Percent Agreement Research Articles

Accuracy of Electronic Health Record Documentation of Parental Presence: A Data Validation and Quality Improvement Analysis.

Parental presence in the neonatal intensive care unit (NICU) is known to improve the health outcomes of an admitted infant. The use of the electronic health record (EHR) to analyze associations between parental presence and sociodemographic factors could provide important insights to families at greatest risk for limited presence during their infant's NICU stay, but there is little evidence about the accuracy of nonvital clinical measures such as parental presence in these datasets. A data validation study was conducted comparing the percentage agreement of an observational log of parental presence to the EHR documentation. Overall, high accuracy values were found when combining two methods of documentation. Additional stratification using a more specific measure, each chart's complete accuracy, instead of overall accuracy, revealed that night shift documentation was more accurate than day shift documentation (76.3% accurate during night shifts, 55.2% accurate during day shifts) and that flowsheet (FS) recordings were more accurate than the free-text plan of care (POC) notes (82.4% accurate for FS, 75.1% accurate for POC notes). This research provides a preliminary look at the accuracy of EHR documentation of nonclinical factors and can serve as a methodological roadmap for other researchers who intend to use EHR data.

Assessing the relative validity of a web-based self-administered 24-hour dietary recall in a Canadian adolescent’s population

BackgroundHealthy eating habits at a young age are crucial to support growth and development and good general health. In this context, monitoring youth dietary intakes adequately with valid tools is important to develop efficient interventions and identify groups that are more at risk of inadequate intakes. This study aimed to assess the relative validity of the self-administered web-based 24-h dietary recall (R24W) for evaluating energy and nutrient intakes among active adolescents.MethodsParticipants were invited to complete one interviewer-administered 24-h dietary dietary recall and the R24W on up to three occasions within one month. A total of 272 French-speaking active adolescents aged 12 to 17 years from the province of Québec were invited to complete three R24W and one interview-administered 24-h recall. Student’s t-test and correlations were conducted on sex-adjusted data. Percent differences, cross-classification (percentage of agreement), weighted Kappa and Bland-Altman plots were calculated.ResultsMean (SD) energy intake from the R24W was 8.8% higher than from the interview-administered 24-h dietary recall (2558 kcal ± 1128 vs. 2444 kcal ± 998, p < 0.05). Significant differences in mean nutrient intake between the R24W and the interview-administered 24-h dietary recall ranged from 6.5% for % E from fat (p < 0.05) to 25.2% for saturated fat (p < 0.001), i.e., higher values with R24W. Sex-adjusted correlations were significant for all nutrients except for % E from proteins and thiamin (range: 0.24 to 0.52, p < 0.01). Cross-classification demonstrated that 36.6% of the participants were classified in the same fourth with both methods, 39.6% in the adjacent fourth, and 5.7% misclassified. Bland-Atman plots revealed proportional bias between the two methods for 7/25 nutrients. Completing at least two recalls with the R24W increased the precision of intake estimates.ConclusionThese data suggest that the R24W presents an acceptable relative validity compared to a standard interview-administered 24-h recall for estimating energy and most nutrients in a cohort of French-speaking adolescents from the province of Québec.

Effectiveness of large language models in automated evaluation of argumentative essays: finetuning vs. zero-shot prompting

To address the long-standing challenge facing traditional automated writing evaluation (AWE) systems in assessing higher-order thinking, this study built an AWE system for scoring argumentative essays by finetuning the GPT-3.5 Large Language Model. The system’s effectiveness was compared with that of the non-finetuned GPT-3.5 and GPT-4 base models via zero-shot prompting, which involves applying the model to perform tasks without any prior specific training or examples on those tasks. The dataset used was the TOEFL Public Writing Dataset provided by Education Testing Service (ETS), containing 480 argumentative essays with ground truth scores under two essay prompts. Three finetuned models were generated: two finetuned exclusively on either prompt and one on both. All finetuned and base models were used to score the remaining essays after finetuning and their scoring effectiveness was compared with ground truth scores, i.e., benchmark scores assigned by ETS-trained human raters. The impact of the variety of finetuning prompts and the robustness of finetuned models were also explored. Results showed a 100% consistency of all models in two scoring sessions. More importantly, the finetuned models significantly outperformed the base models in accuracy and reliability. The best-performing model, finetuned on prompt 1, showed an RMSE of 0.57, a percentage agreement (score discrepancy ≤ 0.5) of 84.72% and a QWK of 0.78. Further, the model finetuned on both prompts did not exhibit enhanced performance, and the two models finetuned on one prompt remained robust when scoring essays from the alternative prompt. These results suggest (1) task-specific finetuning for AWE is beneficial; (2) finetuning does not require a large variety of essay prompts; and (3) fine-tuned models are robust to unseen essays.

