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Context: Horizontal hops can provide insight into how athletes can tolerate high-intensity single-leg stretch loads and are commonly used in athlete monitoring and injury management. Variables like flight, contact, and total time provide valuable diagnostic information to sports science professionals. However, gold-standard assessment tools (eg, 3-dimensional motion capture, force plates) require monetary and technological resources. Therefore, we used a tablet and free software to determine the between-rater, within-rater, and test–retest variability of the temporal events of multiple horizontal hop tests. Design: Reliability study. Methods: Nine healthy males (20.8 [1.3] y, 71.4 [9.8] kg, 171.7 [4.5] cm) across various university sports teams and clubs volunteered and performed several triple (3-Hop) and quintuple (5-Hop) horizontal hops over 3 testing sessions. Six raters detected temporal events from video to determine between-rater variability, while a single rater quantified within-session and test–retest variability. The temporal variables of flight time, ground contact time for each individual hop, and the total time of each hoping series were determined. The consistency of measures was interpreted using the coefficient of variation and interclass correlation coefficients (ICC). Results: Good to excellent between-rater consistency was observed for all hops (ICC =.85–1.00). Absolute (coefficient of variation ≤ 2.0%) and relative consistency (ICC =.98–1.00) was excellent. Test–retest variability showed acceptable levels of absolute consistency (coefficient of variation ≤ 8.7%) and good to excellent consistency in 10/16 variables (ICC =.81–.93), especially those later in the hopping cycle. Conclusions: A tablet and free digitizing software are reliable in detecting temporal events during multiple horizontal hops, which could have exciting implications for power diagnostics and return-to-play decisions. Therefore, rehabilitation and performance professionals can confidently utilize the highly accessible equipment from this study to track multiple hop performances. [ABSTRACT FROM AUTHOR]

Context: The Hip Stability Isometric Test (HipSIT) is commonly employed in clinical settings for evaluating the hip posterolateral muscle strength. In this study, we introduced the "Field Hip Stability Isometric Test" (F-HipSIT) and assessed the intrarater and interrater reliability of this strength assessment specifically designed for sports settings. Design: Reliability study. Methods: Two independent raters (A and B) went to athletes' training facilities to conduct 2 sessions of F-HipSIT spaced at least 1 week apart. The average peak force value from 3 valid attempts of each leg was recorded and normalized by the participant's body mass for statistical analysis. Results: Thirty male and 30 female amateur athletes took part in this study. Rater A obtained similar values in the first (0.39 [0.05] and 0.44 [0.07] kg·f/kg) and second (0.39 [0.06] and 0.45 [0.07] kg·f/kg) testing days for men and women, respectively. Rater B also found similar values in the first (0.35 [0.06] and 0.42 [0.08] kg·f/kg) and second (0.36 [0.06] and 0.45 [0.08] kg·f/kg) testing days for men and women, respectively. Excellent intrarater intraclass correlation coefficient (ICC) values were found for men (ICC =.922) and women (ICC =.930), with coefficient of variation of 6% to 8% and minimal detectable change of 0.06 to 0.10 kg·f/kg. The F-HipSIT presented good interrater reliability for men (ICC =.857) and women (ICC =.868), with coefficient of variation of 5% and minimal detectable change of 0.05 to 0.06 kg·f/kg. Conclusion: The F-HipSIT intrarater and interrater reliability among male and female recreational athletes supports this field test as a quick and convenient screening tool to monitor hip posterolateral muscle strength in sports settings. [ABSTRACT FROM AUTHOR]

Context: Poor knee biomechanics contribute to knee joint injuries. Neuromuscular control over knee position is partially derived from the hip. It is unknown whether isolated activation training of the gluteal muscles improves lower-extremity frontal plane mechanics. This study examined if a home-based hip muscle activation program improves performance on the Forward Step-Down Test as well as increases surface electromyography (sEMG) activation of the gluteal muscles. Design: The study utilized a single-group repeated-measures design. Methods: Thirty-five participants (24 females, mean age = 23.17 [SD 1.36] years) completed an 8-week hip muscle activation program. The Forward Step-Down Test score and sEMG of gluteus maximus and medius were assessed preintervention and postintervention. Results: Forward Step-Down Test scores improved significantly from preintervention (Mdn = 3.5) to postintervention (Mdn = 3.0, T = 109, P =.010, r =.31.), but this result did not meet clinical significance. sEMG analysis revealed a significant increase in mean gluteus maximus activation (P =.028, d = 1.19). No significant dose–response relationship existed between compliance and the Forward Step-Down Test scores or sEMG results. Conclusions: A home-based hip activation program increases gluteus maximus activation without clinically significant changes in frontal plane movement quality. Future studies may find clinical relevance by adding motor learning to the activation training program to improve functional muscle use. [ABSTRACT FROM AUTHOR]

Context: The incidence and recurrence rate of hamstring strain injuries remain persistently high, with recurrent injuries leading to increased time lost during play and extended recovery periods compared with initial injury. Ultrasound imaging assesses important factors such as hamstring fascicle length (FL), pennation angle (PA), cross-sectional area (CSA), muscle thickness (MT), echo intensity (EI), and shear wave elastography (SWE), all impacting athletic performance. However, its reliability must be established before employing any measurement tool in research or clinical settings. Objectives: To determine the reliability and measurement error of ultrasound for assessing hamstring FL, PA, CSA, MT, EI, and SWE among healthy adults and athletes; to synthesize the information regarding the operationalization of ultrasound. Evidence Acquisition: A systematic literature search was done from January 1990 to February 5, 2023, to identify reliability and validity studies of hamstring ultrasound assessment published in peer-reviewed journals with identifiable methodology of outcome measures. Evidence Synthesis: Intraclass correlation coefficient measurement of 14 included studies reported moderate to excellent intrarater, interrater, and test–retest reliabilities of FL, PA, and MT regardless of the site of muscle testing, probe size, and setting, state of muscle, and use of different techniques in the extrapolation of FL. Good to excellent test–retest reliability rates for all hamstring anatomic CSA along midmuscle and different percentages of thigh length using panoramic imaging. Good intrarater reliability of EI regardless of gender and orientation of the probe but with excellent intrarater reliability in transverse scan using maximum region of interest. Good intrarater, interrater, and interday repeatability on SWE with the muscle in a stretched position. Conclusion: Evidence from studies with a predominantly low risk of bias shows that ultrasound is a reliable tool to measure hamstring FL, PA, CSA, MT, EI, and SWE in healthy adults and athletes under various experimental conditions. [ABSTRACT FROM AUTHOR]

Context: Decreased trunk neuromuscular control is a risk factor for both upper- and lower-extremity injuries, yet there are few reliable and valid clinical tests to identify deficits. Objective: The purpose of this study was to determine the reliability and known-groups validity of a novel clinical test, the seated trunk control test (STCT). Design: Cross-sectional reliability and known-groups validity study. Setting: Laboratory. Participants: 89 unique participants: 34 were 3 months postoperative anterior cruciate ligament reconstruction (ACLR) and 55 healthy controls. Methods: For the STCT, participants sat on a balance board with their eyes closed for three 30-second trials while investigators counted balance errors. Intraclass correlations (ICCs) were used to assess interrater reliability (N = 20) and test–retest reliability (N = 40). To assess known-groups validity, independent t tests were used to compare STCT errors at 3 months post-ACLR with healthy matched controls (N = 34/group). Area under a receiver operating characteristic curve identified an optimal cutoff for distinguishing between groups. Results: The STCT had perfect interrater reliability (ICC2,3 = 1.00) and good test–retest reliability (ICC3,3 =.79; 95% confidence interval =.61–.89). The ACLR group made significantly more errors on the STCT (mean [SD] = 15.5 [5.4]) than controls (mean [SD] = 8.2 [4.1]; P <.001, Cohen d = 1.52). The STCT's ability to distinguish between groups was excellent (area under a ROC curve = 0.86). A cutoff of 12 errors maximized sensitivity (76%) and specificity (85%). Conclusions: The STCT is reliable between raters and across days. It also has excellent ability to distinguish between individuals with a recent ACLR and healthy matched controls, which provides initial evidence to suggest that the STCT may be clinically useful for identifying deficits in trunk neuromuscular control. [ABSTRACT FROM AUTHOR]

Purpose: Patients with systemic scleroderma (SSc) often suffer from premature tooth loss. The aim of this study was to radiologically investigate bone loss at dental implants in patients with SSc and compare it with data from the literature on healthy patients. Materials and Methods: Mesial and distal bone level changes at implants were independently determined on panoramic and intraoral radiographs. They were double-checked after determination of evaluability by three different raters. Cohen's kappa was used to test for interrater reliability. Mean bone loss was estimated using linear regression analysis considering the patient as a random-effect implant and performed separately in predefined implant regions for different time points and for the mesial and distal sides of the implants. Results: Mesial and distal bone level changes were analyzed in 61 implants using periapical and panoramic radiographs. In total, 114 radiographs from 18 patients were evaluable in both the mesial and distal regions. After a maximum observation period of 60 months, the mean peri-implant bone loss was 1.68 mm (range: 0.83 to 2.54 mm) at the distal aspect and 1.65 mm (range: 0.81 to 2.48 mm) at the mesial aspect in the right posterior mandible (region 44 to 47 [FDI numbering system]), whereas in the left posterior maxilla (regions 24 to 27), the mean peri-implant bone loss was 0.61 mm (range: 0.32 to 0.91 mm) at the distal aspect and 0.59 mm (range: 0.16 to 1.03 mm) at the mesial aspect. The mean bone loss 60 months after surgery was 1.05 mm (range: 0.85 to 1.25 mm). Conclusions: Marginal bone loss at implants in patients with SSc is comparable to data from the literature collected in healthy subjects. [ABSTRACT FROM AUTHOR]

