Reliable Measurement Research Articles

Comparison Between an Expert Operator an Inexperienced Operator, and Artificial Intelligence Software: A Brief Clinical Study of Cephalometric Diagnostic.

Artificial intelligence (AI) is constantly developing in several medical areas and has become useful to assist with treatment planning. Orthodontics and maxillofacial surgery use AI-based technology to identify and select cephalometric points for diagnostics. Although some studies have shown promising results from the use of AI, the evidence is still limited. Hence, additional investigation is justified. In this retrospective study, 2 human operators (1 expert and 1 inexperienced) and 1 software analyzed 30 lateral cephalograms of individuals with orthodontic treatment indications. They measured 10 cephalometric variables and then 2 weeks later, repeated measurements on 30% of the sample. We evaluated the reliability of the measurements between the 2-time points and the differences in the means between the expert operator and the AI software and between the expert and inexperienced operators. There was high reliability for the expert operator and AI measurements, and moderate reliability for the inexperienced operator measurements. There were some significant differences in the means produced by the AI software and the inexperienced operator compared with the expert operator. Although AI is useful for cephalometric analysis, it should be used with caution because there are differences compared with analysis by humans.

Measurement of Scapholunate Joint Space Width on Real-Time MRI-A Feasibility Study.

The scapholunate interosseous ligament is pivotal for wrist stability, and its impairment can result in instability and joint degeneration. This study explores the application of real-time MRI for dynamic assessment of the scapholunate joint during wrist motion with the objective of determining its diagnostic value in efficacy in contrast to static imaging modalities. Ten healthy participants underwent real-time MRI scans during wrist ab/adduction and fist-clenching maneuvers. Measurements were obtained at proximal, medial, and distal landmarks on both dynamic and static images with statistical analyses conducted to evaluate the reliability of measurements at each landmark and the concordance between dynamic measurements and established static images. Additionally, inter- and intraobserver variabilities were evaluated. Measurements of the medial landmarks demonstrated the closest agreement with static images and exhibited the least scatter. Distal landmark measurements showed a similar level of agreement but with increased scatter. Proximal landmark measurements displayed substantial deviation, which was accompanied by an even greater degree of scatter. Although no significant differences were observed between the ab/adduction and fist-clenching maneuvers, both inter- and intraobserver variabilities were significant across all measurements. This study highlights the potential of real-time MRI in the dynamic assessment of the scapholunate joint particularly at the medial landmark. Despite promising results, challenges such as measurement variability need to be addressed. Standardization and integration with advanced image processing methods could significantly enhance the accuracy and reliability of real-time MRI, paving the way for its clinical implementation in dynamic wrist imaging studies.

The effects of spatial leakage correction on the reliability of EEG-based functional connectivity networks.

Electroencephalography (EEG) functional connectivity (FC) estimates are confounded by the volume conduction problem. This effect can be greatly reduced by applying FC measures insensitive to instantaneous, zero-lag dependencies (corrected measures). However, numerous studies showed that FC measures sensitive to volume conduction (uncorrected measures) exhibit higher reliability and higher subject-level identifiability. We tested how source reconstruction contributed to the reliability difference of EEG FC measures on a large (n = 201) resting-state data set testing eight FC measures (including corrected and uncorrected measures). We showed that the high reliability of uncorrected FC measures in resting state partly stems from source reconstruction: idiosyncratic noise patterns define a baseline resting-state functional network that explains a significant portion of the reliability of uncorrected FC measures. This effect remained valid for template head model-based, as well as individual head model-based source reconstruction. Based on our findings we made suggestions how to best use spatial leakage corrected and uncorrected FC measures depending on the main goals of the study.