In-house homologous recombination deficiency testing in ovarian cancer: a multi-institutional Italian pilot study

AimsPoly (ADP-ribose) polymerase (PARP) inhibitors (PARPIs) represent a standard of care for the clinical management of high-grade serous ovarian cancer (HGSOC). The recognition of homologous recombination deficiency (HRD) has emerged...

Development of the Clinical Placement Quality Survey – Educator (CPQS-E) Tool to Evaluate the Quality of Physiotherapy Clinical Placements

Background: Increasing demand for entry-level clinical education placements has resulted in changes to traditional models. In this evolving landscape, the ability to effectively assess clinical placement quality is critical. However, existing tools are not specific to physiotherapy and/or have focused on student’s perspectives. Purpose: To design a tool that can be utilised by clinical education providers to measure the quality of physiotherapy clinical placements. Methods: A survey was developed based on published recommendations for quality indicators in clinical education. Content and face validity were established using an expert panel of clinical educators (n=18). Test-retest reliability was tested via physiotherapy clinical educators (n=62) completing the survey twice over a two-week period. Reliability of the survey was assessed using intraclass correlation coefficients (ICC), test-retest percentage agreement, and Cronbach’s alpha. Results: The ICC of 0.87 indicated minimal measurement error. The majority (98%, n=62) of test items met criteria for close agreement. The correlation coefficient of reliability ranged from 0.73 to 0.87 across four defined constructs. Conclusion: Initial assessment of the Clinical Placement Quality Survey - Educator (CPQS-E) tool indicates that its properties provide a valid and reliable measure of entry-level physiotherapy placement quality from the perspective of the clinical educator.

Development of a structured validated module to inculcate research skills in medical undergraduates.

Background Evidence-based research aids in decision-making in the health sector for developing health policies for prevention, diagnosis and treatment of diseases. Medical research is not taught in the undergraduate curriculum. Studies show that attributes of research knowledge, awareness and practical involvement in research are low among undergraduate students. We developed and validated a module and trained undergraduate students in research skills through an inter-ventional workshop using the structured module. Methods We did this participatory action research with a mixed-methods approach in the Department of Community Medicine at Adesh Institute of Medical Sciences and Research, Bathinda, Punjab. A structured module was developed by the core committee and validated internally and externally. Pilot testing of the module was done by delivering it in the form of a workshop to 46 students. For statistical analysis, percentage agreements, validity indices, median (interquartile range), satisfaction percentages and Wilcoxon sign test were used. Results The structured and validated module was established to have high face validity (>90%) and content validity (CVI=0.975). The module was successfully pilot tested for delivery through both onsite and online modes. The satisfaction percentage with the workshop was 91% and 100% and overall rating of the module was 74% and 91% by interns and MBBS students, and 100% by faculty. The scores of knowledge and skills were found to be significantly higher on all variables post workshop with p<0.001. All students scored satisfactory grades for research skills. Conclusions Teaching research using a structured validated module improved the knowledge and skills related to research among students. Both students and faculty were satisfied with the use of the structured module.

Mucoepidermoid carcinoma: A comparative analysis of histological grading systems

: Salivary gland carcinomas comprise of only 3-5% of all head and neck malignancies. Mucoepidermoid carcinoma (MEC) is the most common malignant salivary gland tumor. The morphologic diversity of MEC can pose diagnostic challenges hence, various histological grading systems have been proposed based on the quantitative and qualitative analysis. This proves to be greatly consequential in the management and prognosis of patients with MEC.To compare histologic grading methods in MEC of major &amp; minor salivary glands.20 histopathologically diagnosed cases of MEC (10 each major &amp; minor salivary gland) will be analysed using following methods: Qualitative Method: 1) Modified Healey 2) Memorial Sloan-Kettering Cancer Center method. Quantitative method: 1) Armed force Institute of Pathology (AFIP) 2) Brandwein method Histological findings were evaluated. In our study AFIP grading system, 50% Cases were classified as low grade, 35% as intermediate grade and 15% as high graded. According to Brandwein grading system20% of cases were categorized as low, 35% cases as intermediate, 45% cases as high grade MEC. Modified Healey grading system of MEC showed 50%, 40%, 10% cases as low, intermediate and high grade MEC respectively. MSKCC grading system revealed as 55%, 30% and 15% cases as low, intermediate and high grade MEC respectively. Our finding indicated that MSKCC grading system was the most favourable histological grading system as percentage of agreement found to be 85%.Careful microscopic examination is the most important parameter in the grading of MEC. This meticulous microscopic examination emerges as the cornerstone in grading MEC. Both MSKCC and Modified Healey grading methods exhibits effectiveness in evaluating MEC. Our finding indicated that Memorial Slon Kettering Cancer Center (MSKCC) was the most favourable histological grading system as percentage of agreement found to be 85%. However, further longer studies are imperative to substantiate this finding and for establish of universally accepted grading system for Mucoepidermoid carcinoma.

