[Cross-cultural adaptation of the scale balance evaluation systems (Mini-BESTest) assessment in patients with stroke]. / Adaptación transcultural de la escala «sistema de evaluación del equilibrio¼ (Mini-BESTest) en pacientes con accidente cerebrovascular.

OBJECTIVE: The purpose of this study is to adapt cross-culturally to Chilean Spanish the assessment scale "Balance Assessment Systems (Mini-BESTest)" so that it can be applied to patients with stroke. Since stroke is a syndrome that compromises the patient's balance, an essential ability to perform activities of daily living safely, the study of different alternatives to improve the living conditions of patients is considered essential. MATERIALS AND METHODS: Observational, descriptive, cross-sectional study. The process consisted of six stages: direct translation, translation synthesis, back translation, author approval, pre-test, and final consensus. In the pretest, the adapted scale was applied to a sample of stroke patients receiving rehabilitation therapy, who were able to stand up on their own, walk, and follow simple instructions. RESULTS: The process of cross-cultural adaptation to Chilean Spanish of the Mini-BESTest evaluation scale was satisfactorily completed. Interrater reliability obtained percentages of agreement greater than 92% and all were statistically significant, which suggests an excellent level of agreement. There was a trend for subacute patients to require a greater repetition of the command. CONCLUSIONS: Mini-BESTest shows an excellent level of agreement among physiotherapists. These findings offer the possibility of continuing with the validation process of the scale. It is suggested to repeat the instructions to patients with subacute stroke.

A Test of Reliability: Cranial Rhythmic Impulse for Distant Diagnoses.

Context The osteopathic cranial field suggests that cranial rhythmic impulse (CRI) can be used to examine distal segments. However, there is a lack of research on the reliability of using CRI to diagnose other distal segments. This study aims to evaluate the effectiveness of using the cranial vault hold compared to traditional osteopathic diagnostic techniques to diagnose somatic dysfunctions at the following segments: atlantooccipital joint (OA), atlantoaxial joint (AA), cervical-4 (C4), cervical-7 (C7), thoracic-6 (T6), thoracic-12 (T12), lumbar-3 (L3), sacrum, left innominate, right fibular head, and left radial head. Objective To determine if palpation of CRI can reliably detect somatic dysfunctions in multiple distal segments. Methods The study compared osteopathic physicians' diagnoses of specific segments (OA, AA, C4, C7, T6, T12, L3, sacrum, left innominate, right fibular head, and left radial head) using the cranial vault hold and direct palpation. Two osteopathic neuromusculoskeletal medicine experts (cranial group) diagnosed distal segments via the cranial vault hold, while board-certified osteopathic physicians (confirmatory group) used direct palpation. We recruited 44 second-year osteopathic medical students and osteopathic physicians via a school-wide email. Each participant lay supine on a massage table for diagnosis. A neuromusculoskeletal expert, with a scribe, diagnosed the segments using the cranial vault hold. The process was repeated by a second neuromusculoskeletal expert with another scribe. Two osteopathic physicians then diagnosed the same subjects using direct palpatory techniques. Both osteopathic physicians had to agree on a diagnosis for the segment, or it was excluded from comparison. Cohen's kappa coefficient measured inter-rater reliability between the cranial and confirmatory groups. Results Cranial physician 1 provided all 484 diagnoses, while cranial physician 2 provided 152. Cranial physician 1 showed positive agreement with the confirmatory group (κ>0) in 2/11 (18.2%) segments: T12 and left innominate (κ=0.009 and 0.007). Cranial physician 2 showed positive agreement (κ>0) in 4/11 (36.4%) segments: OA, AA, C4, and left innominate (κ=0.050, 0.031, 0.130, and 0.154). Inter-rater reliability between cranial physicians showed positive agreement in 6/11 (54.5%) segments: OA, AA, C4, sacrum, left innominate, and right fibular head (κ=0.125, 0.022, 0.048, 0.036, 0.154, and 0.0261). Conclusion The positive kappa values, all between 0 and 0.2, indicate the inter-rater reliability for diagnosis with the vault hold is above random chance but has none to slight reliability. The kappa coefficients comparing both cranial physicians indicate positive agreement in six segments, supporting palpation of the same phenomena in six out of 11 (54.5%) segments. However, none of the positive kappa values were statistically significant (p>0.05) and the effect sizes were small, likely due to shared bias among the evaluators. We conclude our experiment suggests palpation of the cranium may not reliably diagnose distal segments. However, our experiment may support a connection between CRI and distal segment somatic dysfunctions. Considering diagnoses of certain segments are above random chance, more research is needed to confirm whether there is a connection between palpation of the CRI and the diagnosis of a distal somatic dysfunction.