Distal radius fracture osteosynthesis by volar locking plate: influence of epiphyseal screw positioning on risk of loss of reduction

Ulnar variance is an important radiological parameter for good functional outcome after distal radius fracture osteosynthesis. Secondary loss of reduction due to radial shortening is a common complication after volar locking plate fixation. Some authors recommend beginning by placing the most ulnar epiphyseal screw, ensuring that it is positioned as close as possible to the distal radioulnar and radiocarpal joints. The hypothesis of our study was that the positioning of the ulnar epiphyseal screw relative to the distal radioulnar and radiocarpal joints influences the maintenance of reduction during follow-up.190 distal radius fractures were treated with volar locking plate fixation and divided into two cohorts: cohort A with <2 mm and cohort B with ≥2 mm loss of ulnar variance. Minimum follow-up was 45 days. The positioning of the most ulnar epiphyseal screw was evaluated using a single variable, the ulno-distal index. Means were compared using t-tests and proportions using chi-squared tests. The alpha risk was set at 5%. The intra- and inter-observer reliability of the ulno-distal index measurement were assessed.Mean ulno-distal index was significantly lower in cohort A at 11.28 mm, compared to 13.33 mm in cohort B; p < 0.0001. Ulno-distal index <12 mm was a significant protective factor: p < 0.0001 and relative risk 0.558. No other intrinsic or extrinsic factors of secondary loss of reduction significantly influenced the risk of ulnar variance alteration.The study confirmed the hypothesis that, in distal radius fracture treated with volar locking plate fixation, the closer the ulnar epiphyseal screw to the distal radioulnar joint and radiocarpal joint, the lower the risk of ulnar variance alteration.

The Home-Based Experiences of Palliative and Hospice Care for Children and Caregivers (EXPERIENCE) Measure: Evaluation of Psychometric Properties

ContextHome-based pediatric palliative and hospice care (PPHC) supports the hundreds of thousands of children with serious illness and complex care needs and their families in the home setting. Considerable variation, however, exists in the provision and quality of home-based PPHC in the U.S. Ensuring equitable, high-quality home-based PPHC for all children requires the evaluation of families’ care experiences and assessment of whether these experiences are aligned with their needs and priorities. ObjectivesTo evaluate the psychometric properties of the previously developed 23-item home-based PPHC EXPERIENCE Measure for use with families of children receiving home-based PPHC in the United States. MethodsParticipants included families recruited from the Children's Hospital of Philadelphia, Courageous Parents Network, and several other hospital- and community-based PPHC programs across the U.S. who provide home-based PPHC services. Participants completed the EXPERIENCE Measure at baseline and again at retest. We evaluated the factor structure of the EXPERIENCE Measure, as well as evidence regarding score reliability and validity. ResultsEighty-two family participants completed the baseline and 53 completed the retest questionnaire from 15 states across the U.S. We found evidence for the score reliability and validity of a four-domain EXPERIENCE measure. ConclusionThe EXPERIENCE Measure is a tool with evidence for reliable and valid scores to evaluate family-reported home-based PPHC experiences at the time care is being received. Future work will evaluate the usability (i.e., acceptability, feasibility, and clinical actionability) of EXPERIENCE, including the sensitivity of the instrument to change over time and its impact on real-time clinical actions.

Test–retest reliability and sensitivity of a brief clinical monitoring measure for transgender and gender diverse adults: The Trans Collaborations Clinical Check-In (TC³).

Test–retest reliability and sensitivity of a brief clinical monitoring measure for transgender and gender diverse adults: The Trans Collaborations Clinical Check-In (TC³).

Reliability and validity of cough peak flow measurements in myasthenia gravis

Decreased cough strength in myasthenia gravis (MG) leads to aspiration and increases the risk of MG crisis. The aim of this study was to clarify the reliability and validity of cough peak flow (CPF) measurements in MG. A total of 26 patients with MG who underwent CPF measurements using the peak flow meter by themselves were included. MG symptoms were evaluated by pulmonary function tests and clinical MG assessment scales before and after immune-treatments. The relationship between CPF and pulmonary function tests and MG comprehensive were assessed. The cut-off value of CPF for aspiration risk was determined and the area under the curve (AUC) was calculated. The intraclass correlation coefficient was more than 0.95 for pre-and post-treatment. Positive correlations were found between CPF and almost all spirometric values as well as between the differences of pre-and post-treatment in CPF and quantitative myasthenia gravis score. The CPF for identifying the aspiration risk was used to calculate the CPF cut-off value of 205 L/min with a sensitivity of 0.77, specificity of 0.90, and AUC of 0.85. The CPF, a convenient measure by patients themselves, has a high reliability in patients with MG, and is a useful biomarker reflecting MG symptoms.

