Kappa Analysis Research Articles

Health and Social Problems of Refugee Women and Their Children: A Qualitative Case Study.

We intend to examine the health and social problems of refugee women and their children in this research. A qualitative case study. We conducted this study between December 2022 and January 2023 with 19 refugee women aged 18-49 years. We used the snowball sampling method for data collection, and individual in-depth interviews were conducted. We completely transcribed the interviews and then main themes and sub-themes were created. To ensure reliability, two independent external coders were asked to code the themes and sub-themes, and Kappa analysis was performed according to the results. We found the Kappa analysis value as 0.87. After the analysis of the study data, we conducted the thematic content analysis on the Nvivo 10 software. We emerged the main themes following the qualitative data analysis were (1) experiences during migration, (2) communication while receiving health services, (3) childhood immunization status, (4) deciding to have a child, (5) deciding on the number of children, (6) use of family planning methods, and (7) the person with priority in the family. This research indicated that childhood immunization in refugee children was inadequate, refugee women did not know about family planning methods, and even if they did, they did not use these methods because they wanted to have many children.

Field study on the suitability of oral fluid samples for monitoring of Lawsonia intracellularis and Brachyspira hyodysenteriae by multiplex qPCR under field conditions

BackgroundMonitoring or surveillance of infectious diseases is crucial in terms of herd health management of livestock. Investigations of oral fluids have become an animal friendly routine strategy to monitor respiratory pathogens in pigs. Less is known about the suitability of oral fluids for the detection of enteric pathogens in swine. In the present study we evaluated the use of oral fluids to monitor B. hyodysenteriae and L. intracellularis compared to pooled fecal samples by multiplex qPCR in a pen-wise follow-up of fattening pigs. Therefore, we collected oral fluids at an age of 12, 16 and 20 weeks of life and compared them to pooled fecal samples collected from the same pens on two fattening farms.ResultsCohen´s Kappa analysis revealed a substantial agreement between oral fluids and pooled fecal samples on pen level (Cohen´s Kappa: 0.745; p < 0.001). DNA-loads of L. intracellularis were tendentially higher (p = 0.053) in pooled fecal samples than in the corresponding OFs.ConclusionsThe present study shows that oral fluids are an appropriate tool to monitor B. hyodysenteriae and L. intracellularis on conventional fattening farms under field conditions. However, multiple pen testing should be conducted to increase the diagnostic performance and sensitivity.

Relative validity and reproducibility of a short semi-quantitative food frequency questionnaire for Chinese athletes.

A convenient but efficient tool for evaluating dietary intakes in Chinese professional athletes has yet to be established. The aim of this study was to assess the validity of a short semi-quantitative food frequency questionnaire (FFQ) through comparison with 3-day weighed food records (3DWFRs) and corresponding serum biomarkers from a cohort of 102 professional athletes, while also evaluating its reproducibility. The relative validity was assessed using Spearman correlation coefficients, cross-quintiles classification, weighted kappa, and Bland-Altman analysis, while reproducibility was evaluated using the Spearman correlation coefficients and intraclass correlation coefficient (ICC) between two FFQs. The results showed the median (range) crude correlation coefficients (CCs) between the first FFQ and 3DWFRs for energy and nutrients, and the food groups were 0.331 (0.219 to 0.568) and 0.292 (-0.035 to 0.455), respectively. Omega-3 polyunsaturated fatty acid (EPA, DHA, and EPA+DHA) intake estimated from the FFQ significantly correlated with corresponding serum biomarkers, with CCs ranging from 0.389 to 0.520. Weighted kappa statistics, indicating acceptable consistency (> 0.2) for most items, varied from -0.076 to 0.581, except for vitamin C, vegetables, and oils. Misclassification of nutrients and food groups into extreme quartiles was rare, with a median misclassification rate of 2% (ranging from 1% to 12%) and 3% (ranging 0 to 10%), respectively. Bland-Altman analysis revealed good agreement between FFQ and 3DWFRs, with over 90% of data points falling within the limits of agreement (LOA) for all assessed nutrients and food groups. In the reproducibility analysis, the median (range) crude CC and ICC for energy and nutrients were 0.574 (0.423 to 0.643) and 0.668 (0.558 to 0.763), respectively, while for food groups, they were 0.681 (0.242 to 0.764) and 0.640 (0.371 to 0.787), respectively. In conclusion, the short FFQ demonstrated acceptable relative validity and reproducibility for most nutrients and food groups, suggesting its potential as a valuable tool for assessing dietary intake and nutrition status among young Chinese athletes.

Unlocking the multidimensionality of plantar pressure measurements for the evaluation of footwear in people with diabetes.

