Intraclass Correlation Research Articles

Defining Postinduction Hemodynamic Instability With an Automated Classification Model.

Postinduction hypotension (PIH) may be associated with increased morbidity and mortality. In earlier studies, the definition of PIH is solely based on different absolute or relative thresholds. However, the time-course (eg, how fast blood pressure drops during induction) is rarely incorporated, whereas it might represent the hemodynamic instability of a patient. We propose a comprehensive model to distinguish hemodynamically unstable from stable patients by combining blood pressure thresholds with the magnitude and speed of decline. This prospective study included 375 adult elective noncardiac surgery patients. Noninvasive blood pressure was continuously measured between 5 minutes before up to 15 minutes after the first induction agent had been administered. An expert panel rated whether the patient experienced clinically relevant hemodynamic instability or not. Interrater correlation coefficient and intraclass correlation were computed to check for consistency between experts. Next, an automated classification model for clinically relevant hemodynamic instability was developed using mean, maximum, minimum systolic, mean, diastolic arterial blood pressure (SAP, MAP, and DAP, respectively) and their corresponding time course of decline. The model was trained and tested based on the hemodynamic instability labels provided by the experts. In total 78 patients were classified as having experienced hemodynamic instability and 279 as not. The hemodynamically unstable patients were significantly older (7 years, 95% confidence interval (CI), 4-11, P < .001), with a higher prevalence of chronic obstructive pulmonary disease (COPD) (3% higher, 95% CI, 1-8, P = .036). Before induction, hemodynamically unstable patients had a higher SAP (median (first-third quartile): 161 (145-175) mm Hg vs 150 (134-166) mm Hg, P < .001) compared to hemodynamic stable patients. Interrater agreement between experts was 0.92 (95% CI, 0.89-0.94). The random forest classifier model showed excellent performance with an area under the receiver operating curve (AUROC) of 0.96, a sensitivity of 0.84, and specificity of 0.94. Based on the high sensitivity and specificity, the developed model is able to differentiate between clinically relevant hemodynamic instability and hemodynamic stable patients. This classification model will pave the way for future research concerning hemodynamic instability and its prevention.

Validity and reliability of trunk and lower-limb kinematics during squatting, hopping, jumping and side-stepping using OpenCap markerless motion capture application

ABSTRACT OpenCap is a web-based markerless motion capture platform that estimates 3D kinematics from videos recorded from at least two iOS devices. This study aimed to determine the concurrent validity and inter-session reliability of OpenCap for measuring trunk and lower-limb kinematics during squatting, hopping, countermovement jumping, and cutting. Nineteen participants (10 males, 9 females; age 27.7 ± 4.1 years) were included. Countermovement jump, single-leg triple vertical hop, single-leg squat, sidestep cutting and side hop tasks were assessed. For validity, OpenCap was compared to a marker-based motion capture system using root-mean-square error. Test–retest reliability of OpenCap was determined using intraclass correlations and minimum detectable change (MDC) from two testing sessions. The squat had the lowest RMSE across joint angles (mean = 7.0°, range = 2.9° to 13.6°). For peak angles, the countermovement jump (jump phase) (ICC = 0.62–0.93) and the squat (ICC = 0.60–0.92) had the best reliability across all joints. For initial contact, the side hop had the best inter-session reliability (ICC = 0.70–0.94) across all joint angles. As such, OpenCap validity and reliability are joint and task specific.

Tooth segmentation by low-dose CBCT for orthodontic treatment planning : Explorative ex vivo validation.

Three-dimensional imaging has become an increasingly important component of orthodontics. Associated with this, however, is ahigher radiation exposure for patients. New cone-beam computed tomography (CBCT) devices have been developed that can provide low-dose CBCT(LD-CBCT). We hypothesized that LD-CBCT is as precise and reproducible as standard high-dose CBCT (HD-CBCT) in segmenting roots and crowns as well as measuring tooth length. HD-CBCT and LD-CBCT scans were taken of four human cadaveric heads. Thirty single-rooted teeth were segmented twice by one investigator. The length of each tooth was also measured. Lin's concordance correlation coefficient (CCC) was calculated to assess the agreement of HD-CBCT and LD-CBCT measurements and the intraclass correlation coefficient (ICC) was calculated to assess intrarater reliability. Analyses were supported by Bland-Altman plots. Volume measurements obtained using HD-CBCT were significantly higher than those obtained using LD-CBCT (p < 0.001). CCC was 0.975 (95% confidence interval [CI] = 0.956-0.986) indicating excellent agreement between the two modalities. Intrarater reliability between the two sets of LD-CBCT and HD-CBCT volume measurements was excellent (ICC = 0.998, 95%CI = 0.995-0.999 [HD-CBCT], ICC = 0.997, 95%CI = 0.992-0.998 [LD-CBCT]). CCC for tooth length measurements was 0.991 (95% CI = 0.983-0.995), indicating excellent agreement between HD-CBCT and LD-CBCT. Intrarater reliabilities between the two sets of tooth length measurements were also excellent for both methods (ICC = 0.998, 95%CI = 0.995-0.999 [HD-CBCT], ICC = 0.997, 95%CI = 0.992-0.998 [LD-CBCT]). Within the limitations of this experimental setting, LD-CBCT is as valid as HD-CBCT for measuring tooth length. Regarding the volume differences, in vivo studies are required to determine their clinical relevance.

