Evaluating Airflow Sensor Methods: Precision in Indirect Calorimetry.

This study assesses the impact of three volumetric gas flow measurement methods-turbine (fT); pneumotachograph (fP), and Venturi (fV)-on predictive accuracy and precision of expired gas analysis indirect calorimetry (EGAIC) across varying exercise intensities. Six males (Age: 38 ± 8 year; Height: 178.8 ± 4.2 cm; V ̇ O 2 peak $$ \dot{V}{\mathrm{O}}_2\mathrm{peak} $$ : 42 ± 2.8 mL O2 kg-1 min-1) and 14 females (Age = 44.6 ± 9.6 year; Height = 164.6 ± 6.9 cm; V ̇ O 2 peak $$ \dot{V}{\mathrm{O}}_2\mathrm{peak} $$ = 45 ± 8.6 mL O2 kg-1 min-1) were recruited. Participants completed physical exertion on a stationary cycle ergometer for simultaneous pulmonary minute ventilation ( V ̇ $$ \dot{V} $$ ) measurements and EGAIC computations. Exercise protocols and subsequent conditions involved a 5-min cycling warm-up at 25 W min-1, incremental exercise to exhaustion ( V ̇ O 2 $$ \dot{V}{\mathrm{O}}_2 $$ ramp test), then a steady-state exercise bout induced by a constant Watt load equivalent to 80% ventilatory threshold (80% VT). A linear mixed model revealed that exercise intensity significantly affected V ̇ O 2 $$ \dot{V}{\mathrm{O}}_2 $$ measurements (p < 0.0001), whereas airflow sensor method (p = 0.97) and its interaction with exercise intensity (p = 0.91) did not. Group analysis of precision yielded a V ̇ O 2 $$ \dot{V}{\mathrm{O}}_2 $$ CV % = 21%; SEM = 5 mL O2 kg-1 min-1. Intra- and interindividual analysis of precision via Bland-Altman revealed a 95% confidence interval (CI) precision benchmark of 3-5 mL kg-1 min-1. Agreement among methods decreased at power outputs eliciting V ̇ $$ \dot{V} $$ up to 150 L min-1, indicating a decrease in precision and highlighting potential challenges in interpreting biological variability, training response heterogeneity, and test-retest comparisons. These findings suggest careful consideration of airflow sensor method variance across metabolic cart configurations.

Electrocardiographic artifact.

Electrocardiographic (ECG) artifact, a common nuisance, has a wide range of manifestations with varying clinical significance. Beyond loose leads, motion artifacts and broken wires, artifact can also be caused by external and implanted devices as well as by physiologic signals. ECG artifact can mimic a variety of serious clinical conditions and arrhythmias such as acute myocardial infarction and ventricular tachycardia. The purpose of this review is to provide a structured approach to the recognition of the different forms of ECG artifact and to offer simple and practical steps to avoid misdiagnoses caused by artifact. Special attention is given to artifact whose presence can actually aid in the diagnosis of important and sometimes critical clinical conditions.

Objective assessment of surgical operative performance by observational clinical human reliability analysis (OCHRA): a systematic review.

BACKGROUND: Both morbidity and mortality data (MMD) and learning curves (LCs) do not provide information on the nature of intraoperative errors and their mechanisms when these adversely impact on patient outcome. OCHRA was developed specifically to address the unmet surgical need for an objective assessment technique of the quality of technical execution of operations at individual operator level. The aim of this systematic review was to review of OCHRA as a method of objective assessment of surgical operative performance. METHODS: Systematic review based on searching 4 databases for articles published from January 1998 to January 2019. The review complies with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and includes original publications on surgical task performance based on technical errors during operations across several surgical specialties. RESULTS: Only 26 published studies met the search criteria, indicating that the uptake of OCHRA during the study period has been low. In 31% of reported studies, the operations were performed by fully qualified consultant/attending surgeons and by surgical trainees in 69% in approved training programs. OCHRA identified 7869 consequential errors (CE) during the conduct of 719 clinical operations (mean = 11 CEs). It also identified 'hazard zones' of operations and proficiency-gain curves (P-GCs) that confirm attainment of persistent competent execution of specific operations by individual trainee surgeons. P-GCs are both surgeon and operation specific. CONCLUSIONS: Increased OCHRA use has the potential to improve patient outcome after surgery, but this is a contingent progress towards automatic assessment of unedited videos of operations. The low uptake of OCHRA is attributed to its labor-intensive nature involving human factors (cognitive engineering) expertise. Aside from faster and more objective peer-based assessment, this development should accelerate increased clinical uptake and use of the technique in both routine surgical practice and surgical training.