The offloading effectiveness of custom-made footwear for people with diabetes is assessed using plantar pressure measurements. While such pressure data is multidimensional, it is mostly analyzed using a scalar - maximum peak plantar pressure (PMax). We aimed to investigate the associations between multiple peak plantar pressure parameters for footwear assessment and determine whether this assessment depends on the chosen parameter. In-shoe plantar pressure was measured in 77 participants with diabetes, peripheral neuropathy, and a recent ulcer or amputation history, while walking in their own custom-made footwear. Six peak plantar pressure parameters were extracted, both scalar (i.e. Pmax, time integral and gradient) and multidimensional (i.e. time curve, map and time map). Footwear was ranked from highest to lowest outcome for each parameter and associations with Pmax were compared using Spearman's rank correlation coefficient. A footwear comparison within subjects using Fleiss' Kappa analysis determined the agreement between parameters using two pairs of footwear of each participant. The rank correlation coefficient was moderate to strong between PMax and the other scalar parameters (ρ=0.46-0.70), and negligible to weak between PMax and the multidimensional parameters (ρ=0.03-0.25). Percentage agreement between parameters for the within-subject footwear comparison was poor (47.5%, κ=0.0652). We conclude that the association and agreement between in-shoe peak pressure parameters is low and the assessment of offloading effectiveness depends on the chosen parameter. This is the first step in unlocking the potential of a multidimensional approach in plantar pressure analysis, possibly changing how we evaluate footwear offloading effectiveness.

Evaluation of Analytical Performance of Rapid Diagnostic Test Kits for Blood Groupings

Purpose: This study aimed to determine the analytical performance of ABO and Rh D rapid diagnostic test kits as a substitute for the conventional tube method. Design/Methodology/Approach: 161 participants who visited the Koforidua Technical University Clinic Laboratory were recruited from August to September 2022. The rapid diagnostic ABO and Rh D test kits were used to determine the ABO and Rh D blood groups of the study participants. The concordance rate, kappa analysis and Receiver Operating Characteristics (ROC) were performed. Findings: The strength of agreement of the two diagnostic methods in detecting ABO and Rh D blood type using Kappa analyses was excellent (k꞊1.00; standard error꞊0.00; P-value=0.001). All diagnostic performance statistics of the RDT were not different from the tube method being the standard. Research Limitation: This research focused on the analytical performance of the rapid test kits but not on different brands of the test kits for their comparative studies. Practical Implication: This paper could potentially ensure reliable results, facilitate certification, and enable test kits to be accepted in the market. Social Implication: This study will assist policy-makers in increasing access to healthcare to enable testing in resource-limited settings and improving health outcomes as timely diagnosis and management facilitate better patient outcomes. Originality/ Value: This study is based on providing reliable information on portable and point-of-care diagnostic testing outside conventional laboratory settings for timely diagnosis.

Detection of a novel DNA methylation marker panel for esophageal cancer diagnosis using circulating tumor DNA

BackgroundEsophageal cancer (ECa) is one of the most deadly cancers, with increasing incidence worldwide and poor prognosis. While endoscopy is recommended for the detection of ECa in high-risk individuals, it is not suitable for large-scale screening due to its invasiveness and inconvenience.MethodsIn this study, a novel gene methylation panel was developed for a blood-based test, and its diagnostic efficacy was evaluated using a cohort of 304 participants (203 cases, 101 controls). The assessment focused on the DNA methylation levels of SEPTIN9, tissue factor pathway inhibitor 2 (TFPI2), and the fragile histidine triad gene (FHIT) in patients with ECa, benign esophageal disease, and healthy controls. The receiver operating characteristic (ROC) curve was generated for the panel to calculate the area under the curve (AUC), sensitivity, specificity, and 95% confidence intervals (CIs), along with a comparison to the gold standard of pathological examination. The consistency between biomarker and pathological diagnosis was evaluated with kappa analysis conducted with IBM SPSS Statistics. The Chi-square test or Fisher’s exact test was utilized to assess the association of test positivity with demographic characteristics.ResultsIn patients with ECa, SEPTIN9, TFPI2, and FHIT DNA methylation levels were significantly higher compared to those with benign esophageal disease or healthy controls. The panel demonstrated promising potential as a noninvasive tool for distinguishing malignant tumors from both healthy controls and benign esophageal diseases, achieving an area under the ROC curve of 0.925 (95% CI: 0.889–0.952), with a sensitivity of 79.8% [95% CI 73.6—85.1%] and specificity of 95.0% [95% CI 88.8—98.4%]. In particular, the panel showed exceptional diagnostic efficiency for stage 0, I, and II cancer patients with sensitivity at 69.0, 75.5%, and 78.9%, respectively. The comparison revealed a Kappa value of 0.725 between RT-PCR testing and the established gold standard of pathological examination, indicating a high level of consistency. Additionally, there was no bias in diagnostic efficiency based on age, gender, or the presence of other malignancies (non-esophageal cancers).ConclusionsThe study’s findings suggested that the DNA methylation biomarkers panel holds promise as a non-invasive and convenient diagnostic test for ECa. The panel’s ability to distinguish malignant tumors from benign esophageal diseases, coupled with its high sensitivity and specificity, presented opportunities to enhance the over-all diagnosis of high-risk population when in conjunction with existing detection methods.

