Prevalence-adjusted And Bias-adjusted Kappa Research Articles

PD30-07 DECONSTRUCTING AND QUANTIFYING LIVE SURGICAL FEEDBACK IN THE OPERATING ROOM

You have accessJournal of UrologyCME1 Apr 2023PD30-07 DECONSTRUCTING AND QUANTIFYING LIVE SURGICAL FEEDBACK IN THE OPERATING ROOM Elyssa Y. Wong, Cherine H. Yang, Istabraq S. Dalieh, Daniela C. Sotelo, Jasper A. Laca, Runzhuo Ma, Timothy N. Chu, Rafal Kocielnik, Mitchell G. Goldenberg, Jamal A. Nabhani, Steven Cen, and Andrew J. Hung Elyssa Y. WongElyssa Y. Wong More articles by this author , Cherine H. YangCherine H. Yang More articles by this author , Istabraq S. DaliehIstabraq S. Dalieh More articles by this author , Daniela C. SoteloDaniela C. Sotelo More articles by this author , Jasper A. LacaJasper A. Laca More articles by this author , Runzhuo MaRunzhuo Ma More articles by this author , Timothy N. ChuTimothy N. Chu More articles by this author , Rafal KocielnikRafal Kocielnik More articles by this author , Mitchell G. GoldenbergMitchell G. Goldenberg More articles by this author , Jamal A. NabhaniJamal A. Nabhani More articles by this author , Steven CenSteven Cen More articles by this author , and Andrew J. HungAndrew J. Hung More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003316.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Feedback is essential in surgical training. While all trainees meet case minimums, the feedback they receive can vary in content and quality. We capture the intraoperative feedback provided to trainees during live urologic robotic cases and propose a standardized deconstruction for feedback. METHODS: Eight attending surgeons and nine trainees were prospectively recorded during robotic surgeries at our institution from April-August 2022. Endoscopic video was captured directly from the surgeon console. Dialogue between experts and trainees was recorded with clip-on microphones. A schematic flow for feedback and a classification system for Triggers, Feedback Elements, and Outcomes was developed (Figure 1a) and inter-rater reliability between three trained raters was calculated using prevalence-adjusted and bias-adjusted kappa (PABAK). To examine differences in these classification categories by trainee experience level, we first used generalized estimating equations to estimate weighted average rates across residents and fellows. Next, we used rate ratio (RR) to compare differences in these categories between surgical tasks (dissection vs suturing). RESULTS: Raters had moderate agreement in identifying Trigger, Feedback, and Outcome categories (PABAK 0.6-1.0). In total, 25 robotic teaching cases yielded 3,067 unique lines of feedback. A clear trigger was identified most of the time (59.6%, 95% Confidence Interval [CI] 55.4%, 64.2%). The most frequent trigger was trainee error (28.3%, 95% CI [24.4%, 32.8%]). Most feedback was purely technical (52.3%, 95% CI [46.3%, 59.1%]). The most often combined feedback elements were anatomic and technical components (20.3%, CI [17.3%, 23.8%]). Trainees received more anatomic feedback when performing dissection (RR 2.1, 95% CI [1.7, 2.5]) and more technical feedback when suturing (RR 1.1, 95% CI [1.0, 1.3]) (Figure 1b). Notably, experts repeated feedback less frequently for fellows than residents (RR 0.6, 95% CI [0.1, 1.1]). CONCLUSIONS: We developed a novel framework for feedback that not only captures the dynamic interaction between trainee and expert but accounts for resulting changes in behavior. Investigation into the relationships between Triggers, Feedback, and Outcomes may reveal avenues for optimizing feedback and skill acquisition in different teaching scenarios. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e833 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Elyssa Y. Wong More articles by this author Cherine H. Yang More articles by this author Istabraq S. Dalieh More articles by this author Daniela C. Sotelo More articles by this author Jasper A. Laca More articles by this author Runzhuo Ma More articles by this author Timothy N. Chu More articles by this author Rafal Kocielnik More articles by this author Mitchell G. Goldenberg More articles by this author Jamal A. Nabhani More articles by this author Steven Cen More articles by this author Andrew J. Hung More articles by this author Expand All Advertisement PDF downloadLoading ...

Evaluating remission and low disease activity from the perspective of the patient with axial spondyloarthritis: The cross-sectional ConREspAx study.