Repeatability of exercise-induced changes in mRNA expression and technical considerations for qPCR analysis in human skeletal muscle.

NEW FINDINGS: What is the central question of this study? Are individual changes in exercise-induced mRNA expression repeatable (i.e. representative of the true response to exercise rather than random error)? What is the main finding and its importance? Exercise-induced changes in mRNA expression are not repeatable even under identical experimental conditions, thereby challenging the use of mRNA expression as a biomarker of adaptive potential and/or individual responsiveness to exercise. ABSTRACT: It remains unknown if (1) the observed change in mRNA expression reflects an individual's true response to exercise or random (technical and/or biological) error, and (2) the individual responsiveness to exercise is protocol-specific. We examined the repeatability of skeletal muscle PGC-1α, PDK4, NRF-1, VEGF-A, HSP72 and p53 mRNA expression following two identical endurance exercise (END) bouts (END-1, END-2; 30 min of cycling at 65% of peak work rate (WRpeak ), n = 11) and inter-individual variability in PGC-1α and PDK4 mRNA expression following END and sprint interval training (SIT; 8 × 20 s cycling intervals at ∼170% WRpeak , n = 10) in active young males. The repeatability of key gene analysis steps (RNA extraction, reverse transcription, qPCR) and within-sample fibre-type distribution (n = 8) was also determined to examine potential sources of technical error in our analyses. Despite highly repeatable exercise bout characteristics (work rate, heart rate, blood lactate; ICC > 0.71; CV < 10%; r > 0.85, P < 0.01), gene analysis steps (ICC > 0.73; CV < 24%; r > 0.75, P < 0.01), and similar group-level changes in mRNA expression, individual changes in PGC-1α, PDK4, VEGF-A and p53 mRNA expression were not repeatable (ICC < 0.22; CV > 20%; r < 0.21). Fibre-type distribution in two portions of the same muscle biopsy was highly variable and not significantly related (ICC = 0.39; CV = 26%; r = 0.37, P = 0.37). Since individual changes in mRNA expression following identical exercise bouts were not repeatable, inferences regarding individual responsiveness to END or SIT were not made. Substantial random error exists in changes in mRNA expression following acute exercise, thereby challenging the use of mRNA expression for analysing individual responsiveness to exercise.

Introduction of iodised salt benefits infants' mental development in a community-based cluster-randomised effectiveness trial in Ethiopia.

The effectiveness of salt iodisation in improving the mental development of young children has not been assessed. We implemented a community-based cluster-randomised effectiveness trial in sixty randomly selected districts in the Amhara region of Ethiopia. We randomly allocated each district to treatment and randomly selected one of its villages. In parallel to national salt iodisation efforts, iodised salt was brought early into the markets of the thirty intervention villages before it became widely available in the thirty control villages 4-6 months later. The primary outcome was children's mental development scores on the Bayley Scales. This was an intention-to-treat analysis using mixed linear models adjusted for covariates and clusters. The trial was registered at ClinicalTrials.gov, NCT013496. We assessed 1835 infants aged 5-11 months at baseline. The same children (85 % of the sample) were re-assessed at 20-29 months when all villages had iodised salt. At endline, urinary iodine concentration was higher in children in the intervention group compared with those in the control group (median 228·0 v. 155·1 µg/l, P=0·001). The intervention group had higher scores compared with the control group on the Bayley composite score (raw scores:130·60 v. 128·51; standardised scores: 27·8 v. 26·9; d=0·13; 95 % CI 0·02, 0·23) and three of the four subscales: cognitive (53·27 v. 52·54, d=0·13; 95 % CI 0·03, 0·23), receptive language (20·71 v. 20·18, d=0·13; 95 % CI 0·03, 0·24) and fine motor (35·45 v. 34·94, d=0·15; 95 % CI 0·04, 0·25). The introduction of iodised salt contributes to children's higher urinary iodine concentration and mental development.

