Proportion Of Agreement Research Articles

Dynamic decision making in a mixed market under cooperation: Towards sustainability

Sustainability goals are becoming a priority in many societies. An important element in this context is the success of environmentally friendly products. Hence, we consider a manufacturer-retailer vertical supply chain model, managing a green product and its conventional counterpart, designated by brown product. We analyze three kinds of dynamic market scenarios: no market leadership, the manufacturer as the market leader, and the retailer as the market leader. Under each scenario, we determine the equilibrium decisions for pricing and greening investments as well as their dependence on a cost-sharing proportion agreement between the firms. We find that generally both firms have similar pricing trends, where the gap between the two product prices increases with the share of cost carried by the retailer. Moreover, we analyze how these decisions affect the consumer surplus and the performance of the firms. The absence of a market leader leads to higher consumer surplus with the manufacturer investing more in greening. However, cost-sharing may fail if there is no market leader. The retailer has incentive to share the highest proportion of greening costs when it is the leader. When the manufacturer is the leader, the retailer may have incentive to change the cost-sharing proportion over time. Finally, we compare the greening level and learning trajectories for the different scenarios. We provide essential managerial insights on how decisions should be operated, enabling green products to successfully gain a stable market share.

Inter-partner Agreement of Condom Use and Sexual Positioning in Male Couples

ABSTRACT Accurate, reliable self-reports of sexual behavior are a crucial component of valid HIV risk-estimation and behavioral intervention evaluation, yet this data’s reliability remains understudied. The goal of this study was to describe interpartner agreement on recent receptive anal intercourse (AI) and condomless receptive AI frequencies, among a sample of male couples. We quantified interpartner agreement on self-reported receptive AI and condomless receptive AI (absolute and relative to AI frequency), and position and condom use during a couple’s most recent AI, using cross-sectional data from male partners (US, 2016–2017; N = 718 individuals). Proportional and statistical agreement (intraclass correlation coefficients (ICC), kappa (k)) were assessed. Observed agreement for receptive AI frequency was 49.44% (ICC (95% CI): 0.82(0.79, 0.84)) and for relative receptive frequency, 59.05% (ICC: 0.96 (0.85, 0.96). Agreement on condomless receptive AI was 90.21% (ICC: 0.78 (0.75, 0.82), and for relative condomless receptive AI, 91.15% (ICC: 0.80 (0.77, 0.83). Most recent AI position agreement was 89.42% (k (95% CI): 0.84 (0.80, 0.88)), and condom use, 98.89% (k: 0.82 (0.87, 0.98)). Observed agreement was higher among those who reported consistent positioning and condom use. Further research on self-reported sexual behavior data is needed to improve research validity and intervention effectiveness.

In-field instrumented ergonomic risk assessment: Inertial measurement units versus Kinect V2

Musculoskeletal disorders are a major category of nonfatal work-related diseases in the industry. Therefore, various risk factor assessment methods, such as Rapid Upper Limb Assessment (RULA), were proposed for preventing musculoskeletal disorders in industrial environments. Nevertheless, RULA measurements based on workers' self-report or external rater observation are subjective and suffer from low repeatability. Thus, the objective of this paper is to investigate the accuracy and reliability of (1) a wearable technology (using inertial measurement units) and (2) a marker-less optical technology (using Kinect V2) for RULA risk assessment tool against motion-capture cameras (reference) for different manual material handling tasks. The obtained RULA scores were compared against the reference system using the proportion agreement index (Po) and Cohen's Kappa coefficient (κ). The wearable technology showed a “substantial” agreement (κ > 0.6) with the motion-capture cameras. The marker-less technology showed inconsistency in the agreement with the motion-capture cameras ranging from “fair” (κ < 0.4) to “moderate” (κ > 0.4) agreements, caused by both self-occlusion and object occlusion. Therefore, wearable technology showed to be more suitable than marker-less optical technology for in-field ergonomic risk assessment.

