Inter-rater reliability of the evaluation of muscular chains associated with posture alterations in scoliosis

Background: In the Global postural re-education (GPR) evaluation, posture alterations are associated with anterior or posterior muscular chain impairments. Our goal was to assess the reliability of the GPR muscular chain evaluation. Methods: Design: Inter-rater reliability study. Fifty physical therapists (PTs) and two experts trained in GPR assessed the standing posture from photographs of five youths with idiopathic scoliosis using a posture analysis grid with 23 posture indices (PI). The PTs and experts indicated the muscular chain associated with posture alterations. The PTs were also divided into three groups according to their experience in GPR. Experts' results (after consensus) were used to verify agreement between PTs and experts for muscular chain and posture assessments. We used Kappa coefficients (K) and the percentage of agreement (%A) to assess inter-rater reliability and intra-class coefficients (ICC) for determining agreement between PTs and experts. Results: For the muscular chain evaluation, reliability was moderate to substantial for 12 PI for the PTs (% A: 56 to 82; K: 0.42 to 0.76) and perfect for 19 PI for the experts. For posture assessment, reliability was moderate to substantial for 12 PI for the PTs (% A > 60%; K: 0.42 to 0.75) and moderate to perfect for 18 PI for the experts (% A: 80 to 100; K: 0.55 to 1.00). The agreement between PTs and experts was good for most muscular chain evaluations (18 PI; ICC: 0.82 to 0.99) and PI (19 PI; ICC: 0.78 to 1.00). Conclusions: The GPR muscular chain evaluation has good reliability for most posture indices. GPR evaluation should help guide physical therapists in targeting affected muscles for treatment of abnormal posture patterns.

Reliability of radiographic parameters in adenoid evaluation

The assessment of adenoids by x-ray imaging has been the topic of heated debate, but few studies have looked into the reliability of most existing radiographic parameters. Objective: This study aims to verify the intra-examiner and inter-examiner reproducibility of the adenoid radiographic assessment methods. Materials and Methods: This is a cross-sectional case series study. Forty children of both genders aged between 4 and 14 were enrolled. They were selected based on complaints of nasal obstruction or mouth breathing and suspicion of pharyngeal tonsil hypertrophy. Cavum x-rays and orthodontic teleradiographs were assessed by two examiners in quantitative and categorical terms. Results: All quantitative parameters in both x-ray modes showed excellent intra and inter-examiner reproducibility. Relatively better performance was observed in categorical parameters used in cavum x-ray assessment by C-Kurien, C-Wang, C-Fujioka, and C-Elwany over C-Cohen and C-Ysunza. As for orthodontic teleradiograph grading systems, C-McNamara has been proven to be more reliable than C-Holmberg. Conclusion: Most instruments showed adequate reproducibility levels. However, more research is needed to properly determine the accuracy and viability of each method.

Three-dimensional Doppler evaluation of single spherical samples from the placenta: intra- and interobserver reliability

Objective To evaluate the intra- and interobserver reliability of assessment of three-dimensional power Doppler (3D-PD) indices from single spherical samples of the placenta. Methods Women with singleton pregnancies at 2440 weeks' gestation were included. Three scans were independently performed by two observers; Observer 1 performed the first and third scan, intercalated by the scan of Observer 2. The observers independently analyzed the 3D-PD datasets that they had previously acquired using four different methods, each using a spherical sample: random sample extending from basal to chorionic plate; random sample with 2 cm3 of volume; directed sample to the region subjectively determined as containing more color Doppler signals extending from basal to chorionic plate; or directed sample with 2 cm3 of volume. The vascularization index (VI), flow index (FI) and vascularization flow index (VFI) were evaluated in each case. The observers were blinded to their own and each other's results. Additional evaluation was performed according to placental location: anterior, posterior and fundal or lateral. Intra- and interobserver reliability was assessed by intraclass correlation coefficients (ICC). Results Ninety-five pregnancies were included in the analysis. All three placental 3D-PD indices showed only weak to moderate reliability (ICC < 0.66 and ICC < 0.48, intra- and interobserver, respectively). The highest values of ICC were observed when using directed spherical samples from basal to chorionic plate. When analyzed by placental location, we found lower ICCs for lateral and fundal placentae compared to anterior and posterior ones. Conclusion Intra- and interobserver reliability of assessment of placental 3D-PD indices from single spherical samples in pregnant women greater than 24 weeks' gestation is poor to moderate, and clinical usefulness of these indices is likely to be limited. Copyright (c) 2012 ISUOG. Published by John Wiley & Sons, Ltd.