To evaluate the properties of a single question to determine patient perception of remission and disease activity; to compare this with existing definitions for remission and low disease activity (LDA). Single-center, cross-sectional study in a tertiary care hospital. Patients with axSpA (fulfilling ASAS criteria) were consecutively included. Both the patient's perception of remission and LDA and that of the physician were evaluated with a single question. Agreement between the patients' perception and other current definitions was tested using the prevalence-adjusted and bias-adjusted kappa (PABAK). The sensitivity (S) and specificity (Sp) of current definitions of disease states were tested against the patient's perception as the gold standard. The study population included 105 axSpA patients (63.8% males; 67.6% with radiographic sacroiliitis). Patients considered themselves to be in remission in 21% of cases and in LDA in 51.4%; physicians considered patients to be in remission in 45.7% of cases and in LDA in 35.2%. The poorest agreement was recorded for the patient's and the physician's perception of remission. The best agreement for patients' perception of remission was for a BASDAI<2 and normal C-reactive protein values. This definition was also the most sensitive (S=72.7%) and specific (Sp=83.1%) when the patient's perception was taken as the gold standard. In a real-life setting, the evaluation of remission by the patient through a single question was the hardest criterion to achieve, although it did prove to be a feasible, valid, and specific way to assess remission.

Sleep assessment in preterm infants: Use of actigraphy and aEEG

ObjectiveObjective methods to monitor the sleep of preterm infants at the neonatal intensive care unit (NICU) are required to prevent potentially adverse neurodevelopmental outcomes. This study aimed to determine the concordance of actigraphy and amplitude-integrated electroencephalogram (aEEG) against gold standard direct observation (DO) in assessing sleep/wake states of typically developing preterm infants. MethodsThis prospective observational study was conducted in a single center level III NICU. Sleep variables were measured using Philips Respironics Mini-Mitter® Actiwatch-2 for 24 h and compared with 8-h matched data of aEEG and DO. Sensitivity-specificity analysis, Cohen's kappa, prevalence-adjusted and bias-adjusted kappa (PABAK), and Bland Altman plots were generated. ResultsSeventeen preterm infants were recruited. A total of 11252 epochs were studied. Sensitivity (86.4%), agreement rate (67.9%), and predictive value for wake (47.9%) for the actigraphy were highest at the automatic activity threshold whereas specificity (54.5%) and predictive value for sleep (75.5%) were highest at low threshold. The sensitivity of aEEG was 79.3% and the specificity was 54.3%. At all thresholds, the agreement was largely equivalent with low kappas (0.14–0.17) and PABAK coefficients (0.22–0.35) for actigraphy and DO. Moderate agreement was observed between aEEG and DO according to the PABAK coefficient (0.44). Mean differences in sleep parameters were not different between DO and aEEG as well as DO/aEEG and actigraphy at medium threshold (p > 0.05). ConclusionsActigraphy at medium threshold can be used in depicting sleep in typically developing preterm infants at NICU. aEEG may be an alternative adjunctive method to actigraphy for the evaluation of sleep/wake states in the NICU setting. Clinical trial registration numberNCT04145362

Liver ultrasound in cirrhosis is inadequate for hepatocellular carcinoma surveillance compared to magnetic resonance imaging

Background The guidelines recommend surveillance with liver ultrasound (US) for early detection of hepatocellular carcinoma (HCC). The accuracy of US is operator-dependent and is limited in those with severe obesity or ascites. Magnetic resonance imaging (MRI) may have higher accuracy for detecting HCC, especially early HCC. Objective To assess the accuracy of US for HCC detection using MRI as the clinical gold standard. Methods We performed a retrospective study of 223 patients with cirrhosis who had both abdominal US and MRI within 6 months of each other, between October 2013 and November 2018. Using MRI as the gold standard for detecting HCC, the test characteristics of US and concordance with MRI were evaluated, and potential patient characteristics associated with the false-negative US were examined. Results Of 223 patients, MRI detected HCC in 70 patients while US detected HCC only in 38; thus, the overall sensitivity of US was 54% in detecting HCC, using MRI as the reference standard. The prevalence-adjusted and bias-adjusted kappa (PABAK) was 0.65 for the entire group. However, PABAK was only 0.04 when the subgroup with HCC (n = 70) was analysed. Higher Model for End-Stage Liver Disease (MELD) score was the only factor that was associated with decreased US sensitivity, with the odds of false-negative US increasing by 9.8% for each 1-point increase in MELD. Conclusion Our study showed that MRI performed better than the US in detecting HCC in patients with cirrhosis. Patients with higher MELD may require an MRI for HCC surveillance for early diagnosis of HCC.