Stimulated echo acquisition mode (STEAM) diffusion tensor imaging with different diffusion encoding times in the supraspinatus muscle: Test-retest reliability and comparison to spin echo diffusion tensor imaging.

Diffusion tensor imaging (DTI) provides insight into the skeletal muscle microstructure and can be acquired using a stimulated echo acquisition mode (STEAM)-based approach to quantify time-dependent tissue diffusion. This study examined diffusion metrics and signal-to-noise ratio (SNR) in the supraspinatus muscle obtained with a STEAM-DTI sequence with different diffusion encoding times (Δ) and compared them to measures from a spin echo (SE) sequence. Ten healthy subjects (mean age 31.5 ± 4.7years; five females) underwent 3-Tesla STEAM and SE-DTI of the shoulder in three sessions. STEAM was acquired with Δ of 100/200/400/600 ms. The diffusion encoding time in SE scans was 19ms (b = 500s/mm2). Region of interest-based measurement of fractional anisotropy (FA), mean diffusivity (MD), and SNR was performed. Intraclass correlation coefficients (ICCs) were computed to assess test-retest reliability. ANOVA with post-hoc pairwise tests was used to compare measures between different Δ of STEAM as well as STEAM and SE, respectively. FA was significantly higher (FASTEAM: 0.38-0.46 vs. FASE: 0.26) and MD significantly lower (MDSTEAM: 1.20-1.33 vs. MDSE: 1.62×10-3mm2/s) in STEAM compared to SE (p < 0.001, respectively). SNR was significantly higher for SE (72.3 ± 8.7) than for STEAM (p < 0.001). ICCs were excellent for FA in STEAM (≥0.911) and SE (0.960). For MD, ICCs were good for STEAM100ms-600ms (≥0.759) and SE (0.752). STEAM and SE exhibited excellent reliability for FA and good reliability for MD in the supraspinatus muscle. SNR was significantly higher in SE compared to STEAM.

Accuracy of a Smart Diaper System for Nursing Home Residents for Automatically Detecting Voided Volume: Instrument Validation Study.

Diapers are commonly used by older patients with urination disorders. A smart diaper system (SDS) may be able to estimate the weight of urine comparably to conventional measurements made by weighing diapers. The aim of the current research is to determine the degree of accuracy of an SDS technology specifically designed for the management of urination routines and the use of incontinence pads in older adults. From January to December 2022, 97 older patients with at least 1 chronic disease from 3 nursing homes were included. In this study, the SDS was used for 1 month per patient after obtaining their consent; all patients originally used traditional diapers in the nursing home. The index test measured the change in electrical resistance of the SDS and the reference test measured the change in actual urine weight. When measuring the actual urine weight, the degree of absorption was directly confirmed with the naked eye because the expression value varied according to pressure changes caused by the user's movement or position. The Pearson correlation was used to determine the correlation between the 2 test methods, the intraclass correlation coefficient (ICC) was used to check the degree of agreement between the evaluators, and the Bland-Altman test was used to confirm whether there was a significant difference between the 2 test methods. The average age of the 97 participants was 86.48 (SD 6.26) years, with 10 men and 87 women. There were 73 patients (75%) with hypertension, 86 patients (88%) with dementia, and 86 patients (88%) with 2 or more comorbidities, accounting for the majority. The Pearson correlation coefficient and ICC were 0.971 and 0.985 (P<.001). In the Bland-Altman figure, the difference in the mean between the 2 tests was evenly scattered without showing a specific pattern, indicating that the SDS and actual urine weight were very consistent. The difference between the mean of the 2 tests was -0.045 of the standardized mean difference, and all measurements were located within the 95% CI, so this confirms that the 2 test methods are equivalent. Our study showed a fairly high correlation coefficient and ICC for all patient groups, which reveals that the 2 tests were very consistent and that the SDS can replace traditional diapers, even in a real clinical setting. This study shows the possibility that heath care professionals could be alerted by the SDS to the need for pad replacement due to incontinence, thus avoiding the development of dermatological complications.

