Perfect Kappa Research Articles

Agreement between 2D Visual- and 3D Motion Capture-based Assessment of Foot Strike Pattern.

Foot strike patterns during running are typically categorized into two types: non-rearfoot strike (NRFS) and rearfoot strike (RFS), or as three distinct types: forefoot strike (FFS), midfoot strike (MFS), and RFS, based on which part of the foot lands first. Various methods, including two-dimensional (2D) visual-based methods and three-dimensional (3D) motion capture-based methods utilizing parameters such as the strike index (SI) or strike angle (SA), have been employed to assess these patterns. However, the consistency between the results obtained from each method remains debatable. The purpose of this study was to examine the agreement for assessing foot strike patterns into two (NRFS and RFS) or three types (FFS, MFS, and RFS) between 2D visual- and 3D motion capture-based methods. The authors hypothesized that using two description types (NRFS and RFS) would have high inter-method reliability; however, using three description types (FFS, MFS and RFS) would have lower inter-method reliability because of the difficulty in distinguishing between FFS and MFS. Controlled Laboratory Study. Overall, 162 foot strikes from four healthy runners with various foot strike patterns were analyzed. Running kinematics and kinetics were recorded using a 3D motion capture system with a force platform. Each foot strike was filmed at 240 fps from the sagittal perspective. The visual, SI, and SA methods were used, and the kappa values for each method were calculated. An assessment of the two types of foot strike: NRFS and RFS, revealed almost perfect kappa values (κ = 0.89-0.95) among the visual, SI, and SA methods. In contrast, an assessment of the three types: FFS, MFS, and RFS, revealed relatively low kappa values (κ = 0.58-0.71). Kappa values within the NRFS category, which includes MFS and FFS, ranged from fair to slight (κ = 0.08-0.33). Previous laboratory findings that categorized foot strike patterns into two distinct types may be applied in observational studies, clinical practice, and training situations. Level 2.

Evaluation of total leukocytes count by flow cytometry with Beckman Coulter® DXH900 in the presence of platelet aggregates

The Beckman Coulter® DXH900 uses the impedance method to measure the total leukocytes count. In presence of platelet aggregates, the device identifies the structural changes and associates an alarm with the leukocytes result. The aim of this study was to evaluate the influence of platelet aggregates using the principle of flow cytometry as a second assessment of the white blood cell count. Total leukocytes count was evaluated in 49 specimens with presence of platelet aggregates and 32 without anomaly. The differences between total leukocyte count by the two automatic methods (impedance and flow cytometry) and the microscopic method were compared. Without platelet aggregates, the median values were 5.6 (microscopic cell count), 5.4 (impedance) and 5.4 (flow cytometry) and no discordance was observed. In presence of platelet aggregates, the median values were 5.6, 6.4 and 5.1 respectively. The graphical analysis with the allowable total error range of ± 25.7% showed substantial analytical discrepancies (15/49) using impedance method while the flow cytometry method revealed minor disagreements (3/49). Analytical discordances versus WBC reference ranges showed 88% agreement and a substantial Kappa coefficient of 0.70 by impedance, while the flow cytometry method had 94% agreement and a perfect Kappa coefficient of 0.83. The formation of platelet aggregates increased the total leukocyte count performed DXH900 impedance method. Our study has shown that DXH 900 flow cytometry method may be an alternative to exclude the presence of pseudoleukocytosis. In case flags are generated, the microscopic method may be needed for the confirmation of WBC count.

Prevalence and animal level risk factors associated with Trypanosoma evansi infection in dromedary camels

Surra is a non-cyclic parasitic disease caused by Trypanosoma evansi (T. evansi) and spread by biting flies. The disease has a severe impact on camel health, productivity, and market value, posing a significant threat to food safety and the economy. In a cross-sectional study, 370 blood samples were collected from camels in three Egyptian governorates. Samples were tested using parasitological (thin blood smear (TBS)), card agglutination test for T. evansi (CATT), and PCR to estimate the prevalence of T. evansi infection. Overall, the prevalence of T. evansi among examined camels was 17.3%, 18.9% and 22.7% using TBS, CATT and PCR methods, respectively. The risk of T. evansi infection in older camels (> 10 years) is higher than that in young ones (odds ratio (OR) = 9; 95% CI: 3.5–23.1), particularly during spring (OR = 2.5; 95% CI: 1.1–5.7). Furthermore, females and poor conditioned camels were 2.6 and four times more likely to get infection than males and good conditioned camels, respectively. The level of agreement between diagnostics tests were perfect kappa (> 0.83). Moreover, CATT showed higher sensitivity (0.83; 95% CI: 0.74–0.91) than TBS (0.76; 95% CI: 0.66–0.85) and both had perfect specificity (100%). In conclusion, our findings revealed a high rate of T. evansi infection in camels from the three Egyptian governorates. The CATT is a good test for routine use in control program of trypanosomiasis in camels.

