Weighted Kappa Coefficient Research Articles

Prognostic impact of desmoplastic reaction in esophageal squamous cell carcinoma patients with neoadjuvant therapy

This study aimed to examine the prognostic value of desmoplastic reaction (DR) in esophageal squamous cell carcinoma (ESCC), particularly in patients who received neoadjuvant therapy, such as chemotherapy (NAC) or chemoradiotherapy (NACRT). In total, 153 patients with pStage II/III ESCC were included in this study. Ninety-one patients received neoadjuvant therapy (NAC, 70; NACRT, 21). Patients were classified according to three DR categories based on the presence of keloid-like collagen and/or myxoid stroma. In total, 50, 50, and 53 patients were classified as having mature, intermediate, and immature DR, respectively. The weighted kappa coefficient was 0.623 in the patients with preoperative treatments and 0.782, in those without. The 5-year disease-specific survival (DSS) rates in patients with intermediate/immature DR was significantly worse than those with mature DR (40.7% vs. 73.3%, p < 0.001). Similarly, the 5-year DSS rate in patients with intermediate/immature DR was significantly worse than those with mature DR in a study of patients who received neoadjuvant therapy (46.7% vs. 71.2%, p = 0.009). Multivariate analysis revealed that DR (hazard ratio [HR]: 3.15, 95% confidence interval [CI] 1.58-6.27, p = 0.001), along with N factors, was an independent risk factor for DSS. Moreover, multivariate analysis of patients who received neoadjuvant therapy revealed only DR (HR: 2.47, 95% CI 1.02-5.96, p = 0.045) as independent risk factors for DSS. The DR classification was a valuable prognostic factor not only in the ESCC patients without neoadjuvant therapy but also in those with neoadjuvant therapy.

Interrater agreement between children’s self-reported and their mothers’ proxy-reported dental anxiety: a Chinese cross-sectional study

BackgroundChildren's dental anxiety is common in dental clinics. This study aimed to determine the interrater agreement between children’s self-reported and their mothers’ proxy-reported dental anxiety and its affecting factors.MethodsIn this cross-sectional study performed in a dental clinic, primary school students and their mothers were assessed for enrollment eligibility. The Modified Dental Anxiety Scale plus Facial Image Scale (MDAS-FIS) was employed to test both the children’s self-reported and their mothers’ proxy-reported dental anxiety independently. The interrater agreement was analyzed using percentage agreement and the linear weighted kappa (k) coefficient. Factors affecting children’s dental anxiety were analyzed using univariate and multivariate logistic regression models.ResultsOne hundred children and their mothers were enrolled. The median ages of the children and mothers were 8.5 and 40.0 years old, respectively, and 38.0% (38/100) of the children were female. The scores of children’s self-reported dental anxiety were significantly higher than their mothers' proxy-reported dental anxiety (MDAS-Questions 1–5, all p < 0.05); moreover, there was no agreement between the two groups in terms of all anxiety hierarchies (kappa coefficient = 0.028, p = 0.593). In the univariate model, a total of seven factors (age, gender, maternal anxiety, number of dental visits, mother’s presence or absence, oral health status, and having siblings or not) were involved for analysis, and age [every 1-year increase, odds ratio (OR) = 0.661, 95% confidence interval (CI) = 0.514–0.850, p = 0.001], several dental visits (every 1 visit increase, OR = 0.409, 95% CI = 0.190–0.880, p = 0.022), and mother presence (OR = 0.286, 95% CI = 0.114–0.714, p = 0.007) were affecting factors. In the multivariate model, only age (every 1 year increase) and maternal presence were associated with 0.697-fold (95% CI = 0.535–0.908, p = 0.007) and 0.362-fold (95% CI = 0.135–0.967, p = 0.043) decreases in the risk of children’s dental anxiety during dental visits and treatment, respectively.ConclusionThere was no significant agreement between elementary school students’ self-reported dental anxiety and mothers’ proxy ratings of children’s dental anxiety, which suggests that self-reported dental anxiety by children should be encouraged and adopted, and the mother’s presence during dental visits is strongly recommended.

Occupational Fall Risk Assessment Tool for older workers.

