Reliability Kappa Coefficient Research Articles

Orthodontic patient satisfaction: Validation of an Arabic patient satisfaction questionnaire

Objectives: Orthodontic patient satisfaction is a primary aim of orthodontic treatment. Satisfaction is a multidimensional concept, requiring multi-item questionnaires for it to be adequately assessed. A 58-item, orthodontic patient satisfaction questionnaire (PSQ) was developed to assess orthodontic patient satisfaction. Appropriately adapted assessment tools are needed to assess orthodontics patient satisfaction in different populations. The validity and reliability of such tools should be demonstrated before their use for each target population. The PSQ was yet to be validated in Arabic. Therefore, the objective of this study was to translate, adapt, and validate an Arabic orthodontic PSQ. Material and Methods: The 58-item English PSQ was translated to Arabic through translation and back-translation. An expert panel examined the relevance of PSQ items. The questionnaire was circulated through social media to recruit responses from Arabic-speaking orthodontic patients who completed orthodontic treatment. Cronbach’s alpha, item-total correlation (I-TC), and kappa reliability coefficient were calculated. The analysis of variance test was used to compare satisfaction scores between genders and different orthodontic treatment appliances. Results: Ten items were removed based on expert ratings. The questionnaire was filled by 327 patients (55.6% females, mean age = 28.5 ± 7.2, 59.8% on metal braces, 35.3% on clear aligners, and 5.2% on tooth-colored braces). Nine questionnaire items were removed because of low I-TC (<0.3). The resulting 39-item questionnaire had a Cronbach alpha of 0.79 and a kappa coefficient of 0.82. The mean total PSQ score of the sample was 167.61 ± 21.45. Items with the top ten highest I-TC correlations had a Cronbach’s alpha of 0.90. Patients on metal braces had a highest mean total PSQ score (P = 0.004). Among these patients, satisfaction with situational aspects was lower but satisfaction with dentofacial, psychosocial, and dental improvements were all higher compared to other orthodontic treatments (P < 0.001). Conclusion: The 39-item Arabic PSQ is valid and reliable. A shorter collection of 10 items with high validity were identified. Patients on metal braces had better outcomes, driving higher satisfaction. Studies collecting satisfaction data using the PSQ from orthodontic clinics are needed.

Reliability assessment of the OMERACT whole-body magnetic resonance imaging scoring system for juvenile idiopathic arthritis

Inter-reader reliability of a new scoring system for evaluating joint inflammation and enthesitis in whole body MRI (WBMRI) in juvenile idiopathic arthritis was tested. The scoring system grades 732 item-region combinations of bone marrow and soft tissue changes for commonly involved joints and entheseal sites. Five radiologists rated 17 WBMRI scans through an online rating platform. Item-wise reliability was calculated for 117 items with non-zero scores in >10 % of readings. Interquartile ranges of the five-reader Kappa reliability coefficients were 0.58–0.73 (range: 0.36–0.88) for the joints, 0.65–0.81 (range: 0.39–0.95) for the entheses, and 0.62–0.75 (range: 0.60–0.76) for chronic nonbacterial osteomyelitis-like lesions.

Tinnitus Screener: Short-Term Test-Retest Reliability.

The Tinnitus Screener was introduced in 2015 as a four-item algorithmic instrument to assess the temporal characteristics of a person's reported tinnitus. The Tinnitus Screener was then revised as a six-item version to include a new temporal category and to capture tinnitus duration (acute < 6 months vs. chronic ≥ 6 months). When contrasted with audiologist assessment, the four-item Tinnitus Screener was determined to be highly valid, but the short-term reliability of either version remained unknown. The present analysis focused on determining the test-retest reliability of the six-item Tinnitus Screener. Additionally, we sought to determine whether reliability differed by respondent age, sex, military status, and hearing loss. The Tinnitus Screener was administered to 190 military Service members and 250 military Veterans at two time points separated by 7-31 days. Our analysis focused on test-retest reliability of responses as measured by the kappa coefficient, overall and within subsamples. Percent agreement of tinnitus categorization (temporal categories) and classification (positive/negative) between the two time points was also evaluated. Constant or intermittent tinnitus was found in 31% of Service members and 53% of Veterans. Overall, kappa reliability coefficients were high, near .80, indicating substantial reliability. The majority (96%) of reliability coefficients for the Tinnitus Screener within subsamples were similarly high, ranging from .68 to .88. The updated version of the Tinnitus Screener is shown to be a reliable instrument. The Tinnitus Screener is recommended to inform clinical decision making by determining the temporal characteristics of tinnitus.

