil appearance and cervical lymphadenopathy raise concern for this diagnosis. Tonsillar asymmetry is considered to be the most concerning clinical feature; however, asymmetry is often apparent due to differences in depth or shape of tonsillar fossa and tonsillar pillars, rather than a true difference in volume. There is debate whether a tonsillectomy is required in all cases of tonsil asymmetry to exclude lymphoma, and what clinical features should raise concern. The aim of this study was to establish whether the presence of clinical asymmetry can be deemed a reliable marker for genuine tonsil size discrepancies. We also sought to evaluate the clinical and examination characteristics that are concerning for lymphoma. Retrospective review of clinical records for paediatric tonsil specimens sent for histological evaluation between 1 January 2012 and 1 January 2023 driven by a clinical suspicion of lymphoma at Starship Children's Hospital, New Zealand. Patient demographics and clinical data were recorded. A comparison was made between tonsil size asymmetry on clinical examination (Brodsky criteria) and tonsil volume difference based on dimensions given in pathology reports. One hundred and forty-three patients had tonsillectomies between 2012 and 2022 at Starship Children's Hospital due to concern for lymphoma. Of these, three were positive for lymphoma. Presence of pain and abnormal tonsil appearance were predictors for lymphoma (p<0.02). Interrater reliability agreement between clinical size difference and tonsil volume was poor, Kappa= -0.13 p<0.05. Clinical size difference is a poor predictor for true tonsil volume difference. We advise that assessment of tonsil size should be performed in conjunction with the examination of gross visual abnormalities and lymphadenopathy to guide clinical decision making.

Assessing the Reliability of Miller's Classification and Cairo's Classification in Classifying Gingival Recession Defects: A Comparison Study.

Background and Objectives: Gingival recession results in adverse aesthetics and root sensitivity, and there is a need to treat and prevent its further progression. To overcome these problems, various advances have been made by clinicians in treating gingival recession based on the type of gingival recession. Miller's classification has been used for a long time to classify the type of recession. However, certain limitations have been found with use of Miller's classification such as a lack of clarity in the method for measuring soft and hard tissue loss in the interproximal area. Cairo classification was proposed to overcome limitations of Miller's classification to classify gingival recession. Cairo's classification is a treatment-oriented classification based on buccal and interproximal attachment loss. Therefore, the study was conducted to assess and compare the reliability of Miller's and Cairo's classifications in determining gingival recession. Material and methods: A total of 220 buccal gingival recession defects were included in the study based on the inclusion and exclusion criteria. Four examiners were included in the study. Two examiners classified the recession defects according to Miller's classification and the other two examiners classified recession defects according to Cairo's classification at baseline and at a 1-week interval. Statistical analysis was conducted using SPSS software version 25.0 using Cohen's kappa correlation coefficient and Chi-square test statistics to determine the intra- and inter-rater agreement among the examiners for the two gingival recession classification systems. A p value of <0.05 was considered statistically significant. Results: The intra-rater agreement for Cairo's classification was 0.86 and 0.82, whereas for Miller's classification, it was found to be 0.68. The inter-rater reliability agreement for Cairo's classification was 0.82 and 0.8, whereas for the Miller's classification, it was 0.56 and 0.67. Conclusions: Within the limitations of the study, it was found that Cairo's classification is clearer and more reliable than Miller's classification in the assessment of gingival recession.

Remote paediatric ear examination comparing video-otoscopy and still otoscopy clinician rated outcomes