Evaluation of Common Diagnostic Errors in Panoramic Radiographs and Interobserver Agreement in Error Identification

Aim: Panoramic radiography is frequently used in dental practice as an imaging technique that provides an extensive view of facial anatomical structures. Achieving high-quality radiographic images requires precise positioning and technique. This study aims to evaluate the quality of panoramic radiographs, to identify common errors that compromise diagnostic adequacy, and to analyze interobserver agreement levels concerning these errors. Material and Method: A study analyzed 947 panoramic radiographs from the archive of Ordu University based on nine specific error criteria. Four research assistants evaluated the diagnostic quality of each image, classifying them as “excellent,” “diagnostically acceptable,” or “unacceptable.” Inter-observer agreement was measured with kappa statistics, and overall agreement was evaluated using the Fleiss κ test. Results: The rate of incorrect radiographs was 66.1% to 78.8%, with the most common error criterion differing for each observer. The least common error was the chin tipped too low for observers 1 and 2, and the patient positioned forward for observers 3 and 4. The highest inter-observer agreement was observed regarding the presence of foreign objects on the radiographs, while the lowest agreement occurred in cases where the patient was positioned too far back. Overall, the diagnostic quality of the panoramic radiographs was rated as “acceptable,” with scores ranging from 60.5% to 69.5%. The Fleiss Kappa analysis indicated fair agreement among the four observers in assessing radiographic quality (k=0.252). Conclusion: This study demonstrates that errors in panoramic radiography significantly impact image quality and diagnostic accuracy, highlighting the need for standardization, the use of various imaging models, and enhanced training in radiographic education.

Prevalence of Mandibular Third Molar Impaction Cases on Panoramic Radiographs in 2022

Introduction: Tooth impaction is a condition when a tooth does not erupt, either partially or completely after the normal eruption time has passed. Mandibular third molars are one of the teeth most frequently impacted. Impacted third molars are classified according to Pell-Gregory and George Winter. Previous studies state that gender and age can influence impacted mandibular third molars. This study aims to determine the prevalence of cases of impacted mandibular third molars at the Dental and Oral Hospital of South Sumatra Province in 2022. Methods: This type of study is descriptive observational using 327 of the total population of 709 patient panoramic radiographs in 2022, and identified directly to see impacted mandibular third molars. Reliability testing was carried out using Cohen's Kappa analysis. Results: Evaluation of 327 panoramic radiographs containing impacted mandibular third molars showed that the most common age category was 16-25 years with 229 cases (70.03), based on gender, female 193 cases (59.03%) and male 134 cases (40.97%). Based on the Winter classification, mandibular impaction is most found in the mesioangular position in tooth 38 (55.97%), tooth 48 (49.65%). Based on the Pell and Gregory classification, most mandibular impactions are found in position II A in tooth 38 (42.66%), 48 (44.70%). Conclusion: The prevalence of cases of mandibular third molar impaction at the Dental and Oral Hospital of Sumatra Province was 46,12%, most commonly found in the 16-25 year age category,more frequently in women, and the position was mostly in the mesioangular category and position IIA. Keywords: Impaction, mandibular third molar, panoramic.

Accuracy of O-RADS System in Differentiating Between Benign and Malignant Adnexal Masses Assessed via External Validation by Inexperienced Gynecologists.

Objective: To evaluate the accuracy of the O-RADS system in differentiating between benign and malignant adnexal masses, as assessed by inexperienced gynecologists. Methods: Ten gynecologic residents attended a 20 h training course on the O-RADS system conducted by experienced examiners. Following the training, the residents performed ultrasound examinations on patients admitted with adnexal masses under supervision, recording the data in a database that included videos and still images. The senior author later accessed this ultrasound database and presented the cases offline to ten residents for O-RADS rating, with the raters being blinded to the final diagnosis. The efficacy of the O-RADS system by the residents and inter-observer variability were assessed. Results: A total of 201 adnexal masses meeting the inclusion criteria were evaluated, consisting of 136 (67.7%) benign masses and 65 (32.3%) malignant masses. The diagnostic performance of the O-RADS system showed a sensitivity of 90.8% (95% CI: 82.2-96.2%) and a specificity of 86.8% (95% CI: 80.4-91.8%). Inter-observer variability in scoring was analyzed using multi-rater Fleiss Kappa analysis, yielding Kappa indices of 0.642 (95% CI: 0.641-0.643). The false positive rate was primarily due to the misclassification of solid components in classic benign masses as O-RADS-4 or O-RADS-5. Conclusions: The O-RADS system demonstrates high diagnostic performance in distinguishing benign from malignant adnexal masses, even when used by inexperienced examiners. However, the false positive rate remains relatively high, mainly due to the over-interpretation of solid-appearing components in classic benign lesions. Despite this, inter-observer variability among non-expert raters was substantial. Incorporating O-RADS system training into residency programs is beneficial for inexperienced practitioners. This study could be an educational model for gynecologic residency training for other systems of sonographic features.

