Intraclass Correlation Coefficient Test Research Articles

Shoulder MRI parameters in anticipating anterior shoulder dislocation: Are they a reliable and reproducible tool in clinical practice?

BackgroundAnterior shoulder dislocation (ASD) is a frequently observed musculoskeletal injury that is often encountered in the context of sports activities or as a result of trauma. Several magnetic resonance imaging (MRI) parameters have been previously investigated for the purpose of characterizing the anatomical features, which could potentially be responsible for the episodes of instability. These measurements have the potential to identify patients who are susceptible to dislocation. Consequently, ensuring the reliability and consistency of these measurements is crucial in the diagnosis and the management of athletic or traumatic shoulder injuries. MethodsA group of four students, who had no previous experience in reading MRI series, were selected to perform radiographic measurements on specific parameters of MRI scans. These parameters were glenoid version, glenoid depth, glenoid width, humeral head diameter, humeral containing angle, and the ratio of humeral head diameter to glenoid diameter. The four participants conducted two distinct readings on a total of 28 sets of shoulder MRI scans. Simultaneously, the aforementioned measures were assessed by a consultant shoulder surgeon. ResultsA total of 1512 measurements were categorized into nine sets: eight from students’ measurements (two per student) and one from the consultant. Intra-rater reliability assessed by the intra-class correlation (ICC) test indicated excellent or good reliability for all parameters (p < 0.05), with glenoid depth showing the highest (0.925) and humeral-containing angles the lowest (0.675) ICC value. Inter-rater correlation, also evaluated using ICC, demonstrated strong correlation (p < 0.05), with glenoid diameter having the highest ICC score (0.935) and glenoid depth the lowest (0.849). Agreement analysis, expressed by Cohen's Kappa test, revealed substantial agreement (p < 0.05) for all parameters, with humeral head diameter having the highest agreement (0.90) and humeral-containing angle the lowest (0.73). ConclusionIn this study, intra- and inter-rater MRI parameters are substantially concordant. Credibility comes from these reliability and agreement analyses' statistical significance. Glenoid diameter and depth are the most reliable intrarater and interrater, respectively. Best agreement was with the humeral-containing angle. These data demonstrate repeatability and clinical relevance. Level of EvidenceLevel IV

Diagnostic efficacy of hand-held digital refractometer for determining total serum protein in indigenous sheep of Pakistan.

The study was designed to ascertain the diagnostic efficacy of hand-held digital refractometer in determining total protein (TP). The Sipli sheep (n = 128) were grouped as per gender (females = 99, males = 29) and age (G1 = up till 1 year, n = 35; G2 = from 1 to 2 years, n = 63; G3 = above 2 years, n = 30). The results regarding the overall mean (±SE) values for the TPs attained through serum chemistry analyzer (TP1) and hand-held digital refractometer (TP2) were non-significantly (P≥0.05) different (59.2±1.6g/L and 59.8±0.5g/L, respectively). However, the reference intervals (RIs) were quite different for the two TPs being 45.1-95.7g/L and 57.0-67.0g/L for TP1 and TP2, respectively. Similar results were seen for gender-wise and group-wise results. On the contrary, the results regarding correlation coefficient and logilinear regression showed a negative correlation between the two TPs (r = -0.0244) with an adjusted r-square of 0.059 (5.9% probability). Furthermore, the three tests implied to assess the level of agreement between the two methods (Cronbach alpha, Intraclass correlation coefficient, and Bland & Altman test) revealed least agreement between the two methods. In a nutshell, the results of TP through digital refractometer were not in concordance with those attained through serum chemistry analyzer. However, it can cautiously be used if these results are compared with relevant corrected RIs.

Impact of harmonization on the reproducibility of MRI radiomic features when using different scanners, acquisition parameters, and image pre-processing techniques: a phantom study.