Test-retest and inter-rater reliability of two devices measuring tactile mechanical detection thresholds in healthy adults: Semmes-Weinstein monofilaments and the cutaneous mechanical stimulator.

INTRODUCTION/AIMS: Limitations exist in evaluating mechanical detection thresholds (MDTs) due to a lack of dependable electronic instruments designed to assess Aß fibers and measure MDTs across different body areas. This study aims to evaluate the test-retest and inter-rater reliability of the cutaneous mechanical stimulator (CMS), an electronic tactile stimulator, in quantifying MDTs. METHODS: Using a test-retest design, participants underwent assessments of MDTs using Semmes-Weinstein monofilaments (SWM) and the CMS. This study included 27 healthy volunteers (mean age 24.07 ± 3.76 years). Two raters assessed MDTs using SWM and the CMS at two stimulation sites (the left hand and foot) in two experimental sessions approximately 2 weeks apart. RESULTS: MDTs using SWM and the CMS showed excellent reliability on the hand (intraclass correlation coefficient [ICC] = .84) and foot (ICC = .90). A comparison of results obtained at the two sessions showed that MDTs on the hand displayed good reliability for both SWM (ICC = .63) and the CMS (ICC = .73), whereas MDTs on the foot displayed fair reliability for SWM (ICC = .50) and the CMS (ICC = .42). MDTs exhibited good inter-rater reliability with SWM (ICC = .66) and excellent inter-rater reliability with the CMS (ICC = .82) on the hand, as well as showing fair inter-rater reliability with SWM (ICC = .53) and good inter-rater reliability with the CMS (ICC = .60) on the foot. DISCUSSION: The CMS showed superior inter-rater reliability, indicating its potential as a valuable tool for assessing tactile sensitivity in research and clinical settings.

Reliability of the Moover® 3D Inertial Motion Sensor in Greek Patients With Chronic Neck Pain in a Primary Care Urban Setting.

Introduction Neck pain has a high lifetime prevalence and represents a significant health issue. Reduced active cervical range of motion (ACROM) has been found in neck pain patients. Inertial sensor technology can provide objective measurements to assess the impaired ACROM. Purpose Primarily, this study investigated the inter- and intra-rater reliability of the Moover® three-dimensional (3D) inertial motion sensor (Sensor Medica, Rome, Italy) in Greek patients with non-specific chronic neck pain. Secondly, the intra-rater reliability of the Neck Disability Index (NDI) was also assessed. Methods Fifty patients (18 males and 32 females) suffering from non-specific chronic neck pain participated in this study. Two physiotherapists measured separately each participant's ACROM in three planes, within a 48-hour period. The participants' position and the sequence and direction of the three cervical movements (cervical rotation, lateral flexion, and flexion-extension) were standardized. Results The inter-rater reliability intraclass correlation coefficient (ICC) values were good to excellent ranging from 0.77 to 0.95 for the first measurement and 0.85 to 0.95 for the second (p < 0.001). The intra-rater reliability ICC values were moderate to excellent ranging from 0.74 to 0.92 for the first rater and good to excellent ranging from 0.83 to 0.94 for the secondrater (p < 0.001). Intra-rater reliability of the overall NDI was indicated as good, and ICC was 0.80 (95%CI: 0.65-0.89; p < 0.001). ICC values for all sections were significant and ranged from 0.40 to 0.88. Conclusion This study showed the reliability of the Moover 3D inertial sensor for ACROM measurement in Greek patients with chronic neck pain. The NDI scale also showed good intra-rater reliability in the same sample. Both intra- and inter-rater reliability of the Moover 3D were proven to be acceptable over a 48-hour period. The specific sensor might have a potential application in a clinical setting.

