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Late-onset toxicities often occur in phase I trials investigating novel immunotherapy and molecular targeted therapies. For trials with cohort based designs (such as modified toxicity probability interval, Bayesian optimal interval, and i3+3), patients are often turned away since the current cohort are still being followed without definite dose-limiting toxicities, which results in prolonged trial duration and waste of patient resources. In this paper, we incorporate a probability-of-decision framework into the i3+3 design and allow real-time dosing inference when the next patient becomes available. Both follow-up time for the pending patients and time to dose-limiting toxicities for the observed patients are used in calculating the posterior probability of each possible dosing decision. An intensive simulation study is conducted to evaluate the operating characteristics of the newly proposed probability-of-decision-i3+3 design under various dosing scenarios and patient accrual settings. Results show that the probability-of-decision-i3+3 design achieves comparable safety and reliability performances but much shorter trial duration compared to the complete designs. [ABSTRACT FROM AUTHOR]

Background: This paper describes the collection and integration of mixed methods data to facilitate the final selection of items for the Quality of Life - Aged Care Consumers (QOL-ACC) instrument. The aim of the wider project is to develop a preference-based quality of life instrument that can be used for quality assessment and economic evaluation. Older people have been involved at every stage of the development of the QOL-ACC to ensure that the final instrument captures their perspectives and preferences.Methods: Mixed methods data was collected on draft items for the QOL-ACC instrument across six key quality of life dimensions (mobility, pain management, emotional well-being, independence, social connections, and activities). Qualitative face validity data was collected from older people (aged 66 to 100 years) living in the community and in residential aged care via semi-structured interviews (n = 59). Quantitative data was collected from older people (aged 65 to 91 years) receiving aged care services in the community via an online survey (n = 313). A traffic light pictorial approach was adopted as a practical and systematic way to categorise and present data in a meaningful way that was easy for non-academic workshop members to understand and to be able to discuss the relative merits of each draft item.Results: The traffic light approach supported the involvement of consumer and aged care provider representatives in the selection of the final items. Six items were selected for the QOL-ACC instrument with one item representing each of the six dimensions.Conclusions: This methodological approach has ensured that the final instrument is psychometrically robust as well as meaningful, relevant and acceptable to aged care consumers and providers. [ABSTRACT FROM AUTHOR]

Objective: Due to no existing data, we aimed to derive evidence to support test-retest reliability for the Health Assessment Questionnaire-Disability Index (HAQ-DI) and 36-item Short Form Health Survey physical functioning domain (SF-36 PF) in psoriatic arthritis (PsA).Methods: We identified datasets that collected relevant data for test-retest reliability for HAQ-DI and SF-36 PF, and evaluated them using Outcome Measures in Rheumatology (OMERACT) Filter 2.1 methodology. We calculated intraclass correlation coefficients (ICC) as a measure of test-retest reliability. We then conducted a quality assessment and evaluated the adequacy of test-retest reliability performance.Results: Two datasets were identified for HAQ-DI and 1 for SF-36 PF in PsA. The quality of the datasets was good. The ICCs for HAQ-DI were good and excellent in study 1 (0.90, 95% CI 0.79-0.95) and study 2 (0.94, 95% CI 0.89-0.97). The ICC for SF-36 PF was excellent (0.96, 95% CI 0.92-0.98). The performance of test-retest reliability for both instruments was judged to be adequate.Conclusion: The new data derived support good and reasonable test-retest reliability for HAQ-DI and SF-36 PF in PsA. [ABSTRACT FROM AUTHOR]

Background: One in eight women is diagnosed with breast cancer in the course of their life. As systematic palliative treatment has only a limited effect on survival rates, the concept of health-related quality of life (HRQoL) was developed for measurement of patient-centered outcomes. Various studies have already demonstrated the reliability of paper-based patient-reported outcome (pPRO) and electronic patient-reported outcome (ePRO) surveys and that the 2 means of assessment are equally valid.Objective: The aim of this study was to analyze the acceptance and evaluation of a tablet-based ePRO app for breast cancer patients and to examine its suitability, effort, and difficulty in the context of HRQoL and sociodemographic factors.Methods: Overall, 106 women with adjuvant or advanced breast cancer were included in a 2-center study at 2 major university hospitals in Germany. Patients were asked to answer HRQoL and PRO questionnaires both on a tablet on-site using a specific eHealth assessment website and on paper. The suitability, effort, and difficulty of the app and self-reported technical skills were also assessed. Only the results of the electronically acquired data are presented here. The results of the reliability of the pPRO data have already been published elsewhere.Results: Patients regarded the ePRO assessment as more suitable (80/106, 75.5%), less stressful (73/106, 68.9%), and less difficult (69/106, 65.1%) than pPRO. The majority of patients stated that ePRO assessment improves health care in hospitals (87/106, 82.1%). However, evaluation of ePROs depended on the level of education (P=.003) in the dimensions of effort and difficulty (regression analysis). The app was rated highly in all categories. HRQoL data and therapy setting did not show significant correlations with the app's evaluation parameters.Conclusions: The results indicate that ePRO surveys are feasible for measuring HRQoL in breast cancer patients and that those patients prefer ePRO assessment to pPRO assessment. It can also be seen that patients consider ePRO assessment to improve hospital health care. However, studies with larger numbers of patients are needed to develop apps that address the needs of patients with lower levels of education and technical skills. [ABSTRACT FROM AUTHOR]

Background: Testosterone is used therapeutically in medical settings. Non-prescribed testosterone use is typically illegal, described as 'enhancement' or 'doping', and considered a problem. However, research has found that some non-prescribed testosterone use may be therapeutic (i.e. self-medication). Little is known about testosterone self-medication. It has been noted among individuals who use image and performance enhancing drugs (IPEDs), but never systematically explored.Approach: This paper describes the findings of a 4-year ethnographic study in online forums and social media groups frequented by people who use IPEDs. It focusses on 31 men who used enhancement doses of testosterone, but who described some of their testosterone use as 'testosterone replacement therapy' (TRT). In particular, it focuses on the 26 (84%) of these individuals who self-medicated TRT. Data was analysed thematically (using NVivo) in order to answer the question: 'how and why is testosterone self-medicated?'. Using Bacchi's (2016) problematization approach to policy analysis, this paper also asks, 'what happens to the 'problem' of non-prescribed testosterone use if such use is therapeutic?'.Findings: Self-medicated TRT was found to be very similar to TRT as practised in medical contexts. Self-medication was often practised because of an inability to access testosterone through health practitioners (who were either reluctant or unable to prescribe). However, some individuals were found to prefer self-medication because of price, ease of access, reliability of supply, and because health practitioners were perceived as lacking expertise regarding testosterone use.Conclusion: By documenting the therapeutic use of testosterone outside of medical settings, this paper calls into question previous conceptualisations of all illicit testosterone use as 'abuse', and the utility of the repair/enhancement dichotomy as a foundation for discussions of drug use. It suggests that in some cases the problem may not be non-prescribed testosterone use per se, but policies that prevent access to medical treatment. [ABSTRACT FROM AUTHOR]

Background: The Implementation Leadership Scale (ILS) was developed to assess leadership behavior with regard to being proactive, knowledgeable, supportive, or perseverant in implementing evidence-based practices (EBPs). As part of a study on the implementation of a digitally supported polypharmacy management application in primary care, the original ILS was translated and validated for use in the German language.Rationale: This study aimed to translate the original ILS into German and evaluate its psychometric properties.Methods: The validation sample consisted of 198 primary care physicians in a cluster-randomized controlled trial in which the intervention group implemented a digitally supported clinical decision support system for polypharmacy management. The ILS was assessed using a 12-item scale. The study included a process evaluation with two evaluation waves between 2019 and 2021. The ILS was used within this process evaluation study to assess the leadership support with regard to the implementation of the polypharmacy management. The ILS was translated in a multi-step process, including pre-testing of the instrument and triple, back-and-forth translation of the instrument. We tested the reliability (Cronbach's alpha) and validity (construct and criterion-related validity) of the scale.Results: The four-dimensional structure of the instrument was confirmed (comparative fit index = .97; root mean square error of approximation = .06). Convergent validity was demonstrated by correlations with organizational innovation climate, social capital, and workload, which was consistent with the proposed hypothesis. Criterion-related validity of the ILS was demonstrated by predicting the organizational readiness for change scores using structural equation modeling. The reliability of the scale was good (α = .875).Conclusion: The German version of the ILS created in this study is a reliable and valid measure. The original four-dimensional structure of the ILS was confirmed in a primary care setting. Further psychometric testing is needed to establish the validity and reliability of the ILS and to transfer it to other health care settings. It is a useful tool for identifying the areas for implementation leadership development. Further research is needed on how, why, and when distinct types of leadership behaviors have different effects on healthcare organizations in implementation processes. [ABSTRACT FROM AUTHOR]

Background: Along with the popularity of dental implants, implant esthetic complications are also on the rise. Recently a classification was proposed to comprehensively evaluate these conditions, with the definition of peri-implant soft tissue dehiscence/deficiencies (PSTDs). The aim of this article was therefore to test the inter-examiner agreement when utilizing the established rubrics among 25 standardized cases and 34 clinicians of different skill levels.Methods: Twelve periodontal residents, 12 general dentists, and 10 periodontists participated in this study. All examiners were provided with photographs of 25 single PSTDs and asked to rate all cases based on the proposed classification at a single timepoint. Variance components analysis was conducted with multilevel regression fit in a Bayesian framework to obtain uncertainty intervals for fractional variance contributions and interclass correlation values (ICC) to assess the agreement in the rating of all cases, among all examiners, different skill-level practitioners, and to compare their responses relative to the judgment of a gold standard examiner.Results: Overall, the results showed reproducible and consistent responses among the 34 examiners, and in each subgroup of skill-level, comparable to that of the gold examiner. Nevertheless, periodontists and residents were more likely to agree with the response of the gold standard examiner in their assessments of class and subclass of the PSTDs.Conclusions: The proposed PSTD classification showed reproducible assessments among all examiners, and between examiners of the same skill-level. The response of the gold standard examiner was more in line with the assessment of the periodontists and periodontal residents. [ABSTRACT FROM AUTHOR]

