Weighted Kappa Coefficient Research Articles

Spanish version of Pregnancy Symptoms Inventory: transcultural adaptation and reliability

Aim: To transcultural adapt and analyze the reliability of Spanish version of Pregnancy Symptoms Inventory (PSI) and assess the prevalence of pregnancy symptoms in Spanish pregnant women.Materials and methods: A subsample of 120 healthy pregnant women answered the PSI twice and a sample of 280 report the prevalence and limitation of pregnancy symptoms. The reliability was examined by means of percent agreement and weighted Kappa coefficients. The prevalence of pregnancy symptoms was evaluated by the frequency of answers.Results: Perfect and perfect-acceptable agreement was observed in 82% and 96% of the pregnant women, respectively. Weighted Kappa coefficients ranged from 0.589 to 0.889, indicating a good reliability. The most frequent symptoms perceived by Spanish pregnant women were urinary frequency, poor sleep, increased vaginal discharge and tiredness.Conclusion: Spanish Pregnancy Symptoms Inventory is a brief, conceptually equivalent and satisfactory reliable tool that allows an early assessment of the wide range of pregnancy symptoms in the health care practices.

A novel approach to falls classification in Parkinson’s disease: development of the Fall-Related Activity Classification (FRAC)

BackgroundFalls are a major problem for people with Parkinson’s disease (PD). Despite years of focused research knowledge of falls aetiology is poor. This may be partly due to classification approaches which conventionally report fall frequency. This nosology is blunt, and does not take into account causality or the circumstances in which the fall occurred. For example, it is likely that people who fall from a postural transition are phenotypically different to those who fall during high level activities. Recent evidence supports the use of a novel falls classification based on fall related activity, however its clinimetric properties have not yet been tested. ObjectiveThis study describes further development of the Fall-Related Activity Classification (FRAC) and reports on its inter-rater reliability (IRR). MethodDescriptors of the FRAC were refined through an iterative process with a multidisciplinary team. Three categories based on the activity preceding the fall were identified. PD fallers were categorised as: (1) advanced (2) combined or (3) transitional. Fifty-five fall scenarios were rated by 23 raters using a standardised process. Raters comprised 3 clinical subgroups: (1) physiotherapists, (2) physicians, (3) non-medical researchers. IRR analysis was performed using weighted kappa coefficients and included sub group analysis based on clinical speciality. ResultsExcellent agreement was reached for all clinicians, κ=0.807 (95% CI 0.732 to 0.870). Clinical subgroups performed similarly well (range of κ=0.780 to 0.822). ConclusionThe FRAC can be reliably used to classify falls. This may discriminate between phenotypically different fallers and subsequently strengthen falls predictors in future studies.

Relative validity of a web-based food frequency questionnaire for patients with type 1 and type 2 diabetes in Denmark.

Background:Diet has an important role in the management of diabetes. However, little is known about dietary intake in Danish diabetes patients. A food frequency questionnaire (FFQ) focusing on most relevant nutrients in diabetes including carbohydrates, dietary fibres and simple sugars was developed and validated.Objectives:To examine the relative validity of nutrients calculated by a web-based food frequency questionnaire for patients with diabetes.Design:The FFQ was validated against a 4-day pre-coded food diary (FD). Intakes of nutrients were calculated. Means of intake were compared and cross-classifications of individuals according to intake were performed. To assess the agreement between the two methods, Pearson and Spearman's correlation coefficients and weighted kappa coefficients were calculated.Subjects:Ninety patients (64 with type 1 diabetes and 26 with type 2 diabetes) accepted to participate in the study. Twenty-six were excluded from the final study population.Setting:64 volunteer diabetes patients at the Steno Diabetes Center.Results:Intakes of carbohydrates, simple sugars, dietary fibres and total energy were higher according to the FFQ compared with the FD. However, intakes of nutrients were grossly classified in the same or adjacent quartiles with an average of 82% of the selected nutrients when comparing the two methods. In general, moderate agreement between the two methods was found.Conclusion:The FFQ was validated for assessment of a range of nutrients. Comparing the intakes of selected nutrients (carbohydrates, dietary fibres and simple sugars), patients were classified correctly according to low and high intakes. The FFQ is a reliable dietary assessment tool to use in research and evaluation of patient education for patients with diabetes.