Assessing the walkability of high-density neighborhoods: Development and reliability of the high-density environment assessment tool (HEAT)

BackgroundWalking is a widespread and multifaceted activity among residents in high-density cities, making assessing the neighborhood walking environments important. Existing tools for assessing walkability in high-density cities primarily focus on the immediate environment of sidewalks. However, an individual's walking behavior is influenced by environmental characteristics across multiple dimensions and scales. Consequently, based on a systematic analysis of the features of high-density cities, this study proposes the High-density Environment Assessment Tool (HEAT). This hybrid approach comprehensively assesses walkability in high-density cities by incorporating variables of neighborhood, segment (sidewalk), and crossing. MethodsThe HEAT consisted of three sections with 108 items. To validate the reliability and applicability, field tests were conducted in two 15-min walkable neighborhoods with different built environment contexts in Chongqing City, China. The neighborhood section was objectively assessed using ArcGIS Software. The segment section and crossing section were audited through systematic on-site observation. Four pairs of trained raters assessed all of the segments (n = 139) and crossings (n = 123) within the two neighborhoods. The inter-rater reliability of the repeated audit data was evaluated by Kappa/Weighted Kappa or Percentage Agreement values. A web-based application was used for data collection and input. ResultsFor the neighborhood section, 21 assessment items were included. For the segment and crossing sections, 87 assessment items were included for the reliability test, and 84 (96.6%) of the items indicated satisfying inter-rater reliability (with Kappa/Weighted Kappa value ≥ 0.4 or high Percentage Agreement). In addition, the audit of each segment and crossing sample was completed in an average of 7.9 and 1.8 min, respectively. ConclusionsThe results indicated that the HEAT was reliable and efficient. The HEAT provided an effective tool for assessing the walkability of the neighborhood built environment in high-density cities, thereby facilitating environmental interventions aimed at promoting walking activities.

Interprofessional Comparisons in Patient Safety Culture at a Teaching Hospital Before and During the COVID-19 Pandemic.

The COVID-19 pandemic has posed unprecedented challenges with its impact on patient safety culture and staff well-being. This study was to identify potential changes in safety culture among health care workers from before to during the COVID-19 pandemic, and to determine the differences across occupational groups. The Safety Attitudes Questionnaire (SAQ) was administered electronically in both English and Malay languages using the Google Forms platform in 2018 and was repeated in 2021, during the COVID-19 pandemic. Comparisons were made between 2018 and 2021 to determine changes in patient safety culture for the overall staff population and by occupational groups. A total of 3175 health care workers completed the questionnaire in 2021. Overall, a comparable percentage agreement was found for all SAQ domains in 2018 and 2021 with visible improvements for doctors and support staff. Safety Attitudes Questionnaire domain scores differed in teamwork, safety climate, perception of hospital management, and working condition domains across occupational groups. Self-isolation and COVID-19 were associated with poorer SAQ domain scores, while redeployment was associated with improvements in SAQ domain scores. Interventions targeting areas of weakness as well as utilizing positive experiences such as redeployment should be explored to enhance patient safety in hospitals settings postpandemic.

Comparative evaluation of HPV genotyping: A study on the performance concordance between Anyplex II HPV28 detection and Linear Array genotyping tests in nationwide studies in Brazil.