No easy-to-use fall risk assessment tools have been devised to assess occupational fall risk in older workers. To develop an Occupational Fall Risk Assessment Tool (OFRAT) and report its predictive validity and reliability in older workers. The baseline fall risk assessment was completed by 1113 participants aged ≥60 years who worked ≥4 days/month in Saitama, Japan. Participants were followed up for falls during occupational activities for 1 year, and 30 participants were assessed twice for test-retest reliability. The following assessment measures were summed to form the OFRAT risk score: older age, male sex, history of falls, physical work participation, diabetes, use of medications increasing fall risk, reduced vision, poor hearing, executive dysfunction and slow stepping. The scores were then classified into four grades (0-2 points: very low, 3 points: low, 4 points: moderate and ≥5 points: high). During follow-up, 112 participants fell 214 times during work. The negative binomial regression model showed that participants with higher grades had a higher incidence rate ratio [95% confidence interval] for falls than those with very low grades (low: 1.64 [1.08-2.47], moderate: 4.23 [2.82-6.34] and high: 6.12 [3.83-9.76]). The intraclass correlation coefficient for risk score was 0.86 [0.72-0.93], and the weighted kappa coefficient for grade assessment was 0.74 [0.52-0.95]. The OFRAT is a valid and reliable tool for estimating the occupational fall risk in older workers. It may assist occupational physicians implement strategies to prevent falls in this group.

MRI arterial spin labeling in evaluating hemorrhagic transformation following endovascular recanalization of subacute ischemic stroke.

To investigate the value of the MRI arterial spin labeling (ASL) in evaluating the blood-brain barrier permeability of anterior circulation ischemic lesions in subacute ischemic stroke (SIS) and the risk of hemorrhage transformation (HT) after endovascular recanalization. Patients with anterior circulation SIS treated with endovascular recanalization were prospectively enrolled. The imaging presentations in the MRI ASL sequences, dynamic contrast-enhanced (DCE) sequence, and Xper CT were studied. The relative cerebral blood flow (rCBF), volume transfer constant (Ktrans), and the weighted Kappa coefficient (rKtrans) were analyzed. Among 27 eligible patients, HT occurred in 7 patients (25.92%). Patients with HT had significantly higher rCBF value (1.56 ± 0.16 vs. 1.16 ± 0.16), Ktrans, (0.08 ± 0.03 min vs. 0.03 ± 0.01 min) and rKtrans (3.02 ± 0.89 vs. 1.89 ± 0.56). The ASL imaging sequence had a high consistency with the DCE sequence and Xper CT with a high weighted Kappa coefficient of 0.91 for the DCE sequence and 0.70 for the Xper CT imaging. The DCE sequence was also highly consistent with the Xper CT in imaging classification with a high weighted Kappa coefficient of 0.78. The rCBF value in the 21 patients with the subcortical and basal ganglia infarction was significantly lower than that in the other 6 patients with the cortical infarction (1.222 ± 0.221 vs. 1.413 ± 0.259, t = 1.795, P = 0.004). The MRI ASL sequence has an important role in evaluating the blood-brain barrier permeability and the risk of hemorrhagic transformation of anterior circulation SIS following endovascular recanalization.

Fluoroscopic Categorization of Cementless Acetabular Component Positioning.

The purpose of this study was to evaluate a fluoroscopic method of angle of lateral opening (ALO) categorization based on identification of the visible portion of a pre-existing, circular recess within the metal shell of the BioMedtrix BFX acetabular component, which projects as an ellipse at clinically relevant ALO values. Our hypothesis was that there will be an association between the actual ALO and the categorization of ALO based on identification of the visible portion of the elliptical recess on a lateral fluoroscopic image at clinically relevant values. A custom plexiglass jig was fitted with a two-axis inclinometer and a 24 mm BFX acetabular component attached to its tabletop. Fluoroscopic reference images were obtained with the cup positioned at an ALO of 35, 45 and 55 degrees with a fixed 10 degrees of retroversion. Thirty study fluoroscopic images (10 images at each ALO) were obtained based on randomization at an ALO of 35, 45 and 55 degrees (±0.5 degrees) with 10 degrees of retroversion. The order of the study images was randomized, and a single, blinded observer categorized the 30 study images as representing an ALO of 35, 45 or 55 degrees by comparison to the reference images. Analysis showed perfect (30/30) agreement with a weighted kappa coefficient of 1 (95% confidence interval: -0.717 to 1). The results demonstrate that accurate categorization of ALO can be achieved using this fluoroscopic method. This method may prove to be a simple but effective method of estimating intraoperative ALO.

Comparison of whole-body DW-MRI with 2-[18F]FDG PET for staging and treatment monitoring of children with Langerhans cell histiocytosis.

