Krippendorff's Alpha Research Articles

Investigating the feasibility of 18F-flortaucipir PET imaging in the antemortem diagnosis of primary age-related tauopathy (PART): An observational imaging-pathological study.

Primary age-related tauopathy (PART) is characterized by neurofibrillary tangles and minimal β-amyloid deposition,diagnosed postmortem.This study investigates18F-flortaucipir(FTP) PET imaging for antemortem PART diagnosis. We analyzed FTP PET scans from 50 autopsy-confirmed PART and 13 control subjects. Temporal lobe uptake was assessed both qualitatively and quantitatively. Demographic and clinicopathological characteristics and voxel-level uptake using SPM12 were compared between FTP-positive and FTP-negative cases. Intra-reader reproducibility was evaluated with Krippendorff's alpha. Minimal/mild and moderate FTP uptake was seen in 32% of PART cases and 62% of controls, primarily in the left inferior temporal lobe. No demographic or clinicopathological differences were found between FTP-positive and FTP-negative cases. High intra-reader reproducibility (α=0.83) was noted. FTP PET imaging did not show a specific uptake pattern for PART diagnosis, indicating that in vivo PART identification using FTP PET is challenging. Similar uptake in controls suggests non-specific uptake in PART. 18F-flortaucipir (FTP) PET scans were analyzed for diagnosing PART antemortem. 32% of PART cases had minimal/mild FTP uptake in the left inferior temporal lobe. Similar to PART FTP uptake was found in 62% of control subjects. No specific uptake pattern was found, challenging in vivo PART diagnosis.

Using Immersive Virtual Reality to Classify Pediatric Thoracolumbar Spine Injuries.

Objective This study aimed to assess the reliability and reproducibility of the AO Spine Thoracolumbar Injury Classification System by using virtual reality (VR). We hypothesized that VR is a highly reliable and reproducible method to classify traumatic spine injuries. Methods VR 3D models were created from CT scans of 26 pediatric patients with thoracolumbar spine injuries. Seven orthopedic trainees were educated on the VR platform and AO Spine Thoracolumbar Injury Classification System. Classifications were summarized by primary class and subclass for both rater readings performed two weeks apart with image order randomized. Intra-observer reproducibility was quantified by Fleiss's kappa (kF) for primary classifications and Krippendorff's alpha (aK) for subclassifications along with 95% confidence intervals (CIs) for each rater and across all raters. Inter-observer reliability was quantified by kFfor primary classifications and aKfor subclassifications along with 95% CIs across all raters for the first read, the second read, and all reads combined. The interpretations were as follows: 0-0.2: slight; 0.2-0.4: fair; 0.4-0.6: moderate; 0.6-0.8: substantial; and >0.8: almost perfect agreement. Results A total of 364 classifications were submitted by seven raters. Intra-observer reproducibility ranged from moderate (kF=0.55) to almost perfect (kF=0.94) for primary classifications and from substantial (aK=0.68) to almost perfect (aK=0.91) for subclassifications. Reproducibility was substantial across all raters for the primary class (kF=0.71; 95% CI=0.61-9.82) and subclass (aK=0.79; 95% CI=0.69-0.86). Inter-observer reliability was substantial (kF=0.63; 95% CI=0.57-0.69) for the first read, moderate (kF=0.58; 95% CI=0.52-0.64) for the second read, and substantial (kF=0.61; 95% CI=0.56-0.65) for all reads for primary classifications. For subclassifications, inter-observer reliability was substantial (aK=0.74; 95% CI=0.58-0.83) for the first read, second read (aK=0.70; 95% CI=0.53-0.80), and all reads (aK=0.72; 95% CI=0.60-0.79). Conclusions Based on our findings, VR is a reliable and reproducible method for the classification of pediatric spine trauma, besides its ability to function as an educational tool for trainees. Further research is needed to evaluate its application for other spine conditions.

Observation system for the technical-tactical analysis of judo by the Rio 2016 Olympic champions.