ObjectiveTelemedicine, particularly real time video-otoscopy in rural and remote Australia holds great potential in assessing and managing otology conditions. There is good evidence of store and forward images for assessment, however limited evidence exists for the use of real-time video-otoscopy. The objective of this study was to assess the validity of using real time video-otoscopy, compared to standard store and forward still image otoscopy, in a paediatric population. MethodFifty-two paediatric tympanic membranes in 27 patients were examined and photographed by a telehealth facilitator with prior otoscope training. This occurred at two rural Western Australian health centre sites. These images were stored and forwarded to a tertiary paediatric hospital for otolaryngology department assessment on the day of real-time video-otoscopy consultation. During this consultation the same twenty-seven patients underwent real-time video-otoscopy assessment, which was recorded. Across six domains including, image quality, focus, light, cerumen amount, field of view and tympanic membrane landmarks, real-time video-otoscopy was compared against still image capture. The recording of each real-time video-otoscopy and still image tympanic membrane was assessed by two otology specialists for the ability to diagnose each as either normal or abnormal. An inter-rater reliability agreement was then calculated. ResultsThere was greater image adequacy across five of the six domains for real time video-otoscopy compared to standard store and forward otoscopy images. Substantial agreement in diagnosing each tympanic membrane as either normal or abnormal between each rater was evident. ConclusionThis study supports the use of real time video-otoscopy during telemedicine consultation. With greater image quality, focus, light, field of view and identification of tympanic membrane landmarks video-otoscopy compared to still images has broad clinical applications. This includes primary assessment of the tympanic membrane and post operative follow-up clinical settings. Video-otoscopy offers a promising new way to over-come barriers in delivering ear health care in rural populations.

Clinical pharmacy interventions in an Austrian hospital: a report highlights the need for the implementation of clinical pharmacy services

BackgroundClinical pharmacy services face challenges in Austria due to limited implementation and acceptance, outdated legislation and a lack of guidelines and training, despite the evidence from global studies of the...

Non-invasive assessment of peri-implant mucosal thickness: A cross-sectional study.

This study aimed to evaluate the reliability and reproducibility of different non-invasive methods for the assessment of peri-implant mucosal thickness. Subjects with two adjacent dental implants in the central maxillary region were included in this study. Three different methods to assess facial mucosal thickness (FMT) were compared: digital file superimposition using Digital Imaging and Communication in Medicine (DICOM) and stereolithography (STL) files of the arch of interest (DICOM-STL), DICOM files alone, and non-ionizing ultrasound (US). Inter-rater reliability agreements between different assessment methods were analyzed using inter-class correlation coefficients (ICCs). A total of 50 subjects with 100 bone-level implants constituted the study population. Assessment of FMT using STL and DICOM files demonstrated excellent inter-rater reliability agreement. Mean ICC values of 0.97 and 0.95 were observed in the DICOM-STL and DICOM groups, respectively. Comparison between the DICOM-STL and US revealed good agreement, with an ICC of 0.82 (95% CI: 0.74 to 0.88) and a mean difference of -0.13±0.50mm (-1.13 to 0.86). Comparison between DICOM files alone versus US showed good agreement, with an ICC of 0.81 (95% CI: 0.73 to 0.89) and a mean difference of -0.23±0.46mm (-1.12 to 0.67). Comparison between DICOM-STL and DICOM files revealed excellent agreement, with an ICC of 0.94 (95% CI: 0.91 to 0.96) and a mean difference of 0.1±0.29mm (LOA -0.47 to 0.46). Quantification of peri-implant mucosal thickness via analysis of DICOM-STL files, DICOM files, or US assessment are comparably reliable and reproducible methods.

Quality assessment and comparison of two- and three-dimensional YouTube videos as additional educational tools for cataract surgery: "METAVERSE".

To compare the content and quality of 3D YouTube videos with 2Ds as additional educational tools for phacoemulsification surgery. This cross-sectional study included 2D and side-by-side 3D phacoemulsification videos found on YouTube by searching for "phacoemulsification," "phaco," and "cataract." Data was collected on video length (min), time since upload (days), number of views, likes, dislikes, cataract type, chop technique, and visualization system. Video popularity and interaction were calculated by video power index, interaction index, and viewing rate. Two senior ophthalmologists (SOs) and two ophthalmology residents (ORs) evaluated videos using the DISCERN, global quality score (GQS), and usefulness scoring systems. Inter-rater reliability was assessed using intra-class correlation coefficient (ICC). A total of 457 videos were screened, with 85 in 2D and 85 in 3D deemed appropriate for analysis. 2D videos received significantly more views, likes, dislikes, days since upload, video power index, and viewing rate than 3Ds (p < 0.001). Video length and interaction index in 3D videos were significantly greater than in 2Ds (p < 0.001). All video scoring systems revealed that 3D videos outperformed 2Ds in ORs (p < 0.05). ICC confirmed good inter-rater reliability agreement even at the lowest value (SOs: 0.924, 95% CI, 0.910-0.937; ORs: 0.892, 95% CI, 0.878-0.908). 3D YouTube videos as additional educational tools could help not only SOs but also ORs fully comprehend the breadth and depth of ocular surgeries, particularly phacoemulsification, by improving depth perception. They can also be used to review previously learned procedures, observe new ones, and recall old ones.