A Framework to Assist in Didactic Planning at Undergraduate Level

In the teaching-learning process under the competency-based educational model, the instructor is a facilitator and seeks to generate a flexible and adaptable environment for student learning. One of the first tasks of the facilitator is the structuring of didactic planning. Didactic planning includes strategies for teaching and learning, evidence gathering, and choice of evaluation instruments. In this paper, we propose a framework based on natural language processing techniques with the support of an ontology grounded in the experience of instructors and university level course plans in the information systems area. We employ Bloom’s taxonomy in the ontology design, producing an ascending structure for didactic planning, which allows the student to learn gradually. The developed framework can analyze the key elements that a didactic plan must contain and identify inter-related areas. Evaluation results with Cohen’s kappa coefficient between expert judgement and our framework show that is possible to assist instructors in structuring their didactic planning. Out of the nine processes analyzed with the framework, an almost perfect kappa level was achieved in five processes, a substantial level in three processes, and a moderate level for one process.

Reliable interobserver and intraobserver agreement of the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) classification system of rotator cuff tears

ObjectiveThe ISAKOS Shoulder Committee developed a new comprehensive classification system aimed to describe all rotator cuff tears. The five characteristics of the tears included are pattern (P), extension (E), fatty atrophy (A), retraction (R), and location (L), conforming to the acronym “PEARL.” The objective of this study is to assess if the ISAKOS Rotator Cuff Tear Classification System is reliable by measuring the intraobserver and interobserver multirater reliability. MethodsArthroscopic videos of 36 rotator cuff tears, including tears of varying sizes and configurations, were evaluated twice by four surgeons from different continents blinded to tear type. Intraobserver and interobserver reliability was measured using multirater and intraobserver Kappa coefficients. ResultsIntraobserver reliability: An almost perfect agreement for “location” (κ = 0.98), substantial agreement for “extension” (κ = 0.73) were obtained for mean intrarater kappa, lower κ agreement for “pattern” (κ = 0.58), and relatively high agreement of 0.79 for “retraction.” Every characteristic of “location” had an almost perfect agreement among the surgeons (κ = 0.91). Intrarrater reliability: In the partial-thickness posterosuperior tears “location,” there was good agreement in tears involving less than 50% of the tendon (κ = 0.74) and moderate in those deeper than 50% of the tendon thickness (κ = 0.58). “Extension” in full-thickness posterosuperior RCT achieved moderate agreement. Within the anterior subscapularis tears, we have a substantial agreement in Lafosse´s Type 1 (κ = 0.73), moderate in Types 2 and 3 (κ = 0.45 and κ = 0.46) and slight agreement in Type 4 (κ = 0.06). The overall kappa summarizing all categories indicated moderate agreement (κ = 0.52). The articular pattern in the partial-thickness posterosuperior RCT “location” had a perfect kappa of 1, while the bursal pattern showed an almost complete agreement (κ = 0.87). In the full-thickness posterosuperior RCTs, we observed fair agreement in C, U, and reverse L configurations and slight agreement in L pattern (κ = 0.18). The overall kappa is 0.44 with a confidence interval of 0.41–0.47. There was substantial agreement in every category and the overall kappa for “retraction” (k = 0.70). ConclusionISAKOS rotator cuff tear classification system provides sufficient interobserver reliability for communicating among surgeons and for pooling of data from clinical studies. Study designCohort study (diagnosis); Level of evidence, 2.

Selfie fundus imaging for diabetic retinopathy screening.

