Kappa Correlation Research Articles

Grading Sonographic Severity of Adenomyosis: A Pilot Study Assessing Feasibility and Interobserver Reliability.

The reported prevalence of adenomyosis ranges widely due to different study populations, diagnostic tests and criteria. Categorizing the severity of disease may prove important. This study aims to develop a semi-quantifiable sonographic method to grade the severity of adenomyosis and assess the feasibility and interobserver reliability of this method. Cross-sectional pilot study performed at a gynecology outpatient clinic, included 35 premenopausal women with adenomyosis, not taking hormonal medication. Diagnosis required ≥1 direct sonographic feature of adenomyosis. Two-dimensional (2D) grayscale video clips and 3-dimensional (3D) volumes of the uterus of the first 5 patients were evaluated using 6 offline methods to assess feasibility. Feasible methods were analyzed for interobserver (n = 3) reliability (Fleiss kappa or intraclass correlation) and compared with current ultrasound methods (Cohen's weighted kappa and Spearman's rank correlation). Current methods include real-time estimation (mild/moderate/severe) and counting the individual sonographic features. "eXtended Imaging virtual organ computer-aided analysis (XI VOCAL) counting" (counting affected slices of 20 parallel slices in the 3D volume), "Multiplanar and 3D rendering (MPR) estimation" (grading volume by eyeballing in multiplanar render mode), and "2D-clip estimation" (grading volume in 2D-clips) emerged as feasible methods. "XI VOCAL counting" and "2D-clip estimation" demonstrated good interobserver reliability, whereas "MPR estimation" had poor reliability. Comparison with real-time estimation showed moderate reliability with all methods. "XI VOCAL counting" and "MPR estimation" correlated positively with the number of sonographic features. "XI VOCAL counting" demonstrated to be feasible with good interobserver reliability to assess the severity of adenomyosis in an objective, systematic, and semi-quantifiable fashion and should be validated with large-scale studies for future use. Future studies should also explore the association between sonographic severity and symptoms of adenomyosis.

Development and validation of a questionnaire on radiation protection knowledge, attitudes, and practices among Moroccan dentists.

This study aimed to develop and evaluate the validity and reliability of dentists' radiation protection knowledge, attitudes, and practices (DRP-KAPs) questionnaire. This study was conducted using a stepwise approach. In the first step, items were generated to determine the relevant content and domains after a thorough literature review. In the second step, the content validity of the questionnaire was assessed by seven experts using face and content validity. The content validity index for relevance and clarity (I-CVI, S-CVI/Av, and S-CVI/UA) and the content validity ratio (CVR) were performed. Then, the questionnaire was pre-tested with 10 dentists for face validation. In the third step, reliability was assessed using internal consistency (Kuder-Richardson-20 (KR-20) and Cronbach's alpha) and test-retest (Kappa and intraclass correlation coefficient [ICC]) methods by filling out the questionnaire by 100 dentists practicing in the Rabat-Salé-Kénitra region, in Morocco. The finalized DRP-KAPs questionnaire contains 41 items covering knowledge, attitudes and practices (KAPs). The I-CVIs, S-CVI/UA and S-CVI/AV and CVR values of the 41 items were ≥0.86 for each item, ≥0.82, ≥0.97, and ≥0.71, respectively. With regard to internal consistency reliability, the KR-20 coefficients for the knowledge and practice domains were 0.70 and 0.68, respectively, and the Cronbach alpha for the attitude domain was 0.73. The DRP-KAPs questionnaire has good reliability with the ICC coefficients for attitude items ranging from 0.57 to 0.95 and Kappa coefficients for knowledge and practice items ranging from 0.64 to 1 and 0.77 to 1, respectively. The developed DRP-KAPs questionnaire was found to be a noteworthy tool for assessing radiation protection among dentists, with acceptable internal consistency, good ICC and Kappa coefficients, and good content validity indices.