Health-related quality of life and symptom concordance between patients and physicians in pulmonary arterial hypertension in the United States, Europe, and Japan

This study involved analysis of a real world, cross-sectional survey of physicians and their patients with pulmonary arterial hypertension (PAH). Physician and patient symptom concordance was assessed and patients self-reported Health-Related Quality of Life (HRQoL). Data were drawn from the Adelphi PAH Disease Specific Programme (DSP)™ in the United States, France, Germany, Italy, Spain, United Kingdom, and Japan, between March and August 2022. EQ-5D 5L utility, EQ-5D Visual Analogue Scale (VAS) scores, and emPHasis-10 (e10) HRQoL scores were reported by patients and physician-patient symptom concordance which was assessed with Cohen’s Weighted Kappa (κ) analysis. Of 628 PAH patients, the mean (SD) EQ-5D VAS and e10 scores were 66 (17) and 23 (11). Data was stratified by World Health Organization Functional Class (WHO-FC). As WHO-FC increased, EQ-5D utility and VAS scores decreased and e10 scores increased, indicating poorer patient-reported HRQoL. Symptom concordance varied, ranging from κ = 0.11 - 0.57 (slight-moderate agreement), and physicians frequently underestimated the presence and severity of patient-reported symptoms. Future research should aim to bridge this gap between patient and physician understanding of HRQoL and the symptom burden associated with PAH.

Redefining cardiovascular risk evaluation: employing the CaRi-Heart validated FAI-score in patients screened with SCORE2 and CAD-RADS 2.0 techniques

Abstract Background Cardiac computed tomography (CCT) has confirmed the fat attenuation index (FAI) as a trustworthy marker for coronary inflammation, notably in relation to plaque vulnerability and progression. The systematic coronary risk evaluation 2 (SCORE2) is a valuable instrument for forecasting the 10-year likelihood of initial cardiovascular disease (CVD) occurrence. This study aims to determine risk re-categorization using CaRi-Heart in comparison to SCORE2 and the coronary artery disease-reporting and data system (CAD-RADS 1.0/2.0). Methods We enrolled patients (INTEL-FAT study) undergoing CCT, who were aged 40-69 years and had no previous history of CVD or diabetes. SCORE2 classified very-high-risk regions as follows: low-moderate risk as &amp;lt;2.5% (&amp;lt;50 years) and &amp;lt;5% (50-69 years), high risk as 2.5 to &amp;lt;7.5% (&amp;lt;50 years) and 5 to &amp;lt;10% (50-69 years), and very-high risk as ≥7.5% (&amp;lt;50 years) and ≥10% (50-69 years). The CaRi-Heart risk assessment categorized low risk as FAI-score ≤75th percentile for the LAD or RCA and &amp;lt;95th percentile for the LCX; medium risk as falling between the 76th and 89th percentiles for LAD/RCA and ≥95th percentile for LCX; and high risk as ≥90th percentile for LAD/RCA. Results 203 patients were included, with a mean age of 58.7 ± 6.78; 143 (70.44%) were male. CaRi-Heart assessment redefined 71.13% (69/97) of individuals from high to low SCORE2 risk, and 40.0% (8/30) from low-moderate to high SCORE2 risk. The weighted Cohen's kappa analysis revealed minimal concordance between SCORE2 and CaRi-Heart (k=-0.043). 19.71% of patients categorized as CAD-RADS 1 in CCT were reassigned to high risk after CaRi-Heart evaluation, and 26.66% of those classified as CAD-RADS 4 were downgraded to low risk. Furthermore, of the CAD-RADS 1 P1/P2 group, 15.38% and of the P3/P4 group, 66.66% were upgraded to high risk. Conversely, 45.45% of CAD-RADS 4 P1/P2 and 15.78% of P3/P4 were reassigned to low CaRi-Heart risk. The Cohen's kappa analysis comparing CAD-RADS 1.0 and 2.0 with CaRi-Heart risk revealed a low concordance (k=0.067 and k=0.014). In comparing SCORE2 risk categories to CAD-RADS classifications, a significant association was found for low-moderate SCORE2 with CAD-RADS 2 (diagnostic odds ratio [DOR] of 11.26; 95% CI: 4.37-29.00; p&amp;lt;0.001), and for high SCORE2 with CAD-RADS 4 (DOR: 0.085; 95% CI: 0.036-0.20; p&amp;lt;0.001), indicating a strong predictive value of the SCORE2 system for certain CAD-RADS classifications. Conclusions The CaRi-Heart method significantly alters risk classifications in comparison to the SCORE2 risk assessment models or the anatomical CAD-RADS 1.0 and 2.0 diagnostic instruments. These results indicate the importance of integrating established scoring systems with additional markers, such as the FAI-score. This integration offers critical understanding into the severity and future course of CAD, assisting in risk stratification and informing therapeutic choices.SCORE2, CAD-RADS and CaRi-Heart risk.Interpretation of the CaRi-Heart® risk.