Purpose: There is a growing interest in using computed tomography (CT) scans to opportunistically assess bone mineral density via Hounsfield units (HU). Previous studies have shown lower HU in patients with vertebral compression fractures (VCFs) and that HU can predict pre-existing VCFs. This study evaluated whether HU from CT scans can predict the number of prevalent VCFs. Methods: We studied 353 patients (199 females) aged 58 and older who underwent thorax-abdomen-pelvis or thoracic-lumbar CT scans. HU were measured at T11 and L1. Inter- and intra-observer agreement measuring HU was assessed. We compared mean HU values using the T-test, performed Spearman's correlation between HU and VCFs, and conducted logistic and linear regression analyses to determine the independent effect of sex, age, and HU on the presence and number of VCFs. Results: The median age was 73 years. Ninety-eight patients had at least one VCF, with 46 having one and 52 having two or more VCFs. Inter- and intra-observer agreement assessing HU was excellent (ICC = 0.98 and 0.99 respectively). Mean HU were significantly lower in patients with VCFs (91.14 ± 39.33) than in patients without VCFs (145.03 ± 41.07, p < 0.01). HU negatively correlated with the number of VCFs (r = − 0.54, p < 0.01). Logistic regression showed that age (p < 0.01) and HU (p < 0.01) predicted the presence of VCFs. Linear regression found that HU independently predicted the number of VCFs (p < 0.01), while age (p = 0.67) and sex (p = 0.12) did not. Conclusion: HU from CT scans can predict the presence and number of VCFs. [ABSTRACT FROM AUTHOR]

Purpose: No studies have explored the reliability of the Rigo classification system using surface topography (ST), which would allow optimization without radiation exposure. This study aims to measure and compare the intra- and inter-observer reliability (Kappa values) and accuracy of the Rigo system between ST and X-ray for overall types and subtypes. Methods: X-ray and ST images of 31 adolescent idiopathic scoliosis patients were selected. Three investigators were blinded to assess images using the Rigo system, twice for each patient on different weeks, with 372 overall image readings. Afterwards, all investigators agreed upon the correct Rigo scores for finalized classifications. Results: For Rigo types, the average intra-observer Kappa value was slightly better for ST (0.77, p<0.001) than X-ray (0.75, p<0.001). For Rigo subtypes, the average intra-observer Kappa value was again slightly better for ST (0.74, p<0.001) than X-ray (0.65, p<0.001). The inter-observer reliability was expectedly lower than intra-observer, with ST (0.53, p<0.001) comparable to X-ray (0.54, p<0.001) for the type. For subtype inter-observer reliability, ST (0.43, p<0.001) was slightly better than X-ray (0.36, p<0.001). For the type, the overall accuracy of the observers was slightly lower for ST (77.96%) than X-ray (79.57%). For the subtype, the accuracy of observers was slightly higher for ST (70.97%) than X-ray (65.05%). Conclusion: ST-based Rigo system demonstrates very good intra-rater reproducibility and moderately good inter-rater reproducibility. Surface topography is comparable to X-ray for the Rigo system, and therefore can be considered a reliable alternative in clinical application. [ABSTRACT FROM AUTHOR]

Aim: The aim of the examination was to determine which of the three measurement methods Cobb (CB), Ferguson (FR), and Centroid (CN) has the best repeatability and reliability when the measurements are made by inexperienced researchers. Methods: Three researchers (from the student research group) measured the angle of spine curvature on X-rays of the entire spine in standing anteroposterior view in 50 patients with severe idiopathic scoliosis qualified for surgery. Cobb, Ferguson, and Centroid methods were used. One of the researchers repeated all examinations twice at 3-week intervals. The measurements were compared with each other using the intraclass correlation coefficient (ICC) method. Values less than 0.5 are indicative of poor reliability, values between 0.5 and 0.75 indicate moderate reliability, values between 0.75 and 0.9 indicate good reliability and values greater than 0.90 indicate excellent reliability. Results: The ICC (inter-rater) between the researchers' measurements was 0.9387 for CB, 0.9169 for FR, and 0.9061 for CR. Whereas the ICC (intra-rater) between measurements taken by a single researcher was 0.9824 for CB, 0.9088 for FR, and 0.9546 for CR. Conclusions: The above results show that Cobb angle measurement method is the most reliable for measuring the curvature angle of the spine for novice researchers. Although it seems to be difficult to measure, it provides the most repeatable results. [ABSTRACT FROM AUTHOR]

Background: Hemophilia is characterized by degenerative joint damage. Patients with hemophilic arthropathy present joint damage, reduced range of motion, and decreased strength and functional capacity. Myofascial release therapy aims to decrease pain and improve tissue mobility and functionality. Objectives: To evaluate the safety and efficacy of myofascial release therapy in patients with hemophilic ankle arthropathy. Method: Single-blind randomized controlled trial. Fifty-eight adult patients with hemophilia were randomly allocated to the experimental group (myofascial release therapy with foam roller) or the control group (no intervention whatsoever). The daily home protocol of myofascial release therapy for the lower limbs using a foam roller lasted eight consecutive weeks. The primary variable was the safety of myofascial release therapy (weekly telephone follow-up). The secondary variables were pain intensity (visual analog scale), range of motion (goniometer), functional capacity (2-Minute Walk Test) and muscle strength (dynamometer), at baseline and at 8 and 10 weeks. Results: During the experimental phase, none of the patients in the experimental group developed ankle hemarthrosis. There were statistically significant changes in time*group interaction in ankle dorsal flexion (F[1.75] = 10.72; p <.001), functional capacity (F[1.16] = 5.24; p =.009) and gastrocnemius strength (F[2] = 26.01; p <.001). The effect size of the changes after the intervention was medium-large in pain intensity (d = −1.77), functional capacity (d = 1.34) and gastrocnemius strength (d = 0.76). Conclusion: Myofascial release therapy is a safe form of physical therapy for patients with hemophilia. Myofascial release therapy can effectively complement prophylactic pharmacological treatment in patients with hemophilic arthropathy, improving range of motion in dorsal flexion, functional capacity and gastrocnemius strength. [ABSTRACT FROM AUTHOR]

Study Design.: A retrospective diagnostic test study. Objective.: To establish quantitative fusion criteria for ACCF. Summary of Background Data.: Currently, the criteria of fusion after ACCF remains controversial. Evaluation techniques such as observation of continuous bony trabeculae across the fusion site were qualitative and conducted by naked eyes, limiting its accuracy. Dynamic fusion indicators such as interspinous motion (ISM) have been successfully utilized in anterior cervical discectomy and fusion (ACDF) for evaluating fusion and detecting pseudarthrosis. However, the accuracy of ISM in ACCF is unclear. Methods.: Patients who underwent ACCF in our hospital were reviewed. Imaging data including dynamic radiographs and computed tomography (CT) scans were collected. The distance and angle form of ISM (ISM-dis and ISM-ang) were measured on dynamic radiograph, with CT as the gold standard for fusion. The correlation between ISM methods was analyzed using Spearmann correlation. Receiver operating characteristic (ROC) curves were used to evaluate the accuracy and generate optimal cutoff values. Three observers independently measured the data twice to determine interobserver and intraobserver reliability. Results.: Our study included 178 imaging datasets. ISM-dis showed positive correlation with ISM-ang (r=0.914). The area under ROC (AUC) for ISM-dis and ISM-ang was 0.926 and 0.893. Applying a cutoff value of 1.50 mm to ISM-dis yielded a sensitivity of 87.8% and specificity of 92.3% for detecting pseudarthrosis. For ISM-ang, a cutoff value of 1.75° resulted in a sensitivity of 79.1% and specificity of 92.3%. Intraobserver reliabilities for ISM-dis (0.986, 0.984, and 0.972) were higher than for ISM-ang (0.935, 0.963, and 0.935), as was interobserver reliability (0.985 for ISM-dis and 0.956 for ISM-ang). Fusion rates calculated using ISM-dis and ISM-ang were 52.4% and 61.9%. Conclusions.: ISM can serve as an alternative to CT for assessing fusion, with ISM-dis at a 1.50-mm cutoff and ISM-ang at 1.75°, demonstrating high diagnostic accuracy. [ABSTRACT FROM AUTHOR]

Background: Literature demonstrates variability in the amount of displacement of isolated greater tuberosity (GT) fractures and measurement techniques that orthopaedic surgeons deem warrant surgical intervention. This study aims to assess the intra and interobserver reliability for classifying and measuring the displacement amount for isolated GT fractures. Methods: Eight surgeons, consisting of four shoulder specialists and four trainee surgeons, reviewed 25 plain radiographs on two separate occasions, 3 months apart. They were required to morphologically classify the GT fracture, measure the displacement distance on anteroposterior and axillary views, calculate the GT displacement ratio, and state whether they would offer surgical treatment. Results: There was a lack of good reliability for the classification of the depression and avulsion fracture types. There was good intraobserver but poor interobserver consistency in classifying the split-type fractures. The measurement of the displacement distance showed good intraobserver reliability, but not as good interobserver agreement. Also, the displacement ratio calculated revealed poor consistency. We found good agreement between and within the raters for the treatment decision. No significant difference was noted when comparing the senior surgeons to the junior surgeons. Conclusions: This study has revealed ongoing inconsistency in the classification and measurement of isolated GT fractures. [ABSTRACT FROM AUTHOR]

