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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]

Context: To assess the reliability of a remote 2D markerless motion tracking method (Kinovea) to quantify knee and hip angles during dynamic tasks. Methods: Fourteen healthy adults performed body weight squats and lateral lunges while video recording themselves at home. Knee and hip angles were quantified in the sagittal plane for the squats and in the frontal plane for the lateral lunges. Two students each performed the video analysis procedure twice, 2 weeks apart. Intraclass correlation coefficients were used to calculate the intrarater and interrater reliability for angles at maximum depth. The intrarater and interrater agreement over the joint angle-time signals were quantified using a validation metric; an acceptable agreement threshold was set at a validation metric of 0.803 or higher. Standard error of measurement (SEM) was also calculated. Results: Reliability was good to excellent (intraclass correlation coefficients = .80-.98) for all angle comparisons at maximum depth. The agreement over the entire joint angle-time signal was acceptable for all squat variables except for the interrater hip angle comparison (validation metric = 0.797). None of the lateral lunge variables met the threshold of acceptable agreement. The mean SEM across participants for all joint angle-time signal and for maximum depth was acceptable (<5°) for all measurements (SEM = 1.2°-4.9°). Conclusions: Overall, the reliability, agreement, and SEM quantified in this study support the integration of remote methods to quantify lower-extremity kinematics into research and clinical practice. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study is to measure the concurrent validity of the Athletic Skills Track (AST) by examining whether its outcome score correlates with the holistic judgments of experts about the quality of movement. Method: Video recordings of children performing the AST were shown to physical education teachers who independently gave a holistic rating of the movement quality of each child. Results: Both intra- and interrater reliability of the teachers' ratings were moderate to good. The holistic judgments on movement quality were significantly correlated with AST time, showing that higher ratings were associated with less time required to complete the track. Next, hierarchical stepwise regression indicated that in addition to the holistic rating, also age, but not gender, explained part of the variance in AST time. Conclusion: The findings show that the AST has good concurrent validity and provides a fast, indirect indication for quality of movement. [ABSTRACT FROM AUTHOR]

Objective: This in vitro study aimed to compare the diagnostic outcomes of caries detection in premolar and molar teeth on digital periapical radiographs viewed as grayscale images and in the Java-based software (JBS) pseudocolor spectrum. Method and materials: The study comprised 92 premolar or molar human teeth (n = 46 with caries and n = 46 without clinical caries). For each tooth, digital periapical radiographic images (DPRIs), JBS pseudocolor images, and stereomicroscope images were collected, and caries presence and depth were recorded. In JBS pseudocolor images, regions of interest (ROIs) were detected, and ROI values for caries area (ROI1), non-caries area (ROI2), mesial area (ROI3), and distal area (ROI4) were obtained. The degree of inter-observer agreement was determined using the kappa coefficient, and the sensitivity and specificity of the methods were assessed using ROC analysis. Results: While neither method was consistent with stereomicroscopy in determining caries depth (P < .005), for both observers the kappa value of JBS pseudocolor images were slightly higher than those for DPRIs. ROI1 was found to be significantly lower than ROI2 (P < .001), whereas no difference was found between ROI3 and ROI4 (P = .877). For both observers, the sensitivity and specificity obtained from JBS pseudocolor were above 89%. Conclusion: JBS pseudocolor images can be used for caries detection and offer high sensitivity and specificity. [ABSTRACT FROM AUTHOR]

Background: Musculoskeletal cone-beam computed tomography (CBCT) is an imaging technique for wrist assessment. In this study, we compared image quality and patient satisfaction between CBCT and multidetector computed tomography (MDCT) in traumatic wrist patients in a dose-matched setting. Methods: We prospectively enrolled traumatic patients who were scheduled for CT of the wrist. Patients were randomly assigned to CBCT or MDCT. Radiation dose was kept identical between both modalities. Subsequently, patients were asked to complete a questionnaire regarding the examination. Measurements of contrast-to-noise ratio (CNR) were performed. Three blinded readers independently rated image quality on Likert scales. Results: A total of 125 patients (mean age 35 years [standard deviation 16]; 91 men) were included. A total of 108 patients returned the questionnaire. With equivalent dose, CNRs were higher in CBCT compared to MDCT (p < 0.001) and the median ratings of image quality were better for CBCT compared to MDCT (p ≤ 0.04). Patients only rated positioning in CBCT as more comfortable than in MDCT (p < 0.001), while there were no further differences regarding satisfaction with both modalities. Conclusions: At equivalent dose settings to MDCT, CBCT showed a high image quality for the depiction of bony structures, soft tissue and artifacts in wrist examinations of trauma patients. Overall, patients were equally satisfied with both methods. Altogether, CBCT might be a promising alternative for wrist imaging. However, further studies with more different devices are needed. [ABSTRACT FROM AUTHOR]

Background: A variety of measurement methods and imaging modalities are in use to quantify the morphology of lateral femoral condyle (LFC), but the most reliable method remains elusive in patients with lateral patellar dislocation (LPD). The purpose of this study was to determine the intra- and inter-observer reliability of different measurement methods for evaluating the morphology of LFC on different imaging modalities in patients with LPD. Methods: Seventy-three patients with LPD were included. Four parameters for quantifying the morphology of LFC were retrospectively measured by three observers on MRI, sagittal CT image, conventional radiograph (CR), and three-dimensional CT (3D–CT). The intra-class correlation coefficient was calculated to determine the intra- and inter-observer reliability. Bland–Altman analysis was conducted to identify the bias between observers. Results: The lateral femoral condyle index (LFCI) showed better intra- and inter-observer reliability on MRI and 3D–CT than on CR and sagittal CT images. The mean difference in the LFCI between observers was lowest on 3D–CT (0.047), higher on MRI (0.053), and highest on sagittal CT images (0.062). The LFCI was associated with the lateral femoral condyle ratio (ρ = 0.422, P = 0.022), lateral condyle index (r = 0.413, P = 0.037), and lateral femoral condyle distance (r = 0.459, P = 0.014). The LFCI could be reliably measured by MRI and 3D–CT. Conclusion: The LFCI could be reliably measured by MRI and 3D–CT. The LFCI was associated with both the height and length of LFC and could serve as a comprehensive parameter for quantifying the morphology of LFC in patients with LPD. [ABSTRACT FROM AUTHOR]

Introduction: Health literacy refers to acquiring and utilizing health information to make health-related actions and decisions. Filipino domestic workers with low health literacy are often vulnerable to health problems due to poor living and working conditions. Objective: This study examined the effect of an online health literacy promotion program on health literacy and health knowledge of Filipino domestic workers in Macao. Methods: The mixed method combined quantitative findings of a quasi-experimental study with qualitative results applied. The quasi-experiment included three parallel groups: a synchronous online education group (videoconference group), an asynchronous online education group (video group), and a control group. A total of 88 Filipino domestic workers were assigned to one of these groups, and eight respondents participated in two focus-group interviews respectively after the intervention. Results: For quantitative data, both synchronous and asynchronous online education interventions had positive effects. While comparing with the control group, participants in the videoconference group were more likely to have better health promotion health literacy after the intervention (β = 5.36, p =.02), and participants in the video group were more likely to have better general health literacy (β = 5.17, p =.01), disease prevention health literacy (β = 5.31, p =.04), health promotion health literacy (β = 5.97, p =.01). For qualitative data, three themes and eight subthemes were extracted after the online health literacy promotion program. After integrating the findings of this study, the study found that this program was essential and beneficial for Filipino domestic workers' health knowledge and health literacy. Conclusion: Overall, online health literacy promotion programe had positive impacts on participants revealed in this study. Asynchronous online education has made significant progress in overall health literacy, which may be more suitable as a widely promoted education method because of the characteristics and working conditions of this population. [ABSTRACT FROM AUTHOR]