Intra-rater and Inter-rater Reliability of the Commander Pressure Algometer in Greek Patients With Chronic Neck Pain.

Introduction Non-specific chronic neck pain (NSCNP) is a musculoskeletal disorder that affects 45%-54% of the general population. There is a strong correlation between patient-reported pain and mechanical pain pressure threshold (PPT) measured with an algometer. Purpose This study aims to investigate the intra- and inter-rater reliability of the Commander algometer in Greek NSCNP patients, in an urban primary care setting. Methods Thirty-three patients (22 women and 11 men) suffering from NSCNP (>3 months), the majority (42.4%) between the ages of 50 years and 59 years and overweight, were measured bilaterally both at the neck (mastoid, trapezius head-insertion and mid-portion, C5-C6 facet, insertion of levator scapula) and at the control areas (mid-deltoid and tibialis anterior) using the Commander algometer. Measurements were taken twice over a span of six days, by two raters, in a primary care setting. Intraclass correlation coefficient (ICC) statistics were used as measures of reliability (p = 0.05). Results Intra-rater reliability was "moderate to good" for both raters. ICC values for PPT at the seven bilaterally measured sites varied between 0.67 and 0.86 for the first rater (p ≤ 0.001) and 0.64 and 0.82 for the second rater (p ≤ 0.003). The inter-rater reliability was "moderate to excellent" (ICC = 0.68-0.92) in the first measurement (T1) and "moderate to good" (ICC = 0.68 to 0.89) in the second measurement (T2). Conclusion This study supports the intra- and inter-rater reliability of the Commander algometer in detecting reliably the mechanical PPT, in Greek NSCNP patients, as measured according to the procedures and methodology followed throughout this study.

Refining sleep staging accuracy: Transfer learning coupled with scorability models.

STUDY OBJECTIVES: This study aimed to 1) improve sleep staging accuracy through transfer learning, to achieve or exceede human inter-expert agreement; 2) introduce a scorability model to assess the quality and trustworthiness of automated sleep staging. METHODS: A deep neural network (base model) was trained on a large multi-site polysomnography (PSG) dataset from the United States. Transfer learning was used to calibrate the model to a reduced montage and limited samples from the Korean Genome and Epidemiology Study (KoGES) dataset. Model performance was compared to inter-expert reliability among three human experts. A scorability assessment was developed to predict the agreement between the model and human experts. RESULTS: Initial sleep staging by the base model showed lower agreement with experts (κ=0.55) compared to inter-expert agreement (κ=0.62). Calibration with 324 randomly sampled training cases matched expert agreement levels. Further targeted sampling improved performance, with models exceeding inter-expert agreement (κ=0.70). The scorability assessment, combining biosignal quality and model confidence features, predicted model-expert agreement moderately well (R²=0.42). Recordings with higher scorability scores demonstrated greater model-expert agreement than inter-expert agreement. Even with lower scorability scores, model performance was comparable to inter-expert agreement. CONCLUSIONS: Fine-tuning a pre-trained neural network through targeted transfer learning significantly enhances sleep staging performance for an atypical montage, achieving and surpassing human expert agreement levels. The introduction of a scorability assessment provides a robust measure of reliability, ensuring quality control and enhancing the practical application of the system before deployment. This approach marks an important advancement in automated sleep analysis, demonstrating the potential for AI to exceed human performance in clinical settings.

Preliminary evaluation of a questionnaire for assessing fidelity of early intervention for psychosis services.