Purpose: Quantitative epidemiological tools are routinely used to assess adolescent diet and physical activity (PA) constructs (behaviour, knowledge, and awareness) as risk factors for non-communicable diseases. This study sought to synthesize evidence on the quantitative epidemiological tools that have been used to assess adolescent diet and PA constructs in low to middle-income countries (LMIC).Methods: A systematised review was conducted using 3 databases (EbscoHost, Scopus and Web of Science).Results: We identified 292 LMIC studies assessing adolescent diet and PA. Identified studies predominantly explored behavioural (90%) constructs with a paucity of studies investigating knowledge and awareness. The majority of studies used subjective (94%) and self-administered (78%) tools. Only 39% of LMIC studies used tools validated for their contexts.Conclusions: The findings highlight the need for more contextual tools for assessing adolescent diet and PA in LMICs. Diet and PA measurement tools used in future research will need to incorporate measures of knowledge and awareness for a more comprehensive understanding of the epidemiology of diet and PA in adolescents. Furthermore, there is a need for more evidence on the reliability and validity of these tools for use, in both cross sectional and longitudinal studies, in LMIC contexts. [ABSTRACT FROM AUTHOR]

This paper reports on a cross-language longitudinal study in which we extend previous research on the effects of maternal education on vocabulary growth in Spanish- and English-dominant children at three time points: 16 months, 22 months, and 30 months of age. This study addresses recent conflicting evidence regarding the role of maternal education in children's acquisition of Spanish. Participants were 62 English-dominant children, 47 Spanish-dominant children, and their mothers. Growth curve models were constructed separately for English and Spanish vocabulary. Strong growth rate reliability and effect sizes were evinced for vocabulary across samples. As expected, in English-dominant children, maternal education predicted English vocabulary and growth from 16 to 30 months of age. However, in Spanish-dominant children, there was no significant effect of maternal education on vocabulary or growth, although there was a descriptive advantage for children of college-educated mothers at 30 months of age. In conjunction with prior evidence, we conclude that the effect of maternal education on maternal input and child vocabulary does not generalize readily to children whose first language is Spanish. Our findings contribute to a literature that suggests that focusing on maternal beliefs, input, and the home literacy environment are more fruitful approaches in the study of children learning Spanish in the U.S. Further, the importance of maternal beliefs highlights the need to support parent investment in the quantity and quality of input in the home language. [ABSTRACT FROM AUTHOR]

Objective: To use a robust statistical methodology to develop and validate clinical rating scales quantifying longitudinal motor and cognitive dysfunction in sporadic Creutzfeldt-Jakob disease (sCJD) at the bedside.Methods: Rasch analysis was used to iteratively construct interval scales measuring composite cognitive and motor dysfunction from pooled bedside neurocognitive examinations collected as part of the prospective National Prion Monitoring Cohort study, October 2008-December 2016.A longitudinal clinical examination dataset constructed from 528 patients with sCJD, comprising 1030 Motor Scale and 757 Cognitive Scale scores over 130 patient-years of study, was used to demonstrate scale utility.Results: The Rasch-derived Motor Scale consists of 8 items, including assessments reliant on pyramidal, extrapyramidal and cerebellar systems. The Cognitive Scale comprises 6 items, and includes measures of executive function, language, visual perception and memory. Both scales are unidimensional, perform independently of age or gender and have excellent inter-rater reliability. They can be completed in minutes at the bedside, as part of a normal neurocognitive examination. A composite Examination Scale can be derived by averaging both scores. Several scale uses, in measuring longitudinal change, prognosis and phenotypic heterogeneity are illustrated.Conclusions: These two novel sCJD Motor and Cognitive Scales and the composite Examination Scale should prove useful to objectively measure phenotypic and clinical change in future clinical trials and for patient stratification. This statistical approach can help to overcome obstacles to assessing clinical change in rapidly progressive, multisystem conditions with limited longitudinal follow-up. [ABSTRACT FROM AUTHOR]

Background: Inconsistent responding is a type of invalid responding, which occurs on self-report surveys and threatens the reliability and validity of study results. This secondary analysis evaluated the utility of identifying inconsistent responses as a real-time, direct method to improve quality during data collection for an Internet-based RCT.Methods: The cannabis subscale of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) was administered as part of eligibility screening for the RCT. Following the consent procedure, the cannabis subscale was repeated during the baseline interview. Responses were automatically compared and individuals with inconsistent responses were screened out.Results: Nearly half of those initially eligible for the RCT were subsequently screened out for data quality issues (n = 626, 45.3%). Between-group bivariate analysis found that those screened out (OUT) were significantly older (OUT = 39.5 years (SD = 13.9), IN = 35.7 years (SD = 12.9), p < .001), more had annual incomes less than $20,000CND (OUT = 58.3%, IN = 53.0%, p = .047), used cannabis less often in the past 30 days (OUT = 23.3 days (SD = 9.7), IN = 24.8 days (SD = 11.3), p < .006), and had lower total ASSIST scores at screener (OUT = 19.3 (SD = 8.0), IN = 23.8 (SD = 10.4), p < .001) and baseline (OUT = 17.5 (SD = 7.9), IN = 23.3 (SD = 10.3), p < .001) compared to participants who were screened in to the RCT.Conclusion: Inconsistent responding may occur at high rates in Internet research and direct methods to identify invalid responses are needed. Comparing responses for consistency can be programmed in Internet surveys to automatically screen participants during recruitment and reduce the need for post-hoc data cleaning. [ABSTRACT FROM AUTHOR]

Background/objectives: Isothiocyanate (ITC) is formed via the hydrolysis of glucosinolates by myrosinase, found in cruciferous vegetables. Although myrosinase is inactivated by the cooking process, no studies have incorporated the effect of cooking into the estimation of dietary ITC intake or evaluated the validity. We evaluated the validity of dietary ITC intake estimated from a food frequency questionnaire (FFQ), and urinary ITC levels using 24 h urine samples or a WFR (weighed food record), and evaluated the reproducibility of dietary ITC in two FFQs administered at an interval of 1-year.Subjects/methods: The JPHC-NEXT Protocol Area included a total of 255 middle-aged participants across Japan. We calculated dietary ITC intake from WFR and two FFQs by assuming that cooked cruciferous vegetables contain zero ITC. Urinary ITC excretion was measured at two points during summer and winter. The validity and reproducibility of dietary ITC intake estimated by FFQ were assessed using Spearman's correlation coefficients.Results: Although we observed a moderate correlation between dietary ITC intake derived from a 12-day WFR and urinary ITC excretion, notwithstanding the cooking process, the correlation between dietary ITC intake estimated by FFQ and mean urinary ITC excretion was low. However, the correlation was improved when we compared urinary ITC excretion and a 3-day WFR or FFQ collected during winter. Our FFQ showed good reproducibility.Conclusion: Although seasonality is a critical factor, dietary ITC intake estimated using an FFQ showed moderate validity and reproducibility and can be used in future epidemiological studies. [ABSTRACT FROM AUTHOR]

Objective: To translate and validate the Child Three-Factor Eating Questionnaire (CTFEQr17), assessing cognitive restraint (CR), uncontrolled eating (UE) and emotional eating (EE), among French-speaking Canadian young individuals.Design: Phase 1 comprised a translation and the evaluation of the comprehension of the questionnaire. Phase 2 comprised a confirmatory factor analysis (CFA), the evaluation of internal consistency (Cronbach's α), test-retest reliability (intra-class correlation coefficients (ICC)) and construct validity, including correlations among the CTFEQr17 and Eating Attitudes Test (EAT-26), anthropometrics, dietary intake and diet quality.Setting: Primary and secondary schools, Québec City, Canada.Participants: Phases 1 and 2 included 20 (40 % boys, mean age 11·5 (sd 2·4) years) and 145 (48 % boys, mean age 11·0 (sd 1·9) years) participants, respectively.Results: Phase 1 resulted in the questionnaire to be used in Phase 2. In Phase 2, the CFA revealed that the seventeen item, three-factor model (CTFEQr17) provided an excellent fit. Internal consistency was good (Cronbach's α: 0·81-0·90). Test-retest reliability was moderate to good (ICC = 0·59, (95 % CI 0·48, 0·70), ICC = 0·78, (95 % CI 0·70, 0·84), ICC = 0·50, (95 % CI 0·38, 0·62) for CR, UE and EE, respectively). CR correlated with EAT-26 score (r = 0·43, P < 0·0001). UE and EE correlated negatively with BMI Z-scores (r = -0;·26, P = 0·003; r = -0;·19, P = 0·03, respectively). CR correlated with the proportion of energy intake from protein and diet quality (r = 0·18, P = 0·04; r = 0·20, P = 0·02, respectively).Conclusion: The CTFEQr17 is suitable to use among French-speaking Canadian young individuals. [ABSTRACT FROM AUTHOR]