Facilitating diabetic retinopathy screening using automated retinal image analysis in underresourced settings

AbstractAimTo evaluate an automated retinal image analysis (ARIA) of indigenous retinal fundus images against a human grading comparator for the classification of diabetic retinopathy (DR) status.MethodsIndigenous Australian adults with type 2 diabetes (n = 410) from three remote and very remote primary‐care services in the Northern Territory, Australia, underwent teleretinal DR screening. A single, central retinal fundus photograph (opportunistic mydriasis) for each eye was later regraded using a single ARIA and a UK human grader and national DR classification system. The sensitivity and specificity of ARIA were assessed relative to the comparator. Proportionate agreement and a Kappa statistic were also computed.ResultsRetinal images from 391 and 393 participants were gradable for ‘Any DR’ by the human grader and ARIA grader, respectively. ‘Any DR’ was detected by the human grader in 185 (47.3%) participants and by ARIA in 202 (48.6%) participants (agreement =88.0%, Kappa = 0.76,), whereas proliferative DR was detected in 31 (7.9%) and 37 (9.4%) participants (agreement = 98.2%, Kappa = 0.89,), respectively. The ARIA software had 91.4 (95% CI, 86.3–95.0) sensitivity and 85.0 (95% CI, 79.3–89.5) specificity for detecting ‘Any DR’ and 96.8 (95% CI, 83.3–99.9) sensitivity and 98.3 (95% CI, 96.4–99.4) specificity for detecting proliferative DR.ConclusionsThis ARIA software has high sensitivity for detecting ‘Any DR’, hence could be used as a triage tool for human graders. High sensitivity was also found for detection of proliferative DR by ARIA. Future versions of this ARIA should include maculopathy and referable DR (CSME and/or PDR). Such ARIA software may benefit diabetes care in less‐resourced regions.

Effectiveness of a web-based electronic prospective data collection tool for surgical data in shoulder arthroplasty

BackgroundThe purpose of this study was to demonstrate the validity and efficiency of the Outcomes Management and Evaluation (OME) system, a prospectively designed electronic data collection tool, for collecting comprehensive and standardized surgical data in shoulder arthroplasty. MethodsSurgical data from the first 100 cases of shoulder arthroplasty that were collected into the OME database were analyzed. Surgeons completed a traditional narrative operative note and also an OME case report using an encrypted smartphone. A blinded reviewer extracted data from the operative notes and implant logs in the electronic medical records (EMR) by manual chart review. OME and EMR data were compared with regard to data counts and agreement between 39 variables related to preoperative pathology, including rotator cuff status and glenoid wear, and surgical procedures. Data counts were assessed using both raw percentages and with McNemar's test (with continuity correction). Agreement of nominal variables was analyzed using Cohen's unweighted kappa (κ) and of ordinal variables using the linearly weighted Cohen's test. Efficiency was assessed by calculating the median time needed to complete OME. ResultsCompared to the EMR, the OME database had significantly higher data counts for 56% (22 of 39) of the variables assessed. A high level of proportional and statistical agreement was demonstrated between the data in the 2 datasets. Ten of 39 variables had 100% agreement but could not be statistically compared because both datasets had the same single response under those variables. Among the 29 variables that were compared, 79% (23 of 29) of variables had >80% raw proportional agreement, and 69% (20 of 29) of variables showed at least substantial agreement (κ > 0.6). The median time for completing OME surgery data entry was 92 seconds (IQR 70-126). ConclusionThe prospectively designed, electronic data entry system (OME) is an efficient and valid tool for collecting comprehensive and standardized surgical data on shoulder arthroplasty. Level of evidenceLevel IV; Case series; Diagnostic study

Software-Based Analysis of the Taller-Than-Wide Feature of High-Risk Thyroid Nodules.