Background: Osteoarthritis is a prevalent degenerative joint disease initiating chronic pain and lameness in horses. While several objective gait analysis systems have been developed and validated to quantify lameness severity in horses, methods to evaluate whether peripheral sensitization contributes to the pain experienced are missing. Objectives: To evaluate whether periarticular pressure pain mapping could be proposed as an auxiliary assessment tool in horses. Specific aims were to evaluate the feasibility and intra- and inter-rater reliability of pressure pain thresholds (PPT) determination at sites overlying the distal thoracic limb joints of clinically healthy horses. Study design: Prospective, randomized validation study. Methods: For feasibility assessment, PPT were measured with a hand-held digital algometer at six periarticular landmarks (2 sites per joint, 3 joints) bilaterally on the distal thoracic limb of 40 healthy horses (20 warmblood and 20 Freiberger). The joints tested were the metacarpophalangeal, on the lateropalmar and dorsal aspects (L-MCP and D-MCP), the proximal interphalangeal, on the dorsal and palmar aspect (D-PIP and P-PIP) and the distal interphalangeal, on the dorsal and lateral aspect (D-DIP and L-DIP). A feasibility score, ranging from 0 to 5, was attributed to each testing session. For intra- and inter-rater reliability assessment, L-MCP and D-MCP were selected to be tested again at 2 weeks intervals in 20 out of the 40 horses. Data were analyzed using a mixed-effect linear model to test differences in threshold per site and limb. Intra- and inter-rater correlation was calculated. Bland-Altman plots were performed to evaluate the variability of the measures. Results: The procedure was considered feasible (score <2) in 95% of horses (95% CI 88%--100%). Overall, median [interquartile range (IQR)] PPT was 9.4 (7.5--11.3) N. No significant side differences were found. P-PIP and D-DIP recorded significantly lower PPT (p < 0.001 and p = 0.002, respectively) than L-MCP. Median (IQR) were 9.9 (7.3--12.4) N, 8.4 (6.1--10.5) N and 9.0 (7.4--10.6) N for L-MCP, P-PIP and D-DIP, respectively. The intra-rater agreement was 0.68 (95% CI 0.35--0.86) for L-MCP, and 0.50 (95% CI 0.08--0.76) for D-MCP. Inter-rater agreement was 0.85 (95% CI 0.66--0.94) for L-MCP and 0.81 (0.57, 0.92) for D-MCP. Main limitations: Evaluation of feasibility was performed only for distal thoracic limbs joints; no data are provided for hind limbs or proximal joints. Only warmblood and Freiberger horses were included. Intra- and inter-rater reliability assessments were performed exclusively on data collected at the MCP joint. Conclusion: Pressure pain mapping of distal thoracic limb joints was feasible in horses. Local sensitivity differed among sites and no side differences were noticed. Data collected from the MCP joint suggest highly variable, subject dependent intra-rater reliability, ranging from poor to good, and good to excellent inter-rater reliability. Further studies evaluating pathologic vs. healthy joints are needed before recommendations can be made about clinical usability and diagnostic validity. [ABSTRACT FROM AUTHOR]

Background: The effects of antipsychotic (AP) medications on cognitive functions in individuals at clinical high-risk (CHR) of psychosis are poorly understood. This study compared the effects of AP treatment on cognitive improvement in CHR adolescents and adults. Methods: A total of 327 CHR participants, with an age range of 13 to 45 years, who underwent baseline neuropsychological assessments and a 1-year clinical follow-up were included. Participants with CHR were categorized into four groups based on their age: adolescents (aged < 18) and adults (aged ≥ 18), as well as their antipsychotic medication status (AP+ or AP−). Therefore, the four groups were defined as Adolescent-AP−, Adolescent-AP+, Adult-AP−, and Adult-AP+. Results: During the follow-up, 231 CHR patients received AP treatment, 94 converted to psychosis, and 161 completed the 1-year follow-up. The Adolescent-AP+ group had more positive symptoms, lower general functions, and cognitive impairments than the Adolescent-AP− group at baseline, but no significant differences were observed among adults. The Adolescent-AP+ group showed a significant increase in the risk of conversion to psychosis (p < 0.001) compared to the Adolescent-AP− group. The Adult-AP+ group showed a decreasing trend in the risk of conversion (p = 0.088) compared to the Adult-AP− group. The Adolescent-AP− group had greater improvement in general functions (p < 0.001), neuropsychological assessment battery mazes (p = 0.025), and brief visuospatial memory test-revised (p = 0.020), as well as a greater decrease in positive symptoms (p < 0.001) at follow-up compared to the Adolescent-AP+ group. No significant differences were observed among adults. Conclusions: Early use of AP was not associated with a positive effect on cognitive function in CHR adolescents. Instead, the absence of AP treatment was associated with better cognitive recovery, suggesting that AP exposure might not be the preferred choice for cognitive recovery in CHR adolescents, but may be more reasonable for use in adults. [ABSTRACT FROM AUTHOR]

The Professional Identity Essay (PIE) is a theory and evidence-based Medical Professional Identity Formation (MPIF) measure. We describe trajectories of PIE-measured MPIF over a 4-year US medical school curriculum. Students write PIEs at medical school orientation, clinical clerkships orientation, and post-advanced (near graduation) clerkship. A trained evaluator assigns an overall stage score to narrative responses to nine PIE prompts (inter-rater ICC 0.83, 95% CI [0.57 − 0.96], intra-rater ICC 0.85). Distribution of PIE stage scores across time points were analyzed in the aggregate and individual students were classified as Increase, Stable (no score change) or Decrease based on the trajectories of PIE stage scores over time. 202 students completed 592 PIEs from 2018-2023. There was a significant change in the proportion of PIEs in stages over time (X2 84.40, p < 0.001), 47% (n = 95) students were categorized in the Increase trajectory, 45.5% (n = 92) as Stable and 7.4% (n = 15) as Decrease. Older age and time-predicted stage scores change within trajectories (p < 0.05). Medical students' PIE stage scores increase over time with three distinctive trajectories. Further study is needed to explore the utility of this method for formative assessment, program evaluation, and MPIF research. [ABSTRACT FROM AUTHOR]

The symmetry of the flexion and extension gap influences the functional and long-term outcome after total knee arthroplasty (TKA). Most surgeons check it by applying varus and valgus stress using spacers. This technique has limited accuracy and could be easily extended by rotational movement of the spacer. The objective was to determine the detection threshold and interobserver reliability of this technique. In an in vitro setting with a human cadaveric knee, gap asymmetries were simulated by different medially and laterally applied forces. Using an optical measurement system, the pivot point of the spacer was calculated as a function of the gap symmetry in the first part of the experiment. In the second part, the detection threshold and interobserver reliability of 4 surgeons were determined. For this purpose, gap asymmetries were adjusted to between 0 and 120N in a blinded trial. With a symmetrical gap, the centre of rotation of the spacer was located in the centre of the tibia. With increasing gap asymmetry, the centre of rotation of the spacer shifted to the tight side. This shift was approximately linearly dependent on the force difference. A perfectly balanced gap was detected by the examiners in 50% of the cases. From a force difference of 40N, all examiners identified the gap asymmetry in all cases (ICC = 1.0). The method of spacer rotation described is suitable for reliably detecting gap differences at ≥ 40N, independently of the examiner. [ABSTRACT FROM AUTHOR]

Our aim was to adapt the Clinical Institute of Withdrawal Assessment for Alcohol scale (CIWA-Ar) into Estonian and test its reliability and validity. A total of 72 patients with alcohol withdrawal syndrome participated in the study. In order to assess the interrater reliability, at first assessment the CIWA-Ar was simultaneously completed by two nurses. In order to assess the sensitivity of the CIWA-Ar to the changes in the severity of the withdrawal syndrome, as well as its correlations to several indices characterizing the subjects' current condition, the CIWA-Ar, the Clinical Global Impression Severity subscale (CGI-S), the visual analogue scales for the assessment of the general feeling of malaise, anxiety and depression were filled in and the vital signs were measured at inclusion, in 4 h and after the withdrawal syndrome had been resolved. The intraclass correlation coefficient (ICC) for the Estonian version of the CIWA-Ar total score, used as an indicator of interrater reliability, was excellent. The CIWA-Ar had significant correlations with the psychiatrists' CGI-S ratings of the severity of the patient's condition at all assessment points. Significant correlations were also found between CIWA-Ar and patients' self-ratings, the highest correlations found with self-rated anxiety and general feeling of malaise. CIWA-Ar total score did not correlate with simultaneously measured heart rate, systolic and diastolic blood pressure at the first assessment. At the second assessment, heart rate had a significant correlation with the CIWA-Ar total score. Our study provides confirmation that the CIWA-Ar tool is well applicable in the Estonian language and culture setting. [ABSTRACT FROM AUTHOR]

The article presents a study which described documented factors in multidisciplinary team (MDT) discussions of older adults referred for consideration of surgical versus non-operative management of hip fractures. Topics discussed include characteristics of hip fracture patients, factors impacting MDT decision and reliability, and limitations of the study.

