Objectively Assessed Research Articles

Development and validation of the objective assessment of robotic suturing and knot tying skills for chicken anastomotic model.

To improve patient safety, there is an imperative to develop objective performance metrics for basic surgical skills training in robotic surgery. To develop and validate (face, content, and construct) the performance metrics for robotic suturing and knot tying, using a chicken anastomotic model. Study 1: In a procedure characterization, we developed the performance metrics (i.e., procedure steps, errors, and critical errors) for robotic suturing and knot tying, using a chicken anastomotic model. In a modified Delphi panel of 13 experts from four EU countries, we achieved 100% consensus on the five steps, 18 errors and four critical errors (CE) of the task. Study 2: Ten experienced surgeons and nine novice urology surgeons performed the robotic suturing and knot tying chicken anastomotic task. The mean inter-rater reliability for the assessments by two experienced robotic surgeons was 0.92 (95% CI, 0.9-0.95). Novices took 18.5min to complete the task and experts took 8.2min. (p = 0.00001) and made 74% more objectively assessed performance errors than the experts (p = 0.000343). We demonstrated face, content, and construct validity for a standard and replicable basic anastomotic robotic suturing and knot tying task on a chicken model. Validated, objective, and transparent performance metrics of a robotic surgical suturing and knot tying tasks are imperative for effective and quality assured surgical training.

Comparison of subjectively and objectively assessed sleep problems in breast cancer patients starting neoadjuvant chemotherapy

PurposeTo characterize sleep problems and to compare subjective and objective assessments in breast cancer patients starting neoadjuvant chemotherapy.MethodsSleep characteristics of 54 breast cancer patients starting neoadjuvant chemotherapy were analyzed. Subjective sleep characteristics were assessed with the Pittsburgh Sleep Quality Index (PSQI) and objective sleep measurements with an accelerometer (ActiGraph wGT3X-BT) worn on the wrist for 7 consecutive days.ResultsAccording to the common PSQI cut-off of 8, 10 (18.87%) of the patients were poor sleepers. ActiGraph measures did not mirror this classification as values for poor, and good sleepers did not differ significantly. Overall, Bland-Altman plots illustrated higher ActiGraph values for sleep efficiency and effective sleep time and lower values for sleep latency, compared with PSQI. For total sleep time, less disagreement between both measures was observed. Actigraphy was limited in precise identification of sleep begin and sleep latency but provided supplementary information about number and minutes of awakenings during the night.ConclusionSubjective and objective measurement methods differed substantially in various parameters, with limitations in both methods. A combination of both methods might be most promising.Trial RegistrationClinicaltrials.gov: NCT02999074

A case study comparison of objective and subjective evaluation methods of physical qualities in youth soccer players

ABSTRACT Subjective and objective assessments may be used congruently when making decisions regarding player recruitment in soccer, yet there have been few attempts to examine the level of agreement between these methods. Therefore, we compare levels of agreement between subjective and objective assessments of physical qualities associated with youth soccer performance. In total, 80 male youth soccer players (13.2 ± 1.9 years), and 12 professional coaches volunteered to participate. Players were objectively assessed using five fitness measures: Yo-Yo Intermittent Recovery Test Level 1; Countermovement vertical jump; Functional Movement Screen™; 5/20 m sprint; alongside anthropometric measures. Additionally, coaches subjectively rated each player on the same five physical qualities using 5-point Likert scales. Inter-rater agreement between ratings from lead and assistant coaches was established for each age group. Moreover, Bayesian regression models were fitted to determine how well coach ratings were able to predict fitness test performance. Although inter-rater agreement between lead and assistant coaches was moderate-to-substantial (ω = 0.48–0.68), relationships between coaches subjective rating’s and corresponding fitness test performance were only highly related for the highest and lowest performing players. We suggest that while ratings derived from objective and subjective assessment methods may be related when attempting to differentiate between distinct populations, concerns exist when evaluating homogeneous samples using these methods. Our data highlight the benefits of using both types of measures in the talent identification process.