BackgroundRegular screening for retinopathy and timely intervention reduces blindness from diabetes by 90%. Screening is currently dependent on the interpretation of images captured by trained technicians. Inherent barriers of accessibility and affordability with this approach impede widespread success of retinopathy screening programs. Herein, we report our observations on the potential of a novel approach, Selfie Fundus Imaging (SFI), to enhance diabetic retinopathy screening.MethodsThe study was undertaken over a two-month period during COVID 19 lockdown. 60 diabetic patients participated in the study. Retinal images were captured using three different approaches, handheld smartphone-based photographs captured by patients themselves after a short video-assisted training session (SFI group), and smartphone-based photographs captured by a trained technician and photographs taken on desktop conventional digital fundus camera (Gold standard). Sensitivity and kappa statistics was determined for retinopathy and macular oedema grading.FindingsMean age of the study participants was 52.4 years ± 9.8 years and 78% were men. Of 120 images captured using SFI, 90% were centred-gradable, 8% were decentred-gradable and 2% were ungradable. 82% patients captured the image within a minute (majority by 31–45 s). The sensitivity of SFI to detect diabetic retinopathy was 88.39%. Agreement between SFI grading and standard fundus photograph grading was 85.86% with substantial kappa (0.77). For the detection of diabetic macular oedema, the agreement between SFI images and standard images was 93.67, with almost perfect kappa (0.91).ConclusionFundus images were captured by patients using SFI without major difficulty and were comparable to images taken by trained specialist. With greater penetrance, advances, and availability of mobile photographic technology, we believe that SFI would positively impact the success of diabetic retinopathy screening programs by breaking the barriers of availability, accessibility, and affordability. SFI could ensure continuation of screening schedules for diabetic retinopathy, even in the face a highly contagious pandemic.

Development and Interrater Reliability of a Street Food Stand Assessment Tool

ObjectiveTo design and test the interrater reliability of a Street Food Stand Assessment Tool (SFSAT). DesignVariables were adapted from validated assessment tools, field observations, and the Mexican Dietary Guidelines. Two researchers tested the SFSAT by observing street food stands (SFS) in 3 middle- to high-income neighborhoods. SettingMexico City. ParticipantsFifty-two SFS. Variables MeasuredThe SFSAT contains 14 items for SFS characteristics and 44 items for food and beverages. AnalysisPercent agreement and kappa interrater reliability scores were calculated for each variable. ResultsAlmost perfect kappa interrater reliability scores (0.81–1.00) were reported for 62.7% of SFS characteristic items. Interrater reliability scores for food and beverage availability and variety ranged from 0.00–1.00, whereas the percent agreement for these items ranged from 59.6%–100.0%. Conclusions and ImplicationsThe SFSAT is a reliable assessment tool to measure the availability and variety of street foods and beverages in Mexico City. Future research can update and adapt the SFSAT to the street food environment of other cities—in Mexico and abroad.

Validity and Reliability of the Turkish Translation of the Yale Pharyngeal Residue Severity Rating Scale.

This study aimed to assess the validity and reliability of the Turkish translation of the Yale pharyngeal residue severity rating scale. The scale measures the severity of residue in the vallecula and pyriform sinus. The original scale was translated into Turkish by two bilingual English-Turkish translators, and the Turkish version was translated back into English by two qualified professional translators to assess accuracy. The evaluators were divided into two groups (training and no-training) and two subgroups according to their experience. Intra-rater, inter-rater, and intra-class correlation coefficient measurements were analyzed by calculating agreement rates, kappa, and p values. In the analysis of the reliability, intra-class correlation coefficient values in the overall ratings for both the vallecula and the pyriform sinus were 0.9996 (95% CI 0.9992-0.9998) and 0.9997 (95% CI 0.9995-0.9999), respectively (p < 0.01). High agreement (> 95%) and perfect Fleiss kappa values were obtained for the vallecula and pyriform sinus ratings in the inter-rater initial assessments (κ = 0.959 and κ = 0.967, respectively). Perfect kappa values were found in the intra-rater results for both the vallecula and pyriform sinus (α = 0.9959 and κ = 0.9959, respectively). In the inter-rater secondary analysis, the vallecula and pyriform sinus kappa values were perfect (κ = 0.959 and κ = 0.967, respectively). In the intra-rater analysis, perfect kappa values were obtained for the vallecula and pyriform sinus in the no-training group and less-experience subgroup (κ = 0.9918 and κ = 1.0 for the vallecula, and κ = 1.0 and κ = 0.9902 for the pyriform sinus, respectively) In the inter-rater analysis, perfect kappa values were obtained for the vallecula and pyriform sinus in the no-training group and less-experience subgroup (κ = 0.9507 and κ = 0.9606 for the vallecula, and κ = 0.9836 and κ = 1.0 for the pyriform sinus, respectively). The Turkish translation of the Yale pharyngeal residue severity rating scale demonstrated high validity and reliability scores in determining pharyngeal residue location and value in the fiberoptic endoscopic evaluation of swallowing.