Background: Children with phonological impairment present with pattern‐based errors in their speech production. While some children have difficulties with speech perception and/or the establishment of robust underlying phonological representations, the nature of phonological impairment in children is still not well understood. Given that phonological and lexical development are closely linked, one way to better understand the nature of the problem in phonological impairment is to examine word learning abilities in children. Aims: To examine word learning and its relationship with speech perception, speech production and vocabulary knowledge in children aged 4–5 years. There were two variables of interest: speech production abilities ranging from phonological impairment to typical speech; and vocabulary abilities ranging from typical to above average ('lexically precocious'). Methods & Procedures: Participants were 49 Australian‐English‐speaking children aged 48–69 months. Children were each taught four novel non‐words (out of a selection of eight) through stories, and word learning was assessed at 1 week post‐initial exposure. Word learning was assessed using two measures: confrontation naming and story retell naming. Data were analysed by group using independent‐samples t‐tests and Mann–Whitney U‐tests, and continuously using multiple linear regression. Outcomes & Results: There was no significant difference in word learning ability of children with and without phonological impairment, but regardless of speech group, children with above average vocabulary had significantly better word learning abilities than children with average vocabulary. In multiple linear regression, vocabulary was the only significant predictor of variance in word learning ability. Conclusions & Implications: Children with phonological impairment can be lexically precocious and learn new words like their peers without phonological impairment. Contrary to expectations, vocabulary knowledge rather than expressive phonological ability explained variance in measures of word learning. These findings question an assumption that children with phonological impairment have underspecified phonological representations. They also highlight the heterogeneity among children with phonological impairment and the need to better understand the nature of their difficulty learning the phonological system of the ambient language. WHAT THIS PAPER ADDS: What is already known on the subject: There is limited research examining the word learning abilities of children with phonological impairment. Most previous research focuses on word properties such as phonotactic probability and neighbourhood density. Within the existing literature there are different reports and conclusions regarding the word learning abilities of children with phonological impairment and whether their word learning differs from that of children with typically developing speech. What this study adds to existing knowledge: This study found that vocabulary was the strongest predictor of word learning across children with and without phonological impairment. There was no significant difference in word learning ability between children with and without phonological impairment. However, children with lexically precocious vocabulary abilities were significantly better at word learning than children with average vocabulary abilities. What are the potential or actual clinical implications of this work?: Findings from this study support the importance of assessing and considering measures of word learning—including vocabulary—when working with children with phonological impairment. This study indicates that it is possible to use stories coupled with measures of confrontation naming and story retell to gain deeper insight into children's word learning abilities. [ABSTRACT FROM AUTHOR]

Background: The complexity of communication presents challenges for clinical assessment, outcome measurement and intervention for people with acquired brain injury. For the purposes of assessment or treatment, this complexity is usually managed by isolating specific linguistic functions or speech acts from the interactional context. Separating linguistic functions from their interactional context can lead to discourse being viewed as a static entity comprised of discrete features, rather than as a dynamic process of co‐constructing meaning. The ecological validity of discourse assessments which rely on the deconstruction of linguistic functions is unclear. Previous studies have reported assessment tasks that preserve some of the dialogic features of communication, but as yet, these tasks have not been identified as a distinct genre of assessment. We suggest the term 'co‐constructed communication' to describe tasks which are specifically designed to capture the dynamic, jointly produced nature of communication within a replicable assessment task. Aims: To identify and summarize how co‐constructed communication has been assessed with individuals with non‐progressive acquired communication disability regarding task design, measures and psychometric robustness. Methods: A scoping review methodology was used to identity relevant studies. Systematic database searches were conducted on studies published before July 2021. Studies in the yield were assessed against eligibility criteria, with 37 studies identified as eligible for inclusion. Main contribution: This is the first time that co‐constructed communication has been defined as a genre of discourse assessment for stroke and traumatic brain injury populations. Co‐constructed communication has been assessed for 144 individuals with aphasia and 111 with cognitive–communication disability. Five categories of co‐constructed communication tasks were identified, ranging in complexity. Variability exists in how these assessment tasks are labelled and measured. Assessment measures require further psychometric profiling, specifically regarding test–retest reliability and validity. Conclusions: Co‐constructed communication is a discourse genre which offers researchers and clinicians a replicable method to assess language and communication in an experimentally rigorous way, within an ecologically valid context, bridging the gap between experimental and ecological assessment approaches. What this paper adds: What is already known on this subject: Standardized assessments of language skills and monologue offer reliable, replicable ways to measure language. However, isolating language from an interactional context fundamentally changes the behaviour under study. This raises questions about the ecological validity of the measures we routinely use to determine diagnoses, guide treatment planning and measure the success of treatment. What this study adds to the existing knowledge: This review highlights studies that conceptualize, and often quantify, interaction by combining experimental rigour and aspects of everyday dialogue. This is the first time this genre of discourse assessment has been identified. We propose the term 'co‐constructed communication' to describe this genre and provide an operational definition for the term. What are the practical and clinical implications of this study?: Co‐constructed communication assessment tasks require refinement, particularly regarding aspects of psychometric robustness. In the future, these tasks offer pragmatic, meaningful ways to capture the effect and impact of aphasia and cognitive–communication disability within interaction. [ABSTRACT FROM AUTHOR]

Purpose: Anomia, or word-finding difficulty, is a prevalent and persistent feature of aphasia, a neurogenic language disorder affecting millions of people in the United States. Anomia assessments are essential for measuring performance and monitoring outcomes in clinical settings. This study aims to evaluate the reliability of response time (RT) annotation based on spectrograms and assess the predictive utility of proxy RTs collected during computerized naming tests. Method: Archival data from 10 people with aphasia were used. Trained research assistants phonemically transcribed participants’ responses, and RTs were generated from the onset of picture stimulus to the initial phoneme of the first complete attempt. RTs were measured in two ways: hand-generated RTs (from spectrograms) and proxy RTs (automatically extracted online). Interrater agreement was evaluated based on interclass correlation coefficients and generalizability theory tools including variance partitioning and the ϕ-coefficient. The predictive utility of proxy RTs was evaluated within a linear mixed-effects framework. Results: RT annotation reliability showed near-perfect agreement across research assistants (ϕ-coefficient = .93), and the variance accounted for by raters was negligible. Furthermore, proxy RTs significantly and strongly predicted handannotated RTs (R² = ~0.82), suggesting their utility as an alternative measure. Conclusions: The study confirms the reliability of RT annotation and demonstrates the predictive utility of proxy RTs in estimating RTs during computerized naming tests. Incorporating proxy RTs can enhance clinical assessments, providing additional information for cognitive measurement. Further research with larger samples and exploring the impact of using proxy RTs in different psychometric models could optimize clinical protocols and improve communication interventions for individuals with aphasia. [ABSTRACT FROM AUTHOR]

Young refugee populations continue to grow. This scoping review aims to identify and summarize studies of programs that provide linguistically responsive practices for children who are refugees. Secondary aims of this review are: (a) to identify the gaps in the literature, and (b) to suggest future research and policy directions. By studying key features of linguistically responsive practices for children who are refugees, we can better understand the important components of a high-quality inclusive and equitable environment for all children, including those with minority language backgrounds. We conducted an electronic database search and identified 14 studies. Studies varied in location, country of origin, and language support. The findings from this review revealed a critical need to develop, implement, and study linguistically responsive programs for children who are refugees in host countries. [ABSTRACT FROM AUTHOR]

Objectives To investigate the diagnostic performance of diffusion-weighted imaging (DWI) of the superficial cranial arteries in the diagnosis of GCA. Methods Retrospectively, 156 patients with clinically suspected GCA were included. A new 4-point ordinal DWI rating scale was developed. A post-contrast, fat-suppressed, T1-weighted 'black-blood' sequence (T1-BB) was rated for comparison. Ten arterial segments were assessed: common superficial temporal arteries, temporal and parietal branches, occipital and posterior auricular arteries bilaterally. The expert clinical diagnosis after ≥6 months of follow-up was the diagnostic reference standard. Diagnostic accuracy was evaluated for different rating methods. Results The study cohort consisted of 87 patients with and 69 without GCA. For DWI, the area under the curve was 0.90. For a cut-off of ≥2 consecutive pathological slices, DWI showed a sensitivity of 75.9%, a specificity of 94.2% and a positive likelihood ratio of 13.09. With a cut-off of ≥3 consecutive pathological slices, sensitivity was 70.1%, specificity was 98.6% and the positive likelihood ratio was 48.38. For the T1-BB, values were 88.5%, 88.4% and 7.63, respectively. The inter-rater analysis for DWI with a cut-off of ≥2 pathological slices showed a kappa of 1.00 on the patient level and 0.85 on the arterial segment level. For the T1-BB the kappa was 0.78 and 0.79, respectively. Conclusion DWI of the superficial cranial arteries demonstrates a good diagnostic accuracy and reliability for the diagnosis of GCA. DWI is widely available and can be used immediately in clinical practice for patients with suspected GCA. [ABSTRACT FROM AUTHOR]

This study examines the effectiveness of combining simultaneous prompting method with small group teaching through computer projection, SMART board, tablet computer and humanoid robot to teach discrete skills to children with developmental disabilities (CDD). The study included 14 CDD aged 10–15. It utilizes a multiple probe design across behaviors and probe conditions and replicates them across subjects. Each participant is taught discrete skills within a small group teaching arrangement. The study includes daily probes, full probes, teaching sessions, generalization, and follow‐up sessions. It also collects interobserver reliability and application reliability data. Graphical analysis demonstrates the effectiveness of computer‐based simultaneous prompting incorporating different technologies in a small group teaching setting. Additionally, we examined differences in children's responses to different technological agents in teaching discrete skills to children with developmental disabilities. The study provided preliminary data on which of these agents is best. The results demonstrate its effectiveness by showing that participants maintained the learned behaviors and applied them to a variety of tools, equipment, and individuals in the first, third, and fourth weeks after the intervention. Additionally, the study highlights the subjects' high accuracy in acquiring behavior through observational learning. Finally, simple humanoid robots, tablets, smart SMART boards, and computer projections have been effective in teaching discrete skills to CDD, respectively. [ABSTRACT FROM AUTHOR]