Behavioral recordings annotated by human observers (HOs) from video recordings are a fundamental component of preclinical animal behavioral models of neurobiological diseases. These models are often criticized for their vulnerability to reproducibility issues. Here, we present the EthoWatcher-Open Source (EW-OS), with tools and procedures for the use of blind-to-condition categorical transcriptions that are simultaneous with tracking, for the assessment of HOs intra- and interobserver reliability during training and data collection, for producing video clips of samples of behavioral categories that are useful for observer training. The use of these tools can inform and optimize the performance of observers, thus favoring the reproducibility of the data obtained. Categorical and machine vision-derived outputs are presented in an open data format for increased interoperability with other applications, where behavioral categories are associated frame-by-frame with tracking, morphological and kinematic attributes of an animal's image. The center of mass (X and Y pixel coordinates), the animal's area in square millimeters, the length and width in millimeters, and the angle in degrees were recorded. It also assesses the variation in each morphological descriptor to produce kinematic descriptors. While the initial measurements are in pixels, they are later converted to millimeters using the scale calibrated by the user via the graphical user interfaces. This process enables the creation of databases suitable for machine learning processing and behavioral pharmacology studies. EW-OS is constructed for continued collaborative development, available through an open-source platform, to support initiatives toward the adoption of good scientific practices in behavioral analysis, including tools for evaluating the quality of the data that can alleviate problems associated with low reproducibility in the behavioral sciences. In this article, we present the EthoWatcher-Open Source (EW-OS), with tools and procedures for the use of blind-to-condition categorical transcriptions that are simultaneous with tracking, for the assessment of intra- and interobserver reliability during training and data collection, for producing video clips of samples of behavioral categories that are useful for observer training. The use of these tools is critical and, most of the time, required for behavioral studies, but they are normally overlooked because they are difficult to find or use. For example, to foster the use of concordance analysis, the reliability module can perform inference using only one repetition of the same analysis. More than just bureaucratic requirements, these tools can inform and optimize the performance of observers, thus favoring the reproducibility of the data obtained. Additionally, EW-OS provides extended capabilities of temporal segmentation for categorical and spatial segmentation for morphological and kinematic data extracted from videos. Finally, this software was built to allow for continued collaborative development; is freely available through an open-source platform cooperative environment and is freely available through an open-source platform cooperative environment. [ABSTRACT FROM AUTHOR]

Background: The use of portable hand-held dynamometers is increasing in popularity due to their ease of use in different clinical settings, convenient size, portability, and overall affordability. Reported reliability for external fixation and rater-stabilized hand-held dynamometry (HHD) strength measurements have been found to be 'good' to 'excellent'. Inconsistent agreement has been found between the two stabilization methods and isokinetic HHD testing. Purpose / Hypothesis: Determine the reliability and agreement of HHD measurements in three different rater test positions against three different mechanically produced force magnitudes. The study compared measurements obtained by rater-stabilization to external fixation methods. Study Design: Intra-rater and inter-rater reliability study. Methods: Ten raters took measurements in three different rater test positions against three different force magnitudes created by an external force. Raters were blinded to the randomized force magnitudes. The rater's measurements were compared to measurements taken against an external fixation stabilization device. To establish reliability, Intraclass Correlation Coefficient (ICC), and Standard Error of Measurement (SEM), and Minimal Detectable Change (MDC) were used. To establish agreement, error rates between the rater-stabilized and external fixation stabilization measurements were calculated. Results: ICC's were found to be 'excellent' at.97 and above. The relative SEM ranged from 0.2% to 0.9 % and the relative MDC ranged from 0.7% to 2.8%. The overall error rate was 15.5% and was influenced by force magnitude. Conclusion: The use of standardized rater test positions resulted in 'excellent' intra-rater, inter-rater reliability, low SEM, and low MDC for rater-stabilized HHD measurements. A systematic error was observed, with rater-stabilized measurements resulting in higher values compared with values obtained with the external fixation method. Level of Evidence: 3 [ABSTRACT FROM AUTHOR]

Background: Some individuals have exercise-induced lower leg pain (ELP) caused by a chronic exertional compartment syndrome (CECS). As intracompartmental muscle pressure measurements are invasive with suboptimal test characteristics, other diagnostic tools are needed. Recently, ultrasound-based muscle compartment thickness analysis at 10mmHg (d10) and 80mmHg (d80) external pressure was introduced for this purpose. The difference in compartment thickness at these two external pressures induced by the study device is used to calculate muscle compressibility, a possible marker for CECS. Purpose: The purpose of this study was to investigate the reliability of a novel ultrasound compressibility technique using two distinct internal landmarks at the lower leg in a diverse group of asymptomatic adults. Study design: Cross-sectional study Methods: Healthy volunteers (n=35; 21 female; median age 40 years, range 19-72; BMI 24.1 kg/m2, range 18.3-31.6) not having ELP underwent serial compressibility measurements (n=1678) of both legs by three observers at the tibialis anterior (TA) using the interosseous membrane (IM) and transition zone IM to tibial bone (TZIT) as internal landmarks. Inter- and intra-observer reliability was calculated for values of d10, d80 and compressibility using intraclass correlations (ICC). Results: TA compartments are less compressible using the IM landmark compared to the TZIT landmark (10.5% vs 12.5%; p<0.001). Inter-observer ICC for IM was always higher (d10 0.85; d80 0.82; compressibility 0.51) than for TZIT (d10 0.65; d80 0.53; compressibility 0.20). The intra-observer reliability for d10 and d80 was excellent (ICC>0.90) for all three observers. ICC of compressibility varied among observers and ranged from 0.76 to 0.48, with higher ICCs demonstrated for IM compared to TZIT. Conclusion: Ultrasound based anterior tibial muscle compressibility measurements have moderate inter-observer reliability and excellent intra-observer reliability if the interosseous membrane is used as internal landmark. Future studies are aimed to test muscle compressibility after exercise and in CECS. Level of Evidence: Level 3 [ABSTRACT FROM AUTHOR]

Background: An automated pupillometer is a handheld device used to stimulate the pupillary light response (PLR) and track the entirety of the response from constriction to dilation. Pupillometers provide objective data that clinicians can use to identify and assess brain injury. The validity of these devices has been previously established; however, the inter-rater and inter-trial reliability are unknown. Purpose: The purpose of this study was to assess the inter-rater and inter-trial reliability of the NeurOptics PLR-3000 pupillometer device in measuring pupil size changes, constriction velocities, and dilation velocities. The authors hypothesized that inter-rater and inter-trial reliability would have intraclass correlation coefficients (ICC) greater than or equal to 0.70 for all PLR parameters. Study: Design: Observational, reliability study Methods: Forty-eight healthy adults (age 18-40 years) without a history of neurological injury, optical surgery, or cognitive impairment participated. Two independent raters used the NeurOptics PLR-3000 to measure PLR parameters in the left and right eyes of each subject. Data for the average and individual trials of each PLR parameter were used to determine inter-rater and inter-trial reliability, respectively. Inter-rater and inter-trial reliability was evaluated using descriptive statistics, ICC, the standard error of measurement, Bland-Altman plots, and the minimal detectable change. Results: Seven out of eight NeurOptics 3000-PLR parameters demonstrated moderate-to-excellent inter-rater (ICC range 0.72-0.96) and good-to-excellent inter-trial reliability (ICC range 0.76-0.98). The 75% recovery time parameter exhibited moderate inter-rater (ICC range 0.64-0.67) and poor-to-moderate inter-trial (ICC range 0.41-0.65) reliability. Conclusion: The NeurOptics 3000-PLR demonstrated acceptable reliability in measuring initial and end pupil size, constriction and dilation velocity, and latency to change between different users and trials. However, the device exhibited unacceptable reliability when measuring the time to 75% pupil size recovery. The device can be used in detecting and monitoring brain injury but should be limited to reliable measures only. [ABSTRACT FROM AUTHOR]

Aims The hepatic response after ST-elevation myocardial infarction (STEMI) may be associated with mortality and morbidity. We aimed to assess the cardio-hepatic axis post-STEMI using cardiovascular magnetic resonance (CMR). Methods and results This prospective, observational, single-centre study included consecutive patients with STEMI who underwent CMR after primary angioplasty from January 2015 to January 2019. Standard infarct characteristics were analysed, and hepatic T1 and hepatic extracellular volume (ECV) were assessed using pre- and post-contrast T1 mapping sequences. The primary endpoint was the relationship between native hepatic T1 values and ischaemic right ventricular (RV) involvement, determined by RV ejection fraction (EF) dysfunction and/or the presence of RV acute myocardial infarction (AMI). The diagnostic performance of hepatic T1 values for detecting RV involvement was assessed using the area under the receiver operating characteristic curve (AUC). Of 177 consecutive patients with STEMI undergoing CMR, 142 were included. Patients with RV ischaemic involvement, compared with those without, had significantly higher native hepatic T1 (P < 0.001) and hepatic ECV (P = 0.016). Hepatic T1 values demonstrated a good diagnostic performance in detecting RV involvement (AUC 0.826, P < 0.001) and correlated positively with NT-proBNP values (r = 0.754, P < 0.001). Patients with high hepatic T1 values (> 605 ms) had significantly higher NT-proBNP levels (< 0.001), larger RV end-diastolic volume (P < 0.001), lower RVEF (P < 0.001), and a higher prevalence of RV AMI (P = 0.022) compared with those with hepatic T1 ≤ 605 ms, whereas left ventricular EF and infarct size were similar. Multivariable logistic regression analysis identified RVEF (P = 0.010) and NT-proBNP values (P < 0.001) as independent predictors of increased hepatic T1 values. Patients with increased hepatic T1 values had a higher rate of rehospitalization for heart failure at 17-month follow-up (12.1 vs. 2.0%, P = 0.046). Conclusion Hepatic T1 mapping has emerged as a possible novel imaging biomarker of the cardio-hepatic axis in STEMI, being associated with RV involvement and increased NT-proBNP values. [ABSTRACT FROM AUTHOR]