PURPOSE: Fast, easy, and cost-effective methods are needed for fidelity assessment, quality improvement initiatives, and population-based studies in Early Intervention for Psychosis (EIP) services. Having an online questionnaire assessing the fidelity of EIP services, completed by staff self-reports, and having evidence of reliability and validity, could fill that gap. We assess the reliability and validity of the Early Intervention for Psychosis Services Fidelity Questionnaire (EIPS-FQ), developed in Part I of this set of papers. METHODS: A convenience sample of 10 EIP teams in England was used. Two staff members completed online questionnaires assessing recent and past fidelity. An external rater completed the same questionnaire for the two time periods, using a random sample of patient medical records, program documentation, and interviews with staff. The intra-class correlation coefficient (ICC) was calculated to assess inter-rater reliability. Validity was assessed using Bland-Altman plots, absolute mean differences, and the ICC. RESULTS: The fidelity score measuring recent fidelity ranged from 54.2 to 82.7, out of a possible 100. The ICC assessing reliability of the fidelity score was 0.40 (95% CI: 0.0-0.81). The ICCs for the fidelity sub-category scores ranged from 0 to 0.76. Two sub-categories, comprehensive assessments and family involvement and intervention, had low ICCs, regardless of period examined. CONCLUSIONS: This first attempt at validating the EIPS-FQ has demonstrated that the reliability of the EIPS-FQ is moderate/low, and therefore requires modification prior to use. The next iteration of the fidelity questionnaire will clarify or remove items which had very low reliability and add evidence-based components not identified in the Delphi exercise.

Reliability of Goniometric Techniques for Measuring Hip Flexor Length Using the Modified Thomas Test.

Background: The modified Thomas test (MTT) is commonly used to assess the flexibility of hip musculature, including the iliopsoas, rectus femoris, and tensor fascia latae. This measurement is important to include in a comprehensive musculoskeletal examination. However, existing research shows conflicting results regarding its reliability, particularly due to variations in controlling pelvic tilt during testing, which may lead to inaccurate measurements of hip extension when quantifying the test outcomes. Purpose/Hypothesis: This study aimed to evaluate the intra- and inter-rater reliability of the Modified Thomas Test (MTT) in assessing hip flexor length using a goniometer. It was hypothesized that controlling for pelvic tilt would enhance the reliability of these measurements. Study Design: Intra- and inter-rater reliability study. Methods: Sixty-four healthy individuals were recruited to participate in this study. The MTT was performed twice on each leg by both an experienced and a student physical therapist. Blinded goniometric measurements for hip extension range of motion (ROM) in the MTT position were taken with neutral pelvic tilt being enforced via palpation. A double-blind protocol was used where both examiners were unaware of each other's measurements and the goniometer was covered to blind the measuring therapist to the values as well. ROM values were entered into a Microsoft Excel spreadsheet and quantified using SPSS software. Statistical analysis included calculating Intraclass Correlation Coefficients (ICCs) and Standard Errors of Measurement (SEMs) using SPSS software. Results: The study included 64 participants (mean age = 23.7 ± 4.34 years). The MTT demonstrated high intra-rater reliability (ICC = 0.911) and inter-rater reliability (ICC = 0.851). The SEMs indicated minimal variability around the mean scores. The average hip extension ROM measured was 5.43± 9.73 degrees. Conclusion: These results suggest that the MTT is a reliable tool for assessing hip flexor length in clinical practice, particularly when pelvic tilt is controlled. These results have important implications for accurately testing orthopedic limitations that can contribute to low back, hip, and knee pain. Level of Evidence: 3.

A Retrospective Cohort Analysis Comparing Analytic and Holistic Marking Rubrics in Medical Research Education.