Intrarater and interrater agreement of a 6-item movement control test battery and the resulting diagnosis in patients with nonspecific chronic low back pain

ABSTRACT Objective To investigate the intrarater and interrater agreement of a 6-item test battery in nonspecific chronic low back pain (LBP) and investigate the agreement between raters to assign the resulting movement control (MC) diagnoses. Methods Thirty patients with chronic LBP (18–30 years) were included in this study. Six raters were trained and rated the videos of the patients during the execution of the tests. After one week, the raters re-watched the videos and repeated the examination. A diagnosis of MC was assigned for each patient. Agreement was analyzed using weighted kappa and prevalence-adjusted and bias-adjusted kappa (PABAK) coefficients. Results We showed an acceptable intrarater agreement for the 6-item test battery for four out of six raters, except for one test: prone knee flexion. The results of the interrater agreement between the three pairs of raters showed acceptable agreement levels (k > 0.4), except for two tests, “rocking on all four backward” and “prone knee flexion test.” For the diagnosis of MC impairment, acceptable agreement levels (k > 0.4) were observed for five out of six raters for intrarater agreement. For interrater assessment, we found an acceptable agreement between pairs of raters. Conclusion We showed acceptable levels of agreement between the intrarater and interrater for a 6-item test battery to identify MC impairment, except for two tests. Agreement in the MC diagnoses achieved acceptable levels for five of the six raters (intrarater) and all three pairs of raters (interrater). Such results support the use of the 6-item test battery to detect MC impairment.

PD02-01 DEVELOPMENT AND VALIDATION OF AN OBJECTIVE SCORING TOOL TO EVALUATE SURGICAL DISSECTION: DISSECTION ASSESSMENT FOR ROBOTIC TECHNIQUE (DART)

You have accessJournal of UrologyEducation Research I (PD02)1 Sep 2021PD02-01 DEVELOPMENT AND VALIDATION OF AN OBJECTIVE SCORING TOOL TO EVALUATE SURGICAL DISSECTION: DISSECTION ASSESSMENT FOR ROBOTIC TECHNIQUE (DART) Erik Vanstrum, Runzhuo Ma, Jacqueline Maya-Silva, Daniel I. Sanford, Jessica H. Nguyen, Alireza Ghoreifi, Xiaomeng Lei, Steven Cen, and Andrew J. Hung Erik VanstrumErik Vanstrum More articles by this author , Runzhuo MaRunzhuo Ma More articles by this author , Jacqueline Maya-SilvaJacqueline Maya-Silva More articles by this author , Daniel I. SanfordDaniel I. Sanford More articles by this author , Jessica H. NguyenJessica H. Nguyen More articles by this author , Alireza GhoreifiAlireza Ghoreifi More articles by this author , Xiaomeng LeiXiaomeng Lei More articles by this author , Steven CenSteven Cen More articles by this author , and Andrew J. HungAndrew J. Hung More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001966.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There is a need for effective surgical competency assessment to ensure safe and efficient transfer of skills to training robotic surgeons. Additionally, competency assessment has important implications for credentialing and improving patient outcomes. This project aimed to develop an objective scoring tool that comprehensively evaluates surgical dissection quality. METHODS: The study was conducted in two phases. During phase 1, development, the Delphi method was used to validate content of Dissection Assessment for Robotic Technique (DART). A multi-institutional and multi-disciplinary (n=12 Urology, n=1 OBGYN, n=1 General Surgery) panel of expert surgeons systematically evaluated each element; those with content validity index (CVI) of ≥ 0.8 were included in the final product (Figure 1). During phase 2, validation, 10 blinded reviewers evaluated 46 de-identified videos of the pelvic lymph node and seminal vesicle dissection steps during robot-assisted radical prostatectomy. Inter-rater reliability was calculated using prevalence-adjusted and bias-adjusted kappa (PABAK). Expert and trainee surgeons were defined by prior robotic caseload >100 and ≤100, respectively. Mann-Whitney U test was used to compare between groups. RESULTS: In phase 1, Delphi method achieved content validity in 27/28 elements after 4 rounds. The element that did not reach consensus was use of a 3-point or 5-point scale (CVI=0.64). Most surgeons (93%) agreed that it is important to maximize agreement between raters. In phase 2, the 3-point scale showed greater inter-rater reliability for each domain as compared with the 5-point scale (PABAK≥0.52, ≥0.38, respectively). When rated on the 3-point scale, total scores between experts and trainees exhibited a significant difference (median 17.2 (IQR 16.9-17.4) vs. 15.7 (14.8-16.3), p<0.001). CONCLUSIONS: DART is an objective and reproducible 3-point surgical assessment that effectively differentiates between levels of surgical experience. Source of Funding: Research reported in this publication was supported in part by the National Institute Of Biomedical Imaging And Bioengineering of the National Institutes of Health under Award Number K23EB026493 © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e37-e37 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Erik Vanstrum More articles by this author Runzhuo Ma More articles by this author Jacqueline Maya-Silva More articles by this author Daniel I. Sanford More articles by this author Jessica H. Nguyen More articles by this author Alireza Ghoreifi More articles by this author Xiaomeng Lei More articles by this author Steven Cen More articles by this author Andrew J. Hung More articles by this author Expand All Advertisement Loading ...

