Subjective Examination Research Articles

Long-term inter-platform reproducibility, bias, and linearity of commercial PDFF MRI methods for fat quantification: a multi-center, multi-vendor phantom study.

Proton density fat fraction (PDFF) is a validated biomarker of tissue fat quantification. However, validation has been limited to single-center or multi-center series using non-FDA-approved software. Thus, we assess the bias, linearity, and long-term reproducibility of PDFF obtained using commercial PDFF packages from several vendors. Over 35 months, 438 subjects and 16 volunteers from a multi-center observational trial underwent PDFF MRI measurements using a 3-T MR system from one of three different vendors or a 1.5-T system from one vendor. Fat-water phantom sets were measured as part of each subject's examination. Manual region-of-interest measurements on the %fat image, then cross-sectional bias, linearity, and long-term reproducibility were assessed. Three hundred ninety-two phantom measurements were evaluable (90%). Bias ranged from 2.4 to - 3.8% for the lowest to the highest weight %fat. Regression fits of PDFF against synthesis weight %fat showed negligible non-linear effects and a linear slope of 0.94 (95% confidence interval: 0.938, 0.947). We observed significant vendor (p < 0.001) and field strength (p < 0.001) differences in bias and longitudinal variability. When the results were pooled across sites, vendors, and field strengths, the estimated reproducibility coefficient was 6.93% (95% CI: 6.25%, 7.81%). This study demonstrated good linearity, accuracy, and reproducibility for all investigated manufacturers and field strengths. However, significant vendor-dependent and field strength-dependent bias were found. While longitudinal PDFF measurements may be made using different field strength or vendor MR systems, if the MR system is not the same, based on these results, only PDFF changes ≥ 7% can be considered a true difference. • Phantom fat fraction (PDFF) MRI measurements over 35 months demonstrated good linearity, accuracy, and reproducibility for the vendor systems investigated. • Non-linear effects were negligible (linear slope of 0.94) over 0-100% fat; however, significant vendor (p < 0.001) and field strength (p<0.001) differences in bias and longitudinal variability were identified. Bias ranged from 2.4 to - 3.8% for 0-100 weight% fat, respectively. • Measurement bias could affect the accuracy of PDFF in clinical use. As the reproducibility coefficient was 6.93%, only greater changes in % fat can be considered true differences when making longitudinal PDFF measurements on different MR systems.

Effects of a Resident-Led Subject Exam Review on Mean Scores of Internal Medicine Subject Exam: a Case-control Study.

The National Board of Medical Examiners (NBME) offers Subject Examinations (SE) for students completing the Internal Medicine (IM) clerkship. There is a paucity of literature in regard to the efficacy of review methods prior to rendering said examination. Our medical center's residents conducted a structured review session in preparation for SE administration. The mean SE scores prior to and after the initiation of the resident-led review session were compared. There was no statistically significant association found between the mean NBME scores in the experimental or control groups. We propose that alternative methods be further assessed for efficacy.

B1 artifact reduction in abdominal DCE-MRI using kT -points: First clinical assessment of dynamic RF shimming at 3T.

The excitation inhomogeneity artifact occurring at 3T in the abdomen can lead to dramatic loss of signal and contrast, thereby hampering diagnosis. To assess excitation homogeneity and image quality achieved by nonselective prototypical kT -points pulses, compared to tailored static RF shimming, in clinical routine on a commercial dual-transmit scanner. Retrospective study with Institutional Review Board approval; informed consent was waived. Fifty consecutive patients referred for liver MRI at a single hospital. 3D breath-hold dynamic contrast-enhanced (DCE) MRI at 3T. Flip angle homogeneity was estimated via numerical simulation based on measured static and RF field maps. In all, 20 of the 50 patients underwent DCE-MRI while a pulse designer was present. The effect of RF shimming and kT -point pulses could be compared by repeating the acquisition with each transmit scheme before injection and in the late phase. Signal homogeneity, T1 contrast, enhancement quality, structure details, and global image quality were assessed on a 4-level scale (0 to 3) by two radiologists. Means were compared using Wilcoxon signed-rank tests. Normalized root mean square flip angle error was significantly reduced with kT -points compared to static RF shimming (8.5% ± 1.5% [mean ± standard deviation, SD] vs. 20.4% ± 9.8%; P < 0.0001). The worst case (heavy ascites) led to 13.0% (kT -points) vs. 54.9% (RF shimming). Global image quality was significantly higher for kT -points (2.3 ± 0.5 vs. 1.9 ± 0.6; P = 0.008). One subject's examination was judged unusable with RF shimming by one reader, none with kT -points. 85% of kT -points acquisitions were graded at least 2/3, and only 55% for static RF shimming. KT -points reduce excitation inhomogeneity quantitatively and qualitatively, especially in patients with ascites and prone to B1 shading. 1 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2018;47:1562-1571.