Comparative analysis of a novel spectral-domain OCT biometer versus swept-source OCT or OLCR biometer in healthy pediatric ocular biometry

With the advancements in ocular biometric technology, there have been significant improvements in accurately and efficiently measuring ocular parameters. The aim of this study is to compare the reliability of biometric parameters obtained using a new frequency-domain optical coherence tomography (SD-OCT) biometer with the measurements obtained from swept-source OCT (SS-OCT) and optical low coherence reflectometry (OLCR) biometers. This study employed an observational cross-sectional design. Measurements of axial length (AL), flat and steep corneal keratometry (K1 and K2), and central corneal thickness (CCT) obtained using the The Colombo IOL were compared with those obtained with the IOLMaster 700 and SW-9000 devices. The agreement were evaluated using intraclass correlation coefficient (ICC) and Bland–Altman analyses. The differences of the measurements of the three increments were assessed by one-way ANONA. 73 right eyes of 73 healthy pediatric subjects were analyzed. The AL difference measured by Colombo IOL compared with IOLmaster700 and SW-9000 were 0.00 ± 0.02 mm and − 0.07 ± 0.05 mm, respectively (P > 0.05, ANOVA). There was no statistically significant difference in CCT, K1, and K2 among the three instruments (all P > 0.05, ANOVA). The ICC values for AL, K1, K2, and CCT were 0.999, 0.996, 0.995, and 0.998, respectively. The Bland-Altman analysis showed an agreement of AL, K1, K2, and CCT with Colombo IOL and IOLMaster 700 spanned over 0.08 mm, 0.71D, 0.69D, and 12.17 μm, respectively. The agreement of AL, K1, K2, and CCT with Colombo IOL and SW-9000 spanned approximate 0.21 mm, 0.75D, 1.06D, and 14.37 μm, respectively. The new SD-OCT biometer and the SS-OCT biometer showed strong agreement in measuring AL and CCT in healthy pediatric subjects. This supports the reliability of the new SD-OCT biometer as an alternative for assessing these parameters. However, K1 and K2 could not be used interchangeably in clinical practice. Further research is needed to explore their applicability in different clinical settings and patient populations."light" />

Turkish Translation And Validation of The Expectations of Aesthetic Rhinoplasty Scale.

The aim of this study was to translated, validate, and culturally adapt the original English version of the Expectations of Aesthetic Rhinoplasty Scale (EARS) into Turkish for use in Turkish-speaking communities. Fifty-one patients who wanted to undergo primary rhinoplasty and were literate in Turkish were included in the study. The control group consisted of 81 healthy volunteers who did not require rhinoplasty. A Turkish version of the EARS (EARS-T) was created. The participants completed the EARS-T questionnaire twice, four weeks apart. The internal consistency of the scale (Cronbach's α), the test-retest reliability (intraclass correlation coefficient [ICC]), and differences between the patient and control groups (Pearson's chi-square test) were analyzed. A statistically significant difference was found between the age and gender of the patient and control groups (p = 0.001 and p = 0.001, respectively). Univariate analysis showed that this significant difference did not affect the study results (age: p = 0.2; gender: p = 0.12). In addition, a statistically significant difference was found between the scale scores of the control and rhinoplasty groups (all p < 0.05). The EARS-T had good internal consistency, with high Cronbach's α scores ranging between 0.74 and 0.87. Test-retest reliability was demonstrated by high ICC scores ranging from 0.71 to 0.87. Our study revealed that the EARS-T has good internal consistency, reliability, and validity. Therefore, it can be used to assess the expectations of aesthetic rhinoplasty patients in preoperative consultation practice and in clinical studies related to rhinoplasty.

Evaluating the Psychometric Properties of a Physical Activity and Sedentary Behavior Identity Scale: Survey Study With Two Independent Samples of Adults in the United States.

Emerging evidence suggests a positive association between relevant aspects of one's psychological identity and physical activity engagement, but the current understanding of this relationship is primarily based on scales designed to assess identity as a person who exercises, leaving out essential aspects of physical activities (eg, incidental and occupational physical activity) and sedentary behavior. The goal of this study is to evaluate the validity of a new physical activity and sedentary behavior (PA/SB) identity scale using 2 independent samples of US adults. In study 1, participants answered 21 candidate items for the PA/SB identity scale and completed the International Physical Activity Questionnaire-Short Form (IPAQ-SF). Study 2 participants completed the same PA/SB identity items twice over a 1-week interval and completed the IPAQ-SF at the end. We performed factor analyses to evaluate the structure of the PA/SB identity scale, evaluated convergent validity and test-retest reliability (in study 2) of the final scale scores, and examined their discriminant validity using tests for differences in dependent correlations. The final PA/SB identity measure was comprised of 3 scales: physical activity role identity (F1), physical activity belief (F2), and sedentary behavior role identity (F3). The scales had high test-retest reliability (Pearson correlation coefficient: F1, r=0.87; F2, r=0.75; F3, r=0.84; intraclass correlation coefficient [ICC]: F1: ICC=0.85; F2: ICC=0.75; F3: ICC=0.84). F1 and F2 were positively correlated with each other (study 1, r=0.76; study 2, r=0.69), while both were negatively correlated with F3 (Pearson correlation coefficient between F1 and F3: r=-0.58 for study 1 and r=-0.73 for study 2; F2 and F3: r=-0.46 for studies 1 and 2). Data from both studies also demonstrated adequate discriminant validity of the scale developed. Significantly larger correlations with time in vigorous and moderate activities and time walking and sitting assessed by IPAQ-SF with F1, compared with F2, were observed. Significantly larger correlations with time in vigorous and moderate activities with F1, compared with F3, were also observed. Similarly, a larger correlation with time in vigorous activities and a smaller correlation with time walking were observed with F2, compared with F3. This study provided initial empirical evidence from 2 independent studies on the reliability and validity of the PA/SB identity scales for adults.