Serum and Synovial Fluid Serum Amyloid A Response in Equine Models of Synovitis and Septic Arthritis.

To investigate the serum and synovial fluid serum amyloid A (SAA) response in equine models of synovitis and septic arthritis and to compare handheld and validated immunoturbidometric assays for SAA quantification. Controlled, experimental study. Healthy adult horses (n = 9). Synovitis (n = 4) and septic arthritis (n = 5) were induced using lipopolysaccharide and Staphylococcus aureus, respectively, and serial serum and synovial fluid samples were collected. Serial synovial fluid cytology was performed for both models and synovial fluid from the septic arthritis model was submitted for bacterial culture. Serum and synovial fluid SAA were quantified by handheld test and immunoturbidometric assay. Cytologic and SAA data were compared within and between models (mixed model ANOVA) and results of SAA assays were compared using category-by-category analysis (weighted kappa coefficient). Synovial fluid total nucleated cell counts and total protein increased significantly following induction of both models. Serum and synovial fluid SAA remained normal in synovitis horses and increased significantly in septic arthritis horses. Serum SAA increased more rapidly than synovial fluid SAA. Agreement was 98% when SAA concentrations were low (<50 μg/mL) but the assays diverged when concentrations were greater than ∼100 μg/mL. Overall, there was good category-by-category agreement between SAA assays (weighted kappa = 0.824). Serum and synovial fluid SAA may be useful adjuncts in diagnosing septic arthritis in horses. SAA concentrations for the assays diverged and examination using a larger sample size is needed before direct numeric comparisons between the assays can be made.

Approximate confidence intervals for the weighted kappa coefficient of a binary diagnostic test subject to a case–control design

ABSTRACTCase–control design to assess the accuracy of a binary diagnostic test (BDT) is very frequent in clinical practice. This design consists of applying the diagnostic test to all of the individuals in a sample of those who have the disease and in another sample of those who do not have the disease. The sensitivity of the diagnostic test is estimated from the case sample and the specificity is estimated from the control sample. Another parameter which is used to assess the performance of a BDT is the weighted kappa coefficient. The weighted kappa coefficient depends on the sensitivity and specificity of the diagnostic test, on the disease prevalence and on the weighting index. In this article, confidence intervals are studied for the weighted kappa coefficient subject to a case–control design and a method is proposed to calculate the sample sizes to estimate this parameter. The results obtained were applied to a real example.

Trunk appearance perception scale for physicians (TAPS-Phy) - a valid and reliable tool to rate trunk deformity in idiopathic scoliosis.

BackgroundEvaluation of trunk deformity by physicians in patients with idiopathic scoliosis (IS) has been considered an important part of clinical practice. Different methods to quantify the severity of trunk deformity by external observation have been reported. A valid tool to evaluate patients’ perception of trunk deformity, the Trunk Appearance Perception Scale (TAPS), is hereby validated for use by physicians (TAPS-Phy).MethodsCross-sectional study of patients with non-surgically treated IS. Patients were prospectively recruited. On the day of the visit, a posterior-anterior radiograph in standard position and clinical photographs in three different views (anterior, posterior and forward bending position) were obtained. Patients also completed a TAPS questionnaire (TAPS-Pat). Three different observers scored the TAPS questionnaire (TAPS-Phy), based on the digital photographs previously obtained, twice a week. The angle of trunk inclination (ATRI) was also measured on digital photographs. Inter and intra-rater reliability was calculated through weighted kappa coefficient. External validity was tested by the Spearman correlation coefficient between the TAPS-Phy score and the scoliosis magnitude determined using the magnitude of the largest curve (MLC), ATRI, and TAPS-Pat.ResultsFifty two patients (46 women; mean age 16.6 years) were included. The average curve magnitude of the major curve was 44°. Mean scores of TAPS-Phy for the three evaluators ranged from 3.4 to 3.5. No differences between the three means were found. TAPS-Phy showed good internal consistency (Cronbach’s alpha coefficient 0.84). Inter-observer reliability ranged from slight to substantial (0.14 to 0.63); intra-observer reliability ranged from 0.35 to 0.99. Correlation between TAPS-Phy and ATRI (r = −0.54 to −0.75), MLC (r = −0.47 to −0.6) and TAPS-Pat (r = 0.29 to 0.34) were statistically significant (p < 0.01).ConclusionsTAPS-Phy is a valid and reliable scale to rate a physician’s impression of the severity of the deformity in patients with idiopathic scoliosis and can be useful in routine clinical records.Electronic supplementary materialThe online version of this article (doi:10.1186/s13013-016-0085-8) contains supplementary material, which is available to authorized users.