Clinicopathological assessment of patients with erythroderma

Background Erythroderma is a rare disease, characterized by generalized erythema and scaling of the skin. Aims The aim of this study was to clinicopathologically assess patients with erythroderma who attended the Department of Dermatology at the Faculty of Medicine, Sohag University, Upper Egypt. Patients and methods This was a cross-sectional clinical research study that was carried out on 33 patients with erythroderma. All of the patients were subjected to complete medical history taking and general and dermatological examinations. All of the patients were subjected to laboratory, radiological, and cutaneous histopathological evaluations. Results The mean age of the patients was 46.86 years. According to the clinical and histopathological findings, the erythrodermic patients were categorized into 26 (78.78%) patients who had preexisting dermatoses, four (12.12%) patients had malignancies, and three (9.1%) patients had drug reactions. Moreover, there was moderate and perfect interrater reliability agreement between clinical and histopathology evaluations in the diagnosis of different etiological causes of erythroderma. Limitations A small sample size and small number of included patients were the limitations of the study. Conclusion This study concluded that the main causes of erythroderma were preexisting dermatoses followed by malignancies and drug reactions. Psoriasis was the main preexisting dermatoses in erythrodermic patients. Clinical and histopathology evaluations are essential for accurate diagnosis of different etiological causes of the erythroderma.

Reliability and validity of the DSM-5 Diagnostic Interview Schedule for Children, Adolescents, and Parents-5 in externalizing disorders and common comorbidities.

The Diagnostic Interview Schedule for Children Adolescents and Parents (DISCAP) is a semi-structured diagnostic interview for assessing psychiatric disorders in children and adolescents. Changes to diagnostic criteria introduced in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) required the DISCAP to be revised accordingly. The aim of this study was to evaluate the reliability and validity of the updated DISCAP-5 in clinic-referred children. The DISCAP-5 was administered to parents of n=60 clinic-referred children aged 2-9 years with externalizing problems and a range of comorbid disorders. Inter-rater reliability data were collected using independent ratings of video-recorded DISCAP-5 interviews, and concurrent and discriminant validity were indexed against mother and father reports on the Strengths and Difficulties Questionnaire. Inter-rater reliability agreement was high for the presence and absence of any diagnosis, common externalizing (e.g., oppositional defiant disorder, conduct disorder) and internalizing disorders (separation anxiety disorder, generalized anxiety disorder), and severity of primary and secondary diagnoses. Rating scale data supported the concurrent and discriminant validity of diagnoses based on the DISCAP-5. The DISCAP-5 appears to provide valid and reliable data in the diagnostic assessment of clinic-referred children with behavioral and emotional difficulties across broad ranges of severity and complexity.

Validation of Panoramic Ultrasound Measurement of the Cross-Sectional Area of the Vastus Medialis.

Minnehan, KS, Dexter, WW, Holt, CT, Scharnetzki, L, Alex, JP, Chin, KE, and Kokmeyer, DJ. Validation of panoramic ultrasound measurement of the cross-sectional area of the vastus medialis. J Strength Cond Res 37(1): 41-45, 2023-The cross-sectional area (CSA) of the vastus medialis (VM) is an independent predictor of important clinical outcomes in musculoskeletal conditions of the knee, such as pain and long-term function. Previous studies validated ultrasound (US) to measure larger muscles of the thigh, but this approach has limited accuracy in measuring smaller muscles, such as the VM. In this study, we aimed to validate panoramic US measurements of the CSA of the VM and compare the results with those from the gold standard of magnetic resonance imaging (MRI) (significance set p ≤ 0.05). In this retrospective, single-center study, we compared pairs of US and MRIs taken of 25 adults who participated in a 10-week study of non-weight-bearing activity at a National Aeronautics and Space Administration facility. Images were acquired from various locations on the right thigh at multiple time points. Two researchers independently analyzed the US and MRI pairs by outlining the intermuscular border of the VM in the most distal image. We found excellent agreement between the US and MRI measurements of the CSA of the VM analyzed by researcher 1 (interclass correlation coefficient [ICC]: 0.997) and researcher 2 (ICC: 0.980). We also found excellent agreement for interrater reliability for MRI (ICC: 0.988) and US (ICC: 0.982) and intrarater reliability for US for researcher 1 (ICC: 0.999) and researcher 2 (ICC: 0.996). Our findings demonstrate that US is a valid and reliable tool for measuring the CSA of the VM compared with MRI.

