Interclass Correlation Research Articles

Image quality of whole-body diffusion MR images comparing deep-learning accelerated and conventional sequences.

To compare the image quality of deep learning accelerated whole-body (WB) with conventional diffusion sequences. Fifty consecutive patients with bone marrow cancer underwent WB-MRI. Two experts compared axial b900 s/mm2 and the corresponding maximum intensity projections (MIP) of deep resolve boost (DRB) accelerated diffusion-weighted imaging (DWI) sequences (time of acquisition: 6:42 min) against conventional sequences (time of acquisition: 14 min). Readers assessed paired images for noise, artefacts, signal fat suppression, and lesion conspicuity using Likert scales, also expressing their overall subjective preference. Signal-to-noise and contrast-to-noise ratios (SNR and CNR) and the apparent diffusion coefficient (ADC) values of normal tissues and cancer lesions were statistically compared. Overall, radiologists preferred either axial DRB b900 and/or corresponding MIP images in almost 80% of the patients, particularly in patients with a high body-mass index (BMI > 25 kg/m2). In qualitative assessments, axial DRB images were preferred (preferred/strongly preferred) in 56-100% of cases, whereas DRB MIP images were favoured in 52-96% of cases. DRB-SNR/CNR was higher in all normal tissues (p < 0.05). For cancer lesions, the DRB-SNR was higher (p < 0.001), but the CNR was not different. DRB-ADC values were significantly higher for the brain and psoas muscles, but not for cancer lesions (mean difference: + 53 µm2/s). Inter-class correlation coefficient analysis showed good to excellent agreement (95% CI 0.75-0.93). DRB sequences produce higher-quality axial DWI, resulting in improved MIPs and significantly reduced acquisition times. However, differences in the ADC values of normal tissues need to be considered. Deep learning accelerated diffusion sequences produce high-quality axial images and MIP at reduced acquisition times. This advancement could enable the increased adoption of Whole Body-MRI for the evaluation of patients with bone marrow cancer. Deep learning reconstruction enables a more than 50% reduction in acquisition time for WB diffusion sequences. DRB images were preferred by radiologistsin almost 80% of cases due to fewer artefacts, improved background signal suppression, higher signal-to-noise ratio, and increased lesion conspicuity in patients with higher body mass index. Cancer lesion diffusivity from DRB images was not different from conventional sequences.

P-034 Revolutionizing sperm morphology assessment: A novel artificial intelligence optic microscope (AIOM)-powered platform for consistent and reliable analysis in male infertility diagnosis

Abstract Study question Does AIOM-based live sperm morphology annotation provide consistent and accurate results for assessing sperm morphology? Summary answer AIOM offers precise and reproducible sperm morphology evaluations which can enhance diagnostic efficiency with a single and reliable test. What is known already Semen analysis remains the primary diagnostic tool for male infertility. Unlike concentration and motility, sperm morphology shows a much higher correlation with paternal genetic integrity. However, it poses challenges due to inter-observer and inter-laboratory variability. The 2023 semen proficiency test highlighted these inconsistencies, reporting deviations of up to 13% among laboratories and acceptability ranging from 0% to 43%. This inconsistency is linked to complex staining procedures and interpretive subjectivity. To address these challenges, our study evaluates a novel AIOM-assisted platform, employing a live sperm morphology deep learning model. We aim to explore the platform’s reproducibility and reliability. Study design, size, duration In the first stage, liquefied semen specimens were split into three aliquots, each assigned to one of three operators (operators 1–3). Each operator assessed sperm morphology using Diff-Quik and live sperm morphology using the LensHooke® X12 semen analysis system (Bonraybio, Taichung). In the second stage, a single well-trained operator conducted sperm morphology assessments for three replicates (replicates 1-3) using the two methods. Interclass-correlation coefficients (ICCs) were calculated to assess consistency between replicates and operators. Participants/materials, setting, methods Semen samples (n = 30) were collected post 2-5 day abstinence and liquefied at room temperature for 30 minutes. Specimens were diluted to 100 million/mL with HTF, and underwent Diff-Quik staining according to WHO’s instruction. Aliquot of 3 μL semen specimen was loaded to 10-μm LensHooke® CS3 slide and analyzed by X12 analysis using live sperm morphology algorithm. Main results and the role of chance X12 utilizes a deep learning algorithm to automatically annotate sperm morphology, focusing on parameters such as sperm head, midpiece, tail, and excess residual cytoplasm, ultimately generating outputs for normal morphology and the teratozoospermic index (TZI) based on WHO strict criteria. Compared to manual Diff-Quik analysis, X12 showed higher consistency across all parameters, with ICCs above 0.85, unlike the manual method’s lower ICCs (below 0.70). The determination of abnormal midpiece had the lowest agreement between operators [ICC (95% CI): 0.15 (-0.61–0.58)]. In contrast, X12 demonstrated high agreement in all parameters, with ICC values consistently exceeding 0.85. When comparing the agreement of normal morphology rates between the two methods, a notable difference was observed [(Manual method: 0.59 (0.22–0.8) versus X12: 0.8 (0.61–0.9)]. To minimize inter-operator variability, a highly trained operator conducted three replicates following the manual method, thereby reducing deviations between measures. Remarkably, a single assessment of live sperm morphology produced results that were comparable to the mean average of repeated measures obtained through manual methods. In conclusion, the new platform for sperm morphology assessment, contingent on AIOM technology, is a reproducible and reliable tool in male infertility diagnosis. Limitations, reasons for caution This study’s limitations include its laboratory-based nature and a small sample size. Further research should include a more diverse and larger patient cohort to validate the efficacy and accuracy of AIOM in live sperm morphology assessment. Wider implications of the findings AIOM’s integration of automated interpretation simplifies sperm morphology assessment, reducing sample requirements and is smear-free. This advancement not only enhances diagnostic testing consistency but also eases andrologists’ workloads. This platform can contribute to standardized sperm analysis and improved laboratory management. Trial registration number Not applicable

