Inter-rater Research Articles

43 Etiology of community-acquired bacterial meningitis in children seen in the emergency department in Canada

Abstract Background Bacterial meningitis poses a significant threat to paediatric health, resulting in substantial morbidity and mortality in children. Though previous studies have delineated the causative agents behind community-acquired meningitis, recent vaccination initiatives may have reshaped its underlying etiology. Objectives This study aimed to identify the bacteria responsible for community-acquired bacterial meningitis in children in Canada. Design/Methods This was a retrospective cohort study including children aged 1 day-18 years with confirmed bacterial meningitis, evaluated at a tertiary-care, Canadian emergency department between July 1st 2014 and December 31st 2022. The primary outcome was the pathogen identified. Other variables of interest were mortality, complications, age, sex, and diagnostic method. Medical charts were identified via the hospital’s archives and reviewed by a single co-author. A random sample of 20 (23%) medical charts were independently reviewed by a second co-author to assess inter-rater reliability. We set a target of evaluating at least 50 cases to allow narrow confidence intervals (+/- 13%) for proportions. Results All variables showed excellent inter-rater reliability with Kappa scores and intraclass correlation coefficients higher than 0.60. All 79 eligible cases were included. The main causal agents were Group B Streptococcus (GBS) (n=20; 25%), Streptococcus pneumoniae (n=16; 20%), Neisseria meningitidis (n=16; 20%) and Haemophilus influenzae (n=9; 11%). Etiology exhibited age-dependent variations, with 85% of GBS and 100% of E. coli infections identified in children under two months, while all pneumococcal and Group A Streptococcus cases were in children older than six months. All children infected by S. pneumoniae were vaccinated against pneumococcal infection but the serotype was not covered by vaccination in 7/8 infections. All children with N. meningitidis were either too young to be vaccinated (n=10) or infected by a serotype not covered by the vaccine. Six (7%) patients died and 29 (34%) suffered complications, including hearing impairment (n=5), cerebral ischemia (n=4), seizures (n=4), and subdural abscess (n=3). Fifty-nine bacterias were identified by cerebrospinal fluid culture, 13 by PCR and 7 by both methods. Conclusion GBS is the leading etiology of paediatric community-acquired bacterial meningitis in Canada. Causal agents of bacterial meningitis vary greatly by age. Future studies should work on improving the serotype spectrum of vaccines, prophylaxis in mothers who are GBS carriers, and use of PCR as a diagnostic tool for timely clinical interventions.

31 Impact of the amount of intravenous glucose administration on hospitalization for acute gastroenteritis in a paediatric emergency department

Abstract Background In case of failure of oral rehydration, children with acute gastroenteritis can be hydrated using intravenous (IV) solution. The choice of the intravenous solution itself (solutions containing dextrose versus crystalloids alone) and the glucose quantities to administer are not well established. Objectives The main objective of this study was to evaluate the impact of the amount of intravenous glucose provided to children treated for acute gastroenteritis on hospitalizations. Other objectives were to evaluate practice variation regarding the amount of glucose and liquid provided for IV rehydration in a paediatric emergency department (ED). Design/Methods We conducted a retrospective cohort study from 2019-2022 in a Canadian paediatric ED. We included children with acute gastroenteritis undergoing IV rehydration. Patient with hypoglycemia, metabolic disease or diabetes were excluded. The IV glucose administered during the initial four hours of rehydration was quantified. The primary outcome was hospitalization and return visit in the following seven days was a secondary outcome. 10% of the charts were evaluated in duplicate to assess inter-rater reliability. We examined glucose distribution at one and four hours, and utilized multiple logistic regression to relate glucose amounts with hospitalization and second visit, accounting for age, weight, bicarbonate levels, ondansetron use, and amount of liquid infused. It was estimated that the evaluation of 250 cases would have at least 50 admissions. Results Among 6,939 children evaluated for potential acute gastroenteritis, 250 met our inclusion/exclusion criteria. All variables included in the analysis had excellent inter-rater reliability. Notable variations existed in glucose quantities provided, both at one hour (first quartile: 87 mg/Kg; third quartile: 294 mg/Kg) and four hours (first quartile: 681 mg/Kg; third quartile: 1174 mg/kg) of rehydration. Multiple logistic regression showed a greater hospitalization risk with smaller amount of glucose administered during the initial hour (OR for each 100mg/kg increment: 0.60; 95%CI: 0.42-0.84) and four hours (OR: 0.76; 95%CI: 0.63-0.91) of rehydration. Moreover, children who received more dextrose during the first hour of rehydration were at lower risk of return visit (OR for each 100mg/kg increment: 0.52; 95%CI: 0.35-0.78), as well as during the first four hours (OR for each 100 mg/kg increment: 0.83; 95%CI: 0.73-0.94). Conclusion There was a wide practice variation in intravenous glucose provided to children with acute gastroenteritis. In this population, higher intravenous glucose amount was associated to a lower risk of hospitalization and lower risk of return visit.