AI-Driven Global Sanctions Enhancement

This thesis examines the integration of Artificial Intelligence (AI) into global sanctions management, a field currently dominated by manual processes and semi-automated systems that are inefficient and error-prone. With the increasing complexity and volume of international financial transactions, traditional approaches to sanctions compliance are no longer adequate to meet the demands of dynamic global regulations and enforcement challenges. The primary aim of this research is to explore how AI can revolutionize sanctions management by enhancing accuracy, speed, and adaptability in compliance operations. Key findings reveal that AI can significantly reduce the reliance on human intervention, thereby decreasing operational costs and minimizing errors. AI-enhanced systems are shown to improve the consistency and reliability of compliance measures, effectively manage large volumes of data, and swiftly adapt to regulatory changes. The research highlights that integrating AI into sanctions management not only bolsters compliance efficiency but also strengthens the overall risk management framework of financial institutions. The significance of this research lies in its potential to guide financial institutions in implementing AI solutions that can transform their sanctions compliance frameworks. By providing a detailed roadmap for the adoption of AI, the study contributes to broader efforts to enhance global financial security and compliance, positioning AI as a pivotal technology in the evolution of global sanctions management.

Enhancing the accuracy of low-cost thermocouple devices through deep-wavelet neural network calibration

Data collection using thermocouple sensors in low-cost data acquisition is prone to noise interference, which could reduce the data quality. Noise sources such as cold junction compensators, electromagnetic interference, and Johnson noise can significantly affect the reliability and accuracy of conventional measurements. This study aims to improve the quality of thermocouple sensor readings on low-cost data acquisition using calibration method based on deep learning and the denoising process using a wavelet transform. This taken approach successfully increase the accuracy value of 97.67% with a mean absolute error (MAE) of 0.2. The precision also increases of 262.7% as indicated by the result of signal-to-noise ratio (SNR) with a value of 105.29 dB. Comparative analysis was carried out against National Instruments® device and it was found that deep-wavelet method had a lower and higher of MAE and SNRdB values of 16.67% and 0.8% respectively. This study shows that the denoising-calibration method with deep-wavelet can improve the accuracy and reliability of data from low-cost thermocouple devices.

The Concurrent Validity and Reliability of the Smartphone Measurement Application to Evaluate Iliotibial Band Tightness: A Cross-Sectional Study

Purpose: In recent years, the medical use of smartphones has increased with the development of hardware. The study aims to evaluate the reliability and concurrent validity of iPhone® measurement application to measure ITB tightness. Methods: This was a cross-sectional study. Thirty athletes with ITB tightness (17 males, 13 females) between 20 and 45 years old were included and assessed in this study. The intraclass correlation coefficient (ICC) was used to evaluate the reliability of each smartphone measurement, and Bland–Altman analysis was used to examine measurement errors. The ITB tightness was measured with Ober test using a bubble inclinometer and iPhone® measurement application and evaluated by two experienced physiotherapists. The researchers carried out three measurements for both extremities, using both the bubble inclinometer and the iPhone® measurement application. Measurement values were recorded by a third physiotherapist. Results: The iPhone® measurement application has strong inter-rater (ICC=0.941) and intra-rater (ICC=0.986) reliability and concurrent validity (r=0.945) in measuring ITB tightness. Conclusion: From the cross-sectional study’s results, it can be concluded that the iPhone® measurement application possesses strong intra-rater and inter-rater reliability and concurrent validity and can be used for measuring ITB tightness.

Relative Cortical Atrophy Index as a Strong Predictor of Recurrence After Surgery for Chronic Subdural Hematoma.