Cognitive function in long-term lymphoma survivors: relationship between subjective reports and objective assessments and with quality of life

ABSTRACT Cognitive functioning plays a fundamental role in people's life and quality of life (QoL), and anti-cancer chemotherapy may provoke long-lasting cognitive problems. This study investigated the subjective perception of cognitive functioning in long-term lynfoma survivors and its associations with objectively assessed cognitive functioning and QoL. 198 long-term lynfoma survivors were administered the Cognitive Functioning Self-Assessment Scale (CFSS), the Esame Neuropsicologico Breve 2 (ENB2) and the Short Form 36 Health Survey Questionnaire (SF-36). Subjectively reported cognitive functioning was worse than the norm for the general population (p<0.001). Difficulty in recalling recent information (22%), using of periphrases or generic terms (16.7%) and tip-of-the-tongue phenomena (14.7%) were the cognitive difficulties most frequently reported. CFSS overall score correlated positively with the number of impaired performances (p<0.001) and borderline performances (p=0.014) on the ENB2. Both subjectively and objectively assessed cognitive measures correlated negatively with most assessed QoL domains, indicating that QoL is worse when cognitive functioning is poor. Subjective concerns about one's own cognitive functioning are a reality for long-term lynphoma survivors, who experience these worries more than the general population does. Since improving QoL is a priority in oncology, this study supports the use of interventions to improve cognitive functioning in cancer survivors.

Objective evaluation of compliance after orthodontic treatment using Hawley or vacuum-formed retainers: A 2-center randomized controlled trial over a 3-month period

The aim of this 2-arm parallel trial was to assess patient compliance objectively with Hawley or vacuum-formed retainers in the maxillary arch in a 3-month period after active orthodontic treatment through the use of the thermosensitive microsensor TheraMon. Patients who had just completed orthodontic treatment in the Postgraduate Orthodontic Clinic, School of Dentistry, National and Kapodistrian University of Athens and in a private orthodontic practice were randomly allocated to either the Hawley or vacuum-formed group for retention. Eligibility criteria included patients aged 12-18years who had undergone orthodontic treatment in both arches for≤ 5years. The main outcome was the average objective daily difference in compliance measured with TheraMon between patients receiving either Hawley or vacuum-formed retainers in the maxillary arch for 3months. Secondary outcomes pertained to the average objective difference in compliance between the 2 retainers for the first month in retention and the association between objective measurements of compliance and diary-reported duration of wear for both the first and 3- month periods. Randomization was implemented with a computer-generated randomization list; allocation was concealed in sequentially numbered, sealed, opaque envelopes. Blinding to the study protocol was not feasible either for the patient or orthodontist. Patients were instructed to wear the retainer full-time. Data were analyzed using nonparametric statistics and linear regression with standard errors based on the bootstrap method. Seventy-seven patients (median age 14.8years; interquartile range 1.5; range 12.1-17.6) were randomized in a 1:1 ratio to either a Hawley or vacuum-formed retainer. Baseline characteristics did not present significant differences between groups. One patient from the Hawley group was excluded from 3months' follow-up owing to a microsensor fault. Objectively assessed median daily wear time for the Hawley group was 15.3hours (interquartile range 6.8), whereas for the vacuum-formed group it was 18.3hours (interquartile range 4.6) for the 3-month interval. Patients allocated to vacuum-formed retainers had higher wearing values of 2.10h/d compared with the Hawley group, after adjusting for trial settings (mean difference 2.10; 95% confidence interval 0.32-3.89; P=0.02). Patients from private orthodontic practice had an increased potential for compliance of 2.16h/d compared with university settings after adjusting for type of appliance (mean difference 2.16; 95% confidence interval 0.34-3.97; P=0.02). A significant correlation was detected between objective assessment and self-reported compliance for both retention protocols in the first and 3-month intervals. No harm was observed during follow-up. This study found relatively high compliance in the short-term retention phase for both appliances. Vacuum-formed retainers were better accepted by adolescent patients, whereas those proceeding to private orthodontic practice were more compliant. There was a positive and statistically significant correlation between objective and subjective measures of compliance. This trial was registered in ClinicalTrials.gov: NCT03683862. No funding or conflict of interest to be declared. The protocol was not published before trial commencement.