Inter- and intra-rater reliability of cognitive assessment conducted by assistive robot for older adults living in the community: a preliminary study.

The purpose of this study was to reveal inter- and intra-rater reliability of the detailed evaluation of cognitive function by assistive robot for older adults. We investigated the inter-rater and test-retest reliability. Neurobehavioral Cognitive Status Examination was conducted twice for each participant using an assistive robot and the examiner respectively (Experiment 1). The order of these two tests was randomly selected and the interval between them was 1 week. In Experiment 2, we investigated the test-retest reliability of the first robot test and this additional robot test was conducted approximately 6 weeks after Experiment 1. Fifty-one (13 men and 38 women, mean age: 80.5 ± 5.6 years) participants went through Experiment 1 and 29 of those (eight men and 21 women, mean age: 80.4 ± 4.8 years) completed Experiment 2. In Experiment 1, the interclass coefficient (ICC) in orientation was in the high range and its Cronbach's α was 0.919, rated as excellent internal consistency. On the other hand, other items did not show positive results. In Experiment 2, the ICCs in orientation, attention, and repetition were in the adequate range, while other items showed marginal or low range. Orientation was supposed to be utilised for figuring out initial symptoms of dementia. In the future, as robot functions become more high-tech, a partner robot might be able to measure the symptoms and severity of dementia.

Evaluating the Reliability of Name Writing Rubric Scoring

Early literacy screening tools are often a critical component of schools’ intervention frameworks. As the use of screening tools becomes more prevalent for identifying students who may be at risk for learning difficulties and in need of additional instruction, it is important to continuously evaluate teachers’ implementation of these screening tools and to improve efforts to support their implementation. Measures of name writing as a part of a screening tool can pose specific implementation challenges due to the subjectivity that rubric scoring allows. As such, this study aimed to evaluate the reliability of a rubric used by pre-kindergarten teachers to score a name writing task, as part of a larger screening tool, in the context of their own classrooms, and to examine scoring patterns between researchers and teachers on the name writing rubric. Results revealed that researchers had higher interrater reliability among themselves than the reliability between researchers and teachers. Although there was not a substantial difference between the two groups, it is worthwhile to examine the implementation of screening tool scoring systems in the field to ensure proper identification of and intervention for students who may be at risk for learning difficulties. Implications for researchers and teachers are discussed.

A comparative analysis of lumbar paraspinal muscle morphology between two movement system impairment subgroups of chronic nonspecific low back pain

BackgroundBased on the kinesiopathologic model, the Movement System Impairment (MSI) classification of LBP has shown that repetitive movements could contribute to pathoanatomic tissue changes. However, these changes have not been evaluated in different MSI classification subgroups of patients with LBP. ObjectiveThis study compared the grades of fatty infiltration as one of the muscle's pathologic changes in the lower lumbar paraspinal and psoas muscles between the two subgroups of patients diagnosed with MSI syndromes having opposite movement direction impairments. DesignObservational cross-sectional study. MethodForty-five participants with chronic LBP were enrolled in the study, with 23 patients in the lumbar flexion-rotation (FlexRot) subgroup and 22 in the lumbar extension-rotation (ExtRot) subgroup of MSI. Magnetic resonance imaging (MRI) and the Goutallier Classification System (GCS) were used for fatty grading of lumbar paraspinal and psoas muscles. After the reliability of this grading scale was evaluated, the results were compared between the two subgroups. ResultsThe Mann–Whitney U Test showed significantly higher fat infiltration of lower lumbar multifidus and erector spinae muscles in the lumbar ExtRot subgroup, with no significant difference between the two subgroups in terms of psoas muscles (P ≤ 0.05). Inter-rater reliability of GCS was acceptable to excellent, and intra-rater reliability was good to excellent. ConclusionThe fatty infiltration grade of lumbar paraspinal muscles in L4-L5 and L5-S1 levels are significantly different between the two LBP subgroups of MSI that have two opposite movement direction impairments. The lumbar paraspinal muscles, which contribute to extension, have a higher grade of fat in the ExtRot subgroup, whose symptoms are aggravated by lumbar extension.