Chronic subdural hematoma (CSDH) presents significant management challenges in neurosurgical practice, with recurrence being a notable postoperative consideration. This study aimed to evaluate the Relative Cortical Atrophy (RCA) Index as a predictor of recurrence after CSDH surgery. A retrospective analysis was conducted on 98 patients who underwent surgical evacuation for unilateral CSDH. The RCA Index was calculated using pre- and postoperative cranial imaging, correlating it with patient demographics, hematoma characteristics, and recurrence. Inter-rater reliability among measurements by 4 independent physicians was assessed using the intraclass correlation coefficient (ICC). Correlation and regression analyses were performed to identify the correlation of the RCA Index with other factors and their potential predicting power of CSDH recurrence, respectively. The study population had a mean age of 74.1 (11.9) years, with a 23.5% (23 patients) recurrence rate of CSDH. The ICC analysis showed excellent inter-rater reliability for RCA Index measurements (ICC: 0.998, 95% CI: 0.997-0.998, P < .001). A higher preoperative RCA Index was significantly associated with recurrence (0.215 [0.031] in the recurrent group vs 0.125 [0.034] in the nonrecurrent group, P < .001). The preoperative RCA Index highly correlated with the postoperative RCA Index (Pearson's correlation: 0.918, P < .001), and there was only a small (average: 0.005) but significant increase in the RCA Index of the unaffected hemisphere after surgery (P = .01).The preoperative RCA Index positively correlated with age, preoperative SDH thickness and volume, and recurrence. A RCA Index cutoff value of 0.165 predicted CSDH recurrence with high sensitivity (95.6%) and specificity (93.3%) (area under the curve = 0.97, 95% CI: 0.93-1). The RCA Index is a simple yet robust predictor of CSDH recurrence. Incorporating this measure into the preoperative assessment may enhance surgical planning and postoperative management, potentially reducing recurrence rates.

Helium expansion revisited: Effects of accessible volume on excess adsorption in kerogen matrices

Enhancing our understanding of the excess adsorption capacity in shale gas reservoirs is paramount for accurately predicting production capabilities and refining extraction processes. A significant factor in this calculation is the accessible volume, which can only be measured indirectly using helium as a proxy. In this study, hybrid grand canonical Monte Carlo/molecular dynamics (GCMC/MD) simulations were employed to scrutinize the accessible volume and quantify the excess adsorption capacities of various gases in kerogen matrices, characterized by diverse micropore distributions at 363.15 K (90 °C) and pressures up to 50 MPa. We evaluated multiple approaches to determine accessible volume in simulations, emphasizing the importance of selecting a probe size that reflects the actual size of the adsorbate. The simulation outcomes reveal that accessible volumes derived from the helium expansion method, mimicking the traditional experimental techniques, tend to be overestimated by around a factor of two. This finding challenges the reliability of such measurements and suggests a need for their recalibration based on computer simulation models. Furthermore, when our simulations were compared with various theoretical adsorption isotherm models, the more advanced Supercritical Dubinin-Radushkevich and Supercritical Brunauer-Emmett-Teller models demonstrated better accuracy in predicting absolute adsorption values compared to the more conventional Langmuir model. However, neither model accurately predicted the absolute adsorption quantities, indicating room for improvement. Finally, the simulations underscore the significant adsorption capacity of CO2 compared to other gases, highlighting its promising role in facilitating enhanced gas recovery and geological sequestration within shale formations.

Validation of a new method for the radiological measurement of rod curvature in patients with spine deformity.