Validation and Banding of the ItchyQuant: A Self-Report Itch Severity Scale

Because of the significant emotional and psychosocial impact of chronic pruritus, it is important to accurately assess and measure itch severity. This study aims to validate and apply clinically meaningful bands to the ItchyQuant, an illustrated self-report numeric rating scale (NRS) for itch severity. A total of 76 adults with chronic pruritus were recruited. Participants rated their itch on the ItchyQuant, on a traditional 11-point NRS, and with verbal categorizations (no, mild, moderate, or severe). There was a significant, high correlation between the ItchyQuant and NRS (>0.92, P < 0.0001), demonstrating concurrent validity. Significantly more patients (47.2%) preferred the ItchyQuant than the NRS (23.6%) or had no preference (29.2%), P= 0.0015. Significantly more patients found the ItchyQuant easier to use (45.8%) than the NRS (20.8%) or had no preference (33.3%), P= 0.008. The set of clinically meaningful bands with the highest weighted kappa coefficient of agreement (κ= 0.69) was as follows: 0 (no itch), 1-3 (mild itch), 4-7 (moderate itch), 8-10 (severe itch). The ItchyQuant is a clinically meaningful measure of itch severity, demonstrating face and concurrent validity, that many patients prefer and find easier to use when compared with a traditional NRS. We suggest that the ItchyQuant can be added to the existing armamentarium of itch severity scales. We plan to investigate the ItchyQuant further in cognitively challenged populations.

The Rainbow Scale for Assessing Breast Ptosis: Validation of Three Different Views.

Photographic scales have become an increasingly used tool in objectively assessing outcomes in aesthetic surgery. However, no online photographic scale for assessing breast ptosis has been developed yet that is readily available. This study was designed to validate the online Rainbow Scale for the assessment of breast ptosis for the anterior-posterior (AP), lateral, and oblique views. For the five grades of the Rainbow Scale format, standardized reference photographs were selected. Six plastic surgeons rated 15 photographs for each view three times. Intra- and inter-observer agreements were calculated by using the weighted kappa coefficient and differences in intra- and inter-observer agreements between the three views were assessed for statistical significance using the Kruskal-Wallis test. The mean intra-observer agreements were 0.91 (range, 0.82-0.98) for the AP view, 0.88 (range, 0.77-1.00) for the oblique view, and 0.86 (range, 0.74-0.97) for the lateral view and did not vary significantly between all three views. The mean inter-observer agreements were 0.88 (range, 0.77-0.95) for the AP view, 0.84 (range, 0.72-0.94) for the oblique view, and 0.82 (range, 0.58-0.95) for the lateral view. The mean inter-observer agreements of the AP view varied significantly from the oblique view (P = .012) and the lateral view (P = .001). The Rainbow Scale for breast ptosis has been validated for the AP view, the lateral view, and the oblique view and is reproducible and reliable for the assessment of breast ptosis in three different views in an online setup. 4 Diagnostic.

Test-retest reliability of the Shape/Texture Identification testTM in people with chronic stroke

Objective: To evaluate the test-retest reliability of the Shape/Texture Identification test (STI-testTM) in persons with chronic stroke. Design: A test-retest design. Setting: University hospital outpatient setting. Participants: Forty-five persons (mean age 65 years) with mild to moderate impairments in the arm and hand > 6 months post stroke. Interventions: Not applicable. Main measure: The STI-testTM was used to assess active touch of the hand. It consists of two subtests: identification of shapes and identification of textures, each in three different sizes. Both hands were assessed twice, one week apart. The reliability of the data was evaluated with weighted Kappa statistics and the Svensson rank-invariant method (percentage agreement, systematic and random disagreements). Results: The median total score of the STI-testTM was 5 points (min-max 0-6 points) for the more affected hand and 6 points (min-max 3-6 points) for the less affected hand at both test occasions. The weighted Kappa coefficient was 0.94 for the more affected hand and 0.55 for the less affected hand. The percentage agreement for the more affected hand was 69% for the subtest shapes and 82% for the subtest textures, and for the less affected hand 62% and 91%, respectively. There were no systematic or random disagreements for any of the subtests. Conclusion: The STI-testTM is reliable to assess active touch of the hand after stroke.