Home-based anthropometric, blood pressure and pulse measurements in young children by trained data collectors in the National Children's Study.

OBJECTIVE: The current study assessed whether home-based data collection by trained data collectors can produce high-quality physical measurement data in young children. DESIGN: The study assessed the quality of intra-examiner measurements of blood pressure, pulse rate and anthropometric dimensions using intra-examiner reliability and intra-examiner technical error of measurement (TEM). SETTING: Non-clinical, primarily private homes of National Children's Study participants in twenty-two study locations across the USA. SUBJECTS: Children in four age groups: 5-7 months (n 91), 11-16 months (n 393), 23-28 months (n 1410) and 35-40 months (n 800). RESULTS: Absolute TEM ranged in value from 0·09 to 16·21, varying widely by age group and measure, as expected. Relative TEM spanned from 0·27 to 13·71 across age groups and physical measures. Reliabilities for anthropometric measurements by age group and measure ranged from 0·46 to >0·99 with most exceeding 0·90, suggesting that the large majority of anthropometric measures can be collected in a home-based setting on young children by trained data collectors. Reliabilities for blood pressure and pulse rate measurements by age group ranged from 0·21 to 0·74, implying these are less reliably measured with young children when taken in the data collection context described here. CONCLUSIONS: Reliability estimates >0·95 for weight, length, height, and thigh, waist and head circumference, and >0·90 for triceps and subscapular skinfolds, indicate that these measures can be collected in the field by trained data collectors without compromising data quality. These estimates can be used for interim evaluations of data collector training and measurement protocols.

The effects of two different correction strategies on the snatch technique in weightlifting.

Improving motor skills represents one of the major issues in motor control and motor learning literature. The aim of this study was to investigate which of two strategies, method of amplification of error (MAE) or direct instruction (DI), would be more beneficial for error correction of the snatch technique. Thirty well-trained male weightlifters were randomly assigned to one of three training conditions (MAE, DI and Control). The experiment took place in only one practice session in which each lifter performed 3 pretraining trials, 8 training intervention trials, and 3 post-training trials, and a retention test session after 1 week. An optoelectronic motion capture system was used to measure the kinematic parameters of the weightlifting performance. After the training intervention, data showed that the MAE group revealed a greater improvement in several kinematic parameters when compared to the DI and Control groups, and the benefits derived from its application were still present 1 week later in the retention test. Nevertheless, the findings of the present study should be interpreted with caution due to the relatively small sample size; further research will also be necessary to evaluate the effects of MAE with different ability levels and other sport skills. The present findings could have practical implications for sport psychology and physical education because while practice is obviously necessary for improving learning, the efficacy of the learning process is essential in enhancing learners' motivation and sport enjoyment.

Veldt fires in South Africa: Implications on osteometry and the biological profile.

Standard operating procedures for forensic anthropological analyses dictate that thermally altered remains should not be measured, hindering the creation of a biological profile. Few studies have addressed estimating biological parameters from burned remains, with the greatest focus of this research area being on cremated remains. However, veldt fires are more common than cremation in the South African forensic context. The aim of this study was to explore the degree of structural changes observed in domestic pig (Sus scrofa) bones associated with thermal destruction and the potential impact on the estimation of a biological profile using standard osteometric methods. A total of 96 pig femora were divided equally into two categories: fresh and dry. Within each category, equal samples were exposed to different durations of burning, namely, 5, 10, and 20 min. Ten standard femoral anthropological measurements were collected before and after burning. Technical error of measurement and Wilcoxon signed-rank tests were used to assess changes in the femoral dimensions before and after burning. Most measurements were significantly different after burning, with the fresh bones decreasing in size by up to 7.8% and the dry bones decreasing in size by up to 4.0%. The magnitude of post-burning measurement changes for both burn conditions was similar to, or smaller than has previously been reported for observer measurement errors of commonly used variables investigated for standard osteometric studies. Veldt fires are less intense than cremation, thus causing less shrinkage.