An observational methodology system has been designed which allows the observation and analysis of the technical-tactical behaviour and interaction of judokas during competition. The observation instrument (JUTACTIC) is composed of 8 fixed criteria that provide information related to the competition and the competitors and 13 variable criteria that, throughout the intrasessional monitoring of each combat, allow the behaviour displayed by both judokas and their interaction to be recorded. From an observational sample consisting of matches from the Rio 2016 Olympic champions and the corresponding samples made using the LINCE PLUS software, evidence of validity, reliability, generalizability and applicability of the observation system is provided. The content validity of the observation instrument has been endorsed by a panel of experts (n = 11). Intra and inter-observer reliability has been guaranteed from the results obtained in the Fleiss Kappa and the Krippendorff Alpha. The generalizability analysis with the design structure [Category] [Participants] / [Matches] has confirmed that around seven matches are needed to accurately analyse the behaviour of the competitor under study. The practical application possibilities of the observation instrument has been shown with an example of the results obtained and the regular behaviour structures detected (T-patterns) using the THEME software.

Grading lumbar foraminal stenosis - Interrater agreement of radiologists and radiology trainees before and after education of a standardised grading scale.

Lumbar foraminal stenosis is a key contributor to low back pain. Imaging, particularly MRI, is commonly used in the assessment of foraminal stenosis, contributing to treatment planning. The adoption of a standardised grading system to try and improve inter-rater agreement is thought to be of importance. Our study aims to assess the variability of grading lumbar foraminal stenosis amongst reporting doctors, determine whether education about a validated grading scale increases agreement, and determine if these changes persist over time. A single-site study involving MRI reporting registrars/radiologists was performed. Participants were shown select MRI images and asked to grade the degree of stenosis in each on a 4-point scale. Subsequently, they were educated about Lee etal's grading system and asked to re-grade the cases 1 and 6 weeks later. The level of agreement was calculated using Gwet's AC1 coefficient and Krippendorff's Alpha. The baseline level of agreement was substantial (AC1 = 0.71). This decreased to a moderate level of agreement post-intervention (AC1 = 0.575 at 1-week, P-value 0.033 and AC1 = 0.598 at 6 weeks, P-value 0.012). A grading of severe stenosis was 21% more likely 6 weeks post-education. The baseline agreement at our institution was substantial, thought to be due to the single-centre nature of the study. Moderate agreement was achieved after education regarding the Lee etal.'s scale, in-line with other studies, with changes maintained at 6 weeks, showing retention of the scale parameters. Grading of severe stenosis was more common post intervention.

Workflow for detecting biomedical articles with underlying open and restricted-access datasets.

To monitor the sharing of research data through repositories is increasingly of interest to institutions and funders, as well as from a meta-research perspective. Automated screening tools exist, but they are based on either narrow or vague definitions of open data. Where manual validation has been performed, it was based on a small article sample. At our biomedical research institution, we developed detailed criteria for such a screening, as well as a workflow which combines an automated and a manual step, and considers both fully open and restricted-access data. We use the results for an internal incentivization scheme, as well as for a monitoring in a dashboard. Here, we describe in detail our screening procedure and its validation, based on automated screening of 11035 biomedical research articles, of which 1381 articles with potential data sharing were subsequently screened manually. The screening results were highly reliable, as witnessed by inter-rater reliability values of ≥0.8 (Krippendorff's alpha) in two different validation samples. We also report the results of the screening, both for our institution and an independent sample from a meta-research study. In the largest of the three samples, the 2021 institutional sample, underlying data had been openly shared for 7.8% of research articles. For an additional 1.0% of articles, restricted-access data had been shared, resulting in 8.3% of articles overall having open and/or restricted-access data. The extraction workflow is then discussed with regard to its applicability in different contexts, limitations, possible variations, and future developments. In summary, we present a comprehensive, validated, semi-automated workflow for the detection of shared research data underlying biomedical article publications.

Evaluation of the Oral Hygiene Ability Instrument (OHAI): Test of reliability.

To evaluate the reliability of the new Oral Hygiene Ability Instrument (OHAI) developed to assess the cause of any inability for older adults to manage oral hygiene self-care. Oral hygiene is an important part of oral health. The inability to manage oral hygiene, combined with other risk factors, often results in poor oral health and impaired quality of life. A reliable OHAI could benefit preventive oral health care. The preliminary OHAI uses 33 items in three parts: (I) interview, (II) clinical examination and (III) observation of oral hygiene activities. A total of 37 older adults participated in a test-retest study of Part I. Inclusion criteria were age ≥ 65 years, have at least one tooth and be able to oral hygiene self-care. The intra- and inter-rater reliability of parts II and III used films and photographs of OHAI assessments of 15 different individuals. These films/photographs were assessed twice by four dental professionals who had participated in the OHAI data collection. For statistical analyses of the reliability, per cent agreement, Krippendorff's alpha and E. Svensson's method were used. The test-retest for Part I items showed acceptable-to-good agreement and no systematic disagreement. In Part II, two items showed somewhat limited reliability. Part III showed good intra- and inter-rater reliability. The OHAI items seem stable and reliable for the intended sample, and the instrument may be a valuable tool to identify older adults at risk of impaired oral health. However, two items may need to be reformulated.