OBJECTIVES: The use of analytic rubrics in assessing and grading students' performance has become more prominent among instructors due to its reliability and validity in ensuring consistency in student evaluation. However, there is limited evidence demonstrating the consistency of examiner judgments between analytic marking rubrics and holistic marking rubrics. METHODS: Therefore, we aimed to compare the consistency of marks given using holistic marking methods and analytic rubrics at an Australian university by analyzing the mean mark differences and number of adjudications between two rubric types as well as the inter-rater reliability between two assessors. We analyzed all scores for project manuscripts between 2016 and 2021 for Honours medical students. We compared the mean mark differences graded using the Kruskal-Wallis test and Welch t-test. We used chi-squared tests to compare the frequency of adjudications for each rubric type. We assessed interrater reliability by comparing the marks between the two examiners utilizing Pearson correlation. RESULTS: We found that analytic rubrics have lower mean mark differences and fewer adjudicators are required. We showed a strong positive association between the consistency of marks given and the use of analytic rubrics when compared to holistic marking. Pearson correlation showed a low but stronger correlation between marks awarded by the two assessors when analytic rubrics were used (r = 0.36), compared to holistic marking rubrics (r = 0.24). CONCLUSIONS: Our findings suggest that the use of analytic rubrics may increase the consistency and reliability between two independent examiners in marking medical students' work.

Reliability of the Test of Gross Motor Development Third Edition Among Children with Developmental Coordination Disorder.

AIM: The Test of Gross Motor Development Third Edition (TGMD-3) is used to assess the development of fundamental movement skills in children from 3 to 10 years old. This study aimed to evaluate the intra-rater, inter-rater, and test-retest reliability and to determine the minimal detectable change (MDC) value of the TGMD-3 in children with developmental coordination disorder (DCD). METHODS: The TGMD-3 was administered to 20 children with DCD. The child's fundamental movement skills were recorded using a digital video camera. Reliability was assessed at two occasions by three raters using the generalizability theory. RESULTS: The TGMD-3 demonstrates good inter-rater reliability for the locomotor skills subscale, the ball skills subscale, and the total score (φ = 0.77 - 0.91), while the intra-rater reliability was even higher (φ = 0.94 - 0.97). Test-retest reliability was also shown to be good (φ = 0.79-0.93). The MDC95 was determined to be 10 points. CONCLUSION: This study provides evidence that the TGMD-3 is a reliable test when used to evaluate fundamental movement skills in children with DCD and suggests that an increase of 10 points represents a significant change in the motor function of a child with DCD.

Reliability of Suicide Risk Estimates: A Vignette Study.

OBJECTIVE: Suicide risk assessments are obligatory when patients express a death wish in clinical practice. Yet, suicide risk estimates based on unguided risk assessments have been shown to be of low reliability. Since generalizability of previous studies is limited, the current study aimed to assess inter-rater and intra-rater reliability of risk estimates conducted by psychotherapists and psychology students using written case vignettes. METHOD: In total, N = 256 participants (psychology students, psychotherapists) were presented with 24 case vignettes describing patients at either low, moderate, severe or extreme risk of suicide. Participants were asked to assign a level of risk to each single vignette at a baseline assessment and again at a follow-up assessment two weeks later. RESULTS: Risk estimates showed a low inter-rater reliability, both for students (AC1 = .35) and for psychotherapists (AC1 = .44). Intra-rater reliability was moderate for psychotherapists (AC1 = .59) and rather low for psychology students (AC1 = .47). In general, intra- and intra-rater reliability were highest for vignettes displaying "low" and "extreme" risk. CONCLUSIONS: The results highlight that the reliability of unguided suicide risk assessments is questionable. Standardized risk assessment protocols are therefore recommended. Nonetheless, even reliable risk estimation does not imply predictive validity of risk estimates for future suicidal behavior.

Suicide risk estimates have been shown to be of low reliabilitySuicide risk estimates by psychotherapists and students also showed low inter-rater and intra-rater reliability in the current studyReliable risk estimation does not imply predictive validity of risk estimates for future suicidal behavior.

Consistency between the ACGIH TLV for hand activity and proposed action levels for wrist velocity and forearm muscular load based on objective measurements: an example from the assembly industry.