Objective: To develop and validate classification criteria for microscopic polyangiitis (MPA).Methods: Patients with vasculitis or comparator diseases were recruited into an international cohort. The study proceeded in five phases: (1) identification of candidate items using consensus methodology, (2) prospective collection of candidate items present at the time of diagnosis, (3) data-driven reduction of the number of candidate items, (4) expert panel review of cases to define the reference diagnosis and (5) derivation of a points-based risk score for disease classification in a development set using least absolute shrinkage and selection operator logistic regression, with subsequent validation of performance characteristics in an independent set of cases and comparators.Results: The development set for MPA consisted of 149 cases of MPA and 408 comparators. The validation set consisted of an additional 142 cases of MPA and 414 comparators. From 91 candidate items, regression analysis identified 10 items for MPA, 6 of which were retained. The final criteria and their weights were as follows: perinuclear antineutrophil cytoplasmic antibody (ANCA) or anti-myeloperoxidase-ANCA positivity (+6), pauci-immune glomerulonephritis (+3), lung fibrosis or interstitial lung disease (+3), sino-nasal symptoms or signs (-3), cytoplasmic ANCA or anti-proteinase 3 ANCA positivity (-1) and eosinophil count ≥1×109/L (-4). After excluding mimics of vasculitis, a patient with a diagnosis of small- or medium-vessel vasculitis could be classified as having MPA with a cumulative score of ≥5 points. When these criteria were tested in the validation data set, the sensitivity was 91% (95% CI 85% to 95%) and the specificity was 94% (95% CI 92% to 96%).Conclusion: The 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology classification criteria for MPA are now validated for use in clinical research. [ABSTRACT FROM AUTHOR]

Background: The reward deficiency syndrome (RDS) integrates psychological, neurological, and genetic factors of addictive, impulsive, and compulsive behaviors. However, to date, no instrument has been validated to assess the RDS construct.Aims: The present study developed and tested a tool to assess RDS.Methods: Data were collected on two college and university samples. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed on Sample 1 (N = 1726), and confirmatory analysis was conducted on an independent sample (N = 253). Impulsivity and sensation-seeking were assessed.Results: Based on EFAs, a 29-item Reward Deficiency Syndrome Questionnaire (RDSQ-29) was developed, containing four subscales (lack of sexual satisfaction, activity, social concerns, and risk-seeking behavior). CFA indicated good fit (comparative fit index (CFI) = 0.941; Tucker-Lewis index (TLI) = 0.933; root mean square error of approximation (RMSEA) = 0.068). Construct validity analysis showed strong relationship between sensation-seeking and the RDS scale.Conclusion: The RDSQ-29 is an adequate scale assessing psychological and behavioral aspects of RDS. The RDSQ-29 assesses psychological and behavioral characteristics that may contribute to addictions generally. [ABSTRACT FROM AUTHOR]

Objective: The Psychosocial Assessment Tool (PAT) is a well-validated, brief screener of family psychosocial risk. Since 2014 a web-based version of the PAT (WebPAT) has been available for use by clinicians and researchers, but the psychometric properties have not been examined. The objective of this article was to examine the factor structure and internal consistency of the WebPAT, which was administered to caregivers of youth with cancer.Methods: The WebPAT was administered to 1,252 caregivers of youth with cancer across 29 institutions. Confirmatory factor analysis (CFA) was used to examine the factor structure of the WebPAT. Internal consistencies of the total and subscale scores were examined via the Kuder-Richardson 20 coefficient. The distribution of total PAT score across the three risk categories of the Pediatric Psychosocial Preventative Health Model (PPPHM) was also examined.Results: The CFA supported the original seven-factor structure of the PAT (Family Structure, Social Support, Child Problems, Sibling Problems, Family Problems, Stress Reactions, and Family Beliefs). Internal consistencies were strong for the total PAT score and four subscales (Social Support, Child Problems, Sibling Problems, and Family Problems). The distribution of total PAT scores across PPPHM risk categories was consistent with prior research.Conclusions: The WebPAT is a psychometrically sound screener of psychosocial risk in families of youth with cancer. Healthcare providers can use the WebPAT to assess families' psychosocial risk and guide the provision of psychosocial care. Future research should evaluate the implementation of the PAT and identify barriers and facilitators to implementation. [ABSTRACT FROM AUTHOR]

Background: The assessment of preschoolers' motor skills is essential to know young children's motor development and evaluate the intervention effects of promotion in children's sports activities. The purpose of this study was to review the motor skills assessment tools in Chinese pre-school-aged children, compare them in the international context, and provide guidelines to find appropriate motor skill assessment tools for developing children in China.Methods: A comprehensive literature search was carried out using the WANFAGN, CNKI, VIP, ERIC, EMBASE, MEDLINE, and SPORT Discus databases. Relevant articles published between January 2000 and May 2020 were retrieved. Studies that described the discriminative and evaluative measures of motor skills among the population aged 3-6 years in China were included.Results: A total of 17 studies were included in this study describing seven tools, including four self-developed tools and three international tools used in China. TGMD-2 appeared in a large proportion of the studies. The international tools used in China were incomplete in terms of translation, verification of reliability and validity, item selection, and implementation. Regarding the self-constructed tools, the CDCC was the most utilized self-developed tool, but it was mainly applied in intellectual development assessment. By comparing Chinese self-constructed and international tools, the construction of the CDCC and the Gross Motor Development Assessment Scale contained relatively complete development steps. However, the test content, validity and reliability, implementation instruction, and generalizability of self-constructed tools are still lacking.Conclusions: Both international and self-developed motor skills assessment tools have been rarely applied in China. Available tools lack enough validation and appropriate adjustments. Cultural differences in motor development between Chinese and Western populations should be considered when constructing a Chinese localized motor skill assessment tool. [ABSTRACT FROM AUTHOR]

Objective: To adapt and assess reliability of the Chilean version of Nutritional Environment Measurement for Stores (NEMS-S-CHILE) to measure the food environment of stores in urban areas.Design: NEMS-S-CHILE was the NEMS-S tool adapted to the Chilean food patterns; foods were grouped according to level of processing in (a) unprocessed or minimally processed foods, (b) processed culinary ingredients, (c) processed foods, and (d) ultra-processed foods, and scored according to NEMS-S-CHILE tool. Reliability inter evaluators was measured.Setting: City of Concepción, Bio-Bio region, Chile.Participants: Seventeen of a total of 25 supermarkets, and 9 out of 10 street markets according to the municipal registry and the street market trade unions, representing 74.3% of both types of food premises in Concepción.Results: Reliability inter evaluators was measured by the following aspects: product availability, price, quality, and variety, through the intraclass correlation coefficient (ICC), percent agreement, and Cohen's kappa analysis. Reliability was high for availability, where the kappa index and ICC were acceptable, ranging from moderate to high (0.42 to 1.00 for the kappa coefficient and 0.65 to 1.00 for ICC), as well as for prices (ICC: 0.65-1.00 ), variety (kappa: 0.76-1.00) and quality (percent agreement: 68.2- 100%).Conclusions: The adapted instrument, NEMS-S-CHILE, has a high reliability inter evaluators and can be useful to measure the availability of foods by the level of processing according to the prevalent food system in developing countries. [ABSTRACT FROM AUTHOR]

Background/objectives: Bioelectrical impedance is one of the most used clinical techniques to assess body composition; however, it is necessary that the available predictive equations are valid for the evaluated subjects. This study aimed to develop and cross-validate equations for fat-free mass (FFM) and lean soft tissue mass (LSTM) by bioelectrical impedance for Brazilian women, in addition to test the validity of other available equations.Subjects/methods: Cross-sectional study with 222 women aged 20-59 years, randomly divided into two groups: development and cross-validation. The standard technique for assessing fat mass, FFM and LSTM was dual energy X-ray absorptiometry. Paired t test, multiple regression, and Bland-Altman plots were used to test the validity of the proposed models, as well as to perform cross-validation of the models.Results: The equations derived in this study were: FFM = 16.284 + 0.442 × (Height2/Resistance) - 0.13 × age + 0.302 × Weight - 0.121 × Waist Circumference; r2 = 0.86; SEE = 2.32 kg; and LSTM = 14.732 + 0.427 × (Height2/Resistance) - 0.125 × age + 0.291 × Weight - 0.115 × Waist Circumference; r2 = 0.92; SEE = 2.29 kg. In addition, the new equation for FFM showed better agreement when compared to another equation developed for a Brazilian population.Conclusions: The newly developed equations provide a valid FFM and LSTM estimation and are recommended for Brazilian women with similar characteristics. [ABSTRACT FROM AUTHOR]

Objective: FFQ assess habitual dietary intake and are relatively inexpensive to process, but may take up to 60 min to complete. This article describes the validation of the Flower-FFQ, which consists of four short FFQ measuring the intake of energy and macronutrients or specific (micro)nutrients/foods that can be merged into one complete daily assessment using predefined algorithms.Design: Participants completed the Flower-FFQ and validated regular-FFQ (n 401). Urinary N (n 242) and K excretions (n 361) were measured. We evaluated: (1) group-level bias, (2) correlations and (3) cross-classification.Setting: Observational study.Participants: Dutch adults, 54 ± 11 (mean ± SD) years.Results: Flower-FFQ1, Flower-FFQ2, Flower-FFQ3 and Flower-FFQ4 were completed in ±24, 9, 8 and 9 min (±50 min total), respectively. The regular-FFQ was completed in ±43 min. Mean energy (flower v. regular: 7953 v. 8718 kJ/d) and macronutrient intakes (carbohydrates: 204 v. 222 g/d; protein: 75 v. 76 g/d; fat: 74 v. 83 g/d; ethanol: 8 v. 12 g/d) were comparatively similar. Spearman correlations between Flower-FFQ and regular-FFQ ranged from 0·60 to 0·80 for macronutrients and from 0·40 to 0·80 for micronutrients and foods. For all micronutrients and foods, ≥ 78 % of the participants classified in the same/adjacent quartile. The Flower-FFQ underestimated urinary N and K excretions by 24 and 18 %; 75 and 73 % of the participants ranked in the same/adjacent quartile.Conclusion: Completing the Flower-FFQ required 50 min with a maximum of 25 min per short FFQ. The Flower-FFQ has a moderate to good ranking ability for most nutrients and foods and performs sufficiently to study diet-disease associations. [ABSTRACT FROM AUTHOR]