A Tool for the Assessment of Swallowing Safety and Efficiency in Adults: Turkish Adaptation of Boston Residue and Clearance Scale.

The objective of this study was to create a Turkish language adaptation of the Boston Residue and Clearance Scale (BRACS), a validated and reliable tool. The BRACS scale was first translated into Turkish and a Turkish version was subsequently developed. Fiberoptic endoscopic examination of swallowing (FEES) was administered to collect data from 25 dysphagic patients who were hospitalized after a stroke. The recorded films were subjected to editing procedures to ensure their appropriateness for the assessment of swallowing disorders and were then dispatched to a panel of five speech and language therapists for evaluation using the adaptation of the BRACS instrument. The scoring by the experts was evaluated using both explanatory factor analysis (EFA) and confirmatory factor analysis (CFA). Convergent validity, item reliability, and construct (composite) reliability were measured by calculating the average variance extracted (AVE) values. For the 12 location items, EFA revealed 3 main latent factors: the laryngeal vestibule and the oropharynx and hypopharynx. The Turkish BRACS had excellent inter-rater reliability (Krippendorff's alpha coefficient values ranged from 0.93 to 0.95) and high internal consistency (Cronbach's alpha values ranged from 0.88 to 0.93). Inter-rater ICCs for the first and second sessions were 0.83 and 0.85, respectively. CFA showed that all fitted criteria reached acceptable or perfect fit levels. The findings indicated that the proposed factor structure was validated. The AVE values are between 0.61 and 0.73 which was taken as evidence of convergent validity. The Turkish adaptation of the BRACS tool demonstrates both reliablity and validity, rendering it a useful and credible tool for assessing residual severity, particularly in clinical settings.

Assessment of adaptive behavior in people with intellectual disabilities: Design and development of a new test battery

BackgroundAdaptive behavior is an important characteristic of people with intellectual disabilities, and it has been associated with a person's performance in social and work contexts. Indeed, adaptive behavior denotes what a person does independently, without help, support, reminders, or prompts. In Peru, available measures of adaptive behavior are commercial; thus, there is a need for an open-access tool to assess the adaptive behavior of people with intellectual disabilities. For this reason, the aim of the study was to design and develop a new Adaptive Behavior Test Battery for people from 13 to 60 years old with intellectual disabilities who have an interest in being part of the economically active population. MethodsA cross-sectional design was defined, starting with a qualitative approach to designing and constructing the item pool for the test battery. Then, quantitative indexes Aiken's V for content validity and Krippendorff's alpha for inter-observer reliability were estimated, resulting in a first version of the three subscales that comprised the test battery. The initial versions were tested on a sample of 566 persons with intellectual disabilities from two regions of Peru: Lima (Coast) and San Martín (Jungle). The internal structure was analyzed under a factor analysis approach, along with internal consistency measures of reliability. Further analyses of invariance regarding gender, region, and age were carried out. ResultsThree observer subscales were proposed: Daily living activities (11 items), Instrumental skills (4 items), and Communication (9 items). All subscales showed excellent psychometric properties denoted by the Aiken's V coefficient, Krippendorff's alpha, factor analysis, internal consistency analysis, and invariance analyses. ConclusionThe developed a new Adaptive Behavior Test Battery is a useful tool for the measurement of adaptive behavior and the monitoring of social and labor inclusion programs for people with intellectual disabilities.

MIMIC: Misogyny Identification in Multimodal Internet Content in Hindi-English Code-Mixed Language