Purpose: Motor deficits are widely documented among autistic individuals, and speech characteristics consistent with a motor speech disorder have been reported in prior literature. We conducted an auditory-perceptual analysis of speech production skills in low and minimally verbal autistic individuals as a step toward clarifying the nature of speech production impairments in this population and the potential link between oromotor functioning and language development. Method: Fifty-four low or minimally verbal autistic individuals aged 4–18 years were video-recorded performing nonspeech oromotor tasks and producing phonemes, syllables, and words in imitation. Three trained speech-language pathologists provided auditory perceptual ratings of 11 speech features reflecting speech subsystem performance and overall speech production ability. The presence, attributes, and severity of signs of oromotor dysfunction were analyzed, as were relative performance on nonspeech and speech tasks and correlations between perceptual speech features and language skills. Results and Conclusions: Our findings provide evidence of a motor speech disorder in this population, characterized by perceptual speech features including reduced intelligibility, decreased consonant and vowel precision, and impairments of speech coordination and consistency. Speech deficits were more associated with articulation than with other speech subsystems. Speech production was more impaired than nonspeech oromotor abilities in a subgroup of the sample. Oromotor deficits were significantly associated with expressive and receptive language skills. Findings are interpreted in the context of known characteristics of the pediatric motor speech disorders childhood apraxia of speech and childhood dysarthria. These results, if replicated in future studies, have significant potential to improve the early detection of language impairments, inform the development of speech and language interventions, and aid in the identification of neurobiological mechanisms influencing communication development. [ABSTRACT FROM AUTHOR]

Purpose: Interactions with caregivers during the ordinary activities that occur as families go about their everyday lives are critical to supporting children’s acquisition of social communication and language skills. The purpose of this study was to examine child communication and parent verbal responsiveness across interaction contexts in 211 children (Mage = 20 months) on the autism spectrum (n = 121), with developmental delay (n = 46), or with typical development (n = 44). Method: Families participated in up to eight activities during an hour-long, video-recorded home observation. We tested differences in the strength of associations between diagnostic group and interaction context using linear mixed-effects models, with child rate per minute of communication and proportions of parent follow-in comments and directives as outcome variables. Child communicative functions expressed across contexts were also examined. Results: Children across groups communicated at significantly higher rates per minute during book sharing and play with people compared to other interaction contexts. Most child communication was for the function of joint attention during book sharing, for social interaction during play with people, and for behavior regulation during necessary activities such as family chores and meals. On average, parents of children responded using proportionally more follow-in comments during book sharing and play compared to necessary activities, during which parents used more follow-in directives. Conclusion: Results provide a glimpse into the dyadic communication that may occur within everyday activities at home, which supports the need for future intervention research and may aid clinicians seeking to identify activities that serve as important contexts for intervention. [ABSTRACT FROM AUTHOR]

Purpose: We investigated effects of an adaptive telehealth coaching model on caregiver implementation of enhanced milieu teaching (EMT) with newly diagnosed toddlers with autism. Method: Three caregiver–child dyads participated in a multiple-baseline-across-behaviors, single-case design. Caregivers were taught EMT via telehealth using the teach–model–coach–review approach. EMT strategies were taught sequentially in four components corresponding to design tiers. Caregivers reported their needs for support and adaptation via weekly surveys. Primary outcomes were measures of caregiver’s implementation, including (a) a fidelity checklist for wholistic use of EMT and (b) a percentage of correct use of a subset of key EMT strategies (e.g., matched turns, target talk, expansions, play actions, milieu episodes). Generalization and maintenance of caregiver strategy use in uncoached home activities were measured. The number of different words used by children was measured as a secondary, descriptive outcome. Social validity data were collected through ratings and interviews at the end of the study. Results: There was a functional relation between the intervention and caregiver’s implementation of EMT for all dyads. Caregiver’s use of EMT strategies often generalized and maintained post-intervention. Child response to intervention was variable. Social validity data indicated that the model was beneficial to caregivers and children. Conclusions: An adaptive telehealth coaching model is effective for teaching caregivers of toddlers with autism to implement EMT and potentially helps to bridge the gap between diagnosis and comprehensive intervention. Further exploration of the relation between caregiver fidelity and dosage of active ingredients and child spoken language outcomes is needed. [ABSTRACT FROM AUTHOR]

Purpose: Augmentative and alternative communication (AAC) technology innovation is urgently needed to improve outcomes for children on the autism spectrum who are minimally verbal. One potential technology innovation is applying artificial intelligence (AI) to automate strategies such as augmented input to increase language learning opportunities while mitigating communication partner time and learning barriers. Innovation in AAC research and design methodology is also needed to empirically explore this and other applications of AI to AAC. The purpose of this report was to describe (a) the development of an AAC prototype using a design methodology new to AAC research and (b) a preliminary investigation of the efficacy of this potential new AAC capability. Method: The prototype was developed using a Wizard-of-Oz prototyping approach that allows for initial exploration of a new technology capability without the time and effort required for full-scale development. The preliminary investigation with three children on the autism spectrum who were minimally verbal used an adapted alternating treatment design to compare the effects of a Wizard-of-Oz prototype that provided automated augmented input (i.e., pairing color photos with speech) to a standard topic display (i.e., a grid display with line drawings) on visual attention, linguistic participation, and (for one participant) word learning during a circle activity. Results: Preliminary investigation results were variable, but overall participants increased visual attention and linguistic participation when using the prototype. Conclusions: Wizard-of-Oz prototyping could be a valuable approach to spur much needed innovation in AAC. Further research into efficacy, reliability, validity, and attitudes is required to more comprehensively evaluate the use of AI to automate augmented input in AAC. [ABSTRACT FROM AUTHOR]

Background: Lateral ankle sprains are one of the most common injuries in indoor and court sports. Self-reports and case studies have indicated that these injuries occur via both contact and noncontact injury mechanisms typically because of excessive inversion in combination with plantarflexion and adduction of the foot. Video-based documentation of the injury mechanism exists, but the number of cases reported in the literature is limited. Purpose: To retrieve and systematically analyze a large number of video-recorded lateral ankle injuries from indoor and court sports, as well as describe the injury mechanism, injury motion, and injury pattern across different sports. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 445 unique video-recorded lateral ankle sprain injuries were retrieved from indoor and court sports of broadcasted levels of competition. The videos were independently analyzed by 2 different reviewers. Outcomes included classification of the injury mechanism according to the International Olympic Committee consensus guidelines, primary and secondary motions of ankle joint distortion, and documentation of the fixation point (fulcrum) around which the foot rotates. Results: Overall, 298 (67%) injuries were direct contact, 113 (25%) were noncontact, and 32 (7%) were indirect contact incidents. Direct contact injuries were especially prevalent in basketball (76%), handball (80%), and volleyball (85%), while noncontact injuries dominated in tennis and badminton (96% vs 95% across both). Inversion (65%) and internal rotation (33%) were the primary distortion motions, with the lateral forefoot (53%) and lateral midfoot (40%) serving as the main fulcrums. Landing on another player's foot was the leading cause of injury (n = 246; 55%), primarily characterized by inversion (79%) around a midfoot fulcrum (54%). The noncontact and indirect landings on floor (n = 144; 33%) were primarily characterized by a distortion around a forefoot fulcrum (69%). Conclusion: Two of 3 ankle sprains from online video platforms were direct contact injuries, with most involving landing on another player's foot. The distortion motion seems to be related to the injury mechanism and the fixation point between the foot and the floor. The injury mechanisms varied greatly between sports, and future studies should clearly differentiate and investigate the specific injury mechanisms. [ABSTRACT FROM AUTHOR]