The role of subcutaneous fat and BMI in predicting surgical outcomes and patient reported outcomes in robotic-assisted total hip arthroplasty

BackgroundThe purpose of this study was to assess if subcutaneous fat (SCF) or BMI is a predictor of surgical complications and patient reported outcomes in patients undergoing robotic-assisted total hip arthroplasty (THA). MethodsPatients who underwent robotic-assisted primary THAs at one institution between 2018 and 2020 were included in this retrospective cohort study. Prior to surgery, computed tomography (CT) was used to measure SCF in the posterolateral quadrant of the hip. SCF was measured 3 centimeters (cm) proximal to the greater trochanter (PGT) and 3 cm inferior to the distal tip of the greater trochanter (DGT).Measurements were normalized to the size of the patient's bony anatomy by dividing the subcutaneous fat area measurement by the transverse diameter of the femur 10 cm inferior to the tip of the greater trochanter. Patients were divided into quintiles determined by SCF distribution around the mean (groups 1-5) and BMI (BMI<25, BMI 25-29.9, BMI 30-34.9, BMI 35-39.9, and >40). Ninety day outcomes and PROMIS (Patient Reported Outcome Measures Information System) scores were acquired from the Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) database preoperatively, at 14-112 days post-operative and at the latest follow up. ResultsThere were 175 patients identified with a mean age of 63.83 years (range 27-89) and a mean BMI of 30.73kg/m2 (range 18.2-48.4). Interclass correlation coefficient was greater than 0.9 in all PGT, DGT, and GT measurements. Analysis of Variance (ANOVA) found there was a significantly shorter time from incision to closure in quintiles 1 and 3 when compared to the SCF quintile 5 (p<0.05) and that there was a significantly shorter time from incision to closure in BMI categories 1, 2, and 3 when compared to BMI category 5 (BMI > 40). There were no differences between SCF and BMI as predictive of length of stay, transfusion status, infection, or PROMIS scores. ConclusionIt can be concluded that hip SCF on axial CT images can reliably measure SCF and is predictive of time from incision to closure, but it does not show a significant difference in predicting the length of stay, infection, or PROMIS scores when compared to BMI.

Psychometric properties of the modified Drug Abuse Screening Test Sinhala version (DAST-SL): evaluation of reliability and validity in Sri Lanka