The relationship between rod curvature and postoperative radiographic results is a debated topic. One of the reasons of the heterogeneity of the observed results might reside in the lack of a validated and widely employed method to measure the curvature of the rods. Aim of this study was to present and validate a novel method for rod measurement, which is based on routine X-rays and utilizes a regression algorithm that limits manual measurements and the related errors. Data from 20 adolescent idiopathic scoliosis/Scheuermann kyphosis (AIS/SK) patients and 35 adult spine deformity (ASD) patients for analysis, with 112 rods in total. An orthogonal reference grid was overlaid on the lateral X-ray; sevenpoints were then marked along each rod and their coordinates recorded in a table. Using these coordinates, a third-order polynomial regression was applied to obtain the rod curvature equation (correlation coefficients > 0.97). Three observers (one surgeon, one experienced and one inexperienced observer) independently applied the developed method to measure the rod angulation of the included patients and performed the measurements twice. The reliability of the method was evaluated in terms of intraclass correlation coefficient (ICC), Bland-Altmann plot and 2SR. The intra-observer ICCs for all measurements exceed 0.85, indicating an excellent correlation. For the AIS/SK group, the surgeon showed a slightly lower reliability compared to the other two evaluators (0.93 vs 0.98 and 0.98). However, the surgeon showed a higher reliability in measurements of the rods at the lumbar level, both for L1-S1 and L4-S1 (0.98 vs 0.96 and 0.89; 0.97 vs. 0.85 and 0.91, respectively). The variability also showed excellent results, with a mean variability ranging from 1.09° to 3.76°. The inter-observer ICCs for the three measurement groups showed an excellent reliability for the AIS/SK group (0.98). The reliability was slightly lower but still excellent for the lumbar measurements in ASD patients at L1-S1 (0.89) and L4-S1 (0.83). The results of the 2SR for each measured segment were 4.4° for T5-T11, 5.4° for L1-S1 and 5.5° for L4-S1. The described method represents a reliable and reproducible way to measure rod curvature. This method is based on routine X-rays and utilizes a regression algorithm that limits manual measurements and the related errors.

Validity of Measured vs. Self-Reported Weight and Height and Practical Considerations for Enhancing Reliability in Clinical and Epidemiological Studies: A Systematic Review.

Self-reported measures of height and weight are often used in large epidemiological studies. However, concerns remain regarding the validity and reliability of these self-reported measures. The aim of this systematic review was to summarise and evaluate the comparative validity of measured and self-reported weight and height data and to recommend strategies to improve the reliability of self-reported-data collection across studies. This systematic review adopted the PRISMA guidelines. Four online sources, including PubMed, Medline, Google Scholar, and CINAHL, were utilised. A total of 17,800 articles were screened, and 10 studies were eligible to be included in the SLR based on the defined inclusion and exclusion criteria. The findings from the studies revealed good agreement between measured and self-reported weight and height based on intra-class correlation coefficient and Bland-Altman plots. Overall, measured weight and height had higher validity and reliability (ICC > 0.9; LOA < 1 SD). However, due to biases such as social pressure and self-esteem issues, women underreported their weight, while men overreported their height. In essence, self-reported measures remain valuable indicators to supplement the restricted direct anthropometric data, particularly in large-scale surveys. However, it is essential to address potential sources of bias.

Corticomotor pathway function and recovery after stroke: a look back and a way forward.

Stroke is a leading cause of adult disability that results in motor deficits and reduced independence. Regaining independence relies on motor recovery, particularly regaining function of the hand and arm. This review presents evidence from human studies that have used transcranial magnetic stimulation (TMS) to identify neurophysiological mechanisms underlying upper limb motor recovery early after stroke. TMS studies undertaken at the subacute stage after stroke have identified several neurophysiological factors that can drive motor impairment, including membrane excitability, the recruitment of corticomotor neurons, and glutamatergic and GABAergic neurotransmission. However, the inherent variability and subsequent poor reliability of measures derived from motor evoked potentials (MEPs) limit the use of TMS for prognosis at the individual patient level. Currently, prediction tools that provide the most accurate information about upper limb motor outcomes for individual patients early after stroke combine clinical measures with a simple neurophysiological biomarker based on MEP presence or absence, i.e. MEP status. Here, we propose a new compositional framework to examine MEPs across several upper limb muscles within a threshold matrix. The matrix can provide a more comprehensive view of corticomotor function and recovery after stroke by quantifying the evolution of subthreshold and suprathreshold MEPs through compositional analyses. Our contention is that subthreshold responses might be the most sensitive to reduced output of corticomotor neurons, desynchronized firing of the remaining neurons, and myelination processes that occur early after stroke. Quantifying subthreshold responses might provide new insights into post-stroke neurophysiology and improve the accuracy of prediction of upper limb motor outcomes.