Background: Qualitative movement screening tools provide a practical method of assessing mechanical patterns associated with potential injury development. Biomechanics play a role in hamstring strain injury and are recommended as a consideration within injury screening and rehabilitation programs. However, no methods are available for the in-field assessment of sprint running mechanics associated with hamstring strain injuries. Purpose: To investigate the intra- and interrater reliability of a novel screening tool assessing in-field sprint running mechanics titled the Sprint Mechanics Assessment Score (S-MAS) and present normative S-MAS data to facilitate the interpretation of performance standards for future assessment uses. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Maximal sprint running trials (35 m) were recorded from 136 elite soccer players using a slow-motion camera. All videos were scored using the S-MAS by a single assessor. Videos from 36 players (18 men and 18 women) were rated by 2 independent assessors blinded to each other's results to establish interrater reliability. One assessor scored all videos in a randomized order 1 week later to establish intrarater reliability. Intraclass correlation coefficients (ICCs) based on single measures using a 2-way mixed-effects model, with absolute agreement with 95% CI and kappa coefficients with percentage agreements, were used to assess the reliability of the overall score and individual score items, respectively. T -scores were calculated from the means and standard deviations of the male and female groups to present normative data values. The Mann-Whitney U test and the Wilcoxon signed-rank test were used to assess between-sex differences and between-limb differences, respectively. Results: The S-MAS showed good intrarater (ICC, 0.828 [95% CI, 0.688-0.908]) and interrater (ICC, 0.799 [95% CI, 0.642-0.892]) reliability, with a standard error of measurement of 1 point. Kappa coefficients for individual score items demonstrated moderate to substantial intra- and interrater agreement for most parameters, with percentage agreements ranging from 75% to 88.8% for intrarater and 66.6% to 88.8% for interrater reliability. No significant sex differences were observed for overall scores, with mean values of 4.2 and 3.8 for men and women, respectively (P =.27). Conclusion: The S-MAS is a new tool developed for assessing sprint running mechanics associated with lower limb injuries in male and female soccer players. The reliable and easy-to-use nature of the S-MAS means that this method can be integrated into practice, potentially aiding future injury screening and research looking to identify athletes who may demonstrate mechanical patterns potentially associated with hamstring strain injuries. [ABSTRACT FROM AUTHOR]

* Context.--Recent data suggest mesenteric tumor deposits (MTDs) indicate poor prognosis in small bowel well-differentiated neuroendocrine tumors (SB-NETs), including compared to positive lymph nodes, making their distinction crucial. Objective.--To study interobserver agreement in distinguishing SB-NET MTDs from positive nodes. Design.--Virtual slides from 36 locally metastatic SBNET foci were shared among 7 gastrointestinal pathologists, who interpreted each as an MTD or a positive node. Observers ranked their 5 preferred choices among a supplied list of potentially useful histologic features, for both options. Diagnostic opinions were compared using Fleiss multirater and Cohen weighted κ analyses. Results.--Preferred criteria for MTD included irregular shape (n = 7, top choice for 5), perineural invasion/nerve entrapment (n = 7, top choice for 2), encased thick-walled vessels (n = 7), and prominent fibrosis (n = 6). Preferred criteria for positive nodes included peripheral lymphoid follicles (n = 6, top choice for 4), round shape (n = 7, top choice for 2), peripheral lymphocyte rim (n = 7, top choice for 1), subcapsular sinuses (n = 7), and a capsule (n = 6). Among 36 foci, 10 (28%) each were unanimously diagnosed as MTD or positive node. For 13 foci (36%), there was a diagnosis favored by most observers (5 or 6 of 7): positive node in 8, MTD in 5. Only 3 cases (8%) had a near-even (4:3) split. Overall agreement was substantial (κ = .64, P < .001). Conclusions.--Substantial interobserver agreement exists for distinguishing SB-NET MTDs from lymph node metastases. Favored histologic criteria in making the distinction include irregular shape and nerve/vessel entrapment for MTD, and peripheral lymphocytes/lymphoid follicles and round shape for positive nodes. [ABSTRACT FROM AUTHOR]

Objective: The decision on whether or not and how to treat a local cartilage defect is still made intraoperatively based on the visual presentation of the cartilage and findings from indentations with an arthroscopic probe. The treatment decision is then usually based on grading according to established classifications systems, which, therefore, need to have high reliability and accuracy. The aim of the present study was to evaluate the reliability and accuracy of the Outerbridge classification in staging cartilage defects. Methods: We performed an observer arthroscopic study using the Outerbridge classification on seven fresh‐frozen human cadaveric knees, which collectively exhibited nine cartilage defects. To evaluate accuracy, defect severity was verified through histological examination. Interrater and intrarater reliabilites were calculated using Cohen's kappa and the intra‐class correlation coefficient (ICC 3.1). Results: The interrater and intrarater reliability for the Outerbridge classification ranged from poor to substantial, with 0.24 ≤ κ ≤ 0.70 and κ = 0.55 to κ = 0.66, respectively. The accuracy evaluated by comparison with the histological examination was 63% overall. The erroneous evaluations were, however, still often at the discrimination of grade 2 and 3. We did not find any relationship between higher experience and accuracy or intraobserver reliability. Taken together, these results encourage surgeons to further use diagnostic arthroscopy for evaluating cartilage lesions. Nevertheless, especially in grade 2 and 3, deviations from the histology were observed. This is, however, the point where a decision is made on whether to surgically address the defect or not. Conclusion: Diagnostic arthroscopy is the standard for cartilage lesion assessment, yet interobserver reliability is fair to substantial. Caution is warranted in interpreting varied observer results. The accuracy of the "simpler" Outerbridge classification is insufficient compared to histological examinations, highlighting the need for improved techniques in guideline‐based intraoperative decision‐making. [ABSTRACT FROM AUTHOR]

We describe the development of an observational video coding tool, the Rehabilitation Observation Measure of Engagement (ROME), to quantify engagement in rehabilitative settings at the person (internal state of an individual) and between-system (interaction between individuals) level. Forty-nine children with unilateral spastic cerebral palsy (29 males; Age: M = 9.28 yrs, SD = 3.08 yrs) and their interventionists were videotaped during different activities. Construct validity was examined by correlating the ROME with the Engagement vs. Disaffection with Learning Survey and the Pediatric Rehabilitation Intervention Measure of Engagement – Observation questionnaire. Inter- and intra-rater reliability were examined using two independent raters. The ROME's responsiveness to change was examined by comparing scores across activities. For construct validity, results showed a positive correlation for person-level engagement (r = 0.444, p = 0.003). No relationship was found between-system-level engagement. High intrarater (91.8%) and interrater (96.1%) reliability was found. The ROME's responsiveness to change was supported by children exhibiting lower engagement scores during repetitive shaping activities. These findings provide evidence that the ROME is a reliable tool to objectively examine the construct of engagement within rehabilitation and is valid for quantifying person-level engagement. It provides information that cannot be extracted from questionnaires and can help guide intervention decisions. Behavioral characteristics, including engagement, of the agents involved in rehabilitation are largely unstudied, although engagement is expected to benefit motor learning. The Rehabilitation Observation Measure of Engagement (ROME) is an observation measure that uses predefined codes and can be used universally, as it is not limited to specific language or cognitive levels. The ROME is a reliable tool for objectively measuring the role of the construct of behavioral engagement during rehabilitation and valid for examining person-level engagement. The ROME may be used as a measure of client and service provider process, of intervention quality, or as a decision guide. [ABSTRACT FROM AUTHOR]

The International Classification of Diseases, 11th Edition (ICD-11) includes a new personality disorder (PD) severity diagnosis that may be further characterized using up to five trait domain specifiers. Most of the previous studies have investigated the ICD-11 trait domains using self-report measures. The present study aimed to validate ICD-11 PD trait domains using a multimethod design in a community mental health sample (n = 336). We conducted two confirmatory factor analyses to examine the factor structure of the ICD-11 PD trait model, utilizing clinician-rating, self-report, and informant-report measures. Finally, we examined associations between clinician-rated, self-reported, and informant-reported ICD-11 trait domains with external criteria, specifically traditional PD symptoms and the five-factor model of normal personality. All clinician-rated, self-reported, and informant-reported domain scores loaded meaningfully on their expected factors when controlling for nontrivial method factors. Generally, the trait domains exhibited meaningful associations with conceptually relevant external criteria, although the anankastia domain exhibited more variability in its pattern of correlations across methods. Overall, the ICD-11 trait domain model shows promising reliability and validity, indicating good progress within the field of PD assessment toward a more useful PD operationalization. Public Significance Statement: The International Classification of Diseases, 11th Edition, has a new diagnostic system for personality disorder, which includes dimensional personality traits. Further validation of this system is necessary to ensure that it works well in practice. The present study provides support for validity of the International Classification of Diseases, 11th Edition personality trait model. [ABSTRACT FROM AUTHOR]

Background: Pre-treatment stratification and outcomes of neuroblastoma patients often depend on the assessment of image-defined risk factors (IDRFs) on MR Imaging, usually using Gadolinium-contrast materials which are cautioned in pediatrics. We aimed to address whether gadolinium contrast-enhanced sequences are necessary to identify the presence/absence of IDRFs. Methods: Patients with neuroblastoma with MR imaging were retrospectively identified from 2005 to 2021. Ninety confirmed IDRFs were evaluated in 23 patients. Corresponding MR studies were anonymized, randomized, and independently evaluated by 3 fellowship-trained pediatric radiologists. Each radiologist assessed the studies twice. At the first reading, all enhanced sequences were omitted, while in the second reading, the full study with enhanced sequences were included. Consensus reading was obtained among readers. Inter- and intra-rater agreements using Kappa statistics (κ) as well as the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of non-enhanced MR in assessing IDRFs with respect to enhanced MR were calculated. Results: There were substantial (ĸ: 0.64-0.73) intra-reader agreements, and moderate to substantial (ĸ: 0.57-0.62) inter-reader agreements among radiologists in identifying IDRFs using non-enhanced MR. Non-enhanced MR had a sensitivity of 87.8% (95% CI [79-94]), specificity of 93% (89-96), PPV of 82.3 (73-89), NPV of 95.4 (92-98), and accuracy of 91.6 (88-94) in identifying IDRFs. However, 5/23 patients (21.7%) had a change in staging with the inclusion of contrast sequences. Conclusion: Although contrast sequences have a role in IDRF assessment, the majority can be adequately assessed on MR without gadolinium-contrast enhancement. Validation in a larger cohort is an important next step. [ABSTRACT FROM AUTHOR]