CT-FFR by expanding coronary tree with Newton–Krylov–Schwarz method to solve the governing equations of CFD

Abstract Background A new model of computational fluid dynamics (CFD)-based algorithm for coronary CT angiography (CCTA)-derived fractional flow reserve (FFR) (CT-FFR) analysis by expanding the coronary tree to smaller-diameter lumen (0.8mm) using Newton–Krylov–Schwarz (NKS) method to solve the three-dimensional time-dependent incompressible Navier-Stokes equations has been developed; however, the diagnostic performance of this new method has not been sufficiently investigated. Objectives The aim of this study was to determine the diagnostic performance of a novel CT-FFR technique by expanding the coronary tree in the CFD domain. Methods Six centers enrolled 338 symptomatic patients with suspected or known coronary artery disease (CAD) who were prospectively underwent CCTA and FFR. Stenosis assessment in CCTA and CT-FFR analysis were performed in independent core laboratories. Hemodynamically significant stenosis was defined by an CT-FFR and FFR ≤0.80, and anatomically obstructive CAD was defined as a CCTA with stenosis ≥50%. Diagnostic performance of CT-FFR was evaluated against invasive FFR using receiver operator characteristic (ROC) curve analysis. The correlation between CT-FFR and invasive FFR was analyzed using the Spearman correlation coefficient and Bland-Altman analysis. Intra-observer and inter-observer agreement were evaluated utilizing the intraclass correlation coefficient (ICC). Results In this study, 338 patients with 422 targeted vessels were investigated, revealing hemodynamically significant stenosis in 31.1% (105/338) of patients and anatomically obstructive stenosis in 54.1% of patients. On a per-vessel basis, the area under the receiver-operating characteristic curve for CT-FFR was 0.94 versus 0.76 for CCTA (p &amp;lt; 0.001). Per-vessel accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were 89.8%, 89.3%, 90.0%, 79.0%, and 99.2%, respectively, for CT-FFR and were 68.4%, 82.8%, 62.3%, 48.1%, and 89.6%, respectively, for CCTA stenosis. CT-FFR and FFR were well correlated (r = 0.775, p &amp;lt; 0.001) with a Bland-Altman bias of 0.0011, and limits of agreement from -0.1509 to 0.1531 (p = 0.770). The intraclass correlation coefficients with CT-FFR for intro- and inter-observer agreement were 0.919 (95% CI: 0.866 to 0.952) and 0.909 (95% CI: 0.851 to 0.945), respectively. The average computation time for CT-FFR analysis was maintained at 11.7 minutes. Conclusion This novel CT-FFR model with the inclusion of smaller lumen provides high diagnostic accuracy in detecting hemodynamically significant CAD. Furthermore, the integration of the NKS method ensures that the computation time remains within an acceptable range for potential clinical applications in the future.

Validity, reliability and responsiveness of digital visual analogue scales for chronic spontaneous urticaria monitoring: A CRUSE® mobile health study.

CRUSE® is an app that allows patients with chronic spontaneous urticaria (CSU) to monitor their daily disease activity through the use of visual analogue scales (VASs). We aimed to determine the concurrent validity, reliability, responsiveness and minimal important difference (MID) of CRUSE® VASs. We evaluated the properties of three daily VASs: VAS for how much patients were affected by their CSU ('VAS urticaria'), VAS for the impact of urticaria on work/school productivity ('VAS productivity') and the VAS of EQ-5D. Concurrent validity was assessed by measuring the association between each VAS and the Urticaria Activity Score (UAS). Intra-rater reliability was determined based on the data of users providing multiple daily questionnaires within the same day. Test-retest reliability and responsiveness (ability to change), respectively, were tested in clinically stable and clinically unstable users. MIDs were determined using distribution-based methods. We included 5938 patients (67,380 days). Concurrent validity was high, with VAS urticaria being more strongly associated with the UAS score than the remaining VASs. Intra-rater reliability was also high, with intraclass correlation coefficients (ICC) being above 0.950 for all VASs. Moderate-high test-retest reliability and responsiveness were observed, with reliability ICC being highest for VAS EQ-5D and responsiveness being highest for VAS urticaria. The MID for VAS urticaria was 17 (out of 100) units, compared to 15 units for VAS productivity and 11 units for VAS EQ-5D. Daily VASs for CSU available in the CRUSE® app display high concurrent validity and intra-rater reliability and moderate-high test-retest reliability and responsiveness.