Nurse-led cardiovascular diseases risk assessment and communication using WHO/ISH risk prediction chart in a tertiary care hospital of North India.

Cardiovascular diseases (CVDs) contribute to most of the potentially preventable burden through early risk assessment. Nurse-led CVD risk assessment is an effective strategy to address the human resource crisis for CVD prevention. An interventional study was conducted in medicine wards of a tertiary care hospital in North India to train nurses in CVD risk assessment and its communication. All bedside nurses (n = 30) of selected wards were enrolled and trained in CVD risk assessment and communication using WHO/ISH risk prediction charts. Once fully trained, each nurse enrolled patients (>40 years of age) from their respective wards to assess and communicate CVD risk. To calculate the reliability of risk assessment, investigator simultaneously assessed CVD risk with nurses. The mean age of nurses was 32.07 ± 6.31 years. The results revealed that training significantly increased the knowledge of nursing personnel (P < 0.001). There was perfect inter-rater reliability agreement (Cohen's k = 0.929) between nurses and investigators while assessing CVD risk. Nurses demonstrated good communication skills. The study concluded that nurses can be trained successfully in CVD risk assessment and communication. The study recommends the task shifting of CVD risk assessment to nurses after providing proper training.

Polypoidal Choroidal Vasculopathy Diagnosis and Neovascular Activity Evaluation Using Optical Coherence Tomography Angiography.

Purpose To examine choroidal neovascularization (CNV) characteristics in patients with exudative age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV), using swept-source optical coherence tomography angiography (SS-OCTA), and investigate agreement with OCT B-scan, fundus fluorescein angiography (FFA), and indocyanine green angiography (ICGA) by two different examiners. Methods This is a retrospective multicentric study that involved patients with a history of AMD and PCV. Examiner A, who had access to OCTA, B-scan OCT, FFA, and ICGA imaging, had to differentiate between AMD and PCV, study the activity of AMD using Coscas' criteria (active vs. quiescent), and categorize PCV subtypes, while examiner B had only access to OCTA. Then, the diagnostic concordance was assessed between both examiners. Results A total of 27 patients (11 females (40.7%) and 16 males (59.3%), P = 0.231) were included in the analysis. Among those, 13 patients presented with neovascular AMD and 14 patients with PCV. There were 92.3% of correct answers regarding appropriate diagnosis and lesion characterization among AMD patients, against 61.5% of correct answers among PCV patients. The overall interrater reliability agreement between examiners, using Cohen's kappa coefficient (κ) was 0.70 (0.5082-0.8916). Disagreement was found with one active AMD misdiagnosed as inactive AMD, three inactive PCV misdiagnosed as inactive AMD, and one inactive PCV misdiagnosed as active AMD. Conclusion SS-OCTA alone remains limited in some specific phenotypes of PCV, which suggests the ongoing role of B-scan OCT associated with FFA and ICGA in the diagnosis of these conditions.