Over the years, social media has emerged as one of the most popular platforms where people express their views and share thoughts about various aspects. The social media content now includes a variety of components such as text, images, videos etc. One type of interest is memes, which often combine text and images. It is relevant to mention here that, social media being an unregulated platform, sometimes also has instances of discriminatory, offensive and hateful content being posted. Such content adversely affects the online well-being of the users. Therefore, it is very important to develop computational models to automatically detect such content so that appropriate corrective action can be taken. Accordingly, there have been research efforts on automatic detection of such content focused mainly on the texts. However, the fusion of multimodal data (as in memes) creates various challenges in developing computational models that can handle such data, more so in the case of low-resource languages. Among such challenges, the lack of suitable datasets for developing computational models for handling memes in low-resource languages is a major problem. This work attempts to bridge the research gap by providing a large-sized curated dataset comprising 5,054 memes in Hindi-English code-mixed language, which are manually annotated by three independent annotators. It comprises two subtasks: (i) Subtask-1 (Binary classification involving tagging a meme as misogynous or non-misogynous), and (ii) Subtask-2 (multi-label classification of memes into different categories). The data quality is evaluated by computing Krippendorff's alpha. Different computational models are then applied on the data in three settings: text-only, image-only, and multimodal models using fusion techniques. The results show that the proposed multimodal method using the fusion technique may be the preferred choice for the identification of misogyny in multimodal Internet content and that the dataset is suitable for advancing research and development in the area.

Methodologies and key considerations for implementing the International Classification of Diseases-11th revision morbidity coding: insights from a national pilot study in China.

The aim of this study was to disseminate insights from a nationwide pilot of the International Classification of Diseases-11th revision (ICD-11). The strategies and methodologies employed to implement the ICD-11 morbidity coding in 59 hospitals in China are described. The key considerations for the ICD-11 implementation were summarized based on feedback obtained from the pilot hospitals. Coding accuracy and Krippendorff's alpha reliability were computed based on the coding results in the ICD-11 exam. Among the 59 pilot hospitals, 58 integrated ICD-11 Coding Software into their health information management systems and 56 implemented the ICD-11 in morbidity coding, resulting in 3723959 diagnoses for 873425 patients being coded over a 2-month pilot coding phase. The key considerations in the transition to the ICD-11 in morbidity coding encompassed the enrichment of ICD-11 content, refinement of tools, provision of systematic and tailored training, improvement of clinical documentation, promotion of downstream data utilization, and the establishment of a national process and mechanism for implementation. The overall coding accuracy was 82.9% when considering the entire coding field (including postcoordination) and 92.2% when only one stem code was considered. Krippendorff's alpha was 0.792 (95% CI, 0.788-0.796) and 0.799 (95% CI, 0.795-0.803) with and without consideration of the code sequence, respectively. This nationwide pilot study has enhanced national technical readiness for the ICD-11 implementation in morbidity, elucidating key factors warranting careful consideration in future endeavors. The good accuracy and intercoder reliability of the ICD-11 coding achieved following a brief training program underscore the potential for the ICD-11 to reduce training costs and provide high-quality health data. Experiences and lessons learned from this study have contributed to WHO's work on the ICD-11 and can inform other countries when formulating their transition plan.

Adapting the Client Priority Rating Scale to better fit the sexual health counselling setting: a quality improvement study.

When demand for counselling in community-based clinics exceeds capacity, waiting lists are typically formed. Determining allocation priority solely on wait time can overlook client risk factors that can elevate priority. We undertook to rigorously adapt the only existing validated counselling triage tool, to better fit the sexual health setting. Sexual health counsellors were surveyed about aspects of client presentations that flagged increased priority. The revised Client Priority Rating Scale (CPRS-R) was created through systematic analysis and decision making, informed by survey results and literature review. Four expert sexual health counsellors independently rated the priority of 14 hypothetical clinical vignettes using the CPRS and CPRS-R. Criterion (concurrent), content and face validity are evidenced in the revised scale. Average interrater agreement was higher on the CPRS-R (28%) than the CPRS (11%); however, this difference was marginal (P =0.06). According to Gwet's Agreement Coefficient (AC) and Krippendorff's Alpha, both the CPRS and the CPRS-R demonstrate comparable interrater reliability, substantial and moderate, respectively. Kendall's W indicates the CPRS yielded higher reliability. However, the difference is not substantial. The CPRS-R is a triage tool designed for the sexual health counselling setting. This tool has demonstrated criterion, content and face validity, as well as moderate to substantial inter-rater reliability. It can be used in sexual health settings to inform assessments about client priority, along with clinical judgement and peer consultation.

Interobserver variability in thyroid ultrasound.