Validity and reliability of the new NIMHANS intellectual disability screening instrument (NID-Screener) for children and adolescents in India

IntroductionThere is a gap in tools specifically designed for assessing Intellectual Disability (ID) in Indian settings. To address this, the NIMHANS intellectual disability screening instrument (NID-Screener) was developed by the Department of Child and Adolescent Psychiatry, National Institute of Mental Health and Neuro Sciences. MethodsTen non experts/language and ten experts rated face and content validity of NID-Screener respectively. Content validity was measured by Content Validity Ratio, Content Validity Indices (I-CVI, S-CVI) and Modified Kappa statistics. Construct validity was calculated by performing Exploratory Factor Analysis(EFA) on responses from 275 parent(s)/guardian(s) of children and adolescents (6–17 years). Criterion Validity was tested against Brief Intellectual Disability Scale (BIDS) and Clinical Diagnosis by Child and Adolescent Psychiatrist. Kappa Statistics was used to calculate inter – method and inter-Rater Reliability. Cronbach’s alpha was used to assess Internal Consistency. This study was approved by NIMHANS ethics committee. ResultsFindings revealed that NID-Screener has good face and content validity (S-CVI/Average = 0.917). Criterion Validity was excellent (Kappa Value=0.862, p-value<0.001) when compared with BIDS. Sensitivity and specificity were found to be 84.7 %, 89 % respectively against Clinical Diagnosis. On EFA, only one underlying factor with Eigen value > 1 was identified (55.8 % of total variance). Kappa value was found to be 0.971 and 0.942 for inter- rater and inter –method reliability respectively(p-value<0.001). NID-Screener has good internal consistency [Cronbach’s alpha = 0.841]. ConclusionsNID-Screener is a reliable and valid tool for screening ID among children and adolescents in India, facilitating its early detection through diagnostic assessments and subsequent interventions.

Development, field testing, and initial validation of an adherence rubric for caregiver coaching

IntroductionThe translation and use of evidence-based practices (EBPs) within early intervention (EI) systems presents challenges. The Office of Special Education (OSEP) has emphasized results-driven accountability to expand state accountability from compliance to also include quality services that align with EBPs. OSEP’s results-driven accountability provided states the opportunity to design State Systemic Improvement Plans (SSIP) to strengthen the quality of EI services by increasing the capacity of EI systems to implement, scale-up, and sustain use of EBPs. Caregiver coaching is widely accepted as an EBP within EI settings, yet uptake and fidelity to coaching practices remains limited. Such widespread implementation of caregiver coaching is partially limited by a lack of measurement tools that operationalize behaviors consistent with coaching. In this study, we describe the development of the Kentucky Coaching Adherence Rubric-Revised (KCAR-R) and psychometric testing of the instrument.MethodsWe developed and tested the KCAR-R to measure fidelity of coaching practices within a state-wide professional development program, the Coaching in Early Intervention Training and Mentorship Program. We define operational elements of the KCAR-R and rubric design elements related to: creators; users and uses; specificity, judgment complexity; evaluative criteria; quality levels; quality definitions; scoring strategies; presentation; explanation; quality processes; accompanying feedback information; secrecy; and exemplars. With regard to psychometric validation of the KCAR-R, interrater reliability was analyzed using intraclass correlation coefficients across eight raters and 301 randomly selected video submissions. Internal consistency was evaluated using Cronbach’s alpha across 429 video submissions.ResultsResults showed 0.987 agreement, indicating excellent interrater reliability; item level internal consistency values ranged from 0.860 to 0.882. for scale if item deleted and 0.834 for the total scale.DiscussionFindings from this study showed that the KCAR-R operationalized behaviors that exemplify caregiver coaching and may serve as a resource for other states or programs to document the quality and fidelity of evidence-based EI services. To influence EI provider practices at a systems level, we used implementation science to guide our work and provide examples of how EI systems seeking ways to create sustainable quality services may build upon our approach.