An Overview of Mobile Language Learning in Selected Review Studies: 2010-2018

There has been a growing number of reviews of mobile language learning (MLL) conducted on various aspects of this field of study over the last two decades. However, unlike in other fields, there is a paucity of overviews of reviews that assess and integrate findings from multiple reviews, and that compare and contrast such findings, or establish gaps in existing reviews. The current overview examined 17 review studies published between 2010 and 2018, and investigated twenty-three characteristics extracted from these reviews with a view to comparing them and synthesising the main findings of these reviews. The selection criteria used were: reviews published between 2010 and June 2018, reviews published in peer-reviewed journals, use of at least one bibliographic database, reviews focusing on mobile language learning (MLL) or having MLL as one of the learning domains, and reviews published in English. Some of the findings of this overview are: most reviews were qualitative in nature and few of them had clearly and precisely formulated purposes; there is a lack of theoretical frameworks by the majority of these review studies; there were 25 precise and specific mobile device typologies reported by eleven reviews, of which personal digital assistants (PDAs) and mobile phones were the two most reported mobile device types, respectively; language was the most reported subject area followed by mathematics; fewer reviews mentioned and specified their research designs, their coding procedures, their inter-rater reliability agreement, and their quality assessment. Finally, English as a foreign language (EFL) was the major target language and vocabulary learning was the main focus of MLL.

Quantitative characterisation of ballistic cartridge cases from micro-CT

Evaluation of cartridge cases is essential within forensic ballistic analysis and is used in an attempt to establish a connection to the weapon used to fire it. This study consists of two experiments. The aims of Experiment 1 were to establish whether micro-CT is appropriate and repeatable for ballistic cartridge case analysis and if measurements can be extracted repeatably and reliably. Experiment 2 aimed to compare cartridge cases from two weapons to establish the magnitude of variation within and between weapons. A total of 48 cartridge cases fired by two distinct weapons were collected and micro-CT scanned to a high resolution. One randomly selected cartridge was scanned ten times under the same conditions to ensure repeatability of the scanning conditions in Experiment 1. Three novel measurements to quantitatively assess the firing pin impressions were proposed in Experiment 1 and comparatively analysed from two weapons in Experiment 2. Experiment 1 showed that micro-CT is an effective and highly repeatable and reliable method for 3-dimensional imaging and measurement of ballistic cartridge cases. Furthermore, high agreement for inter-rater reliability was found between five raters. Quantitative micro-CT analysis of the firing pin impression measurements in Experiment 2 showed a significant difference between the two studied weapons using Welch’s t-test (p < 0.01). This study shows the advantage and reliability of utilising micro-CT for firing pin impression analysis. Quantitation of the firing pin impression allows distinction between the weapons studied. With expansion to further weapons, application of this methodology could complement current analysis techniques through classification models.

The development of the Western Australian Haemodialysis Vascular Access Complexity instrument.

BackgroundThe Western Australian Haemodialysis Vascular Access Classification instrument was developed to classify the cannulation complexity of the arteriovenous fistula or arteriovenous graft as simple, challenging, or complex. Although the instrument was developed by experts in haemodialysis nursing, the instrument had not undergone formal validity or reliability testing.ObjectivesEvaluate the Western Australian Haemodialysis Vascular Access Classification instrument for content validity, interrater and test–retest reliability.DesignProspective cohort study.ParticipantsContent validity was assessed by haemodialysis nursing experts (n = 8). The reliability testing occurred in one in‐centre and one satellite haemodialysis unit in Western Australia from September to November 2019. Reliability testing was performed by 38 haemodialysis nurses in 67 patients receiving haemodialysis and 247 episodes of cannulation.MeasurementsInterrater and test–retest reliability assessment was conducted using κ, adjusted κ, Bland–Altman plots, intraclass correlation coefficient and Pearson's correlation coefficient.ResultsThe final version of the instrument (n = 20 items) had individual item‐level content validity indices ranging from 0.625 to 1.00 with a scale‐level content validity index of 0.89. For both interrater (n = 172 pairs) and test–retest (n = 101 pairs), most individual variables had excellent adjusted κ (n = 33 variables), some fair to good agreement (n = 6 variables) and one variable with poor agreement. The classification of simple, challenging and complex demonstrated adjusted κ of fair to good, to excellent agreement for interrater reliability with lower levels of agreement for test–retest reliability.ConclusionsThis instrument may be used to match a competency‐assessed nurse to perform the cannulation thereby minimising the risk of missed cannulation and trauma.