Shape is one of the most important features in the diagnosis of malignant thyroid nodules. This characteristic has been described qualitatively, but only shapes that appear markedly different can be easily differentiated at first interpretation. This study sought to clarify whether software-based shape indexes are useful for the detection of thyroid cancers. In the final analysis, 200 participants with 231 pathologically proven nodules participated in the study. Ultrasound features were assessed by clinicians. The tumor contour was auto-defined, and shape indexes were calculated using commercial software. Of the 231 nodules, 134 were benign and 97 were malignant. The presence of taller-than-wide (TTW) dimensions differed significantly between the benign and malignant thyroid tumors. Designation of TTW assessed by the software had a higher kappa value and proportional agreement than TTW assessed by clinicians. Disagreement between the clinician and software in designating nodules as TTW occurred for 28 nodules. The presence of other ultrasonic characteristics and small differences in the height and width measurements were causes for the incorrect interpretation of the TTW feature. The proposed software-based quantitative analysis of tumor shape seems to be promising as an important advance compared with conventional TTW features evaluated by operators because it allows for a more reliable and consistent distinction and is less influenced by other ultrasonic features.

Interrater Agreement and Reliability of PERCIST and Visual Assessment When Using 18F-FDG-PET/CT for Response Monitoring of Metastatic Breast Cancer.

Response evaluation at regular intervals is indicated for treatment of metastatic breast cancer (MBC). FDG-PET/CT has the potential to monitor treatment response accurately. Our purpose was to: (a) compare the interrater agreement and reliability of the semi-quantitative PERCIST criteria to qualitative visual assessment in response evaluation of MBC and (b) investigate the intrarater agreement when comparing visual assessment of each rater to their respective PERCIST assessment. We performed a retrospective study on FDG-PET/CT in women who received treatment for MBC. Three specialists in nuclear medicine categorized response evaluation by qualitative assessment and standardized one-lesion PERCIST assessment. The scans were categorized into complete metabolic response, partial metabolic response, stable metabolic disease, and progressive metabolic disease. 37 patients with 179 scans were included. Visual assessment categorization yielded moderate agreement with an overall proportion of agreement (PoA) between raters of 0.52 (95% CI 0.44–0.66) and a Fleiss kappa estimate of 0.54 (95% CI 0.46–0.62). PERCIST response categorization yielded substantial agreement with an overall PoA of 0.65 (95% CI 0.57–0.73) and a Fleiss kappa estimate of 0.68 (95% CI 0.60–0.75). The difference in PoA between overall estimates for PERCIST and visual assessment was 0.13 (95% CI 0.06–0.21; p = 0.001), that of kappa was 0.14 (95% CI 0.06–0.21; p < 0.001). The overall intrarater PoA was 0.80 (95% CI 0.75–0.84) with substantial agreement by a Fleiss kappa of 0.74 (95% CI 0.69–0.79). Semi-quantitative PERCIST assessment achieved significantly higher level of overall agreement and reliability compared with qualitative assessment among three raters. The achieved high levels of intrarater agreement indicated no obvious conflicting elements between the two methods. PERCIST assessment may, therefore, give more consistent interpretations between raters when using FDG-PET/CT for response evaluation in MBC.

An Evaluation of Posture Recognition Based on Intelligent Rapid Entire Body Assessment System for Determining Musculoskeletal Disorders.

Determining the potential risks of musculoskeletal disorders through working postures in a workplace is expensive and time-consuming. A novel intelligent rapid entire body assessment (REBA) system based on convolutional pose machines (CPM), entitled the Quick Capture system, was applied to determine the risk levels. The aim of the study was to validate the feasibility and reliability of the CPM-based REBA system through a simulation experiment. The reliability was calculated from the differences of motion angles between the CPM-based REBA and a motion capture system. Results show the data collected by the Quick Capture system were consistent with those of the motion capture system; the average of root mean squared error (RMSE) was 4.77 and the average of Spearman’s rho (ρ) correlation coefficient in the different 12 postures was 0.915. For feasibility evaluation, the linear weighted Cohen’s kappa between the REBA score obtained by the Quick Capture system and those from the three experts were used. The result shows good agreement, with an average proportion agreement index (P0) of 0.952 and kappa of 0.738. The Quick Capture system does not only accurately analyze working posture, but also accurately determines risk level of musculoskeletal disorders. This study suggested that the Quick Capture system could be applied for a rapid and real-time on-site assessment.