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Objective: To optimize high-resolution 7 T MRI of the cochlea and measure normal cochlea and the cochlear nerve morphometry in vivo. Materials and methods: Eight volunteers with normal hearing were scanned at 7 T using an optimized protocol. Two neuroradiologists independently scored image quality. The basal turn lumen diameter (BTLD), height, width, length and volume of the cochlear, long (LD) and short (SD) diameter the calculated cross-sectional area (CSA) of the cochlear nerve were measured. Intra and inter-observer reliability was assessed using intraclass correlation (ICC). Results: 3D T2W DRIVE combined with dielectric pads, allowed acquisition of high-resolution images showing detailed structures, such as the crista ampullaris in the semicircular canals. The overall grading scores from neuroradiologists were excellent. In the left ear, averaging over all subjects gave BTLD of 2.6 ± 0.05 mm, height of 4.9 ± 0.1 mm, width of 4.4 ± 0.2 mm, length of 36.5 ± 0.4 mm, volume of 0.16 ± 0.02 ml, LD of 1.31 ± 0.1 mm, SD of 1.06 ± 0.1 mm, and CSA of 1.1 ± 0.1 mm2. The right ear gave BTLD of 2.6 ± 0.04 mm, height of 4.9 ± 0.1 mm, width of 4.4 ± 0.3 mm, length of 35.5 ± 0.4 mm, volume of 0.16 ± 0.02 ml, LD of 1.29 ± 0.1 mm, SD of 1.07 ± 0.1 mm, and CSA of 1.10 ± 0.2 mm2. No statistically significant difference was found between the sides of the head (p-value > 0.05). The intra-observer reliability was high (0.77–0.94), while the inter-observer reliability varied from moderate to high (0.55–0.81). Conclusion: 7 T MRI can provide excellent visualization of the internal structure of the cochlear and of the vestibulocochlear nerve in vivo. [ABSTRACT FROM AUTHOR]

Health personnel lack a common standard for assessing lethality of suicide attempts. This may lead to inconsistent assessments and unclear reports about suicide attempts. We argue that the Risk-Rescue Rating Scale (RRRS) may help in resolving this problem. It is a measure based on observable indications of the medical danger of a suicide attempt and of the patient's efforts to avoid or achieve rescue. The instrument is a clinician-rated supplement to self-reports and can be administered in a few minutes and learned in a single brief teaching session. We adapted the RRRS for contemporary use in a Norwegian acute adolescent mental health service clinic. We developed a training program for clinicians, a user manual, and a series of five video-based role-played interview cases for reliability testing. In this study, we recruited 28 clinicians with professional backgrounds typical of Norwegian mental health personnel. They rated five role-played video interviews using the RRRS and the well-established interview instrument the Suicide Intent Scale (SIS) and obtained 140 sets of scores. We estimated the interrater reliability (intraclass correlation coefficient [ICC]) to be.93 for the RRRS and.94 for the SIS, both excellent levels. Correlation was.80 between the RRRS and SIS items that were similar to the RRRS and.53 for SIS items measuring other topics, indicating good concurrent and discriminant validity. Adopting a common standard for communicating about suicide attempts can improve clinical practice, and the RRRS may prove to be a reliable and practical candidate for this task. [ABSTRACT FROM AUTHOR]

Background: Out-of-hospital cardiac arrest (OHCA) presents significant challenges with low survival rates, emphasizing the need for effective bystander CPR training. In Basic Life Support (BLS) training, the role of instructors is pivotal as they assess and correct learners' cardiopulmonary resuscitation (CPR) techniques to ensure proficiency in life-saving skills. This study evaluates the concordance between CPR quality assessments by Basic Life Support (BLS) instructors and those determined through Quantitative CPR (QCPR) devices, utilizing data from BLS courses conducted at National Cheng Kung University Hospital from October 2017 to April 2018. Methods: The study analyzed existing data from BLS courses, comparing CPR quality assessments made by instructors with those recorded by QCPR devices. Key metrics such as chest compression speed, depth, and recoil were examined to identify the degree of consistency between human and automated evaluations. Results: In this study, CPR performance was analyzed using QCPR devices and BLS instructors across metrics like speed, depth, and recoil. Employing the Cohen kappa statistic revealed moderate to low interrater reliability, the kappa value is 0.65 (95% C.I. 0.65–0.65) for depth, 0.56 (95% C.I. 0.33–0.79) for speed, and 0.50 (95% C.I.0.28–0.71) for recoil. Correlation analysis visualized in a heatmap indicated a higher consistency in depth evaluations (correlation coefficient = 0.7) compared to speed and recoil, suggesting a need for improved alignment in CPR training assessments. Conclusions: The study underscores the importance of refining CPR training methods and adopting advanced technological aids to enhance the reliability of CPR skill assessments. By improving the accuracy of these evaluations, the training can be better tailored to increase the effectiveness of life-saving interventions, potentially boosting survival rates in out-of-hospital cardiac arrest scenarios. [ABSTRACT FROM AUTHOR]

AbstractPurposeMaterials and methodsResultsConclusion\nIMPLICATIONS FOR REHABILITATIONThe Trunk Impairment Scale–modified Norwegian version (TIS-modNV) measures trunk control for clinical and research purposes. This study examined the validity and reliability of the TIS-modNV in people with multiple sclerosis (pwMS).Sixty-eight pwMS (mild to moderate) participated. The TIS-modNV and the Mini-Balance Evaluation Systems Test (Mini-BESTest) scores were compared for construct validity using Spearman’s rho (rs). TIS-modNV performance was videotaped and rated by four physiotherapists on two occasions. The inter- and intrarater reliability was analyzed via intraclass correlation coefficients (ICC), standard errors of measurement (SEM), Bland–Altman plots, and kappa statistics (k).Validity was demonstrated (rs = 0.55–0.61). Interrater reliability for the total score was moderate to good (ICC(A,1) =0.67; ICC(C,1) = 0.78), and the SEM was 2 points (12.8%). Interrater reliability varied across the rater pairs (ICC(A,1) = 0.54-0.81) as displayed in the Bland–Altman plots. Item-level interrater agreement varied from poor to good (k = 0.10–0.79). Intrarater reliability of the total scores was moderate to good (ICC(A,1) = 0.67–0.82).This study supports the construct validity and overall reliability of the TIS-modNV in pwMS with mild to moderate disability. However, variations in rater reliability need to be addressed.The Trunk Impairment Scale – modified Norwegian version (TIS-modNV) can be used to assess impairments in trunk control among people with mild to moderate multiple sclerosis (MS).Results of this study support construct validity and overall reliability of the TIS-modNV in individuals with MS.To address concerns about reliability, comprehensive training for raters and caution when comparing scores obtained by different raters are recommended.The Trunk Impairment Scale – modified Norwegian version (TIS-modNV) can be used to assess impairments in trunk control among people with mild to moderate multiple sclerosis (MS).Results of this study support construct validity and overall reliability of the TIS-modNV in individuals with MS.To address concerns about reliability, comprehensive training for raters and caution when comparing scores obtained by different raters are recommended. [ABSTRACT FROM AUTHOR]

AbstractObjective: Teletherapy via videoconferencing has become common practice but has unique challenges. We aimed to develop and validate the first performance-based observer-rated measure of teletherapy skills: The Teletherapy Facilitative Interpersonal Skills Performance Task (Tele-FIS). Methods: We developed a set of 12 Tele-FIS video stimulus clips as simulations of four research-informed common therapeutic challenges in teletherapy: technology, distraction, boundaries and privacy, and emotional disconnection. A total of 153 therapists recorded interventions to the clips which were later rated on interpersonal skills. Results: The Tele-FIS performance task demonstrated good interrater reliability, internal consistency, test-retest reliability, and convergent validity. The Tele-FIS was positively associated with self-reported facilitative interpersonal skills, self-efficacy, attitudes towards technology, and observer-rated skills on a version of the FIS task that simulates in-person therapy. Therapists performed similarly on teletherapy clips of emotional disconnection and privacy issues compared to clips of in-person therapy. Therapists performed worse on Tele-FIS clips of technology and distraction challenges than in-person therapy clips. Conclusions: The Tele-FIS has potential as an assessment tool in skills training for trainees and licensed clinicians as well as future research about therapeutic work via teletherapy. Results are discussed to consider therapist skill and the use of practice-relevant materials in training. [ABSTRACT FROM AUTHOR]