This study investigated the impact of ComBat harmonization on the reproducibility of radiomic features extracted from magnetic resonance images (MRI) acquired on different scanners, using various data acquisition parameters and multiple image pre-processing techniques using a dedicated MRI phantom. Four scanners were used to acquire an MRI of a nonanatomic phantom as part of the TCIA RIDER database. In fast spin-echo inversion recovery (IR) sequences, several inversion durations were employed, including 50, 100, 250, 500, 750, 1000, 1500, 2000, 2500, and 3000 ms. In addition, a 3D fast spoiled gradient recalled echo (FSPGR) sequence was used to investigate several flip angles (FA): 2, 5, 10, 15, 20, 25, and 30 degrees. Nineteen phantom compartments were manually segmented. Different approaches were used to pre-process each image: Bin discretization, Wavelet filter, Laplacian of Gaussian, logarithm, square, square root, and gradient. Overall, 92 first-, second-, and higher-order statistical radiomic features were extracted. ComBat harmonization was also applied to the extracted radiomic features. Finally, the Intraclass Correlation Coefficient (ICC) and Kruskal-Wallis's (KW) tests were implemented to assess the robustness of radiomic features. The number of non-significant features in the KW test ranged between 0-5 and 29-74 for various scanners, 31-91 and 37-92 for three times tests, 0-33 to 34-90 for FAs, and 3-68 to 65-89 for IRs before and after ComBat harmonization, with different image pre-processing techniques, respectively. The number of features with ICC over 90% ranged between 0-8 and 6-60 for various scanners, 11-75 and 17-80 for three times tests, 3-83 to 9-84 for FAs, and 3-49 to 3-63 for IRs before and after ComBat harmonization, with different image pre-processing techniques, respectively. The use of various scanners, IRs, and FAs has a great impact on radiomic features. However, the majority of scanner-robust features is also robust to IR and FA. Among the effective parameters in MR images, several tests in one scanner have a negligible impact on radiomic features. Different scanners and acquisition parameters using various image pre-processing might affect radiomic features to a large extent. ComBat harmonization might significantly impact the reproducibility of MRI radiomic features.

Multimodality radiomics for tumor prognosis in nasopharyngeal carcinoma.

The prognosis of nasopharyngeal carcinoma (NPC) is challenging due to late-stage identification and frequently undetectable Epstein-Barr virus (EBV) DNA. Incorporating radiomic features, which quantify tumor characteristics from imaging, may enhance prognosis assessment. To investigate the predictive power of radiomic features on overall survival (OS), progression-free survival (PFS), and distant metastasis-free survival (DMFS) in NPC. A retrospective analysis of 183 NPC patients treated with chemoradiotherapy from 2010 to 2019 was conducted. All patients were followed for at least three years. The pretreatment CT images with contrast medium, MR images (T1W and T2W), as well as gross tumor volume (GTV) contours, were used to extract radiomic features using PyRadiomics v.2.0. Robust and efficient radiomic features were chosen using the intraclass correlation test and univariate Cox proportional hazard regression analysis. They were then combined with clinical data including age, gender, tumor stage, and EBV DNA level for prognostic evaluation using Cox proportional hazard regression models with recursive feature elimination (RFE) and were optimized using 20 repetitions of a five-fold cross-validation scheme. Integrating radiomics with clinical data significantly enhanced the predictive power, yielding a C-index of 0.788 ± 0.066 to 0.848 ± 0.079 for the combined model versus 0.745 ± 0.082 to 0.766 ± 0.083 for clinical data alone (p<0.05). Multimodality radiomics combined with clinical data offered the highest performance. Despite the absence of EBV DNA, radiomics integration significantly improved survival predictions (C-index ranging from 0.770 ± 0.070 to 0.831 ± 0.083 in combined model versus 0.727 ± 0.084 to 0.734 ± 0.088 in clinical model, p<0.05). The combination of multimodality radiomic features from CT and MR images could offer superior predictive performance for OS, PFS, and DMFS compared to relying on conventional clinical data alone.