Validation of a hand-held ultrasound device in the evaluation of aortic stenosis

Abstract Introduction Hand-held Ultrasound devices (HHUD) are increasingly used in routine clinical practice, although until recently they did not have continuous Doppler. There is no evidence on the usefulness of an HHUD for the assessment of aortic stenosis (AS) in real life. Objective To validate the use of a new HHUD device in a real-life scenario. Material and methods Observational, single-center and prospective study, including patients diagnosed with AS with a previous standard echocardiography. Patients were randomly recruited from a tertiary cardiac imaging laboratory. Immediately after the reference echocardiography performed by an imaging expert, a Cardiology trainee with ASE level II repeated the study blindly with an HHUD. Agreement between the two tests was evaluated by measuring the mean aortic valve gradient (mAG). An intraclass correlation coefficient (ICC) test, linear regression, and Bland-Altman test were performed to compare the two methods. Results 101 patients were recruited. The reference test calculated a mAG of 29 mmHg (19.8 - 42.2) versus a mAG of 27.2 mmHg (16.2 - 43.9) in HHUD. The statistical analysis showed a good correlation between both tests (ICC: 0.87 (95% CI: 0.79 -0.94) and r=0.89 (95% CI: 0.85-0.94) (Figure). The Bland-Altman test showed a non-significant underestimation (1.61 ± 0.9 mmHg; p= 0.09). The HHUD classified 29 cases as severe or major AS compared to 31 in the reference test (kappa= 0.81; 95% CI: 0.68 - 0.94). The HHUD showed an excellent agreement for classification of AS in at least severe AS grade. The kappa analysis had a value of 0.81 (95% CI 0.68 – 0.94) with a global agreement of 92.1%. The positive predictive value was 89.6%. The negative predictive value was 93.1%. Sensitivity and specificity were 83.8% and 95.7%. The rest of the variables evaluated showed poorer agreement. In those patients with obesity, worse acoustic window, atrial fibrillation and critical AS, the agreement was worse. Conclusions The new HHUD evaluated by an operator with limited experience showed good agreement with the reference echocardiographic device in determining the mean aortic gradient.Central picture

Automated AI-based coronary calcium scoring using retrospective CT data from SCAPIS is accurate and correlates with expert scoring.

Evaluation of the correlation and agreement between AI and semi-automatic evaluations of calcium scoring CT (CSCT) examinations using extensive data from the Swedish CardioPulmonary bio-Image study (SCAPIS). In total, 5057 CSCT examinations were performed on one CT system at Linköping University Hospital between October 8, 2015, and June 12, 2018. AI evaluations were compared to semi-automatic CSCT results from expert reader evaluations rendered within SCAPIS. Pearson correlation, intraclass correlation coefficients (ICC), and Bland-Altman analysis were applied for Agatston (AS), volume (VS), mass scores (MS), number of lesions and lesion location. Agreement of Agatston score classifications into cardiovascular (CV) risk categories was evaluated with weighted kappa analysis. The evaluation included 4567 subjects, 2229 (48.8%) male, 2338 (51.2%) female, 50-64 years of age (mean 57.3 ± 4.4). The AS ranged from 0 to 2871 in the cohort, with 2846 subjects having an AS of 0. Mean and median AS were 51.4 and 0.0, respectively. Total AS, VS, MS and number of lesions ICCs were 0.994, 0.994, 0.994, 0.960 (p < 0.001), respectively. Bland-Altman analyses rendered mean differences ± 1.96 SD upper and lower limits of agreement for AS -0.04, -52.5 to 52.4, VS -0.44, -46.51 to 45.63, and MS -0.07, -9.62 to 9.48. Weighted kappa analysis for CV risk category classifications was 0.913, and overall accuracy was 91.2%. There was excellent correlation and agreement between AI and semi-automatic evaluations for all calcium scores, number of lesions and lesion location. High degrees of agreement and accuracy were found for the CV risk categorization. Question Can AI function as a tool for enhancing the efficiency and accuracy of Coronary Artery Calcium Score (CACS) evaluations in clinical radiology practice? Findings This study confirms the robustness of AI-derived CACS results across extensive datasets, though its generalizability is limited by data acquisition from a single CT system. Clinical relevance This study suggests that AI holds significant promise as a tool for enhancing the efficiency and accuracy of CACS evaluations, with implications for improving patient diagnostics and reducing radiologist workload in clinical practice.