A Note on the Linearly and Quadratically Weighted Kappa Coefficients

The linearly and quadratically weighted kappa coefficients are popular statistics in measuring inter-rater agreement on an ordinal scale. It has been recently demonstrated that the linearly weighted kappa is a weighted average of the kappa coefficients of the embedded 2 by 2 agreement matrices, while the quadratically weighted kappa is insensitive to the agreement matrices that are row or column reflection symmetric. A rank-one matrix decomposition approach to the weighting schemes is presented in this note such that these phenomena can be demonstrated in a concise manner.

Evaluation of the Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis (MPATH-Dx) classification scheme for diagnosis of cutaneous melanocytic neoplasms: Results from the International Melanoma Pathology Study Group

Pathologists use diverse terminology when interpreting melanocytic neoplasms, potentially compromising quality of care. We sought to evaluate the Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis (MPATH-Dx) scheme, a 5-category classification system for melanocytic lesions. Participants (n=16) of the 2013 International Melanoma Pathology Study Group Workshop provided independent case-level diagnoses and treatment suggestions for 48 melanocytic lesions. Individual diagnoses (including, when necessary, least and most severe diagnoses) were mapped to corresponding MPATH-Dx classes. Interrater agreement and correlation between MPATH-Dx categorization and treatment suggestions were evaluated. Most participants were board-certified dermatopathologists (n=15), age 50years or older (n=12), male (n=9), based in the United States (n=11), and primary academic faculty (n=14). Overall, participants generated 634 case-level diagnoses with treatment suggestions. Mean weighted kappa coefficients for diagnostic agreement after MPATH-Dx mapping (assuming least and most severe diagnoses, when necessary) were 0.70 (95% confidence interval 0.68-0.71) and 0.72 (95% confidence interval 0.71-0.73), respectively, whereas correlation between MPATH-Dx categorization and treatment suggestions was 0.91. This was a small sample size of experienced pathologists in a testing situation. Varying diagnostic nomenclature can be classified into a concise hierarchy using the MPATH-Dx scheme. Further research is needed to determine whether this classification system can facilitate diagnostic concordance in general pathology practice and improve patient care.

Multicentre evaluation of multidisciplinary team meeting agreement on diagnosis in diffuse parenchymal lung disease: a case-cohort study