Qualitative drivers of postoperative prophylactic antibiotics use and resistance in Ethiopia.

The World Health Organization (WHO) cautions against unnecessary prolongation of postoperative antibiotics to prevent surgical site infections (SSI), however this practice is still common in many countries. This study aims to describe drivers of prolonged postoperative antibiotic prescribing and clinicians' perspectives on antibiotics resistance and stewardship in Ethiopia. We conducted semi-structured interviews of 16 surgeons and nine surgical ward nurses at three academic referral hospitals in Addis Ababa. Audio recordings were transcribed verbatim and coded. Codes were inductively and iteratively derived between two researchers, tested for inter-rater reliability (IRR), and the codebook was consistently applied to all transcripts. Thematic analysis was performed to understand drivers of prolonged prophylactic antibiotic use in surgical patients. Interviews revealed factors contributing to postoperative prophylactic antibiotics overprescribing, including inadequate infection prevention and control (IPC) practices, wide variability in local prescribing practices, and distrust in the applicability of WHO guidelines. Antimicrobial resistance was also identified as a major concern by staff. Barriers to improving stewardship included a lack of multidisciplinary teamwork to inform prescribing decisions, while solutions included constructing appropriate context-specific guidelines and improving evidence-based practices through input from local stakeholders, including surgeons, clinical pharmacists, and nurses. Study participants perceived that existing evidence and guidelines did not apply in their settings due to high rates of surgical site infections and gaps in perioperative IPC practices (e.g., availability of water for handwashing, sterility breaches). These gaps were a key contributor to prophylactic antibiotic overprescribing, reinforcing the need to strengthen upstream and perioperative surgical antisepsis processes. The findings of this study underscore the importance of engaging multidisciplinary teams in strengthening antimicrobial stewardship efforts, aligning processes to achieve compliance with best practices, and the need for rigorous, contextually appropriate studies from these settings to inform policy.

Cultural adaptation, validity and reliability of the Turkish version of north star ambulatory assessment.

The North Star Ambulatory Assessment (NSAA) is a functional motor outcome measure originally developed for patients with Duchenne muscular dystrophy (DMD). The aim of this study was to perform the cultural adaptation and investigate the validity and reliability of the Turkish version of the NSAA (T-NSAA) in DMD. After translation process, internal consistency, interrater and test-retest reliability of the NSAA were determined by using the Cronbach Alpha Coefficient and Intraclass Correlation Coefficient (ICC), respectively. Absolute reliability was determined by using the Standard Error of Measurement (SEM) with minimal detectable change at 95% limits of confidence (MDC95). Lower limb functionality of children was evaluated by Vignos Lower Extremity Scale (VLERS). To establish convergent validity, the correlations between T-NSAA and Motor Function Measure (MFM-32), 6-minute walk test (6-MWT), and VLERS were analyzed by using the Spearman's correlation coefficient. The study was completed with 86 patients with DMD whose age were mean 104.56 ± 24.66 months. The internal consistency (Cronbach's α = 0.94), intra-reliability (ICC = 0.977) and inter-reliability (ICC = 0.972) of T-NSAA were excellent. SEM and MDC values were low indicating satisfactory absolute agreement (< %10). The T-NSAA had strong correlations with the MFM-total score, 6-MWT, and VLERS (p < 0.01). T-NSAA is a valid and reliable tool to assess ambulatory status of Turkish-speaking DMD population. NCT05549999, Date of registration: September 19, 2022.