Postmastectomy Breast Reconstruction in Irradiated Patients: A 12-year follow-up of Deep Inferior Epigastric Perforator and Latissimus Dorsi Flap Outcomes

The aim of the current study was to conduct a 12-year follow-up on the authors´ previously evaluated group of irradiated patients who underwent postmastectomy breast reconstruction with deep inferior epigastric perforator (DIEP) and latissimus dorsi (LD)-flaps with implant.The follow-up involved 67% of the patients from the original cohort (17 DIEP and 13 LD). Patient-reported outcome measures (PROMS) were measured using the BREAST-Q, SF-36, a satisfaction form, and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaires. Aesthetics were evaluated by a board of independent plastic surgeons.The average follow-up time was 12.6 years (DIEP) and 11.8 years (LD). Contralateral symmetry procedures were performed on 15 DIEP and 9 LD patients. Both groups underwent an average of 2.5 reconstructive procedures. The BREAST-Q and satisfaction questionnaires showed no group difference. SF-36 showed no group difference but had significantly higher values in both groups compared to the general population with regard to the physical role limitations (p=0.034 and p=0.004, respectively). The DASH scores showed minimal shoulder function impact in the LD group.Aesthetic evaluations revealed a discrepancy between the opinions of the patients and surgeons, with patients valuing the size (p=0.015) and overall aesthetic (p=0.012) of the reconstructed breast higher in the DIEP group. The weighted kappa analysis showed poor agreement between patients and surgeons. Over time, the patients´ preferences shifted from LD to DIEP flaps, possibly due to the more natural aging process associated with autologous reconstruction. This underscores the importance of long term follow-up studies.

ELISA genotyping of hepatitis B virus in China with antibodies specific for genotypes B and C

Hepatitis B virus (HBV) causes hepatitis B (HB) and distinct HBV genotypes can lead to different prognoses. However, HBV genotyping is rarely done in clinics, because the traditional method by PCR-based DNA sequencing is impractical for clinical diagnosis with tedious process and low success rate. Herein, we have established an ELISA-based genotyping method to quickly determine the HBV genotypes of HB patients in China. First, two commercial antibodies, 16D12 and 6H3 specific for HBV genotypes B and C respectively, are chosen as capture antibodies, since these two genotypes dominate in China. Then two home-made genotype-specific antibodies, B19 and C04, are used as the detection antibodies for genotypes B and C in sandwiched ELISA. The ELISA kit shows high sensitivity (> 95%) and specificity (> 95%) in detecting genotypes B and C of Chinese HB patients. Moreover, the ELISA kit has demonstrated higher success rate (98.7%) than PCR-based DNA sequencing (93.5%) and a commercial PCR-based genotyping kit (92.2%) for sera with HBV DNA ≥ 1000 IU/mL and HBsAg ≥ 250 IU/mL. Such an advantage is more obvious for the sera with HBV DNA < 1000 IU/mL. The kappa analysis between the ELISA and PCR-based DNA sequencing results exhibits a kappa of 0.836, indicating a good correlation.

Pilot study for the development of an automatically generated and wearable-based early warning system for the detection of deterioration of hospitalized patients of an acute care hospital.