Diffuse parenchymal lung disease represents a diverse and challenging group of pulmonary disorders. A consistent diagnostic approach to diffuse parenchymal lung disease is crucial if clinical trial data are to be applied to individual patients. We aimed to evaluate inter-multidisciplinary team agreement for the diagnosis of diffuse parenchymal lung disease. We did a multicentre evaluation of clinical data of patients who presented to the interstitial lung disease unit of the Royal Brompton and Harefield NHS Foundation Trust (London, UK; host institution) and required multidisciplinary team meeting (MDTM) characterisation between March 1, 2010, and Aug 31, 2010. Only patients whose baseline clinical, radiological, and, if biopsy was taken, pathological data were undertaken at the host institution were included. Seven MDTMs, consisting of at least one clinician, radiologist, and pathologist, from seven countries (Denmark, France, Italy, Japan, Netherlands, Portugal, and the UK) evaluated cases of diffuse parenchymal lung disease in a two-stage process between Jan 1, and Oct 15, 2015. First, the clinician, radiologist, and pathologist (if lung biopsy was completed) independently evaluated each case, selected up to five differential diagnoses from a choice of diffuse lung diseases, and chose likelihoods (censored at 5% and summing to 100% in each case) for each of their differential diagnoses, without inter-disciplinary consultation. Second, these specialists convened at an MDTM and reviewed all data, selected up to five differential diagnoses, and chose diagnosis likelihoods. We compared inter-observer and inter-MDTM agreements on patient first-choice diagnoses using Cohen's kappa coefficient (κ). We then estimated inter-observer and inter-MDTM agreement on the probability of diagnosis using weighted kappa coefficient (κw). We compared inter-observer and inter-MDTM confidence of patient first-choice diagnosis. Finally, we evaluated the prognostic significance of a first-choice diagnosis of idiopathic pulmonary fibrosis (IPF) versus not IPF for MDTMs, clinicians, and radiologists, using univariate Cox regression analysis. 70 patients were included in the final study cohort. Clinicians, radiologists, pathologists, and the MDTMs assigned their patient diagnoses between Jan 1, and Oct 15, 2015. IPF made up 88 (18%) of all 490 MDTM first-choice diagnoses. Inter-MDTM agreement for first-choice diagnoses overall was moderate (κ=0·50). Inter-MDTM agreement on diagnostic likelihoods was good for IPF (κw=0·71 [IQR 0·64-0·77]) and connective tissue disease-related interstitial lung disease (κw=0·73 [0·68-0·78]); moderate for non-specific interstitial pneumonia (NSIP; κw=0·42 [0·37-0·49]); and fair for hypersensitivity pneumonitis (κw=0·29 [0·24-0·40]). High-confidence diagnoses (>65% likelihood) of IPF were given in 68 (77%) of 88 cases by MDTMs, 62 (65%) of 96 cases by clinicians, and in 57 (66%) of 86 cases by radiologists. Greater prognostic separation was shown for an MDTM diagnosis of IPF than compared with individual clinician's diagnosis of this disease in five of seven MDTMs, and radiologist's diagnosis of IPF in four of seven MDTMs. Agreement between MDTMs for diagnosis in diffuse lung disease is acceptable and good for a diagnosis of IPF, as validated by the non-significant greater prognostic separation of an IPF diagnosis made by MDTMs than the separation of a diagnosis made by individual clinicians or radiologists. Furthermore, MDTMs made the diagnosis of IPF with higher confidence and more frequently than did clinicians or radiologists. This difference is of particular importance, because accurate and consistent diagnoses of IPF are needed if clinical outcomes are to be optimised. Inter-multidisciplinary team agreement for a diagnosis of hypersensitivity pneumonitis is low, highlighting an urgent need for standardised diagnostic guidelines for this disease. National Institute of Health Research, Imperial College London.

How well do patients and providers agree on the severity of dyspnea?

Understanding the severity of patients' dyspnea is critical to avoid under- or overtreatment of patients with acute cardiopulmonary conditions. To evaluate the agreement between dyspnea assessment by patients and healthcare providers and to explore which factors contribute to discordance in assessment. Prospective study of patients hospitalized for acute cardiopulmonary diseases at an urban teaching hospital. A numerical rating scale (0-10) was used to assess dyspnea severity as perceived by patients and assessed by providers. Agreement was defined as a score within ±1 between patient and healthcare provider; differences of ≥2 points were considered over- or underestimations. The relationship between patient self-perceived dyspnea severity and provider rating was assessed using a weighted kappa coefficient. Of the 138 patients enrolled, 33% had a diagnosis of heart failure, 30% chronic obstructive pulmonary disease, and 13% pneumonia; median age was 72 years, and 57% were women. In all, 96 patient-physician and 138 patient-nurses pairs were included in the study. The kappa coefficient for agreement was 0.11 (95% confidence interval [CI]: 0.01 to 0.21) between patients and physicians and 0.18 (95% CI: 0.12 to 0.24) between patients and nurses. Physicians underestimated patients' dyspnea 37.9% of the time and overestimated it 25.8% of the time, whereas nurses underestimated it 43.5% of the time and overestimated it 12.4% of the time. Admitting diagnosis was the only patient factor associated with discordance. Agreement between patient perception of dyspnea and healthcare providers' assessment is low. Future studies should prospectively test whether routine assessment of dyspnea results in better patient outcomes. Journal of Hospital Medicine 2016;11:701-707. © 2016 Society of Hospital Medicine.