Ultrasound evaluation of thyroid nodules is the preferred technique, but it is dependent on operator interpretation, leading to inter-observer variability. The current study aimed to determine the inter-physician consensus on nodular characteristics, risk categorization in the classification systems, and the need for fine needle aspiration puncture. Four endocrinologists from the same center blindly evaluated 100 ultrasound images of thyroid nodules from 100 different patients. The following ultrasound features were evaluated: composition, echogenicity, margins, calcifications, and microcalcifications. Nodules were also classified according to ATA, EU-TIRADS, K-TIRADS, and ACR-TIRADS classifications. Krippendorff's alpha test was used to assess interobserver agreement. The interobserver agreement for ultrasound features was: Krippendorff's coefficient 0.80 (0.71-0.89) for composition, 0.59 (0.47-0.72) for echogenicity, 0.73 (0.57-0.88) for margins, 0.55 (0.40-0.69) for calcifications, and 0.50 (0.34-0.67) for microcalcifications. The concordance for the classification systems was 0.7 (0.61-0.80) for ATA, 0.63 (0.54-0.73) for EU-TIRADS, 0.64 (0.55-0.73) for K-TIRADS, and 0.68 (0.60-0.77) for K-TIRADS. The concordance in the indication of fine needle aspiration puncture (FNA) was 0.86 (0.71-1), 0.80 (0.71-0.88), 0.77 0.67-0.87), and 0.73 (0.64-0.83) for systems previously described respectively. Interobserver agreement was acceptable for the identification of nodules requiring cytologic study using various classification systems. However, limited concordance was observed in risk stratification and many ultrasonographic characteristics of the nodules.

Accuracy and inter-rater agreement among practitioners using quick thoracic ultrasonography to diagnose calf pneumonia.

Thoracic ultrasonography (TUS) is a commonly used tool for on-farm detection of pneumonia in calves. Different scanning methods have been described, but the performance of novice practitioners after training has not been documented. In this study, 38 practitioners performed quick TUS (qTUS) on 18-23 calves each. Pneumonia was defined as lung consolidation 1cm or more in depth. Diagnostic parameters (accuracy [Acc], sensitivity [Se] and specificity [Sp]) were compared to those of an experienced operator. Cohen's kappa and Krippendorff's alpha (Kalpha) were determined. The potential effects of training and exam sessions on performance were evaluated. The average relative Se and Sp were 0.66 (standard deviation [SD] = 0.26; minimum [Min.]-Maximum [Max.] = 0-1) and 0.71 (SD = 0.19; Min.-Max. = 0.25-1), respectively. The average relative Acc was 0.73 (SD = 0.11; Min.-Max. = 0.52-0.96). Over all sessions, Cohen's kappa averaged 0.40 (SD = 0.24; Min.-Max. = 0.014-0.90) and Kalpha was 0.24 (95% confidence interval [CI]: 0.20-0.27), indicating 'fair' agreement. Calf age and housing influenced Se and Sp. Supervised practical training improved Se by 17.5% (95% CI: 0.01-0.34). The separate effects of calf age and housing could not be determined. This study showed that qTUS, like any other clinical skill, has a learning curve, and variability in performance can be substantial. Adequate training and certification of one's skill are recommended to assure good diagnostic accuracy.

Cross-cultural adaptation and reliability assessment of the Indonesian version of the Computer Workstation Ergonomics: Self-Assessment Checklist.

Prolonged use of computer devices can have adverse health effects, but these can be mitigated by setting up computer workstations according to ergonomic principles. The Computer Workstation Ergonomics: Self-Assessment Checklist can guide workers in implementing these principles. However, the checklist is only available in English, which may reduce the accuracy of the instrument when used by non-English speakers, including Indonesians. The objective of this study was to cross-culturally adapt the Computer Workstation Ergonomics: Self-Assessment Checklist for use in Indonesia. Additionally, a reliability assessment was conducted on the adapted checklist. This study followed a six-stage cross-cultural adaptation process, including translation, synthesis of translation, back translation, expert committee review, pretesting, and documentation submission. The final version of the adapted checklist underwent testing for intra-rater reliability, inter-rater reliability, and internal consistency. The cross-cultural adaptation process resulted in an Indonesian version of the Computer Workstation Ergonomics: Self-Assessment Checklist. Furthermore, the Krippendorff's alpha values for the intra-rater and inter-rater reliability of the adapted checklist ranged from 0.59 to 0.78 (mean = 0.70) and 0.20 to 0.82 (mean = 0.56), respectively. The study produced an Indonesian version of the Computer Workstation Ergonomics: Self-Assessment Checklist that had an adequate reliability. The adapted checklist can serve as a practical tool for evaluating and improving computer workstations in Indonesia.