Evaluating pelvic tilt using the pelvic antero-posterior radiographs: A novel method.

Pelvic tilt (PT) is an important parameter for orthopedic surgeries involving hip and spine, typically determined from sagittal pelvic radiographs. However, various challenges can compromise the feasibility of measurement from sagittal imaging, including obscured landmarks, anatomical variations, hardware interference, and limited medical resources. Addressing these challenges and with the aim of reducing radiation exposure to patients, our study developed a novel method to estimate PT from antero-posterior (AP) radiographs, using vertical distances from the pelvic outlet and obturator foramen. We correlated these measurements with PT, defined both anatomically (anterior pelvic plane, PTa) and mechanically (centers of femoral heads and sacral plate, PTm). The study explored creating linear, exponential, and multivariate regression models based on twelve 3D CT-derived pelvic models (six men, six women), simulating AP radiograph projections with controlled PTs. We then validated these models against 105 pairs of patient stereoradiographs. Statistical analysis revealed that combined exponential-linear models yielded the most accurate results, with Pearson correlation coefficients of 0.75 for PTa and 0.77 for PTm, and mean absolute errors of 3.7° ± 2.6° for PTa and 4.5° ± 3.4° for PTm, showing excellent measurement reliability (all ICCs > 0.9) without significant gender discrepancies. In conclusion, this study presents a validated, simple, and accessible method for estimating PT using AP radiograph parameters, supported by the Supporting Information S1: Excel Tool, showing great potential for clinical application in hip and spine procedures.

Balance measures for fall risk screening in community-dwelling older adults with COPD: A longitudinal analysis

BackgroundChronic obstructive pulmonary disease (COPD) increases fall risk, but consensus is lacking on suitable balance measures for fall risk screening in this group. We aimed to evaluate the reliability and validity of balance measures for fall risk screening in community-dwelling older adults with COPD. MethodsIn a secondary analysis of two studies, participants, aged ≥60 years with COPD and 12-month fall history or balance issues were tracked for 12-month prospective falls. Baseline balance measures – Brief Balance Evaluation Systems Test (Brief BESTest), single leg stance (SLS), Timed Up and Go (TUG), and TUG Dual-Task (TUG-DT) test – were assessed using intra-class correlation (ICC2,1) for reliability, Pearson/Spearman correlation with balance-related factors for convergent validity, t-tests/Wilcoxon rank-sum tests with fall-related and disease-related factors for known-groups validity, and area under the receiver operator characteristic curve (AUC) for predictive validity. ResultsAmong 174 participants (73 ± 8 years; 86 females) with COPD, all balance measures showed excellent inter-rater and test-retest reliability (ICC2,1 = 0.88–0.97) and moderate convergent validity (r = 0.34–0.77) with related measures. Brief BESTest and SLS test had acceptable known-groups validity (p < 0.05) for 12-month fall history, self-reported balance problems, and gait aid use. TUG test and TUG-DT test discriminated between groups based on COPD severity, supplemental oxygen use, and gait aid use. All measures displayed insufficient predictive validity (AUC<0.70) for 12-month prospective falls. ConclusionThough all four balance measures demonstrated excellent reliability, they lack accuracy in prospectively predicting falls in community-dwelling older adults with COPD. These measures are best utilized within multi-factorial fall risk assessments for this population.

Cultural adaption, translation, preliminary reliability and validity of psychological and behavioural measures for adolescents living with HIV in Botswana: A multi-stage approach.