Evaluating Reliability of DNA Methylation Measurement.

DNA methylation is a widely studied epigenetic phenomenon. Alterations in methylation patterns influence human phenotypes and risk of disease. The Illumina Infinium HumanMethylation450 (HM450) and MethylationEPIC (EPIC) BeadChip are widely used microarray-based platforms for epigenome-wide association studies (EWASs). In this chapter, we will discuss the use of intraclass correlation coefficient (ICC) for assessing technical variations induced by methylation arrays at single-CpG level. ICC compares variation of methylation levels within- and between-replicate measurements, ranging between 0 and 1. We further characterize the distribution of ICCs using a mixture of truncated normal and normal distributions, and cluster CpG sites on the arrays into low- and high-reliability groups. In practice, we recommend that extra caution needs to be taken for associations at the CpG sites with low ICC values.

Accuracy of GEBV of sires based on pooled allele frequency of their progeny.

Despite decreasing genotyping costs, in some cases individually genotyping animals is not economically feasible (e.g., in small ruminants). An alternative is to pool DNA, using the pooled allele frequency (PAF) to garner information on performance. Still, the use of PAF for prediction (estimation of genomic breeding values; GEBVs) has been limited. Two potential sources of error on accuracy of GEBV of sires, obtained from PAF of their progeny themselves lacking pedigree information, were tested: (i) pool construction error (unequal contribution of DNA from animals in pools), and (ii) technical error (variability when reading the array). Pooling design (random, extremes, K-means), pool size (5, 10, 25, 50, and 100 individuals), and selection scenario (random, phenotypic) also were considered. These factors were tested by simulating a sheep population. Accuracy of GEBV-the correlation between true and estimated values-was not substantially affected by pool construction or technical error, or selection scenario. A significant interaction, however, between pool size and design was found. Still, regardless of design, mean accuracy was higher for pools of 10 or less individuals. Mean accuracy of GEBV was 0.174 (SE 0.001) for random pooling, and 0.704 (SE 0.004) and 0.696 (SE 0.004) for extreme and K-means pooling, respectively. Non-random pooling resulted in moderate accuracy of GEBV. Overall, pooled genotypes can be used in conjunction with individual genotypes of sires for moderately accurate predictions of their genetic merit with little effect of pool construction or technical error.

Reliability of Repeated Trials Protocols for Body Composition Assessment by Air Displacement Plethysmography.

Air displacement plethysmography (ADP) is fast, accurate, and reliable. Nevertheless, in about 3% of the cases, standard ADP tests provide rogue results. To spot these outliers and improve precision, repeated trials protocols have been devised, but few works have addressed their reliability. This study was conducted to evaluate the test-retest reliabilities of two known protocols and a new one, proposed here. Ninety-two healthy adults (46 men and 46 women) completed six consecutive ADP tests. To evaluate the reliability of single measurements, we used the results of the first two tests; for multiple measures protocols, we computed the test result from trials 1-3 and the retest result from trials 4-6. Bland-Altman analysis revealed that the bias and the width of the 95% interval of agreement were smaller for multiple trials than for single ones. For percent body fat (%BF)/fat-free mass, the technical error of measurement was 1% BF/0.68 kg for single trials and 0.62% BF/0.46 kg for the new protocol of multiple trials, which proved to be the most reliable. The minimal detectable change (MDC) was 2.77% BF/1.87 kg for single trials and 1.72% BF/1.26 kg for the new protocol.

Concurrent Validity of Power From Three On-Water Rowing Instrumentation Systems and a Concept2 Ergometer.