Concurrent Validity and Interunit Reliability of 25-Hz GNSS Units for Profiling Sprinting Performance.

Dennison, L, Duthie, GM, Ehrmann, F, and Psarakis, MA. Concurrent validity and interunit reliability of 25-Hz GNSS units for profiling sprinting performance. J Strength Cond Res XX(X): 000-000, 2024-Profiling sprint performance by assessing within-race velocity or time is crucial for understanding an athlete's capabilities and identifying areas for improvement. While traditional gold standard systems provide valid and reliable measurements, they are often costly, laboratory-based, or impractical for field-based settings. New Global Navigation Satellite System (GNSS) units (25 Hz) with higher sampling rates may address some of these limitations. The purpose of the project was to evaluate the concurrent validity and interunit reliability of 25-Hz GNSS units by examining their agreement with laser devices and timing gates for velocity measurements and sprint/interval times. Concurrent validity was assessed during a real track and field training session. Thirty subjects each completed 3 to 6 maximal 40-meter sprints, for a total of 106 sprints, while being assessed simultaneously through all systems. Interunit reliability was assessed by placing 3 GNSS units on a motor vehicle and completing 60 accelerations from 0 to 60 m. Low mean bias (<1%) and typical error less than <2% for all measurements demonstrate excellent agreement between GNSS and criterion devices. The units demonstrated good reliability for the 0-10 m interval time (intraclass correlation coefficient [ICC] = 0.86), excellent reliability for all remaining 10 m to 60 m intervals (ICC = 0.91-0.99), sprint times 0-60 m (ICC = 0.97), and maximal sprint velocity (ICC = 1.0). These GNSS units provide an efficient and feasible alternative to traditional measurement devices. For coaches, this technology offers a scalable method to concurrently assess the sprint performances of multiple athletes during training and competitions, enabling evidence-based decisions to guide athletic development.

French Version of the User Mobile Application Rating Scale: Adaptation and Validation Study.

Managing noncommunicable diseases effectively requires continuous coordination and monitoring, often facilitated by eHealth technologies like mobile health (mHealth) apps. The end-user version of the Mobile Application Rating Scale is a valuable tool for assessing the quality of mHealth apps from the user perspective. However, the absence of a French version restricts its use in French-speaking countries, where the evaluation and regulation of mHealth apps are still lacking, despite the increasing number of apps and their strong relevance in health care. This study aims to translate and culturally adapt a French version of the user Mobile Application Rating Scale (uMARS-F) and to test its overall and internal reliability. Cross-cultural adaptation and translation followed the universalist approach. The uMARS-F was evaluated as part through a cohort study using the French mHealth app "MonSherpa" (Qare). Participants were French-speaking adults with Apple or Android phones, excluding those with difficulty understanding French, prior app use, or physical limitations. They assessed the app using the uMARS-F twice (T1 and T2) 1 week apart. Scores for each section and overall were assessed for normal distribution using the Shapiro-Wilk test and presented as mean (SD), and potential floor or ceiling effects were calculated accordingly. Overall reliability was evaluated using intraclass correlation coefficients and internal reliability using Cronbach α. Concordance between the 3 subscales (objective quality, subjective quality, and perceived impact), 4 sections, and 26 items at T1 and T2 was evaluated using the paired t test (2-tailed) and Pearson correlation. In total, 167 participants assessed the app at both T1 and T2 (100% compliance). Among them, 49.7% (n=83) were female, and 50.3% (n=84) were male, with a mean age of 43 (SD 16) years. The uMARS-F intraclass correlation coefficients were excellent for objective quality (0.959), excellent for subjective quality (0.993), and moderate for perceived impact (0.624). Cronbach α was good for objective quality (0.881), acceptable for subjective quality (0.701), and excellent for perceived impact (0.936). The paired t tests (2-tailed) demonstrated similar scores between the 2 assessments (P>.05), and the Pearson correlation coefficient indicated high consistency in each subscale, section, and item (r>0.76 and P<.001). The reliability and validity of the measures were similar to those found in the original English version as well as in the Spanish, Japanese, Italian, Greek, and Turkish versions that have already been translated and validated. The uMARS-F is a valid tool for end users to assess the quality of mHealth apps in French-speaking countries. The uMARS-F used in combination with the French version of the Mobile Application Rating Scale could enable health care professionals and public health authorities to identify reliable, high-quality, and valid apps for patients and should be part of French health care education programs.

Chinese Version of the Nonverbal Pain Assessment Tool: Critical Patient Reliability and Validity.