Test-retest repeatability of a deep learning architecture in detecting and segmenting clinically significant prostate cancer on apparent diffusion coefficient (ADC) maps.

To evaluate short-term test-retest repeatability of a deep learning architecture (U-Net) in slice- and lesion-level detection and segmentation of clinically significant prostate cancer (csPCa: Gleason grade group > 1) using diffusion-weighted imaging fitted with monoexponential function, ADCm. One hundred twelve patients with prostate cancer (PCa) underwent 2 prostate MRI examinations on the same day. PCa areas were annotated using whole mount prostatectomy sections. Two U-Net-based convolutional neural networks were trained on three different ADCm b value settings for (a) slice- and (b) lesion-level detection and (c) segmentation of csPCa. Short-term test-retest repeatability was estimated using intra-class correlation coefficient (ICC(3,1)), proportionate agreement, and dice similarity coefficient (DSC). A 3-fold cross-validation was performed on training set (N = 78 patients) and evaluated for performance and repeatability on testing data (N = 34 patients). For the three ADCm b value settings, repeatability of mean ADCm of csPCa lesions was ICC(3,1) = 0.86-0.98. Two CNNs with U-Net-based architecture demonstrated ICC(3,1) in the range of 0.80-0.83, agreement of 66-72%, and DSC of 0.68-0.72 for slice- and lesion-level detection and segmentation of csPCa. Bland-Altman plots suggest that there is no systematic bias in agreement between inter-scan ground truth segmentation repeatability and segmentation repeatability of the networks. For the three ADCm b value settings, two CNNs with U-Net-based architecture were repeatable for the problem of detection of csPCa at the slice-level. The network repeatability in segmenting csPCa lesions is affected by inter-scan variability and ground truth segmentation repeatability and may thus improve with better inter-scan reproducibility. • For the three ADCm b value settings, two CNNs with U-Net-based architecture were repeatable for the problem of detection of csPCa at the slice-level. • The network repeatability in segmenting csPCa lesions is affected by inter-scan variability and ground truth segmentation repeatability and may thus improve with better inter-scan reproducibility.

A prospective evaluation of inter-rater agreement of routine medical records audits at a large general hospital in S\xe3o Paulo, Brazil

BackgroundThe quality of patient medical records is intrinsically related to patient safety, clinical decision-making, communication between health providers, and continuity of care. Additionally, its data are widely used in observational studies. However, the reliability of the information extracted from the records is a matter of concern in audit processes to ensure inter-rater agreement (IRA). Thus, the objective of this study is to evaluate the IRA among members of the Patient Health Record Review Board (PHRRB) in routine auditing of medical records, and the impact of periodic discussions of results with raters.MethodsA prospective longitudinal study was conducted between July of 2015 and April of 2016 at Hospital Municipal Dr. Moysés Deutsch, a large public hospital in São Paulo. The PHRRB was composed of 12 physicians, 9 nurses, and 3 physiotherapists who audited medical records monthly, with the number of raters changing throughout the study. PHRRB meetings were held to reach a consensus on rating criteria that the members use in the auditing process. A review chart was created for raters to verify the registry of the patient’s secondary diagnosis, chief complaint, history of presenting complaint, past medical history, medication history, physical exam, and diagnostic testing. The IRA was obtained every three months. The Gwet’s AC1 coefficient and Proportion of Agreement (PA) were calculated to evaluate the IRA for each item over time.ResultsThe study included 1884 items from 239 records with an overall full agreement among raters of 71.2%. A significant IRA increase of 16.5% (OR = 1.17; 95% CI = 1.03—1.32; p = 0.014) was found in the routine PHRRB auditing, with no significant differences between the PA and the Gwet’s AC1, which showed a similar evolution over time. The PA decreased by 27.1% when at least one of the raters was absent from the review meeting (OR = 0.73; 95% CI = 0.53—1.00; p = 0.048).ConclusionsMedical record quality has been associated with the quality of care and could be optimized and improved by targeted interventions. The PA and the Gwet’s AC1 are suitable agreement coefficients that are feasible to be incorporated in the routine PHRRB evaluation process.