Advances in laboratory techniques for HPV diagnosis necessitate a thorough assessment of the efficiency, replicability, sensitivity, and specificity of those methods. This study aims to validate and compare HPV detection/genotyping using the Anyplex™ II HPV28 Detection assay (Seegene) assay and the Linear Array HPV Genotyping test (Roche Diagnostics) on genital samples for use in epidemiological studies. From 6,388 penile and cervical DNA samples collected in the POP-Brazil, 1,745 were randomly selected to be included in this study. The samples were submitted to HPV detection and genotyping following the manufacturers' protocols. DNA was genotyped using the Anyplex™ II HPV28 Detection kit (Seegene), and the results were compared to those obtained using the Linear Array HPV Genotyping test (Roche Diagnostics). Concordance of HPV genotyping results was assessed by the percentage agreement and Cohen's kappa score (κ). The agreement between the two methodologies was deemed good for HPV detection (κ = 0.78). Notably, Anyplex™ II HPV28 demonstrated enhanced capability in detecting a broader spectrum of genotypes compared to Linear Array. Anyplex™ II HPV28 exhibited comparable results to the Linear Array assay in clinical specimens, showcasing its potential suitability for a diverse array of research applications requiring the detection and genotyping of HPV. The study supports the utility of Anyplex™ II HPV28 as an effective tool for HPV screening in epidemiological studies, emphasizing its robust performance in comparison to established diagnostic tests.

Development of a questionnaire for patient perception to functional appliances

ObjectiveTo developed and evaluate the validity, reliability, and Arabic translation of a questionnaire for preadolescent perception to removable functional appliances.Subjects and methodsA new questionnaire was drafted based on previously used questionnaires. Twelve orthodontic experts were selected within content and face validity panel and twenty preadolescents wearing functional appliances were participated in the face validation of the questionnaire. Two rounds of content validity were performed with the same experts. The final form of the validated questionnaire was translated from English to Arabic language. The content validity index (CVI) was used for content validity and the Cronbach’s alpha test was used to assess the internal consistency reliability of the questionnaire.ResultsDuring the first round of content validity, 50 items were relevant to the underlying construct (Item-CVI ≥ 0.78), while four items were considered not valid (Item-CVI < 0.78) and the average scale-CVI was 0.93. In terms of face validation by experts, the percentage of agreement was adequate (96.4%). The questionnaire was modified by removing the non-valid items, adding/modifying items, and merging some categories. For second round of content validity, all items were found to be valid (I-CVI ≥ 0.78) and the overall questionnaire had adequate content validity (Scale-CVI/Ave = 0.94). The translated valid questionnaire also achieved a perfect agreement (100%) for face validity by patients. The internal consistency was appropriate (≥ 0.7).ConclusionsA new valid, reliable, and translated questionnaire (English and Arabic versions) that cover the majority of aspects of patients’ perception during treatment with removable functional appliances has been developed.

Dispersive Solid Phase Extraction of Melatonin with Graphene/Clay Mixtures and Fluorescence Analysis in Surfactant Aqueous Solutions.

In this work, the dispersive solid phase extraction (dSPE) of melatonin using graphene (G) mixtures with sepiolite (SEP) and bentonite (BEN) clays as sorbents combined with fluorescence detection has been investigated. The retention was found to be quantitative for both G/SEP and G/BEN 4/96 and 10/90 w/w mixtures. G/clay 4/96 w/w mixtures were selected to study the desorption process since the retention was weaker, thus leading to easier desorption. MeOH and aqueous solutions of the nonionic surfactant Brij L23 were tested as desorbents. For both clays and an initial sample volume of 25 mL, a percentage of melatonin recovery close to 100% was obtained using 10 or 25 mL of MeOH as desorbent. Further, using a G/SEP mixture, 25 mL as the initial sample volume and 5 mL of MeOH or 60 mM Brij L23 solution as the desorbent, recoveries of 98.3% and 90% were attained, respectively. The whole method was applied to herbal tea samples containing melatonin, and the percentage of agreement with the labeled value was 86.5%. It was also applied to herbal samples without melatonin by spiking them with two concentrations of this compound, leading to recoveries of 100 and 102%.

Diagnostic performance of mpox virus (MPXV) real-time PCR assays: multicenter assessment and extended sensitivity analysis.