Background: Infectious disease outbreaks present unique challenges to study designs for vaccine evaluation. Test-negative design (TND) studies have previously been used to estimate vaccine effectiveness and have been proposed for Ebola virus disease (EVD) vaccines. However, there are key differences in how cases and controls are recruited during outbreaks and pandemics of novel pathogens, whcih have implications for the reliability of effectiveness estimates using this design.Methods: We use a modelling approach to quantify TND bias for a prophylactic vaccine under varying study and epidemiological scenarios. Our model accounts for heterogeneity in vaccine distribution and for two potential routes to testing and recruitment into the study: self-reporting and contact-tracing. We derive conventional and hybrid TND estimators for this model and suggest ways to translate public health response data into the parameters of the model.Results: Using a conventional TND study, our model finds biases in vaccine effectiveness estimates. Bias arises due to differential recruitment from self-reporting and contact-tracing, and due to clustering of vaccination. We estimate the degree of bias when recruitment route is not available, and propose a study design to eliminate the bias if recruitment route is recorded.Conclusions: Hybrid TND studies can resolve the design bias with conventional TND studies applied to outbreak and pandemic response testing data, if those efforts collect individuals' routes to testing. Without route to testing, other epidemiological data will be required to estimate the magnitude of potential bias in a conventional TND study. Since these studies may need to be conducted retrospectively, public health responses should obtain these data, and generic protocols for outbreak and pandemic response studies should emphasize the need to record routes to testing. [ABSTRACT FROM AUTHOR]

Background: Vaccination rates for measles, mumps, and rubella (MMR) and diphtheria, tetanus, pertussis, and polio (Tdap-IPV) are not optimal among German adolescents. Education in combination with easy access to vaccination may be a promising approach to improve vaccination rates. The present paper describes a pilot study of a planned cluster randomized controlled trial (cRCT) in which we aim to improve MMR and Tdap-IPV vaccination rates together with knowledge and self-efficacy in a school setting.Methods: The study covered 863 students from 41 classes of four schools. The optimization and feasibility of access to schools, recruitment strategies, intervention, and assessment procedures were examined. The course and content of the educational unit were evaluated with a mixed-methods approach. A pre-post measurement design was tested for the vaccination rate in all schools. Additionally, at two schools, improvement in vaccination-related knowledge and perceived self-efficacy were measured by questionnaire pre-educational unit (n=287) and post-educational unit (n=293). The remaining two schools provided only postintervention data. Finally, we evaluated the psychometric properties (i.e., reliability, retest reliability, and change rates) of the questionnaire, applying Cronbach's alpha, factor analyses, generalized estimating equations and linear mixed models.Results: The findings of the pilot study indicated good feasibility. Of the total sample, 437 students (50.9%) brought their vaccination cards to school, 68 students received Tdap-IPV vaccinations, and 11 received MMR vaccinations. Out of six knowledge questions, on average, the students had M=2.84 (95% CI [2.69, 3.10]) correct answers before and M=4.45 (95% CI [4.26, 4.64]) after the class. Ranging from 1 to 4, the self-efficacy scale changed by 0.3 points (p <.001); Cronbach's alpha was 0.67 and 0.76 pre- and post-educational unit, respectively, and a one-factor solution was found. Content analysis of the five semistructured group interviews (n=12, 58.3% female) showed that all students found the length of the intervention to be appropriate. The teaching methods, including interactive and social media components, were perceived as very good.Conclusions: A school-based educational and on-site vaccination intervention appears to be feasible in terms of procedures and the adequacy of the instruments for the adolescent target group.Trial Registration: ISRCTN, ISRCTN18026662 . Pilot study for main trial registered 8 December 2017. [ABSTRACT FROM AUTHOR]

Background: The Patient Benefit Assessment Scale for Hospitalised Older Patients (P-BAS HOP) is a tool developed to both identify the priorities of the individual patient and to measure the outcomes relevant to him/her, resulting in a Patient Benefit Index (PBI), indicating how much benefit the patient had experienced from the hospitalisation. The reliability and the validity of the P-BAS HOP appeared to be not yet satisfactory and therefore the aims of this study were to adapt the P-BAS HOP and transform it into a picture version, resulting in the P-BAS-P, and to evaluate its feasibility, reliability, validity, responsiveness and interpretability.Methods: Process of instrument development and evaluation performed among hospitalised older patients including pilot tests using Three-Step Test-Interviews (TSTI), test-retest reliability on baseline and follow-up, comparing the PBI with Intraclass Correlation Coefficient (ICC), and hypothesis testing to evaluate the construct validity. Responsiveness of individual P-BAS-P scores and the PBI with two different weighing schemes were evaluated using anchor questions. Interpretability of the PBI was evaluated with the visual anchor-based minimal important change (MIC) distribution method and computation of smallest detectable change (SDC) based on ICC.Results: Fourteen hospitalised older patients participated in TSTIs at baseline and 13 at follow-up after discharge. After several adaptations, the P-BAS-P appeared feasible with good interviewer's instructions. The pictures were considered relevant and helpful by the participants. Reliability was tested with 41 participants at baseline and 50 at follow-up. ICC between PBI1 and PBI2 of baseline test and retest was 0.76, respectively 0.73. At follow-up 0.86, respectively 0.85. For the construct validity, tested in 169 participants, hypotheses regarding importance of goals were confirmed. Regarding status of goals, only the follow-up status was confirmed, baseline and change were not. The responsiveness of the individual scores and PBI were weak, resulting in poor interpretability with many misclassifications. The SDC was larger than the MIC.Conclusions: The P-BAS-P appeared to be a feasible instrument, but there were methodological barriers for the evaluation of the reliability, validity, and responsiveness. We therefore recommend further research into the P-BAS-P. [ABSTRACT FROM AUTHOR]

Infectious disease models can be of great use for understanding the underlying mechanisms that influence the spread of diseases and predicting future disease progression. Modeling has been increasingly used to evaluate the potential impact of different control measures and to guide public health policy decisions. In recent years, there has been rapid progress in developing spatio-temporal modeling of infectious diseases and an example of such recent developments is the discrete-time individual-level models (ILMs). These models are well developed and provide a common framework for modeling many disease systems; however, they assume the probability of disease transmission between two individuals depends only on their spatial separation and not on their spatial locations. In cases where spatial location itself is important for understanding the spread of emerging infectious diseases and identifying their causes, it would be beneficial to incorporate the effect of spatial location in the model. In this study, we thus generalize the ILMs to a new class of geographically dependent ILMs, to allow for the evaluation of the effect of spatially varying risk factors (e.g., education, social deprivation, environmental), as well as unobserved spatial structure, upon the transmission of infectious disease. Specifically, we consider a conditional autoregressive (CAR) model to capture the effects of unobserved spatially structured latent covariates or measurement error. This results in flexible infectious disease models that can be used for formulating etiological hypotheses and identifying geographical regions of unusually high risk to formulate preventive action. The reliability of these models is investigated on a combination of simulated epidemic data and Alberta seasonal influenza outbreak data ($2009$). This new class of models is fitted to data within a Bayesian statistical framework using Markov chain Monte Carlo methods. [ABSTRACT FROM AUTHOR]

Rationale: Inspiratory flow limitation (IFL), characterized by flattening of individual breaths on the airflow/time tracing, is a noninvasive indicator of elevated upper airway resistance. An IFL "event" in isolation has not been defined, nor has the ability to reproducibly identify event occurrence been tested. IFL events and their association with immediate physiological responses-as well as the impact of characteristics such as age, sex, sleep stage, sleepiness, and event duration on their association with such outcomes-have not been studied. Symptomatic patients with a normal to mildly abnormal apnea-hypopnea index who have predominant IFL on their polysomnography may benefit from treatment. Objectives: To test the reproducibility of identifying IFL events and their termination and to determine the frequency of the immediate physiological response to their occurrence, including desaturation, electroencephalography (EEG) arousal, and increased heart rate (HR). Methods: Fifty-eight patients with obstructive sleep apnea (OSA) underwent full diagnostic polysomnography. IFL events and their termination were identified manually using predefined rules from the unscored nasal cannula flow channel alone and were evaluated for responses such as EEG arousal, oxygen desaturation of ⩾3%, and HR increase. Results: Interscorer reliability was acceptable, with an average percent agreement for occurrence of 82% ± 3%. Of all IFL events, 24% (regardless of the definition) were not associated with an EEG arousal, an increase in HR, or O2 desaturation. Of all IFL events scored, 25% caused O2 desaturation, 40% were associated with an EEG arousal, and 55% were associated with an increase in HR; 67% caused either an EEG arousal and/or an increase in HR. Responses were observed to occur either in isolation or in combination. IFL events that terminated with at least two non-IFL breaths, one of which had a 200% increase in amplitude, were significantly associated with O2 desaturation, EEG arousal, and increase in HR compared with events that ended in one non-IFL breath. IFL events that had a >50% reduction in flow amplitude compared with baseline were significantly associated with O2 desaturation compared with events that had a 30% reduction or less. Conclusions: Most IFL events resulted in immediate physiological responses, and no single consequence reliably occurred after every event. We propose a framework that can incorporate the scoring of IFL events into assessing the diagnosis and severity of OSA and suggest that no single consequence be used to define IFL as a respiratory event. The relationship of IFL events to OSA outcomes remains to be tested. [ABSTRACT FROM AUTHOR]