Background: Despite their prominence in the sport and human movement sciences, to date, there is no systematic insight about the development and content of movement quality assessments in athletic populations. This is an important gap to address, as it could yield both practical and scientific implications related to the continued screening of movement quality in athletic contexts. Hence, this study aimed to systematically review the (i) developmental approach, (ii) movements included, (iii) scoring system utilised, and (iv) the reliability of movement competency assessments used in athletic populations. Methods: Electronic databases (SPORTDiscus, MEDLINE, CINAHL, Web of Science, Scopus) were searched for relevant articles up to 12 May 2023. Studies were included if they reported data about the developmental approach, movements included, scoring system utilised and reliability of assessment in an athletic population. A modified Downs and Black checklist was used to measure study quality. Results: From a total of 131 identified studies: (i) 26 (20%) described the developmental approach of an assessment; (ii) 113 (86%) included descriptions of the movements included; (iii) 106 (81%) included a description of scoring system and criteria; and (iv) 77 (59%) studies included reliability statistics. There were 36 assessments identified within these studies, comprising 59 movements in total. Each assessment scored movement quality through a Likert or binary classification system. Conclusion: First, the results demonstrate that choosing an appropriate movement quality assessment in an athletic population may be a complex process for practitioners as the development approach, movements included and scoring criteria vary substantially between assessments. Second, academics could use these results to help design new assessments for novel applications that meet rigour and reliability requirements. Third, these results have the potential to foster guidelines of use for the reliable assessment of movement quality in athletic populations. Key Points: • The developmental approach, movements included and reliability of movement quality assessments vary within the literature. Given this, it is suggested that practitioners and researchers think critically when selecting an assessment that is appropriate for their context. • The assessment of composite scores appears more reliable than movement specific scores. Moreover, users of various movement quality assessments should be aware that rater experience can affect assessment reliability. • The relationship between movement quality assessments and their target application may not be universal. Therefore, the development of new assessments is warranted for emerging applications and to overcome issues in current assessments. [ABSTRACT FROM AUTHOR]

Objectives: The objectives of the study were to investigate the association between change in postoperative (post-op) tibial plateau angle (TPA) in dogs and cranial cruciate ligament disease (CCLD) after tibial plateau leveling osteotomy (TPLO) during 6 months on the post-op outcome. Methods: The inclusion criteria included 60 dogs with CCLD treated with TPLO fulfilled. TPA measurements were taken immediately post-op and 6 months post-op by three observers, and change in TPA was calculated. The outcome was evaluated using lameness score, owner questionnaire, and gait analysis performed preoperatively and 6 months post-op. Results: The mean change in TPA was 0.22 ± 0.75°. The interobserver reliability for TPA measurements was excellent. No differences in TPA measurements between observers were found (p = 0.07–0.105). No association between the change in TPA and outcome was found. The multivariate linear regression model for the symmetry index of peak vertical force (SIPVF) 6 months post-op was significant (R 2 = 0.210; p = 0.031), and the TPA at 6 months post-op was the only significant factor (ß = 0.459; 95% CI: 0.41–1.44; p < 0.001), indicating that a lower TPA 6 months post-op results in lower SIPVF values. Conclusion: The study indicated that lower TPAs 6 months post-op lead to a more symmetrical gait in hindlimbs 6 months post-op. No other significant factor between post-op changes in TPA and outcome after TPLO was found. Our results showed little post-op TPA change up to 6 months. This indicates that change in TPA is not present as reported. [ABSTRACT FROM AUTHOR]

Background: Early interventions in high-risk children seek to improve prognosis, minimize developmental delays, and prevent functional deterioration. The objective of this study was to evaluate the level of agreement between the face-to-face assessment and tele-assessment of neuromotor development in high-risk children between 0 and 18 months of age. Methods: Forty-five children at high risk of developmental delays were included in this study (33% female, mean gestational age of 35.31 ± 4.03 weeks). The patients were included in a face-to-face and a tele-assessment using the Alberta Infant Motor Scale (AIMS) and the level of motor evolution (Niveaux d'Évolution Motrice, NEM) assessments. Results: The analysis showed excellent interrater reliability (ρ ≥ 0.99) for the AIMS. The NEM assessment showed almost perfect reliability (kappa ≥ 0.81) for most items. Seven of them showed substantial reliability (kappa = 0.61–0.80), one moderate reliability (kappa = 0.568), and one fair reliability (kappa = 0.338). Conclusions: This study reveals an excellent/substantial interrater reliability for most of the items assessed. The results are promising to increase the accessibility to a clinical diagnosis and a rehabilitation approach to minimize the development of neuromotor delays in children at high risk. [ABSTRACT FROM AUTHOR]

Introduction: People diagnosed with cancer are the most frequent users of palliative care. However, there are no specific standards for early identifying patients with palliative care needs in mainland China. The Supportive and Palliative Care Indicators tool (SPICT) can identify patients with cancer who are in need of palliative care across healthcare settings. Objective: To translate, cross-cultural adapt the SPICT and validate it among cancer patients with palliative care needs in a Chinese healthcare context. Method: We translated and culturally adapted the SPICT from English into Chinese, following both Beaton's and WHO's recommendations: (1) initial translation, (2) synthesis, (3) back translation, (4) expert committee review, and (5) pretest. The psychometric properties (e.g., content validity, internal consistency, and inter-rater reliability) were analyzed. Convenience sample was used to recruit 212 hospitalized cancer patients between January and August 2023. Their needs were assessed by two nurses within 24hours to determine the inter-rater reliability and stability of the Mandarin version of SPICT (SPICT-CH). Results: All of 36 items were retained in response to expert review. The Scale-Content Validity Index/Ave (S-CVI/Ave) of the SPICT-CH was 0.98, demonstrating very strong content validity. The SPICT-CH exhibited good coherence (Cronbach's alpha = 0.76) and reliability (Kappa = 0.71, 95% CI 0.71-0.72, P < 0.05). Conclusion: The SPICT-CH has good content validity and acceptable reliability among cancer patients within a Chinese hospital setting. This instrument can be effectively integrated into routine clinical practice to early identify patients who need palliative care in mainland China. [ABSTRACT FROM AUTHOR]

Background: Although the Neer and AO/OTA classifications have been widely accepted, observer reliability studies of these two classifications have questioned their reliability and reproducibility to date. We developed an entirely new classification, the Mitsuzawa classification, for dislocated and displaced proximal humeral fractures and tested all three classifications for their intra- and interobserver reliability. Methods: Two experienced shoulder surgeons and two orthopedic residents independently evaluated the Xray (xR) values of 100 proximal humeral fractures (PHFs). The inclusion criteria for PHFs were (1) fracture-dislocation of the glenohumeral joint, (2) severely displaced fracture that required arthroplasty, such as hemi-arthroplasty or reverse shoulder arthroplasty, and (3) age > 18 years. Four reviewers classified all 100 fractures according to the Neer, AO/OTA, and Mitsuzawa classifications on two occasions. The intraobserver reliability was calculated using a Cohen κ statistic, while the interobserver reliability was calculated using a Fleiss κ statistic. Results: The average intraobserver agreements for the Neer, AO/OTA, and Mitsuzawa classifications were 0.57 (moderate), 0.67 (substantial), and 0.77 (substantial), respectively. The average interobserver agreements for the Neer, AO/OTA, and Mitsuzawa classifications were 0.49 (moderate), 0.56 (moderate), and 0.73 (substantial), respectively. The most common fracture type in each classification was an anterior dislocated fracture with a greater tuberosity fragment, which corresponded to A3a (57 cases) in the Mitsuzawa classification. Conclusions: The Mitsuzawa classification of PHF incorporates different perspectives regarding glenohumeral compatibility, assessment before and after shoulder dislocation reduction, and the degree of displacement of the proximal stump of the humeral shaft. Compared with the Neer and AO/OTA classifications, our new classification system adopted a user-friendly flowchart format and provided satisfactory intra- and interobserver reliability. Level of evidence: Level IV. [ABSTRACT FROM AUTHOR]

AbstractIn the field of neuropsychology, the accuracy of neuropsychological data interpretation has significant implications for both research and clinical practice. The process of test interpretation is fraught with challenges, and a lack of consensus among neuropsychologists can lead to discrepancies in assessment outcomes. Smith et al. (2020) identified this concerning lack of consensus in test score interpretation, raising questions about the standardization of interpretive practices within the field. Similarly, Tuokko and Gabriel (2006) reported moderate interrater agreement in identifying cognitive impairments, with a 77.7% consensus rate, using both history and all available information. The current study investigated the extent to which independent neuropsychologists could reach consistent diagnostic conclusions using only numeric data and the statistical methods available in the Meyers Neuropsychological Battery (MNB), without access to clinical history or contextual information. The results demonstrated a high degree of accuracy, with an overall agreement rate of 85.5% to 92.2% among the six raters. This finding underscores the potential of standardized statistical approaches to enhance the objectivity and consistency of neuropsychological assessments. The study advances neuropsychological assessment methodology by showing that statistical pattern-matching techniques can yield reliable and uniform diagnostic outcomes, even in the absence of additional clinical data. [ABSTRACT FROM AUTHOR]