Reliability of the Cutting Alignment Scoring Tool (CAST) to Assess Trunk and Limb Alignment During a 45-Degree Side-Step Cut.

BackgroundThree-dimensional (3D) motion analysis is considered the gold standard for evaluating human movement. However, its clinical utility is limited due to cost, operating expertise, and lengthy data processing time. Numerous qualitative scoring systems have been introduced to assess trunk and lower extremity biomechanics during functional tasks. However, the reliability of qualitative scoring systems to evaluate cutting movements is understudied. Purpose/Hypotheses: To assess the inter-rater and intra-rater reliability of the Cutting Alignment Scoring Tool (CAST) among sports medicine providers and to evaluate rater agreement of each component of the CAST. The hypotheses were: 1) there would be good–to-excellent inter-rater and intra-rater reliability among sports medicine providers, 2) there would be good to almost perfect agreement for cut width and trunk lean variables and moderate to good agreement for valgus variables of the CAST.Study DesignRepeated MeasuresMethodsTen videos of a 45-degree side-step cut performed by adolescent athletes were independently rated on two occasions by six raters (2 medical doctors, 2 physical therapists, and 2 athletic trainers). The variables assessed include trunk lean to the opposite direction of the cut, increased cut width, knee valgus at initial load acceptance (static), and knee valgus throughout the task (dynamic). Variables were scored as either present, which were given a score of “1”, or not present, which were given a score of “0”. Video sequence was randomized in each rating session, and a two-week wash out period was given.ResultsThe cumulative inter-rater and intra-rater reliabilities were good (ICC: 0.808 and ICC: 0.753). Almost perfect kappa coefficients were recorded for cut width (k=0.949). Moderate kappa coefficients were found for trunk lean (k= 0.632) and fair kappa coefficients were noted for dynamic and static valgus (k=0.462 and k= 0.533 respectively).ConclusionThese findings suggest that the CAST is a reliable tool to evaluate trunk and LE alignment during a cutting task by sports medicine providers.Level of EvidenceLevel 2 Diagnosis

Selfie Fundus Imaging (SFI) for Diabetic Retinopathy Screening During COVID 19 Pandemic

Background: Regular screening for retinopathy and timely intervention reduces blindness from diabetes by 90%. Screening is currently dependent on interpretation of images captured by trained technicians. Inherent barriers of accessibility and affordability with this approach impedes widespread success of retinopathy screening programs. Herein, we report our observations on the potential of a novel approach, Selfie Fundus Imaging (SFI), to enhance retinopathy screening.Methods: The study was undertaken over a two-month period during COVID 19 lockdown. 60 diabetic patients participated in the study. Retinal images were captured using three different approaches, handheld smartphone based photographs captured by patients themselves after a short video assisted training session (SFI group), smartphone based photographs captured by a trained technician and photographs taken on desktop conventional digital fundus camera (Gold standard). Sensitivity and kappa statistics was determined for retinopathy and macular edema grading.Findings: Mean age of the study participants was 52.4 years +/- 9.8 years and 78% were men. Of 120 images captured using SFI, 90% were centred-gradable, 8% were decentred-gradable and 2% were ungradable. 82% patients captured the image within a minute (majority by 31-45 seconds). The sensitivity of SFI to detect diabetic retinopathy was 88.39%. Agreement between SFI grading and standard fundus photograph grading was 85.86% with substantial kappa (0.77). For the detection of diabetic macular edema, the agreement between SFI images and standard images was 93.67, with almost perfect kappa (0.91).Interpretation: Fundus images were captured by patients using SFI without major difficulty and were comparable to images taken by trained specialist. With greater penetrance, advances, and availability of mobile photographic technology, we believe that SFI would positively impact success of diabetic retinopathy screening programs by breaking the barriers of availability, accessibility, and affordability. SFI could ensure continuation of screening schedules for diabetic retinopathy, even in the face a highly contagious pandemic.Funding: The study was not funded by any intramural or extramural agencies/ companies/ sponsors. It was carried out independently by the authors without seeking any funding.Conflict of Interest: None to declare. Ethical Approval: This prospective, comparative study was initiated after obtaining due ethical clearance (IECPG-646/19/12/2018) from the institutional ethics committee and followed the tenets of the Helsinki Declaration.