Análise de métodos para detectar sarcopenia em idosas independentes da comunidade

Resumo Introdução: O envelhecimento impõe modificações na composição corporal dos indivíduos. Uma das características mais marcantes desse período é a perda progressiva de massa, força e função musculares, conhecida como sarcopenia. Objetivos: Verificar a presença de sarcopenia em idosas hígidas da comunidade utilizando combinações de diferentes métodos para avaliar massa muscular (MM) e desempenho físico, bem como se há concordância entre as combinações para diagnóstico da sarcopenia. Método: Estudo transversal com 37 idosas da Universidade Aberta da Maturidade. Os parâmetros para avaliar a MM foram: circunferência da panturrilha (CP) e massa muscular esquelética (MME) por meio da impedância bioelétrica (BIA) e índice de músculo esquelético (IME). Quanto à performance física, realizou-se a força de preensão palmar (FPP) com dinamômetro manual, velocidade de marcha (VM) em 10 metros e o timed up and go (TUG) para mobilidade funcional. Para comparar os métodos diagnósticos de sarcopenia foram empregadas quatro combinações distintas: C1= IME+FPP+VM; C2= IME+FPP+TUG; C3= CP+FPP+VM e C4= CP+FPP+TUG, de acordo com o proposto pelo consenso europeu. Para verificação da diferença entre os métodos foram aplicados os testes de Kruskal-Wallis e as comparações múltiplas para dados não pareados; e o coeficiente Kappa ponderado para avaliação do grau de concordância. Resultados: As combinações C1 e C2 identificaram pré-sarcopenia, sarcopenia e sarcopenia grave. Entre C1 e C2, evidenciou-se alta concordância (0,92), já C3 e C4 não identificaram presença de sarcopenia nas idosas. Conclusão: A CP, para avaliar a MM, pode não detectar a sarcopenia em idosas com excesso de peso. Porém, a alta concordância entre as duas combinações que utilizaram o IME e VM ou TUG, indicam a aplicação de ambas na prática clínica.

Predicting the occurrence of large-diameter trees using airborne laser scanning

Large-diameter trees are important for both ecological and economic reasons, but they have become increasingly rare. Thus, there is an interest in easily locating such trees, and for this purpose, the use of airborne laser scanning (ALS) seems suitable. Our objective was to assess the accuracy of area-based ALS estimation in predicting the number of large-diameter Scots pines (Pinus sylvestris L.). A sample of 856 trees with a diameter &gt;35 cm were measured from 1109 sample plots located in eastern Norway. We fitted negative binomial and zero-inflated negative binomial models for predicting large-diameter tree counts. ALS-derived and external variables were used as predictors when fitting the models. The accuracy was assessed based on the weighted kappa coefficient and cross validation. Our best model was based on three ALS height distribution variables, one horizontal ALS variable, and plot elevation. Its overall accuracy was 65.8% and the weighted kappa was 0.55. Although there was a clear relationship between the response and the proposed predictor variables, fairly large errors in the predicted large-diameter tree counts were common.

Validation of the Critical Care Pain Observation Tool (CPOT) in a Small Community Hospital Setting

This IRB approved quantitative validation study utilized a repeated measure design to determine if the CPOT tool is a valid and reliable tool to detect pain for non-verbal critical care patients in our small community hospital setting. Our study utilized a convenience sample of 52 critical care patients who were considered for inclusion if they were >18 y/o and were unable to communicate the presence or absence of pain verbally or through gestures. Recruitment of eligible patients was done through daily rounds by the PI and/or the staff nurse. Consent was not required by the IRB. Each patient received a study folder containing 3 sets of 2 CPOT scoring tools. Patients were assessed with the current method of pain assessment - Assume Pain Present (+/− APP) and the CPOT tool. Both assessments were completed by two RNs at the bedside on three separate occasions. At the conclusion of the study, results were tabulated by a statistician. Interrater reliability was found to be acceptable with a weighted kappa coefficient of 0.950. There was a statistically significant high correlation between the CPOT and APP, indicating good convergent validity at 0.98. Our research demonstrated the CPOT to be a valid and reliable tool to detect the presence of pain in our hospital setting. Future research will focus on the use of the CPOT to increase the confidence of the RN in both assessment of pain for this patient population and collaboration with other members of the health care team to provide safe and appropriate intervention related to pain for this vulnerable patient population.