Purpose: Instrumentation systems are increasingly used in rowing to measure training intensity and performance but have not been validated for measures of power. In this study, the concurrent validity of Peach PowerLine (six units), Nielsen-Kellerman EmPower (five units), Weba OarPowerMeter (three units), Concept2 model D ergometer (one unit), and a custom-built reference instrumentation system (Reference System; one unit) were investigated. Methods: Eight female and seven male rowers [age, 21 ± 2.5 years; rowing experience, 7.1 ± 2.6 years, mean ± standard deviation (SD)] performed a 30-s maximal test and a 7 × 4-min incremental test once per week for 5 weeks. Power per stroke was extracted concurrently from the Reference System (via chain force and velocity), the Concept2 itself, Weba (oar shaft-based), and either Peach or EmPower (oarlock-based). Differences from the Reference System in the mean (representing potential error) and the stroke-to-stroke variability (represented by its SD) of power per stroke for each stage and device, and between-unit differences, were estimated using general linear mixed modeling and interpreted using rejection of non-substantial and substantial hypotheses. Results: Potential error in mean power was decisively substantial for all devices (Concept2, -11 to -15%; Peach, -7.9 to -17%; EmPower, -32 to -48%; and Weba, -7.9 to -16%). Between-unit differences (as SD) in mean power lacked statistical precision but were substantial and consistent across stages (Peach, ∼5%; EmPower, ∼7%; and Weba, ∼2%). Most differences from the Reference System in stroke-to-stroke variability of power were possibly or likely trivial or small for Peach (-3.0 to -16%), and likely or decisively substantial for EmPower (9.7-57%), and mostly decisively substantial for Weba (61-139%) and the Concept2 (-28 to 177%). Conclusion: Potential negative error in mean power was evident for all devices and units, particularly EmPower. Stroke-to-stroke variation in power showed a lack of measurement sensitivity (apparent smoothing) that was minor for Peach but larger for the Concept2, whereas EmPower and Weba added random error. Peach is therefore recommended for measurement of mean and stroke power.

Accuracy of self-reported BMI using objective measurement in high school students.

Self-reported measures for body mass index (BMI) are considered a limitation in research design, especially when they are a primary outcome. Studies have found some populations to be quite accurate when self-reporting BMI; however, there is mixed research on the accuracy of self-reported measurements in adolescents. The aim of this study is to examine the accuracy of self-reported BMI by comparing it with measured BMI in a sample of U.S. adolescents and to understand gender differences. This cross-sectional study collected self-reported height and weight measurements of students from five high schools in four states (Tennessee, South Dakota, Kansas and Florida). Trained researchers took height and weight of students for an objective measurement. BMI was calculated from both sources and categorized (underweight, normal, overweight and obese) using the Centers for Disease Control and Prevention's BMI-for-age percentiles. Participants (n 425; 51⋅0 % female) had a mean age of 16⋅3 years old, and the majority were White (47⋅5 %). Limits of agreement (LOA) analysis revealed that BMI and weight were underreported, and height was overreported in the overall sample, in females, and in males. LOA analysis was fair for BMI in all three groups. Overall agreement in BMI categorisation was considered substantial (Κ 0⋅71, P < 0⋅001). As BMI increased, more height and weight inaccuracies led to decreased accuracy in BMI categorisation, and the specificity of obese participants was low (50⋅0 %). This study's findings suggest that using self-reported values to categorize BMI is more accurate than using continuous BMI values when self-reported measures are used in health-related interventions.

The Dark Side of Gadolinium: A Study of Arthrographic Contrast at Extreme Concentrations.

Magnetic resonance arthrography is used to optimally image the detailed intraarticular anatomy of the joint space. A common iatrogenic complication of arthrography is the extra-articular injection of the gadolinium solution in the periarticular tissues; however, a less common complication involves the abnormal concentration of gadolinium within the prepared injectate. The following describes the inadvertent injection of a hyper-concentrated intraarticular solution of gadolinium and the subsequent appearance that resulted in the post-procedure magnetic resonance imaging examination. In addition, an in-vitro experiment was performed to determine the exact etiology of the abnormal magnetic resonance imaging findings that resulted in this case. The subsequent discussion revisits the signal intensity of gadolinium at extreme concentration ranges and proposes modifications of procedure protocol to mitigate the chance of a repeat event.