To comprehensively investigate the diagnostic performance of routinely used assays in MPXV testing, the National Center of Clinical Laboratories in China conducted a nationwide external quality assessment (EQA) scheme and an evaluated nine assays used by ≥ 5 laboratories in the EQA. MPXV virus-like particles with 2700, 900 and 300 copies/mL were distributed to 195 EQA laboratories. For extended analysis, triple-diluted samples from 9000 to 4.12 copies/mL were repeated 20 times using the assays employed by ≥ 5 laboratories. The diagnostic performance was assessed by analyzing EQA data and calculating the limits of detection (LODs). The performance was competent in 87.69% (171/195) of the participants and 87.94% (175/199) of the datasets. The positive percentage agreements (PPAs) were greater than 99% for samples at 2700 and 900 copies/mL, and 95.60% (761/796) for samples at 300 copies/mL. The calculated LODs for the two clades ranged from 228.44 to 924.31 copies/mL and were greater than the LODs specified by the respective kits. EasyDiagnosis had the lowest calculated LODs and showed superior performance in EQA, whereas BioGerm and Sansure, with higher calculated LODs, did not perform well in EQA. This study provides valuable information from the EQA data and evaluation of the diagnostic performance of MPXV detection assays. It also provided insights into reagent optimization and enabled prompt public health interventions for the outbreak.

Comparison of RT-PCR and ELISA Methods in the Diagnosis of Hepatitis C Virus in Patients

Background: Since HCV virus is the primary cause of liver cirrhosis and cancer, prompt diagnosis and timely treatment of this disease can prevent many complications. Due to the importance and necessity of this study, it aims to comparatively evaluate RT-PCR and ELISA methods in order to detect the presence of HCV infection in patients admitted to Baghiyatallah Hospital. Methods: Sera of 49 patients admitted to Baghiyatallah Hospital since September, 2019 to August, 2020, were tested for RNA detection of HCV virus using RT-PCR and for the presence of anti-HCV antibody at the same time. Results: In this study, the mean age of patients was approximately 38.3+6.3. The percentage of positive cases of HCV virus in the studied patients according to ELISA test and PCR test were 28.6% and 20.4%, respectively. Percentage of HCV positive cases had p = 0.001 based on PCR and ELISA tests by age group, number of sexual partners, history previous HCV infection, liver cirrhosis, addiction and treatment of previous HCV infection which was significantly different; However, it was not significant in terms of gender (p = 0.5232). According to Kappa coefficient, the percentage of agreement is 91.8 in both methods which indicates that the two models are consistent (P = 0.001) and the diagnostic value of ELISA versus PCR with sensitivity and specificity were 100% and 89.7%, respectively. Conclusion: ELISA susceptibility to anti-HCV antibody is more than 99%, but its specificity is low compared to RT-PCR method. On the other hand, these tests show only hepatitis C affection and does not distinguish between chronic acute or improved infection. It is not able to detect patients in the window phase, so the simultaneous application of ELISA and molecular methods is recommended to diagnose and follow the treatment of HCV virus.

Diagnosing OSA and Insomnia at Home Based Only on an Actigraphy Total Sleep Time and RIP Belts an Algorithm "Nox Body Sleep™".

The COVID-19 pandemic has influenced clinical sleep protocols with stricter hospital disinfection requirements. Facing these new rules, we tested if a new artificial intelligence (AI) algorithm: The Nox BodySleep™ (NBS) developed without airflow signals for the analysis of sleep might assess pertinently sleep in patients with Obstructive Sleep Apnea (OSA) and chronic insomnia (CI) as a control group, compared to polysomnography (PSG) manual scoring. NBS is a recurrent neural network model that estimates Wake, NREM, and REM states, given features extracted from activity and respiratory inductance plethysmography (RIP) belt signals (Nox A1 PSG). Sleep states from 139 PSG studies (CI N = 72; OSA N = 67) were analyzed by NBS and compared to manually scored PSG using positive percentage agreement, negative percentage agreement, and overall agreement metrics. Similarly, we compared common sleep parameters and OSA severity using sleep states estimated by NBS for each recording and compared to manual scoring using Bland-Altman analysis and intra-class correlation coefficient. For 127,170 sleep epochs, an overall agreement of 83% was reached for Wake, NREM and REM states (92% for REM states in CI patients) between NBS and manually scored PSG. Overall agreement for estimating OSA severity was 100% for moderate-severe OSA and 91% for minimal OSA. The absolute errors of the apnea-hypopnea index (AHI) and total sleep time (TST) were significantly lower for the NBS compared to no scoring of sleep. The intra-class correlation was higher for AHI and significantly higher for TST using the NBS compared to no scoring of sleep. NBS gives sleep states, parameters and AHI with a good positive and negative percentage agreement, compared with manually scored PSG.