Comparative analysis of imaging and novel markerless approach for measurement of postural parameters in dental seating tasks

Postural inaccuracies in persistent dental tasks indicated an upsurge in the prevalence of musculoskeletal disorders in dentists. This makes it imperative to restrain awkward postural movements while working. Biased results in self-reporting surveys; discomfort, expense, and time consumption involved in using wearable sensors; and expert’s opinion are required in observational methods. Hence, it is important to use significantly reliable, cheap technology as a substitute to overcome the shortcomings of the mentioned techniques. In this study, the markerless Kinect V2–based system was developed and compared with the conventional imaging technique for real-time postural assessment of dental seating tasks. The study assessed the angle parameters related to the dentist’s bodily movement of upper arm, lower arm, wrist, neck, and trunk. Ten dentists from the local dental institution volunteered for the study. Dentists were monitored with both techniques while performing real-time dental procedures. The agreement between the techniques was assessed using Bland–Altman plot at 95% bias, Pearson’s (r1) and concordance (r2) correlation coefficients, mean difference, and percentage error. For conclusive agreement analysis, contingency coefficient, proportion agreement index, Cohen’s kappa, and Mann–Whitney U at 95% confidence interval (CI) were evaluated. Data acquired from both techniques possessed strong correlations (r1 and r2 &gt;0.90). Good agreement in Rapid Upper Limb Assessment data using Cohen’s kappa (0.67) at standard Landis and Koch’s scale was also observed. Postural analysis of slow-motion tasks like dentistry using the Kinect V2 system proved to be unobtrusive and efficient. This may be used by dentists to have periodic postural check. In future, Kinect V2–based feedback system may be used to develop an assistive technology using predictive algorithms, which may help in reducing the probability of occurrence of work-related musculoskeletal disorders in dentists.

Insole System-Based Neural Network Model to Evaluate Force Risk in Cube Method: Application to Pepper Farming Tasks

Most agricultural workers are exposed to musculoskeletal disorders due to the characteristics of agricultural work performed manually. As observational methods to prevent musculoskeletal disorders, a cube method has been proposed that considers the risk factors of posture, time and force workload simultaneously. However, force workload could evaluate using the weight of an object or qualitative measurement to prevent interfering with a worker’s occupation. The purpose of this study is to propose a novel method for evaluating quantitatively the risk factor of force in agricultural field using insole system and artificial neural network model. Agricultural simulated experiments were performed on ten healthy adult males and six observers were recruited to evaluate the risk factors of force for the experiments. The model was constructed using the signals measured in the insole system and the consensus among observers about evaluation results. To verify the performance of the model, the performance measurement was calculated using 10-fold cross-validation. The results of the proposed method are compared with those of the observers to verify reproducibility and usefulness. The model showed more than 97% prediction accuracy in all risk levels, and the proposed method showed 1.59%, 0.99 and 0.98 in the coefficient of variation, proportion agreement index, Cohen’s kappa coefficient, and high reproducibility and usefulness when compared with the observers’ evaluation. The method of quantitatively evaluating the risk factor of force proposed in this study is possible to be applied to various agricultural works using observational methods.

Likeness, Familiarity, and the Ambient Portrait Average.

This artist-led research project involved 10 visual artists producing 10 ambient portraits and a portrait average of a locally familiar Sitter, and 10 ambient portraits and a portrait average of a less locally familiar Sitter. All were then assessed for likeness by more than 150 members of the general public attending an exhibition during Australia's 2018 National Science Week. The results of this study are that portrait averages can be highly shape accurate and tend to be seen as a good likeness by all viewers. However, the portrait average is not necessarily the best likeness. Extending and validating our previous findings regarding the relationship of likeness, familiarity, and shape accuracy (as measured using geometric morphometrics) in portraiture, unfamiliar viewers favouring shape accurate depictions of a Sitter attained statistical significance. Familiar viewers, however, although also tending to view shape accurate depictions a good to very good likeness, were shown to have a stronger preference for portraits that exaggerate a Sitter's facial distinctiveness, including an exaggeration of their head pose, providing such exaggerations are in approximate proportional agreement.