AB-HFPEF score: A new and improved HFpEF prediction tool for the Indian patient

Abstract Background/Introduction Heart failure with preserved ejection fraction (HFpEF) remains underdiagnosed in low-middle income countries including India. The simple and validated H2FPEF score has largely replaced the diagnostic need for invasive right heart catheterization. The score has therapeutic implications by stratifying patients into low, intermediate and high-risk groups. The relevance of this score is yet to be ascertained in the Indian population. Purpose We hypothesized that the H2FPEF score may fall short in accurately predicting HFpEF in our population, thus warranting a new score. Methods We conducted a prospective observational study over one year at the out-patient department of a tertiary-care hospital in India. Patients presenting with clinical features of heart failure were screened and enrolled in the study. Demographic, clinical, laboratory and echocardiographic details were recorded by the principal investigator using an online data collection tool. Patients were stratified into ‘low risk’, ‘intermediate risk’ and ‘high risk’ probabilities, with respective cut-off values of 0-3, 4-6, and 7-9 using the point-based score, and <30%, 30-59%, and >60% via the continuous model of H2FPEF score. Pearson’s chi-square test identified significant risk factors that were purposed into a novel AB-HFPEF score. Cohen’s kappa correlation determined the degree of agreement in the risk stratifications of the H2FPEF and the AB-HFPEF score, using the continuous scoring model as the reference. Results Among the 189 patients screened, 137 were enrolled in the study. The baseline characteristics are recorded in Table 1. Pedal edema and uncontrolled hypertension were noteworthy risk factors. A novel AB-HFPEF score was subsequently designed and scored as follows: Age (> 60 years) - 1, BMI (> 30 kg/m2) - 2, uncontrolled Hypertension (>140/90 mmHg) - 1, Filling pressure (E/e' > 9) - 1, Pulmonary Artery Systolic Pressure (> 35 mmHg) - 1, pedal Edema - 1, atrial Fibrillation - 3. Receiver operating characteristics (ROC) curve analysis demonstrated an area under the ROC curve (AUC) of 0.85 (95%CI, 0.78 to 0.91) for ‘low risk’ strata and 0.87 (95%CI, 0.81 to 0.93) for ‘high risk’ strata. The optimal stratification was 0-2, 3-4, and 5-10 points for the ‘low risk’, ‘intermediate risk’, and ‘high risk’ respectively. There was a moderate agreement of the AB-HFPEF score with the reference score (κ = 0.48 (95% CI, 0.36 to 0.60), p < 0.001), while the point-based H2FPEF score had only a slight agreement (κ = 0.15 (95% CI, 0.05 to 0.25), p < 0.001), as illustrated in Figure 1. Conclusion(s) The novel AB-HFPEF score performs better risk stratification in Indian patients with HFpEF as compared to the point-based H2FPEF score. We hence propose the AB-HFPEF score as an instrument for tailored cardiology care in the Indian demographic, laying the cornerstone for larger validation and prognostication studies.Table 1:Baseline characteristicsFigure 1:Heat Map Illustration

Comprehensive assessment of imaging quality of artificial intelligence-assisted compressed sensing-based MR images in routine clinical settings

BackgroundConventional MR acceleration techniques, such as compressed sensing, parallel imaging, and half Fourier often face limitations, including noise amplification, reduced signal-to-noise ratio (SNR) and increased susceptibility to artifacts, which can compromise image quality, especially in high-speed acquisitions. Artificial intelligence (AI)-assisted compressed sensing (ACS) has emerged as a novel approach that combines the conventional techniques with advanced AI algorithms. The objective of this study was to examine the imaging quality of the ACS approach by qualitative and quantitative analysis for brain, spine, kidney, liver, and knee MR imaging, as well as compare the performance of this method with conventional (non-ACS) MR imaging.MethodsThis study included 50 subjects. Three radiologists independently assessed the quality of MR images based on artefacts, image sharpness, overall image quality and diagnostic efficacy. SNR, contrast-to-noise ratio (CNR), edge content (EC), enhancement measure (EME), scanning time were used for quantitative evaluation. The Cohen’s kappa correlation coefficient (k) was employed to measure radiologists’ inter-observer agreement, and the Mann Whitney U-test used for comparison between non-ACS and ACS.ResultsThe qualitative analysis of three radiologists demonstrated that ACS images showed superior clinical information than non-ACS images with a mean k of ~ 0.70. The images acquired with ACS approach showed statistically higher values (p < 0.05) for SNR, CNR, EC, and EME compared to the non-ACS images. Furthermore, the study’s findings indicated that ACS-enabled images reduced scan time by more than 50% while maintaining high imaging quality.ConclusionIntegrating ACS technology into routine clinical settings has the potential to speed up image acquisition, improve image quality, and enhance diagnostic procedures and patient throughput.