To assess and compare the diagnostic accuracy of whole-body (WB) DW-MRI with 2-[18F]FDG PET for staging and treatment monitoring of children with Langerhans cell histiocytosis (LCH). Twenty-three children with LCH underwent 2-[18F]FDG PET and WB DW-MRI at baseline. Two nuclear medicine physicians and two radiologists independently assessed presence/absence of tumors in 8 anatomical areas. Sixteen children also performed 2-[18F]FDG PET and WB DW-MRI at follow-up. One radiologist and one nuclear medicine physician revised follow-up scans and collected changes in tumor apparent diffusion (ADC) and standardized uptake values (SUV) before and after therapy in all detectable lesions. 2-[18F]FDG PET results were considered the standard of reference for tumor detection and evaluation of treatment response according to Lugano criteria. Sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy of WB DW-MRI at baseline were calculated, and the 95% confidence intervals were estimated by using the Clopper-Pearson (exact) method; changes in tumor SUVs and ADC were compared using a Mann-Whitney U test. Agreement between reviewers was assessed with a Cohen's weighted kappa coefficient. Analyses were conducted using SAS software version 9.4. Agreement between reviewers was perfect (kappa coefficient = 1) for all analyzed regions but spine and neck (kappa coefficient = 0.89 and 0.83, respectively) for 2-[18F]FDG PET images, and abdomen and pelvis (kappa coefficient = 0.65 and 0.88, respectively) for WB DW-MRI. Sensitivity and specificity were 95.5% and 100% for WB DW-MRI compared to 2-[18F]FDG PET. Pre to post-treatment changes in SUVratio and ADCmean were inversely correlated for all lesions (r: -0.27, p = 0·06) and significantly different between responders and non-responders to chemotherapy (p = 0.0006 and p = 0·003 for SUVratio and ADCmean, respectively). Our study showed that WB DW-MRI has similar accuracy to 2-[18F]FDG PET for staging and treatment monitoring of LCH in children. While 2-[18F]FDG PET remains an approved radiological examination for assessing metabolically active disease, WB DW-MRI could be considered as an alternative approach without radiation exposure. The combination of both modalities might have advantages over either approach alone.

High Concordance between D:A:Dr and the Framingham Risk Score in Brazilians Living with HIV.

People living with HIV (PLHIV) have twice the risk of developing cardiovascular diseases, making it essential to identify high cardiovascular risk (CVR). However, there is no validated CVR calculator for PLHIV in Brazil. We performed a cross-sectional study with 265 individuals living with HIV, aged 40 to 74 years, to assess the agreement between three CVR scores: Framingham Risk Score (FRS), Atherosclerotic Cardiovascular Disease (ASCVD) Risk Score, and a specific for PLHIV, Reduced Data Collection on Adverse Effects of Anti-HIV Drugs (D:A:Dr). We assessed agreement using the weighted Kappa coefficient and the Bland-Altman plot. The median age was 52 years (47-58), 58.9% were men, 34% were hypertensive and 8.3% had a detectable viral load. There was an almost perfect agreement between D:A:Dr x FRS (k = 0.82; 95% CI 0.77-0.87; p < 0.001), and substantial agreement between FRS vs. ASCVD (k = 0.74; 95% CI 0.69-0.79; p < 0.001) and between D:A:Dr vs. ASCVD (k = 0.70; 95% CI 0.64-0.76; p < 0.001). The Bland-Altman plot revealed greater discordance between scores as the CVR increased. Our results suggest that the FRS and the D:A:Dr are adequate to classify the CVR in this population, and the D:A:Dr score can be used as an alternative to the FRS in Brazil, as other international guidelines have already advocated.

Reliability of foot posture index (FPI-6) for evaluating foot posture in patients with knee osteoarthritis.