The relationship between moderate to vigorous physical activity and cognitive rigidity in anorexia nervosa

A drive for physical activity despite underweight is a core feature of anorexia nervosa. This pilot study detects which aspect of physical activity, if any, could be related to cognitive rigidity in anorexia nervosa.Twenty-eight outpatients with anorexia nervosa and 24 healthy participants were assessed for cognitive flexibility with the Trail Making Test (TMT) and for multiple dimensions of physical activity by subjective and objective assessments. Correlation analysis was conducted to disentangle the relationship between cognitive rigidity and the different aspects of physical activity, then, the moderating effect of anorexia nervosa on this relationship was assessed. A principal component analysis was performed to incorporate all variables of physical activity in (a) global factor(s) reflecting the multidimensional nature of this construct.Cognitive rigidity (TMT b - a score) was significantly correlated to the amount of objectively assessed physical activity estimated, only in the sample of patients with anorexia nervosa. The principal component analysis confirms the correlation between a single construct of “physical activity” and cognitive rigidity in anorexia nervosa only.This pilot study suggests a relationship between cognitive rigidity and physical activity that could help explain the persistence of the latter despite ongoing malnutrition in patients with anorexia nervosa.

Indoor exposure to particulate matter and volatile organic compounds in dwellings and workplaces and respiratory health in French farmers

IntroductionFew investigations have related objective assessments of indoor air pollutants to respiratory health in farmers, in spite of the many rural environmental hazards to which they are exposed. Chemical air pollution has been particularly neglected.ObjectiveWe investigated the relationships of indoor exposure to particulate matter (PM) and volatile organic compounds (VOCs) to respiratory health in farmers.MethodsNineteen VOCs (5 families) and PM (from ultrafine to total suspended particles (TSP)) were objectively assessed in dwellings and workplaces in 109 French farmers during a week. To take into account multiple exposures, scores of exposure were computed for total VOCs and VOCs families. Individuals filled a standardized questionnaire and underwent spirometry with bronchodilation test.ResultsOn average, VOCs concentrations were higher in dwellings than in workplaces. The reverse was observed for PM. When considering the mean concentrations of air pollutants for the whole farm (dwellings + workplaces), asthma (9.3%) was positively associated with elevated exposure to benzene (adjusted odds-ratio (ORa) = 6.64, 95%CI: 1.56–28.27), trichloroethylene (4.80, 1.00–23.30) and halogenated hydrocarbons score (2.9, 95% 1.3–6.8). Early airway obstruction (FEF25–75 < 80%, with normal FEV1 and FVC and FEV/FVC ≥ 70%) (29.8%) was related to elevated exposure to 2-butoxyetylacetate (11.49, 1.55–85.37) and glycol ethers score (2.0; 1.0–4.1) in the whole farm and to PM2.5 (ORa = 5.26, 95% CI: 1.09–25.28) in the granary/stable. The risk of Chronic Obstructive Pulmonary Diseases (FEV/FVC < 70%) (COPD) (4.26%) was found to be larger with elevated exposure to aldehydes (OR = 3.95, 1.09–14.26).ConclusionIndoor chemical air pollution is detrimental to farmers’ respiratory health. More epidemiological investigations with detailed exposure assessments and clinical measures of respiratory effects are needed in rural settings to corroborate these findings.

Indoor exposure to particulate matter and volatile organic compounds in dwellings and workplaces and respiratory health in French farmers