Non-Spatial Impairments Affect False-Positive Neglect Diagnosis Based on Cancellation Tasks.

To diagnose egocentric neglect after stroke, the spatial bias of performance on cancellation tasks is typically compared to a single cutoff. This standard procedure relies on the assumption that the measurement error of cancellation performance does not depend on non-spatial impairments affecting the total number of cancelled targets. Here we assessed the impact of this assumption on false-positive diagnoses. We estimated false positives by simulating cancellation data using a binomial model. Performance was summarised by the difference in left and right cancelled targets (R-L) and the Centre of Cancellation (CoC). Diagnosis was based on a fixed cutoff versus cutoffs adjusted for the total number of cancelled targets and on single test performance versus unanimous or proportional agreement across multiple tests. Finally, we compared the simulation findings to empirical cancellation data acquired from 651 stroke patients. Using a fixed cutoff, the rate of false positives depended on the total number of cancelled targets and ranged from 10% to 30% for R-L scores and from 10% to 90% for CoC scores. The rate of false positives increased even further when diagnosis was based on proportional agreement across multiple tests. Adjusted cutoffs and unanimous agreement across multiple tests were effective at controlling false positives. For empirical data, fixed versus adjusted cutoffs differ in estimation of neglect prevalence by 13%, and this difference was largest for patients with non-spatial impairments. Our findings demonstrate the importance of considering non-spatial impairments when diagnosing neglect based on cancellation performance.

Response to Validity and Reliability of a Nutrition Screening Tool in Identifying Malnutrition Among Hospitalized Adult Patients

BACKGROUND Malnutrition among hospitalized patients is closely associated with various medical complications. This study aimed to determine the validity and reliability of a 3-Minute Nutrition Screening (3-MinNS) tool in identifying the risk of malnutrition among hospitalized patients that can be administered by healthcare professionals. METHODS A cross-sectional study was conducted between January and December 2012. A total of 350 adult patients in a teaching hospital were screened for risk of malnutrition using 3-MinNS and Subjective Global Assessment (SGA). To assess interrater reliability, each patient was screened for risk of malnutrition using 3-MinNS by 2 different nurses on 2 different occasions within 24 hours after admission. To assess the validity of 3-MinNS, the level of risk of malnutrition identified by the nurses using 3-MinNS was compared with the risk of malnutrition as assessed by a dietitian using SGA within 48 hours after the patients' enrolment into the study. The sensitivity, specificity, and predictive values were calculated in detecting patients at risk of malnutrition. Interrater reliability was determined using κ statistics. RESULTS Using SGA, the estimated prevalence of moderate to severe malnutrition was 36.3% (127/350). There was 94% proportional agreement between 2 nurses using 3-MinNS, and interrater reliability was substantial (κ = 0.79, P < .001). The analysis showed that 3-MinNS had moderate sensitivity (61.4%-68.5%) but high specificity (95.1%). CONCLUSIONS The 3-MinNS is a reliable and valid screening tool for use by healthcare professionals for identifying newly admitted medical and surgical patients who are at risk of malnutrition.