A Comparative Study on the Consistency of Ultrasound and X-Ray in Assessing Risser Sign.

Adolescent idiopathic scoliosis (AIS) is a 3-dimensional spinal deformity involving lateral curvature, sagittal plane imbalance, and vertebral rotation. In China, AIS affects over 3 million individuals, with 300,000 new cases annually. AIS impacts physical and psychological well-being, necessitating tailored treatment plans based on growth risk factors. This study evaluates the consistency of ultrasound and X-ray assessments of the Risser sign in AIS patients and explores correlations between iliac crest distance and pelvic rotation degree. This prospective study enrolled 80 patients diagnosed with AIS from June to September 2023 at Changzhou Sports Hospital. Eligible participants were aged 10-18 with a Cobb angle >10°. Ultrasonographic examinations were conducted by 3 experienced physicians using the VINNO V10 portable ultrasound system. The primary outcome was the Risser stage determined by X-ray and ultrasound, with secondary outcomes including thoracic and thoracic-lumbar segment rotation angles. Statistical analyses included kappa statistics, correlation analyses, and multiple regression. Among the 77 valid cases, 154 iliac wings were evaluated, with a high concordance rate of 77% between ultrasound and X-ray assessments. kappa values for left and right iliac crests were 0.723 and 0.808, respectively. Grouping Risser grades (0-1, 2-3, and 4-5) into 3 categories yielded kappa values of 0.93, 0.96, and 0.93, indicating high consistency. Significant correlations were found between iliac crest distances and rotation angles (left iliac crest distance and left thoracic rotation angle, r = 0.56, P < .001; right iliac crest distance and right thoracic-lumbar rotation angle, r = 0.69, P < .001; right iliac crest distance and right thoracic rotation angle, r = 0.39, P < .01). Ultrasound is a reliable, radiation-free alternative to X-ray for assessing the Risser sign in AIS patients. Despite observed inconsistencies in intermediate Risser grades, ultrasound's ability to reduce radiation exposure and provide consistent results makes it a valuable tool in clinical practice. Further research is needed to optimize ultrasound techniques and explore its potential for early detection and intervention in scoliosis management.

A fully automated model for land use classification from historical maps using machine learning

Digital land use data before the age of satellites is scarce. Here, we build a machine learning model, using Extreme Gradient Boosting, that can automatically detect land use classes from an orthophoto map of Sweden (economic maps, 1:10 000 and 1:20 000) constructed from 1942 to 1988. Overall, the machine learning model demonstrated robust performance, with Cohen's Kappa and Matthews Correlation Coefficient of 0.86. The F1 values of the individual classes were 0.98, 0.95, 0.84, and 0.87 for graphics, arable land, forest, and open land, respectively. While the model can be used to detect land use changes in arable land, higher uncertainties associated with forest and open land necessitate further investigation at regional scales or exploration of improved mapping techniques. The code is publicly available to enable easy adaptation for classifying other historical maps.

Evaluation of a Multi-Component Phenotype Algorithm for Systemic Lupus Erythematosus across the PCORnet, OMOP, and i2b2 Common Data Models

The aim of this study was to evaluate the performance of a computable phenotype for systemic lupus erythematosus (SLE) patients when it is ported from a local data warehouse to the i2b2, OMOP, and PCORnet CDMs. We adapted the SLE phenotype to the Northwestern Medicine (NM) Enterprise Data Warehouse (EDW) and NU i2b2, OMOP, and PCORnet instances. Each of the phenotype’s 17 components were determined by a rules-based algorithm built on diagnosis, medication, lab, and procedure codes. We assessed the phenotype over 168 clinician-confirmed SLE patients and 100 healthy controls and calculated agreement between the EDW and CDMs for overall SLE classification, individual SLICC criteria membership, and individual code occurrence level aggregates - count, first and last date, lab values using Cohen’s kappa (Cκ) and intraclass correlation coefficients (ICC). For overall SLE classification, agreement of the OMOP and PCORnet datamarts with the EDW was high (Cκ 0.928, 0.802, respectively) while that of i2b2 was low (Cκ 0.328). For the panel of SLICC criteria, OMOP had high agreement for 14/17 SLICC criteria (Cκ 0.792-1.000). PCORnet had high agreement for 13/17 criteria (Cκ 0.708-1.000). i2b2 had high agreement for 10/17 criteria (Cκ 0.813-1.000) with the exception of lab-based criteria. While agreement between the EDW and CDMs at the level of individual codes was relatively poor, agreement at the levels of overall SLE classification and individual SLICC criteria were reasonably high for OMOP and PCORnet, suggesting that inconsistencies at a micro, code level become less apparent at the macro, phenotype level.