BackgroundPsychoactive drug use is an important public health issue in Sri Lanka as it causes substantial health, social and economic burden to the country. Screening for substance use disorders in people who use drugs is vital in preventive health care, as it can help to identify problematic use early. Screening can aid in referring those in need, for the most appropriate treatment and care. Thus, preventing them from developing severe substance use disorders with complications. The Drug Abuse Screening Test (DAST-10) is an evidence-based tool widely used to assess the severity of psychoactive drug use. This study aimed to culturally adapt and evaluate the validity and reliability of the Drug Abuse Screening Test (DAST-10) in Sri Lanka.MethodsThe DAST-10 was culturally adapted, and the nine-item Sinhala version (DAST-SL) was validated using exploratory and confirmatory factor analysis. The validation study was conducted in the Kandy district among people who use drugs, recruited using respondent-driven sampling. Criterion validity of the questionnaire was assessed by taking the diagnosis by a psychiatrist as the gold standard. Cut-off values for the modified questionnaire were developed by constructing Receiver Operating Characteristic (ROC) curves. The reliability of the DAST-SL was assessed by measuring its internal consistency and test re-test reliability.ResultsThe validated DAST-SL demonstrated a one-factor model. A cut-off value of ≥ 2 demonstrated the presence of substance use disorder and had a sensitivity of 98.7%, specificity of 91.7%, a positive predictive value of 98.8% and a negative predictive value of 91.3%. The area under the curve of the ROC curve was 0.98. A cut-off score of ≤ 1 was considered a low level of problems associated with drug use. The DAST-SL score of 2–3 demonstrated a moderate level of problem severity, a score of 4–6 demonstrated a substantial level of problems, and a score of ≥ 7 demonstrated a severe level of drug-related problems. The questionnaire demonstrated high reliability with an internal consistency of 0.80 determined by Kuder–Richardson Formula-20 and an inter-class correlation coefficient of 0.97 for test re-test reliability.ConclusionThe DAST-SL questionnaire is a valid and reliable tool to screen for drug use problem severity in people who use drugs in Sri Lanka.

GPT-based chatbot tools are still unreliable in the management of prosthetic joint infections.

Artificial intelligence chatbot tools responses might discern patterns and correlations that may elude human observation, leading to more accurate and timely interventions. However, their reliability to answer healthcare-related questions is still debated. This study aimed to assess the performance of the three versions of GPT-based chatbots about prosthetic joint infections (PJI). Thirty questions concerning the diagnosis and treatment of hip and knee PJIs, stratified by a priori established difficulty, were generated by a team of experts, and administered to ChatGPT 3.5, BingChat, and ChatGPT 4.0. Responses were rated by three orthopedic surgeons and two infectious diseases physicians using a five-point Likert-like scale with numerical values to quantify the quality of responses. Inter-rater reliability was assessed by interclass correlation statistics. Responses averaged "good-to-very good" for all chatbots examined, both in diagnosis and treatment, with no significant differences according to the difficulty of the questions. However, BingChat ratings were significantly lower in the treatment setting (p = 0.025), particularly in terms of accuracy (p = 0.02) and completeness (p = 0.004). Agreement in ratings among examiners appeared to be very poor. On average, the quality of responses is rated positively by experts, but with ratings that frequently may vary widely. This currently suggests that AI chatbot tools are still unreliable in the management of PJI.

Poster 266: Sagittal Tibial Tubercle-Trochlear Groove Distance Predicts Patellofemoral Chondral Lesion Size and Is Associated With Postoperative Complications

Objectives: The purpose of this study was to assess the association between sagittal tibial tubercle-trochlear groove (sTT-TG) distance and patellofemoral chondral lesion size in patients undergoing cartilage restoration procedures. Methods: A retrospective review of patients who underwent an osteochondral allograft (OCA) transplantation or autologous chondrocyte implantation (ACI) was conducted. Patients were included if they had an articular cartilage lesion located in the patella, trochlea, or both (bipolar lesions). Lesion size of individual patella and trochlear lesions were measured intra-operatively at implantation. Total lesion area was calculated as a sum of all present chondral lesions in the patellofemoral joint. The preoperative sTT-TG distance was measured independently on magnetic resonance imaging (MRI) by 2 authors and an Interclass Correlation Coefficient (ICC) was calculated. Categorical and linear regression models accounting for demographic variables and sTT-TG distance were used to assess the relationship between sTT-TG and lesion size. Results: Eighty patients (85 knees) composed of 50 women (mean age: 31.5±10.4 years) were included. Forty-one patients underwent OCA transplantation and 44 underwent ACI. Intra-rater (ICC: 0.99, 0.98) and inter-rater reliability (ICC: 0.96) were excellent for sTT-TG measurements. A bivariate correlation analysis demonstrated that sTT-TG was significantly inversely related to MRI defect size (-0.45, p&lt;0.01). Similarly, sTT-TG was inversely related to patellar lesion size and total lesion area, but not trochlear lesion size (Table 1). When controlling for demographics, a more negative sTT-TG remained an independent predictor of larger defects on MRI and patellar lesions: 9.3 mm2 and 9.8 mm2 lesion size increase on MRI (p&lt;0.001) and intraoperatively (p=0.01), respectively, for every 1 mm decrease in sTT-TG. For every 1 mm increase in sTT-TG, the risk of all complications occurring decreased by 14.1% (ß=0.859, p=0.007). Conclusions: In this cohort of patients undergoing patellofemoral cartilage restoration, a more negative sTT-TG distance is a predictor of larger patellar lesions and increased risk for all complications.