Validation of real-time polymerase chain reaction versus conventional polymerase chain reaction for diagnosis of brucellosis in cattle sera

Background and Aim:Different polymerase chain reaction (PCR) techniques have and are still being used for the direct detection of Brucella DNA in serum samples of different animal species and humans without being validated or properly validated, resulting in discrepancies. Thus, this study aimed to evaluate the diagnostic performance of the TaqMan Real-Time-PCR (RT-PCR) targeting the bcsp31 gene versus conventional PCR for the accurate diagnosis of brucellosis at the genus level in cattle sera.Materials and Methods:One hundred and eighty-four serum samples were collected from bacteriologically positive and negative cows with ages ranging from 1 to 5 years old at some infected private farms in the Nile Delta under quarantine measures as well as brucellosis free farms. These samples were classified into four groups after serological diagnosis and investigated by TaqMan RT-PCR and conventional PCR targeting the IS711 gene for Brucella DNA detection. The diagnostic performance characteristics of both PCR techniques were estimated considering the bacteriological results as a gold standard.Results:TaqMan RT-PCR revealed superiority over conventional PCR; it was able to detect Brucella DNA in 95% (67/70) and 89% (25/28) of the cattle sera samples belonging to Group 1 (serologically and bacteriologically positive) and Group 2 (serologically negative but bacteriologically positive), respectively. On evaluating the diagnostic performance, TaqMan RT-PCR showed superior diagnostic sensitivity (93.9%), diagnostic specificity (88.4%), performance index (182.3), almost perfect kappa agreement (0.825±0.042), strong positive correlation (r=0.826), high accuracy based on the receiver operating characteristic (ROC) curve, and area under the ROC curve (0.911) at p<0.05 and CI of 95%.Conclusion:A cattle serum sample is not the metric of choice for targeting Brucella genomic DNA by conventional PCR. The time-saving and rapid TaqMan RT-PCR method revealed a better diagnostic performance in the detection of Brucella DNA in cattle sera. Such performance offered by TaqMan RT-PCR may be considered a step toward the possibility of using such technology in the direct differentiation between Brucella-infected and -vaccinated cattle immunized by smooth vaccines from cattle sera using primers specific for such vaccines.

The Feasibility of the Ages &amp; Stages Questionnaires, Third Edition (ASQ-3, Thai Version) for the Assessment of Child Development in Thailand

Objective: To conduct a feasibility and psychometric properties study by assessing the validity, sensitivity, specificity, and length of time answering the Ages &amp; Stages Questionnaire, Third Edition (ASQ-3, Thai version) to pinpoint developmental progress in children aged 12, 30, and 36 months and compare it with the standardized Bayley-III. Materials and Methods: Three hundred participants, who were the parents of children aged 12, 30, and 36 months old, and the children engaged in the present research. They were divided into two groups, 1) participants who received the questionnaires beforehand and completed them at the Queen Sirikit National Institute of Child Health (QSNICH), 2) participants who received and completed the questionnaires at the QSNICH on the same day. While the parents were filling out the ASQ-3, Thai version, child development progress was assessed using the Bayley-III. The length of time was recorded and compared between the two groups. Results: The present study showed that the ASQ-3, Thai version had a sensitivity of 78.6%, 96.7%, and 83.3% among children at 12, 30 and 36 months old, respectively. The specificity was at 90.3%, 95.7%, and 98.7% among 12, 30 and 36-month-old children, respectively. The validity for 30-month-old children was very high and had almost perfect kappa agreement of 0.81 to 1, while the validity among children at 12 and 36-month-old was substantial (kappa agreement of 0.67 to 0.86). Conclusion: The feasibility and accuracy of ASQ-3, Thai version is an applicable suitable developmental screening tool for children at 12, 30 and 36 months old in time limited circumstances and with insufficient health personnel. The validity of the ASQ-3, Thai version is acceptable when comparing to the standardized Bayley-III. The questionnaire is faster to complete than the child development progress assessment using the Bayley-III. Keywords: ASQ-3 (Thai version), Psychometric properties, Developmental screening, Feasibility