Analyzing electroencephalogram signals with machine learning to comprehend online learning media

&lt;p&gt;In E-learning, evaluating students' comprehension of lecture video content is significant. The surge in online platform usage due to the pandemic has been remarkable, but the pressing issue is that learning outcomes still need to match the growth. Addressing this, a scientific system that gauges the comprehensibility of lecture videos becomes crucial for the effective design of future courses. This research paper is based on a cognitive approach utilizing EEG signals to determine student's level of comprehension. The study involves the design, evaluation, and comparison of multiple machines learning models, aiming to contribute to developing an efficient learning system. Fifteen distinct machine learning (ML) classifiers were implemented, among them AdaBoost (ADA), gradient boosting (GBC), extreme gradient boosting (XGboost), extra trees (ET), random forest (RF), light gradient boosting machine (light gum), and decision tree (DT) algorithms standouts. The DT exhibited exceptional performance across metrics such as area under the curve (AUC), accuracy, recall, F1 score, Kappa, precision, and matthews correlation coefficient (MCC). It achieved nearly 1.0 in these metrics while taking a short training time of only 1.7 seconds. This reveals its potential as an efficient classifier for electroencephalography (EEG) datasets and highlights its viability for practical implementation.&lt;/p&gt;

Rapid and specific differentiation of Salmonella enterica serotypes typhi and Paratyphi by multicolor melting curve analysis

Rapid and accurate identification of Salmonella enterica serotypes Typhi and Paratyphi (A, B and C), the causal agents of enteric fever, is critical for timely treatment, case management and evaluation of health policies in low and middle-income countries where the disease still remains a serious public health problem. The present study describes the development of a multiplex assay (EFMAtyping) for simultaneous identification of pathogens causing typhoid and paratyphoid fever in a single reaction by the MeltArray approach, which could be finished within 2.5 h. Seven specific genes were chosen for differentiation of typhoidal and nontyphoidal Salmonella. All gene targets were able to be detected by the EFMAtyping assay, with expected Tm values and without cross-reactivity to other relevant Salmonella serovars. The limit of detection (LOD) for all gene targets was 50 copies per reaction. The LOD reached 102–103 CFU/ml for each pathogen in simulated clinical samples. The largest standard deviation value for mean Tm was below 0.5 °C. This newly developed EFMAtyping assay was further evaluated by testing 551 clinical Salmonella isolates, corroborated in parallel by the traditional Salmonella identification workflow, and serotype prediction was enabled by whole-genome sequencing. Compared to the traditional method, our results exhibited 100% of specificity and greater than 96% of sensitivity with a kappa correlation ranging from 0.96 to 1.00. Thus, the EFMAtyping assay provides a rapid, high throughput, and promising tool for public health laboratories to monitor typhoid and paratyphoid fever.

Artificial intelligence and dental age estimation: development and validation of an automated stage allocation technique on all mandibular tooth types in panoramic radiographs.

Age estimation in forensic odontology is mainly based on the development of permanent teeth. To register the developmental status of an examined tooth, staging techniques were developed. However, due to inappropriate calibration, uncertainties during stage allocation, and lack of experience, non-uniformity in stage allocation exists between expert observers. As a consequence, related age estimation results are inconsistent. An automated staging technique applicable to all tooth types can overcome this drawback.This study aimed to establish an integrated automated technique to stage the development of all mandibular tooth types and to compare their staging performances.Calibrated observers staged FDI teeth 31, 33, 34, 37 and 38 according to a ten-stage modified Demirjian staging technique. According to a standardised bounding box around each examined tooth, the retrospectively collected panoramic radiographs were cropped using Photoshop CC 2021® software (Adobe®, version 23.0). A gold standard set of 1639 radiographs were selected (n31 = 259, n33 = 282, n34 = 308, n37 = 390, n38 = 400) and input into a convolutional neural network (CNN) trained for optimal staging accuracy. The performance evaluation of the network was conducted in a five-fold cross-validation scheme. In each fold, the entire dataset was split into a training and a test set in a non-overlapping fashion between the folds (i.e., 80% and 20% of the dataset, respectively). Staging performances were calculated per tooth type and overall (accuracy, mean absolute difference, linearly weighted Cohen's Kappa and intra-class correlation coefficient). Overall, these metrics equalled 0.53, 0.71, 0.71, and 0.89, respectively. All staging performance indices were best for 37 and worst for 31. The highest number of misclassified stages were associated to adjacent stages. Most misclassifications were observed in all available stages of 31.Our findings suggest that the developmental status of mandibular molars can be taken into account in an automated approach for age estimation, while taking incisors into account may hinder age estimation.