Background: The Pentagon Drawing Test (PDT) is a common assessment for visuospatial function. Evaluating the PDT by artificial intelligence can improve efficiency and reliability in the big data era. This study aimed to develop a deep learning (DL) framework for automatic scoring of the PDT based on image data.Methods: A total of 823 PDT photos were retrospectively collected and preprocessed into black-and-white, square-shape images. Stratified fivefold cross-validation was applied for training and testing. Two strategies based on convolutional neural networks were compared. The first strategy was to perform an image classification task using supervised transfer learning. The second strategy was designed with an object detection model for recognizing the geometric shapes in the figure, followed by a predetermined algorithm to score based on their classes and positions.Results: On average, the first framework demonstrated 62%accuracy, 62%recall, 65%precision, 63%specificity, and 0.72 area under the receiver operating characteristic curve. This performance was substantially outperformed by the second framework, with averages of 94%, 95%, 93%, 93%, and 0.95, respectively.Conclusion: An image-based DL framework based on the object detection approach may be clinically applicable for automatic scoring of the PDT with high efficiency and reliability. With a limited sample size, transfer learning should be used with caution if the new images are distinct from the previous training data. Partitioning the problem-solving workflow into multiple simple tasks should facilitate model selection, improve performance, and allow comprehensible logic of the DL framework. [ABSTRACT FROM AUTHOR]

Transthoracic echocardiography (TTE) and Cardiac Magnetic Resonance (CMR) have complementary roles in the severity grading of mitral regurgitation (MR). Our objective was to systematically review the correlation of MR severity as assessed by TTE and CMR. We searched MEDLINE and Cochrane Library for original series published between January 1st, 2000 and March 23rd, 2020. We used Cohen's kappa coefficient to measure agreement between modalities. We plotted a hierarchical summary receiver operator characteristic (HSROC) curve and estimated the area under the curve (AUC) to assess the concordance between the two imaging modalities for the detection of severe MR. We identified 858 studies, of which 65 underwent full-text assessment and 8 were included in the meta-analysis. A total of 718 patients were included (425 males, 59%) in the final analysis. There was significant heterogeneity in the methods used and considerable variation in kappa coefficient, ranging from 0.10 to 0.48. Seven out of eight studies provided the necessary data to plot HSROC curves and calculate the AUC. The AUC for detecting severe MR was 0.83 (95% CI 0.80 to 0.86), whereas the AUC for detecting moderate to severe MR was 0.83 (95% CI 0.79 to 0.86). The agreement between TTE and CMR in MR severity evaluation is modest across the entire spectrum of severity grading. However, when focusing on patients with at least moderate MR the concordance between TTE and CMR is very good. Further prospective studies comparing hard clinical endpoints based on the CMR and TTE assessment of MR severity are needed. [ABSTRACT FROM AUTHOR]

Aim: To analyze the agreement between tuberculin skin test (TST) and fourth-generation QuantiFERON (QFT)-TB Gold Plus [interferon gamma (INF-γ) release assays (IGRA)] for latent tuberculosis infection (LTBI) diagnosis among under-five children who are undernourished and/or who have history of contact with active tuberculosis (TB) patients.Methods: Children from the age group of 6 months to 5 years (undernourished or tuberculosis household contacts) were screened through anganwadis (government playschools) and TB Health posts from Mumbai, India during September 2019 to January 2021. Both TST and QFT-TB Gold Plus test were carried out to diagnose LTBI.Results: Out of the total 299, 35 (11.7%) (95% CI 8.1-15.3%) children tested positive by IGRA (QFT-TB Gold Plus) and 68 (22.7%) (95% CI 18.0-27.4%) by TST, suggestive of moderate concordance (κ = 0.483) between both tests. IGRA and TST showed moderate concordance in children <24 months (κ = 0.478). Moreover, 26 (21.1%) children with TB contact had both TST and IGRA positive with moderate concordance (κ = 0.550). A fair concordance (κ = 0.396) was observed between IGRA and TST in undernourished children. Also, 45 (15.0%) children showed discordance of which 39 (13.0%) had positive TST but negative IGRA and 6 (2.0%) had negative TST but positive IGRA.Conclusions: The study strongly recommends both TST and QFT-TB Gold Plus test for the diagnosis of LTBI in under-five children. A moderate concordance in children <24 months endorses the reliability of QFT-TB Gold Plus in diagnosing LTBI in this age group. This study highlights the need for screening undernourished children for LTBI to consider repeating IGRA testing for TST positives as per the window period and risk of ongoing exposure. [ABSTRACT FROM AUTHOR]

Background: Patient complaints about care in general practice are underutilized as a source of safety improvement data.Objective: This study aimed to adapt a secondary care complaints analysis tool for use in general practice contexts and assess the validity, reliability and usability of the adapted tool.Methods: The study was conducted in two phases. Phase A: The Healthcare Complaints Analysis Tool (HCAT) designed for use in secondary care was adapted for use in general practice using an iterative six-stage process. Phase B: Participants from key stakeholder groups [General practitioners (n = 5), complaints managers (n = 9), health service researchers (n = 4)]. Participants completed an online survey and analysed 20 fictionalized patient complaints using the adapted tool. Inter-rater reliability and agreement with a referent standard were analysed using Gwet's AC1 statistic.Results: Phase A: The HCAT was adapted to the Healthcare Complaints Analysis Tool (General Practice) [HCAT(GP)]. The HCAT(GP) tool consists of three domains (clinical, management and relationship problems), and seven categories. The HCAT(GP) had both content and face validity. Phase B: Inter-rater reliability was substantial for the HCAT(GP) categories (Gwet's AC1 = 0.65). Within-group agreement on the seven HCAT(GP) categories was substantial to perfect (AC1 0.61-0.85). Participants had substantial to perfect agreement with the referent standard across the survey with a mean AC1 of 0.899 (Range 0.76-0.97).Conclusions: This study reports the adaptation of the HCAT(GP) and has established that the tool has sufficient validity, reliability and usability. This adapted tool can be applied to general practice complaints to identify areas for improvement. [ABSTRACT FROM AUTHOR]

Background: Patients remain an under-utilized source of information on patient safety, as reflected by the dearth of patient-report measures of safety climate, particularly for use in general practice settings. Extant measures are marked by poor coverage of safety climate domains, inadequate psychometric properties and/or lack of consideration of usability.Objective: To develop a novel patient-report measure of safety climate specifically for completion by general practice patients, and to establish the validity, reliability and usability of this measure.Methods: An iterative process was used to develop the safety climate measure, with patient and general practitioner input. A cross-sectional design was employed to examine the validity (content, construct and convergent), reliability (internal consistency), and usability (readability and burden) of the measure.Results: A total of 584 general practice patients completed the measure. The exploratory factor analysis identified five factors pertaining to safety climate in general practice: Feeling of Safety with GP; Practice Staff Efficiency and Teamwork; Staff Stress and Workload; Patient Knowledge and Accountability, and; Safety Systems and Behaviours. These factors strongly correlated with two global safety measures, demonstrating convergent validity. The measure showed strong internal consistency, and was considered usable for patients as indicated by readability and duration of completion.Conclusion: Our novel measure of safety climate for use in general practice demonstrates favourable markers of validity, reliability and usability. This measure will provide a mechanism for the patient voice to be heard in patient safety measurement, and to be used to improve patient safety in general practice. [ABSTRACT FROM AUTHOR]

Background: Even though both EUCAST and CLSI consider broth microdilution (BMD) as the reference method for antimicrobial susceptibility testing (AST) of colistin, the method exhibits potential flaws related to properties of the colistin molecule.Objectives: To develop a flow cytometry method (FCM) for colistin AST and to validate it against BMD, a commercial screening test and WGS.Methods: Colistin-mediated loss of membrane integrity in Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter spp. was detected with the fluorescent probe YoPro-1 by FCM. An international collection of 65 resistant and 109 susceptible isolates were analysed and the colistin concentration required to reach the EC50 was compared with the BMD MIC and the presence of genotypic resistance markers.Results: The overall FCM sensitivity and specificity for colistin resistance was 89% and 94%, with E. coli > K. pneumoniae > P. aeruginosa, whereas the performance for Acinetobacter spp. was poor. All tested E. coli were correctly categorized. Three K. pneumoniae isolates with genotypic findings consistent with colistin resistance were detected by FCM but not BMD. Compared with BMD, FCM delivered AST results with a 75% reduction of time.Conclusions: Here, we present a rapid FCM-based AST assay for qualitative and quantitative testing of colistin resistance in E. coli and K. pneumoniae. The assay revealed probable chromosomal colistin resistance in K. pneumoniae that was not detected by BMD. If confirmed, these results question the reliability of BMD for colistin testing. [ABSTRACT FROM AUTHOR]

An observational coding system was developed to track clinical change in children with autism spectrum disorder (ASD) during psychotherapy. The Pediatric Autism Spectrum Therapy Observation System (PASTOS) consists of 23 items divided into 5 subscales and is used to rate child behaviors in individual psychotherapy sessions. Manual-based cognitive behavioral therapy session transcripts of 22 children diagnosed with ASD (IQ > 70) and a concurrent anxiety disorder (M = 9.41 years, SD = 1.56 years) enrolled in a randomized, controlled trial were coded. Results suggested that the PASTOS exhibited promising interrater reliability, internal consistency, convergent validity at post-treatment, and treatment sensitivity. The PASTOS may be a useful tool for studying process and outcome in psychotherapy research on children with ASD. [ABSTRACT FROM AUTHOR]