4 Domain Sports PROM en español: adaptación transcultural en la población chilena y análisis de confiabilidad

BackgroundPatient-Reported Outcome Measures (PROMs) are tools of increasing interest in the sports population. The purpose of this study was to perform the cross-cultural adaptation and reliability analysis of the 4 Domain Sports Patient-Reported Outcome Measure (4DSP) into Spanish. MethodsA six-stage cross-cultural adaptation protocol was executed to obtain the Spanish version of the 4DSP (S-4DSP). Subsequently, the questionnaire was administered to a population of 108 postoperative athletes with ACL (Anterior Cruciate Ligament) injuries. The questionnaire was administered again after 30 days. Acceptability, floor and ceiling effects, internal consistency (Cronbach's alpha), and reproducibility (Intraclass Correlation) were evaluated. ResultsThe S-4DSP was fully completed by 108 participants (mean age 34±10.75, 26% women), achieving 100% acceptability. No floor effect was detected. The statistical analysis yielded a global Cronbach's alpha for the questionnaire of 0.65, and domain-specific alphas of 0.88, 0.72, 0.27, and 0.68 for the first, second, third, and fourth domains, respectively. The Intraclass Correlation test reached a maximum of 0.94 and a minimum of 0.48 for the first and fifth questions, respectively. ConclusionsThe S-4DSP is a reliable and useful tool for evaluating Spanish-speaking athletes after ACL reconstruction.

The Effect of Calcium Hydroxide Pastes on Isolated Vital Nerve Fibers

IntroductionCalcium hydroxide pastes (CHPs), commonly used for disinfecting root canals during endodontic treatment, are generally considered safe. However, accidental extrusions result in minimal injuries and little to no discomfort, except when extruded pastes come into contact with nerve bundles, such as the inferior alveolar nerve. Currently, there is a lack of information about the possible role of specific paste vehicles on the extent of nerve injury. The purpose of this study was to compare the role that paste vehicles, such as water or methylcellulose, may play when nerve fibers are exposed to CHP. MethodsIsolated sciatic nerves of Sprague-Dawley rats were exposed to either water-based or methylcellulose-based CHP for varying durations of time (30, 60, or 90 minutes). Histopathological changes, including axonal edema, myelin alterations, and loss of cellular outlines, were assessed, and the degrees of changes were compared using chi-square intraclass correlation coefficient tests. ResultsBoth groups exposed to the pastes demonstrated varying degrees of histopathologic changes, including axonal edema, myelin changes, and loss of cellular outlines, at different exposure times. The water-based calcium hydroxide paste induced these changes more rapidly than the methylcellulose-based paste. Similar patterns were observed in the scanning electron microscopic findings. Exposure time emerged as an important difference in the effects of the 2 pastes. In each of these tests, all observations of water-based paste exposure were rated as moderate to severe, whereas the observed cellular changes (axonal, myelin, and intact cellular outline) were rated as mild to moderate after exposure to methylcellulose-based paste for the same exposure durations. The chi-square tests indicated a statistically significant association between the material and each of the outcomes (axonal changes: χ²15 = 81.0, P < .001; myelin changes: χ²15 = 81.0, P < .001; intact cellular outline, χ²15 = 81.0, P < .001). The intraclass correlation coefficient value was 0.93. ConclusionsThe study demonstrates that axonal and myelin damage increase with longer exposure times, with water-based CHP causing more damage than methylcellulose-based CHP at each time point.

Sample size determination for conducting a pilot study to assess reliability of a questionnaire.

This article is a narrative review that discusses the recommended sample size requirements to design a pilot study to assess the reliability of a questionnaire. A list of various sample size tables that are based on the kappa agreement test, intra-class correlation test and Cronbach's alpha test has been compiled together. For all calculations, type I error (alpha) was set at a maximum value of 0.05, and power was set at a minimum value of 80.0%. For the kappa agreement test, intra-class correlation test, and Cronbach's alpha test, the recommended minimum sample size requirement based on the ideal effect sizes shall be at least 15, 22, and 24 subjects respectively. By making allowances for a non-response rate of 20.0%, a minimum sample size of 30 respondents will be sufficient to assess the reliability of the questionnaire. The clear guideline of minimum sample size requirement for the pilot study to assess the reliability of a questionnaire is discussed and this will ease researchers in preparation for the pilot study. This study provides justification for a minimum requirement of a sample size of 30 respondents specifically to test the reliability of a questionnaire.