Validity of self-assessment pubertal Tanner stages by realistic color images and Pubertal Development Scale in a longitudinal cohort study.

To date, the reliability of pubertal development self-assessment tools is questioned, and very few studies have explored the comparison between these tools in longitudinal studies. Hence, this study aimed to examine the reliability of pubertal development self-assessment using realistic color images (RCIs) and the Pubertal Development Scale (PDS) in a longitudinal cohort study. Our longitudinal study recruited 1,429 participants (695 boys and 734 girls), aged 5.8-12.2 years old, in Chongqing, China. We conducted two surveys, 6 months apart. Tanner stages were examined by trained medical students at each visit. RCIs and PDS scores were used to self-assess puberty at each visit. Agreement between physical examination and self-assessment was determined using weighted kappa (wk), accuracy, and Kendall rank correlation. The concordance of puberty self-assessment using RCIs at baseline and the first follow-up was almost perfect in girls and boys, wk >0.800 (p < 0.001). At baseline, the concordance of genital development self-assessment using RCIs was fair in boys, wk = 0.285 (p < 0.001), and that of boys' pubic hair development self-assessment using RCIs was poor, wk = 0.311 [95% confidence interval (CI) -0.157 to 0.818]. The wk of the PDS was less than 0.300, except for breast development. The reliability and validity of the PDS in this study population were low, and the consistency of the PDS was not good. The concordance of RCIs is better than that of the PDS. Pubertal development self-assessment using RCIs is reliable, while the reliability and validity of the PDS are unacceptable. Therefore, RCIs are recommended as a reliable pubertal development self-assessment tool to measure pubertal development for large-scale epidemiological investigations and long-term longitudinal studies in China.

Reliability of Angle Measurements Based on the Epiphyseal Scar for Knee Osteotomy: An International Multicenter Radiographic Study.

The proximal tibial epiphyseal inclination can be used as a prognostic factor for good results after knee osteotomy and measured using the tibial bone varus angle (TBVA). This angle depends on the visibility of the epiphyseal plate, which has shown poor reproducibility when measured on standard radiographs by conventional methods. To evaluate the measurement reliability of the TBVA and other angles based on the epiphyseal scar using a digital image display. Cohort study (diagnosis); Level of evidence, 3. A total of 100 whole-leg radiographs were analyzed twice by 3 orthopaedic surgeons from 2 countries in a blinded and randomized manner. Observers measured the hip-knee-ankle angle, mechanical lateral distal femoral angle, medial proximal tibial angle, and TBVA. The growth plate-tibial plateau (GPTP) angle, defined as the angle between the epiphyseal scar and tibial plateau, was measured; this angle has not yet been described for osteotomy. In addition, a modified version of the TBVA (mTBVA), defined as that between the epiphyseal scar, its center, and the center of the talus, was measured. The Ahlbäck score for osteoarthritis and a 3-grade score for epiphyseal scar visibility were also determined. The reliability of the angle measurements and scoring was evaluated using the Fleiss kappa and intraclass correlation coefficient (ICC). The scores for epiphyseal scar visibility showed fair interobserver (Fleiss kappa correlation coefficient [κ] = 0.29-0.35) and strong intraobserver (Fleiss κ = 0.62-0.69) reliability. TBVA, GPTP angle, and mTBVA measurements showed good interobserver reliability (ICC, 0.76-0.77), while the GPTP angle achieved excellent intraobserver reliability (ICC, >0.9). Using digital image display, angles that depend on the epiphyseal scar-such as TBVA, GPTP angle, and mTBVA-can achieve acceptable measurement reliability despite the low agreement on the visibility of the epiphyseal scar.