Public Views of Dairy Calf Welfare and Dairy Consumption Habits of American Youth and Adults.

The primary objective of this study was to explore views of dairy calf welfare and dairy product consumption habits among youth and adults. The secondary objective was to explore views of dairy calf welfare and dairy product consumption habits among a subset of parent-child pairs. Participants 5–17 years of age (n = 463) and 18 years old or greater (n = 1,310) completed an in-person survey at the Minnesota State Fair (St. Paul, MN, USA) in summer 2018. A subset of these data was comprised of parent-child pairs (n = 188). The survey was administered via Qualtrics using iPads and included multiple-choice questions about demographics and calf welfare, an open-ended question on “what dairy calves need to have a good life,” and multiple-choice questions about participants' consumption of dairy products and nondairy alternative products. Content analysis was used for responses to the open-ended question, and concepts to describe dairy calf welfare views were identified. Fisher's exact test and Cohen's Kappa were used to investigate the relationships between parent-child pair responses about dairy calf welfare. In addition to these methods, prevalence-adjusted and bias-adjusted kappa (PABAK) were used to investigate the relationships between parent-child pair responses about consumption habits. The median age of all youth participants was 11 years and 61% were female, 82% were urban residents, and 63% did not have prior experience handling agricultural animals but 83% had visited a farm in the past. Most youth participants (94.4%) indicated that they consumed dairy products, while 47.1% consumed nondairy alternatives products. Median age range of all adult participants was 45–54 years, 65% were female, 82% urban residents, and 81% did not have prior experience handling agricultural animals but 63% had visited a farm in the past. Most adult participants (94%) indicated that they consumed dairy products and 47% indicated that they consumed nondairy alternative products. In response to “what dairy calves need to have a good life,” youth and adults most commonly focused on issues related to biological functioning (82 and 70% of youth and adults mentioning this concept, respectively), followed by natural living (44 and 50%, respectively), humane care (30 and 20%, respectively), and affective states (5% of both youth and adults). For the natural living concept of animal welfare, parent and child responses were slightly associated (Kappa = 0.19; P = 0.01; overall agreement = 61%). Almost all participants reported consuming dairy products, therefore, the agreement is high between parents and children because in most households (90%), both parents and children consume dairy products. However, child consumption was observed to be lower (75%, 9/12) when parents do not consume dairy than when parents do consume dairy (95%, 167/176), leading to a Kappa of 0.20 (P = 0.006, PABAK = 0.81) and a slight association between parents and children. The results suggest that biological functioning is highly valued by the public and views of parents and their children related to natural living in dairy calves are slightly associated.

Occupational Therapists, Physiotherapists and Orthopaedic Surgeons Agree on the Decision for Carpal Tunnel Surgery.

Therapist-led pathways have been proposed as waitlist management strategies prior to surgery for conditions such as carpal tunnel syndrome (CTS) in public hospitals. These models of care typically shift the initial care of patients and decision-making from surgeons to therapists and, have been shown to reduce the number of patients requiring surgery and improve wait-times. This occurs despite limited evidence of surgeon-therapist agreement on key decisions, such as the need for surgery. The purpose of this was study was to assess the agreement between therapists and orthopaedic surgeons regarding the need for surgery for patients who have CTS. This blinded inter-rated agreement study was embedded in a multicentre randomised parallel groups trial of 105 patients with CTS referred to four orthopaedic departments and waitlisted for an appointment. The trial evaluated the effect of a therapist-led care pathway on the need for surgery and outcomes related to symptoms and function. Patients were randomised to either remain on the orthopaedic waitlist or receive group education, a splint and home exercises. The decision on the need for surgery at 6 months was made by a member of the orthopaedic consultant team or by one of the 14 participating therapists. The therapists and surgeons were blinded to each other's decision. Agreement was determined using percentage agreement, kappa coefficients (k), prevalence-adjusted and bias-adjusted kappa (PABAK), and Gwet's first-order agreement coefficient (AC1). Substantial agreement was seen between therapists and surgeons regarding the need for surgery (PABAK=0.74 (0.60-0.88)). Agreement was significantly associated with experience (P=.02). Therapists with advanced experience and scope of practice demonstrated perfect agreement with surgeons (PABAK=1.00 (95% CI: 1.00-1.00)). Mid-career therapists demonstrated substantial agreement (PABAK=0.67 (95% CI: 0.42-0.91)) and early-career therapists demonstrated fair agreement (PABAK=0.43 (95% CI: -0.04-0.90)). Therapists with advanced scope of practice make decisions that are consistent with orthopaedic surgeons.