Acute deteriorations of health status are common in hospitalized patients and are often preceded by changes in their vital signs. Events such as heart attacks, death or admission to the intensive care unit can be averted by early detection, therefore so-called Early Warning Scores (EWS) such as the National Early Warning Score 2 (NEWS2), including basic vital parameters such as heart rate, blood pressure, respiratory rate, temperature and level of consciousness, have been developed for a systematic approach. Although studies have shown that EWS have a positive impact on patient outcomes, they are often limited by issues such as calculation errors, time constraints, and a shortage of human resources. Therefore, development of tools for automatic calculation of EWS could help improve quality of EWS calculation and may improve patient outcomes. The aim of this study is to analyze the feasibility of wearable devices for the automatic calculation of NEWS2 compared to conventional calculation using vital signs measured by health care professionals. We conducted a prospective trial at a large tertiary hospital in Switzerland. Patients were given a wristband with a photoplethysmogram (PPG) sensor that continuously recorded their heart rate and respiratory rate for 3 consecutive days. Combined with data from the electronic health record (EHR), NEWS2-score was calculated and compared to NEWS2 score calculated from vital parameters in the EHR measured by medical staff. The main objective of our study was to assess the agreement between NEWS2 scores calculated using both methods. This analysis was conducted using Cohen's Kappa and Bland-Altman analysis. Secondary endpoints were compliance concerning the medical device, patient acceptance, data quality analysis and data availability and signal quality for all time stamps needed for accurate calculation. Of 210 patients enrolled in our study, NEWS2 was calculated in 904 cases, with 191 cases being directly compared to conventional measurements. Thirty-three of these measurements resulted in a NEWS2 ≥ 5, 158 in a NEWS2 < 5. Comparing all 191 measurements, accordance was substantial (K = 0.76) between conventional and automated NEWS2. No adverse effects due to the device were recorded. Patient acceptance was high. In conclusion, the study found strong agreement between automated and conventional NEWS2 calculations using wearable devices, with high patient acceptance despite some data quality challenges. To maximize the potential of continuous monitoring, further research into fully automated EWS calculations without relying on spot measurements is suggested, as this could provide a reliable alternative to traditional methods. January 26, 2023, NCT05699967.

Visual assessment and quantitative analysis of dual-energy CT virtual non-calcium in imaging diagnosis of multiple myeloma.

To evaluate the reliability and diagnostic performance of dual-energy CT virtual non-calcium imaging in diagnosing bone marrow infiltration in multiple myeloma. Seventy-two patients with multiple myeloma and ten controls were recruited. Patients received dual-energy CT and MRI while controls underwent dual-energy CT only, covering the cervical, thoracic, and lumbar spine and the pelvis. Virtual non-calcium images were compared with magnetic resonance images for confirmation and pattern classification. Fleiss Kappa analysis assessed consistency between virtual non-calcium and MRI classifications. Inter-observer agreement for virtual non-calcium and CT attenuation values was evaluated using Bland-Altman analysis. Diagnostic performances across various sites were evaluated using analysis of variance and receiver operating characteristic curve analysis. Dual-energy CT achieved higher consistency in classifying bone marrow infiltration in multiple myeloma than did MRI (kappa = 0.944). In the overall analysis, the mean virtual non-calcium attenuation values in the bone marrow infiltration group (- 28.3 HU; 95% confidence interval (CI), - 32.1, - 24.6) were higher than those in the non-bone marrow infiltration (- 97.5 HU; 95% CI, - 104.7, - 90.3) and control (- 89.1 HU; 95% CI, - 95.1, - 83.1; F = 172.027, P < 0.001) groups. The optimal cutoff values for virtual non-calcium attenuation varied across the overall (- 42.2 HU), cervical spine (- 21.9 HU), thoracic spine (- 42.8 HU), lumbar spine (- 56.9 HU), and pelvis (- 66.3 HU). Dual-energy CT virtual non-calcium imaging and MRI exhibited good consistency in categorising bone marrow infiltration patterns in multiple myeloma. Different virtual non-calcium attenuation value cutoffs should be used to diagnose bone marrow infiltration in various body regions.

The correlation of neurosurgery motor examinations with ISNCSCI motor examinations in patients with spinal cord injury: a multicenter TRACK-SCI study.

The International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) assessment is the gold standard for evaluation of neurological function after spinal cord injury (SCI). Although it is an invaluable tool for diagnostic and research purposes, it is time consuming and can be impractical in acute injury settings. Clinical neurosurgery motor examinations (NMEs) could serve as an expeditious surrogate for SCI research when ISNCSCI motor examinations are not feasible. The aim of this study was to evaluate the agreement between motor examinations performed by the neurosurgery clinical team and ISNCSCI examiners. The multicenter prospective Transforming Research and Clinical Knowledge in Spinal Cord Injury (TRACK-SCI) registry was queried to identify patients with recorded neurosurgery and research motor examinations within 24 hours of each other. Pearson correlations and modified Bland-Altman analyses were performed using data from matching upper-extremity, lower-extremity, and combined examinations. Kappa analysis was used to test interrater reliability with respect to determination of American Spinal Injury Association Impairment Scale (AIS) grade. There were 72 pairs of matching clinical and research examinations in 63 patients. NME scores were strongly correlated with ISNCSCI motor scores (R = 0.962, p < 0.001). Both upper- and lower-extremity NME scores were strongly correlated with upper- and lower-extremity ISNCSCI motor scores, respectively (R = 0.939, p < 0.001; and R = 0.959, p < 0.001, respectively). In modified Bland-Altman analyses, total, upper-extremity, and lower-extremity NME scores and ISNCSCI motor scores showed low systematic bias and high agreeability (total: bias = 0.3, limit of agreement [LoA] = 36.6; upper extremity: bias = -0.5, LoA = 17.6; lower extremity: bias = 0.8, LoA = 24.0). There were 66 pairs of examinations that had thorough sensory and rectal examinations for AIS grade calculation. Using kappa analysis to test the interrater reliability of AIS grade calculation using NME versus ISNCSCI motor scores, the authors found a weighted kappa of 0.883 (SE 0.061, 95% CI 0.736-0.976), indicating strong agreement. Overall, this study suggests that ISNCSCI motor scores and NME scores are strongly correlated and highly agreeable. When conducting SCI research, a thorough clinical motor examination may be a useful surrogate when ISNCSCI examinations are missing.