To Evaluate the Effect of Prophylactic Agents on the Surface Morphology of Different Orthodontic Wires at Different Temperatures: An In vitro Study

Aim and Objective: The aim and objective are to evaluate the effect of prophylactic agents on the surface morphology of different types of orthodontic wires of different dimensions at two different temperatures. Materials and Methods: Stainless steel (SS), NiTi, and titanium-molybdenum alloy (TMA) wires of 0.016 inch round and 0.017 inch × 0.025-inch dimensions were immersed in prophylactic agents such as 0.2% NaF, 0.2% CHx and 1.23% APF for 1.5 h at 37°C and 45°C. A one-way analysis of variance, Bonferroni test, and intraclass correlation coefficient test was performed to eliminate the bias. Scanning electron microscope was used to evaluate the surface characteristics of wire and quantitative analysis was performed using ImageJ software. Results: Highest corrosion can be seen on TMA wires of 0.016 inch and 0.017 inch × 0.025 inch when exposed to 1.23% APF gel at 45°C and lowest corrosion can be seen on SS wires of 0.017 inch × 0.025 inch when exposed to 0.2% NaF mouthwash at 37°C. Conclusion: The results suggest that sodium fluoride is the mouthwash of choice when used with all three types of orthodontic wires used for different orthodontic purposes and APF gel should not be recommended when TMA wires are used at high temperatures as it causes corrosion which can lead to increased friction.

Investigation of geometric object and indoor mapping capacity of Apple iPhone 12 Pro LiDAR

LiDAR (light detection and ranging) sensors use laser beams to calculate distances in the surroundings. These sensors can be applied to a wide range of tasks, and they are frequently helpful in tasks like building 3D maps, navigating airplanes, robots, conducting mining operations, and automated driving. High-resolution distance measurements are taken by LiDAR sensors, but they also gather environmental data. This information aids in locating, identifying, and quantifying things and their surroundings. The iPhone 12 Pro, which Apple released in 2020, was evaluated for accuracy with various geometric shapes and its capacity to recognize indoor environments. Free of charge 3D Scanner and the Clirio Scan application were employed in this situation. However, it was found that the root mean square error and mean error in indoor mapping were ±1.41 cm and -0.56 cm in 3D Scanner and ±3.94 cm and -0.60 cm in the Clirio Scan application, respectively, despite the findings obtained showing low accuracy in scanning small geometric objects due to the scanning difficulty. Clirio does not reject the null hypothesis in the t-test that was conducted. The accuracy of the LiDAR sensor in indoor mapping has been shown to be more promising than that of small items. In order to evaluate the reliability and reusability of the indoor mapping application according to reference measurements, intraclass correlation test was performed and the results were determined to be reliable.

Cross-cultural adaption and inter-rater reliability of the Swedish version of the updated clinical frailty scale 2.0

BackgroundWorldwide, there is a large and growing group of older adults. Frailty is known as an important discriminatory factor for poor outcomes. The Clinical Frailty Scale (CFS) has become a frequently used frailty instrument in different clinical settings and health care sectors, and it has shown good predictive validity. The aims of this study were to describe and validate the translation and cultural adaptation of the CFS into Swedish (CFS-SWE), and to test the inter-rater reliability (IRR) for registered nurses using the CFS-SWE.MethodsAn observational study design was employed. The ISPOR principles were used for the translation, linguistic validation and cultural adaptation of the scale. To test the IRR, 12 participants were asked to rate 10 clinical case vignettes using the CFS-SWE. The IRR was assessed using intraclass correlation and Krippendorff’s alpha agreement coefficient test.ResultsThe Clinical Frailty Scale was translated and culturally adapted into Swedish and is presented in its final form. The IRR for all raters, measured by an intraclass correlation test, resulted in an absolute agreement value among the raters of 0.969 (95% CI: 0.929–0.991) and a consistency value of 0.979 (95% CI: 0.953–0.994), which indicates excellent reliability. Krippendorff’s alpha agreement coefficient for all raters was 0.969 (95% CI: 0.917–0.988), indicating near-perfect agreement. The sensitivity of the reliability was examined by separately testing the IRR of the group of specialised registered nurses and non-specialised registered nurses respectively, with consistent and similar results.ConclusionThe Clinical Frailty Scale was translated, linguistically validated and culturally adapted into Swedish following a well-established standard technique. The IRR was excellent, judged by two established, separately used, reliability tests. The reliability test results did not differ between non-specialised and specialised registered nurses. However, the use of case vignettes might reduce the generalisability of the reliability findings to real-life settings. The CFS has the potential to be a common reference tool, especially when older adults are treated and rehabilitated in different care sectors.