Computer-supported collaborative learning (CSCL) seeks to improve students' learning with the support of technology. Although CSCL facilitates an enriching environment for cooperation, CSCL activities might be affected by asymmetrical participation. Group awareness tools have proven to enhance learners' interactions, balancing the levels of participation and increasing the learning outcomes. This study investigates the effect of a group awareness tool (GAT) on participation within synchronous CSCL activities in the context of extracurricular activities. We designed a quasi-experimental within-subject study (GAT exposure and control condition) and tested an ad hoc GAT in a web-based CSCL platform with high school students (N = 140). The measured variables included the effect of the GAT on students' participation and the quality of discussion. A complementary analysis evaluated students' perceptions of the tool. Results revealed that the implementation of a GAT encourages students to take part in CSCL discussions without explicitly hindering its quality. Even so, the balance of participation was not significantly affected. Students further reported that they found the GAT useful to regulate collaboration. The results from the study provide further knowledge of the functioning of group awareness tools in secondary education and share an insight into how students perceive them. [ABSTRACT FROM AUTHOR]

The infusion of multicultural factors into all aspects of training, research, and service is an expected competency for professionals in health service psychology. This includes skills in multicultural case conceptualization, the basis upon which diagnoses, and treatment interventions are selected. However, there is a paucity of research on the effects of training on multicultural case conceptualization ability and limited evidence of its effectiveness. Using a single-case research design, this study addressed this inadequacy by training doctoral students to interpret and integrate multicultural factors in their case conceptualizations. Results indicated no functional relationship between the training intervention and multicultural case conceptualization skills. A combination of statistical and visual analyses indicated weak effects of the intervention for two participants and a counter to the intended direction of effect for one participant. The limitations of the study and valuable insights are discussed, raising important implications for future research and training. [ABSTRACT FROM AUTHOR]

• A single measure can estimate adherence across two CBT programs for youth anxiety. • A measure of competence had mixed psychometric evidence across two CBT programs. • Observer- and consult-rated adherence measures converged across two CBT programs. • Findings offer new ways of assessing quantity and quality in youth anxiety treatment. Measures designed to assess the quantity and quality of practices found across treatment programs for specific youth emotional or behavioral problems may be a good fit for evaluating treatment fidelity in effectiveness and implementation research. Treatment fidelity measures must demonstrate certain reliability and validity characteristics to realize this potential. This study examines the extent to which two observational measures, the Cognitive-Behavioral Treatment for Anxiety in Youth Adherence Scale (CBAY-A) and the CBAY Competence Scale (CBAY-C), can assess the quantity (the degree to which prescribed therapeutic techniques are delivered as intended) or quality (the competence with which prescribed techniques are delivered) of practices found in two distinct treatment programs for youth anxiety. Treatment sessions (N = 796) from 55 youth participants (M age = 9.89 years, SD = 1.71; 46% female; 55% White) with primary anxiety problems who participated in an effectiveness study were independently coded by raters who coded quantity, quality, and the youth–clinician alliance. Youth received one of three treatments: (a) standard (i.e., cognitive-behavioral therapy program), (b) modular (i.e., a cognitive-behavioral and parent-training program), and (c) usual clinical care. Interrater reliability for the CBAY-A items was good across the standard and modular conditions but mixed for the CBAY-C items. Across the standard and modular conditions, the CBAY-A Model subscale scores demonstrated evidence of construct validity, but the CBAY-C Model subscale scores showed mixed evidence. The results provide preliminary evidence that the CBAY-A can be used across different treatment programs but raise concerns about the generalizability of the CBAY-C. [ABSTRACT FROM AUTHOR]

In healthcare, effective communication and teamwork are pivotal in reducing medical errors. Integrating team training into health professions education is crucial. Accurate measurement of team performance during training requires reliable assessment tools. The TeamSTEPPS® Team Performance Observation Tool (TPOT), recently updated by the Agency for Healthcare Research and Quality, serves this purpose. However, it had not been translated and validated for use in Thailand. We aimed to translate and assess the psychometric properties of the Thai version of TPOT. Employing a back-translation process, TPOT was adapted to the Thai context. The resulting Thai TPOT instrument was administered to 518 healthcare professionals who had undergone TeamSTEPPS® training. Participants were asked to evaluate two prerecorded, 7-minute simulated team emergency scenarios using the Thai TPOT instrument. Results exhibited high internal consistency (Cronbach's alpha =.96) and inter-rater reliability (ICC =.98). Confirmatory factor analysis affirmed the construct validity of the Thai TPOT. These findings establish the Thai TPOT as useful for evaluating teamwork within healthcare teams. [ABSTRACT FROM AUTHOR]

Objective: To provide information regarding the procedures, safety, tolerability, and measurement properties of the 6-min step test. Data sources: MEDLINE, EMBASE, CINAHL, and SPORTDiscus (from inception until January 2024). Review methods: Studies that examined adults with acute or chronic diseases, and outcomes related to procedures, safety, tolerability, or measurement properties of the 6-min step test were included. Outcome data were summarized and combined in meta-analyses. The quality of included studies was assessed by the Consensus-based Standards for the selection of health Measurement Instruments checklist, and the quality of evidence was determined according to the Grading of Recommendations Assessment, Development, and Evaluation system. Results: Fourteen studies, involving 847 participants, were included. All studies performed the 6-min step test in 6 min; however, some studies varied the step height and the use of upper limb support. The test appears to be safe and well tolerated by individuals. Moderate- to high-quality evidence demonstrated appropriate results for test-retest reliability (4 studies; Intraclass correlation coefficient 0.96; 95% CI 0.91–0.98; n = 125), criterion validity (4 studies; r = 0.53; 95% CI 0.30–0.71; n = 307), and construct validity (4 studies; r = 0.63; 95% CI 0.52–0.73; n = 233). Conclusion: This review provides recommendations for applying the 6-min step test in clinical and research settings. No adverse events were reported, and the test appears to be well tolerated. Adequate results were found for test-retest reliability, criterion validity, and construct validity. Review Registration: PROSPERO (CRD42022347744). [ABSTRACT FROM AUTHOR]

Purpose: Whether photographs included in the operative report of knee arthroscopies can make the surgeon liable in the event of a legal investigation remains unknown. The main objective of this study was to establish inter-observer reliability in determining the presence or absence of lesions of the cartilage, meniscus and anterior cruciate ligament (ACL). Secondary objective was to assess the inter-observer reliability in classifying lesions. Method: A retrospective observational study was conducted in a continuous serie of 60 patients who underwent knee arthroscopy from the same operator. The photographs of each patient's operative report were presented separately to three experts, blinded to each other. Each expert had to decide on the presence or absence of injuries to the following structures: meniscal, cartilage and ACL and then, classify it. Primary and secondary endpoints were evaluated using the Fleiss' kappa index. Results: Inter-observer reliability for lesion detection was between 0.4 and 0.61 for all structures with three exceptions: for cartilage, it was low (0.15) at the lateral tibial plateau and poor (-0.01) at the external condyle. On the contrary, the concordance was almost perfect (0.8) for the ACL. For classifying cartilaginous and meniscal lesions, inter-observer reliability was poor (from 0.03 to 0.14), except for at the lateral meniscus (0.65). Conclusion: Inter-observer reliability of arthroscopic knee diagnoses is poor when photographs alone are used. In the event of a legal investigation following knee arthroscopy, the photographs included in the operative report should not be used alone to hold the surgeon liable. [ABSTRACT FROM AUTHOR]