Introduction: Alopecia areata (AA) is a non-scarring autoimmune disease characterized by patchy hair loss. The aim of this study was to validate a novel trichoscopic scoring tool, the Severity TRichoscopy Index for Alopecia Areata (STRIAA), for rapid assessment of AA severity. Methods: Anonymized images from 340 patients were scored by two independent raters who analyzed four scalp areas (vertex, occipital, and left and right parietal) for trichoscopic signs: black dots, yellow dots, exclamation mark hairs, broken hairs, and short vellus hairs. Scores (0–3) were assigned according to the number of trichoscopic signs per area, resulting in a total STRIAA score out of 60. Results: STRIAA showed high interrater reliability (Cronbach's alpha 0.99) and significant correlation with the Severity of Alopecia Tool (SALT) score (p < 0.001). Yellow and black dots were significantly associated with the SALT score. Conclusions: The STRIAA provides a rapid and comprehensive assessment of AA severity, complementing current assessment tools in clinical practice. [ABSTRACT FROM AUTHOR]

Background/Objectives: Cutaneous T-cell lymphoma (CTCL), including Mycosis fungoides (MF) and Sézary syndrome (SS), is a challenging-to-diagnose lymphoproliferative malignancy characterized by T-cell dysfunction and progressive cutaneous and extra cutaneous involvement. Disease severity assessment in CTCL is crucial for guiding treatment. This study aims to evaluate the interrater agreement and interrater reliability of mSWAT among dermatology residents and identify lesion types most prone to scoring variability. Methods: Sixteen dermatology residents with varied experience levels assessed 14 patients with confirmed MF/SS diagnoses. Using mSWAT, residents independently scored lesions severity on a standardized set of patient's photos. The results were compared with reference mSWAT scores provided by an experienced clinician. Descriptive statistics and the Shapiro–Wilk test were applied to evaluate data distributions, while Student's t-test assessed score deviations from reference values. Furthemore, we conducted a pilot the high frequency ultrasound (HFUS) study on a single patient, whose mSWAT score and photographs are also presented in the manuscript. Results: Significant discrepancies were observed in 64.29% of cases (9/14), with tumors and infiltrative lesions in erythrodermic SS patients posing particular scoring challenges. Misclassification of tumors as patches or plaques was a frequent issue, leading to underestimations in mSWAT scores. Residents' assessments of infiltrative lesions were also notably inconsistent. Conclusions: This study highlights significant interobserver variability in mSWAT scoring among less experienced dermatology residents, particularly with tumor and erythrodermic lesions. Findings underscore the need for enhanced training and standardized scoring protocols to improve mSWAT reliability. Similar to other comparable indices, such as PASI, the mSWAT should be employed consistently by the same physician during each assessment to systematically monitor and evaluate the skin condition of a patient under observation. However, broader application requires the acquisition of sufficient experience. The study suggests the use of the HFUS as an objective method of assessment of the skin lesion infiltration in MF/SS patients. [ABSTRACT FROM AUTHOR]

Implicit biases about disability contribute to discriminatory behaviors and explicit attitudes toward people with disability, an issue that is of significant importance for rehabilitation researchers. The current study reviewed existing measures of implicit disability biases published between 2000 and April 2022. The search was conducted among seven databases, five major rehabilitation counseling journals, and relevant references in the retrieved articles. A total of 66 studies were identified and reviewed. Results showed that the Implicit Association Test (IAT) was the most frequently used measure of implicit disability biases. A few studies used priming tasks, inhibition tasks, and other tasks based on rating scales to measure implicit disability biases. The strengths and limitations of the measures are discussed, and recommendations for rehabilitation practitioners, educators, and researchers are provided. [ABSTRACT FROM AUTHOR]

Upper cervical complex fractures are associated with high rates of neurological damage and mortality. The Dickman's classification is widely used in the diagnosis of upper cervical complex fractures. However, it falls short of covering the full spectrum of complex fractures. This limitation hinders effective diagnosis and treatment of these injuries. To address the diagnostic gap in upper cervical complex fractures, the study introduces a novel classification system for these injuries, assessing its reliability and usability. Proposal of a new classification system for upper cervical complex fractures. The study comprised the clinical data of 242 patients with upper cervical complex fractures, including 32 patients treated at our hospital, along with an additional 210 cases from the literature. The interobserver and intra-observer reliability (kappa coefficient, κ) of this classification system were investigated by 3 spine surgeons. The 3 researchers independently reevaluated the upper cervical complex fracture classification system 3 months later. The proposed classification categorizes upper cervical complex fractures into 3 main types: Type I combines odontoid and Hangman's fractures into 2 subtypes; Type II merges C1 with odontoid/Hangman's fractures into 3 subtypes; and Type III encompasses a combination of C1, odontoid, and Hangman's fractures, divided into 2 subtypes. Meanwhile, a questionnaire was administered in 15 assessors to evaluate the system's ease of use and clinical applicability. A total of 45 cases (18.6%) unclassifiable by Dickman's classification were successfully categorized using our system. The mean κ value of inter-observer reliability was 0.783, indicating substantial reliability. The mean κ value of intraobserver reliability was 0.862, indicating almost perfect reliability. Meanwhile, thirteen assessors (87.7%) stated that the classification system is easy to remember, easy to apply, and they expressed intentions to apply it in clinical practice in the future. This system not only offers high confidence and reproducibility but also serves as a precise guide for clinicians in formulating treatment plans. Future prospective applications are warranted to further evaluate this classification system. [ABSTRACT FROM AUTHOR]

Objectives The study is aimed to perform magnetic resonance (MR) cartigram of the articular disc in patients with asymptomatic and symptomatic temporomandibular disorders (TMD). Materials and Methods Thirty-nine volunteers were divided into three groups: 16 symptomatic TMD, 16 asymptomatic TMD, and 7 controls. The articular disc was divided into three segments (anterior, middle, and posterior) and analyzed using morphological magnetic resonance imaging (MRI) and T2 mapping sequences. T2 relaxation values were measured and assessed by an experienced radiologist and two observers. The T2 values in the discs were compared between the control, asymptomatic, and symptomatic groups using the Kruskal–Wallis test. The right and left discs were compared using the Wilcoxon signed rank test. Inter-examiner reliability among different examiners was evaluated. Results The controls had the highest T2 values compared with the other groups. The comparison among the right and left sides of all the groups revealed statistically significant results in the anterior portion in the asymptomatic group and the middle portion in the symptomatic group (p < 0.05). The inter-examiner reliability coefficients among the three examiners were consistently high, with values of 0.921, 0.920, and 0.930. Conclusion Our study found the T2 relaxation time span was shorter than that reported in previous studies, which could be attributed to the early stage of cartilage deterioration in the individuals with TMD inferring treatment at this phase may be eventually effective with a good prognosis. [ABSTRACT FROM AUTHOR]

Background Magnetic resonance imaging (MRI) is key in evaluating central cartilage tumors. The BACTIP (Birmingham Atypical Cartilaginous Tumour Imaging Protocol) protocol assesses central cartilage tumor risk based on the tumor size and degree of endosteal scalloping on MRI. It provides a management protocol for assessment, follow-up, or referral of central cartilage tumors. Objectives Our study compared four MRI sequences: T1-weighted (T1-w), fluid sensitive (Short Tau Inversion Recovery (STIR)- weighted, STIR-w), and grayscale inversions (T1-w GSI and short tau inversion recovery [STIR] GSI) to see how reliably endosteal scalloping was detected. Materials and Methods Two senior consultant musculoskeletal radiologists with experience reviewed randomly selected 60 representative central cartilage tumor cases with varying degree of endosteal scalloping to reflect a spectrum of BACTIP pathologies. The endosteal scalloping was graded as per the definition of BACTIP A, B, and C. They agreed on a consensus BACTIP grade for each of the 240 key images (60 cases × 4 sequences), which was considered the final "consensus" BACTIP grade. These 240 images were then randomized into a test set and given to two fellowship-trained consultant musculoskeletal radiologists for analysis. They assigned a BACTIP grade to each of the 240 selected images while being blinded to the final "consensus" BACTIP grade. The training set was further subdivided into three groups based on the MR image quality (good quality, average quality, and poor quality) to ascertain if the quality of the acquired images influenced intraobserver and interobserver agreements on the BACTIP grading. The two observers were blinded to the grade assigned to the image quality. Results Linearly weighted kappa analysis was performed to measure the agreement between the BACTIP grading answers by two observers and the "consensus" BACTIP grading answers, as well as the BACTIP grading agreement between the two observers themselves. The analysis revealed that T1-w and STIR-w sequences demonstrated more consistent and higher agreement across different image qualities. However, the T1-w GSI and STIR-w GSI sequences exhibited lower agreement, particularly for poor-quality images. T1-w imaging demonstrated substantial agreement between BACTIP gradings for poor-quality images, suggesting potential resilience of T1-w sequence in challenging imaging conditions. Conclusion T1-w imaging is the best sequence for BACTIP grading of endosteal scalloping, followed by fluid-sensitive STIR sequences. [ABSTRACT FROM AUTHOR]