Examining Interobserver Reliability of Metric and Morphoscopic Characteristics of the Mandible.

Mandibular metric and morphological characteristics have long been used for sex and ancestry estimation. Currently, there are no large-scale studies examining interobserver agreement, particularly examining the role of observer experience. This study examines the interobserver agreement of six morphoscopic and eleven metric mandibular variables. Four observers with varied levels of experience scored 183 mandibles from the William M. Bass Donated Skeletal Collection. Absolute agreement and consistency were evaluated with the intraclass correlation coefficient (ICC). Additionally, technical error of measurement (TEM) and relative TEM (%TEM) were calculated for each metric variable. All analyses were conducted twice-once with all observers and again with only experienced observers. Results show mean morphoscopic agreement of 0.543 among all observers and 0.615 for experienced observers, and mean metric agreement of 0.886 among all observers and 0.911 for experienced observers. Further, no TEM exceeded 2 mm. All results were significant (p < 0.001).

Standardized anthropological measurement of postcranial bones using three-dimensional models in CAD software.

This study introduces a standardized protocol for conducting linear measurements of postcranial skeletal elements using three-dimensional (3D) models constructed from post-mortem computed tomography (PMCT) scans. Using femoral DICOM datasets, reference planes were generated and plane-to-plane measurements were conducted on 3D surface rendered models. Bicondylar length, epicondylar breadth, anterior-posterior (AP) diameter, medial-lateral (ML) diameter and cortical area at the midshaft were measured by four observers to test the measurement error variance and observer agreement of the protocol (n=6). Intra-observer error resulted in a mean relative technical error of measurement (%TEM) of 0.11 and an intraclass correlation coefficient (ICC) of 0.999 (CI=0.998-1.000); inter-observer error resulted in a mean %TEM of 0.54 and ICC of 0.996 (CI=0.979-1.000) for bicondylar length. Epicondylar breadth, AP diameter, ML diameter and cortical area also yielded minimal error. Precision testing demonstrated that the approach is highly repeatable and is recommended for implementation in anthropological investigation and research. This study exploits the benefits of virtual anthropology, introducing an innovative, standardized alternative to dry bone osteometric measurements.

Correction of a Technical Error in the Golf Swing: Error Amplification Versus Direct Instruction.

Performance errors drive motor learning for many tasks. The authors' aim was to determine which of two strategies, method of amplification of error (MAE) or direct instruction (DI), would be more beneficial for error correction during a full golfing swing with a driver. Thirty-four golfers were randomly assigned to one of three training conditions (MAE, DI, and control). Participants were tested in a practice session in which each golfer performed 7 pretraining trials, 6 training-intervention trials, and 7 posttraining trials; and a retention test after 1 week. An optoeletronic motion capture system was used to measure the kinematic parameters of each golfer's performance. Results showed that MAE is an effective strategy for correcting the technical errors leading to a rapid improvement in performance. These findings could have practical implications for sport psychology and physical education because, while practice is obviously necessary for improving learning, the efficacy of the learning process is essential in enhancing learners' motivation and sport enjoyment.

Differential effects of main error correction versus secondary error correction on motor pattern of running.

The aim of this study was to gain a better understanding of how the run pattern varies as a consequence to main error correction versus secondary error correction. Twenty-two university students were randomly assigned to one of two training-conditions: 'main error' (ME) and 'secondary error' (SE) correction. The rear-foot strike at touchdown was hypothesized as the 'main error', whereas an incorrect shoulder position (i.e., behind the base of support) as the 'secondary error'. In order to evaluate any changes in run pattern at the foot touchdown instant, the ankle, knee and hip joint angles, the height of toe and heel (with respect to the ground), and the horizontal distance from the heel to the projected center of mass on the ground were measured. After the training-intervention, the ME group showed a significant improvement in the run pattern at the foot touchdown instant in all kinematic parameters, whereas no significant changes were found in the SE group. The results support the hypothesis that the main error can have a greater influence on the movement patterns than a secondary error. Furthermore, the findings highlight that a correct diagnosis and the correction of the 'main error' are fundamental for greater run pattern improvement.