To translate and validate the Nonverbal Pain Assessment Tool. Timely assessment of the pain degree of nonverbal intensive care unit (ICU) patients can provide humanistic care. However, there is a lack of pain assessment tools that can meet the needs of patients who cannot use language in ICUs in China. A cross-sectional survey. We conducted forward-backward translation of the Nonverbal Pain Assessment Tool. A total of 300 critically ill patients in the intensive care unit who could not communicate verbally completed the Chinese version of the Nonverbal Pain Assessment Tool and the Critical Care Pain Observation Tool. Exploratory and confirmatory factor analyses were performed to verify structural validity, and content validity and reliability analyses were also conducted. The Nonverbal Pain Assessment Tool demonstrated high internal consistency (α = 0.901) and interrater reliability (intraclass correlation coefficient = 0.981), with good split-half reliability. Content validity was established through acceptable item-level content validity index and scale-level content validity index scores. Exploratory factor analysis showed a single factor explaining 71.79% of total variance, and confirmatory factor analysis confirmed good model fit. The Spearman rank correlation coefficient was 0.917 between the Nonverbal Pain Assessment Tool and the Critical Care Pain Observation Tool. The Chinese Nonverbal Pain Assessment Tool demonstrated significant differences in scores between different states of consciousness and illness severity, supporting its known-groups validity. The Chinese version of the Nonverbal Pain Assessment Tool is a reliable and valid tool for nonverbal pain assessment in ICU patients in China. The Chinese version of the Nonverbal Pain Assessment Tool can assess the pain of patients who cannot use language in ICU, which provides a new valuable assessment tool for Chinese clinicians and nurses in pain assessment and management. Our study followed the STROBE Checklists. Patients actively cooperated and participated in data collection during the implementation of the study.

Turkish adaptation of the antenatal risk questionnaire-revised: study of validity and reliability

ObjectiveThis study sought to translate the Antenatal Risk Questionnaire-Revised (ANRQ-R) into Turkish and evaluate its psychometric properties for assessing psychosocial vulnerabilities among Turkish-speaking pregnant women.MethodsThe ANRQ-R was translated into Turkish following standard linguistic adaptation procedures. Psychometric properties were then examined using a cross-sectional study design, involving 156 pregnant women recruited from antenatal clinics in Turkey. Participants completed the Turkish ANRQ-R and the Edinburgh Postnatal Depression Scale (EPDS). Statistical analyses, including intraclass correlation coefficients (ICC) for test-retest reliability, Pearson correlation analysis for item-total test correlations, and Receiver Operating Characteristic (ROC) analysis for diagnostic accuracy, were conducted.ResultsThe ANRQ-R Turkish version showed high test-retest reliability with an ICC of 0.888 for the total score. Moderate to good ICCs were obtained for individual Likert-type items (0.572–0.849). Criterion-related validity was established via moderate correlations with the EPDS and its anxiety subscale EPDS-3 A (r = 0.537 and r = 0.431, respectively). ROC analysis demonstrated good discriminatory power (Area Under the Curve = 0.75) with an optimal cut-off score of 17, yielding 78% sensitivity and 65% specificity for identifying potential depression cases.ConclusionsThis study provides preliminary evidence of the overall reliability of the Turkish version of the ANRQ-R as a measure of psychosocial risk among Turkish-speaking women during pregnancy. Despite some limitations in item-level internal consistency indicators, integration of the ANRQ-R into routine antenatal care could enhance early identification and intervention strategies, potentially improving maternal health outcomes. Future research should aim to further validate the scale across diverse populations and settings, using a diagnostic tool as the reference standard.

Deep learning super-resolution reconstruction for fast and high-quality cine cardiovascular magnetic resonance.