A Systems Approach to Improving Foundational Reading Skills at a Preschool in India

Holistic Education School located in Mumbai, India, created a strategic improvement plan to address the poor foundational reading skills of its kindergarten students. Curriculum Based Measure (CBM) assessment data showed a rise in reading performance during the implementation of the plan, from 87% of the students scoring below grade level in 2016 to 89% achieving grade level benchmarks in 2021. An instrumental case study qualitative research design was employed to describe the nature of changes made in relation to the increase in performance. Data were collected from a variety of sources and coded through inductive and deductive processes that achieved intercoder agreement of 97.87% and 0.73 Kappa coefficient for reliability. Triangulation, member checking, and clarifying researcher bias, were employed to maximize validity. The findings describe the nature of transformation undertaken by the strategic improvement plan on key systems-level elements like curriculum, professional development, student engagement, parent engagement, and school leadership.

Magnified endoscopy with texture and color enhanced imaging with indigo carmine for superficial nonampullary duodenal tumor: a pilot study

This pilot study aimed to investigate the utility of texture and color enhancement imaging (TXI) with magnified endoscopy (ME) for the preoperative diagnosis of superficial nonampullary duodenal epithelial tumors (SNADETs). We prospectively evaluated 12 SNADETs. The visibility for ME-TXI, ME with indigo carmine (ICME)—white-light imaging (WLI), ICME-TXI compared to ME-NBI (narrow-band imaging) was scored (+ 2 to − 2 ME-NBI was set as score 0) by 3 experts. Scores + 2 and + 1 were defined as improved visibility. The intra-observer and interobserver agreement for improved visibility of surface structure (SS) was evaluated. Sensitivity, specificity, and positive predictive value (PPV) for Vienna Classification (VCL) C4/5 associated with the preoperative diagnosis of ICME-TXI were analyzed. The SS visibility score of ICME-TXI was significantly higher than that of ME-NBI, ME-TXI, and ICME-WLI (P < 0.001 respectively). The kappa coefficients of reliability for intra-observer and interobserver agreement for the SS visibility improvement with ICME-TXI were 0.96, 1.00, 1.00 and 0.70, 0.96, 0.96 respectively. All endoscopists preferred ICME-TXI for visualizing SS mostly for all lesions. The sensitivity, specificity, and PPV (%) of ICME-TXI for VCL C4/5 were 80, 66.7, and 63.2, respectively. ICME-TXI facilitates the visibility of the SS of SNADETs and may contribute to their preoperative diagnosis.

Ortaokul Öğretmenlerinin Okullardaki Biçimsel ve Doğal Grup İlişkilerinin Örgütsel Sonuçları

The aim of this study is to determine the organizational results of formal and informal group relations of teachers at schools. In accordance with the holistic multiple case pattern, study group of the research has been selected on the basis of volunteerism and maximum diversity sampling out of purpose sampling methods. The group consists of 12 teachers from 3 middle schools Muratpaşa, Kepez and Aksu towns of Antalya province, respectively. Descriptive analysis has been used in the analysis of the qualitative data and consistency testing has been utilized. The Cohen’s Kappa reliability coefficient has been calculated as meaningful with the level of 0.818.&#x0D; According to the results of the research; group relations increase organizational commitment and job satisfaction, while reducing stress. In addition, good friendship relationships increase school loyalty and reduce the intention of relocation. However, negative results such as conflicts between different groups have an adverse effect on the organizational climate and the resistance of the members of the group to the decisions of the administration by taking power from each other. Emotional commitment levels of teachers were higher than continuation commitment and normative commitment. Relationships with other employees and perceived social support were mostly affected by job satisfaction. The most stressful resource among the participating teachers is school administrators and it is seen that the participants have been observed emotion-focused coping strategy in the first place.