Human immunodeficiency virus (HIV) remains a significant public health issue among young people living in Botswana. There is a need for reliable and valid psychological and behavioural measures of causally important constructs for this population. We developed a new HIV knowledge measure for use with 10-19-year-olds living with HIV and translated and adapted additional tools measuring HIV adjustment, HIV disclosure cognitions and affect, HIV communication beliefs, antiretroviral (ART) adherence, and self-esteem, using a multi-step process. This included (1) item generation for the HIV knowledge questionnaire, (2) translation including back-translation and expert review, (3) cognitive interviewing, (4) reliability testing (5) preliminary validity analysis. The HIV Knowledge Questionnaire for Adolescents living with HIV, the Illness Cognition Questionnaire, the Adolescent HIV Disclosure Cognition and Affect Scale, the HIV Communication Beliefs Scale, and the Rosenberg Self-Esteem Scale showed acceptable or good reliability and some evidence of validity for adolescents living with HIV in Botswana.

Airway and Voice Outcomes After Thyroarytenoid Myomectomy for Bilateral Vocal Fold Immobility.

Type 4 posterior glottic stenosis and bilateral vocal fold paralysis are clinically challenging causes of bilateral vocal fold immobility (BVFI) that result in glottic airway obstruction. Established procedures for BVFI typically worsen dysphonia. We hypothesize the use of thyroarytenoid myomectomy (TAM) in the setting of BVFI will improve dyspnea with decreased detriment to voice. Eleven unilateral TAM procedures were performed between April 2021 and June 2023 at a single institution. Pre- and postoperative patient reported outcomes were compared. Representative images of maximal glottic opening were analyzed in ImageJ to calculate ipsilateral bowing index (BI), total BI, maximum glottic surface area (MGSA), and maximum opening angle (MOA). Statistical comparisons were performed with paired t-tests when normality was confirmed with Shapiro-Wilk test and otherwise with Wilcoxon signed-rank tests, with threshold for significance of α = 0.05. Interrater reliability for objective glottal measures was compared with intraclass correlation coefficient (ICC). Dyspnea Index improved from mean (standard error) of 24.1 (3.8) to 9.1 (3.3), p = 0.004. Voice Handicap Index-10 improved from 20.0 (4) to 10.3 (3.8), p = 0.011. Glottal Function Index improved from 9.6 (1.4) to 6.3 (1.3), p = 0.017. There was no significant difference in ipsilateral BI, total BI, MOA, and median MGSA. There was good to excellent ICCs for all comparisons (0.83-0.95). TAM demonstrated significant improvement in symptoms from BVFI while not significantly altering glottal structure. These data suggest TAM improves dyspnea in patients with BVFI without significantly impairing voice. 4 Laryngoscope, 2024.

MEASURING BIRTH OUTCOMES: VALIDATING THE PERINATAL OUTCOME INDEX

We undertook a study to assess the reliability and validity of a new measure of low risk maternity care. A Perinatal Outcome Index (POI), which combines intrapartum process of care and clinical outcome items into a summary index score, was originally developed and evaluated in the Netherlands. It was designed to measure the extent to which a labour and birth are "optimal", that is, one with minimal intervention resulting in a healthy mother and a healthy baby. We modified the Dutch index to make it applicable to a Canadian setting. A panel of experts who were not connected with the study reviewed the modified version for applicability, feasibility of obtaining data easily, and content validity. Data were abstracted from the health records of 324 women in one hospital and two midwifery practices to obtain Perinatal Outcome Index scores and examine aspects of construct validity. We measured the inter-rater reliability of the research assistants who abstracted information. The panel achieved consensus on all items in the modified Perinatal Outcome Index to establish content (face) validity. Labour and birth data were readily obtained from health records with high inter-rater reliability (Kappa 0.78). In a linear regression model, birth at home, multiparity, and having a midwife or family physician as a care provider were significantly associated with higher scores (having a more optimal birth) and accounted for 37% of the score variance. The Perinatal Outcome Index has satisfied our expectations for content and construct validity. Research assistants found it easy to use and data items were readily available from women's health records. Inter-rater reliability was acceptable. We believe the modified index will be useful for comparative studies among women at low or average risk, and for quality assurance programs.