Importance of the triglyceride level in identifying patients with a Type III Hyperlipoproteinemia phenotype using the ApoB algorithm

Hyperlipoproteinemia Type III (HLP3), also known as dysbetalipoproteinemia, is defined by cholesterol and triglyceride (TG) enriched remnant lipoprotein particles (RLP). The gold standard for diagnosis requires demonstration of high remnant lipoprotein particle cholesterol (RLP-C) by serum ultracentrifugation (UC), which is not readily available in daily practice. The apoB algorithm can identify HLP3 using total cholesterol (TC), plasma triglyceride (TG), and apoB. However, the optimal TG cutoff is unknown. We analyzed apoB algorithm defined HLP3 at different TG levels to optimize the TG cutoff for the algorithm. 128,485 UC lipid profiles in the Very Large Database of Lipids (VLDbL) were analyzed. RLP-C was assessed at TG≥133mg/dL, ≥175mg/dL, ≥200mg/dL, and ≥ 250mg/dL. Sensitivity (Sn), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), and prevalence adjusted and bias-adjusted kappa (PABAK) were calculated against UC Criterion (VLDL-C/TG≥0.25) for HLP3. The median age (IQR) was 57years (46-68). 45% were men, 20.1% had diabetes, and 25.5% had hypertension. The median RLP-C level for the TG cutoffs (mg/dL) of ≥ 133, ≥ 175, ≥ 200, and ≥ 250 were 34, 43, 50, and 62 mg/dL, respectively, compared to 67 mg/dL in UC defined HLP3. TG≥133mg/dL yielded optimal results (Sn 29.5%, Sp 98.5%, PABAK 0.96, PPV 13.6%, NPV 99.4%). TG≥133mg/dL allows for high sensitivity in screening for HLP3. Higher TG cutoffs may identify more severe HLP3 phenotypes, but with a large loss in sensitivity for HLP3.

Descripción de la prueba semiológica de Compresión y flexión del pulgar, para el diagnóstico de Rizartrosis. Estudio de Cohorte Transversal

BackgroundThumb pain secondary to osteoarthritis of the trapezium-metacarpal joint is a common condition, especially in women, and causing high levels of disability in some patients. The diagnosis of rhizarthrosis is based on localised pain, inflammation, and instability on physical examination, in addition to radiographic evaluation. There are currently several semiological tests that can be used in the diagnosis of symptomatic rhizarthrosis, one of which is the Grind or grinding test, which is considered the gold standard. The present study aims to describe and evaluate the thumb compression and flexion test designed for the diagnosis of rhizarthrosis. MethodsA cross-sectional study was carried out during the period from January 2007 to May 2013. The study included a total of 230 patients that came to the clinic with symptoms suggestive of rhizarthrosis, and on whom the Grind test, the compression test, and flexion were simultaneously performed to confirm the diagnosis. ResultsOf the 230 patients who attended the clinic, 87.8% (202) were women with a mean age of 60 years (32 to 86 years). A bilateral involvement was observed in 14.8% of the patients. Just under half (47.8%) currently had co-morbidities that included, among others, carpal tunnel syndrome (67.3%) and trigger finger (11.8%). The prevalence-adjusted and bias-adjusted kappa (PABAK) concordance index between the two semiological signs was 0.948, indicating an excellent level of agreement between both. All (100%) of the patients were diagnosed by the flexion and compression test. DiscussionDue to obtaining a positive test in all the patients evaluated with the compression and flexion test, it should be considered as a complementary test in the clinical evaluation of patients with rhizarthrosis. Further studies are necessary to validate this test in order to establish its sensitivity and specificity. Evidence LevelII

Shared spiritual beliefs between adolescents with cancer and their families.