Validation of a Novel Mobile Application for Assessing Pediatric Tracheostomy Emergency Simulations.

Pediatric tracheostomy is associated with high morbidity and mortality, yet clinician knowledge and quality of tracheostomy care may vary widely. In situ simulation is effective at detecting and mitigating related latent safety threats, but evaluation via retrospective video review has disadvantages (eg, delayed analysis, and potential data loss). We evaluated whether a novel mobile application is accurate and reliable for assessment of in situ tracheostomy emergency simulations. A novel mobile application was developed for assessment of tracheostomy emergency in situ simulation team performance. After 1.25 hours of training, 6 raters scored 10 tracheostomy emergency simulation videos for the occurrence and timing of 12 critical steps. To assess accuracy, rater scores were compared to a reference standard to determine agreement for occurrence or absence of critical steps and a timestamp within ±5 seconds. Interrater reliability was determined through Cohen's and Fleiss' kappa and intraclass correlation coefficient. Raters had 86.0% agreement with the reference standard when considering step occurrence and timing, and 92.8% agreement when considering only occurrence. The average timestamp difference from the reference standard was 1.3 ± 18.5 seconds. Overall interrater reliability was almost perfect for both step occurrence (Fleiss' kappa of 0.81) and timing of step (intraclass correlation coefficient of 0.99). Using our novel mobile application, raters with minimal training accurately and reliably assessed videos of tracheostomy emergency simulations and identified areas for future refinement. With refinements, this innovative mobile application is an effective tool for real-time data capture of time-critical steps in in situ tracheostomy emergency simulations.

The additive diagnostic value of cytology in fine needle biopsy of pancreatic adenocarcinoma: A tertiary center experience.

Endoscopic ultrasound guide fine needle biopsy (EUS-FNB) is the main diagnostic tool for pancreatic adenocarcinoma. In most instances, only histology is obtained via FNB, without sending cytological slides. The aim of our study was to assess the additive diagnostic yield of cytology performed through FNB. We conducted a retrospective study of all patients with histological diagnosis of pancreatic adenocarcinoma who were diagnosed by EUS-FNB. Overall, 80 patients were included in the study period. The overall concordance between cytology and histology all FNB needles was 78.2%. Notably, cytological assessment improved the diagnostic yield for malignancy by 12.8%. The overall kappa coefficient correlation between histology and cytology was .501, 95% CI 0.361-0.641. However, the kappa correlation for suspicious of malignancy and malignant was excellent of .872, 95% CI 0.733-1, suggesting that cytology is crucial when histology is inconclusive. Further analysis showed that the Acquire and Sharkcore needles outperformed the Procore needle in term of concordance between cytology and histology (kappa correlation of .527, 95% CI 0.331-0.724, .515, 95% CI 0.265-0.764, and .297, 95% CI -0.051-0.646), respectively. Performing cytology specimen when using FNB improves the diagnostic yield in pancreatic adenocarcinoma.

Prevalence of weakness and factors mediating discrepancy between reported and observed leg weakness in people with sciatica

PurposeTo establish the prevalence and agreement between reported and observed leg weakness in people with sciatica. To establish which factors mediate any identified difference between reported and observed leg weakness in people with sciatica.Methods68 people with a clinical diagnosis of sciatica, records from spinal service, secondary care NHS Hospital, England, UK reviewed. Primary outcome measures were the sciatica bothersome index for reported leg weakness and the Medical Research Council scale for observed weakness. Agreement was established with Cohen’s Kappa and intraclass correlation coefficient. Potential factors that may mediate a difference between reported and observed weakness included leg pain, sciatica bothersome index sensory subscale, age, hospital anxiety and depression subscale for anxiety.Results85% of patients reported weakness but only 34% had observed weakness. Cohen’s Kappa (0.066, 95% CI − 0.53, 0.186; p = 0.317)] and ICC 0.213 (95% CI − 0.26, 0.428, p = 0.040) both showed poor agreement between reported and observed weakness. The difference between reported and observed measures of weakness was mediated by the severity of leg pain (b = 0.281, p = 0.024) and age (b = 0.253, p = 0.042).ConclusionThere is a high prevalence of reported leg weakness in people with sciatica, which is not reflected in observed clinical measures of weakness. Differences between reported and observed weakness may be driven by the severity of leg pain and age. Further work needs to establish whether other objective measures can detect patient reported weakness.