Reservoir risk modelling using a hybrid approach based on the feature selection technique and ensemble methods

Flash flooding is a type of global devastating hydrometeorological disaster that seriously threatens people’s property and physical safety, as well as the normal operation of water conservancy facilities, such as reservoirs, so an accurate assessment of reservoir risk for certain areas is necessary. Therefore, the purpose of this study was to propose a novel methodological approach for reservoir risk modelling based on the feature selection method (FSM) and tree-based ensemble methods (Bagging and Random Forest [RF]). The results showed that: (1) the J48-GA based ensemble models achieved higher learning and predictive capabilities compared to conventional ensemble models without the FSM. (2) For the classification accuracy, the J48-GA-RF (96.4%) outperformed RF (96.0%), J48-GA-Bagging (93.9%) and Bagging (93.5%). And the J48-GA-RF achieved the highest prediction AUC value (0.995), an almost perfect Kappa indexes value (0.926) and the best practicality value (30.88%). (3) In particular, the results indicated that all of the models showed high performance, both in training and in the validation of a dataset. Additionally, this study could provide a reference for disaster managers, hydraulic engineers and policy makers to implement location-specific flash flood risk reduction strategies.

Interobserver and Intraobserver Variability in the CT Assessment of COVID-19 Based on RSNA Consensus Classification Categories

PurposeTo assess the interobserver and intraobserver agreement of fellowship trained chest radiologists, nonchest fellowship-trained radiologists, and fifth-year radiology residents for COVID-19-related imaging findings based on the consensus statement released by the Radiological Society of North America (RSNA).MethodsA survey of 70 chest CTs of polymerase chain reaction (PCR)-confirmed COVID-19 positive and COVID-19 negative patients was distributed to three groups of participating radiologists: five fellowship-trained chest radiologists, five nonchest fellowship-trained radiologists, and five fifth-year radiology residents. The survey asked participants to broadly classify the findings of each chest CT into one of the four RSNA COVID-19 imaging categories, then select which imaging features led to their categorization. A 1-week washout period followed by a second survey comprised of randomly selected exams from the initial survey was given to the participating radiologists.ResultsThere was moderate overall interobserver agreement in each group (κ coefficient range 0.45-0.52 ± 0.02). There was substantial overall intraobserver agreement across the chest and nonchest groups (κ coefficient range 0.61-0.67 ± 0.06) and moderate overall intraobserver agreement within the resident group (κ coefficient 0.58 ± 0.06). For the image features that led to categorization, there were varied levels of agreement in the interobserver and intraobserver components that ranged from fair to perfect kappa values. When assessing agreement with PCR-confirmed COVID status as the key, we observed moderate overall agreement within each group.ConclusionOur results support the reliability of the RSNA consensus classification system for COVID-19-related image findings.

Feasibility and Reliability of a Questionnaire to Assess the Mode, Frequency, Distance and Time of Commuting to and from School: The PACO Study.

Active commuting to and from school has several health implications. Self-reporting is the most common assessment tool, but there is a high heterogeneity of questionnaires in the scientific literature. The purpose of this study was to analyse the feasibility and reliability of the Spanish “New Version of Mode and Frequency of Commuting To and From School” questionnaire in children and adolescents. A total of 635 children (5–12 years old) and 362 adolescents (12–18 years old) filled out the questionnaire twice (14 days apart). Feasibility was evaluated using an observational checklist. The test-retest reliability of the “New Version of Mode and Frequency of Commuting To and From School” questionnaire and the distance and time to school were examined using the kappa and weight kappa coefficient (κ). No misunderstanding of questions was reported. The time to complete the questionnaire was 15 ± 3.62 and 9 ± 2.26 min for children and adolescents, respectively. The questionnaire showed substantial and almost perfect kappa coefficients for the overall six items (k = 0.61–0.94) in children and adolescents. The “New Version of Mode and Frequency of Commuting To and From School” questionnaire is a feasible and reliable questionnaire in Spanish children and adolescents.