Reliability, Validity and Classification Accuracy of the South Oaks Gambling Screen in a Brazilian Sample

The purpose of this study was to examine the reliability, validity and classification accuracy of the South Oaks Gambling Screen (SOGS) in a sample of the Brazilian population. Participants in this study were drawn from three sources: 71 men and women from the general population interviewed at a metropolitan train station; 116 men and women encountered at a bingo venue; and 54 men and women undergoing treatment for gambling. The SOGS and a DSM-IV-based instrument were applied by trained researchers. The internal consistency of the SOGS was 0.75 according to the Cronbach`s alpha model, and construct validity was good. A significant difference among groups was demonstrated by ANOVA (F ((2.238)) = 221.3, P < 0.001). The SOGS items and DSM-IV symptoms were highly correlated (r = 0.854, P < 0.01). The SOGS also presented satisfactory psychometric properties: sensitivity (100), specificity (74.7), positive predictive rate (60.7), negative predictive rate (100) and misclassification rate (0.18). However, a cut-off score of eight improved classification accuracy and reduced the rate of false positives: sensitivity (95.4), specificity (89.8), positive predictive rate (78.5), negative predictive rate (98) and misclassification rate (0.09). Thus, the SOGS was found to be reliable and valid in the Brazilian population.

Evaluation of quality of life in severely obese patients after bariatric surgery carried out in the public healthcare system

Objectives: To assess QoL of obese patients in the Brazilian public healthcare system, before and after bariatric surgery, and to determine the appropriateness of the Moorehead-Ardelt Questionnaire II (M-A-QoLQII) compared with the Short-Form Health Survey (SF-36). Subjects and methods: Forty-one severe obese patients in a waiting-list, and 84 patients who underwent bariatric surgery were included. Correlations were tested and reliability determined by the Cronbach's coefficient. Results: BMI differed between the pre- and post-surgery groups (52.3 +/- 8.3 kg/m(2) vs. 32.5 +/- 6.4 kg/m(2), p < 0.001). The latter showed better scores in the SF-36 domains than in the pre-surgery. SF-36 and M-A-QoLQII categories were correlated (r = 0.53, 0.49 and 0.47, for vitality, mental health, and general health domains, p < 0.001). In the logistic regression, age, previous BMI, and loss of excess weight were associated with functional capacity. Conclusions:The outcomes of bariatric surgery obtained in a Brazilian public healthcare center were successful. M-A-QoLII represents a useful tool to assess surgery outcomes, including QoL. Arq Bras Endocrinol Metab. 2012;56(1):33-8

A new HPLC-DAD-MS/MS method for the simultaneous determination of major compounds in the crude extract of Lychnophora salicifolia Mart. (Brazilian arnicao) leaves: Application to chemical variability evaluation