FAmily CEntered (FACE) Advance Care Planning helps family decision makers to understand and honor patients' preferences for future health care, if patients cannot communicate. Spiritual well-being is a key domain of pediatric oncology care and an integral dimension of pediatric advance care planning. As part of four-site randomized controlled trial of FACE for teens with cancer, the functional assessment of chronic illness therapy-spiritual well-being- version 4 (FACIT-Sp-EX-4) was completed independently by 126 adolescents with cancer/family dyads. The prevalence-adjusted and bias-adjusted kappa (PABAK) measured congruence on FACIT-Sp-EX-4. Adolescents (126) had mean age of 16.9years, were 57% female and 79% White. Religious/spiritual classifications were: Catholic (n=18), Protestant (n=76), Mormon (n=3), none/atheist (n=22), other (n=5), and unknown (n=2). Agreement at item level between spiritual well-being of adolescents and families was assessed. Three items had ≥90% agreement and Excellent PABAK: "I have a reason for living," "I feel loved," "I feel compassion for others in the difficulties they are facing." Three items had <61% agreement and Poor PABAK: "I feel a sense of harmony within myself," "My illness has strengthened my faith or spiritual beliefs," "I feel connected to a higher power (or God)." Dyadic congruence was compared by social-demographics using median one-way analysis. Male family members (median=72%) were less likely to share spiritual beliefs with their adolescent than female family members (median=83%), P=.0194. Family members may not share spiritual beliefs with adolescents and may be unaware of the importance of spiritual well-being for adolescents.

Accuracy of Physical Examination to Detect Synovial and Extra-Synovial Pathologies in Psoriatic Arthritis in Comparison to Ultrasonography.

We aimed to explore the accuracy of physical examination (PE) to detect the synovial and extra-synovial pathologies in psoriatic arthritis (PsA) in comparison to ultrasonography (US). Twenty-nine PsA patients with hand pain were included in the study. A detailed PE of the hands was performed and US scans were performed for the joints, extensor and flexor tendons, and entheses of the second to fifth fingers of both hands. The agreement between PE and US findings was calculated. The strongest agreement for the joints was between “swollen joints” and power Doppler (PD) signals in the metacarpophalangeal (MCP) joints and grey scale synovitis in the proximal interphalangeal (PIP) joints. The agreement of tender entheses on PE and inflammation on US (hypoechogenicity, thickening, and/or PD signals) was poor for both extensor (Kappa = −0.027, Prevalence Adjusted and Bias Adjusted Kappa (PABAK) = 0.344) and flexor compartments (Kappa = 0.039, PABAK = 0.569). Similar to enthesitis, comparison of any PE and US findings showed a poor agreement at the extensor and flexor tendon regions (extensor: Kappa = 0.123, PABAK = 0.448, and flexor: Kappa = 0.171, PABAK = 0.431). Our study showed that there was a poor to fair agreement of PE and US findings of hands. US can add value when determining the source of pain in PsA in the small joints.

Interrater Reliability of Historical Virtual Audits Using Archived Google Street View Imagery.

Impaired mobility occurs in up to half of community-dwelling older adults and is associated with poor health outcomes and high health care costs. Although the built environment impacts mobility, most studies of older adults lack information about environmental-level factors. In-person observational audits can be utilized but cannot assess the historical environment. We applied a 78-item checklist to archived Google Street View imagery to assess historical residence access and neighborhood characteristics. Interrater reliability between two raters was tested on 50 addresses using prevalence-adjusted and bias-adjusted kappa (PABAK). The mean PABAK for all items was .75, with 81% of the items having substantial (PABAK ≥ .61) or almost perfect (PABAK ≥ .81) agreement. Environmental assessment using archived virtual imagery has excellent reliability for factors related to residence access and many neighborhood characteristics. Archived imagery can assess past neighborhood characteristics, facilitating the use of historical environment data within existing cohorts.

Three tesla and 3D multiparametric combined imaging evaluation of axial spondyloarthritis and pelvic enthesopathy