Health and fitness content intended to inspire people to live healthy lives (e.g. "fitspiration") has been linked to negative body image among girls and young women. Fitness influencers purport wanting to motivate healthy behaviors. This study seeks to examine the presence of strategies known to positively influence health behaviors (e.g. attitudes, self-efficacy) as well as of content known to have a negative influence (e.g. objectification) among fitness influencers. We conducted a content analysis (N = 441) of a random sample of one year of posts from four Instagram fitness influencers popular with girls and young women in the United States. The main analysis consisted of codes related to objectification, health promotion strategies, health-related content, and social engagement (i.e., likes). We found that fitness influencers included content that conveyed constructs previously found to positively influence health behaviors (e.g., attitudes and self-efficacy), but objectification was frequently present, in more than half of the posts. Additionally, we found that the presence of objectification in posts was negatively associated with likes, a form of social endorsement. We suggest health communicators aim to work in tandem with fitness influencers to include content that may motivate positive health behaviors and improve media literacy and that influencers aim to reduce the amount of objectifying content included in their posts. Our findings shed light on content being conveyed and possible insights into the negative effects associated with viewing such content. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the predictive validity and reliability of the Waterlow scale in critically adult hospitalised patients. Design: A multi‐centre cohort study. Methods: This study was conducted in 72 intensive care units (ICUs) in 38 tertiary hospitals in Gansu Province, China. All adults admitted to the ICU for greater than or equal to 24 h without pressure injury (PI) on admission were screened by the Waterlow scale on admission, during ICU stay and ICU discharge from April 2021 to February 2023. Receiver operating characteristic (ROC) curves were used to determine a potential cut‐off value for critical adult hospitalised patients. Cut‐off values were then determined using Youden's index, and sensitivity, specificity, positive predictive value, negative predictive value and accuracy were calculated based on these cut‐off values. Test–retest reliability was used to evaluate inter‐rater reliability. Results: A total of 5874 critical patients on admission were included, and 5125 of them were assessed regularly. The area under curve (AUC) was 0.623 (95% CI, 0.574–0.690), with a cut‐off score of 19 showing the best balance among sensitivity of 62.7%, specificity of 57.4%, positive predictive value of 2.07% and negative predictive value of 99.08%. The test–retest reliability between the first assessment and the regular assessment was 0.447. Conclusions: The Waterlow scale shows insufficient predictive validity and reliability in discriminating critical adults at risk of PI development. To further modify the items of the Waterlow scale, exploring specific risk factors for PI in the ICU and clarifying their impact degree was necessary. Risk predictive models or better tools are inevitable in the future. Patient or Public Contribution: Patients or family members supported nurses with PI risk assessment, skin examination and other activities during the inquiry. [ABSTRACT FROM AUTHOR]

The VIA-Youth (Park & Peterson, 2006) is perhaps the most commonly administered youth measure of the Peterson and Seligman (2004) character strengths. This article is the first in a series describing revision of the VIA-Youth, with the goals of making the development process more transparent, targeting scale unidimensionality, achieving measurement invariance, and extending the age range to 8–17. A sample of 286 youth in three countries completed 198 candidate items, from which a 98-item inventory was developed. Ratings of strengths were provided for 250 of the youth by 202 parents and 164 teachers. The relative size of relationships between informants was related to youth age, and to ratings of the observability and evaluativeness of the strengths, in the expected direction. The findings suggest youth self-report of character strengths and ratings by significant others are not highly related, but are consistent with prior studies of informant convergence in youth ratings. [ABSTRACT FROM AUTHOR]

Connected speech is often used to assess many aspects of an individual's language abilities after stroke. However, it is unknown the degree to which elicitation methods differ in generating structural and syntactic aspects of connected speech, two critical components of successful communication. Quantifying the degree to which elicitation methods differ in eliciting structurally, syntactically, and lexically complex connected speech at the earliest stage of stroke before reorganization and rehabilitation of function independent of clinical diagnosis of aphasia has not been examined to date. Addressing this gap has implications for early clinical intervention as well as empirical studies of connected speech production. We compared two common elicitation methods, picture description and storytelling on lexical, structural, and syntactic measures of connected speech in speakers during the acute stage of left hemisphere stroke. We measured connected speech using an automated quantitative production analysis approach (Fromm et al., 2021) in 71 native-English speaking participants (27 female; 59 ± 13 years) within an average 3.9 days from left hemisphere stroke onset. We tested the degree of agreement and consistency between elicitation methods for lexical, structural, and syntactic measures of connected speech, as well as the degree of concordance in classifying deficits across individuals. Storytelling elicited significantly more words and more structurally complex, lexically diverse, and syntactically accurate speech in comparison to picture description. Elicitation methods differed in measuring outcomes across participants for the lexical and syntactic, but not structural complexity aspects of connected speech where storytelling classified more participants with impairments in comparison to picture description. These differences suggest storytelling provides assessment of connected speech abilities more reflective of real-world abilities where its use is particularly critical for examining individual differences and providing diagnoses of acute stroke language deficits. As a result, using storytelling as a connected speech elicitation method more effectively captures a patient's language capabilities after stroke, consequently informing clinical diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Objective To evaluate rates, risk factors and outcomes of delayed diagnosis of seven serious paediatric conditions. Methods This was a retrospective, cross- sectional study of children under 21 years old visiting 13 community and tertiary emergency departments (EDs) with appendicitis, bacterial meningitis, intussusception, mastoiditis, ovarian torsion, sepsis or testicular torsion. Delayed diagnosis was defined as having a previous ED encounter within 1 week in which the condition was present per case review. Patients with delayed diagnosis were each matched to four control patients without delay by condition, facility and age. Conditional logistic regression models evaluated risk factors of delay. Complications were compared between by delayed diagnosis status. Results Among 14 972 children, delayed diagnosis occurred in 1.1% (range 0.3% for sepsis to 2.6% for ovarian torsion). Hispanic (matched OR 2.71, 95% CI 1.69 to 4.35) and non- Hispanic black (OR 2.40, 95% CI 1.21 to 4.79) race/ethnicity were associated with delayed diagnosis, whereas Asian and other race/ethnicity were not. Public (OR 2.21, 95% CI 1.42 to 3.44) and other (OR 2.43, 95% CI 1.50 to 3.93) insurance were also associated with delay. Non- English language was associated with delay (OR 1.65, 95% CI 1.02 to 2.69). Abnormal vital signs were associated with a lower likelihood of delay (OR 0.15, 95% CI 0.09 to 0.25). In an adjusted model, Hispanic race/ethnicity, other insurance, abnormal vital signs and complex chronic conditions (CCCs) were associated with delay. The odds of a complication were 2.5- fold (95% CI 1.6 to 3.8) higher among patients with a delay. Conclusion Delayed diagnosis was uncommon across 13 regional EDs but was more likely among children with Hispanic ethnicity, CCCs or normal vital signs. Delays were associated with a higher risk of complications. [ABSTRACT FROM AUTHOR]

The National Heart, Lung, and Blood Institute (NHLBI) Learn About Chronic Obstructive Pulmonary Disease (COPD) YouTube playlist educates the public on diagnosing, treating, and managing COPD. Despite its potential benefits, it is unknown if users with inadequate health literacy will likely understand and apply the information described in these videos. Assess the Learn About COPD playlist's readability, actionability, and understandability. Central tendency statistics were computed to describe the meta-data of 28 videos available as of April 2023. Assessments included the Patient Education Materials Assessment Tool for Audiovisual Materials (PEMAT-AV), Accessible Health IT for Limited-Literacy Populations Checklist (LLPC), and the Modified Centers for Disease Control and Prevention (CDC)-Clear Communication Index (CCI) for audiovisual materials. Playlist videos received an average of over 2,000 views (Mdn = 2,220, IQR = 496–8336), with very few "likes" (Mdn = 13, IQR = 1–48 "likes"). PEMAT-understandability (Mdn = 81.81%, IQR = 80–97.72%) and LLPC (Mdn = 87.50%, IQR = 75–93.75%) scores were high (above 80%). However, the modified CDC-CCI median score was 57.14% (IQR = 42.86–75%), and the median PEMAT-actionability score was 50% (IQR = 0–66.67%). The playlist earned passing understandability, acceptability, and usability scores but scored poorly on actionability and communication clarity. Findings could inform enhancements to NHLBI's Learn About COPD YouTube playlist. [ABSTRACT FROM AUTHOR]

Background and Objectives: Questionnaires designed to test knowledge and self-perception can be valuable tools for diagnosing a dentist's understanding of the management and administration of a practice. The objective of this study was to create and authenticate a questionnaire for assessing dentists' self-perception on oral healthcare management developed from discussions with experts in this field. Material and Methods: In order to create and verify a questionnaire survey, a cross-sectional, descriptive, and analytical study was carried out. Participants' personal information and 31 statements across four categories made up the final questionnaire form. The answers to the questionnaire were in the form of a Likert scale. After refining the initial version, a total of 36 interviews were conducted at dental offices to verify the validity. For the Exploratory Factor Analysis (EFA), we used the Kaiser–Meyer–Olkin (KMO) index, the Bartlett sphericity test, and also Cronbach alpha coefficient for the validity of the questionnaire. Results: The accuracy of the instrument was measured by intrarater and interrater reliability. For the EFA, all the communalities exceeded the threshold of 0.05. With a Cronbach's alpha coefficient of 0.898, the questionnaire has sufficient internal consistency. Conclusions: The questionnaire demonstrates robust reliability and validity, thereby affirming its suitability for its intended purpose. [ABSTRACT FROM AUTHOR]