K-Alpha Calculator–Krippendorff's Alpha Calculator: A user-friendly tool for computing Krippendorff's Alpha inter-rater reliability coefficient

Krippendorff's Alpha is a measure for assessing inter-rater reliability, facilitating triangulated evaluations among multiple raters. Indeed, Krippendorff's Alpha is key in validating the dependability of human assessments, thereby reinforcing the robustness of human-based choices in contexts where interpretive variability could otherwise undermine the research outcomes. Despite its versatility across various data types, the procedure for computing this coefficient might limit its applicability for researchers unfamiliar with specialised statistical software. Addressing this issue, this paper introduces the “K-Alpha Calculator”—Krippendorff's Alpha Calculator—a freely accessible, user-friendly, web application available at https://www.k-alpha.org designed for easy computation of Krippendorff's Alpha. By offering a web interface without any software dependency, the K-Alpha Calculator seeks to promote the broader integration of such a reliability metric in research processes. We envisage that the tool's contribution could support researchers in enhancing methodological rigour, fostering conclusions are rooted in triangulated interpretations and assessments. The K-Alpha Calculator is both a computational tool and an educational resource, encouraging more researchers to include reliability measures in their studies.•Development of the K-Alpha Calculator.The study centres on the introduction of a web-based application: the K-Alpha Calculator. The tool is developed to simplify the calculation of Krippendorff's Alpha without any required software dependency.•User-friendly interface for diverse data types.The K-Alpha Calculator is characterised by its accessibility and user-friendliness, designed to simplify the procedures for computing the Krippendorff's Alpha. Its utility extends to various data types, which aligns with the intrinsic versatility of this coefficient.

Improved visualization of cochlear implant electrodes on photon counting detector CT

AbstractBackgroundCochlear implants (CIs) are used to rehabilitate moderate to profound sensorineural hearing loss and stimulate the auditory system via a multichannel electrode array positioned in the scala tympani. Imaging evaluation of CIs is substantially degraded by metallic artifacts. Photon‐counting detector (PCD)‐CT has the potential to minimize such artifacts, though this has not been convincingly established in prior studies. This study compared the visualization of CI electrodes on PCD‐CT to conventional energy integrating detector (EID)‐CT.Materials and MethodsFive patients with CIs were prospectively recruited to undergo temporal bone imaging on both EID‐CT and PCD‐CT scanners yielding 2D and 3D Volume Rendering Technique (VRT) images. Three nonblinded neuroradiologists reviewed 2D and 3D VRT images for the ability to resolve CI electrode leads using a Likert scale. The average Likert scores of PCD‐CT versus EID‐CT were calculated for each reader for both 2D and 3D VRT images. (Likert scores 1–5 based on inferior to superior rating of PCD‐CT compared to EID‐CT). Inter‐rater agreement was assessed using Krippendorff's alpha with ordinal weights. ResultsFive patients underwent temporal bone CT for CI array evaluation. As evidenced by 5‐point Likert scales that were independently used by the three reviewers, this study demonstrated superior resolution of CI electrode array using PCD‐CT as compared to EID‐CT with an average score of 4.2 ± 0.8 for 2D images and 4.9 ± 0.4 for 3D VRT images.ConclusionsPCD‐CT is superior to EID‐CT in the visualization of CI electrodes, particularly in 3D VRT imaging.

Turkish validity and reliability study on the quick aphasia battery.