To compare standard-resolution balanced steady-state free precession (bSSFP) cine images with cine images acquired at low resolution but reconstructed with a deep learning (DL) super-resolution algorithm. Cine cardiovascular magnetic resonance (CMR) datasets (short-axis and 4-chamber views) were prospectively acquired in healthy volunteers and patients at normal (cineNR: 1.89 × 1.96 mm2, reconstructed at 1.04 × 1.04 mm2) and at a low-resolution (2.98 × 3.00 mm2, reconstructed at 1.04 × 1.04 mm2). Low-resolution images were reconstructed using compressed sensing DL denoising and resolution upscaling (cineDL). Left ventricular ejection fraction (LVEF), end-diastolic volume index (LVEDVi), and strain were assessed. Apparent signal-to-noise (aSNR) and contrast-to-noise ratios (aCNR) were calculated. Subjective image quality was assessed on a 5-point Likert scale. Student's paired t-test, Wilcoxon matched-pairs signed-rank-test, and intraclass correlation coefficient (ICC) were used for statistical analysis. Thirty participants were analyzed (37 ± 16 years; 20 healthy volunteers and 10 patients). Short-axis views whole-stack acquisition duration of cineDL was shorter than cineNR (57.5 ± 8.7 vs 98.7 ± 12.4 s; p < 0.0001). No differences were noted for: LVEF (59 ± 7 vs 59 ± 7%; ICC: 0.95 [95% confidence interval: 0.94, 0.99]; p = 0.17), LVEDVi (85.0 ± 13.5 vs 84.4 ± 13.7 mL/m2; ICC: 0.99 [0.98, 0.99]; p = 0.12), longitudinal strain (-19.5 ± 4.3 vs -19.8 ± 3.9%; ICC: 0.94 [0.88, 0.97]; p = 0.52), short-axis aSNR (81 ± 49 vs 69 ± 38; p = 0.32), aCNR (53 ± 31 vs 45 ± 27; p = 0.33), or subjective image quality (5.0 [IQR 4.9, 5.0] vs 5.0 [IQR 4.7, 5.0]; p = 0.99). Deep-learning reconstruction of cine images acquired at a lower spatial resolution led to a decrease in acquisition times of 42% with shorter breath-holds without affecting volumetric results or image quality. Question Cine CMR acquisitions are time-intensive and vulnerable to artifacts. Findings Low-resolution upscaled reconstructions using DL super-resolution decreased acquisition times by 35-42% without a significant difference in volumetric results or subjective image quality. Clinical relevance DL super-resolution reconstructions of bSSFP cine images acquired at a lower spatial resolution reduce acquisition times while preserving diagnostic accuracy, improving the clinical feasibility of cine imaging by decreasing breath hold duration.

Validity and reproducibility of a food frequency questionnaire to determine dietary intakes among Lebanese athletes.

Nutrition is a basic need for athletes; thus, adequate dietary intake is crucial for maintaining overall health, facilitating training adaptations and boosting athletic performance. Accurate dietary assessment tools are required to minimize the challenges faced by athletes. This study verifies the validity and reproducibility of a 157 item semi-quantitative food frequency questionnaire (FFQ) among Lebanese athletes. This is the only Arabic questionnaire in Lebanon that estimates food consumption for athletes which can also be used in Arabic speaking countries. There has been no previous validated food frequency questionnaire that estimated food consumption for athletes in Lebanon. A total of 194 athletes were included in the study to assess the validity of the food frequency questionnaire against four days dietary recalls by comparing the total nutrient intake values from the food frequency questionnaire with the mean values of four 24-hour dietary recalls using Spearman correlation coefficient and Bland Altman plots. In order to measure the reproducibility, the intra class correlation coefficients were calculated by repeating the same food frequency questionnaire after one month. The intra-class correlation coefficient between the two-food frequency questionnaires ranged from average (0.739 for carbohydrates) to good (0.870 for energy (Kcal)), to excellent (0.919 for proteins) concerning macronutrients and ranged from average (0.688 for vitamin D), to excellent (0.952 for vitamin B12), indicating an acceptable reproducibility. Spearman's correlation coefficients of dietary intake estimate from the food frequency questionnaire and the four dietary recalls varied between 0.304 for sodium, 0.469 for magnesium to 0.953 for caloric intake (kcal). Bland-Altman plots illustrated a percentage of agreement ranging between 94.3% for fats to 96.4% for proteins. This food frequency questionnaire has a reliable validity and reproducibility to evaluate dietary assessments and is an appropriate tool for future interventions to ensure the adoption of adequate eating strategies by athletes.

The mSQUASH is a feasible and valid measurement tool to uniformly assess daily physical activity in patients with rheumatic diseases

BackgroundThe modified Short QUestionnaire to ASsess Health-enhancing physical activity (mSQUASH) was originally developed and validated in Dutch patients with axial spondyloarthritis (axSpA). To support world-wide distribution, applicability and comparability of...

Responses of several measures to different intensity levels of upper limb exergames in children with neurological diagnoses: a pilot study

BackgroundTherapy intensity is among the most critical factors influencing neurorehabilitative outcomes. Because of its simplicity, time spent in therapy is the most commonly used measure of therapy intensity. However, time spent in therapy is only a vague estimate of how hard a patient works during therapy. Several measures have been proposed to better capture the amount of work a patient puts forth during therapy. Still, it has never been analyzed how these measures respond to changes in therapist-selected exercise intensity in children with neurological conditions.ObjectivesTo investigate the response and the reliability of heart rate variability (HRV), skin conductance (SC), activity counts per minute (AC/min), movement repetitions per minute (MOV/min), and perceived exertion to different therapist-tailored intensity levels of upper limb technology-assisted therapy in children with neurological conditions.MethodsIn this pilot cross-sectional study, participants engaged in three personalized, randomized exergame intensity levels (“very easy”, “challenging”, “very difficult”) for eight minutes each. We assessed all measures at each intensity level. The experiment was conducted twice on two consecutive days. We quantified reliability using intra-class correlation coefficients (ICC).ResultsWe included 12 children and adolescents aged 11.92 (±3.03) years. HRV, MOV/min, and perceived exertion could differentiate among the three intensity levels. HRV, MOV/min, perceived exertion, and AC/min showed moderate to excellent (0.62 ≤ ICC ≤ 0.98) test-retest reliability.ConclusionHRV, MOV/min, and perceived exertion show potential for becoming valid and reliable intensity measures for an upper limb robotic rehabilitative setting. However, studies with larger sample sizes and more standardized approaches are needed to understand these measures’ responses better.