Objectives. This study aimed to investigate the consistency between results of the American Conference for Governmental Occupational Hygienists (ACGIH) threshold limit value (TLV) for hand activity and proposed action levels of objective measurements in risk assessments of work-related musculoskeletal disorders. Methods. Wrist velocities and forearm muscular load were measured for 11 assemblers during one working day. Simultaneously, each assembler's hand activity level (HAL) during three sub-cycles was rated twice on two separate occasions by two experts, using a HAL scale. Arm/hand exertion was also rated by the assemblers themselves using a Borg scale. In total, 66 sub-cycles were assessed and assigned to three exposure categories: A) below ACGIH action limit (AL) (green); B) between AL and TLV (yellow); and C) above TLV (red). The median wrist velocity and the 90th percentile of forearm muscular load obtained from the objective measurements corresponding to the sub-cycles were calculated and assigned to two exposure categories: A) below or C) above the proposed action level. Results. The agreement between ACGIH TLV for hand activity and the proposed action level for wrist velocity was 87%. Conclusions. The proposed action level for wrist velocity is highly consistent with the TLV. Additional studies are needed to confirm the results.

Curiosities in a Table: Learning Points for Responsible Clinical Rating.

This article presents a table containing redacted data from a real study. The table contains three curiosities: statistical significance in the absence of clinical significance, narrow standard deviations, and the absence of a placebo effect. The data in the table had been obtained by an inexperienced rater; how the inexperience compromised the data is explained. Action points for rater experience, rater training, and rating procedures are suggested.

Arthroscopic Assessment of Temporomandibular Joint Pathologies-Is It Possible for Non-Specialists in Arthroscopy? Analysis of Variability and Reliability of Dental Students' Ratings after a Comprehensive One-Semester Introduction.

Background: Arthroscopy of the temporomandibular joint (TMJ) plays a long-established role in the diagnostics and therapy of patients suffering from arthrogenic temporomandibular disorders (TMDs), which do not respond adequately to conservative/non-invasive therapy. However, the interpretation of arthroscopic findings remains challenging. This study investigates the reliability and variability of assessing arthroscopic views of pathologies in patients with TMDs by non-specialists in arthroscopy and whether a standardized assessment tool may improve correctness. Methods: Following a comprehensive one-semester lecture, dental students in the clinical stage of education were asked to rate 25 arthroscopic views (freeze images and corresponding video clips) regarding the severity of synovitis, adhesions, and degenerative changes on a scale of 0-10 (T1). The results were compared to ratings stated by two European-board-qualified academic OMF surgeons. In a second round (T2), the students were asked to repeat the ratings using a 10-point rating scheme. Results: With regard to all three subcategories, congruency with the surgeons' results at T1 was at a low level (p < 0.05 in 19/75 cases) and even decreased at T2 after the implementation of the TMDs-SevS (p < 0.05 in 38/75 cases). For both T1 and T2, therefore, the inter-rater agreement was at a low level, showing only a slight agreement for all three subcategories (Fleiss' Kappa (κ) between 0.014 and 0.099). Conclusions: The judgement of the arthroscopic pathologies of the TMJ remains an area of temporomandibular surgery that requires wide experience and training in TMDs to achieve expertise in TMJ arthroscopic assessments, which cannot be transferred by theoretical instruction alone.

Inter-rater reliability and clinical relevance of subjective and objective interpretation of videofluoroscopy findings.