Background: Magnetic resonance imaging (MRI) visual scales of brain atrophy are important for differential diagnosis of dementias in routine clinical practice. Atrophy patterns in early- and late-onset Alzheimer's disease (AD) can be different according to some studies.Objective: Our goal was to assess brain atrophy patterns in early- and late-onset AD using our recently developed simple MRI visual scales and evaluate their reliability.Methods: We used Hippocampo-horn percentage (Hip-hop) and Parietal Atrophy Score (PAS) to compare mediotemporal and parietal atrophy on brain MRI among 4 groups: 26 patients with early-onset AD, 21 younger cognitively normal persons, 32 patients with late-onset AD, and 36 older cognitively normal persons. Two raters scored all brain MRI to assess reliability of the Hip-hop and PAS. Brain MRIs were obtained from Alzheimer's Disease Neuroimaging Initiative (ADNI) database.Results: The patients with early-onset AD had significantly more pronounced mediotemporal and also parietal atrophy bilaterally compared to the controls (both p < 0.01). The patients with late-onset AD had significantly more pronounced only mediotemporal atrophy bilaterally compared to the controls (p < 0.000001), but parietal lobes were the same. Intra-rater and inter-rater reliability of both visual scales Hip-hop and PAS were almost perfect in all cases (weighted-kappa value ranged from 0.90 to 0.99).Conclusion: While mediotemporal atrophy detected using Hip-hop is universal across the whole AD age spectrum, parietal atrophy detected using PAS is worth rating only in early-onset AD. Hip-hop and PAS are very reliable MRI visual scales. [ABSTRACT FROM AUTHOR]

Background: AMSTAR-2 ('A Measurement Tool to Assess Systematic Reviews, version 2') and ROBIS ('Risk of Bias in Systematic Reviews') are independent instruments used to assess the quality of conduct of systematic reviews/meta-analyses (SR/MAs). The degree of overlap in methodological constructs together with the reliability and any methodological gaps have not been systematically assessed and summarized in the field of nutrition.Methods: We performed a systematic survey of MEDLINE, EMBASE, and the Cochrane Library for SR/MAs published between January 2010 and November 2018 that examined the effects of any nutritional intervention/exposure for cancer prevention. We followed a systematic review approach including two independent reviewers at each step of the process. For AMSTAR-2 (16 items) and ROBIS (21 items), we assessed the similarities, the inter-rater reliability (IRR) and any methodological limitations of the instruments. Our protocol for the survey was registered in PROSPERO (CRD42019121116).Results: We found 4 similar domain constructs based on 11 comparisons from a total of 12 AMSTAR-2 and 14 ROBIS items. Ten comparisons were considered fully overlapping. Based on Gwet's agreement coefficients, six comparisons provided almost perfect (> 0.8), three substantial (> 0.6), and one a moderate level of agreement (> 0.4). While there is considerable overlap in constructs, AMSTAR-2 uniquely addresses explaining the selection of study designs for inclusion, reporting on excluded studies with justification, sources of funding of primary studies, and reviewers' conflict of interest. By contrast, ROBIS uniquely addresses appropriateness and restrictions within eligibility criteria, reducing risk of error in risk of bias (RoB) assessments, completeness of data extracted for analyses, the inclusion of all necessary studies for analyses, and adherence to predefined analysis plan.Conclusions: Among the questions on AMSTAR-2 and ROBIS, 70.3% (26/37 items) address the same or similar methodological constructs. While the IRR of these constructs was moderate to perfect, there are unique methodological constructs that each instrument independently addresses. Notably, both instruments do not address the reporting of absolute estimates of effect or the overall certainty of the evidence, items that are crucial for users' wishing to interpret the importance of SR/MA results. [ABSTRACT FROM AUTHOR]

Background: Deficit accumulation frailty indices (FIs) are widely used to characterize frailty. FIs vary in number and composition of items; the impact of this variation on reliability and clinical applicability is unknown.Method: We simulated 12 000 studies using a set of 70 candidate deficits in 12 080 community-dwelling participants 65 years and older. For each study, we varied the number (5, 10, 15, 25, 35, 45) and composition (random selection) of items defining the FI and calculated descriptive and predictive estimates: frailty score, prevalence, frailty cutoff, mortality odds ratio, predicted probability of mortality for FI = 0.28 (prevalence threshold), and FI cutoff predicting 10% mortality over the follow-up. We summarized the estimates' medians and spreads (0.025-0.975 quantiles) by number of items and calculated intraclass correlation coefficients (ICCs).Results: Medians of frailty scores were 0.11-0.12 with decreasing spreads from 0.04-0.24 to 0.10-0.14 for 5-item and 45-item FIs. The median cutoffs identifying 15% as frail was 0.19-0.20 and stable; the spreads decreased with more items. However, medians and spreads for the prevalence of frailty (median: 11%-3%), mortality odds ratio (median: 1.24-2.19), predicted probability of mortality (median: 8%-17%), and FI cutoff predicting 10% mortality (median: 0.38-0.20) varied markedly. ICC increased from 0.19 (5-item FIs) to 0.84 (45-item FIs).Conclusions: Variability in the number and composition of items of individual FIs strongly influences their reliability. Estimates using FIs may not be sufficiently stable for generalizing results or direct application. We propose avenues to improve the development, reporting, and interpretation of FIs. [ABSTRACT FROM AUTHOR]

Objective: A model that can predict reliably the risk of pre-eclampsia (PE)-related pregnancy complications does not exist. The aim of this study was to develop and validate internally a clinical prediction model to predict the risk of a composite outcome of PE-related maternal and fetal complications within 7, 14 and 30 days of testing in women with suspected or confirmed PE.Methods: The data for this study were derived from a prospective, multicenter, observational cohort study on women with a singleton pregnancy and suspected or confirmed PE at 20 to < 37 weeks' gestation. For the development of the prediction model, the possible contribution of clinical and standard laboratory variables, as well as the biomarkers soluble fms-like tyrosine kinase-1 (sFlt-1), placental growth factor (PlGF) and their ratio, in the prediction of a composite outcome of PE-related complications, consisting of maternal and fetal adverse events within 7, 14 and 30 days, was explored using multivariable competing-risks regression analysis. The discriminative ability of the model was assessed using the concordance (c-) statistic. A bootstrap validation procedure with 500 replications was used to correct the estimate of the prediction model performance for optimism and to compute a shrinkage factor for the regression coefficients to correct for overfitting.Results: Among 384 women with suspected or confirmed PE, 96 (25%) had an adverse PE-related outcome at any time after hospital admission. Important predictors of adverse PE-related outcome included sFlt-1/PlGF ratio, gestational age at the time of biomarker measurement and protein-to-creatinine ratio as continuous variables. The c-statistics (corrected for optimism) for developing a PE-related complication within 7, 14 and 30 days were 0.89, 0.88 and 0.87, respectively. There was limited overfitting, as indicated by a shrinkage factor of 0.91.Conclusions: We propose a simple clinical prediction model with good discriminative performance to predict PE-related complications. Determination of its usefulness in clinical practice awaits further investigation and external validation. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Background: User-friendly information at the point of care for health care professionals should be well structured, rapidly accessible, comprehensive, and trustworthy. The reliability of information and the associated methodological process must be clear. There is no standard tool to evaluate the trustworthiness of such point-of-care (POC) information.Objective: We aim to develop and validate a new tool for assessment of trustworthiness of evidence-based POC resources to enhance the quality of POC resources and facilitate evidence-based practice.Methods: We designed the Critical Appraisal of Point-of-Care Information (CAPOCI) tool based on the criteria important for assessment of trustworthiness of POC information, reported in a previously published review. A group of health care professionals and methodologists (the authors of this paper) defined criteria for the CAPOCI tool in an iterative process of discussion and pilot testing until consensus was reached. In the next step, all criteria were subject to content validation with a Delphi study. We invited an international panel of 10 experts to rate their agreement with the relevance and wording of the criteria and to give feedback. Consensus was reached when 70% of the experts agreed. When no consensus was reached, we reformulated the criteria based on the experts' comments for a next round of the Delphi study. This process was repeated until consensus was reached for each criterion. In a last step, the interrater reliability of the CAPOCI tool was calculated with a 2-tailed Kendall tau correlation coefficient to quantify the agreement between 2 users who piloted the CAPOCI tool on 5 POC resources. Two scoring systems were tested: a 3-point ordinal scale and a 7-point Likert scale.Results: After validation, the CAPOCI tool was designed with 11 criteria that focused on methodological quality and author-related information. The criteria assess authorship, literature search, use of preappraised evidence, critical appraisal of evidence, expert opinions, peer review, timeliness and updating, conflict of interest, and commercial support. Interrater agreement showed substantial agreement between 2 users for scoring with the 3-point ordinal scale (τ=.621, P<.01) and scoring with the 7-point Likert scale (τ=.677, P<.01).Conclusions: The CAPOCI tool may support validation teams in the assessment of trustworthiness of POC resources. It may also provide guidance for producers of POC resources. [ABSTRACT FROM AUTHOR]