Applying a discriminant model based on combination of pediatric critical illness score,D-dimer and procalcitonin in early predicting the severity of pediatric infection

Objective To establish a discriminant method based on clinical and laboratory data and common examinations for early predicting the severity of pediatric infection. Methods Consecutive hospitalized patients diagnosed as septic shock were included who were admitted between June 2014 and May 2015 retrospectively.Gender (male-female ratio: 1.251.00)and age (1 month to 6 years old) were matched in all of 18 patients with septic shock, and 27 patients diagnosed as systemic inflammatory response syndrome (SIRS), sepsis and severe sepsis on admission were included respectively in order of sequential admission number during the same period.Additional 36 gender- and age-matched children with common infection (non-SIRS)were enrolled as controls.The clinical and laboratory examination data of all the included patients were collected and then the pediatric critical illness scores (PCIS)were made according to the worst condition within 24 hours of hospitalization.The parameters correlated with the severity of infection were evaluated by rank correlation and Logistic regression analysis.The discriminant models were established based on κth-nearest-neighbor analysis and evaluated with clinical diagnosis by interrater agreement test. Results Except for platelet count, the other indexes including PCIS, neutrophil count, C-reactive protein, procalcitonin (PCT), international normalized ratio of prothrombin time, activated partial thromboplastin time, thrombin time, fibrinogen, fibrin/fibrinogen degradation product (FDP)and D-dimer (D-D)all had differences among groups with varying infection severity (all P<0.001). The Spearman's coefficient ρ of PCIS, PCT, D-D and FDP correlated to infection severity were -0.837, 0.680, 0.679 and 0.648, respectively (all P<0.001). Multivariate cumulative odds Logistic regression analysis showed PCIS, D-D and PCT were related to infection severity (all P<0.05). The total error rate of discriminant models based on 3-index combination (Mahalanobis transformation, k=2)was 0.091 that was lower than any models based on 2-index combination or single-index.Using the discriminant model based on three-index combination, the infection severity of 26 patients admitted during June 2015 were predicted with a high interrater agreement (weighted Kappa coefficient: 0.670, P<0.001)compared to clinical diagnosis. Conclusion The discriminant model based on combination of PCIS, D-D and PCT could assist predicting the severity of pediatric infection earlier. Key words: Infection; Discriminant analysis; Pediatric critical illness score; D-dimer; Procalcitonin

Assessment of furcal perforations in the vicinity of different root canal sealers using a cone beam computed tomography system with and without the application of artifact reduction mode: an ex vivo investigation on extracted human teeth

To investigate observer ability to diagnose exvivo simulated endodontic furcal perforations in root-filled teeth from cone beam computed tomography (CBCT) images using different artifact reduction algorithms. Our study consisted of 135 first maxillary molar teeth. In 89 teeth, furcation perforations were created using dental burs. Forty-six teeth without artificial perforations were used as controls. MTA Fillapex, Activ GP, and AH Plus were used with or without metal posts. All teeth were imaged using Planmeca ProMax 3-D Max CBCT, and four image modes were obtained as without artifact reduction and with artifact reduction in low, medium, and high modes. Images were evaluated by three observers for the presence or absence of furcation perforation using a five-point scale. Weighted kappa coefficients were calculated to assess observer agreement. Receiver operating characteristic analysis was performed. Areas under the curve (AUCs) were calculated for each image mode, observer, treatment group, and reading and were compared using Χ(2) tests, with a significance level of α=0.05. The effects on diagnosis were calculated using analysis of variance (ANOVA). Intraobserver agreements for all observers ranged from 0.857 to 0.945. Kappa coefficients among different observers ranged from 0.673 to 0.763. AUC values ranged from 0.83 to 0.92, and there were no statistically significant differences (P>.05) between different CBCT image modes. Ratings in Activ GP treatment groups with or without posts showed statistically significant differences (P<.001). All CBCT image modes performed similarly in detecting furcal perforations near different root canal sealers with or without posts.