Inter-rater reliability in quality assurance (QA) of pediatric chest X-rays

PurposeThe goal of the study is to determine the inter-rater agreement on multiple factors that were utilized to evaluate the quality of pediatric chest X-ray exams from different levels of healthcare provision in an African setting. MethodsThe image quality of pediatric chest X-rays from 3 South African medical centers of varying level of healthcare service were retrospectively assessed by 3 raters for 12 quality factors including: (1) absent body parts; (2) under inspiration; (3) patient rotation; (4) scapula in the way; (5) patient kyphosis/lordosis; (6) artefact/foreign body; (7) central vessel visualization; (8) peripheral vessels visualization; (9) poor collimation; and (10) trachea and bronchi visualization; (11) post-cardiac vessel visualization; and (12) absent or wrong image orientation. Analysis was performed using the Brennan-–Prediger coefficient of agreement for inter-rater reliability and Cochran's Q statistic and McNemar's test for inter-rater bias. Results1077 X-rays were reviewed. The least difference between observers in the frequency of the errors was noticed for factors (1) absent body parts and (12) absent or wrong image orientation with almost perfect agreement between raters. κ score for these two factors among all raters and between each pair of raters was more than 0.95 with no significant inter-rater bias.Conversely, there was poor agreement for the remaining factors with the least agreed on being factor (3) patient rotation with a κ score of 0.23. This was followed by factors (2) under inspiration (κ score of 0.32) and factors (4) scapula in the way (κ score of 0.35) respectively. There was significant inter-rater bias for all these three factors. ConclusionMany of the factors used to assess the quality of a chest X-ray in children demonstrate poor reliability despite mitigation against variations in training, standard quality definitions and level of healthcare service provision. New definitions, objective measures and recording tools for assessing pediatric chest radiographic quality are required.

Flexion-extension standing radiographs underestimate instability in patients with single-level lumbar spondylolisthesis: comparing flexion-supine imaging may be more appropriate.

Generally, most spine surgeons agree that increased segmental motion viewed on flexion-extension radiographs is a reliable predictor of instability; however, these views can be limited in several ways and may underestimate the instability at a given lumbar segment. Consecutively collected adult (≥18 years old) patients with symptomatic single-level lumbar spondylolisthesis were reviewed from a two-surgeon database from 2015 to 2019. Routine standing lumbar X-rays (neutral, flexion, extension) and supine lumbar MRI (sagittal T2-weighted imaging sequence) were performed. Patients were excluded if they had prior lumbar surgery, missing radiographic data, or if the time between X-rays and MRI was >6 months. All 39 patients with symptomatic, single-level lumbar spondylolisthesis were identified. The mean age was 57.3±16.7 years and 66% were female. There was good intra- and inter-rater reliability agreement between measured values on the presence of instability. The slip percentage (SP) difference was significantly highest in the flexion-supine (FS) (5.7 mm, 12.3%) and neutral standing-supine (NS) (4.3 mm, 8.7%) groups, both of which were significantly higher compared with the flexion-extension (FE) group (1.8 mm, 4.5%, P<0.001). Ventral instability based on SP >8% was observed more frequently in FS (79.5%) and NS (52.6%) groups compared with FE group (16.7%, P<0.001). No statistically significant correlation was found between SP and disc angle for all radiographic views. Comparing standing lateral and flexion X-rays with supine MRIs provides higher sensitivity to assess instability than standard flexion-extension radiographs. The FS and NS comparisons also show greater slip percentage differences at higher slip grades, but not at different lumbar levels. These changes are not dependent on age or gender.

Accuracy of Computed Tomography Attenuation Value of Lumbar Vertebra to Assess Bone Mineral Density.