Objective: To determine the reliability of FPI-6 in the assessment of foot posture in patients with knee osteoarthritis (KOA). Methods: Thirty volunteers with KOA (23 females, 7 males) were included in this study, assessed by two raters and at three different moments. Inter-rater and test-retest reliability were assessed with Cohen's Weighted Kappa (Kw) and Intraclass Correlation Coefficient (ICC). Bland-Altman plots and respective 95% limits of agreement (LOA) were used to assess both inter-rater and test-retest agreement and identify systematic bias. Moreover, the internal consistency of FPI-6 was assessed by Spearman's correlation coefficient. Results: FPI-6 total score showed a substantial inter-rater (Kw = .66) and test-retest reliability (Kw = .72). The six items of FPI-6 demonstrated inter-rater and test-retest reliability varying from fair to substantial (Kw = .33 to .76 and Kw = .40 to .78, respectively). Bland-Altman plots and respective 95% LOA indicated that there appeared no systematic bias and the acceptable agreement of FPI-6 total score for inter-rater and test-retest was excellent. There was a statistically significant positive correlation between each item and the total score of FPI-6, which indicated that FPI-6 had good internal consistency. Conclusion: In conclusion, the reliability of FPI-6 total score and the six items of FPI-6 were fair to substantial. The results can provide a reliable way for clinicians and researchers to implement the assessment of foot posture in patients with KOA.

1272 A PILOT ROUTINE ELECTRONIC HEALTH RECORD FUNCTIONAL TRACKING SCORE FOR OLDER PATIENTS IN HOSPITAL

Abstract Introduction Approximately one-third of older patients leave hospital with a new functional impairment. Tracking rehabilitation progress following acute illness could improve recognition and understanding of hospital-acquired disability. However, traditional mobility and functional scores include measures that are not part of routine rehabilitation therapy, adding a time burden for staff to report. Capturing data already recorded in routine electronic records could provide an efficient patient tracking measure of rehabilitation success. Methods A scoping literature review appraised existing scores of mobility and functional status. Analysis of 15 admissions through the Royal Infirmary of Edinburgh identified mobility and functional domains which were reliably recorded in free text electronic health records. A pilot score was drafted, comprising admission and discharge scores (0-30 points), medical progress (0-10), physiotherapy and occupational therapy tracking (0-30). Higher scores indicate greater functional independence. Expert feedback was obtained through focus group discussion with physiotherapists and occupational therapists. The approach was tested in a fresh set of six case studies. Two independent scorers applied the scoring schema and agreement was assessed using Cohen’s weighted-kappa coefficient. Results The selected electronic health records contained 438 medical, 352 nursing and 183 therapist entries. Existing measures such as the Barthel Index were not recorded for any patient. Focus group discussion identified value in the overall approach and informed item-weighting. The pilot functional score allowed visualisation of rehabilitation trajectories over the course of each admission. Excellent inter-rater reliability was demonstrated for the medical (Cohen’s Kappa 0.99, 95% confidence interval [CI] 0.96–1.00) and physiotherapy (Kappa 0.96, 95% CI 0.93–0.99) components. Conclusions A functional tracking score generated from routine health records proved feasible and reproducible in this pilot. Future development should assess validity, reliability and prognostic power in larger populations, exploring automation using natural language processing. Development of graphic visualisations may aid communication within multidisciplinary teams.

Peritumoral imaging features of thymic epithelial tumors for the prediction of transcapsular invasion: beyond intratumoral analysis

The purpose of this study was to differentiate cases without transcapsular invasion (Masaoka-Koga stage I) from cases with transcapsular invasion (Masaoka-Koga stage II or higher) in patients with thymic epithelial tumors (TETs) using tumoral and peritumoral computed tomography (CT) features. This retrospective study included 116 patients with pathological diagnoses of TETs. Two radiologists evaluated clinical variables and CT features, including size, shape, capsule integrity, presence of calcification, internal necrosis, heterogeneous enhancement, pleural effusion, pericardial effusion, and vascularity grade. Vascularity grade was defined as the extent of peritumoral vascular structures in the anterior mediastinum. The factors associated with transcapsular invasion were analyzed using multivariable logistic regression. In addition, the interobserver agreement for CT features was assessed using Cohen's or weighted kappa coefficients. The difference between the transcapsular invasion group and that without transcapsular invasion was evaluated statistically using the Student's t-test, Mann-Whitney U test, chi-square test, and Fisher's exact test. Based on pathology reports, 37 TET cases without and 79 with transcapsular invasion were identified. Lobular or irregular shape [odds ratio (OR): 4.19; 95% confidence interval (CI): 1.53-12.09; P = 0.006], partial complete capsule integrity (OR: 5.03; 95% CI: 1.85-15.13; P = 0.002), and vascularity grade 2 (OR: 10.09; 95% CI: 2.59-45.48; P = 0.001) were significantly associated with transcapsular invasion. The interobserver agreement for shape classification, capsule integrity, and vascularity grade was 0.840, 0.526, and 0.752, respectively (P < 0.001 for all). Shape, capsule integrity, and vascularity grade were independently associated with transcapsular invasion of TETs. Furthermore, three CT TET features demonstrated good reproducibility and help differentiate between TET cases with and without transcapsular invasion.