Objective The aims of this study are to compare the multiphasic contrast-enhanced computed tomography (CECT) characteristics of infiltrative hepatocellular carcinoma (HCC) with nodular HCC and to assess the conspicuity of infiltrative HCC on different phases of CECT. Materials and Methods This retrospective study comprised consecutive treatment-naive cirrhotic patients diagnosed with infiltrative and nodular HCC between January 2020 and December 2021 based on a multiphasic CECT (comprising arterial, portal venous, and delayed phases). The diagnosis of HCC was based on the Liver Imaging Reporting and Data System (LI-RADS) v2018 criteria (LR-4 and LR-5 lesions). Infiltrative HCCs are characterized by large, irregular, permeative lesions spread over multiple liver segments or lobes. Nodular HCCs comprise well-defined tumor nodules. Two radiologists independently reviewed all CT images. Additionally, lesion conspicuity on the arterial, portal venous, and delayed phases was assessed. Results One hundred fifty-eight patients (117 nodular and 41 infiltrative HCCs; mean age: 55.6 ± 17.2 years; 90 [56.9%] males) were included. Arterial phase hyperenhancement, portal venous/delayed phase washout, and delayed phase enhancing capsule were significantly associated with nodular HCCs (p = 0.002, 0.0001, and <0.0001, respectively). Portal vein, hepatic vein thrombosis, biliary dilatation, and ascites were significantly associated with infiltrative HCCs (p < 0.0001, 0.004, <0.0001, and 0.003, respectively). The interobserver agreement for the conspicuity of infiltrative HCC was the highest for the delayed phase (weighted kappa = 0.611). Conclusion Infiltrative HCCs show the major LI-RADS features less frequently compared with nodular HCCs, and venous thrombosis is an important clue to the diagnosis. The delayed phase of multiphasic CECT is critical to identifying these lesions. [ABSTRACT FROM AUTHOR]

Objective: Tools for classifying adverse drug reactions (ADRs) have not yet been validated in the context of the neonatal intensive care unit (NICU). The study aims to investigate the inter-rater reliability of the Hartwig tool and the Liverpool avoidability assessment tool (LAAT) in assessing the severity and avoidability of ADR cases in hospitalized neonates. Methods: An observational and prospective study was conducted in the NICU of a maternity hospital in Natal, Brazil. The Hartwig tool and LAAT were employed to assess the severity and avoidability of ADRs, respectively. Three experienced clinical pharmacists independently assessed all ADR cases. Inter-rater reliability was measured using Cohen's kappa coefficient (k) with corresponding 95% confidence intervals (CI). Results: Among 79 ADR cases, the mean gestational age was 29.7 ± 4.4 weeks, and the birth weight averaged 1446.0 ± 1179.3 g. The assessment of ADR severity using the Hartwig tool revealed a significant overall correlation (overall k = 0.573; 95% CI 0.395 to 0.753) with exact agreement (EA) and extreme disagreement (ED) rates between evaluators of 86.5% and 2.5%, respectively. However, no statistically significant correlation was observed for determining avoidability using the LAAT (overall k = 0.017; 95% CI − 0.048 to 0.082), with an EA rate of 83.6% and ED rate of 10.1%. Conclusion: The Hartwig tool demonstrates good reproducibility among different evaluators in determining the severity of ADRs, unlike the LAAT for assessing avoidability. [ABSTRACT FROM AUTHOR]

Introduction: Widespread pain may be related to psychosocial aspects in several musculoskeletal conditions, but the literature on carpal tunnel syndrome (CTS) is scarce. Objective: To determine the relationship between pain extent and psychological factors (catastrophizing, kinesiophobia, anxiety symptoms, and depression) in people with CTS. Methods: A cross-sectional study was conducted. The independent variables were: pain intensity, disability (QuickDASH), duration of symptoms, anxiety and depressive symptoms, catastrophizing, and kinesiophobia. The main outcome was: pain extent (% of total area and categories "pain within the median nerve-innervated territory" versus "extra-median nerve pain"). Correlation analysis was performed using Spearman's correlation coefficient. A linear regression model and binary logistic regression (both with forward selection) were performed to determine the main predictors of pain extent. Results: Forty-eight participants were included. A moderate positive correlation was found between catastrophizing (r = 0.455; p = 0.024) and disability (r = 0.448; p = 0.024) with total pain extent area. Regression models indicated that catastrophizing explained 22% of the variance in the pain extent (β = 0.003; 95% CI: 0.002–0.005), while kinesiophobia was the variable that best explained the distribution of pain in the extra-median territory (R2 Nagelkerke = 0.182). Null or weak correlations were found for the rest of the associations. Conclusion: Catastrophizing and kinesiophobia were the main indicators of pain extent in people with CTS. Clinicians are advised to use specific questionnaires to check for the presence of catastrophizing or kinesiophobia in people with CTS and wider pain extension. [ABSTRACT FROM AUTHOR]

Construct: The McMaster Narrative Comment Rating Tool aims to capture critical features reflecting the quality of written narrative comments provided in the medical education context: valence/tone of language, degree of correction versus reinforcement, specificity, actionability, and overall usefulness. Background: Despite their role in competency-based medical education, not all narrative comments contribute meaningfully to the development of learners' competence. To develop solutions to mitigate this problem, robust measures of narrative comment quality are needed. While some tools exist, most were created in specialty-specific contexts, have focused on one or two features of feedback, or have focused on faculty perceptions of feedback, excluding learners from the validation process. In this study, we aimed to develop a detailed, broadly applicable narrative comment quality assessment tool that drew upon features of high-quality assessment and feedback and could be used by a variety of raters to inform future research, including applications related to automated analysis of narrative comment quality. Approach: In Phase 1, we used the literature to identify five critical features of feedback. We then developed rating scales for each of the features, and collected 670 competency-based assessments completed by first-year surgical residents in the first six-weeks of training. Residents were from nine different programs at a Canadian institution. In Phase 2, we randomly selected 50 assessments with written feedback from the dataset. Two education researchers used the scale to independently score the written comments and refine the rating tool. In Phase 3, 10 raters, including two medical education researchers, two medical students, two residents, two clinical faculty members, and two laypersons from the community, used the tool to independently and blindly rate written comments from another 50 randomly selected assessments from the dataset. We compared scores between and across rater pairs to assess reliability. Findings: Single and average measures intraclass correlation (ICC) scores ranged from moderate to excellent (ICCs =.51–.83 and.91–.98) across all categories and rater pairs. All tool domains were significantly correlated (p's <.05), apart from valence, which was only significantly correlated with degree of correction versus reinforcement. Conclusion: Our findings suggest that the McMaster Narrative Comment Rating Tool can reliably be used by multiple raters, across a variety of rater types, and in different surgical contexts. As such, it has the potential to support faculty development initiatives on assessment and feedback, and may be used as a tool to conduct research on different assessment strategies, including automated analysis of narrative comments. [ABSTRACT FROM AUTHOR]

Background: The exploration of Chat generative pre-training transformer's (GPT's) applications in medicine is gaining momentum, with artificial intelligence, particularly ChatGPT, showing promise in enhancing orthopedic care. ChatGPT can assist clinicians by providing relevant information based on patient symptoms, medical history, and radiological findings, aiding in differential diagnosis, and suggesting appropriate imaging modalities. This study focuses on evaluating the effectiveness of ChatGPT-4 in diagnosing and managing common orthopedic fractures. Methods: This study involved inputting a diverse set of fracture images into the ChatGPT-4 model. The process commenced by prompting ChatGPT with four questions: "What does the radiograph show?" The second prompt instructed ChatGPT with the actual diagnosis, followed by inquiries on how a clinician should manage the condition and potential complications. All generated responses underwent grading by two authors (musculoskeletal radiologist and orthopedic trainee), utilizing a 5-point Likert scale. Intraclass correlation coefficient (ICC) analysis measurements were performed to assess inter-rater reliability. Descriptive statistical analysis was then employed to provide a comprehensive summary of the study's findings. Results: ChatGPT demonstrated limitations in identifying diagnoses based on inputted X-ray images. However, it excelled in providing comprehensive information about fracture management and potential complications. There was excellent interobserver reliability with a kappa of 0.9. Conclusion: Our study underscores the utility of ChatGPT as a valuable tool for aiding in the management of common fractures, offering a comprehensive overview of diagnosis, management, and potential complications. The findings highlight its potential role as a supplementary resource in orthopedic practice. [ABSTRACT FROM AUTHOR]

This review evaluated single-case experimental design research that examined challenging behavior interventions utilizing punishment elements. Thirty articles published between 2013 and 2022 met study inclusion criteria. Study quality was also assessed. Through multiple levels of analysis (e.g., descriptive statistics, non-parametric statistics), we examined (a) participant and study trends, (b) differential outcomes related to temporal reinforcement approaches (antecedent, consequent, or combined reinforcement) applied alongside punishment element(s), (c) differential outcomes related to the punishment type (negative, positive) applied alongside reinforcement, and (d) effect sizes associated with study rigor across peer-reviewed and gray literature. Our results may tentatively suggest that, for certain situations, concurrently applying punishment with antecedent reinforcement approaches may coincide with significantly larger effect sizes compared to combined temporal reinforcement approaches, while positive punishment applied concurrently with reinforcement may coincide with larger but non-significant intervention effects. Most featured articles met rigor criteria, but larger effects were seen in peer-reviewed literature. [ABSTRACT FROM AUTHOR]