Introduction: Few investigations have related objective assessments of indoor air pollutants to respiratory health in farmers, in spite of the many rural environmental hazards to which they are exposed. Chemical air pollution has been particularly neglected. Objective: We investigated the relationships of indoor exposure to particulate matter (PM) and volatile organic compounds (VOCs) to respiratory health in farmers. Methods: Nineteen VOCs (5 families) and PM (from ultrafine to total suspended particles (TSP)) were objectively assessed in dwellings and workplaces in 109 French farmers during a week. To take into account multiple exposures, scores of exposure were computed for total VOCs and VOCs families. Individuals filled a standardized questionnaire and underwent spirometry with bronchodilation test. Results: On average, VOCs concentrations were higher in dwellings than in workplaces. The reverse was observed for PM. When considering the mean concentrations of air pollutants for the whole farm (dwellings + workplaces), asthma (9.3%) was positively associated with elevated exposure to benzene (adjusted odds-ratio (ORa) = 6.64, 95%CI: 1.56–28.27), trichloroethylene (4.80, 1.00–23.30) and halogenated hydrocarbons score (2.9, 95% 1.3–6.8). Early airway obstruction (FEF25–75 &lt; 80%, with normal FEV1 and FVC and FEV/FVC ≥ 70%) (29.8%) was related to elevated exposure to 2-butoxyetylacetate (11.49, 1.55–85.37) and glycol ethers score (2.0; 1.0–4.1) in the whole farm and to PM2.5 (ORa = 5.26, 95% CI: 1.09–25.28) in the granary/stable. The risk of Chronic Obstructive Pulmonary Diseases (FEV/FVC &lt; 70%) (COPD) (4.26%) was found to be larger with elevated exposure to aldehydes (OR = 3.95, 1.09–14.26). Conclusion: Indoor chemical air pollution is detrimental to farmers’ respiratory health. More epidemiological investigations with detailed exposure assessments and clinical measures of respiratory effects are needed in rural settings to corroborate these findings.

Stop the Bleed Training: Rescuer Skills, Knowledge, and Attitudes of Hemorrhage Control Techniques

BackgroundBystanders play a significant role in the immediate management of life-threatening hemorrhage. The Stop the Bleed (STB) program was designed to train lay rescuers (LRs) to identify and control life-threatening bleeding. The aim of this study was to evaluate the efficacy of STB training for rescuers from different backgrounds. We hypothesized that STB training would be appropriate to increase skills and knowledge of bleeding control techniques for all providers, regardless of level of medical training. Study designCourse participants anonymously self-reported confidence in six major areas. A five-point Likert scale was used to quantitate participant's self-reported performance. Results were stratified into medical rescuers (MR) and LRs. Students' ability to perform STB skills were objectively assessed using an internally validated 15-point objective assessment tool. Data were pooled and analyzed using Student's t-test and chi-Squared test with P < 0.05 considered significant. Results are presented as average with standard deviation (SD) unless otherwise stated. ResultsA total of 1974 participants were included in the study. Precourse confidence was lowest for both groups in management of active severe bleeding and ability to pack a bleeding wound. Postcourse confidence improved significantly for both groups in all 6 core areas measured (P < 0.001). The most significant increases were reported in the two previous areas of lowest precourse confidence-management of active severe bleeding—LRs 2.0 (SD 1.2) versus 4.2 (SD 0.9) and MRs 2.6 (SD 1.4) versus 4.6 (SD 0.6), P < 0.001—and ability to pack a bleeding wound—LR 2.1 (SD 1.3) versus 4.4 (SD 0.8) and MR 2.7 (SD 1.3) versus 4.7 (SD 0.05), P < 0.001. Objective assessment of LR skills at the end of the course demonstrated combined 99.3% proficiency on postcourse objective assessments. ConclusionsThis study provides quantitative evidence that Stop the Bleed training is effective, with both LRs and MRs demonstrating improved confidence and skill proficiency after a 1-h course. Future program development should focus on building a pool of instructors, continued training of LRs, and determining how often skills should be recertified.

A training intervention for home care nurses in cross-cultural communication: An evaluation study of changes in attitudes, knowledge and behaviour.

To assess whether a training intervention in cross-cultural communication can positively impact attitudes, knowledge and behaviour and to investigate possible dependencies between these components. (Controlled) longitudinal multimethod evaluation. A training based on theoretical considerations and informed by semi-standardized interviews with home care nurses was developed and evaluated. Participants rated their cross-cultural attitudes, knowledge and behaviour and answered case vignettes assessing their knowledge before and after this training. Shift observations assessed behaviourial aspects at t1 and t2. Data were collected between June 2016-March 2017 and between April 2017-November 2017. Analyses of variance and multiple linear regression models were employed. The training showed promising tendencies with cross-cultural attitudes, knowledge and behaviour with diverging results for initially quite high self-reports showing positive but mostly not significant developments and objective assessments mostly showing significant positive changes. There were significant associations between self-reported cross-cultural behaviour at t1 and objective cross-cultural knowledge at t2, whereas self-rated and objectively assessed knowledge showed no significant associations. Shift observations showed significant positive developments in participants' communication behaviour. Our study shows the importance of using different methods and targeting different outcomes areas to rate impacts of (cross-cultural) training interventions. Future studies should consider challenging conditions in home care nursing affecting the success of interventions and investigate mechanisms of skill acquisition in nursing. This is one of very few studies using multi-method approach to evaluate a cross-cultural competency intervention and simultaneously assess cross-cultural attitudes, knowledge and behaviour including possible dependencies between these aspects.