Impact of the use of food ingredients and additives on the estimation of ultra-processed foods and beverages.

Increasing consumption of ultra-processed foods (UPF), defined by the NOVA classification, has been associated with obesity and other health outcomes. However, some authors have criticized the UPF definition because it is somewhat subjective. Most studies identify UPF using food descriptions; nevertheless, NOVA developers described a list of ingredients, including substances not commonly used for cooking and "cosmetic additives" that could be used to identify UPF. Assessing the impact of the use of different UPF definitions is particularly relevant with respect to children's diet, because several dietary policies target this age group. Thus, our study compared the frequency of UPF among foods and beverages and their share in the diet of Chilean preschoolers using three different methods of identifying UPF. We used cross-sectional 24-h dietary recall data from 962 preschoolers enrolled in the Food and Environment Chilean Cohort (FECHIC) in 2016. All foods and beverages consumed were classified according to NOVA, considering their description (classic method), the presence of ingredients markers of UPF (ingredient marker method), and the presence of markers plus all cosmetic additives (food additive method). We also estimated the caloric share and quintiles of UPF consumption using the three methods. We used kappa coefficients, consistency-of-agreement intra-class correlation (CA-ICC), absolute agreement intra-class correlation (AA-ICC), and weighted kappa coefficients for assessing agreement between methods. The proportion of UPF products were 65% in the "classic," 67% in the "ingredient marker," and 73% in the "food additive" method, and kappa coefficients between methods varied from 0.79 to 0. 91. The caloric share of UPF was 47, 52, and 58% with "classic," "ingredient marker," and "food additive" methods, respectively. Consistency-of-agreement was higher than the absolute agreement between the methods (CA-ICC = 0.81; AA-ICC = 0.74). For quintiles of UPF consumption, we found weighted kappa of 0.65 as measure of agreement between "classic" and "ingredient marker," and 0.51 between "classic" and "food additive" methods. Searching for all possible markers of UPF in the list of ingredients increased the proportion of food products identified as UPF compared to the classic method. These differences affected the estimated caloric share of UPF in Chilean preschoolers' diets.

Association between Migraine and Workplace Social Support in the Social Context of China: Using a Validated Chinese Version of the DCSQ.

Workplace social support might have a protective function against migraine in the social context of China, as close co-worker relationships and collectivism are acknowledged as work values in Chinese society. This paper aimed to analyse the association between migraine and workplace social support. The validity and reliability of the Chinese version of the Support scale of the Demand-Control-Support Questionnaire (DCSQ) used were also determined. Following international guidelines, this study was carried out in two stages. Stage I involved translations and pilot testing to assess content and face validity of the Chinese version of the DCSQ Support scale. Stage II was a cross-sectional survey (N = 677 bank employees) to evaluate structural validity, internal consistency and test-retest reliability of the Support scale, as well as to examine the association between workplace social support and a migraine-positive diagnosis. A high level of social support in the workplace was associated with a 74% decreased likelihood of migraine (adjusted OR = 0.26, 95%CI: 0.14-0.46). Of the six aspects of workplace social support, co-worker support had the greatest protective effect (adjusted OR = 0.49, 95% CI: 0.39-0.60). The Chinese version of the DCSQ Support scale established satisfactory content and face validity (I-CVIs ≥ 0.78; S-CVIAVE ≥ 0.90). Confirmatory factor analysis verified its one-dimensional theoretical factor, with adequate internal consistency (Cronbach's α 0.98; item-total correlations ≥ 0.80) and test-retest reliability (weighted Kappa coefficients 0.81-0.87; percentages agreement 85.23-88.92%). In the Chinese social context, workplace social support could protect against migraine, with the strongest benefit coming from co-workers. This study also provides a Chinese-language DCSQ Support scale as a valid and reliable instrument for measuring workplace social support.

The Japanese version of the occupational future time perspective scale: A validation study.