During ongoing narratives, event boundaries trigger processes relevant for subsequent memory. Previous work has shown that novel, unrelated input presented at an event boundary can retroactively interfere with short-term retention of the preceding event. This interference was attributed to a perturbation of offset-related processes taking place within seconds after encoding and supporting the binding of elements into a coherent event memory. However, the temporal specificity of this memory interference and whether its impact extends to longer retention delays has not been addressed. Here, participants viewed either individual or pairs of short narrative movie clips. Susceptibility to interference at event boundaries was probed by presenting the second clip either immediately after the first, or with a 2s encoding delay. In free and cued recall, after 20 min and 24 h, only memory for movie clips that were immediately followed by a second clip was reduced compared to clips shown in isolation. Intact offset-related processes (as indexed by successful recall of the first movie) did not negatively affect encoding of the subsequent clip. Together, these results indicate that the 2s time-window immediately after an event is relevant for successful consolidation and long-term retention of memory. [ABSTRACT FROM AUTHOR]

Introduction: Various techniques have been described for restoring leg length and offset during total hip arthroplasty (THA). We herein describe a novel "Quartered Head Technique" (QHT) involving a series of femoral osteotomies. Methods: 124 hips were included in the analysis. An anterolateral approach was used in all cases. Leg length, and offset were assessed intraoperatively and reproduced using the QHT. A leg-length discrepancy (LLD) of <6 mm was chosen as acceptable based on previously published literature. Postoperative pelvic radiographs were assessed by two independent observers to ensure inter-observer reliability. Results: The mean absolute postoperative difference in leg length from the contralateral leg was +3.58 mm. 84% of patients had LLD within ±6 mm of the contralateral limb. Mean absolute postoperative difference in offset from the contralateral leg was +3.88 mm. 90% of patients were within ±6 mm offset of the contralateral limb. There was no statistical difference noted between observer measurement. Conclusions: The QHT provides a simple, inexpensive, yet effective method of maintaining femoral leg length and offset during total hip arthroplasty [ABSTRACT FROM AUTHOR]

Background: While often used, Hilgenreiner's line may not always be a reliable reference plane following triple innominate pelvic osteotomy or trauma to the triradiate cartilage. The inferior sacral-iliac line is a horizontal line connecting the sclerotic corners of the inferior sacral-iliac joints. This is a consistent landmark in the ossifying infant pelvis as well as the fully developed adult pelvis. The goal of this study was to determine if there is a difference in measurements between the inferior sacral-iliac line and Hilgenreiner's line in order to identify an alternative horizontal reference plane. Methods: 3 reviewers (fellowship-trained paediatric orthopaedic surgeon, junior orthopaedic resident, senior orthopaedic resident) reviewed 100 paediatric non-osteotomized pelvises. The difference between Hilgenreiner's line and the inferior sacral-iliac line were measured and reported. Measurements were repeated a minimum of 48 hours apart, resulting in 600 comparisons between Hilgenreiner's line and the inferior sacral-iliac line. The standard error of measurement was calculated to assess the variation in measurements between each individual observer and the group as a whole. Results: The mean standard error of measurement between Hilgenreiner's line and the inferior sacral-iliac line was 0.44° (95% CI, ± 0.86). Reviewers 1–3 demonstrated a mean standard error of measurement of 0.38, 0.28, and 0.35 (95% CI, ± 0.74, 0.55, and 0.86) respectively. There was no statistically significant difference between reviewers (p > 0.05). Intra-observer reliability for reviewers 1, 2, and 3 was 0.64 (0.47–0.76), 0.75 (0.63–0.83), and 0.54 (0.32–0.69) respectively, with an inter-observer reliability of 0.42 (0.20–0.60) degrees. Conclusions: In this proof-of-concept study, the inferior sacral-iliac line was found to be an appropriate alternative to Hilgenreiner's line that is easily identifiable for all levels of orthopaedic training. Future inferior sacral-iliac line studies should demonstrate the reliability of multiple acetabular measurements, both pre- and post-osteotomy. [ABSTRACT FROM AUTHOR]

Antimicrobials prescribed without indications can lead to antimicrobial resistance (AMR). This study aimed to develop a validated support and audit antimicrobial prescription assessment tool (AmPAT) to assess the rationality of prescriptions by generalist medical doctors in outpatient settings at primary and secondary healthcare facilities. Multiphase content validity study. AmPAT was developed in four phases. Phase 1 involved item identification and development based on literature and expert suggestions. In phase 2, the face and content validity were assessed using the Delphi technique in two rounds (16 experts in round 1 and 19 in round 2). The content validity ratio (CVR) and content validity index (CVI) were calculated. A pilot study was conducted in Phase 3 in primary and secondary-level healthcare facilities (n = 92 prescriptions) in Chandigarh, India. Five experts assessed the rationality of 30 prescriptions for inter-rater reliability. The inter-rater agreement and internal consistency were calculated using Fleiss-Kappa statistics and Cronbach's alpha, respectively. Phase 4 included a large cross-sectional study (n = 945 prescriptions) for estimating the internal consistency of AmPAT. AmPAT was developed with 19 items under three sections (patient, clinical, and treatment details). The mean CVR was 0.91 (range 0.16–1.00), and mean CVI was 0.96 (range 0.58–1.00). The kappa value was 0.91 (range 0.59–1.00) for inter-rater agreement. The Cronbach's alpha was 0.75 (95%CI 0.66–0.82) and 0.76 (0.68–0.82) in phases 3 and 4, respectively. AmPAT, with good reliability, inter-rater agreement, and internal consistency, was developed to assess the rationality of antimicrobials prescribed in outpatient departments at primary and secondary-level healthcare settings. [ABSTRACT FROM AUTHOR]

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

Intensive longitudinal data (ILD) has been collected to capture the dynamic fluctuations of procrastination; however, researchers have typically measured daily procrastination by modifying trait measures (e.g., adding a time reference "today") without adequately testing their reliabilities. The main purpose of this study was to use an advanced approach, dynamic structural equation modeling, to assess the between- and within-person reliabilities of a widely used six-item measure of daily procrastination. A total of 252 participants completed retrospective measures of various types of trait procrastination and daily measures of procrastination over 34 consecutive days. The results showed that the entire scale for daily procrastination and five of its six items had high between- and within-person reliabilities, but one item had much lower reliabilities, suggesting that this item may be inappropriate in everyday contexts. Furthermore, we found moderate to strong associations between the latent trait factor of procrastination and trait measures of procrastination. In addition, we identified substantial between-person variation in person-specific reliabilities and explored its relevant factors. Overall, this study assessed the reliabilities of a daily measure of procrastination, which facilitated future studies to obtain more reliable and consistent results and to better estimate the reliability of ILD. [ABSTRACT FROM AUTHOR]

Purpose: Following the Rehabilitation Treatment Specification System (RTSS) framework, the current study investigated the active ingredients in the modified semantic feature analysis (mSFA) targeting either noun or verb retrieval in Mandarin--English bilingual adults with aphasia (BWA). Method: Twelve Mandarin--English BWA completed mSFA treatment for nouns and verbs. Eight of them completed both noun and verb treatment, while four completed either type of treatment. Performance in each step was scored and analyzed using mixed-effects modeling. Then, regression was performed to estimate the effect of treatment performance on the accuracy of naming probes for trained and semantically related items in both treated and untreated languages. Results: Participants demonstrated significant improvements in all treatment steps during both noun and verb treatment, yet the effect varied depending on the trained word category and treatment language. Moreover, all treatment components contributed significantly to the treatment outcomes. Better treatment performance in spontaneous naming was significantly associated with improved naming accuracy of the trained items in noun mSFA, while better treatment performance in spontaneous naming, feature analysis, and sentence production was significantly associated with enhanced naming of the semantically related untrained items in noun mSFA. Importantly, performance in all treatment steps of both noun and verb mSFA significantly predicted naming accuracy in the untreated language. Conclusion: Findings provided strong evidence of the potential active ingredients of semantic-based naming therapy in Mandarin--English BWA and highlighted the importance of examining treatment ingredients within the RTSS framework. [ABSTRACT FROM AUTHOR]

Purpose: The present study explored the extent to which early prelinguistic communication skills predict expressive language in toddlers with autistic siblings (Sibs-autism), who are known to be at high likelihood for autism and language disorder, and a comparison group of toddlers with non-autistic older siblings (Sibs-NA). Method: Participants were 51 toddlers (29 Sibs-autism, 22 Sibs-NA) aged 12-- 18 months at the first time point in the study (Time 1). Toddlers were seen again 9 months later (Time 2). Three prelinguistic communication skills (i.e., intentional communication, vocalization complexity, and responding to joint attention) were measured at Time 1 via the Communication and Symbolic Behavior Scales Developmental Profile--Behavior Sample. An expressive language aggregate was calculated for each participant at Time 2. A series of correlation and multiple regression models was run to evaluate associations of interest between prelinguistic communication skills as measured at Time 1 and expressive language as measured at Time 2. Results: Vocalization complexity and intentional communication displayed significant zero-order correlations with expressive language across sibling groups. Vocal complexity and responding to joint attention did not have significant added value in predicting later expressive language, after covarying for intentional communication across groups. However, sibling group moderated the association between vocalization complexity and later expressive language, such that vocal complexity displayed incremental validity for predicting later expressive language, covarying for intentional communication, only within Sibs-NA. ts indicate that prelinguistic communication skills, in particuunication, show promise for predicting later expressive lanautistic children. These findings provide additional empirical n that early preemptive interventions targeting prelinguistic ls, especially intentional communication, may have the language acquisition and support more optimal language opulation at high likelihood for a future diagnosis of both disorder. Conclusions: Resul lar intentional comm guage in siblings of support for the notio communication skil potential to scaffold outcomes in this p autism and language [ABSTRACT FROM AUTHOR]