Circulating tumor cells enumeration and characterization in patients with lung cancer treated with immunotherapy.

e15030 Background: Programmed death-ligand 1 (PD-L1) is a predictive biomarker for immunotherapy in the treatment of non-small cell lung cancer (NSCLC). Assessing PD-L1 expression from the tumor specimen can be challenging because of tissue accessibility, heterogeneity, and dynamic changes in PD-L1 expression that may impact the status of PD-L1 during disease evolution and treatment. Hence, assessing PD-L1 status from archival tumor might not reflect its actual state on the tumor and having a real-time assessment of its expression with the use of non-invasive techniques such circulating tumor cells (CTCs) is useful. Methods: We conducted a single centre prospective study to detect CTCs in the blood of patients with stage III-IV NSCLC treated with immunotherapy using the standard CellSearch technology for CTC enumeration and the Epic Sciences technology for CTCs enumeration and assessment of PD-L1 protein expression on CTCs. CTCs were detected at baseline before treatment initiation and after 2 cycles of treatment. Study endpoints included CTCs detection and concordance between the 2 technologies, PD-L1 expression assessment on CTCs with the Epic Sciences technology, and concordance with tissue-based expression. Comparisons were made using Pearson correlation coefficient (PCC) and intraclass correlation coefficient (ICC) for count data and percentage of perfect agreement. Results: Between 2019 and 2022, 48 patients treated with immunotherapy were enrolled in the study. The mean ± standard deviation (SD) age was 66.8 ± 10.3 years, 63% were females, 42% received combination chemotherapy and immunotherapy, and 44% had adenocarcinoma histology. The tissue PD-L1 expression was high (≥50%), intermediate (1-49%), and low (&lt;1%) in 36%, 31% and 33% of patients respectively. The mean ± SD baseline CTCs count per 7.5ml was 1.97 ± 4 with CellSearch and 1.38 ± 2.72 per ml with Epic Sciences. After 2 treatment cycles, 22% and 41% of patients had an increase in their CTCs count with CellSearch and Epic Sciences, respectively and 30% and 29% had a decrease in their CTCs. The PCC and ICC for baseline CTCs detected by CellSearch and Epic Sciences were 0.72 and 0.61, respectively and for CTCs detected after 2 cycles of treatment by the 2 technologies were -0.16 and 0.45 respectively. One patient had PD-L1 expression on their CTCs with the Epic Sciences technology and there was no association between the PD-L1 expression on CTCs and on matched tissue samples. Conclusions: This study showed a moderate to strong correlation between the 2 technologies for baseline CTCs detection and moderate to poor correlation for CTCs detection after 2 cycles of therapy. No association was found between CTCs and tissue PD-L1 expression. Future work needs to further investigate the role of PD-L1 expression on CTCs.

Educational technology to promote self-efficacy in newborn care: a validation study.

To build and validate an educational technology consisting of a flipchart to promote self-efficacy in newborn care. A methodological study was carried out in two stages: (i) creation of the flipchart and (ii) validation by 25 experts and 50 people who could be the target audience (pregnant women, mothers or family members of newborns). Clarity, language, practical relevance and theoretical relevance were reviewed using the Suitability Assessment of Materials (SAM) instrument. The Content Validity Index and the Flesch Readability Index were calculated. The serial album "Can you take care of your baby" consists of 30 pages. The overall Content Validity Index was 0.93 among experts and 1.0 among the target audience. The flipchart was considered superior quality material, reaching an agreement percentage of 94.9, indicating that it is suitable as an educational technology. Participants suggested adjustments, incorporated into the material for printed production. The flipchart developed and with content validated by experts is suitable for use in health education activities that aim to promote self-efficacy in caring for newborns.

Preliminary Developing PBL-ESDG Learning Tools on Global Warming Topics: Needed to Train Earth Science Literacy and Student Creativity

This research aims to analyze the preliminary development process of Problem-Based Learning (PBL) learning tools integrated with Education Sustainable Development Goals (ESDG) on the topic of global warming which aims to train students' earth science literacy and creativity. 3D research design (define, design, develop) is used as a type of initial development research which is an adaptation of 4D design. This research used a validation sheet instrument with assessment indicators in the form of content assessment criteria, presentation criteria, and language criteria. The results of the assessment by 3 experts (2 experts in physics learning instrument development and 1 high school physics learning instructor expert) were analyzed using the percentage of agreement. The research results showed that the entire learning tool was declared valid for each construct, content, and presentation criteria with several improvements. At the development stage, there are improvements to input and suggestions from validators so that the learning tools used are better. Thus, this learning tool can be used for learning to train creativity and earth science literacy for high school students. The recommendation for further research is that this tool can be used as a reference in developing learning tools and implemented in learning on the topic of global warming for high school students level

Deep Learning-Based Automatic Classification of Ischemic Stroke Subtype Using Diffusion-Weighted Images.