The clinical reasoning of musculoskeletal physiotherapists in relation to the assessment of vertebrobasilar insufficiency: A qualitative study

The aim of this study was to investigate the clinical reasoning processes of physiotherapists in relation to the assessment of vertebrobasilar insufficiency (VBI). Using a qualitative multiple case studies design 12 physiotherapists (mean = 12.89 years clinical experience, SD = 3.44) with an MSc in Manipulative Physiotherapy were shown 2 patient vignettes of a cervical spine disorder and associated symptoms of VBI sequentially in 4 sections and questioned as to their clinical reasoning processes via audio taped semi-structured interviews. Transcripts of the interviews were analysed for common themes. The therapists’ hypothesis generation in relation to VBI was mainly based on the subjective examination (SE) with no new patho-anatomic hypotheses being generated in the physical examination. The major indicators of VBI involvement were dizziness particularly if associated with other symptoms (visual disturbances, history of trauma and headache) and if exacerbated by cervical spine movements. Therapists demonstrated a lack of confidence in functional positional testing (FPT) and based decisions on the use of high velocity thrust techniques on subjective findings. The results of this study emphasise the importance of physiotherapists’ clinical reasoning process during the SE particularly in view of the questionable diagnostic utility of FPT.

M. C. Behera. Globalising and Rural Development: Competing Paradigms and Emerging Realities, New Delhi/Thousand Oaks/London: Sage Publications. 2006. Paperback. Indian Rs 550.00.

Rural development provides an understanding which is both broader and more specific than development in terms of economic growth. It is broader because it entails much more than economic growth as factors affecting it are not contained within the discipline of formal economics. Rural development includes not only attention to production, but also to the analysis of distributional issues and, therefore, demands an inter-disciplinary approach in which the broader social and political factors interacting with economic processes are subject to examination. Even in this age of globalisation, rural development has acquired a central role in the international development discourse. This is because there is a shift in the development paradigm along with the process of globalisation and nations need to formulate their rural development strategies fitting into this international discourse.

451 皮膚描記テストの評価システムの開発

Dermographism test is one way of estimating atopic dermatitis and urticaria. In actual test, the examiner scratches subject's skin surface by a spatula. After that, the examiner estimates skin response for several minutes. However, the test result is influenced by examiner's subjectivity and environment. Therefore, the aim of this study is to develop the system for dermographism, and to examine the methodology of estimation for blood flow and skin color. This study reports the prototype of dermographometer. The subject's skin in medial forearm site was scratched by the developed dermographometer, and was estimated by Laser spectrum blood flow imaging equipment and Colorimeter. It found that there are differences of recovery process between normal and atopic subjects.

The Performance of Military Personnel on USAFI Subject Examinations

THIS REPORT presents comparative test findings for members of the armed forces and civilian students both of whom had taken the same examination. The examinations reported upon here were the United States Armed Forces Institute (USAFI) Subject Examinations. These tests are standardized, achieve ment examinations in high school or college courses suchas: American History; Civics; Algebra; Economics; etc. They were constructed during 1942 and 1943 primarily for accreditation purposes and were designed so as to be useful in assessing the subject matter competency of individuals who had completed course work under a variety of educational settings. Each USAFI Subject Exami nation requires approximately two hours to complete. There are two parallel forms of each subject examination. One test form is available to civilian edu cational institutions, while a second form is reserved for use by the armed forces. Members of the armed forces are tested by qualified testing personnel in the United States and throughout the world. The answer sheets are scored by USAFI's and are then sent to USAFI, Madison, for official recording purposes. Samples of the answer sheets are saved and periodic check studies are made as to the effectiveness of the examinations. Tables I and H summarize the performance (Mean Score, Standard Deviation, and Percent Failing the test) of military and civilian examinees on the USAFI Subject Examinations. As can be seen, the performance data are surprisingly in close agreement for many of the 16 Subject Examinations. Obviously the relatively small size of the military examinee group may account for the favorable empirical differences obtained thus far between civilian and military examinees; for example: High School and College Modern European H i story, High School Civics. Where the military test results diverge noticeably and un favorably as compared to the civilian test results; for example: High School American History; CoUege Algebra; College Electricity and Magnetism; there is reason to believe that these examinations are being taken by military person nel who are possibly reaching beyond their actual educational preparation or attainments as of that date. To cite an example of the above, it is known that the Army requires applicants for the Army's Special Weapons Course at Fort Leavenworth to take th? College Algebra Test. In many instances, it is believed that applicants for the above training have not had the necessary preparation to pass the Subject Examination, or have not had sufficient time to review for it. The situation in regards to the High School American History Examination is probably somewhat similar in that military personnel, seeking to obtain a High School Equivalency Diploma via the High School GED Tests and the passing of the Subject Examination in American History, may be prematurely over-reaching