The Generic Error Rating Tool: A Novel Approach to Assessment of Performance and Surgical Education in Gynecologic Laparoscopy.

OBJECTIVE: Global rating scales are commonly used to rate surgeons' skill level. However, these tools lack granularity required for specific skill feedback. Recently, an alternative framework has been developed that is designed to measure technical errors during laparoscopy. The purpose of the present study was to gather validity evidence for the Generic Error Rating Tool (GERT) in gynecologic laparoscopy. DESIGN: Video recordings of total laparoscopic hysterectomies were analyzed by 2 blinded reviewers using the GERT and the Objective Structured Assessment of Technical Skills (OSATS) scale. Several sources of validity were examined according to the unitary framework of validity. Main outcomes were interrater and intrarater reliability regarding total number of errors and events. Further, surgeons were grouped according to OSATS scores (OSATS ≥ 28 = high performers and OSATS < 28 = low performers), and the number of errors and events was compared between groups. Correlation analysis between GERT and OSATS scores was performed. Lastly, error distribution within procedure steps was explored and compared between high- and low-performing surgeons. SETTING: University teaching hospital. PARTICIPANTS: A total of 20 anonymized video recordings of total laparoscopic hysterectomies. RESULTS: Interrater and intrarater reliability was high (intraclass correlation coefficient >0.95) for total number of errors and events. Low performers made significantly more errors than high performers did (median = 49.5 [interquartile range: 34.5-66] vs median = 31 [interquartile range: 16.75-35.25], p = 0.002). There was a significant negative correlation between individual OSATS scores and total number of errors (Spearman ρ = -0.76, p < 0.001, and ρ = -0.88, p < 0.001, for raters 1 and 2, respectively). Error distribution varied between operative steps, and low performers made more errors in some steps, but not in others. CONCLUSION: GERT allows for objective and reproducible assessment of technical errors during gynecologic laparoscopy and could be used for performance analysis and personalized surgical education and training.

Accuracy and reliability of measurements obtained from computed tomography 3D volume rendered images.

Forensic pathologists commonly use computed tomography (CT) images to assist in determining the cause and manner of death as well as for mass disaster operations. Even though the design of the CT machine does not inherently produce distortion, most techniques within anthropology rely on metric variables, thus concern exists regarding the accuracy of CT images reflecting an object's true dimensions. Numerous researchers have attempted to validate the use of CT images, however the comparisons have only been conducted on limited elements and/or comparisons were between measurements taken from a dry element and measurements taken from the 3D-CT image of the same dry element. A full-body CT scan was performed prior to autopsy at the Office of the Chief Medical Examiner for the State of Maryland. Following autopsy, the remains were processed to remove all soft tissues and the skeletal elements were subject to an additional CT scan. Percent differences and Bland-Altman plots were used to assess the accuracy between osteometric variables obtained from the dry skeletal elements and from CT images with and without soft tissues. An additional seven crania were scanned, measured by three observers, and the reliability was evaluated by technical error of measurement (TEM) and relative technical error of measurement (%TEM). Average percent differences between the measurements obtained from the three data sources ranged from 1.4% to 2.9%. Bland-Altman plots illustrated the two sets of measurements were generally within 2mm for each comparison between data sources. Intra-observer TEM and %TEM for three observers and all craniometric variables ranged between 0.46mm and 0.77mm and 0.56% and 1.06%, respectively. The three-way inter-observer TEM and %TEM for craniometric variables was 2.6mm and 2.26%, respectively. Variables that yielded high error rates were orbital height, orbital breadth, inter-orbital breadth and parietal chord. Overall, minimal differences were found among the data sources and high accuracy was noted between the observers, which prove CT images are an acceptable source to collect osteometric variables.