Accuracy of self-perceived cardiovascular disease risk and factors predicting risk underestimation in perimenopausal and postmenopausal women in Ismailia, Egypt.

Cardiovascular disease (CVD) is the leading cause of death globally, with women at higher risk after menopause. This increased risk is attributed to both aging and hormonal changes. Prior research has established a link between CVD risk perception and adopting healthy behaviors to prevent CVD. This study aimed to assess the accuracy of self-perceived CVD risk in perimenopausal and postmenopausal women, and to identify factors that predict CVD risk underestimation among them. A cross-sectional study was conducted in the administrative sectors of Suez Canal University campus in Ismailia, Egypt, over a period of eight months starting in July 2022. A total of 390 eligible women (employees and workers) were randomly selected. Participants were interviewed to obtain data on demographics, medical history, self-perceived risk of CVD, self-perceived general health, awareness of factors that increase the risk of developing CVD, perceived stress, health literacy, numeracy, and self-perceived 10-year risk of developing major cardiovascular events. They also underwent measurements of blood pressure, weight, and height. The updated 2019 WHO/CVD risk non-laboratory-based prediction chart for the North Africa and Middle East Region was used to predict the 10-year risk of major cardiovascular events for the study participants. Risk accuracy was measured by comparing self-perceived CVD risk with predicted CVD risk. The ratio of self-perceived to predicted moderate/high CVD risk was 27.7% to 44.3%, respectively. The accuracy of CVD risk perception was 68.2%. Kappa analysis results showed fair and significant agreement between self-perceived and predicted CVD risk (kappa ± SE = 35.9 ± 4.1%, p < 0 .001). The proportion of women who underestimated their risks was 24.1%. Of those in the high-risk group, 93.3% underestimated their CVD risk, compared to 50.6% in the moderate-risk group. Factors that significantly predicted CVD risk underestimation included being married (aOR 14.5; 95% CI 1.4-149.9), low income (aOR 2.321; 95% CI 1.09-4.909), high BMI (aOR 4.78; 95% CI 1.9-11.9), hypertension (aOR 3.5; 95% CI 2-6.2), and old age (aOR 1.46; 95% CI 1.3-1.6). Approximately one-third of our study participants misperceived their CVD risk; of those who did, 75.8% underestimated it. Marital status, old age, low income, high BMI, and hypertension strongly predicted CVD risk underestimation. These findings identified the menopausal women subgroups that could benefit from targeted health interventions designed to reduce CVD risk underestimation and improve risk accuracy.

A Computer Vision System for an Automated Scoring of a Hand-drawn Geometric Figure

Visual Reproduction is a condition to measure Visual Spatial Memory as one of the cognitive domains commonly used to measure visuo-spatial memory. Geometric figures serve as stimulus material, and probands have to reproduce the figures from memory through a hand drawing. The scoring of the drawing has subjective elements. This study aims to evaluate the scoring criteria for the Figural Reproduction Test (FRT), part of the Indonesian Neuropsychological Test Battery, and to develop and evaluate an automated scoring system based on computer vision technology (FRT-CVAS). Scoring evaluation conducted by Cohen Kappa analysis, accuracy, sensitivity, and specificity. The analyzes of the three criteria of the manual confirmed a subjective element in the scoring of the shape of triangles by a moderate (0.74) inter-rater agreement; this agreement could be improved to 0.84 by a slight modification of its criteria. FRT-CVAS, based on computer vision’s identification of the different elements of the hand drawing, was developed and trained using 290 drawings. The system was additionally tested by comparing its scoring with the scoring of two independent raters on 120 drawings from a second data set. FRT-CVAS recognized all elements, and its comparison between human raters showed a high accuracy and sensitivity (minimally 0.91), while the specificity was 0.80 for one of the three criteria. FRT-CVAS offers a highly standardized, consistent, precise, and objective output from the first card in the FRT. This approach is advantageous to data-hungry alternatives such as deep learning when applied to the automated scoring of hand drawings with relatively little data available for training.