Background: Network meta-analysis (NMA) has attracted growing interest in evidence-based medicine. Consistency between different sources of evidence is fundamental to the reliability of the NMA results. The purpose of the present study was to estimate the prevalence of evidence of inconsistency and describe its association with different NMA characteristics.Methods: We updated our collection of NMAs with articles published up to July 2018. We included networks with randomised clinical trials, at least four treatment nodes, at least one closed loop, a dichotomous primary outcome, and available arm-level data. We assessed consistency using the design-by-treatment interaction (DBT) model and testing all the inconsistency parameters globally through the Wald-type chi-squared test statistic. We estimated the prevalence of evidence of inconsistency and its association with different network characteristics (e.g., number of studies, interventions, intervention comparisons, loops). We evaluated the influence of the network characteristics on the DBT p-value via a multivariable regression analysis and the estimated Pearson correlation coefficients. We also evaluated heterogeneity in NMA (consistency) and DBT (inconsistency) random-effects models.Results: We included 201 published NMAs. The p-value of the design-by-treatment interaction (DBT) model was lower than 0.05 in 14% of the networks and lower than 0.10 in 20% of the networks. Networks including many studies and comparing few interventions were more likely to have small DBT p-values (less than 0.10), which is probably because they yielded more precise estimates and power to detect differences between designs was higher. In the presence of inconsistency (DBT p-value lower than 0.10), the consistency model displayed higher heterogeneity than the DBT model.Conclusions: Our findings show that inconsistency was more frequent than what would be expected by chance, suggesting that researchers should devote more resources to exploring how to mitigate inconsistency. The results of this study highlight the need to develop strategies to detect inconsistency (because of the relatively high prevalence of evidence of inconsistency in published networks), and particularly in cases where the existing tests have low power. [ABSTRACT FROM AUTHOR]

Background: Early recurrences of atrial arrhythmias (ERAA) after atrial fibrillation (AF) catheter ablation do not predict procedural failure. A well-demarcated homogeneous lesion delivered by cryoballoon is less arrhythmogenic, and the recommended three-months blanking period may not refer to cryoballoon ablation (CBA).Objective: We aimed to evaluate the predictive role of ERAA after second-generation CBA using an implantable loop recorder.Methods: This prospective observational study enrolled 100 patients (58 males, median age 58) with paroxysmal/persistent AF undergoing pulmonary vein (PV) CBA using second-generation cryoballoon with simultaneous ECG loop recorder implantation. The duration of follow-up was 12 months, with scheduled visits at 3, 6 and 12 months.Results: 99 patients from 100 completed the 12-month follow-up period. ERAA occurred in 31.3 % of patients. 83.9 % of patients with ERAA also developed late recurrences. The 12-month freedom from AF in patients with ERAA was significantly lower than in those without ERAA (p < 0.0001). Non-paroxysmal AF and longer arrhythmia history were associated with increased risk of both early (HR 3.27; 95 % CI 1.32-8.08; p = 0.010 and HR 1.0147; 95 % CI 1.008-1.086; p = 0.015, respectively) and late recurrences (HR 3.89; 95 % CI 1.67-9.04; p = 0.002 and HR 1.0142; 95 % CI 1.007-1.078; p = 0.019, respectively) of AF. ERAA were another predictor for procedural failure (HR 15.2; 95 % CI (6.42-35.99; p = 0.019).Conclusions: ERAA occurred in the third of the patients after PV second-generation CBA and are strongly associated with procedural failure. Longer duration of AF history and persistent AF are independent predictors of AF's early and late recurrence. [ABSTRACT FROM AUTHOR]

Background: Noninvasive myocardial imaging modalities, such as cardiac magnetic resonance (CMR), single photon emission computed tomography (SPECT), and Positron emission tomography (PET), are well-established and extensively used to detect cardiac amyloid (CA). The purpose of this study is to directly compare CMR, SPECT, and PET scans in the diagnosis of CA, and to provide evidence for further scientific research and clinical decision-making.Methods: PubMed, Embase, and Cochrane Library were searched. Studies used CMR, SPECT and/or PET for the diagnosis of CA were included. Pooled sensitivity, specificity, positive and negative likelihood ratio (LR), diagnostic odds ratio (DOR), their respective 95% confidence intervals (CIs) and the area under the summary receiver operating characteristic (SROC) curve (AUC) were calculated. Quality assessment of included studies was conducted.Results: A total of 31 articles were identified for inclusion in this meta-analysis. The pooled sensitivities of CMR, SPECT and PET were 0.84, 0.98 and 0.78, respectively. Their respective overall specificities were 0.87, 0.92 and 0.95. Subgroup analysis demonstrated that 99mTc-HMDP manifested the highest sensitivity (0.99). 99mTc-PYP had the highest specificity (0.95). The AUC values of 99mTc-DPD, 99mTc-PYP, 99mTc-HMDP were 0.89, 0.99, and 0.99, respectively. PET scan with 11C-PIB demonstrated a pooled sensitivity of 0.91 and specificity of 0.97 with an AUC value of 0.98.Conclusion: Our meta-analysis reveals that SEPCT scans present better diagnostic performance for the identification of CA as compared with other two modalities. [ABSTRACT FROM AUTHOR]

The authors investigated the reproducibility of nighttime home blood pressure (BP) measured by a wrist-type BP monitoring device. Forty-six hypertensive patients (mean 69.0±11.6 years, 56.5% male) self-measured their nighttime BP hourly using simultaneously worn wrist-type and upper arm-type nocturnal home BP monitoring devices at home on two consecutive nights. Using the average 7.4±1.3 measurements on the first night and the average 7.0 ± 1.8 measurements on the second night, the authors assessed the reliability and the reproducibility of nighttime BP measured on the two nights. The difference between nights in systolic BP (SBP) measured by the wrist-device was not significant (1.6±7.0 mmHg, p = .124), while the difference in diastolic BP (DBP) was marginally significant (1.4±4.9 mmHg, p = .050). The intraclass correlation coefficients (ICCs) for agreement between nights were high both in SBP and DBP average (SBP: 0.835, DBP: 0.804). Averaging only three points of SBP resulted in lower ICC values, but still indicated good correlations (ICC > 0.6). On the other hand, the correlations of the standard deviation and average real variability of SBP between nights were low, with ICCs of 0.220 and 0.436, respectively. In conclusion, the average SBP values measured on the first night were reliable even when averaging only three readings. The reproducibility of nighttime BP variability seemed inferior to that of BP average; it might be better to measure nighttime BP over multiple nights to assess BP variability. However, this hypothesis needs verification in other study population. In addition, our study population had well-controlled BP, which limits the generalizability of this findings to all hypertensive patients. [ABSTRACT FROM AUTHOR]

Background: Adjustment disorder is one of the most widespread mental disorders worldwide. In ICD-11, adjustment disorder is characterised by two main symptom clusters: preoccupation with the stressor and failure to adapt. A network analytic approach has been applied to most ICD-11 stress-related disorders. However, no study to date has explored the relationship between symptoms of adjustment disorder using network analysis.Aims: We aimed to explore the network structure of adjustment disorder symptoms and whether its structure replicates across questionnaire versions and samples.Method: A network analysis was conducted on adjustment disorder symptoms as assessed by the Adjustment Disorder-New Module (ADNM-8) and an ultra-brief version (ADNM-4) using data from 2524 participants in Nigeria (n = 1006), Kenya (n = 1018) and Ghana (n = 500).Results: There were extensive connections between items across all samples in both ADNM versions. Results highlight that preoccupation symptoms seem to be more prominent in terms of edges strengths (i.e. connections) and had the highest centrality in all networks across samples and ADNM versions. Comparisons of network structure invariance revealed one difference between Nigeria and Ghana in both ADNM versions. Importantly, the ADNM-8 global strength was similar in all networks whereas in the ADNM-4 Kenya had a higher global strength score compared with Nigeria.Conclusions: Results provide evidence of the coherence of adjustment disorder in ICD-11 as assessed by the ADNM questionnaire. The prominence of preoccupation symptoms in adjustment disorder highlights a possible therapeutic target to alleviate distress. There is a need to further replicate the network structure of adjustment disorder in non-African samples. [ABSTRACT FROM AUTHOR]

Background: Among people living with HIV (PLHIV), more flexible and sensitive tuberculosis (TB) screening tools capable of detecting both symptomatic and subclinical active TB are needed to (1) reduce morbidity and mortality from undiagnosed TB; (2) facilitate scale-up of tuberculosis preventive therapy (TPT) while reducing inappropriate prescription of TPT to PLHIV with subclinical active TB; and (3) allow for differentiated HIV-TB care.Methods and Findings: We used Botswana XPRES trial data for adult HIV clinic enrollees collected during 2012 to 2015 to develop a parsimonious multivariable prognostic model for active prevalent TB using both logistic regression and random forest machine learning approaches. A clinical score was derived by rescaling final model coefficients. The clinical score was developed using southern Botswana XPRES data and its accuracy validated internally, using northern Botswana data, and externally using 3 diverse cohorts of antiretroviral therapy (ART)-naive and ART-experienced PLHIV enrolled in XPHACTOR, TB Fast Track (TBFT), and Gugulethu studies from South Africa (SA). Predictive accuracy of the clinical score was compared with the World Health Organization (WHO) 4-symptom TB screen. Among 5,418 XPRES enrollees, 2,771 were included in the derivation dataset; 67% were female, median age was 34 years, median CD4 was 240 cells/μL, 189 (7%) had undiagnosed prevalent TB, and characteristics were similar between internal derivation and validation datasets. Among XPHACTOR, TBFT, and Gugulethu cohorts, median CD4 was 400, 73, and 167 cells/μL, and prevalence of TB was 5%, 10%, and 18%, respectively. Factors predictive of TB in the derivation dataset and selected for the clinical score included male sex (1 point), ≥1 WHO TB symptom (7 points), smoking history (1 point), temperature >37.5°C (6 points), body mass index (BMI) <18.5kg/m2 (2 points), and severe anemia (hemoglobin <8g/dL) (3 points). Sensitivity using WHO 4-symptom TB screen was 73%, 80%, 94%, and 94% in XPRES, XPHACTOR, TBFT, and Gugulethu cohorts, respectively, but increased to 88%, 87%, 97%, and 97%, when a clinical score of ≥2 was used. Negative predictive value (NPV) also increased 1%, 0.3%, 1.6%, and 1.7% in XPRES, XPHACTOR, TBFT, and Gugulethu cohorts, respectively, when the clinical score of ≥2 replaced WHO 4-symptom TB screen. Categorizing risk scores into low (<2), moderate (2 to 10), and high-risk categories (>10) yielded TB prevalence of 1%, 1%, 2%, and 6% in the lowest risk group and 33%, 22%, 26%, and 32% in the highest risk group for XPRES, XPHACTOR, TBFT, and Gugulethu cohorts, respectively. At clinical score ≥2, the number needed to screen (NNS) ranged from 5.0 in Gugulethu to 11.0 in XPHACTOR. Limitations include that the risk score has not been validated in resource-rich settings and needs further evaluation and validation in contemporary cohorts in Africa and other resource-constrained settings.Conclusions: The simple and feasible clinical score allowed for prioritization of sensitivity and NPV, which could facilitate reductions in mortality from undiagnosed TB and safer administration of TPT during proposed global scale-up efforts. Differentiation of risk by clinical score cutoff allows flexibility in designing differentiated HIV-TB care to maximize impact of available resources. [ABSTRACT FROM AUTHOR]