Accurate classification of ischemic stroke subtype is important for effective secondary prevention of stroke. We used diffusion-weighted image (DWI) and atrial fibrillation (AF) data to train a deep learning algorithm to classify stroke subtype. Model development was done in 2,988 patients with ischemic stroke from three centers by using U-net for infarct segmentation and EfficientNetV2 for subtype classification. Experienced neurologists (n=5) determined subtypes for external test datasets, while establishing a consensus for clinical trial datasets. Automatically segmented infarcts were fed into the model (DWI-only algorithm). Subsequently, another model was trained, with AF included as a categorical variable (DWI+AF algorithm). These models were tested: (1) internally against the opinion of the labeling experts, (2) against fresh external DWI data, and (3) against clinical trial dataset. In the training-and-validation datasets, the mean (±standard deviation) age was 68.0±12.5 (61.1% male). In internal testing, compared with the experts, the DWI-only and the DWI+AF algorithms respectively achieved moderate (65.3%) and near-strong (79.1%) agreement. In external testing, both algorithms again showed good agreements (59.3%-60.7% and 73.7%-74.0%, respectively). In the clinical trial dataset, compared with the expert consensus, percentage agreements and Cohen's kappa were respectively 58.1% and 0.34 for the DWI-only vs. 72.9% and 0.57 for the DWI+AF algorithms. The corresponding values between experts were comparable (76.0% and 0.61) to the DWI+AF algorithm. Our model trained on a large dataset of DWI (both with or without AF information) was able to classify ischemic stroke subtypes comparable to a consensus of stroke experts.

Comparison of three colloidal gold immunoassays and GeneXpert Carba-R for the detection of Klebsiella pneumoniae blaKPC-2 variants.

The increasing use of ceftazidime-avibactam has led to the emergence of a wide range of ceftazidime-avibactam-resistant blaKPC-2 variants. Particularly, the conventional carbapenemase phenotypic assay exhibited a high false-negative rate for KPC-2 variants. In this study, three colloidal gold immunoassays, including the Gold Mountainriver CGI test, Dynamiker CGI test and NG-Test CARBA5, and GeneXpert Carba-R, were used to detect the presence of KPC-2 carbapenemase and its various variants in 42 Klebsiella pneumoniae strains. These strains covered blaKPC-2 (13/42) and 16 other blaKPC-2 variants including blaKPC-12 (1/42), blaKPC-23 (1/42), blaKPC-25 (1/42), blaKPC-33 (6/42), blaKPC-35 (1/42), blaKPC-44 (1/42), blaKPC-71 (1/42), blaKPC-76 (8/42), blaKPC-78 (1/42), blaKPC-79 (1/42), blaKPC-100 (1/42), blaKPC-127 (1/42), blaKPC-128 (1/42), blaKPC-144 (1/42), blaKPC-157 (2/42), and blaKPC-180 (1/42). For KPC-2 strains, all four assays showed 100% negative percentage agreement (NPA) and 100% positive percentage agreement (PPA) with sequencing results. For all 16 KPC-2 variants, GeneXpert Carba-R showed 100% NPA and 100% PPA, and the three colloidal gold immunoassays showed 100% NPA, while the PPAs of the Gold Mountainriver CGI test, Dynamiker CGI test, and NG-Test CARBA5 were 87.5%, 87.5%, and 68.8%, respectively. We also found a correlation between the mutation site in the amino acid of the variants and false-negative results by colloidal gold immunoassays. In conclusion, the GeneXpert Carba-R has been proven to be a reliable method in detecting KPC-2 and its variants, and the colloidal gold immunoassay tests offer a practical and cost-effective approach for their detection. For the sample with a negative result by a colloidal gold immunoassay test but not matching the drug-resistant phenotype, it is recommended to retest using another type of kit or the GeneXpert Carba-R assay, which can significantly improve the accuracy of detection.