Predicted and achieved overjet and overbite measurements with the Invisalign appliance: a retrospective study.

To determine whether achieved outcome regarding overjet and overbite matched the predicted outcome following treatment with Invisalign (Align Technology, San Jose, Calif) aligner appliances. Data including pretreatment, predicted and achieved overjet, and overbite measurements provided by Align's digital treatment facility, ClinCheck Pro, were evaluated. Descriptive statistics, Mann-Whitney U-test, and Wilcoxon rank-sum intraclass correlation (ICC) test results were calculated. From an initial sample of 600, 355 adult patients satisfied the inclusion and exclusion criteria. ICC scores for data input were excellent. Median (interquartile range [IQR]) age was 30.14 (23.33, 39.92) years and most (n = 259; 72.95%) were women. Almost one-third (n = 101; 28.45%) had undergone extraction as part of their treatment. More aligners were prescribed in the initial digital treatment plan for patients (median, 44; IQR: 35, 51.5; minimum, 17; maximum, 92) undergoing extractions as part of their orthodontic treatment than those who were not (median, 24; IQR: 18.25, 32; minimum, 13; maximum, 85) (P < .0001). Planned changes in overjet differed significantly from achieved outcomes (P < .001). Planned increases in overbite resulted in up to more than twice (222.72%) as much increase than predicted. Planned reduction of overbite achieved 8.69% of its predicted reduction in extraction cases. Achieved overjet and overbite measurements differed significantly from the predicted outcomes at the end of an initial sequence of aligners. Planned increases in overbite resulted in greater overbite correction than predicted, particularly in extraction cases. Planned overbite reduction was challenging, especially in patients with extractions.

Youtube is an unreliable source of information about delayed ejaculation treatment.

Social platforms such as YouTube have become sources of information about diseases as they can be easily and rapidly accessed. However, this also has the risk of ill-intentioned content and misleading information. To evaluate the reliability of YouTube video content about delayed ejaculation treatment. YouTube videos were searched using the terms "delayed ejaculation," "retarded ejaculation," "inhibited ejaculation," and "anejaculation." Videos were excluded if they were not in English, were not related to the subject, or did not have audio and visual content. In accordance with the scientifically proven accurate information, the videos were separated as reliable (Group 2, n: 112) and unreliable videos (Group 1, n: 94). The groups were compared in respect of the video characteristics, and the scores obtained in the DISCERN-5, Global Quality Scale, the Patient Education Materials Assessment Tool Audiovisual, and the Journal of the American Medical Association scales. Intraclass correlation test was used to evaluate the level of agreement between the two investigators. Of the 1200 videos, 994 were excluded. No significant difference was determined between the Group 1 and Group 2 in respect of the median number of views [1672 (4555) vs 1547 (28,559), p = 0.63] and likes [10 (42) vs 17 (255), p = 0.07]. There was a greater number of videos in the Group 2 (54.4%) and the points obtained on the scoring scales were significantly higher than the Group 1 (p < 0.001). The videos originating from universities/professional organizations/non-profit physician/physician group were comprised the majority of the reliable videos (55.3%) and the unreliable videos had more content related to treatment (71.4%) (p < 0.001). Although there was a greater number of reliable videos related to the problem of delayed ejaculation, the content could be misleading and should be avoided by patients seeking treatment without consulting a physician.

A New Proposed Combined CT and MRI Staging System for Covid-19-Associated Rhino-Orbito-Cerebral Fungal Infection: A Multi-center Study with Pathological Correlation