Lychnophora salicifolia Mart., which occurs in the Brazilian Cerrado in the states of Bahia and Minas Gerais as well as in the southeast of the state of Goias, is the most widely distributed and also the most polymorphic species of the genus. This plant is popularly known to have anti-inflammatory and analgesic activities. In this work, we have studied the variation in terms of polar metabolites of ninety-three Lychnophora salicifolia Mart, specimens collected from different regions of the Brazilian Cerrado. Identification of the constituents of this mixture was carried out by analysis of the UV spectra and MS data after chromatographic separation. Twenty substances were identified, including chlorogenic acid derivatives, a flavonoid C-glucoside, and other sesquiterpenes. The analytical method was validated, and the reliability and credibility of the results was ensured for the purposes of this study. The concentration range required for analysis of content variability within the analyzed group of specimens was covered with appropriate values of limits of detection and quantitation, as well as satisfactory precision and recovery. A quantitative variability was observed among specimens collected from the same location, but on average they were similar from a chemical viewpoint. In relation to the study involving specimens from different locations, there were both qualitative and quantitative differences among plants collected from different regions of Brazil. Statistical analysis revealed that there is a correlation between geographical localization and polar metabolites profile for specimens collected from different locations. This is evidence that the pattern of metabolites concentration depends on the geographical distribution of the specimens. (C) 2012 Elsevier B.V. All rights reserved.

The role of evaluation in decision-making in the management of health services

The management of health services is a complex administrative practice due to the breadth of the field of health and the need to reconcile individual, corporate and collective interests that are not always convergent. In this context, the evaluation needs to have specific characteristics in order to fulfill its role. The scope of this study was to establish the characteristics that the evaluation for the management of health services should have to contribute to decision-making. Usefulness, opportunity, feasibility, reliability, objectivity and directionality represent the set of principles upon which the evaluation should be based. Evaluations should lead to decisions that guarantee not only their efficiency and effectiveness but also their implementation. The evaluation process should ensure that decisions involve all stakeholders in order to render the implementation of decisions feasible, and take into account the health needs of the population and the goals set for the services. The scope of this article is to elicit a debate among different stakeholders in the evaluation in the hope that it can contribute to the reflection on the real usefulness of evaluations in which the political component in management has been increasingly prevalent.

Evaluation of the agreement by examiners according to classifications of third molars

Objectives. This study recorded and evaluated the intra-and inter-group agreement degree by different examiners for the classification of lower third molars according to both the Winter's and Pell & Gregory's systems. Study Design. An observational and cross-sectional study was realized with forty lower third molars analyzed from twenty digital panoramic radiographs. Four examiner groups (undergraduates, maxillofacial surgeons, oral radiologists and clinical dentists) from Aracaju, Sergipe, Brazil, classified them in relation to angulation, class and position. The variance test (ANOVA) was applied in the examiner findings with significance level of p<0.05 and confidence intervals of 95%. Results. Intra- and inter-group agreement was observed in Winter's classification system among all examiners. Pell & Gregory's classification system showed an average intra-group agreement and a statistical significant difference to position variable in inter-group analysis with greater disagreement to the clinical dentists group (p<0.05). Conclusions. High reproducibility was associated to Winter's classification, whereas the system proposed by Pell & Gregory did not demonstrate appropriate levels of reliability.

Validity of the 'protocol of oro-facial myofunctional evaluation with scores' for young and adult subjects

The aims of this study were to analyse the validity, sensitivity and specificity of the protocol of oro-facial myofunctional evaluation with scores (OMES) for oro-facial myofunctional disorder (OMD) diagnosis in young and adult subjects. Eighty subjects were examined. The OMES was validated against the Nordic Orofacial Test-Screening (NOT-S) protocol (criterion validity) (Spearman correlation test). The construct validity was tested by analysis of the ability of the OMES (i) to differentiate healthy subjects (n = 22) from temporomandibular disorder (TMD) patients (n = 22), which frequently have OMD (MannWhitney test) and (ii) to measure the changes that occurred in a subgroup with TMD between the period before and after oro-facial myofunctional therapy (T group, n = 15) (Wilcoxon test). Two speech therapists trained with the OMES participated as examiners (E). There was a statistically significant correlation between the OMES and NOT-S protocols, which was negative because the two scales are inverse (r = -0.86, P < 0.01). There was a significant difference between the healthy and TMD subjects regarding the oro-facial myofunctional status (OMES total score, P = 0.003). After therapy, the T group showed improvement in the oro-facial myofunctional status (OMES total score, P = 0.001). Inter- and intra-examiner agreement was moderate, and the reliability coefficients ranged from good to excellent. The OMES protocol presented mean sensitivity and specificity = 0.80, positive predictive value = 0.76 and negative predictive value = 0.84. Conclusion: The OMES protocol is valid and reliable for clinical evaluation of young and adult subjects, among them patients with TMD.