This study aimed to develop and validate a Japanese version of the Occupational Future Time Perspective scale (OFTP-J) and assess its structural validity, construct validity, internal consistency, and test-retest reliability among Japanese workers. The online survey was conducted with 2046 participants who met the eligibility criteria. The Japanese version of the OFTP scale was developed through translation and back-translation processes. Confirmatory factor analysis was performed to evaluate the structural validity. Pearson's correlations were computed to assess construct validity, and Cronbach's alpha coefficients were calculated to determine internal consistency. Test-retest reliability was examined using Cohen's weighted kappa coefficients and intraclass correlation coefficients. The confirmatory factor analysis supported an 8-item model with three factors (i.e., focus on opportunities, perceived remaining time, and focus on limitations) for the Japanese version of the OFTP scale. The scale demonstrated high internal consistency, with Cronbach's alpha coefficients ranging from 0.81 to 0.92. Construct validity was supported by significant correlations between the OFTP scale and its subscales, possible antecedents (age, self-rated health, and job control), and possible outcomes (learning goal orientation, job crafting, and work engagement). Test-retest reliability was confirmed with moderate agreement. The OFTP-J was found to be reliable and valid. It can be used to measure OFTP among Japanese workers and facilitate comparative research with the original English version. The OFTP-J provides valuable insights into the learning motivation and work engagement of the aging workforce.

Development and validation of a new standardized measure for assessing experiences of discrimination within mental health services. A participatory research project.

People with mental disorders frequently report experiences of discrimination within mental health services, which can have significant detrimental effects on individuals' well-being and recovery. This study aimed to develop and validate a new standardized measure aiming to assess experiences of stigmatization among people with mental disorders within mental health services. The scale was developed in Italian and tested for ease of use, comprehension, acceptability, relevance of items and response options within focus group session. A cross-sectional validation survey was conducted among mental health service users in Italy. Exploratory factor analysis with Promax oblique rotation, the Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy and the Bartlett's test of sphericity were used to assess the suitability of the sample for factor analysis. Reliability was assessed as internal consistency using Cronbach's alpha and as test-retest reliability using weighted kappa and intraclass correlation coefficient (ICC). Precision was examined by Kendall's tau-b coefficient. Overall, 240 people with mental disorders participated in the study; 56 also completed the retest evaluation after 2 weeks. The 18 items of the scale converged over a two-factor solution ('Dignity violation and personhood devaluation' and 'Perceived life restrictions and social exclusion'), accounting for 56.4% of the variance (KMO 0.903; Bartlett's test p<0.001). Cronbach's alpha for the total score was 0.934. The scale showed one item with kappa above 0.81, four items between 0.61 and 0.80, ten items between 0.41 and 0.60, two items between 0.21 and 0.40 and only one item below 0.20. ICC was 0.928 (95% CI 0.877-0.958). Kendall's tau-b ranged from 0.450 to 0.617 (p<0.001). The newly developed scale represents a valid and reliable measure for assessing experiences of stigma among patients receiving care within mental health services. The scale has provided initial evidence of being specifically tailored for individuals with psychotic and bipolar disorders. However, the factorial structure of the scale should be replicated through a confirmatory factor analysis on a larger sample of individuals with these conditions.

Reliability of the NACC Telephone-administered Neuropsychological Battery (T-cog) and Montreal Cognitive Assessment for participants in the USC ADRC.

Restrictions during the COVID-19 pandemic necessitated remote administration of neuropsychological testing. We assessed the test-retest reliability for a telephone-administered cognitive battery, recommended for use in the National Institute on Aging Alzheimer's Disease Research Center (ADRC). 64 participants in the University of Southern California ADRC clinical core underwent repeat telephone evaluation using the T-cog Neuropsychological Battery. Reliability was measured by intraclass correlation coefficient (ICC) for continuous variables and weighted Kappa coefficient for categorical variables. Mean scores for Montreal Cognitive Assessment (MoCA) total and Craft Story 21 Immediate and Delayed Recall were compared using paired t tests. Mean age was 74.8 (8.3 standard deviation); 73.4% were female. ICCs ranged from 0.52 to 0.84, indicating moderate test-retest reliability except for number span backward, which showed poor reliability. Weighted Kappa for MoCA items ranged from -0.016 to 0.734; however, relatively good observed agreement was seen across all items (70.3% to 98.4%). Although MoCA total scores did not significantly change, Craft Story 21 Immediate and Delayed Recall mean scores increased between first and second administrations (P<0.0001). Test-retest reliability for the T-cog Neuropsychological Battery is adequate. The variation seen in testing is similar to results seen from face-to-face testing, with Craft Story 21 recall showing modest and expected practice effects. Moderate test-retest reliability is seen in most measures of the National Alzheimer's Coordinating Center Neuropsychological Test Battery and the Montreal Cognitive Assessment (MoCA).Intraclass correlation coefficients ranged from 0.52 to 0.84, except for number Span backward.Weighted Kappa for MoCA items varied, but good observed agreement was seen.MoCA total mean score did not change significantly between administrations.Craft Story 21 Immediate and Delayed Recall means increased on repeat testing (P<0.0001).