Inter-examiner Reliability of Two Methods for Scoring Post-Orthodontic White Spot Lesions from Digital Photographs.

To compare the reliability of two scoring systems for detecting white spot lesions (WSLs) from clinical photographs captured during debonding of fixed orthodontic appliances. Digital images of 58 healthy adolescents (34 females and 24 males) were examined, depicting 384 buccal surfaces of maxillary incisors, canines, and first premolars. Three trained examiners (E1, E2 and E3) independently evaluated the fully anonymized photos in a randomized order using the Gorelick index (GI) and the modified International Caries Detection and Assessment System (ICDAS II). A 1-2-week interval separated the scorings. Spearman's rank correlation coefficient, Fisher's z-test, and the interclass correlation coefficient (ICC) were applied to compare the scoring methods and express examiner agreement. The two scoring systems showed a moderate to strong positive relationship, but inter-examiner variations were significant (p<0.05). We found moderate to good reliability (ICC 0.60 to 0.84) with the ICDAS II system and good to excellent values with the GI (ICC 0.72 to 0.94), depending on the examiner. The agreement concerning the sound surfaces and the most severe WSLs was perfect, whereas the scoring of the milder lesion stages appeared more uncertain. A moderate to strong positive relationship was demonstrated between the two methods when scoring the presence and severity of WSLs from digital images. Significant inter-examiner variations affected reliability.

Empowering Medical Education: Unveiling the Impact of Reflective Writing and Tailored Assessment on Deep Learning.

Reflective thinking offers learners insight and encourages deeper understanding by leveraging past experiences. This study explores the impact of reflective writing, a self-assessment tool, on undergraduate medical students. The focus is on training students using author-specific reflection rubrics based on Moon's model. A mixed-methods study involving 32 volunteered students undertaking an interactive 3-hour session on reflective thinking and writing (RT&W). 19 students submitted reflections, which were self-graded by students and two faculties independently. The perceptions of students were gathered through questionnaires and focus group discussions. The analysis was done using the mean, inter-class correlational coefficient, and thematic analysis. Inter-rater reliability and inter-class correlation coefficient for reflective writing rubric scores was 63.2%, i.e. below the acceptable threshold. Cronbach's Alpha for the learner perception questionnaire was 0.90. The outcome of the student's perception questionnaire recognized the value of reflective writing in terms of professional skills enhancement (4.83±0.39) and improvement after feedback (4.17±0.72). However, satisfaction with overall training was comparatively lower (2.5±0.52). Focus group discussions revealed six themes. Reflective writing enhances the learning outcomes, deepens understanding, and refines judgment. The author-specific reflection rubric, though reliable, warrants empirical validation with a larger and more diverse participant pool. Undergraduate programs should prioritize mastery of reflection and meta-cognitive learning approaches to optimize educational outcomes.

Development and Validation of a Micronutrients Knowledge, Attitudes, and Practices Questionnaire for Adolescents Using Psychometric Analysis.

Introduction The development of a questionnaire that measures knowledge, attitude, and practices towards micronutrients will help to develop nutrition intervention programs. The present study aimed to develop and assess the validity and reliability of a questionnaire on knowledge, attitude, and practices (KAP) on micronutrients in adolescents in India. Methods A total of 150 adolescent girls participated in the study. The literature was reviewed to formulate an initial draft of a questionnaire (122 items). Face and content validity were measured by participants and subject experts, respectively, and the content validity index was calculated. Construct validity was assessed using the principal component method of exploratory factor analysis.Internal consistency and test-retest reliability were determined by Cronbach's α value and interclass correlation coefficient correlations, respectively. Results The content validity index for all items except eight items from thepractice subscalewas satisfactory. Face validity results showed that participants understood all items. Exploratory factor analysis suggested a four-factor construct (perceived susceptibility and severity, perceived benefits, readiness to change, and perceived barrier) in the attitude subscale. Internal consistency for knowledge, attitude, and practice items were 0.980, 0.840, and 0.930, respectively. For knowledge and attitude items, interclass correlation coefficient correlation estimates ranged between 0.705 to 0.987 and 0.775 to 0.997, respectively, whereas for practice items, it ranged from 0.701 to 0.945. In the final questionnaire, 134 items consisting of 33 knowledge, 21 attitudes, and 80 practices (55 dietary practices and 25 other practices related to micronutrients) were included. Conclusion The results provided evidence of the validity and reliability of the questionnaire on micronutrients and that can be used to assess the knowledge, attitude, and practices on micronutrients in adolescents.Further studies in different diverse settings are recommended.