Influence of Clinically Invisible, but Optical Coherence Tomography Detected, Optic Disc Margin Anatomy on Neuroretinal Rim Evaluation

PURPOSE. We previously demonstrated that most eyes have regionally variable extensions of Bruch's membrane (BM) inside the clinically identified disc margin (DM) that are clinically and photographically invisible. We studied the impact of these findings on DM- and BM opening (BMO)-derived neuroretinal rim parameters. METHODS. Disc stereo-photography and spectral domain optical coherence tomography (SD-OCT, 24 radial B-scans centered on the optic nerve head) were performed on 30 glaucoma patients and 10 age-matched controls. Photographs were colocalized to SD-OCT data such that the DM and BMO could be visualized in each B-scan. Three parameters were computed: (1) DM-horizontal rim width (HRW), the distance between the DM and internal limiting membrane (ILM) along the DM reference plane; (2) BMO-HRW, the distance between BMO and ILM along the BMO reference plane; and (3) BMO-minimum rim width (MRW), the minimum distance between BMO and ILM. Rank-order correlations of sectors ranked by rim width and spatial concordance measured as angular distances between equivalently ranked sectors were derived. RESULTS. The average DM position was external to BMO in all quadrants, except inferotemporally. There were significant sectoral differences among all three rim parameters. DM- HRW and BMO-HRW sector ranks were better correlated (median rho = 0.84) than DM- HRW and BMO-MRW (median rho = 0.55), or BMO-HRW and BMO-MRW (median rho = 0.60) ranks. Sectors with the narrowest BMO-MRW were infrequently the same as those with the narrowest DM-HRW or BMO-HRW. CONCLUSIONS. BMO-MRW quantifies the neuroretinal rim from a true anatomical outer border and accounts for its variable trajectory at the point of measurement. (Invest Ophthalmol Vis Sci. 2012;53:1852-1860) DOI:10.1167/iovs.11-9309

Sulcus anatomy and diameter in pseudophakic eyes and correlation with biometric data: Evaluation with a 50 MHz ultrasound biomicroscope

PURPOSE: To evaluate the sulcus anatomy and possible correlations between sulcus diameter and white-to-white (WTW) diameter in pseudophakic eyes, data that may be important in the stability of add-on intraocular lenses (IOLs). SETTING: University Eye Hospital, Tuebingen, Germany. DESIGN: Case series. METHODS: In pseudophakic eyes, the axial length (AL) and horizontal WTW were measured by the IOLMaster device. Cross-sectional images were obtained with a 50 MHz ultrasound biomicroscope on the 4 meridians: vertical, horizontal (180 degrees), temporal oblique, and nasal oblique. Sulcus-to-sulcus (STS), angle-to-angle (ATA), and sclera-to-sclera (ScTSc) diameters were measured. The IOL optic diameter (6.0 mm) served as a control. To test reliability, optic measurements were repeated 5 times in a subset of eyes. RESULTS: The vertical ATA and STS diameters were statistically significantly larger than the horizontal diameter (P=.0328 and P=.0216, respectively). There was no statistically significant difference in ScTSc diameters. A weak correlation was found between WTW and horizontal ATA (r = 0.5766, P<.0001) and between WTW and horizontal STS (r = 0.5040, P=.0002). No correlation was found between WTW and horizontal ScTSc (r = 0.2217, P=.1217). CONCLUSIONS: The sulcus anatomy had a vertical oval shape with the vertical meridian being the largest, but it also had variation in the direction of the largest meridian. The WTW measurements showed a weak correlation with STS. In pseudophakic eyes, Soemmerring ring or a bulky haptic may affect the ciliary sulcus anatomy.