Efficiency and relevance of post-exposure prophylaxis prescription by emergency physicians: a monocentric retrospective study

Background: Preventing infection with HIV remains a major public health challenge. Exposed persons are offered support and quick access to the post-exposure prophylaxis (PEP) by hospital emergency services. This study aimed to investigate the accuracy of the prescription of emergency PEP for patients with sexual fluid exposure in a French emergency department (ED) by comparing data in medical files and actual prescriptions. Methods: We retrospectively collected data for patients consulting for sexual exposure in a single Parisian ED from 2015 to 2016. For each patient, researchers independently checked whether the emergency physician prescribed PEP according to French guidelines. Our primary outcome was the appropriateness of the emergency PEP prescription after sexual fluid exposure. We calculated the Cohen weighted kappa coefficient with its 95% confidence interval (CI) for determining the agreement in indication for PEP. Results: We included 346 patients in the analysis. Half of the patients were men who had sex with men (n=178). The most frequent sexual exposure was anal insertive or receptive (n=177; 51%). PEP was prescribed in 94% of cases (n=328). In 33 cases (10%) the indication for PEP was not clear, but PEP was prescribed in 17 cases (52%). The Kappa value for determining the indication for PEP was 0.55 (95% confidence interval 0.36-0.74), indicating poor agreement for prescription. The agreement was lowest for men who had sex with men: 0.29 (0.05-0.53). Conclusion: Strategies are needed to improve the relevance of the prescription of PEP in French EDs to avoid the excess secondary effects and cost.

Comparing Korea Occupational Safety & Health Agency and National Health Insurance Service's cardio-cerebrovascular diseases risk-assessment tools using data from one hospital's health checkups.

Cardio-cerebrovascular diseases (CVDs) are the most common cause of death worldwide. Various CVD risk assessment tools have been developed. In South Korea, the Korea Occupational Safety & Health Agency (KOSHA) and the National Health Insurance Service (NHIS) have provided CVD risk assessments with health checkups. Since 2018, the KOSHA guide has stated that NHIS CVD risk assessment tool could be used as an alternative of KOSHA assessment tool for evaluating CVD risk of workers. The objective of this study was to determine the correlation and agreement between the KOSHA and the NHIS CVD risk assessment tools. Subjects of this study were 17,485 examinees aged 20 to 64 years who had undergone medical examinations from January 2021 to December 2021 at a general hospital. We classified subjects into low-risk, moderate-risk, high-risk, and highest-risk groups according to KOSHA and NHIS's CVD risk assessment tools. We then compared them with cross-analysis, Spearman correlation analysis, and linearly weighted kappa coefficient. The correlation between KOSHA and NHIS tools was statistically significant (p-value < 0.001), with a correlation coefficient of 0.403 and a kappa coefficient of 0.203. When we compared risk group distribution using KOSHA and NHIS tools, CVD risk of 6,498 (37.1%) participants showed a concordance. Compared to the NHIS tool, the KOSHA tool classified 9,908 (56.7%) participants into a lower risk category and 1,079 (6.2%) participants into a higher risk category. In this study, KOSHA and NHIS tools showed a moderate correlation with a fair agreement. The NHIS tool showed a tendency to classify participants to higher CVD risk group than the KOSHA tool. To prevent CVD more effectively, a higher estimation tool among verified CVD risk assessment methods should be selected and managements such as early intervention and treatment of risk factors should be performed targeting the high-risk group.

Development of a Video-Based Tool for the Self-Assessment of Eating Rates in Young Adult Females.