Poster 291: Entry Point-Transition Point Angle as a Novel 3-Dimensional Metric of Patellar Instability

Objectives: Three-dimensional (3D) modeling has increasing utility in identifying differences in trochlear morphology in patients with patellar instability when compared to historical 2-dimensional (2D) attempts. Distortions in the proximal medial ridges of trochleas are a distinguishing feature of trochlear dysplasia. Recently, the entry-point to transition-point (EP-TP) angle was established as a novel 3D metric to quantify degree of dysplasia, as it captures the tracking of the patella within the trochlea. However, previous attempts relied on 3D prints, which are not widely accessible. The purpose of this study is to validate this new measurement and compare differences between patients with patellar instability and the general population. Methods: Forty-three patients with recurrent patellar dislocations who were treated by a single surgeon between January 2020 and July 2023 were included. The study received an institutional review board exemption. Individuals from the New Mexico Decedent Image Database with no history of patellar instability or patellofemoral pain were used to obtain computed tomography (CT) images from the general population. Stereolithography (STL) models of distal femurs in 3D were generated from CT images using ScanIP. Minimum and maximum principal curvature maps were taken as screenshots from maps generated in MeshLab. Two people independently conducted measurements using a custom measuring tool displaying anteroposterior views and curvature maps of the distal femur. The measurers were asked to locate the medial and lateral ridges, transition point, and apex of the trochlea groove for each femur. A Mann–Whitney U test was performed to evaluate whether the recurrent dislocators had higher EP-TP values. P values below 0.01 were regarded as significant. Interclass correlation for both raters (ICC (1, k), reliability of values within this study) and single rater (ICC (1,1), reliability of measurement within clinical practice) and the 95% CI thereof, was computed for the 2 independent measurements. Results: A total of 100 femurs were measured, including 43 recurrent dislocators and 57 population femurs. The recurrent dislocator cohort had a mean EP-TP of 40.9° with a standard deviation of 16.4°. The general population cohort had a mean EP-TP of 11.3° with a standard deviation of 12.3°. EP-TP for dislocators and general population was significantly different. (p &lt; 0.001). ICC (1, k) was 0.81 with a 95%-confidence interval of 0.72 to 0.87. ICC (1,1) was 0.69 with a 95% CI of 0.57 to 0.78. Conclusions: EP-TP angle is a novel metric that helps quantify trochlear dysplasia, which can help clinicians better understand patellar instability. In this study, we validate EP-TP angle by showing that EP-TP angle was significantly different between femurs of recurrent dislocators and the general population.

Agreement between Ultra-Short-Term and Standard Heart Rate Variability Analysis in Resting and Post-Exercise Conditions.

Short-term (5 min) heart rate variability (HRV) analysis is widely used in assessing autonomic nervous system activity during exercise. While shortening the HRV measurement duration can help improve its application efficiency, its accuracy needs to be verified. This study investigated the agreement between ultra-short-term (UST) HRV (3 or 4 min) and standard 5 min HRV and explored the optimal recording duration under resting and post-exercise conditions. Fourteen participants exercised on a cycle ergometer at 60% of their maximum peak power. Data were collected during the rest condition (Pre-E) and three post-exercise conditions (Post-E1, Post-E2, and Post-E3), with indicators of the standard deviation (SDNN) of the ultra-short and short-term RR intervals and the root mean square (RMSSD) of the continuous difference between RR intervals. Repeated measures ANOVA, Cohen's d statistic, Bland-Altman analysis, and interclass correlation coefficients (ICC) assessed the agreement between UST-HRV and ST-HRV. The consistency results of SDNN and RMSSD in resting and post-exercise were different. At the Pre-E, Post-E2, and Post-E3 phases, no statistical differences for SDNN and RMSSD were observed, with ICCs surpassing 0.9, indicating a high level of agreement. However, at Post-E2, there was a significant difference between 3 min RMSSD and 5 min RMSSD (p < 0.05), as well as between 3 min SDNN, 4 min SDNN, and 5 min SDNN (p < 0.05). Furthermore, the limits of agreement were observed to decrease as the time duration increased in Bland-Altman plots. UST-HRV analysis is a reliable substitute for standard 5 min HRV assessment, particularly during resting conditions. For post-exercise measurements, assessing the appropriateness of a 3- or 4 min duration based on the exercise's length is recommended to ensure accuracy and reliability.