The development and application of a triage system for urolithiasis during COVID-19.

PurposeTo balance epidemic prevention with the therapeutic needs of patients with urolithiasis during the COVID-19 pandemic, we developed a triage system to guide medical staff in making priority decisions.MethodsThe study began with a review of the literature to propose a theoretical framework. Then, focus groups were assembled to develop, supplement, refine and form a consensus on the indications of the triage system. Finally, the system was implemented in the clinic. The validity and reliability of the system were tested by a content validity index and the interrater reliability kappa coefficient. Changes in patient characteristics and waiting time before and after the epidemic were compared.ResultsThe theoretical framework was based on disease pathophysiology, including obstruction, infection, kidney dysfunction, and other symptoms. With this guide, a 28-item triage system with categories of T1–5 (low priority to urgent) was developed. The content validity index and the interrater reliability coefficient were 0.833 and 0.812, respectively. During clinical application, although the total number of patients remained steady, the proportion of T1 decreased significantly; even though the overall waiting time of patients did not change significantly, it increased for T1 and decreased for T2–4 in 2020 compared with 2019 (P < 0.05).ConclusionThis triage tool based on the dimensions of obstruction, infection, kidney dysfunction, and other symptoms has good psychometric properties and significant utility for prioritizing patients with urolithiasis during times of crisis. With this system, patients of moderate to high priority were treated promptly during the COVID-19 pandemic.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00345-021-03871-7.

Psychometric properties of a modified version of Brazilian household food insecurity measurement scale - Pró-Saúde study.

We present results of initial steps of the psychometric evaluation of a proposed modified version of the Brazilian Household Food Insecurity Measurement Scale aimed at assessing adults' recall of food insecurity at age 12. Data were obtained through self-administered questionnaires from civil servants at university campuses in Rio de Janeiro, who participated in the first and fourth waves of the longitudinal Pró-Saúde Study. We evaluated test-retest reliability (n=58), internal consistency, factor structure, convergent, discriminant validity (n=3,253). Test-retest reliability kappa coefficients were above 0.65; Cronbach's α coefficient was 0.84. Factor loadings were above 0.800. The composite reliability was above 0.90. The square root values of the Average Variance Extracted were positive and statistically significant. Household food insecurity during childhood was strongly associated with larger family size and several sociodemographic conditions at age 12: female head of household, residence in rural area or small town, worse standard of living, and insufficient food due to lack of money. This initial evaluation suggests good performance. Further investigation should include additional psychometric properties and other population contexts.

Imbalance in Axial-plane Rotator Cuff Fatty Infiltration in Posteriorly Worn Glenoids in Primary Glenohumeral Osteoarthritis: An MRI-based Study.

Imbalance in Axial-plane Rotator Cuff Fatty Infiltration in Posteriorly Worn Glenoids in Primary Glenohumeral Osteoarthritis: An MRI-based Study.

Monitoring Spatial-Temporal Transition Dynamics of Transport Infrastructure Space in Urban Growth Phenomena: A Case Study of Lagos—Nigeria