To propose a combined computed tomography (CT) and magnetic resonance imaging (MRI) based classification system in the management of COVID-19-associated rhino-orbito-cerebral (C-ROC) fungal infection and to assess the reliability of such proposed staging system. This was a multi-center prospective study conducted on 122 adults with previously confirmed COVID-19 infection. CT and contrast-enhanced MRI (CE-MRI) were performed for all patients. Three radiologists (with experience of 8, 10, and 14 years) independently assessed all images. Then, each patient was assigned a radiological stage based on the five stages of the proposed system according to the radiological extent of the fungal infection. The intra-class correlation coefficient (ICC) test assessed the inter-rater agreement. Based on the pathological evaluation of post-operative specimens, a diagnosis of fungal infection was documented. The most prevalent severity stage among all raters was stage IV in 29.5-31.1% patients. The overall inter-rater agreement of the proposed staging system was excellent (ICC 0.971, 95% CI;0.960-0.979). Moreover, the most common detected pathogen was Mucormycosis (n=87, 71.3%). Furthermore, there was a statistically significant association between the patients' outcome and the severity stage (P value 0.001) and there was no statistically significant association between ethmoid and sphenoid sinus affection and cranial extension (P value 0.081). Our proposed combined CT and MRI severity staging system has a high inter-rater agreement. Moreover, it can aid in the early detection of the C-ROC fungal infection, improve preoperative planning, and subsequently improve the patient's outcome.

Health-related quality of life in patients aged 6-18 years with chronic hepatitis C treated with sofosbuvir/velpatasvir.

The aim of this study was to assess the effect of treatment with sofosbuvir/velpatasvir (SOF/VEL) on the health-related quality of life (HRQL) of children with chronic hepatitis C. In the non-commercial, non-randomized, open-label PANDAA-PED study, 50 children aged 6-18 years with chronic hepatitis C were treated with a fixed dose of SOF/VEL. All patients achieved sustained virologic response 12 weeks after the end of treatment (SVR12). Evaluation of HRQL was performed twice: at baseline (before the treatment) and during the SVR12 analysis using the KIDSCREEN-27 questionnaires, which included 5 dimensions of HRQL, for child self-reporting and parent proxy reporting. The normal range for the population was set to T values of 50 ± 10 points. Child-parent agreement was analysed using the intra-class correlation coefficient (ICC) and Bland-Altman test. Mean T values were within the normal range for all dimensions, both before and after treatment. There was a significant improvement in physical well-being based on the children's self-assessment (from 48.53 to 51.21, p = .03). In addition, a trend towards better scores in the 'social support & peers' part of the parent proxy evaluation (from 45.98 to 48.66, p = .06) was noticed. After the treatment, the proportion of children self-assessing their physical well-being as below normal significantly decreased from 17% to 5% (p = .007). HRQL scores were not associated with patients' sex, but in most cases, younger age correlated with better HRQL. Evaluation of the ICC for child self-reports versus parent proxy reports revealed poor to moderate agreement for most single measures. Bland-Altman analysis showed that in all dimensions, both before and after treatment, the limits of agreement (LoAs) exceeded ±5 points (half of the SD and considered a maximum allowed difference). A significant proportion of children with chronic hepatitis C have decreased HRQL in all dimensions, but effective treatment with SOF/VEL leads to an improvement in some areas of well-being. As the effect of HCV on HRQL is more pronounced in older patients, treatment of younger children should be indicated to prevent them from experiencing decreased HRQL due to ongoing HCV infection in the future.

Sutures positioning technique enhances the predictability and concordance between preoperative simulation and actual outcomes in rhinoplasty

The predictability and concordance between simulated and actual outcomes in rhinoplasty are uncertain. Here, we introduce a suture positioning technique (SPT), a simple and low-cost method to minimize the gap between the simulated and actual outcomes of rhinoplasty. Seventy patients were enrolled in this study between January 2018 and January 2021. Preoperative simulations were performed using Adobe Photoshop. The control group underwent surgery using simulation and intuition. In the SPT group, sutures were used to assist in the preoperative identification of the ideal nasal tip position. The SPT effectiveness was tested by measuring the nasal parameters and using the patient's subjective satisfaction questionnaire at T1 (Time 1, immediately postoperatively) and T2 (Time 2, at least 1 year postoperatively). The intraclass correlation coefficient test showed a satisfactory correlation between simulation and postoperative outcomes in both groups. However, the SPT group had a higher correlation than the control group, especially for the nasal length (16% higher at T1 and 15% higher at T2). The mean absolute difference (MAD) between the outcomes and simulation indicated that the MAD of nasal tip projection between T2 and simulation and MAD of nasal length between T1 (or T2) and simulation were statistically significant between groups. Additionally, the SPT group was more satisfied with the postoperative outcomes and were consistent with the preoperative simulation. This study demonstrated the effectiveness of SPT in intraoperative quality control. This technique may be adopted by surgeons to achieve good concordance between simulated and actual surgical outcomes.