416: The effect of cervical manipulation on fetal fibronectin result: a systematic review

The manufacturers of fetal fibronectin (fFN) currently discourage its use after cervical manipulation due to potential iatrogenic expression of the protein. The purpose of this study was to determine if cervical manipulation via sterile vaginal examination (SVE), transvaginal ultrasound (TVU), and/or sexual intercourse affects the accuracy of fFN results. Electronic databases were searched from inception until June 2019. We included all prospective cohort studies that provided fFN results after SVE, TVU, and/or coitus. The primary outcome was agreement between pre-manipulation and post-manipulation swabs, estimated using kappa statistics and proportion agreement with 95% confidence intervals (CI). Secondary outcomes included frequency in which the fFN result changed after cervical manipulation and mean percentage of discordant pairs. Baseline fFN swabs were not obtained in studies examining sexual intercourse; therefore, the results of these articles were examined separately. Outcome data was combined to estimate relative risk of a positive qualitative fFN result after coitus and differences in concentration of quantitative fFN. Of 807 studies identified, 6 were included. Four studies, including 484 pairs of fFN swabs, assessed SVE or TVU. Two studies assessed the effect of coitus on fFN results (121 patients reporting intercourse within 24 hours vs. 141 controls). For SVE and TVU, there was an overall 92.2% (CI 89.3-94.3%) agreement between pre- and post-manipulation swabs with a kappa of 0.703. After SVE or TVU, the fFN result changed from negative to positive and positive to negative 5.3% and 16.5% of the time, respectively. The mean percentage of discordant pairs was 6.9%. Patients who had coitus within 24 hours were more likely to have a positive fFN result (39.7% compared with 7.1%, RR 5.6; 95% CI, 3.0-10.6). Cervical manipulation via SVE or TVU does not significantly affect fFN results; therefore, its use after these exposures is clinically acceptable. Conversely, the use of fFN within 24 hours of sexual intercourse should continue to be discouraged.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Evaluation of Babesia gibsoni GPI-anchored Protein 47 (BgGPI47-WH) as a Potential Diagnostic Antigen by Enzyme-Linked Immunosorbent Assay.

Babesia gibsoni is one of the important pathogens causing severe incurable canine babesiosis, suggesting the necessity to develop a sensitive, specific, and highly automated diagnostic method for clinical application. Surface proteins are ideal candidates for diagnostic targets because they are the primary targets for host immune responses during host-parasite interactions. Glycosylphosphatidylinositol (GPI)-anchored proteins are abundant on the surface of parasites and play an important role in parasite diagnosis. In this study, a GPI-anchored protein named BgGPI47-WH was obtained and mouse anti-rBgGPI47-WH polyclonal antibody was produced by immunizing mice with the purified protein and Freund's adjuvant. Western blot was used to identify the native form and immunogenicity of BgGPI47-WH. An ELISA method was established by using recombinant BgGPI47-WH protein to evaluate its potential as a diagnostic antigen and the established method exhibited high specificity. The antibody response was evaluated by using the B. gibsoni-infected sera collected from different experimental dogs and the established ELISA could recognize antibodies at day 6 until day 101 post infection, indicating the potential use of BgGPI47-WH for early stage diagnosis. The specificity of the established ELISA was further evaluated by using 147 clinical samples collected from animal hospitals and 17.0% (25/147) of the samples were tested positive, with an overall proportion agreement of 86.39% between the results from BgGPI47-WH and BgSA1. Our results indicated that BgGPI47-WH could be used as a reliable diagnostic antigen and this study has proposed a practical method for early diagnosis of B. gibsoni.

Validity and Reliability of a Nutrition Screening Tool in Identifying Malnutrition Among Hospitalized Adult Patients.