Background: Dysphagia is commonly evaluated using videofluoroscopy (VFS). As its ratings are usually subjective normal-abnormal ratings, objective measurements have been developed. We compared the inter-rater reliability of the usual VFS ratings to the objective measurement VFS ratings and evaluated their clinical relevance. Methods: Two blinded raters analyzed the subjective normal-abnormal ratings of 77 patients' VFS. Two other blinded raters analyzed the objective measurements of pharyngeal aerated area with bolus held in the oral cavity (PAhold), the pharyngeal area of residual bolus during swallowing (PAmax), the pharyngeal constriction ratio (PCR), the maximum pharyngoesophageal segment opening (PESmax), pharyngoesophageal segment opening duration (POD), airway closure duration (ACD), and total pharyngeal transit time (TPT). We evaluated the inter-rater agreement in the subjective ratings and the objective measurements. Clinical utility analysis compared the measurements with the VFS findings of pharyngeal phase abnormality, penetration/aspiration, and cricopharyngeal relaxation. Results: In the pharyngeal findings, the subjective analysis inter-rater agreement was mainly moderate to strong. The strongest agreements were on the pharyngeal residues and penetration/aspiration findings. The objective measurements had fair to good inter-rater agreement. Clinical utility analysis found statistically significant connections between TPT and pharyngeal phase abnormality, normal PCR and lack of penetration/aspiration, and normal PESmax and normal cricopharyngeal relaxation. Conclusions: The subjective analysis had moderate to strong inter-rater agreement in the pharyngeal VFS findings, especially concerning pharyngeal residues and penetration/aspiration detection, reflecting the efficacy and safety of swallowing. The objective measurements had fair to good inter-observer reproducibility and could thus improve the reliability of VFS diagnostics. Level of evidence: 4.

Inter-rater reliability of ACS-NSQIP colorectal procedure coding in Canada.

BACKGROUND: The American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) uses Current Procedural Terminology (CPT) codes for risk-adjusted calculations. This study evaluates the inter-rater reliability of coding colorectal resections across Canada by ACS-NSQIP surgical clinical nurse reviewers (SCNR) and its impact on risk predictions. METHODS: SCNRs in Canada were asked to code simulated operative reports. Percent agreement and free-marginal kappa correlation were calculated. The ACS-NSQIP risk calculator was utilized to illustrate its impact on risk prediction. RESULTS: Responses from 44 of 150 (29.3 â€‹%) SCNRs revealed 3 to 6 different codes chosen per case, with agreement ranging from 6.7 â€‹% to 62.3 â€‹%. Free-marginal kappa correlation ranged from moderate agreement (0.53) to high disagreement (-0.17). ACS-NSQIP risk calculator predicted large absolute differences in risk for serious complications (0.2 â€‹%-13.7 â€‹%) and mortality (0.2 â€‹%-6.3 â€‹%). CONCLUSION: This study demonstrated low inter-rater reliability in coding ACS-NSQIP colorectal procedures in Canada among SCNRs, impacting risk predictions.

Evaluating the Reliability of MyotonPro in Assessing Muscle Properties: A Systematic Review of Diagnostic Test Accuracy.

Background and Objectives: Muscle properties are critical for performance and injury risk, with changes occurring due to physical exertion, aging, and neurological conditions. The MyotonPro device offers a non-invasive method to comprehensively assess muscle biomechanical properties. This systematic review evaluates the reliability of MyotonPro across various muscles for diagnostic purposes. Materials and Methods: Following PRISMA guidelines, a comprehensive literature search was conducted in Medline (PubMed), Ovid (Med), Epistemonikos, Embase, Cochrane Library, Clinical trials.gov, and the WHO International Clinical Trials platform. Studies assessing the reliability of MyotonPro across different muscles were included. A methodological quality assessment was performed using established tools, and reviewers independently conducted data extraction. Statistical analysis involved summarizing intra-rater and inter-rater reliability measures across muscles. Results: A total of 48 studies assessing 31 muscles were included in the systematic review. The intra-rater and inter-rater reliability were consistently high for parameters such as frequency and stiffness in muscles of the lower and upper extremities, as well as other muscle groups. Despite methodological heterogeneity and limited data on specific parameters, MyotonPro demonstrated promising reliability for diagnostic purposes across diverse patient populations. Conclusions: The findings suggest the potential of MyotonPro in clinical assessments for accurate diagnosis, treatment planning, and monitoring of muscle properties. Further research is needed to address limitations and enhance the applicability of MyotonPro in clinical practice. Reliable muscle assessments are crucial for optimizing treatment outcomes and improving patient care in various healthcare settings.

Evaluation of a Semi-Automated Wound-Halving Algorithm for Split-Wound Design Studies: A Step towards Enhanced Wound-Healing Assessment.