Aims The effects of isolated contemporary low-dose breast cancer (BC) radiotherapy (RT) on the heart remain poorly understood. This study aims to assess the long-term impacts of BC-RT on cardiac structure and function. Methods and results Seventy-six women (62 ± 7 years) without history of prior heart disease, who had undergone RT for either first left (n = 36) or right (n = 40) BC, without additional medical oncology therapy apart from hormonal treatment 11 ± 1 years earlier, underwent transthoracic echocardiography, cardiac magnetic resonance imaging (CMR), computed tomography coronary angiography (CTCA), NT-proBNP, and a 6-min walk test (6MWT). They were compared with 54 age-matched healthy female controls. By CTCA, 68% of BC patients exhibited no or very mild coronary disease, while only 11% had moderate stenosis (50–69%) and 3% had significant stenosis (>70%). Despite slightly reduced regional echocardiographic midventricular strains, BC patients exhibited similar global left and right ventricular volumes, ejection fractions, and global strains by echocardiography and CMR as controls. Mitral E/e′ ratios were slightly higher, and mitral deceleration times were slightly lower, but NT-proBNP was similar to controls. Also, 6MWT was normal. None had late gadolinium enhancement, and extracellular volume fraction was similar in BC (28 ± 3 vs. 29 ± 3, P = 0.15) and controls. No differences were observed relative to dose or side of RT. Conclusion Aside from minor alterations of regional strains and diastolic parameters, women who received isolated RT for BC had low prevalence of coronary disease, normal global systolic function, NT-proBNP, and exercise capacity and showed no structural changes by CMR, refuting significant long-term cardiotoxicity in such low-risk patients. [ABSTRACT FROM AUTHOR]

Introduction: The British Thyroid Association Ultrasound-classification is a risk stratification model which grades thyroid nodules in U2–5 based on their sonographic appearance. Existence of variability between the ultrasound operators when U-scoring is reported in the literature with some evidence found in the author's department. The aim of this study was to investigate whether there is significant disagreement in the department and identify potential reasons for variability. Methods: Eight operators, radiologists and sonographers, were recruited to grade 33 TNs and answer a tick box questionnaire using the British Thyroid Association lexicon. The inter-operator variability for the U-categories, indication for fine-needle aspiration biopsy and ultrasound features was assessed using Fleiss' kappa and Gwet-AC1. The operators' accuracy was measured against the most experienced operator in the department using Cohen's kappa and percentage agreement. Results: Fair agreement (Fleiss' K = 0.21) was obtained between the participants when U-scoring (U2–5). Fair-to-moderate agreement was noted between sonographers (K = 0.40). Significant variability was demonstrated between radiologists (p > 0.05). Indication for fine-needle aspiration biopsy reached fair to almost substantial agreement (radiologists' AC1 = 0.34, sonographers' AC1 = 0.58, overall AC1 = 0.41). No significant variability measured for echogenicity (K = 0.29), composition (K = 0.33), shape (K = 0.58), margin (K = 0.45), halo (K = 0.34) and vascularity (K = 0.44). Accuracy reached fair agreement (mean Cohen's K = 0.29) and moderate agreement (mean AC1 = 0.53) for the U-categories and fine-needle aspiration biopsy, respectively. Radiologists demonstrated lower accuracy. Conclusion: No significant inter-rater variability in U-scoring or recommending fine-needle aspiration biopsy was demonstrated between all the operators in the department. Radiologists showed significant variability in U-scoring and lower accuracy. Reliability and accuracy could be improved by addressing those problematic categories and features identified with this study. [ABSTRACT FROM AUTHOR]

Accident analysis methods are used to model the multifactorial cause of adverse incidents. Methods such as AcciMap, STAMP-CAST and recently AcciNet, are systemic approaches that support the identification of safety interventions across sociotechnical system levels. Despite their growing popularity, little is known about how reliable systems-based methods are when used to describe, model and classify contributory factors and relationships. Here, we conducted an intra-rater and inter-rater reliability assessment of AcciMap, STAMP-CAST and AcciNet using the Signal Detection Theory (SDT) paradigm. A total of 180 hours' worth of analyses across 360 comparisons were performed by 30 expert analysts. Findings revealed that all three methods produced a weak to moderate positive correlation coefficient, however the inter-rater reliability of STAMP-CAST was significantly higher compared to AcciMap and AcciNet. No statistically significant or practically meaningful differences were found between methods in the overall intra-rater reliability analyses. Implications and future research directions are discussed. Practitioners who undertake accident analysis within their organisations should consider the use of STAMP-CAST due to the significantly higher inter-rater reliability findings obtained in this study compared to AcciMap and AcciNet, particularly if they tend to work alone and/or part of relatively small teams [ABSTRACT FROM AUTHOR]

The evaluation of impaired self-awareness (ISA) after brain injury is not widespread in Japan, and there is a lack of Japanese assessments of self-awareness. To translate the original version of the Awareness Questionnaire (AQ), an instrument for assessing ISA, into Japanese using a validated method and examine its reliability and validity in inpatients with stroke. This cross-sectional, prospective study enrolled 130 participants. The double-translation process was used to develop the Japanese version of the AQ. Data were collected from 120 patients. High intra-rater reliability was observed for the patient (Cronbach's α = 0.824) and clinician samples (Cronbach's α = 0.933). High intra- and inter-rater reliability were found for all AQ items [interclass coefficient (ICC) (1, 1) = 0.828, ICC (2, 1) = 0.852, ICC (3, 1) = 0.848]; however, the sub-item analysis revealed only moderate reliability. Validity assessment revealed a low but significant positive correlation (r = 0.209; p < 0.05) between the Japanese version of the AQ and the Japanese version of the Self-Regulation Skills Interview and a low but significant negative correlation (r = 0.197; p < 0.05) between the Japanese version of the AQ and the Mini-Mental State Examination. The Japanese version of the AQ was developed and applied to stroke patients, but the concept of post-stroke ISA may differ from ISA after traumatic brain injury, highlighting the need for a stroke-specific version of the AQ. [ABSTRACT FROM AUTHOR]

Blood flow restriction (BFR) training can temporarily reduce cortical GABA concentrations and increase the size of motor volleys to deafferented muscles, which can promote motor recovery in stroke survivors. To determine the effect of low-intensity resistance training with BFR (LIRT-BFR) on lower extremity muscle strength, balance, functional mobility, walking capacity, gait speed, anxiety, and depression in stroke survivors and to compare the results with high-intensity resistance training (HIRT). It was a two-arm, single-blinded, randomized controlled trial in which 32 ischemic stroke participants were randomly allocated to LIRT-BFR or HIRT group. The LIRT-BFR group received low load resistance training (40% of 1-Repetition Maximum (1-RM)) with BFR, whereas HIRT group received high load resistance training (80% of 1-RM). The 6-Minute Walk Test (6-MWT), five-time sit-to-stand test (5TSTST), Timed Up and Go (TUG) test, and Barthel index were the primary outcome measures. The secondary outcome measures included gait speed (m/s), stride length (cm), cadence (steps/min), and Hospital Anxiety and Depression. All the primary and secondary outcome measures were significantly improved in both groups (p < 0.05). The LIRT-BFR group showed a slightly greater, but non-significant, improvement as compared to the HIRT group in terms of mean change observed in 6-MWT (81 m vs 62 m), 5TSTST (−5.27 vs −4.81), gait speed (0.19 vs 0.12), stride length (18 vs 13), and cadence (8 vs 6). No adverse event was reported. LIRT-BFR produced a significant improvement in muscle strength, balance, walking capacity, and anxiety and depression in ischemic stroke patients, and the improvement are comparable to HIRT. NCT05281679 [ABSTRACT FROM AUTHOR]

BACKGROUND: Hospitalized patients are well described as having a high prevalence of constipation. While the risks associated with constipation in trauma patients are well known, the prevalence rate is not. OBJECTIVE:This study aims to measure the prevalence of constipation and associated risk factors in trauma patients. METHODS:This study is a single-center analytic cross-sectional study on constipation in hospitalized trauma patients aged 18-65 years, admitted from January 2021 to July 2021 to the trauma service at The Royal Melbourne Hospital, a Level I major trauma and teaching hospital servicing the state of Victoria, Australia. Exclusion criteria include patients with traumatic brain injury, blunt or penetrating abdominal or spinal injuries, pregnancy, and gastrointestinal comorbidities. RESULTS:A total of N =99 patients were studied, of which n = 78 (78.8%) were male with a median (interquartile range) age of 46 years (33-58). The overall prevalence of constipation was 76%. The univariate analysis demonstrated higher constipation rates in males and patients with multisystem injuries. However, in the multivariate analysis, mode of toileting and mobility were not associated with constipation after adjusting for confounding factors. CONCLUSION: This study demonstrated a high prevalence of constipation in all trauma patients. There is a strong association between the development of constipation in patients with multisystem injuries when compared to those with single system. [ABSTRACT FROM AUTHOR]