Variability and Reliability of Examiners

This study aimed to assess the variability and reliability of examiners at a public university in Pakistan. Its primary focus was to identify the inter-rater reliability of teachers test scores to improve the testing standards by making teachers aware of their rating criteria, rating methods and their impact on the student’s final score. Data was collected from 8 teachers from the English department at a Pakistani public university and was analysed with the help of SPSS software. The study findings revealed that the teachers did not vary substantially in their overall evaluations and the interclass correlation between teachers’ ratings was 0.935 which indicates high inter-rater reliability. Moreover, a questionnaire filled out by the teachers after the scoring revealed that they hardly differed in their scoring criteria and did not vary significantly in selecting the sub skills of writing to be scored. These findings have further implications in promoting standardised assessment practices, fostering fairness and objectivity in student evaluations, and ultimately enhancing the quality and credibility of the university’s academic programs.

Exploring consistent ratios in morphometry of the proximal tibia: insights for knee arthroplasty.

The current study, which delves into proximal tibia morphometric parameters in a Greek sample, not only analyzes whether specific linear distance ratios are consistent but also paves the way for a potential novel metric system for knee arthroplasty imaging studies using constant ratios. These findings could have significant implications for future enlarged research and clinical practice. A total of 38 dried tibiae were evaluated by two independent investigators. The following distances were measured with a digital Vernier sliding caliper: (1) the mediolateral distance of the proximal surface (A), (2) the anteroposterior distance of the proximal surface (B), (3) The longitudinal length of the bone (C), (4) the line connecting the anterior margin of the proximal surface with the highest peak of the tibia tuberosity (D), (5) the depth of the proximal margin of the medial articular facet (AF) (medial plateau) (E) and (6) the depth of the proximal margin of the lateral AF (lateral plateau) (F). The A, B, C, D, E, and F mean distances were 71.3mm, 47.4mm, 340.2mm, 37.1mm, 42mm, and 35.9mm. Reliability analysis for each observer on all measurements revealed an interclass correlation (ICC) score of 0.975 (observer 1) and 0.971 (observer 2). The ratio A/B was 1.5, A/C was a constant 0.2, and D/C was 0.1. The ratio E/F was 1.2. The six measurements (A-F) showed excellent inter-observer reliability (all ICC values > 0.990). The study established constant ratios of the studied linear distances around the proximal tibia. Considering these ratios, asymmetrical tibial components in knee arthroplasty seem to replicate the native anatomy more closely. Furthermore, the distance from the anterior margin of the proximal surface to the tibial tuberosity peak, constituting one-tenth of the longitudinal length of the tibia, shows promise as a metric system for imaging studies, especially in assessing lesions around tibial components.

Fat Fraction Extracted from Whole-Body Magnetic Resonance (WB-MR) in Bone Metastatic Prostate Cancer: Intra- and Inter-Reader Agreement of Single-Slice and Volumetric Measurements.

This study evaluates the repeatability and reproducibility of fat-fraction percentage (FF%) in whole-body magnetic resonance imaging (WB-MRI) of prostate cancer patients with bone metastatic hormone naive disease. Patients were selected from the database of a prospective phase-II trial. The treatment response was assessed using the METastasis Reporting and Data System for Prostate (MET-RADS-P). Two operators identified a Small Active Lesion (SAL, <10 mm) and a Large Active Lesion (LAL, ≥10 mm) per patient, performing manual segmentation of lesion volume and the largest cross-sectional area. Measurements were repeated by one operator after two weeks. Intra- and inter-reader agreements were assessed via Interclass Correlation Coefficient (ICC) on first-order radiomics features. Intra-reader ICC showed high repeatability for both SAL and LAL in a single slice (SS) and volumetric (VS) measurements with values ranging from 0.897 to 0.971. Inter-reader ICC ranged from 0.641 to 0.883, indicating moderate to good reproducibility. Spearman's rho analysis confirmed a strong correlation between SS and VS measurements for SAL (0.817) and a moderate correlation for LAL (0.649). Both intra- and inter-rater agreement exceeded 0.75 for multiple first-order features across lesion sizes. This study suggests that FF% measurements are reproducible, particularly for larger lesions in both SS and VS assessments.

Measurement properties and interpretability of the Patient-Reported Impact of Dermatological Diseases (PRIDD) measure.