Efficacy of Medical Students as Stop the Bleed Participants and Instructors

The Stop the Bleed (STB) program trains lay rescuers to identify and control life-threatening bleeding. Recently, medical students were allowed to become coinstructors. The aim of this study was to assess the efficacy of medical student course participation as both learners and instructors. No previous study to date has provided a critical objective assessment of medical student learners and educators of STB courses. Participants anonymously self-reported pre- and postcourse confidence in 6 major skill areas using a 5-point Likert scale. At the end of the course, students' ability to perform STB skills was assessed using an internally validated 15-point objective assessment tool. Two US medical schools (Tulane University School of Medicine and Louisiana State University in New Orleans) which represent private and state institutions, respectively. A total of 423 medical students were enrolled in the course. A pilot group of medical students volunteered to be instructors and their ability to effectively teach the course was objectively assessed. Overall precourse confidence was highest in holding pressure on a wound and lowest in identification of severe active bleeding. Postcourse participant confidence increased significantly in all 6 core areas, including confidence to teach hemorrhage control skills to others. Objective assessment of medical students by STB instructors found 72.4% of medical students achieving perfect scores on their skill proficiency assessments. An assessment of 48 medical student instructors found that all students were able to proficiently serve as instructors. This study demonstrates that medical students can effectively master STB skills and can also serve as competent course instructors. Future program development should focus on continued training of medical students and their involvement as instructors to help increase the availability of STB courses.

Teaching NICU Fellows How to Relay Difficult News Using a Simulation-Based Curriculum: Does Comfort Lead to Competence?

Problem: Neonatal Intensive Care Unit (NICU) clinicians must frequently relay difficult news to patient families, and the need for formal training for NICU trainees to develop this skill has been established. Although previous studies have shown improved trainee self-efficacy and comfort in handling difficult conversations after formal communication training, it remains unclear whether these interventions lead to improved objectively assessed short-term and long-term performance. Intervention: A simulation-based intervention emphasizing the SPIKES protocol for delivery of bad news was implemented for 15 fellows in the 3-year Baylor College of Medicine Neonatal-Perinatal Medicine fellowship program in the 2013–2014 academic year. Simulations involved video-recorded encounters between each fellow and a standardized parent (SP) involving communication of difficult news. Each fellow was evaluated before (preintervention), immediately after (postintervention), and 3–4 months after the intervention (follow-up) with an (a) evaluation of video-recorded sessions by two expert raters blinded to the timing of the encounter (blinded rater evaluation [BRE]), (b) Self-Assessment Questionnaire, (c) Content Test evaluating knowledge of taught concepts, and (d) SP evaluation (SPE). Context: The 1st- and 2nd/3rd-year fellows participated in the study at separate times in the academic year to accommodate their schedules. First-year fellows had had more prior communication training and less NICU clinical experience than the 2nd/3rd-year fellows at the time of their intervention. Outcome: Although all fellows displayed improved Self-Assessment and Content Test scores at postintervention with retention at the follow-up assessment, the BREs showed no statistically significant improvement in postintervention scores and showed a decline in follow-up scores. First-year fellows had higher BRE postintervention scores than the senior fellows. SPEs showed no difference in scores at all 3 assessment stages. Lessons Learned: As previously described in the literature, trainee self-efficacy and knowledge may improve in the short term and long term with a simulation-based curriculum in communication of difficult news. However, these results may be inconsistent with those of objective evaluations by expert raters and standardized parents. The impact of the curriculum may be heightened if it reinforces previously learned skills, but the effect may wane over time if not reinforced frequently with additional formal training or in the clinical setting. The results of this study highlight the importance of objective assessments in evaluating the utility of a simulation-based communication curriculum and the need for longitudinal curricula to promote retention of the concepts and skills being taught.