Eating speed assessments are often based on self-reports, and establishing objective "ratings" is required to improve accuracy. However, no relevant simple assessment tool incorporating "ratings" is currently available. This study aimed to develop a group-adaptable eating rate assessment tool for young females using smartphones. Fifty female college students were directly observed while eating, and a self-assessment tool for the eating rate was created using video. Using the directly observed eating rate of a test food A as the gold standard (GS), we compared the eating rate self-assessment findings between those obtained using a conventional questionnaire and those obtained using an assessment tool. The validity and reproducibility of the assessment tool were verified. In terms of validity, the correlation coefficient for the GS questionnaire (r=0.442, p<0.001) was similar to that for the self-assessment tool (r=0.491, p<0.001). The reproducibility of repeated measurements of the self-assessment tool was inferior to that of the questionnaire (weighted kappa coefficients; 0.393 vs. 0.804). This may be explained in part by participants selecting the same items with specific words such as "fast" or "slow" on two occasions. As for the validity of test food A, additional measurements for test food C on a subset of subjects (n=16) showed a strong positive correlation (r=0.845, p<0.001) between A and C. The present study suggests that a video-based self-assessment tool we developed for young adult females is straightforward, and allows the subjects to observe specific and visual ratings in a manner that is less burdensome and time-effective than conventional questionnaire methods.

Automatic assessment of knee osteoarthritis severity in portable devices based on deep learning

BackgroundFor knee osteoarthritis, the commonly used radiology severity criteria Kellgren–Lawrence lead to variability among surgeons. Most existing diagnosis models require preprocessed radiographs and specific equipment.MethodsAll enrolled patients diagnosed with KOA who met the criteria were obtained from **** Hospital. This study included 2579 images shot from posterior–anterior X-rays of 2,378 patients. We used RefineDet to train and validate this deep learning-based diagnostic model. After developing the model, 823 images of 697 patients were enrolled as the test set. The whole test set was assessed by up to 5 surgeons and this diagnostic model. To evaluate the model’s performance we compared the results of the model with the KOA severity diagnoses of surgeons based on K-L scales.ResultsCompared to the diagnoses of surgeons, the model achieved an overall accuracy of 0.977. Its sensitivity (recall) for K-L 0 to 4 was 1.0, 0.972, 0.979, 0.983 and 0.989, respectively; for these diagnoses, the specificity of this model was 0.992, 0.997, 0.994, 0.991 and 0.995. The precision and F1-score were 0.5 and 0.667 for K-L 0, 0.914 and 0.930 for K-L 1, 0.978 and 0.971 for K-L 2, 0.981 and 0.974 for K-L 3, and 0.988 and 0.985 for K-L 4, respectively. All K-L scales perform AUC > 0.90. The quadratic weighted Kappa coefficient between the diagnostic model and surgeons was 0.815 (P < 0.01, 95% CI 0.727–0.903). The performance of the model is comparable to the clinical diagnosis of KOA. This model improved the efficiency and avoided cumbersome image preprocessing.ConclusionThe deep learning-based diagnostic model can be used to assess the severity of KOA in portable devices according to the Kellgren–Lawrence scale. On the premise of improving diagnostic efficiency, the results are highly reliable and reproducible.

Binary and multi-class automated detection of age-related macular degeneration using convolutional- and transformer-based architectures

Background and Objective: Age-related macular degeneration (AMD) is an eye disease that happens when ageing causes damage to the macula, and it is the leading cause of blindness in developed countries. Screening retinal fundus images allows ophthalmologists to early detect, diagnose and treat this disease; however, the manual interpretation of images is a time-consuming task. In this paper, we aim to study different deep learning methods to diagnose AMD.Methods: We have conducted a thorough study of two families of deep learning models based on convolutional neural networks (CNN) and transformer architectures to automatically diagnose referable/non-referable AMD, and grade AMD severity scales (no AMD, early AMD, intermediate AMD, and advanced AMD). In addition, we have analysed several progressive resizing strategies and ensemble methods for convolutional-based architectures to further improve the performance of the models.Results: As a first result, we have shown that transformer-based architectures obtain considerably worse results than convolutional-based architectures for diagnosing AMD. Moreover, we have built a model for diagnosing referable AMD that yielded a mean F1-score (SD) of 92.60% (0.47), a mean AUROC (SD) of 97.53% (0.40), and a mean weighted kappa coefficient (SD) of 85.28% (0.91); and an ensemble of models for grading AMD severity scales with a mean accuracy (SD) of 82.55% (2.92), and a mean weighted kappa coefficient (SD) of 84.76% (2.45).Conclusions: This work shows that working with convolutional based architectures is more suitable than using transformer based models for classifying and grading AMD from retinal fundus images. Furthermore, convolutional models can be improved by means of progressive resizing strategies and ensemble methods.