Malnutrition among hospitalized patients is closely associated with various medical complications. This study aimed to determine the validity and reliability of a 3-Minute Nutrition Screening (3-MinNS) tool in identifying the risk of malnutrition among hospitalized patients that can be administered by healthcare professionals. A cross-sectional study was conducted between January and December 2012. A total of 350 adult patients in a teaching hospital were screened for risk of malnutrition using 3-MinNS and Subjective Global Assessment (SGA). To assess interrater reliability, each patient was screened for risk of malnutrition using 3-MinNS by 2 different nurses on 2 different occasions within 24 hours after admission. To assess the validity of 3-MinNS, the level of risk of malnutrition identified by the nurses using 3-MinNS was compared with the risk of malnutrition as assessed by a dietitian using SGA within 48 hours after the patients' enrolment into the study. The sensitivity, specificity, and predictive values were calculated in detecting patients at risk of malnutrition. Interrater reliability was determined using κ statistics. Using SGA, the estimated prevalence of moderate to severe malnutrition was 36.3% (127/350). There was 94% proportional agreement between 2 nurses using 3-MinNS, and interrater reliability was substantial (κ = 0.79, P < .001). The analysis showed that 3-MinNS had moderate sensitivity (61.4%-68.5%) but high specificity (95.1%). The 3-MinNS is a reliable and valid screening tool for use by healthcare professionals for identifying newly admitted medical and surgical patients who are at risk of malnutrition.

Reliability of Observational Assessment Methods for Outcome-based Assessment of Surgical Skill: Systematic Review and Meta-analyses

Reliable performance assessment is a necessary prerequisite for outcome-based assessment of surgical technical skill. Numerous observational instruments for technical skill assessment have been developed in recent years. However, methodological shortcomings of reported studies might negatively impinge on the interpretation of inter-rater reliability. To synthesize the evidence about the inter-rater reliability of observational instruments for technical skill assessment for high-stakes decisions. A systematic review and meta-analysis were performed. We searched Scopus (including MEDLINE) and Pubmed, and key publications through December, 2016. This included original studies that evaluated reliability of instruments for the observational assessment of technical skills. Two reviewers independently extracted information on the primary outcome (the reliability statistic), secondary outcomes, and general information. We calculated pooled estimates using multilevel random effects meta-analyses where appropriate. A total of 247 documents met our inclusion criteria and provided 491 inter-rater reliability estimates. Inappropriate inter-rater reliability indices were reported for 40% of the checklists estimates, 50% of the rating scales estimates and 41% of the other types of assessment instruments estimates. Only 14 documents provided sufficient information to be included in the meta-analyses. The pooled Cohen's kappa was .78 (95% CI 0.69-0.89, p < 0.001) and pooled proportion agreement was 0.84 (95% CI 0.71-0.96, p < 0.001). A moderator analysis was performed to explore the influence of type of assessment instrument as a possible source of heterogeneity. For high-stakes decisions, there was often insufficient information available on which to base conclusions. The use of suboptimal statistical methods and incomplete reporting of reliability estimates does not support the use of observational assessment instruments for technical skill for high-stakes decisions. Interpretations of inter-rater reliability should consider the reliability index and assessment instrument used. Reporting of inter-rater reliability needs to be improved by detailed descriptions of the assessment process.

Arabic translation and psychometric testing of the self-screening malnutrition universal screening tool in inflammatory bowel disease patients.

Objectives:To translate and validate the malnutrition universal screening tool (MUST) for use in Arabic-speaking outpatients with inflammatory bowel disease (IBD).Methods:We translated the MUST into Arabic by using the Brislin back-translation method. This methodological study was performed between August 2016 and November 2017 on 143 outpatients with IBD at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. The patients must completed the self-administered (PSA) Arabic version of the MUST. Then, the health-care practitioners (HCPs) administered the Arabic MUST and performed standard patient clinical assessment. The nutrition risk was defined as low (MUST score=0), medium (MUST score=1), or high (MUST score >1). The chance-corrected proportional agreement between the scores from the PSA and HCP-administered Arabic MUST was evaluated using Cohen’s kappa coefficient. Internal consistency was evaluated using Cronbach’s alpha statistic.Results:The overall agreement between the PSA and HCP-administered Arabic MUST was almost perfect (agreement=95.9%, expected agreement=72.4%, kappa=0.85, p<0.0001). The calculated Cronbach’s alpha statistic for MUST scores in 15/143 (10%) patients was 0.79. The calculated Pearson’s correlation coefficient between PSA and HCP-administered MUST scores was 0.93 (p<0.0001).Conclusions:The PSA and HCP-administered Arabic MUST showed perfect agreement in outpatients with IBD.