GRBAS and Cape-V Scales: High Reliability and Consensus When Applied at Different Times

Objectives. To evaluate whether the overall dysphonia grade, roughness, breathiness, asthenia, and strain (GRBAS) scale, and the Consensus Auditory Perceptual Evaluation-Voice (CAPE-V) scale show the same reliability and consensus when applied to the same vocal sample at different times. Study Design. Observational cross-sectional study. Methods. Sixty subjects had their voices recorded according to the tasks proposed in the CAPE-V scale. Vowels /a/ and /i/ were sustained between 3 and 5 seconds. Reproduction of six sentences and spontaneous speech from the request "Tell me about your voice" were analyzed. For the analysis of the GRBAS scale, the sustained vowel and reading tasks of the sentences was used. Auditory-perceptual voice analyses were conducted by three expert speech therapists with more than 5 years of experience and familiar with both the scales. Results. A strong correlation was observed in the intrajudge consensus analysis, both for the GRBAS scale as well as for CAPE-V, with intraclass coefficient values ranging from 0.923 to 0.985. A high degree of correlation between the general GRBAS and CAPE-V grades (coefficient = 0.842) was observed, with similarities in the grades of dysphonia distribution in both scales. The evaluators indicated a mild difficulty in applying the GRBAS scale and low to mild difficulty in applying the CAPE-V scale. The three evaluators agreed when indicating the GRBAS scale as the fastest and the CAPE-V scale as the most sensitive, especially for detecting small changes in voice. Conclusions. The two scales are reliable and are indicated for use in analyzing voice quality.

Fatigue Reliability of 3 Single-Unit Implant-Abutment Designs

Objectives: Because the mechanical behavior of the implant-abutment system is critical for the longevity of implant-supported reconstructions, this study evaluated the fatigue reliability of different implant-abutment systems used as single-unit crowns and their failure modes. Methods and Materials: Sixty-three Ti-6Al-4V implants were divided in 3 groups: Replace Select (RS); IC-IMP Osseotite; and Unitite were restored with their respective abutments. Anatomically correct central incisor metal crowns were cemented and subjected to separate single load to failure tests and step-stress accelerated life testing (n = 18). A master Weibull curve and reliability for a mission of 50,000 cycles at 200 N were calculated. Polarized-light and scanning electron microscopes were used for failure analyses. Results: The load at failure mean values during step-stress accelerated life testing were 348.14 N for RS, 324.07 N for Osseotite, and 321.29 N for the Unitite systems. No differences in reliability levels were detected between systems, and only the RS system mechanical failures were shown to be accelerated by damage accumulation. Failure modes differed between systems. Conclusions: The 3 evaluated systems did not present significantly different reliability; however, failure modes were different. (Implant Dent 2012;21:67-71)

Reliability of buildings in service limit state for maximum horizontal displacements

Brazilian design code ABNT NBR6118:2003 - Design of Concrete Structures - Procedures - [1] proposes the use of simplified models for the consideration of non-linear material behavior in the evaluation of horizontal displacements in buildings. These models penalize stiffness of columns and beams, representing the effects of concrete cracking and avoiding costly physical non-linear analyses. The objectives of the present paper are to investigate the accuracy and uncertainty of these simplified models, as well as to evaluate the reliabilities of structures designed following ABNT NBR6118:2003[1&] in the service limit state for horizontal displacements. Model error statistics are obtained from 42 representative plane frames. The reliabilities of three typical (4, 8 and 12 floor) buildings are evaluated, using the simplified models and a rigorous, physical and geometrical non-linear analysis. Results show that the 70/70 (column/beam stiffness reduction) model is more accurate and less conservative than the 80/40 model. Results also show that ABNT NBR6118:2003 [1] design criteria for horizontal displacement limit states (masonry damage according to ACI 435.3R-68(1984) [10]) are conservative, and result in reliability indexes which are larger than those recommended in EUROCODE [2] for irreversible service limit states.