PurposeAxial spondyloarthritis (SpA) is a group of diseases with temporally disseminated symptoms and clinical signs, which render the diagnosis challenging. Laboratory and MRI findings are used in addition for confirming the diagnosis and evaluation of disease activity. The purpose of this study was to evaluate clinically suspected axial SpA to determine the technical success of a multiparametric and 3D rheumatology lumbosacral MR imaging (MRLI) protocol and to assess the disease distribution, inter-reader reliability, and impact on patient management. MethodsA consecutive series of patients with clinical suspicion of axial SpA were included. Two rheumatologists recorded the clinical findings and disease activity on a confidence scale before and after MRLI. Two musculoskeletal (MSK) radiologists read the imaging data including enthesitis, arthritis, osseous lesions, ADC values, and enhancement. Prevalence-adjusted and bias-adjusted kappa (PABAK), ICC and Fisher exact test were calculated. ResultsThere were 41 patients including 31 females and 10 males with ages of 41 ± 10 and 41 ± 12 (mean ± SD), respectively. The spine T2W imaging received the highest quality scores followed by whole abdomen-pelvis 3D-T2W imaging, 3D-CEMR (contrast-enhanced MRI), and DWI. On spine imaging, acute and chronic lesions of lumbar spine and sacroiliac joints were seen in 4/41, 18/41 and 6/41, and 27/41 of the patients, respectively. Several additional enthesopathy lesions were seen on the whole abdomen-pelvis 3D sequence. ADC value of bone lesions was different 0.95 ± 0.23 (mean ± SD) than normal bone (0.20 ± 0.1). PABAK for acute and chronic findings ranged 0.70–1.0 and 0.41-0.51, respectively. Imaging changed the diagnosis in 17 of 41 patients. No association was noted with respect to treatment change (p = 1) or clinical response (p = 0.2). ConclusionMultiparametric lumbosacral MR imaging is a technically successful modality to identify multiple spinal and additional extraspinal sites of involvement in SpA, which are helpful in establishing the diagnosis of axial SpA. Larger patient population study is warranted to evaluate further impact on the treatment efficacy.

A novel method for performing antigenic vaccine matching for foot-and-mouth disease in absence of the homologous virus

Foot-and-mouth-disease (FMD) is a highly contagious transboundary animal disease that has negative consequences on regional and international trade. Vaccination is an important approach for FMD control and an essential consideration is the degree of cross-protection conferred by the vaccine against currently circulating field viruses. The objective of this study was to evaluate a new vaccine matching technique that does not require knowledge concerning the homologous vaccine virus. As a proof of concept, the vaccine-match was assessed for 41 FMD field viruses isolated from southern Africa over a 25-year period.A diverse group of 20 SAT1 and 21 SAT2 FMDV isolates collected from cattle and wildlife during 1991–2015 were selected for this study. Virus neutralization tests were performed against two sets of pooled sera for each serotype: vaccinated cattle sera (4–16 weeks post-vaccination) and convalescent cattle sera (3 weeks post-experimental challenge). Novel r1-values were calculated as the ratio of the titre of the vaccinated sera to the titre for convalescent cattle sera. A validation r1-value was calculated based on an assumption concerning the true homologous vaccine virus. There was a strong positive correlation between r1-values for the novel and the validation methods for SAT1 viruses (Spearman’s rho = 0.84, P < 0.01) and a very strong correlation for SAT2 viruses (Spearman’s rho = 0.90, P < 0.01). In addition, there was moderate to good agreement between the novel and validation methods for both serotypes based on a r1-value cut-off of 0.3, which is presumed to represent a good vaccine-match. The agreement between methods using prevalence-adjusted and bias-adjusted kappa (PABAK) was 0.67 and 0.84 for SAT1 and SAT2 viruses, respectively.The new r1-value method provides a feasible, alternative vaccine matching approach that could benefit FMD control in southern Africa.

Intertester reliability of clinical shoulder instability and laxity tests in subjects with and without self-reported shoulder problems

ObjectiveFirst, to investigate the intertester reliability of clinical shoulder instability and laxity tests, and second, to describe the mutual dependency of each test evaluated by each tester for identifying self-reported...

Validity of Actigraphy in Measurement of Sleep in Young Adults With Type 1 Diabetes.

Accurate objective measurement of sleep, an important health behavior, is needed. Individuals with type 1 diabetes mellitus (T1DM) have altered sleep architecture and reduced sleep quality in comparison with healthy controls. The aim of this investigation was to compare a commonly used actigraphy device, Actiwatch2, with polysomnography (PSG)-based measures of sleep in young adults with T1DM, and to determine which Actiwatch2 threshold setting provides the best correspondence. Subjects age 18-30 years with T1DM wore the Actiwatch2 while simultaneously undergoing in-laboratory PSG. Sleep parameters were derived from the Actiwatch2 using the three different sensitivity thresholds (low, medium, and high) provided by the manufacturer and compared with sleep parameters from PSG. Statistical analysis included intraclass correlation coefficients and Bland-Altman plots for comparison of sleep parameters. Cohen kappa and the prevalence-adjusted and bias-adjusted kappa (PABAK) were calculated to determine agreement between epoch-by-epoch sleep and wake data measured by the PSG versus Actiwatch2. Twenty-seven subjects were included in the analysis. The low threshold setting provided the greatest agreement and least bias in comparison with PSG for sleep parameters (intraclass correlation coefficient range 0.38 to 0.77). Mean differences between the low setting and PSG were nonsignificant (P > .65) for all sleep parameters except sleep onset latency (P = .04). All three settings provided approximately equivalent and moderate epoch-by-epoch agreement with the PSG (PABAK coefficients ranging from 0.56 to 0.63). When measuring sleep with the Actiwatch2 in young adults with T1DM, the low threshold setting provides the most accurate estimates of sleep parameters in comparison with PSG.