Anatomical landmark detection on bi-planar radiographs for predicting spinopelvic parameters.

Accurate landmark detection is essential for precise analysis of anatomical structures, supporting diagnosis, treatment planning, and monitoring in patients with spinal deformities. Conventional methods rely on laborious landmark identification by medical experts, which motivates automation. The proposed deep learning pipeline processes bi-planar radiographs to determine spinopelvic parameters and Cobb angles without manual supervision. The dataset used for training and evaluation consisted of 555 bi-planar radiographs from un-instrumented patients, which were manually annotated by medical professionals. The pipeline performed a pre-processing step to determine regions of interest, including the cervical spine, thoracolumbar spine, sacrum, and pelvis. For each ROI, a segmentation network was trained to identify vertebral bodies and pelvic landmarks. The U-Net architecture was trained on 455 bi-planar radiographs using binary cross-entropy loss. The post-processing algorithm determined spinal alignment and angular parameters based on the segmentation output. We evaluated the pipeline on a test set of 100 previously unseen bi-planar radiographs, using the mean absolute difference between annotated and predicted landmarks as the performance metric. The spinopelvic parameter predictions of the pipeline were compared to the measurements of two experienced medical professionals using intraclass correlation coefficient(ICC) and mean absolute deviation (MAD). The pipeline was able to successfully predict the Cobb angles in 61% of all test cases and achieved mean absolute differences of 3.3° (3.6°) and averaged ICC of 0.88. For thoracic kyphosis, lumbar lordosis, sagittal vertical axis, sacral slope, pelvic tilt, and pelvic incidence, the pipeline produced reasonable outputs in 69%, 58%, 86%, 85%, 84%, and 84% of the cases. The MAD was 5.6° (7.8°), 4.7° (4.3°), 2.8mm (3.0mm), 4.5° (7.2°), 1.8° (1.8°), and 5.3° (7.7°), while the ICC was measured at 0.69, 0.82, 0.99, 0.61, 0.96, and 0.70, respectively. Despite limitations in patients with severe pathologies and high BMI, the pipeline automatically predicted coronal and sagittal spinopelvic parameters, which has the potential to simplify clinical routines and large-scale retrospective data analysis.

Automated deep learning-based bone mineral density assessment for opportunistic osteoporosis screening using various CT protocols with multi-vendor scanners

This retrospective study examined the diagnostic efficacy of automated deep learning-based bone mineral density (DL-BMD) measurements for osteoporosis screening using 422 CT datasets from four vendors in two medical centers, encompassing 159 chest, 156 abdominal, and 107 lumbar spine datasets. DL-BMD values on L1 and L2 vertebral bodies were compared with manual BMD (m-BMD) measurements using Pearson’s correlation and intraclass correlation coefficients. Strong agreement was found between m-BMD and DL-BMD in total CT scans (r = 0.953, p < 0.001). The diagnostic performance of DL-BMD was assessed using receiver operating characteristic analysis for osteoporosis and low BMD by dual-energy x-ray absorptiometry (DXA) and m-BMD. Compared to DXA, DL-BMD demonstrated an AUC of 0.790 (95% CI 0.733–0.839) for low BMD and 0.769 (95% CI 0.710–0.820) for osteoporosis, with sensitivity, specificity, and accuracy of 80.8% (95% CI 74.2–86.3%), 56.3% (95% CI 43.4–68.6%), and 74.3% (95% CI 68.3–79.7%) for low BMD and 65.4% (95% CI 50.9–78.0%), 70.9% (95% CI 63.8–77.3%), and 69.7% (95% CI 63.5–75.4%) for osteoporosis, respectively. Compared to m-BMD, DL-BMD showed an AUC of 0.983 (95% CI 0.973–0.993) for low BMD and 0.972 (95% CI 0.958–0.987) for osteoporosis, with sensitivity, specificity, and accuracy of 97.3% (95% CI 94.5–98.9%), 85.2% (95% CI 78.8–90.3%), and 92.7% (95% CI 89.7–95.0%) for low BMD and 94.4% (95% CI 88.3–97.9%), 89.5% (95% CI 85.6–92.7%), and 90.8% (95% CI 87.6–93.4%) for osteoporosis, respectively. The DL-based method can provide accurate and reliable BMD assessments across diverse CT protocols and scanners.