How Accurate are Recalls of Self-Weighing Frequency? Data from a 24-Month Randomized Trial.

BackgroundSelf-weighing is an important component of self-monitoring during weight loss. However, methods of measuring self-weighing frequency need to be validated. This analysis compared self-reported to objective weighing frequency.MethodsData came from a 24-month RCT. Participants received 12 months of a behavioral weight loss program and were randomly assigned to: 1) daily self-weighing, 2) weekly weighing, or 3) no weighing (excluded from analysis). Objective weighing frequency was measured by Wi-Fi enabled scales and self-reported weighing frequency was assessed every 6 months by questionnaire. Objective weights were categorized to match the scale of the self-report measure.ResultsAt 12 months, there was 80.8% agreement between self-reported and objective weighing frequency (weighted kappa = 0.67, p < 0.001). At 24 months, agreement decreased to 48.5% (kappa = 0.27, p < 0.001). At both time points where disagreements occurred, self-reported frequencies were generally greater than objectively assessed weighing. Both self-reported and objectively assessed weighing frequency were associated with weight loss at 12 and 24 months (p’s < 0.001).ConclusionsSelf-reported weighing frequency is modestly correlated with objective weighing frequency; however, both are associated with weight change over time. Objective assessment of weighing frequency should be used to avoid overestimating actual frequency.

Impact of home mechanical ventilation on sleep quality.

The number of patients receiving home mechanical ventilation (HMV) has dramatically increased in recent years. Although physiological parameters, health-related quality of life and long-term outcomes frequently serve as primary outcomes, only a few studies have primarily addressed sleep quality in patients undergoing HMV. Therefore, this review article summarizes the current knowledge on sleep quality in patients receiving HMV. HMV can be performed noninvasively via face masks or invasively via tracheal cannulas. Studies in patients receiving invasive HMV therapy are clearly lacking. Most studies in this field have focused on invasively ventilated patients in the ICU, but the findings are not necessarily applicable to patients undergoing invasive HMV. On the other hand, there are several trials showing that noninvasive ventilation (NIV) has the potential to improve sleep quality in patients with severe sleep disturbances associated with chronic hypercapnic respiratory failure. To this end, both subjectively and objectively assessed sleep qualities by polysomnography are reported to improve after long-term NIV is initiated. Although HMV has the potential to improve sleep quality in patients with chronic hypercapnic respiratory failure, it can also have a negative impact on sleep quality, particularly in cases of patient-ventilator asynchrony or leakage. Therefore, both subjective and objective polysomnographic assessments of sleep quality should become an integral part of managing patients who receive HMV therapy.

Early patient-reported outcomes versus objective function after total hip and knee arthroplasty: a prospective cohort study.

The purpose of this study was to assess early physical function after total hip or knee arthroplasty (THA/TKA), and the correlation between patient-reported outcome measures, physical performance and actual physical activity (measured by actigraphy). A total of 80 patients aged 55 to 80 years undergoing THA or TKA for osteoarthritis were included in this prospective cohort study. The main outcome measure was change in patient reported hip or knee injury and osteoarthritis outcome score (HOOS/KOOS) from pre-operatively until post-operative day 13 (THA) or 20 (TKA). Secondary measures were correlations to objectively assessed change in physical performance (paced-walk, chair-stand, stair-climb tests) at day 14 (THA) or 21 (TKA) and actual physical activity (actigraphy) measured at day 12 and 13 (THA) or 19 and 20 (TKA). Patients reported improved physical function (HOOS or KOOS) pre-operatively until day 13 (THA) or 20 (TKA) with a mean difference of 7 (95% confidence interval (CI) 1 to 13, p= 0.033) and 6 (95% CI 1 to 12, p = 0.033) percentage points, respectively. By contrast, objectively assessed physical function and activity declined, with no correlations between subjective and objective assessments for either THA or TKA patients (r2 ≤ 0.16, p ≥ 0.314). Early improvement in patient-reported physical function after THA/TKA does not correlate with objectively assessed function, and patient reported outcomes should not be used as the only measure of recovery. Cite this article: Bone Joint J 2017;99-B:1167-75.