Exploring precarious employment and women's health within the context of U.S. microenterprise using focus groups.

Nursing has been a leader in exploring social determinants of health within the context of U.S. microenterprise and women's health. The purpose of this study was to explore precarious employment within the context of microenterprise and women's health using focus groups with clientele from New Mexico (NM). The specific aims were to identify (1) the health concerns of low-income women who utilized resources from Women's Economic Self-Sufficiency Team (WESST), and (2) the meaning of precarious employment in low-income women's lives. Fourteen women, ranging in age from 21-65 years, who were affiliated with regional WESST sites around NM participated in focus groups and completed a demographic questionnaire. Focus group data were analyzed using content analysis. The degree of interrater agreement was determined by calculating the Cohen's kappa, percentage agreement, and prevalence-adjusted and bias-adjusted kappa (PABAK). Two broad themes emerged from these data: (1) Working for Yourself and (2) Strategies. Although the women identified concerns about participation in microenterprise, flexibility, freedom, and feeling purposeful were motivators to pursue a small business. The kappa statistics on the five transcripts revealed poor inter-rater agreement, yet PABAK, which is a more sophisticated inter-rater reliability index, indicated that inter-rater agreement between the two raters was satisfactory. Despite the challenges associated with microenterprise in the US, women found value in working for themselves.

Causes of inappropriate hospital days: development and validation of a French assessment tool for rehabilitation centres

To develop and validate a list of criteria to assess the causes of inappropriate hospital days for patients admitted to rehabilitation centres and sub-acute care units. The tool was developed by a multidisciplinary panel of 33 experts, using a formalized consensus method. It collects both the needs of patients (distinguishing healthcare needs (9 criteria) and accommodation needs (9 criteria)) and the reasons for inappropriateness (19 criteria). Inappropriate days were identified using the tool to assess appropriateness of hospital days validated previously. Reliability was studied by measuring agreement between two independent simultaneous ratings. The validation study was performed on a randomized sample of 576 hospital days from 22 wards in France. Inter-rater reliability was evaluated using the κ-statistic and prevalence-adjusted and bias-adjusted kappa (PABAK). For patient accommodation needs, the inter-rater reliability was estimated by a κ-value of 0.80 (95% confidence interval (95% CI) 0.66-0.92) and a PABAK of 0.80 (95% CI 0.63-0.91). There was good agreement on the reasons for inappropriateness, with κ-values from 0.30 to 0.60 and PABAK from 0.46 to 0.69. The κ-coefficient varied from 0.33 to 0.49 for the assessment of patient healthcare needs, with PABAK ranging from 0.49 to 0.72. The instrument is suitable and valid to assess the causes of inappropriate hospital days in rehabilitation centres and sub-acute care units. The study showed that the tool can be easily used by healthcare workers, which makes it useful for quality improvement.

Agreement Between Self-Report and Birth Certificate for Gestational Diabetes Mellitus: New York State PRAMS

This study examined agreement (concordance or convergent validity) between self-report and birth certificate for gestational diabetes. Study population was 2,854 women who had live births 2-6 months earlier and responded to a questionnaire from the New York State Pregnancy Risk Assessment Monitoring System (PRAMS) survey, 2004-2006. Agreement between self-report and birth certificate was assessed for the study population overall, and for subgroups defined by race, age, education, marital status, number of previous live births, time of first prenatal care, and birth weight of the newborn. A total of 258 women self-reported gestational diabetes, while birth certificates indicated that 138 women had gestational diabetes. For the study population overall, percent agreement was 93.8% and Kappa was 0.53. Due to the moderate bias index (68.2% overall, ranged from 33.3 to 100% in subgroups) and the high skewed prevalence index (91.8% overall, ranged from 70.7 to 97.5% in subgroups), we determined Prevalence-Adjusted and Bias-Adjusted Kappa (PABAK) was a better measure of agreement. PABAK was 0.88 overall, indicating very good agreement. PABAK was uniformly high in all subgroups. The highest PABAK was found among women aged 25 years and younger (0.93), and the lowest PABAK was among Asian women (0.79). Although the absence of a gold standard for gestational diabetes hinders assessment of criterion validity, high PABAK measures suggest that self-reporting by PRAMS respondents is feasible for identifying cases of gestational diabetes for surveillance and population-based epidemiologic research.