Assessing Chat Generative Pre-training Transformer’s Proficiency in Identifying, Diagnosing, and Managing Orthopedic Fractures

Abstract Background: The exploration of Chat generative pre-training transformer’s (GPT’s) applications in medicine is gaining momentum, with artificial intelligence, particularly ChatGPT, showing promise in enhancing orthopedic care. ChatGPT can assist clinicians by providing relevant information based on patient symptoms, medical history, and radiological findings, aiding in differential diagnosis, and suggesting appropriate imaging modalities. This study focuses on evaluating the effectiveness of ChatGPT-4 in diagnosing and managing common orthopedic fractures. Methods: This study involved inputting a diverse set of fracture images into the ChatGPT-4 model. The process commenced by prompting ChatGPT with four questions: “What does the radiograph show?” The second prompt instructed ChatGPT with the actual diagnosis, followed by inquiries on how a clinician should manage the condition and potential complications. All generated responses underwent grading by two authors (musculoskeletal radiologist and orthopedic trainee), utilizing a 5-point Likert scale. Intraclass correlation coefficient (ICC) analysis measurements were performed to assess inter-rater reliability. Descriptive statistical analysis was then employed to provide a comprehensive summary of the study’s findings. Results: ChatGPT demonstrated limitations in identifying diagnoses based on inputted X-ray images. However, it excelled in providing comprehensive information about fracture management and potential complications. There was excellent interobserver reliability with a kappa of 0.9. Conclusion: Our study underscores the utility of ChatGPT as a valuable tool for aiding in the management of common fractures, offering a comprehensive overview of diagnosis, management, and potential complications. The findings highlight its potential role as a supplementary resource in orthopedic practice.

Reliability of Three Pain Assessment Tools in Children Requiring Dental Treatment: A Comparative Clinical Study

ABSTRACT Background: Accurate pain assessment in pediatric dental patients is crucial for effective pain management and treatment planning. Materials and Methods: A total of 120 children aged 6-12 years, requiring dental treatment, were enrolled in this study. Each child was assessed using the three pain scales after undergoing a standardized dental procedure. The assessments were performed by two independent evaluators to determine inter-rater reliability. The intraclass correlation coefficient (ICC) was used to evaluate the reliability of each tool. Data were analyzed using descriptive statistics and repeated measures ANOVA to compare the mean pain scores across the three scales. Results: The mean pain scores reported were 4.3 ± 1.2 for the VAS, 4.5 ± 1.4 for the FPS-R, and 4.2 ± 1.3 for the WBFPRS. The ICC values for inter-rater reliability were 0.88 for the VAS, 0.86 for the FPS-R, and 0.90 for the WBFPRS, indicating high reliability for all tools. However, the WBFPRS showed slightly higher reliability compared to the other scales. No significant differences were found in pain scores across the three tools (P = 0.72). Conclusion: All three pain assessment tools demonstrated high reliability in assessing pain in pediatric dental patients. The Wong-Baker Faces Pain Rating Scale showed the highest inter-rater reliability, suggesting it may be the most reliable tool for clinical use in this population.

Validation of a software-based torsional measurement method of the lower limb: A retrospective study.

The aim of this study was to evaluate a software-based measurement tool of computed tomography imaging to assess torsional alignment of the lower limb-usually used for patients with posttraumatic deformities and patellofemoral issues-and compare these measurements with manual measurements of two experienced raters. This study was a retrospective analysis of 58 lower limbs (47 patients, 20 men and 27 women) aged between 19 and 97 years. Inclusion criteria were the clinical indication for torsion measurement of the lower limb. Legs with incomplete imaging and age less than 18 years were excluded. Femoral and tibial torsion were measured separately. Torsional alignment was assessed software-based at two time points by two raters. Rater one additionally assessed manual-based measurement at two time points. The software used was mediCAD 3D Knee Version 2.5.33 (Hectec). Subsequently, intra- and inter-rater reliability was calculated using the intraclass correlation coefficient (ICC). Validity testing was performed by means of precision, concordance correlation coefficient according to Lin (ccc) and Pearson correlation coefficient. High intra-rater reliability for software-based as well as manual-based evaluation of torsional alignment was found for the tibia as well as the femur (ICC ranging between 0.870 and 0.993). Inter-rater reliability also showed highly significant results of both manual and software-based measurements (ICC ranging between 0.851 and 0.993). For almost all comparisons (except the tibia left), software-based measurements showed higher ICC scores above 0.9, and, therefore, classified as 'excellent reliability'. For validity testing, correlation coefficients and precision showed very good correspondence of the measurements (all values > 0.9), without systematic deviations. Software-based measurement of torsional alignment according to the measurement method developed by H.-A. Waidelich proved to be a reliable and valid technique. Especially for inexperienced surgeons, software-based measurement, therefore, might improve confidence in reliable medical decisions in diagnostics and treatment. Level III.