The quick aphasia battery (QAB), which assesses all areas of language in detail and quickly, was developed in English. It has been shown to be suitable for bedside patients. There is a need for a Turkish bedside test that allows for a comprehensive yet rapid assessment of stroke patients in terms of aphasia. The aim of this study was to create a Turkish version of QAB (QAB-TR) and to determine its validity and reliability in Turkish-speaking patients after a stroke. The study was conducted with 188 people aged 41-88 years. Of these, 37 (19.7%) had aphasia (12 chronic, 25 acute), 53 (28.2%) were acute stroke patients without aphasia, and 98 (52.1%) were healthy controls. Internal consistency and criterion validity, test-retest reliability, and inter-rater reliability of the QAB-TR were performed. The language assessment test for aphasia was used for criterion validity. For the inter-rater reliability of the test, two different speech language therapists (SLP) administered the QAB-TR. For test-retest reliability, 2 weeks later, the same SLP who filled out the QAB-TR the first time was administered the test again. To test the validity of the test, correlations between the items and subsections were determined. Receiver operating characteristic (ROC) analysis was performed to examine the sensitivity and selectivity of the QAB-TR score, and a cut-off value was determined to distinguish patients with aphasia. The inter-rater Krippendorff's alpha value of the QAB-TR total was 0.6754. There was no statistically significant difference (p>.05) between the first and second QAB-TR total scores. The correlation analysis between the QAB-TR subsection scores and the total QAB-TR score (0.244-0.897) revealed statistically significant relationships. The area under the ROC curve was statistically significant and was found to be 0.853 (95% confidence interval: 0.799-0.906). The cut-off point for the QAB score to discriminate between patients with aphasia and those without aphasia was found to be 8.825, with 0.767 sensitivity and 0.765 selectivity (1-0.235). All the study results show that QAB-TR has internal consistency, criterion validity, test-retest reliability, and inter-rater reliability. It can be administered in as little as 15min and provides information about the multidimensional linguistic profiles of individuals. QAB-TR can be used for both clinical and study purposes as a language battery that allows for the measurement of the strengths and weaknesses of Turkish-speaking individuals who have suffered a stroke in basic language areas in acute and chronic periods. It can be easily administered at the bedside for individuals who have just suffered an acute stroke and can facilitate early assessment of individuals in terms of aphasia and early initiation of therapy, if necessary.

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

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

Automated Image Quality and Protocol Adherence Assessment of Examinations in Teledermatology: First Results.

Introduction: Image quality and acquisition protocol adherence assessment is a neglected area in teledermatology. We examine if it is feasible to use deep learning methods to automate the assessment of the adherence of examinations to image acquisition protocols. In this study, we focused on the quality criteria of two image acquisition protocols: (1) approximation image and (2) panoramic image, as these are present in all teledermatology examination protocols currently used by the Santa Catarina State Integrated Telemedicine and Telehealth System (STT/SC). Methods: We use a data set of 36,102 teledermatological examinations performed at the STT/SC during 2021. As our validation process, we adopted standard machine learning metrics and an inter-rater agreement (IRA) study with 11 dermatologists. For the approximation image protocol, we used the Mask-Region based Convolutional Neural Network (RCNN) Object Detection Deep Learning (DL) architecture to identify the presence of a lesion identification tag and a ruler used to provide a frame reference of the lesion. For the panoramic image protocol, we used DensePose, a pose estimation DL, architecture to assess the presence of a whole patient body and its orientation. A combination of the two approaches was additionally validated through an IRA study between specialists. Results: Mask-RCNN achieved a score of 96% mean average precision (mAP), while DensePose presented 75% mAP. IRA achieved a level of agreement of 96.68% with the Krippendorff alpha score. Conclusions: Our results show the feasibility of using deep learning to automate the image quality and protocol adherence assessment in teledermatology, before the specialist's manual analysis of the examination.

Sexual and Gender Minority Patients’ First Pelvic Examination Experiences: What Clinicians Need to Know

This study aims to identify factors that influence the first pelvic exam experiences of sexual and gender minority (SGM) adolescents and young adults who were assigned female at birth (AFAB). Using purposive sampling, we recruited SGM AFAB individuals, ages 18 to 24, who had at least one pelvic examination. Semi-structured interviews and an iterative approach allowed for the emergence of factors influencing the first pelvic exam experience. Items included in the final code directory had Krippendorff's alpha intercoder reliability score > 0.7. Interviews were analyzed using ATLAS.ti. Thirty participants completed interviews. Fourteen participants identified as bisexual, two gay, one lesbian, three pansexual, eight queer, and two straight/heterosexual. Sixteen participants identified as cisgender, nine genderqueer/gender nonconforming, and five transgender. Factors influencing the first pelvic exam experience were organized as patient or clinician level factors. Patient Level Factors: Gender identity, sexual orientation, history of sexual trauma, and participant's relationship to their body were central factors influencing the exam experience. Speculum insertion during the exam induced anxiety and pain for some. Clinician Level Factors: Clinicians' gender, age, and race or ethnicity influenced the exam experience. Most participants preferred detailed communication. Participants offered recommendations to ensure gender-affirming, patient-centered care during the first pelvic exam. SGM AFAB individuals identify patient and clinician-level factors influencing their first pelvic exam experiences. This study underscores the need for changes in medical education and health systems to ensure SGM AFAB individuals have their needs met and feel comfortable in reproductive health settings.