Background: Chronic leg ulcers present a global challenge in healthcare, necessitating precise wound measurement for effective treatment evaluation. This study is the first to validate the "split-wound design" approach for wound studies using objective measures. We further improved this relatively new approach and combined it with a semi-automated wound measurement algorithm. Method: The algorithm is capable of plotting an objective halving line that is calculated by splitting the bounding box of the wound surface along the longest side. To evaluate this algorithm, we compared the accuracy of the subjective wound halving of manual operators of different backgrounds with the algorithm-generated halving line and the ground truth, in two separate rounds. Results: The median absolute deviation (MAD) from the ground truth of the manual wound halving was 2% and 3% in the first and second round, respectively. On the other hand, the algorithm-generated halving line showed a significantly lower deviation from the ground truth (MAD = 0.3%, p < 0.001). Conclusions: The data suggest that this wound-halving algorithm is suitable and reliable for conducting wound studies. This innovative combination of a semi-automated algorithm paired with a unique study design offers several advantages, including reduced patient recruitment needs, accelerated study planning, and cost savings, thereby expediting evidence generation in the field of wound care. Our findings highlight a promising path forward for improving wound research and clinical practice.

Unsupervised Segmentation of Knee Bone Marrow Edema-like Lesions Using Conditional Generative Models.

Bone marrow edema-like lesions (BMEL) in the knee have been linked to the symptoms and progression of osteoarthritis (OA), a highly prevalent disease with profound public health implications. Manual and semi-automatic segmentations of BMELs in magnetic resonance images (MRI) have been used to quantify the significance of BMELs. However, their utilization is hampered by the labor-intensive and time-consuming nature of the process as well as by annotator bias, especially since BMELs exhibit various sizes and irregular shapes with diffuse signal that lead to poor intra- and inter-rater reliability. In this study, we propose a novel unsupervised method for fully automated segmentation of BMELs that leverages conditional diffusion models, multiple MRI sequences that have different contrast of BMELs, and anomaly detection that do not rely on costly and error-prone annotations. We also analyze BMEL segmentation annotations from multiple experts, reporting intra-/inter-rater variability and setting better benchmarks for BMEL segmentation performance.

Evaluation of data collection bias of third molar stages of mineralisation for age estimation in the living.

Age assessment of the living is a fundamental procedure in the process of human identification, in order to guarantee fair treatment of individuals, which has ethical, civil, legal, and medical repercussions. The careful selection of the appropriate methods requires evaluation of several parameters: accuracy, precision of the method, as well as its reproducibility. The approach proposed by Mincer et al. adapted from Demirjian et al. exploring third molar mineralisation, is one of the most frequently considered for age estimation of the living. Thus, this work aims to assess potential bias in the data collection when applying the classification stages for dental mineralisation adapted by Mincer et al. A total of 102 orthopantomographs, of clinical origin, belonging to individuals aged between 12 and 25 years ([Formula: see text] = 20.12 years, SD = 3.49 years; 65 females, 37 males, all of Portuguese nationality) were included and a retrospective analysis performed by five observers with different levels of experience (high, average, and basic). The performance and agreement between five observers were evaluated using Weighted Cohen's Kappa and the Intraclass Correlation Coefficient. To access the influence of impaction on third molar classification, variables were tested using ordinal logistic regression Generalised Linear Model. It was observed that there were variations in the number of teeth identified among the observers, but the agreement levels ranged from moderate to substantial (0.4-0.8). Upon closer examination of the results, it was observed that although there were discernible differences between highly experienced observers and those with less experience, the gap was not as significant as initially hypothesised, and a greater disparity between the classifications of the upper (0.24-0.49) and lower third molars (>0.55) was observed. When bone superimposition is present, the classification process is not significantly influenced; however, variation in teeth angulation affects the assessment. The results suggest that with an efficient preparation, the level of experience as a factor can be overcome. Mincer and colleague's classification system can be replicated with ease and consistency, even though the classification of upper and lower third molars presents distinct challenges.