Deep learning prediction of error and skill in robotic prostatectomy suturing.

Manual objective assessment of skill and errors in minimally invasive surgery have been validated with correlation to surgical expertise and patient outcomes. However, assessment and error annotation can be subjective and are time-consuming processes, often precluding their use. Recent years have seen the development of artificial intelligence models to work towards automating the process to allow reduction of errors and truly objective assessment. This study aimed to validate surgical skill rating and error annotations in suturing gestures to inform the development and evaluation of AI models. SAR-RARP50 open data set was blindly, independently annotated at the gesture level in Robotic-Assisted Radical Prostatectomy (RARP) suturing. Manual objective assessment tools and error annotation methodology, Objective Clinical Human Reliability Analysis (OCHRA), were used as ground truth to train and test vision-based deep learning methods to estimate skill and errors. Analysis included descriptive statistics plus tool validity and reliability. Fifty-four RARP videos (266min) were analysed. Strong/excellent inter-rater reliability (range r = 0.70-0.89, p < 0.001) and very strong correlation (r = 0.92, p < 0.001) between objective assessment tools was demonstrated. Skill estimation of OSATS and M-GEARS had a Spearman's Correlation Coefficient 0.37 and 0.36, respectively, with normalised mean absolute error representing a prediction error of 17.92% (inverted "accuracy" 82.08%) and 20.6% (inverted "accuracy" 79.4%) respectively. The best performing models in error prediction achieved mean absolute precision of 37.14%, area under the curve 65.10% and Macro-F1 58.97%. This is the first study to employ detailed error detection methodology and deep learning models within real robotic surgical video. This benchmark evaluation of AI models sets a foundation and promising approach for future advancements in automated technical skill assessment.

Hernia mesh and social media: misinformation, legal solicitation, and conflict of interest.

Patients often utilize social media platforms as a resource for medical information. Lately, hernia mesh has been surrounded by controversy due to highly publicized mesh recalls. We aimed to assess the rates of misinformation, legal solicitation, and conflict of interest of hernia mesh information on Facebook and YouTube. We conducted a cross-sectional study of Facebook posts and YouTube videos using the search term "hernia mesh." The first 150 public Facebook posts and YouTube videos were initially selected, in addition to the first 30 posts of public Facebook groups. Video/post characteristics and the presence of misinformation, legal solicitation, and conflict of interest were independently recorded by three trained raters. Fleiss' kappa coefficient (ĸ) was calculated to determine Inter-rater agreement. A total of 129 Facebook posts and 108 YouTube videos were analyzed. 29% of posts/videos were uploaded by a law firm and 24% were uploaded by medical professionals. The raters indicated that an average of 11% posts/videos contained misinformation, 17% involved legal solicitation, and 21% included conflicts of interest. Inter-rater agreement was fair for misinformation (ĸ = 0.380-0.382), substantial/almost perfect for legal solicitation (ĸ = 0.780-0.876), and moderate for conflict of interest (ĸ = 0.448-0.505). With regard to hernia mesh, misinformation, legal solicitation, and conflict of interest are somewhat common on popular social media platforms. Trained raters had a high level of agreement on legal solicitation but limited agreement on misinformation. Our findings suggest that recognizing misinformation on social media regarding hernia mesh is difficult.

Supplemental Material for Police and Researcher Use of the Ontario Domestic Assault Risk Assessment (ODARA): Interrater Agreement and Examination of Published Norms

Supplemental Material for Police and Researcher Use of the Ontario Domestic Assault Risk Assessment (ODARA): Interrater Agreement and Examination of Published Norms

Magnetic Resonance Imaging - Derived Psoas Muscle Area and Survival in Patients Treated Invasively for Peripheral Arterial Disease.