Patient-reported outcome measures (PROMs) are crucial for assessing the impact of dermatological conditions on patients' lives, but the existing dermatology-specific PROMs are not recommended for use according to the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN). We developed the Patient-Reported Impact of Dermatological Diseases (PRIDD) measure in partnership with patients. It has strong evidence of content validity, structural validity, internal consistency, acceptability, and feasibility. To test PRIDD's remaining measurement properties and establish the interpretability of scores against the COSMIN criteria using classic and modern psychometric methods. A global longitudinal study consisting of two online surveys administered two to four weeks apart. Adults (≥ 18 years) living with a dermatological condition were recruited through the International Alliance of Dermatology Patient Organizations' (GlobalSkin) membership network. Participants completed PRIDD, a demographics questionnaire, and other related measures including the Dermatology Life Quality Index (DLQI). We tested PRIDD's criterion validity, construct validity and responsiveness (Spearman's ρ, independent-samples t-tests and ANOVA), test-retest reliability (interclass correlation coefficient [ICC]), measurement error (Smallest Detectable Change or Limits of Agreement [LoA], distribution-based Minimally Important Change [MIC]), floor and ceiling effects (number of minimum and maximum scores and Person-Item Location Distribution Maps), score bandings (κ coefficient of agreement) and anchor-based MIC. 504 patients with 35 dermatological conditions from 38 countries participated. Criterion validity (ρ = 0.79), construct validity (76% hypotheses met), test-retest validity (ICC = 0.93), and measurement error (LoA = 1.3 < MIC = 4.14) were sufficient. Floor and ceiling effects were in the acceptable range (< 15%). Score bandings were determined (κ = 0.47), however, the anchor-based MIC could not be calculated due to an insufficient anchor. PRIDD is a valid and reliable tool to evaluate the impact of dermatological disease on patients' lives in research and clinical practice. It is the first dermatology-specific PROM to meet the COSMIN criteria. These results support the value of developing and validating PROMs with a patient-centred approach and using classic and modern psychometric methods. Further testing of responsiveness and MIC, cross-cultural translation, linguistic validation, and global data collection are planned.

Structural Validity of the Interpersonal Behaviors Questionnaire in Greek University Sport-Students

The examination of the interpersonal behaviors of undergraduate student-athletes can contribute to the research on the perceptions of students for satisfaction and frustration of basic psychological behaviors by teachers in the context teaching classes. Aim of this study was to translate into Greek and investigate the factorial validity and internal consistency of the Interpersonal Behavior Questionnaire (IBQ; 24-item six factors). 252 full-time undergraduate student-athletes (125 males and 127 females) were used ranging in age 18 to 38 years. The results of CFA showed a good fit of the data to the model, while the multi-sample results indicated invariance for factor loadings and correlations between male and female samples. Internal consistency coefficients Cronbach alpha and interclass correlation were moderate significant. In conclusion, the IBQ-Gr version has valid and reliable psychometric properties and can be applied to examination of the perceptions interpersonal behaviors others into Greek population.

Exploring chat generated pre-trained transformer-3 ability to interpret MRI knee images and generate reports

Objectives: The study’s objective was to determine if Chat Generated Pre-Trained Transformer-3 (ChatGPT)-4V can interpret magnetic resonance imaging (MRI) knees and generate preliminary reports based on images and clinical history provided by the radiologist. Materials and Methods: This cross-sectional observational study involved selecting 10 MRI knees with representative imaging findings from the institution’s radiology reporting database. Key MRI images were then input into the ChatGPT-4V model, which was queried with four questions: (i) What does the image show?; (ii) What is the sequence?; (iii) What is the key finding?; and, (iv) Finally, the model generated a report based on the provided clinical history and key finding. Responses from ChatGPT-4 were documented and independently evaluated by two musculoskeletal radiologists through Likert scoring. Results: The mean scores for various questions in the assessment were as follows: 2 for “What does the image show?,” 2.10 for “What is the sequence?,” 1.15 for “What is the key finding?,” and the highest mean score of 4.10 for the command “Write a report of MRI of the…” Radiologists consistently gave mean scores ranging from 2.0 to 2.5 per case, with no significant differences observed between different cases (P &gt; 0.05). The interclass correlation coefficient between the two raters was 0.92 (95% Confidence interval: 0.85–0.96). Conclusion: ChatGPT-4V excelled in generating reports based on user-fed clinical information and key findings, with a mean score of 4.10 (good to excellent proficiency). However, its performance in interpreting medical images was subpar, scoring ≤2.10. ChatGPT-4V, as of now, cannot interpret medical images accurately and generate reports.

Video analysis of real-life shoulder dystocia to assess technical and non-technical performance.