Objective assessment of leg edema using ultrasonography with a gel pad.

Ultrasonography (US) is useful for visual detection of edematous tissues to assess subcutaneous echogenicity. However, visualization of subcutaneous echogenicity is interpreted differently among operators because the evaluation is subjective and individual operators have unique knowledge. This study objectively assessed leg edema using US with a gel pad including fat for normalization of echogenicity in subcutaneous tissue. Five younger adults and four elderly people with leg edema were recruited. We compared assessments of US and limb circumference before and after the intervention of vibration to decrease edema in younger adults, and edema prior to going to sleep and reduced edema in the early morning in elderly people. These assessments were performed twice in elderly people by three operators and reliability, interrater differences, and bias were assessed. For US assessment, echogenicity in subcutaneous tissue was normalized to that of the gel pad by dividing the mean echogenicity of subcutaneous tissue by the mean echogenicity of the gel pad. In younger adults, the normalized subcutaneous echogenicity before the intervention was significantly higher than that after the intervention. In elderly people, echogenicity indicating edema was significantly higher than that after edema reduction. Edema was detected with accuracy rates of 76.9% in younger adults and 75.0% in elderly people. Meanwhile, limb circumference could be used to detect edema in 50.0% of healthy adults and 87.8% of elderly people. The intra-reliability was excellent (intraclass correlation coefficient > 0.9, p < 0.01), and the inter-reliability was good (intraclass correlation coefficient > 0.7, p < 0.01) for normalized subcutaneous echogenicity. Bland-Altman plots revealed that inter-rater differences and systematic bias were small. Normalized subcutaneous echogenicity with the pad can sensitively and objectively assess leg edema with high reliability. Therefore, this method has the potential to become a new gold standard for objective assessment of leg edema in clinical practice.

Homogeneity of variance of measures associated with objective assessment of esthetic outcome after treatment with radiation therapy in early breast cancer.

e12085 Background: Breast cancer is an increasingly treatable disease which means that many women will live a long time with the esthetic consequences of their treatment. The majority of women with early breast cancer are given whole breast external beam radiation therapy (EBRT) after lumpectomy (breast conservation). It has been demonstrated, using an objective assessment of esthetic outcome in patients from a randomized trial that “redness”, a surrogate for radiation induced erythema grade I or II, is significantly greater after one year in patients receiving EBRT compared with those receiving intraoperative radiation therapy (IORT). However, it has been observed that not all women given EBRT have detectable erythema, which implies that there is a greater variability in this group. In order to test this hypothesis a test of unequal group variances was performed. Methods: 991 frontal digital photographs were analyzed from women participating in the TARGIT A Trial (NCT00983684) at four sites (Lublin, Mannheim, Copenhagen and Perth). Photographs taken at baseline (before surgery), 1 and 2 years (after surgery and EBRT or IORT) were objectively assessed, blinded to treatment received, by BCCT.core software which produces overall Harris scores, and scores for various measures of symmetry, color and scar. The scores for color were analyzed in SAS v9.4 using PROC GLM. Results: cEMDL, a color score associated with "lightness", showed significant heterogeneity of variance (using Levene's and Welch's Tests, p &lt; 0.0001) in the women treated with EBRT, but not in those treated with IORT (p = 0.4). However, cX2b (associated with "redness") showed significant heterogeneity of variance in both the EBRT and IORT treated groups (p &lt; 0.0001), although the point estimates moved in different directions. Conclusions: This study demonstrates that there are complex changes in skin color following radiation therapy to the breast, and assumptions regarding homogeneity of variance should be checked if required by the statistical analysis.