Design and evaluation of a mobile application to assist the self-monitoring of the chronic kidney disease in developing countries

BackgroundThe chronic kidney disease (CKD) is a worldwide critical problem, especially in developing countries. CKD patients usually begin their treatment in advanced stages, which requires dialysis and kidney transplantation, and consequently, affects mortality rates. This issue is faced by a mobile health (mHealth) application (app) that aims to assist the early diagnosis and self-monitoring of the disease progression.MethodsA user-centered design (UCD) approach involving health professionals (nurse and nephrologists) and target users guided the development process of the app between 2012 and 2016. In-depth interviews and prototyping were conducted along with healthcare professionals throughout the requirements elicitation process. Elicited requirements were translated into a native mHealth app targeting the Android platform. Afterward, the Cohen’s Kappa coefficient statistics was applied to evaluate the agreement between the app and three nephrologists who analyzed test results collected from 60 medical records. Finally, eight users tested the app and were interviewed about usability and user perceptions.ResultsA mHealth app was designed to assist the CKD early diagnosis and self-monitoring considering quality attributes such as safety, effectiveness, and usability. A global Kappa value of 0.7119 showed a substantial degree of agreement between the app and three nephrologists. Results of face-to-face interviews with target users indicated a good user satisfaction. However, the task of CKD self-monitoring proved difficult because most of the users did not fully understand the meaning of specific biomarkers (e.g., creatinine).ConclusionThe UCD approach provided mechanisms to develop the app based on the real needs of users. Even with no perfect Kappa degree of agreement, results are satisfactory because it aims to refer patients to nephrologists in early stages, where they may confirm the CKD diagnosis.

Assessing time use in long-term institutional care: development, validity and inter-rater reliability of the Groningen Observational instrument for Long-Term Institutional Care (GO-LTIC).

BackgroundLimited research has examined what is actually done in the process of care by nursing staff in long-term institutional care. The applied instruments employed different terminologies, and psychometric properties were inadequately described. This study aimed to develop and test an observational instrument to identify and examine the amount of time spent on nursing interventions in long-term institutional care using a standardized language.MethodsThe Groningen Observational instrument for Long-Term Institutional Care (GO-LTIC) is based on the conceptual framework of the Nursing Interventions Classification. Developmental, validation, and reliability stages of the GO-LTIC included: 1) item generation to identify potential setting-specific interventions; 2) examining content validity with a Delphi panel resulting in relevant interventions by calculating the item content validity index; 3) testing feasibility with trained observers observing nursing assistants; and 4) calculating inter-rater reliability using (non) agreement and Cohen’s kappa for the identification of interventions and an intraclass correlation coefficient for the amount of time spent on interventions. Bland-Altman plots were applied to visualize the agreement between observers. A one-sample student T-test verified if the difference between observers differed significantly from zero.ResultsThe final version of the GO-LTIC comprised 116 nursing interventions categorized into six domains. Substantial to almost perfect kappa’s were found for interventions in the domains basic (0.67–0.92) and complex (0.70–0.94) physiological care. For the domains of behavioral, family, and health system interventions, the kappa’s ranged from fair to almost perfect (0.30–1.00). Intraclass correlation coefficients for the amount of time spent on interventions ranged from fair to excellent for the physiological domains (0.48–0.99) and poor to excellent for the other domains (0.00–1.00). Bland Altman plots indicated that the clinical magnitude of differences in minutes was small. No statistical significant differences between observers (p > 0.05) were found.ConclusionsThe GO-LTIC shows good content validity and acceptable inter-rater reliability to examine the amount of time spent on nursing interventions by nursing staff. This may provide managers with valuable information to make decisions about resource allocation, task allocation of nursing staff, and the examination of the costs of nursing services.

TF-Test Modified: New Diagnostic Tool for Human Enteroparasitosis.