Comparison of intra- and inter-reader agreement of abbreviated versus comprehensive MRCP for pancreatic cyst surveillance.

To retrospectively compare inter- and intra-reader agreement of abbreviated MRCP (aMRCP) with comprehensive MRI (cMRCP) protocol for detection of worrisome features, high-risk stigmata, and concomitant pancreatic cancer in pancreatic cyst surveillance. 151 patients (104 women, mean age: 69[10] years) with baseline and follow-up contrast-enhanced MRIs were included. This comprised 138 patients under cyst surveillance with 5-year follow-up showing no pancreatic ductal adenocarcinoma (PDAC), 6 with pancreatic cystic lesion-derived malignancy, and 7 with concomitant PDAC. The aMRCP protocol used four sequences (axial and coronal Half-Fourier Single-shot Turbo-spin-Echo, axial T1 fat-saturated pre-contrast, and 3D-MRCP), while cMRCP included all standard sequences, including post-contrast. Three blinded abdominal radiologists assessed baseline cyst characteristics, worrisome features, high-risk stigmata, and PDAC signs using both aMRCP and cMRCP, with a 2-week washout period. Intra- and inter-reader agreement were calculated using Fleiss' multi-rater kappa and Intra-class Correlation Coefficient (ICC). 95% confidence intervals (CI) were calculated. Cyst size, growth, and abrupt main pancreatic duct transition had strong intra- and inter-reader agreement. Intra-reader agreement was ICC = 0.93-0.99 for cyst size, ICC = 0.71-1.00 for cyst growth, and kappa = 0.83-1.00 for abrupt duct transition. Inter-reader agreement for cyst size was ICC = 0.86 (aMRCP) and ICC = 0.83 (cMRCP), and for abrupt duct transition was kappa = 0.84 (aMRCP) and kappa = 0.69 (cMRCP). Thickened cyst wall, mural nodule and cyst-duct communication demonstrated varying intra-reader agreements and poor inter-reader agreements. aMRCP showed high intra- and inter-reader agreement for most pancreatic cyst parameters that highly rely on T2-weighted sequences.

Dorsal wrist ganglion: clinical and imaging correlation in symptomatic population based on high-field MRI.

To determine prevalence in the symptomatic population of dorsal mucoid cysts centered on dorsal capsuloscapholunate septum (DCSS) using high-field magnetic resonance imaging (MRI) for anatomoclinical and epidemiological correlations. This single-center retrospective study analyzed all 3-Tesla MRIs consecutively performed for painful wrists in 295 patients. Two blinded readers performed measurements. The protocol included T1 spin echo and 3D proton density sequences with fat saturation. Inter-observer reliability was assessed using kappa and intra-class correlation coefficients for cyst detection and volumetry, respectively. Disagreements concerning cyst detection were resolved by a consensus reading. Cyst size, relationship to extrinsic and scapholunate ligaments (SL), continuity of SL, minimum distance to the posterior interosseous nerve (PIN), cyst communication with joint, and anatomical classifications of cysts were analyzed. Correlation tests were performed to assess associations. Two-hundred ninety-five patients (mean age 39.6 +/- 15.6 (standard deviation), 161 males) were evaluated for detection of dorsal wrist cysts identified in 150/295. In this subgroup, the mean age was 38.7 years (15-75), the sex ratio of 0.6 (59% women), and the median volume cyst of 8.7 mm3 (0.52-2555). Cyst detection, volume, and major axis measurements showed very high agreement between observers, respectively, 0.89, 0.96, and 0.91. 42 patients had dorsal SL pain. A weak negative correlation was found between distance to PIN and dorsal SL pain (r = -0.2415; p < 0.05) and a weak positive correlation between Guérini's classification and dorsal SL pain (r = 0.2466; p < 0.05). High-field MRI is the modality of choice for the detection, anatomical, and volumetric assessment of dorsal cysts. Preoperative assessment will be aided by the proposed revised anatomical classification. High-field MRI is the modality of choice for the anatomical study of dorsal ganglion cysts. It allows the radiologist to accurately describe the anatomical relationships, size, and visibility of the pedicle, essential information for the surgeon's preoperative assessment. Dorsal mucoid wrist ganglion is a condition for which prevalence remains to be determined. High-field MRI is a reproducible imaging modality for the detection and assessment of dorsal wrist cysts. High-field MRI has a key role in the preoperative management of dorsal mucoid cysts.