Lagos is one of the fastest growing world mega-cities with a huge urban mobility crisis, the traditional aggregate city’s development model could not provide reliable scientific solutions to monitor the competing demands of various land-use components and the urbanization’s effects on transport infrastructure space. This study uses a disaggregated predictive spatial modeling approach to investigate the evolutionary dynamics of transportation infrastructure space to address the fragmented urban chain process. The methodology involves analysis and modeling of the land-use spatial transition changes that have occurred over the past three decades using three Landsat imagery epochs (1984, 2013, and 2019) in remote sensing ARC-GIS 10.7. Furthermore, the prediction of the two-temporal milestones (2030 and 2050) using hybrid cellular automata-Markov (CA-Markov) implemented in IDIRISI SELVA 17.0 software when the tides of social-demographic factors were expected to bring about significant urban spatial transformation. The forecast results are expected to increase the area for transport infrastructure spaces by 93 km2 (7.3%) in 2030 and 157 km2 (12.4%) in 2050. The model’s kappa reliability coefficient estimates for the three temporal scales (k1984 = 85%; k2013 = 88% and k2019 = 89%) are higher than the 80% minimum adjudged strong agreement between the ground truth and prediction classified images in literature. The model provides efficient tool in urban development planning and sustainable transport decisions.

College Teachers' and Administrators' Perceptions Regarding Organization Levels of Schools

The aim of this study is to analyze college teachers 'and administrators' perceptions regarding organization levels of schools. For this purpose, the opinions of 32 teachers who were teaching in the 10 grades and 18 administrators at 9 colleges (government and private) in which the college program has been conducted in four cities in TRNC have been taken. After the literature review, specialists' opinions were taken to develop the scale form of the qualitative study. With this scale form opinions of administrators and teachers teaching in classes 10 12 IGCSE, AS and A-Level) were analyzed qualitatively. Data obtained by semi-structured interview form was analyzed using NVivo 12 Plus Program. The Kappa Reliability Coefficient was found as 0.89. As a result of the qualitative study, it was found that school principals have the most important responsibility for the effective organizations at school. Therefore, it can be said that school principals should be able to define the school goals well and balance the relationship between the school stakeholders. It has been concluded that the correct organization has a positive effect on the academic success of the students.

Prevalence of MRI Shoulder Abnormalities in Asymptomatic Professional and Collegiate Ice Hockey Athletes.

Background:The literature demonstrates a high prevalence of asymptomatic knee and hip findings on magnetic resonance imaging (MRI) in athletes. Baseball pitchers are shown to have a high prevalence of asymptomatic shoulder MRI findings, but the incidence of asymptomatic shoulder MRI findings has not been systematically evaluated in nonthrowing contact athletes.Purpose/Hypothesis:The purpose of this study was to determine the prevalence of shoulder abnormalities in asymptomatic professional and collegiate hockey players. We hypothesized that, similar to overhead throwing athletes, ice hockey players will have a high prevalence of asymptomatic MRI findings, including labral, acromioclavicular (AC), and rotator cuff pathology on MRI.Study Design:Cross-sectional study; Level of evidence, 4.Methods:A total of 25 asymptomatic collegiate and professional hockey players (50 shoulders) with no history of missed games or practice because of shoulder injury, pain, or dysfunction underwent bilateral shoulder noncontrast 3.0-T MRI. MRIs were read blinded by 2 board-certified radiologists at 2 separate time points, 3 months apart, to determine the prevalence of abnormalities of the joint fluid, bone marrow, rotator cuff tendon, biceps tendon, labrum, AC joint, and glenohumeral joint. Interrater and intrareader reliability was determined, and regression analysis was performed to identify the prevalence and relationship to stick-hand dominance.Results:Labral abnormalities were seen in 25% of the shoulders. AC joint abnormalities and rotator cuff findings were noted in 8% and 6% of shoulders, respectively. One shoulder was noted to have a biceps tendon abnormality, and 1 shoulder demonstrated glenohumeral joint chondral findings. Interrater reliability coefficients were 0.619 for labral abnormalities. Intrareader reliability kappa coefficients were 0.493 and 0.718 for both readers, respectively, for labral abnormalities. Regression analysis was performed and revealed that the overall shoulder pathology was more common in the nondominant stick hand (top stick hand) (coefficient –0.731; P = .021).Conclusion:Professional and collegiate ice hockey players had an overall prevalence of labral abnormalities in 25% of their shoulders, with findings more often found in the nondominant stick hand. Rotator cuff abnormalities were uncommon in ice hockey players. These findings differ significantly from published reports examining professional baseball players and other overhead sports athletes.