Objectives: This systematic review focuses on the use of the in vitro hollow fibre infection model (HFIM) for microbial culture. We summarize the direction of the field to date and propose best-practice principles for reporting of the applications.Methods: Searches in six databases (MEDLINE®, EMBASE®, PubMed®, BIOSIS®, SCOPUS® and Cochrane®) up to January 2020 identified 129 studies meeting our inclusion criteria. Two reviewers independently assessed and extracted data from each publication. The quality of reporting of microbiological and technical parameters was analysed.Results: Forty-seven out of 129 (36.4%) studies did not report the minimum pharmacokinetic parameters required in order to replicate the pharmacokinetic profile of HFIM experiments. Fifty-three out of 129 (41.1%) publications did not report the medium used in the HFIM. The overwhelming majority of publications did not perform any technical repeats [107/129 (82.9%)] or biological repeats [97/129 (75.2%)].Conclusions: This review demonstrates that most publications provide insufficient data to allow for results to be evaluated, thus impairing the reproducibility of HFIM experiments. Therefore, there is a clear need for the development of laboratory standardization and improved reporting of HFIM experiments. [ABSTRACT FROM AUTHOR]

Background: Null hypothesis significance testing (NHST) is among the most frequently employed methods in the biomedical sciences. However, the problems of NHST and p-values have been discussed widely and various Bayesian alternatives have been proposed. Some proposals focus on equivalence testing, which aims at testing an interval hypothesis instead of a precise hypothesis. An interval hypothesis includes a small range of parameter values instead of a single null value and the idea goes back to Hodges and Lehmann. As researchers can always expect to observe some (although often negligibly small) effect size, interval hypotheses are more realistic for biomedical research. However, the selection of an equivalence region (the interval boundaries) often seems arbitrary and several Bayesian approaches to equivalence testing coexist.Methods: A new proposal is made how to determine the equivalence region for Bayesian equivalence tests based on objective criteria like type I error rate and power. Existing approaches to Bayesian equivalence testing in the two-sample setting are discussed with a focus on the Bayes factor and the region of practical equivalence (ROPE). A simulation study derives the necessary results to make use of the new method in the two-sample setting, which is among the most frequently carried out procedures in biomedical research.Results: Bayesian Hodges-Lehmann tests for statistical equivalence differ in their sensitivity to the prior modeling, power, and the associated type I error rates. The relationship between type I error rates, power and sample sizes for existing Bayesian equivalence tests is identified in the two-sample setting. Results allow to determine the equivalence region based on the new method by incorporating such objective criteria. Importantly, results show that not only can prior selection influence the type I error rate and power, but the relationship is even reverse for the Bayes factor and ROPE based equivalence tests.Conclusion: Based on the results, researchers can select between the existing Bayesian Hodges-Lehmann tests for statistical equivalence and determine the equivalence region based on objective criteria, thus improving the reproducibility of biomedical research. [ABSTRACT FROM AUTHOR]

Biological age captures some of the variance in life expectancy for which chronological age is not accountable, and it quantifies the heterogeneity in the presentation of the aging phenotype in various individuals. Among the many quantitative measures of biological age, the mathematically uncomplicated frailty/deficit index is simply the proportion of the total health deficits in various health items surveyed in different individuals. We used 3 different statistical methods that are popular in machine learning to select 17-28 health items that together are highly predictive of survival/mortality, from independent study cohorts. From the selected sets, we calculated frailty indexes and Klemera-Doubal's biological age estimates, and then compared their mortality prediction performance using Cox proportional hazards regression models. Our results indicate that the frailty index outperforms age and Klemera-Doubal's biological age estimates, especially among the oldest old who are most prone to biological aging-caused mortality. We also showed that a DNA methylation index, which was generated by applying the frailty/deficit index calculation method to 38 CpG sites that were selected using the same machine learning algorithms, can predict mortality even better than the best performing frailty index constructed from health, function, and blood chemistry. [ABSTRACT FROM AUTHOR]

Objective: Automated Truck-Mounted Attenuators (ATMAs) have the potential to improve work zone safety by removing the human driver out of a vehicle that is positioned in work zones to absorb impact from errant vehicles. However, this automated technology is expensive and can be detrimental to safety and project success if operated incorrectly (e.g., operating limitations and procedures not followed). Therefore, it is important to understand users' perceptions of ATMAs and how training can improve appropriate adoption of this technology. The objective of this study was to evaluate how work zone workers perceive the usefulness of and the capabilities of automation in Truck-Mounted Attenuators.Methods: A survey study was conducted with 13 Department of Transportation (DOT) workers in Colorado and California. Each of the DOT workers in this study had some previous experience with the ATMA, either in real-world applications and/or formal training. The survey collected information on participant job specifications, experience with the ATMA, training received, trust in the ATMA, usability of the HMIs, and operating capabilities of the automation.Results: Workers reported an overall positive acceptance of this technology. This was supported by their expectation that it would reduce crash severity; that there was a reasonable workload associated with operating procedures for the automation; and by their overall trust in the automation's reliability. However, workers noted concerns regarding their trust in the automation under various contexts, such as poor visibility and denser traffic volumes. Further, trust in the technology was greatest among workers with higher levels of ATMA training and longer experience working with the ATMA.Conclusions: This research presents a novel perspective on user acceptance of ATMA technology. These findings can help jurisdictions achieve the safety improvements that investment and deployment of automation in work zones offers, by identifying the disconnect between operators and technology. [ABSTRACT FROM AUTHOR]

Background: As proven to reflect the work state of heart and physiological situation objectively, electrocardiogram (ECG) is widely used in the assessment of human health, especially the diagnosis of heart disease. The accuracy and reliability of abnormal ECG (AECG) decision depend to a large extent on the feature extraction. However, it is often uneasy or even impossible to obtain accurate features, as the detection process of ECG is easily disturbed by the external environment. And AECG got many species and great variation. What's more, the ECG result obtained after a long time past, which can not reach the purpose of early warning or real-time disease diagnosis. Therefore, developing an intelligent classification model with an accurate feature extraction method to identify AECG is of quite significance. This study aimed to explore an accurate feature extraction method of ECG and establish a suitable model for identifying AECG and the diagnosis of heart disease.Methods: In this research, the wavelet combined with four operations and adaptive threshold methods were applied to filter the ECG and extract its feature waves first. Then, a BP neural network (BPNN) intelligent model and a particle swarm optimization (PSO) improved BPNN (PSO-BPNN) intelligent model based on MIT-BIH open database was established to identify ECG. To reduce the complexity of the model, the principal component analysis (PCA) was used to minimize the feature dimension.Results: Wavelet transforms combined four operations and adaptive threshold methods were capable of ECG filtering and feature extraction. PCA can significantly deduce the modeling feature dimension to minimize the complexity and save classification time. The PSO-BPNN intelligent model was suitable for identifying five types of ECG and showed better effects while comparing it with the BPNN model.Conclusion: In summary, it was further concluded that the PSO-BPNN intelligent model would be a suitable way to identify AECG and provide a tool for the diagnosis of heart disease. [ABSTRACT FROM AUTHOR]

Background: Medical imaging methods such as PET and MRI aid clinical assessment of Alzheimer's disease (AD). Less expensive, less technically demanding, and more widely deployable technologies are needed to expand objective screening for diagnosis, treatment, and research. We previously reported brain tissue near-infrared optical spectroscopy (NIR) in vitro indicating the potential to meet this need.Objective: To determine whether completely non-invasive, clinical, NIR in vivo can distinguish AD patients from age-matched controls and to show the potential of NIR as a clinical screen and monitor of therapeutic efficacy.Methods: NIR spectra were acquired in vivo. Three groups were studied: autopsy-confirmed AD, control and mild cognitive impairment (MCI). A feature selection approach using the first derivative of the intensity normalized spectra was used to discover spectral regions that best distinguished "AD-alone" (i.e., without other significant neuropathology) from controls. The approach was then applied to other autopsy-confirmed AD cases and to clinically diagnosed MCI cases.Results: Two regions about 860 and 895 nm completely separate AD patients from controls and differentiate MCI subjects according to the degree of impairment. The 895 nm feature is more important in separating MCI subjects from controls (ratio-of-weights: 1.3); the 860 nm feature is more important for distinguishing MCI from AD (ratio-of-weights: 8.2).Conclusion: These results form a proof of the concept that near-infrared spectroscopy can detect and classify diseased and normal human brain in vivo. A clinical trial is needed to determine whether the two features can track disease progression and monitor potential therapeutic interventions. [ABSTRACT FROM AUTHOR]