Is the Pediatric Eosinophilic Esophagitis Symptom Score v2.0 reliable for telemedicine?

Eosinophilic esophagitis (EoE) is a chronic immune-mediated disease. Telemedicine is a healthcare technology used when a patient is separated by distance. The reliability of the Pediatric Eosinophilic Esophagitis Symptom Score, version 2.0 (PEESS v2.0) for telemedicine applications, has not been studied yet. Therefore, we aimed to evaluate the reliability of PEESS v2.0 for telemedicine. We sent a telesurvey using questionnaires via electronic telecommunication as the telemedicine method. Children with EoE and their parents were asked to complete PEESS v2.0 with the telesurvey method (unsynchronized with the physician) and attend in-person visits one week apart. Intraclass correlation (ICC), Wilcoxon, and Bland-Altman tests were used as reliability analyses. Reliability was defined as a strong agreement between the measurements in ICC ≥ 0.8 and a p-value of ≤0.05 and no statistically significant difference between the scores of the two methods in the Wilcoxon and Bland-Altman analyses, i.e. a p-value of >0.05. The total scores of children and parents were higher in in-person visits than in the telesurvey (Wilcoxon tests, p ≤ 0.05). Bland- Altman analysis showed that the mean difference in total scores between the two methods was significant for both children and parents (p ≤ 0.05). ICC levels for the children and parent scores for the entire group ranged from 0.595 to 0.763 (moderate agreement). Unsynchronized telesurvey use of PEESS v2.0 is unreliable both for children and parents. We suggest testing the reliability of chosen telemedicine methods before using them in clinical and research practice.

Critical Factors Affecting the Bid Cost of Building Construction Projects

A cost database is essential for contractors to estimate accurate bid costs, and most contractors use historical cost databases for this purpose. Factors that influence bid cost should be investigated so that they are accurate. From the existing literature, this study identifies 30 factors that affect bid costs, and a survey was sent to 80 prime and subcontractors to determine the critical factors. The intraclass correlation test was conducted to determine the consistency of the responses. Then the Relative Importance Index (RII) was determined to identify the critical factors inhibiting the bid cost. In addition, the Mann-Whitney test was performed to determine whether the critical factors were highly ranked. Using RII and Mann-Whitney tests, the study determined seven critical factors that affect the bid cost of building projects: failure to track labor productivity; failure to report site-specific project conditions; failure to report complexity of the project; lacking documentation of union restrictions, regulations, local building code, and safety requirements; failure to report change order impact on labor productivity; failure to incorporate change orders into a cost control program; and failure to report project description. These findings will assist contractors to accurately bid building projects.

Assessing Tumor Volume for Sporadic Vestibular Schwannomas: A Comparison of Methods of Volumetry

Introduction: The size of vestibular schwannomas (VS) is a major factor guiding the initial decision of treatment and the definition of tumor control or failure. Accurate measurement and standardized definition are mandatory; yet no standard exist. Various approximation methods using linear measures or segmental volumetry have been reported. We reviewed different methods of volumetry and evaluated their correlation and agreement using our own historical cohort. Methods: We selected patients treated for sporadic VS by Gammaknife radiosurgery (GKRS) in our department. Using the stereotactic 3D T1 enhancing MRI on the day of GKRS, 4 methods of volumetry using linear measurements (5-axis, 3-axis, 3-axis-averaged, and 1-axis) and segmental volumetry were compared to each other. The degree of correlation was evaluated using an intraclass correlation test (ICC 3,1). The agreement between the different methods was evaluated using Bland-Altman diagrams. Results: A total of 2,188 patients were included. We observed an excellent ICC between 5-axis volumetry (0.98), 3-axis volumetry (0.96), and 3-axis-averaged volumetry (0.96) and segmental volumetry, respectively, irrespective of the Koos grade or Ohata classification. The ICC for 1-axis volumetry was lower (0.72) and varied depending on the Koos and Ohata subgroups. None of these methods were substitutable. Conclusion: Although segmental volumetry is deemed the most accurate method, it takes more effort and requires sophisticated computation systems compared to methods of volumetry using linear measurements. 5-axis volumetry affords the best adequacy with segmental volumetry among all methods under assessment, irrespective of the shape of the tumor. 1-axis volumetry should not be used.