Secured Routing in Mobile Ad hoc Networks (MANETs)

A Mobile Adhoc Network (MANET) is prone to attacks. Adversaries take hold of the network, thus degrading their performance. Various attacks are prevalent in MANET, out of which Byzantine attack plays a vital role. A node or group of nodes present in the routing path between the source and the destination may be compromised due to Byzantine attack. In this paper, Cohen Kappa Reliability Coefficient based Mitigation (CKRCM) mechanism is proposed to deal with these attacks. The intermediate nodes are monitored by their neighbors for a timestamp. If the monitoring node does not receive an acknowledgment, then the nodes are perceived to be attacked. The trustworthiness of the nodes is built by computing the trusts and reliabilities of the nodes. It is seen that the proposed scheme outperforms the existing scheme in terms of Throughput, Packet Delivery Ratio (PDR) and Packet Loss Ratio (PLR).

The reliability and validity of the Chinese version of The Pressure Ulcer Risk Primary or Secondary Evaluation Tool

Objective To translate The Pressure Ulcer Risk Primary or Secondary Evaluation Tool (PURPOSE-T) into Chinese, and assess its reliability and validity in Chinese hospitalized patients. Methods The original PURPOSE-T was translated into Chinese and back translated and modified for cultural adaptation according to guidelines. The reliability and validity of the Chinese version of PURPOSE-T were tested in 230 hospitalized patients. Results The Chinese version of PURPOSE-T consists of three parts and contains 25 entries. The inter-rater consistency Kappa coefficient was 0.798, the weighted Kappa coefficient was 0.843. The evaluation results were compared with binary variables with a Kappa coefficient of 0.745. The test-retest reliability Kappa coefficient and the weighted Kappa coefficient were 0.863 and 0.892. Two classified assessment Kappa coefficient was 0.857. The item content validity index ranged from 0.83 to 1.00, and the scale content validity index was 0.98. The phi correlation coefficient of PURPOSE-T and Braden scale was 0.781; the phi correlation coefficient of Waterlow Scale evaluation result was 0.777. The correlation coefficient between Chinese PURPOSE-T items and Braden scale items ranged from 0.605 to 0.877 (P<0.01), and the Waterlow Scale items ranged from 0.599 to 0.887 (P<0.01). Conclusions The Chinese version of PURPOSE-T appears to possess adequate validity, test-retest reliability and internal consistency. The newly translated Chinese version of PURPOSE-T may be used to assess the risk of pressure injury in inpatients in China. Key words: Pressure injury; Risk evaluation; Reliability; Validity

Learning from the Field and Its Listserv: Issues That Concern Health Literacy Practitioners.

This study assesses the content of email messages posted to the Health Literacy Discussion List (HLDL) during a two-year period. The study identifies issues of concern to list subscribers, describes the purposes the list serves for health professionals, and contributes to the health literacy literature by providing an email listserv as a research corpus. The authors conducted an inductive qualitative analysis of email posts to the HLDL from October 2013 to October 2015. Using an iterative process, the authors identified descriptive categories for types of posts and topics of posts. The first (SKR) and second (JM) authors reviewed subject lines of all 2,036 posts and brainstormed type and topic categories, independently read and sorted a random sample of 200 posts into those categories, and then discussed discrepancies. Based on the latter experience, the authors combined, added, or excluded certain categories and jointly created a detailed description for each type and topic category. We then sorted another random sample of 200 posts and generated a list of key words relating emails to topic categories. A Cohen's kappa reliability coefficient was calculated to establish intercoder reliability. The third author (RVR) then conducted key word searches for sorting the remaining 1,836 email posts. The existence and frequency of email clusters and the content of emails in these clusters were used to identify and explore in greater detail the "hot topics" of interest to the field. Our analysis suggests the utility of the HLDL as a platform for sharing information and resources, announcements and calls for action, technical assistance and professional discourse.