Preliminary validation of the Norwegian version of the Berlin Misophonia Questionnaire Revised (BMQ-R-NOR).

To perform a psychometric evaluation of a Norwegian version of the Berlin Misophonia Questionnaire Revised (BMQ-R-NOR). Participants completed online versions of the self-report questionnaire BMQ-R-NOR on two occasions and MQ-NOR on one occasion. Convergent validity was assessed through Spearman's correlation between BMQ-R-NOR and MQ-NOR. Internal consistency was evaluated with McDonald's omega and Cronbach's alpha. Test-retest reliability was evaluated using Cohen's weighted kappa and intraclass correlation. 82 participants with self-reported misophonia took part in the study at T1, and 53 of these participated at T2. However, only 41 of them were included in the test-retest analyses due to 12 participants being in treatment between T1 and T2. Subscales from the BMQ-R-NOR and MQ-NOR were significantly positively correlated, indicating evidence of convergent validity (rs = 0.22*-0.74**). The BMQ-R-NOR showed overall good internal consistency (omega = 0.72-0.93; alpha = 0.70-0.93) and satisfactory test-retest reliability (ICC = 0.35-0.92). The psychometric properties of the BMQ-R-NOR are considered satisfactory. However, it is advised to exercise caution when using it until further comprehensive validation studies are conducted to ensure robustness and reliability in clinical practice.

Inter-rater reliability of ACS-NSQIP colorectal procedure coding in Canada

BackgroundThe American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) uses Current Procedural Terminology (CPT) codes for risk-adjusted calculations. This study evaluates the inter-rater reliability of coding colorectal resections across Canada by ACS-NSQIP surgical clinical nurse reviewers (SCNR) and its impact on risk predictions. MethodsSCNRs in Canada were asked to code simulated operative reports. Percent agreement and free-marginal kappa correlation were calculated. The ACS-NSQIP risk calculator was utilized to illustrate its impact on risk prediction. ResultsResponses from 44 of 150 (29.3 ​%) SCNRs revealed 3 to 6 different codes chosen per case, with agreement ranging from 6.7 ​% to 62.3 ​%. Free-marginal kappa correlation ranged from moderate agreement (0.53) to high disagreement (−0.17). ACS-NSQIP risk calculator predicted large absolute differences in risk for serious complications (0.2 ​%–13.7 ​%) and mortality (0.2 ​%–6.3 ​%). ConclusionThis study demonstrated low inter-rater reliability in coding ACS-NSQIP colorectal procedures in Canada among SCNRs, impacting risk predictions.

Translation and validation of the Myasthenia Gravis Activities of Daily Living Questionnaire: Latvian version.

Our aim was to translate, adapt and validate the Myasthenia Gravis Activities of Daily Living scale into the Latvian language and to evaluate this instrument (MG-ADL-L) in terms of construct validity and reliability. We enrolled patients with a confirmed MG diagnosis, who could speak Latvian fluently. We performed translation and adaptation according to the cross-cultural adaptation guidelines for self-reported measures. The patients were evaluated by a physician according to the Myasthenia Gravis Foundation of America classification (MGFA) and using the Myasthenia Gravis Composite Score (MGCS). Patients were asked to complete the MG-ADL-L and the 15-item Myasthenia Gravis Quality of Life (MGQOL15) Internal consistency was evaluated based on Cronbach's α, reproducibility-Cohen's weighted kappa and construct validity-Spearman's correlation between the MG-ADL-L and the MGQOL15 and MGCS. We used the Kruskal-Wallis H test to compare the MG-ADL-L score distribution between the MGFA groups. 38 enrolled patients in the study. There was an acceptable internal consistency (Cronbach's α = 0.76) and moderate to very good agreement between the test and retest scores (Cohen's weighted kappa = 0.54 and 0.81). The MG-ADL-L showed a moderate positive correlation with the MGQOL15 (r = 0.5, p = 0.001) and the MGCS (r = 0.62, p < 0.001). There was a significant difference in MG-ADL-L scores between the MGFA groups (p = 0.007). The MG-ADL-L is a valid and reliable self-reported scale to assess and evaluate symptom severity and the impact of the disease on the lives of patients with MG.