Three-Dimensional Assessment and Comparison of the Maxillary Tuberosity Between Skeletal and Dental Class I and Class II Adults in Maxillary Third Molar Agenesis Using Cone Beam Computed Tomography: A Descriptive Cross-Sectional Human Study.

The objective of this study was to assess and compare the dimensions (width (W), height (H), and length (L)) of the tuberosity distal to maxillary permanent second molar in individuals with skeletal and dental Class I and Class II malocclusions who had maxillary third molar agenesis. Cone beam computed tomography (CBCT) was used to measure the left (L) and right (R) anatomical tuberosity dimensions in three dimensions using the WillMaster software (HDX WILL Corporation, Korea). The measurements were compared between Class I (n = 35)and Class II (n = 35) normo-hypodivergent adult subjects. The dimensions were measured at regular 2 mm intervals from the cementoenamel junction (CEJ) and distovestibular root of the maxillary second molar in terms of the width (e.g., W1, W2, and W3), height (e.g., H1, H2, and H3), length (e.g., L1, L2, and L3) to the posterior limit of the tuberosity. Statistical analysis included descriptive statistics, Mann-Whitney U tests, and intraclass correlation coefficient tests. The width of the tuberosity at LW0, LW1, and LW2 was significantly higher in Class I compared to that in Class II. The right tuberosity in Class II showed significantly higher values in height at all reference points. The right tuberosity at RL0and RL1 exhibited significantly higher values in the length of the Class II group compared to the Class I group. The dimensions of the maxillary tuberosity (width, height, and length) varied between the Class I and Class II groups. Wider maxillary tuberosities were observed in the Class I group, while the Class II group had greater height and length dimensions of the tuberosity.

Accuracy of Pulse Oximetry for Long-Term Oxygen Therapy Assessment in COPD.

Landmark studies of long-term oxygen therapy (LTOT) in patients with chronic obstructive pulmonary disease (COPD) used partial pressure of oxygen (PaO2) to define severe hypoxemia, however pulse oximetry (SpO2) is commonly used instead. GOLD guidelines recommend evaluation with arterial blood gas (ABG) if SpO2 is ≤ 92%. This recommendation has not been evaluated in stable outpatients with COPD undergoing testing for LTOT. Evaluate the performance of SpO2 compared to ABG analysis of PaO2 and arterial oxygen saturation (SaO2) to detect severe resting hypoxemia in patients with COPD. Retrospective analysis of paired SpO2 and ABG values from stable outpatients with COPD who underwent LTOT assessment in a single center. We calculated false negatives (FN) as an SpO2 >88% or 89% in the presence of pulmonary hypertension with a PaO2 ≤ 55 mmHg or ≤ 59 mmHg in the presence of pulmonary hypertension. Test performance was assessed using ROC analysis, intra-class correlation coefficient (ICC), test bias, precision, and Arms (accuracy root-mean-square). An adjusted multivariate analysis was used to evaluate factors affecting SpO2 bias. Of 518 patients, the prevalence of severe resting hypoxemia was 74 (14.3%), with 52 missed by SpO2 (FN 10%) including 13 (2.5%) with an SpO2 > 92% (occult hypoxemia). FN and occult hypoxemia in Black patients were 9% and 1.5% and among active smokers 13% and 5%. The correlation between SpO2 and SaO2 was acceptable (ICC: 0.78; 95% CI 0.74 - 0.81) and the bias of SpO2 was 0.45% with a precision of 2.6 (-4.65 to +5.55%), and Arms of 2.59. These measurements were similar in Black patients, but in active smokers, correlation was lower and bias showed greater overestimation of SpO2. ROC analysis suggests that the optimal SpO2 cut off to warrant LTOT evaluation by ABG is ≤ 94%. SpO2 as the only measure of oxygenation carries a high FN rate in detecting severe resting hypoxemia in patients with COPD undergoing evaluation for LTOT. Reflex measurement of PaO2 by ABG should be used as recommended by GOLD, ideally at a cutoff higher than SpO2 ≤ 92% especially in active smokers.