Limited reliability of grading scapular notching according to Nerot-Sirveaux on anteroposterior radiographs.

Incidences of scapular notching (SN) in reverse shoulder arthroplasty (RSA) range between 0% and 96%, and controversy remain as to its relevance for patient outcome. We assessed the reliability of scapular notching (SN) grading based on the Sirveaux classification system using anteroposterior radiographs. 206 RSA procedures with 5-year postoperative anteroposterior shoulder radiographs were classified independently by seven assessors according to Sirveaux (session 1). After a review meeting, three assessors re-classified the radiographs along with quality criteria (session 2). SN grading by the majority of assessors was taken as the reference. Classification interobserver reliability was analyzed using Kappa statistics. The incidence of SN was estimated at 53% and 37% at the first and second sessions, respectively. Interobserver reliability Kappa coefficients resulting from the first and second sessions were 0.27 and 0.43, respectively. Case selection based on radiographic quality criteria did not improve SN grading reliability in the second session. Agreement between individual surgeons was low when grading SN in RSA according to Sirveaux using anteroposterior radiographs. Consensus among several assessors may increase reliability in research settings.

Fizik Öğretimi Sürecinde Yaşanan Sorunların Değerlendirilmesine Yönelik Bir Çalışma

In the matter of teaching and learning physics lesson, in this study that is conducted to determine the reasons of expressing the lesson as difficult, the reasons of problems faced while teaching physics lesson, and the sources of these problems; and with the aim of making suggestions related to determined cases, case study method has been preferred as depth examination of the process and discovery of cause-and-effect relationships. Participants of the study consist of 60 physics teachers working in 2016-2017 school year, and 180 students taking physics lesson around Trabzon, Van and Denizli. In the research, within the frame of ethical rules the teachers in the participating group have been coded in the form of O01, O02, O03, . . . , O60; and students in vocational high school have been coded in the form of M01, M02, . . . , M60; in Anatolian high school have been coded in the form of A01, A02, . . . , A60, in science high school students have been coded in the form of F01, F02, . . . , F60. In the study, clinical interview has been used as data collection tool. Interviews having with physics teachers and students taking physics lesson have been recorded with tape recorder by permission of the participants. Obtained data after the records were transcribed, have been subjected to descriptive analysis by using NVivo 9 Program. In order to provide reliability of this analysis, consistence of the classifications made by two independent observers has been examined. Consistency relations of codifications of the data acquired from the classification made by two independent observers have been calculated as 0.80 (Kappa Reliability coefficient) by using NVivo 9 Program. In consideration of the results from the interview, reasons of expressing physics lesson as a difficult one, main problems faced with teaching and learning physics lesson, sources of the problems experienced during teaching and learning physics lesson; and the things might be done in order to teach and learn physics lesson better have been stated in the study. Additionally, proposals have been brought forward to minimize the problems might be had during teaching and learning of physics lesson.

Reliability of CSF turbulence and choroid plexus visualization on fast-sequence MRI in pediatric hydrocephalus.

OBJECTIVE Endoscopic third ventriculostomy with choroid plexus cauterization for the treatment of neonatal and infant hydrocephalus has gained popularity in the past decade. Identifying treatment failure is critically important. Results of a pilot study of 2 novel imaging markers seen on fast-sequence T2-weighted axial MRI showed potential clinical utility. However, the reliability of multiple raters detecting these markers must be established before a multicenter validation study can be performed. METHODS Two sets of de-identified single-shot T2-weighted turbo spin-echo axial images were prepared from scans of patients before and after they underwent endoscopic third ventriculostomy with choroid plexus cauterization between March 2013 and January 2016. The first set showed the lateral and third ventricles for visualization of turbulent CSF dynamics, and the second set showed the lateral ventricular atria for choroid plexus glomus detection. Three raters (Group 1) received written instructions before evaluating each image set once and then again 1 week later. Another 8 raters (Group 2) evaluated both image sets after oral instruction and group training on a pretest image set. Fleiss' kappa coefficients with 95% CIs were calculated for intrarater and interrater reliability in Group 1 and interrater reliability in Group 2. RESULTS Intrarater reliability kappa coefficients for Group 1 were ≥ 0.74 for turbulence and ≥ 0.80 for choroid plexus; their interrater kappa coefficients at the initial assessment were 0.50 (95% CI 0.37-0.62) and 0.56 (95% CI 0.43-0.69), respectively. The Group 2 interrater kappa scores were 0.82 (95% CI 0.78-0.86) for turbulence and 0.62 (95% CI 0.58-0.66) for choroid plexus. CONCLUSIONS With minimal training, intrarater reliability on visualization of turbulence and the choroid plexus was substantial, but interrater reliability was only moderate. After modestly increasing training, interrater reliability improved to near perfect and to substantial reliability for visualization of turbulence and choroid plexus, respectively. Given adequately trained observers, a multicenter investigation into the validity and potential clinical utility of the imaging markers seems feasible.