BackgroundComputed tomography (CT) attenuation (Hounsfield unit [HU]) value of lumbar vertebra may provide an alternative method in the detection of osteoporosis during CT scans.MethodsA cross-sectional study on 50 patients of age 50 and above with contrast-enhanced CT (CECT) and dual-energy X-ray absorptiometry (DXA) was conducted from November 2018 to November 2019. Single region of interest (ROI) was placed at the anterior trabecular part of L1 vertebra on CECT to obtain HU value. Correlation of CT HU value of L1 vertebra and DXA T-score, interrater reliability agreement between HU value of L1 vertebra and T-score in determining groups of with and without osteoporosis, ROC curve analysis for diagnostic accuracy and cut-off value of CT for detection of osteoporosis were identified.ResultsSignificant correlation between HU value of L1 vertebra and L1 T-score (r = 0.683)/lowest skeletal T-score (r = 0.703) (P < 0.001). Substantial agreement between HU value of L1 vertebra and DXA in determining the groups with and without osteoporosis (k = 0.8; P < 0.001). The area under the receiver operating characteristic (AUROC) curve was 0.93 (95% CI: 0.86, 1.00) using HU value (P < 0.001). Cut-off value for osteoporosis was 149 HU.ConclusionHU value of lumbar vertebra is an effective alternative for the detection of osteoporosis with high diagnostic accuracy in hospitals without DXA facility.

Mobile photographic screening for dental caries in children: Diagnostic performance compared to unaided visual dental examination.

This study was conducted to compare the use of intraoral photographs with the unaided visual dental examination as a means of dental caries detection in children. Children aged 4- to 14-year-olds were visually examined at their schools. Following dental examinations, children had five photographs of their teeth taken using a smartphone camera. Four dental reviewers, who are different from those who visually examined the children, assessed intraoral photographs for dental caries. Sensitivity, specificity, and inter-rater reliability agreement were estimated to assess the diagnostic performance of the photographic method relative to the benchmark visual dental assessments. Caries prevalence was measured using dft/DFT (decayed and filled teeth) index. One hundred thirty-eight children (67 male and 71 female) were enrolled and had a mean age of 7.8 ± 2.1 years. The caries prevalence (dft/DFT > 0) using photographic dental assessments ranged from 30percent to 39percent but was not significantly different from the prevalence (42percent) estimated with the visual dental examination (P ≥ 0.07). The sensitivity and specificity of the photographic method for detection of dental caries compared to visual dental assessments were 58-80percent and 99.7-99.9percent, respectively. The sensitivity for the photographic assessments was high in the primary dentition (63-82percent) and children ≤7-year-olds (67-78percent). The inter-rater reliability for the photographic assessment versus the benchmark ranged from substantial to almost perfect agreement (Kappa=0.72-0.87). The photographic approach to dental screening, used within the framework of its limitations, yielded an acceptable diagnostic level of caries detection, particularly in younger children with primary dentition.

Assessment of gingival thickness using digital file superimposition versus direct clinical measurements.

This study was aimed at evaluating the correlation and reproducibility of gingival thickness quantification using digital and direct clinical assessment methods. Patients in need of tooth extraction were allocated into two groups according to the gingival thickness measurement method, either using an endodontic spreader (pre-extraction) or a spring caliper (post-extraction), both on the mid-facial (FGT) and mid-lingual (LGT). Pre-extraction Digital Imaging and COmmunications in Medicine (DICOM) and STereoLithography (STL) files of the arch of interest were obtained and merged for corresponding digital measurements. Inter-rater reliability between digital and direct assessment methods was analyzed using inter-class correlation coefficients (ICC). Excellent inter-rater reliability agreement was demonstrated for all parameters. Comparison between the endodontic spreader and the digital method revealed excellent agreement, with ICC of 0.79 (95% CI 0.55, 0.91) for FGT and 0.87 (95% CI 0.69, 0.94) for LGT, and mean differences of 0.08 (- 0.04 to 0.55) and 0.25 (- 0.30 to 0.81) mm for FGT and LGT, respectively. Meanwhile, the comparison between the caliper and the digital method demonstrated poor agreement, with ICC of 0.38 (95% CI - 0.06, 0.70) for FGT and 0.45 (95% CI - 0.02, 0.74) for LGT, and mean differences of 0.65 (0.14 to 1.16) and 0.64 (0.12 to 1.17) mm for FGT and LGT, respectively. Digital measurement of gingival thickness is comparable with direct clinical assessments performed with transgingival horizontal probing using an endodontic spreader. Digital assessment of gingival thickness is a non-tissue invasive, reliable, and reproducible method that could be utilized as an alternative to horizontal transgingival probing.