Managing obstetric shoulder dystocia requires swift action using correct maneuvers. However, knowledge of obstetric teams' performance during management of real-life shoulder dystocia is limited, and the impact of non-technical skills has not been adequately evaluated. We aimed to analyze videos of teams managing real-life shoulder dystocia to identify clinical challenges associated with correct management and particular non-technical skills correlated with high technical performance. We included 17 videos depicting teams managing shoulder dystocia in two Danish delivery wards, where deliveries were initially handled by midwives, and consultants were available for complications. Delivery rooms contained two or three cameras activated by Bluetooth upon obstetrician entry. Videos were captured 5 min before and after activation. Two obstetricians assessed the videos; technical performances were scored as low (0-59), average (60-84), or high (85-100). Two other assessors evaluated non-technical skills using the Global Assessment of Team Performance checklist, scoring 6 (poor) to 30 (excellent). We used a spline regression model to explore associations between these two score sets. Inter-rater agreement was assessed using interclass correlation coefficients. Interclass correlation coefficients were 0.71 (95% confidence interval 0.23-0.89) and 0.82 (95% confidence interval 0.52-0.94) for clinical and non-technical performances, respectively. Two teams had low technical performance scores; four teams achieved high scores. Teams adhered well to guidelines, demonstrating limited head traction, McRoberts maneuver, and internal rotation maneuvers. Several clinical skills posed challenges, notably recognizing shoulder impaction, applying suprapubic pressure, and discouraging women from pushing. Two non-technical skills were associated with high technical performance: effective patient communication, with teams calming the mother and guiding her collaboration during internal rotational maneuvers, and situation awareness, where teams promptly mobilized all essential personnel (senior midwife, consultant, pediatric team). Team communication, stress management, and task management skills were not associated with high technical performance. Videos capturing teams managing real-life shoulder dystocia are an effective tool to reveal challenges with certain technical and non-technical skills. Teams with high technical performance are associated with effective patient communication and situational awareness. Future training should include technical skills and non-technical skills, patient communication, and situation awareness.

Development and Validation of Performance-Based Assessment of Daily Living Tasks in Age-Related Macular Degeneration.

To establish the reliability and validity of five performance-based activities of daily living task tests (ADLTT), to correlate structure to function, to evaluate the impact of visual impairment (VI) on age-related macular degeneration (AMD), and to develop new outcome measures. A multidisciplinary team developed five ADLTTs: (1) reading test (RT); (2) facial expression (FE) recognition; (3) item search (IS) task; (4) money counting (MC) task; and (5) making a drink (MD), tested with binocular and monocular vision. ADLTTs were tested for known-group (i.e., difference between AMD group and controls) and convergent (i.e., correlation to other measures of visual function), validity metrics, and test-retest reliability in 36 patients with VI (visual acuity (logMAR VA > 0.4) in at least one eye caused by AMD versus 36 healthy controls without VI. Compared to controls, AMD patients had a slower reading speed (-77.41 words/min; P < 0.001); took longer to complete MC using monocular worse eye and binocular vision (15.13 seconds and 4.06 seconds longer compared to controls, respectively; P < 0.001); and MD using monocular worse eye vision (9.37 sec; P = 0.033), demonstrating known-group validity. Only RT and MC demonstrated convergent validity, showing correlations with VA, contrast sensitivity, and microperimetry testing. Moderate to good test-retest reliability was observed for MC and MD (interclass correlation coefficient = 0.55 and 0.77; P < 0.001) using monocular worse eye vision. Real-world ADL functioning associated with VI-related AMD can be assessed with our validated ADLTTs, particularly MC and MD. This study validates visual function outcome measures that are developed for use in future clinical practice and clinical trials.

Clinical validation of the nursing outcome "Swallowing status: pharyngeal phase" in patients with laryngeal cancer.

This study aimed to clinically validate the nursing outcome "Swallowing status: pharyngeal phase" (1013). A two-stage study was designed: (1) Chinese translation and cultural adaptation and (2) clinical validation. Internal consistency and interrater reliability tests were performed on 285 patients with laryngeal cancer, and an additional 130 patients were randomly selected from the 285 patients as an independent sample. Criterion-related validity tests were performed using the standardized swallowing assessment (SSA). Nursing outcome sensitivity was detected by scoring two time points. The Cronbach's alpha coefficients were 0.951 for the nursing outcome and 0.942-0.965 for each indicator. The interclass correlation coefficient (ICC) values for each indicator ranged from 0.73 to 0.929. The scores of the nursing outcome were negatively correlated with the SSA scores (r = -0.555, p<0.01). With the exception of two indicators, there was a significant difference (p<0.05) between the total scores of the scale and its 11 indicator scores for the two time points. The results indicated that the nursing outcome "Swallowing status: pharyngeal phase" (1013) exhibited satisfactory psychometric properties and high sensitivity to change. The nursing outcome "Swallowing status: pharyngeal phase" (1013) demonstrated good reliability, validity, and sensitivity in patients with laryngeal cancer. The nursing outcome "Swallowing status: pharyngeal phase" (1013) can be used to assess swallowing function in patients with laryngeal cancer and provide guidance for the development of rehabilitation intervention plans and nursing care.