Intestinal parasitosis is highly prevalent worldwide, being among the main causes of illness and death in humans. Currently, laboratory diagnosis of the intestinal parasites is accomplished through manual technical procedures, mostly developed decades ago, which justifies the development of more sensitive and practical techniques. Therefore, the main objective of this study was to develop, evaluate, and validate a new parasitological technique referred to as TF-Test Modified, in comparison to three conventional parasitological techniques: TF-Test Conventional; Rugai, Mattos & Brisola; and Helm Test/Kato-Katz. For this realization, we collected stool samples from 457 volunteers located in endemic areas of Campinas, São Paulo, Brazil, and statistically compared the techniques. Intestinal protozoa and helminths were detected qualitatively in 42.23% (193/457) of the volunteers by TF-Test Modified technique, against 36.76% (168/457) by TF-Test Conventional, 5.03% (23/457) by Helm Test/Kato-Katz, and 4.16% (19/457) by Rugai, Mattos & Brisola. Furthermore, the new technique presented "almost perfect kappa" agreement in all evaluated parameters with 95% (P < 0.05) of estimation. The current study showed that the TF-Test Modified technique can be comprehensively used in the diagnosis of intestinal protozoa and helminths, and its greater diagnostic sensitivity should help improving the quality of laboratory diagnosis, population surveys, and control of intestinal parasites.

Prostate cancer: what about reproducibility of decision made at multidisciplinary team management?

The prostate cancer (PCa) treatment is multimodal. Thus multidisciplinary team management (MDTM) decision-making process appears as a tool to answer all aspects of PCa treatment. Our aim was to evaluate the reproducibility of therapeutic decisions made at MDTM. We compared therapeutic decisions of PCa by presenting the same file of patient under a fake identity after 6 to 12 months from the first presentation. Forty-nine files of radical prostatectomy (RP) (28 pT2, 21 pT3) performed for clinical localized PCa were represented at MDTM which included urologist, oncologist, pathologist and radiologist. Analysis of therapeutic decisions comprised criteria such as: TNM stage, Gleason score, margin status and comorbidities. The reproducibility was assessed statistically by Kappa coefficient. Study subjects included 49 patients who underwent radical prostatectomy (RP). The mean age was similar in pT2 and pT3 groups (P = .09). The mean serum PSA value was 8.32 ng/mL (range, 3.56-19.5) in pT2 group and 9.4 ng/mL (range, 3.8-22) in pT3 group. The margin status in pT2 and pT3 groups was positive in 25.0% and 47.6%, respectively. The decisions made at first and second MDTM for pT2 group were the same in 100% of cases with a perfect kappa coefficient (k = 1). In the group of pT3 (n = 21), the decisions were different in 33% at the second MDTM in comparison to the first MDTM. Especially for pT3b only 29% were reproducible decision with a slight agreement (k = 0.1). Concerning pT3a, 86% of the decisions were reproducible with a substantial agreement (k = 0.74). We showed a reliability and reproducibility of decision made at MDTM when guidelines are well defined. The therapeutic attitudes were less reproducible in locally advanced PCa but decision concerning those cases should be made in the setting of guidelines.

Ocorrência de ceceio em fricativas vozeadas e não vozeadas em crianças com fissura labiopalatina operada

Objetivo investigar se o ceceio, quando identificado, difere entre as fricativas alveolares não vozeadas e vozeadas produzidas por crianças com fissura labiopalatina operada. Métodos estudo prospectivo, em que frases constituídas pelas consoantes [s] e [z] produzidas por 32 crianças com fissura labiopalatina operada (idade média, 8 anos, 8 meses) foram selecionadas de um banco de dados e posteriormente julgadas auditivamente. Todas as crianças apresentavam relação inter-arcos alteradas, conforme avaliação ortodôntica realizada por três ortodontistas (concordância inter-juiz quase perfeita, kappa= 0.81), a partir da análise de modelos de gesso. Três fonoaudiólogas julgaram auditivamente as produções áudio gravadas. A concordância inter-juízes variou entre 56% e 78% e entre 59% e 93% para as frases constituídas de [s] e [z], respectivamente. Resultados o ceceio foi identificado em 69% das crianças e, particularmente, em 72% e 50% das produções envolvendo [s] e [z], respectivamente. Houve diferença significante entre os julgamentos para as fricativas [s] e [z], com maior ocorrência de ceceio em [s]. Conclusões deformidades dentofaciais podem favorecer a ocorrência do ceceio na população com fissura labiopalatina. A maior ocorrência do ceceio em [s] em comparação à [z], a partir da identificação auditiva, pode ser justificado por razões acústicas e/ou articulatórias. Sugere-se que o ceceio é dependente do contexto fonético-fonológico da frase devendo o mesmo ser considerado para fins clínicos e de pesquisa.