Comparison of Objective and Subjective Sedentary Behavior

Physical activity decreases the risk of chronic disease, while sedentary behavior increases this risk. Questionnaires are an easy, inexpensive way to quantify sedentary behavior. However, there tends to be error with self-report. PURPOSE: To compare time in sedentary behaviors assessed via activity monitor (objective) with sedentary time assessed by self-report (subjective). METHODS: Office staff and administrators with a sedentary job description at a University were recruited. The activPAL3 activity monitor was placed on the participants’ (n=44) thigh and worn continuously for seven days. Participants completed the Occupational Sitting Questionnaire (OSPAQ) and Paffenbarger Physical Activity Questionnaire (PPAQ) for the timeframe that the activPAL3 was worn. Data were expressed in total time (hrs/day) spent sedentary over a typical work week. A Pearson Product Correlation was utilized to examine the relationship between the subjective sedentary time at work (OSPAQ) and over a 24 hr period (PPAQ) and objective (activPAL3) sedentary time. The agreement between the objective and subjective assessments was evaluated using a Bland-Altman analysis. Differences between objective and subjective scores for each individual were calculated and the mean error was determined. RESULTS: Participants were predominantly Caucasian (95%), middle-aged (48 y + 10), and had an average BMI (30. 5 + 8.2). A positive, weak correlation between sedentary time assessed subjectively from the OSPAQ (r = .100; p = .518) and PPAQ (r = .317; p = .036), and objectively by the activPAL3 activity monitor was found. The mean error of the sedentary time estimated during the workday was approximately one hour (1.07 + 1.02) and approximately four hours (3.52 + 2.31) for the entire day, with most participants underestimating sedentary time. The Bland Altman analysis found no systematic bias in the OSPAQ (p = .743), while a trend of proportional underestimation bias in the PPAQ (p = .001) was found relative to the activPAL3 measures. CONCLUSION: Self-reported sedentary time subjectively assessed by the PPAQ and OSPAQ was weakly correlated to sedentary time objectively assessed by the activPAL3 activity monitor over a 24 hour period and while at work. The lack of a relation demonstrated substantial error in self-reported assessment.

Awareness of functional ability in people with early-stage dementia.

Assessment of functional ability in people with early-stage dementia (PwD) is an important area of study because it forms part of the diagnostic process and may help in monitoring disease progression. Most researchers and clinicians rely on informant ratings rather than observing actual functional performance or employing self-ratings. There has however been little research to verify whether informant ratings of functioning are accurate, and there has been even less research investigating the accuracy of self-ratings of functional ability in PwD. No study has used the performance-monitoring metacognitive approach to investigate awareness of functional ability. Thirty-seven people with early-stage dementia completed an objective functional assessment and provided self-ratings before and after completing each section of the objective test. Informants provided ratings of functioning and burden. Scores were converted to percentages to allow for direct comparison. Objectively assessed functional ability significantly correlated with self-ratings and informant ratings. Self-ratings did not correlate with informant ratings. For converted scores, self-ratings were more similar than informant ratings to the objectively assessed mean scores. Burden was unrelated to functional assessments after correcting for multiple comparisons. Self-rated functional ability was more accurate than informant ratings when compared with objectively assessed ability, with informants tending to significantly underestimate the functional ability of PwD. The findings call into question the likelihood that informants will provide accurate ratings of functional ability and suggests that self-ratings may offer a more accurate estimate of functional ability. Self-ratings made by PwD should be more widely employed in clinical and research settings. Copyright © 2017 John Wiley & Sons, Ltd.

Objective and Subjective Eating Speeds Are Related to Body Composition and Shape in Female College Students

Eating speed reportedly relates to body composition and shape. Little is known about the relationship between the objectively assessed eating speed and the body composition and shape. This study examined relationships between eating speed as assessed both objectively and subjectively, and body composition and shape. The following variables of body composition and shape were measured in 84 female college students: body mass, relative body fat mass (%Fat), body mass index (BMI), and circumferences of the waist, abdomen and hip. After measuring the body composition and shape, subjects consumed a 174-kcal salmon rice ball. The following chewing variables were measured by observing videotape recordings of the subjects' faces: number of chews per bite, total number of chews, total meal duration, number of bites, and chewing rate. The subjects were categorized into three groups (fast, moderate and slow) according to their own subjective assessments of the actual eating speed. In objective assessments of the eating speed, the total number of chews and the total meal duration were significantly negatively correlated with the body mass, %Fat, BMI, and circumferences of the waist, abdomen and hip. In subjective eating-speed assessments, the body mass, %Fat, BMI, and circumferences of the waist, abdomen and hip were greater in the fast eating group than in the slow eating group. Both the objectively and subjectively assessed eating speeds are related to the body composition and shape. The present study supports that fast eating may relate to gains in body mass and/or fat mass.