Psoas muscle parameters estimated from computed tomography images, as surrogates for sarcopenia, have been found to be associated with post-interventional outcomes after a wide range of cardiovascular procedures. The pre-interventional assessment in patients undergoing invasive treatment for peripheral arterial disease is increasingly often carried out with magnetic resonance imaging (MRI), and we therefore sought to investigate the predictive potential of MRI-derived psoas muscle area in this cohort. A total of 899 patients with available sufficient quality pre-interventional MRI conducted within 6 months prior to treatment undergoing open, endovascular, or hybrid revascularization procedures for claudication and/or limb-threatening ischemia at Tampere University hospital between 2010 and 2020 were retrospectively studied in this single-center cohort study. The follow-up lasted until 17 June 2021. Psoas muscle areas were measured from the magnetic resonance images at the L4 level, and the reliability of muscle parameter measurements was tested with intraclass correlation coefficient analysis. The average psoas muscle area values (mean of left and right psoas surface areas) were z-scored and analyzed separately for men and women. The median follow-up time was 5.9 years (interquartile range (IQR) = 2.7-7.8), and the overall mortality count was 259 (28.8%) (29.5% n = 168/569 for men and 27.6% n = 91/330 for women). The intraclass correlation coefficient analysis showed excellent interrater reliability for psoas muscle measurements. The muscle surface areas were larger in men (mean = 7.58 cm2) compared to women (mean = 5.27 cm2) (p < 0.001). Higher psoas muscle area was associated with better survival in women (p = 0.003, hazard ratio (HR) = 0.71, 95% confidence interval (CI) = 0.6-0.9 per 1 SD), whereas in men, an independent association of the muscle parameter with mortality was not found. MRI-derived psoas muscle area may be a prognostic factor for clinical use.

Development and validation of a pediatric internationally agreed ultrasound knee synovitis protocol (PIUS-knee) by the PReS imaging working party

ObjectivesTo identify an optimal pediatric musculoskeletal ultrasound (MSUS) protocol for the detection of knee arthritis in patients with juvenile idiopathic arthritis (JIA) including a comparison with existing protocols. Secondary aims were to correlate MSUS-identified B-Mode (BM) and Power Doppler-Mode (PD) synovitis with clinical findings.MethodsConsecutive JIA patients with confirmed knee arthritis after clinical examination underwent a thorough MSUS study protocol which included views identified and consented by the Pediatric Rheumatology european Society (PReS) Imaging Working Party for the detection of synovitis. In total eight views including measurement of the suprapatellar recess were included. Scoring of synovitis followed the pediatric OMERACT criteria (BM and PD severity grading 0 to 3). Interobserver reliability of BM and PD was tested before study begin. Previously published MSUS protocols for knee synovitis were also identified from the literature and their scan protocols compared to identify differences in sensitivity for synovitis according to the number and specific type of views included. Finally, a clinically applicable MSUS protocol for knee synovitis could be proposed.ResultsIn 114 patients with clinically active knee inflammation, BM positivity (grading ≥ 1) was most frequently detected in the suprapatellar longitudinal and transverse scans performed in any positioning (frequency 97–99% in suprapatellar longitudinal in 30° or neutral respectively). PD positivity was however higher in these views performed in 30° flexion compared to neutral. Intrasynovial PD positivity (grading ≥ 1) was most frequently detected in the lateral parapatellar (69%, sensitivity 0.68, specificity 0.98), medial parapatellar (frequency 67%, sensitivity 0.67, specificity 1.0), the longitudinal lateral (68%, sensitivity 0.67, specificity 0.98) and suprapatellar transverse in 30° (frequency 64%, sensitivity 0.64, specificity 1.0). A combination of five views was the most sensitive for BM and PD synovitis. The suprapatellar recess size was analyzed by age and gender. For each group, the recess was wider in knees with arthritis than without (p < 0.001). Interobserver reliability of BM and PD positivity showed 85% agreement, with kappa 0.74 (very good). Three published studies with knee synovitis MSUS protocols were identified, which included a range of 1–3 views. Evaluation of the sensitivity of positive PD findings of each of these protocols reached a range of 53–83%; the highest sensitivity (91%) was achieved with the 5 views as identified by this study. These five views were therefore combined to form the Pediatric Internationally agreed Ultrasound (PIUS) knee protocol.ConclusionBM and PD positivity reliably correlated with the identification of pathological findings in knees of patients with JIA. From an internationally agreed protocol of eight images, a combination of five showed the greatest sensitivity for synovitis. This protocol, termed ‘PIUS-Knee’ performed well when compared to existing protocols.