Remote Digital Preoperative Assessments for Cleft Lip and Palate May Improve Clinical and Economic Impact in Global Plastic Surgery.

Reconstructive surgical care can play a vital role in the resource-poor settings of low- and middle-income countries. Telemedicine platforms can improve the efficiency and effectiveness of surgical care. The purpose of this study is to determine whether remote digital video evaluations are reliable in the context of a short-term plastic surgical intervention. The setting for this study was a district hospital located in Latacunga, Ecuador. Participants were 27 consecutive patients who presented for operative repair of cleft lip and palate. We calculated kappa coefficients for reliability between in-person and remote digital video assessments for the classification of cleft lip and palate between two separate craniofacial surgeons. We hypothesized that the technology would be a reliable method of preoperative assessment for cleft disease. Of the 27 (81.4%) participants, 22 received operative treatment for their cleft disorder. Mean age was 11.1 ± 8.3 years. Patients presented with a spectrum of disorders, including cleft lip (24 of 27, 88.9%), cleft palate (19 of 27, 70.4%), and alveolar cleft (19 of 27, 70.4%). We found a 95.7% agreement between observers for cleft lip with substantial reliability (κ = .78, P < .01). There was an 82.6% agreement between observers for cleft palate, with a moderate interrater reliability (κ = .55, P = .01). We found only a 47.8% agreement between observers for alveolar cleft with a nonsignificant, weak kappa agreement (κ = .06, P = .74). Remote digital assessments are a reliable way to preoperatively diagnose cleft lip and palate in the context of short-term plastic surgical interventions in low- and middle-income countries. Future work will evaluate the potential for real-time, telemedicine assessments to reduce cost and improve clinical effectiveness in global plastic surgery.

Learning from the field and its listserv: Issues that concern health literacy practitioners

This study assesses the content of email messages posted to the Health Literacy Discussion List (HLDL) during a two-year period. The study identifies issues of concern to list subscribers, describes the purposes the list serves for health professionals, and contributes to the health literacy literature by providing an email listserv as a research corpus. The authors conducted an inductive qualitative analysis of email posts to the HLDL from October 2013 to October 2015. Using an iterative process, the authors identified descriptive categories for types of posts and of posts. The first (SKR) and second (JM) authors reviewed subject lines of all 2,036 posts and brainstormed type and topic categories, independently read and sorted a random sample of 200 posts into those categories, and then discussed discrepancies. Based on the latter experience, the authors combined, added, or excluded certain categories and jointly created a detailed description for each type and topic category. We then sorted another random sample of 200 posts and generated a list of key words relating emails to topic categories. A Cohen's kappa reliability coefficient was calculated to establish intercoder reliability. The third author (RVR) then conducted key word searches for sorting the remaining 1,836 email posts. The existence and frequency of email clusters and the content of emails in these clusters were used to identify and explore in greater detail the hot topics of interest to the field. Our analysis suggests the utility of the HLDL as a platform for sharing information and resources, announcements and calls for action, technical assistance and professional discourse.