Comparison of Phenotypic and Genotypic Identification Methods of Pasteurella multocida Serotypes Isolated from Pigs

Background: Pasteurella multocida serotypes A and D are commonly associated with pneumonia and pleuritis in pigs. Different phenotypic techniques, such as hyaluronidase and acriflavine tests, and genotyping techniques, such as PCR, are used to distinguish between these serotypes. The objective of this study was to compare the capsular identification methods of type A and type D P. multocida isolated from pigs using both phenotypic (hyaluronidase and acriflavine tests) and genotypic (multiplex PCR) techniques.Materials, Methods &amp; Results: A total of 44 lyophilized P. multocida isolates, obtained between 1981 and 1997 from pig farms at Rio Grande do Sul State, Brazil, were analyzed. The isolates were reactivated in Brain Heart Infusion (BHI) broth and cultured in BHI broth and blood agar supplemented with 5% sheep blood. Colony identity was further confirmed by evaluating colony morphology in blood agar and confirming the absence of growth on MacConkey agar. Bacteria in Tryptone Soy Agar (TSA) were used for the Triple Sugar Iron (TSI), Sulfide-Indole-Motility (SIM), and nitrate, glucose, lactose, sucrose and mannitol fermentation tests. For hyaluronidase test, P. multocida colonies were streaked transversally across the entire plate, approximately 3-5mm apart, in order to observe their lines of growth. Following this, a hyaluronidase producing strain of Staphylococcus aureus was heavily streaked at right angles to the P. multocida lines and the plates were incubated at 37°C for 24 h. Type A isolates were then identified as those with smaller colonies in the region adjacent to the Staphylococcus aureus streak (negative satellitism). For acriflavine test, the isolates were inoculated into tubes containing 2 mL of BHI, incubated at 37°C for 18-24 h, centrifuged (500 g for 15 min) and 1.5 mL of the supernatant was discarded. A 1:1000 solution of acriflavine neutral (0.5 mL) was then added to the residual broth containing bacteria and kept at room temperature. Solutions of acriflavine were freshly prepared each week and stored protected from light. Type D strains were identified by the appearance of a heavy flocculent precipitate within 5 min. DNA extraction by heat shock was performed prior to multiplex PCR for the detection of capsular genes hyaD-hyaC (capsular typing A) and dcbF (capsular typing D). Test of symmetry and a weighted kappa coefficient were used to evaluate correlations and to assess agreement of the results between the identification methods, respectively. Phenotypic tests showed that two isolates were type D (4.55%), 40 were type A (90.9%) and two (4.55%) were untypable isolates (4.55%) while PCR showed that 38 isolates were type A (86.36%) and six were type D (13.64%). The correlation analysis between the phenotypic and genotypic tests showed that 90.9% of the strains were identified as belonging to the same serotype by both tests and the weighted kappa coefficient (K = 0.633) indicates a substantial agreement between the two tests.Discussion: There was a disagreement between the phenotypic and genotypic results in four of the isolates (9.09%). The phenotypically untypable isolates were classified as type D by multiplex PCR. Nonetheless, we conclude that PCR testing is a more reliable method to differentiate between P. multocida serotypes A and D.

The Intra- and Inter-rater Reliability and the Learning Curve for a Simple Neurological Score for Rats

Results: The intra- and inter-rater agreement was determined using Cohen's weighted kappa coefficient. The intra-rater reliability was initially poor for the novice (κ [95% confidence interval], 0.31[−0.02, 0.64]), but it improved significantly after 3-week self education using the standardized video (0.81 [0.69, 0.93], showing almost perfect agreement. The reliability of the experienced researcher was good at all times ( κ=0.64, 0.76, 0.71, for week 1, 2, 3, respectively), indicating substantial agreement. The inter-rater reliability showed clear improvement after self-education (κ= 0.44, 0.69, 0.69, for week 1, 2, 3, respectively). Although the total sum score was highly reliable, some of the individual items showed lower intra-and inter-rater agreement. However, each rater showed greater within-rater variability for different subtests. Conclusion: The simple sensorimotor performance test showed high degree of intra- and inter-rater agreement when performed by experienced or properly educated raters. The inaccuracy of the novice was rectified by 3-week self-education using a video. (Brain & NeuroRehabilitation 2016; 9: 31-36)