Utilizing 3D Model and Comparison Software Tools in Improving Assessment Methods: A Pilot Study

Purpose/Objectives: This manuscript investigates the effectiveness of computer-assisted design and manufacturing (CAD/CAM) technology in preclinical dental education. The COVID-19 pandemic created a need for remote teaching approaches. In preclinical fixed prosthodontics courses, traditional evaluation methods rely on faculty to visually grade laboratory projects utilizing rubrics and 2D images. Assessment and feedback vary amongst faculty, and faculty calibration has been inconsistent in reducing intra-and inter-rater variability. This study aimed to compare faculty assessment of student full coverage crown (FCC) preparations traditionally versus digitally through 3D model visual assessment and/or comparative analysis software reports. Methods: Eighteen UTHealth Houston School of Dentistry faculty participated, each randomly assigned into one of three assessment groups: traditional visual Group (TV), 3D Group (3D), and 3D visual assessment supplemented with comparative analysis software report (3D+) Group. Faculty graded the same eight lithium disilicate typodont preparations for all three assessment groups. Results: Survey results showed the ease of use and efficiency among the three assessment methods varied significantly. Grading scores revealed that axial wall reduction significantly differed among the three assessment methods. Conclusion: This study concludes that the combination of the two digital assessment methods can overcome the limitations of traditional evaluation methods and digital methods alone by providing objective feedback to students and enhancing their learning experience.

Prioritizing sustainability indicators for Uganda's built environment: Expert perspectives using the Delphi technique

The growing emphasis on energy efficiency within the built environment, driven by global concerns over climate change, has resulted in notable shifts in building energy consumption patterns. Achieving reductions in building energy use and CO₂ emissions through sustainable strategies necessitates the development of country-specific policies. While numerous energy assessment tools are available internationally, they often lack contextual relevance for Uganda and many Sub-Saharan African countries.Therefore, there is a pressing need for a tool tailored to Uganda's distinct climatic conditions. This study aimed to identify key building sustainability indicators to promote energy efficiency in Ugandan buildings. Utilizing the Delphi Technique, experts from academia, construction, energy consulting, and government agencies evaluated 35 building indicators over two assessment rounds. The consensus among experts was validated using the Interrater Agreement, with a significant Kendall's W value exceeding 0.6, rising from 0.655 in the first round to 0.704 in the second. Construction consultants showed the highest W value (0.77) in the second round, followed by energy consultants (0.74), while academicians had the lowest (0.7). The Chi-square test demonstrated strong agreement in ranking indicators across 34 degrees of freedom. The most significant indicators identified include "B20 - Optimization of energy use," "B8 - Advanced design and construction technology," and "B27 - Natural ventilation design," among others. The Delphi Technique was instrumental in achieving expert consensus, while interrater agreement was used to validate and ensure the reliability of the findings. The developed framework provides critical insights for policymakers, practitioners, and researchers seeking to advance energy efficiency and sustainability within Uganda's built environment.

The reliability of a modified three-stage cervical vertebrae maturation method for estimating skeletal growth in males and females.

Reliability of the six-stage cervical vertebrae maturation method to evaluate skeletal growth was evaluated on the combined male and female samples and revealed diverse results. The current study aimed to determine the reliability of the modified three-stage cervical vertebrae maturation method for estimating the skeletal growth of males and females. Pretreatment lateral cephalometric radiographs of 137 orthodontic patients were utilized to evaluate the intra- and inter-observer reliability of a modified cervical vertebrae maturation method. Four independent examiners categorized each radiograph into one of the three skeletal growth stages according to the cervical vertebrae morphology: (1) a pre-peak group (combining the CS1 and CS2 stages), (2) a peak group (combining the CS3 and CS4 stages), and (3) a post-peak group (combining the CS5 and CS6 stages). The Kappa index and the Fleiss multirater Kappa test were carried out to determine the reproducibility of this method. The studied sample included cephalometric radiographs of 68 males (49.6%) and 69 females (50.4%) aged between 7 and 58 years; no significant age difference was found between the sexes (p = 0.189). The overall inter-observer reliability was 0.689 (p < 0.001), and the inter-observer reliability for the post-peak stage showed only Kappa = 0.896 (p < 0.001). The Kappa values were significantly greater in males than in females during the peak stage (0.626 and 0.488, respectively). A modified three-stage cervical vertebrae maturation method showed substantial overall inter-examiner agreement; however, differential reliability for diverse skeletal maturation stages and sexes was found.