Autism Screening at 18 Months of Age: a Comparison of the Q-CHAT and the M-CHAT

2021 ◽  
Author(s):  
Raymond Sturner ◽  
Barbara Howard ◽  
Paul Bergmann ◽  
Shana Attar ◽  
Lydia Stewart ◽  
...  
Keyword(s):  
Validation Study ◽  
Full Range ◽  
Early Learning ◽  
Performance Characteristics ◽  
Autism Symptoms ◽  
Autism Screening ◽  
Expected Performance ◽  
Low Sensitivity ◽  
Dichotomous Scoring

Abstract Background: Autism screening is recommended at 18 and 24-month pediatric well visits. The M-CHAT-R screen requires a follow-up interview (M-CHAT-R/F) when positive. M-CHAT-R/F may be less accurate for 18- than 24-month-olds and accuracy for identification prior to two years is not known in samples including children passing screens. Since autism symptoms may emerge gradually, items with ordinal responses, such as Q-CHAT-10, might better capture autism signs than the dichotomous (i.e., yes/no) items in M-CHAT-R. The objective of this study was to determine the accuracy of the M-CHAT-R/F and the Q-CHAT-10 for predicting autism in a sample of children who screen positive or negative at 18 months old.Methods: This is a community pediatrics validation study with screen positive (96) and age and practice-matched screen negative children (314) recruited for diagnostic evaluations completed prior to two years old.Clinical diagnosis of autism based on results of in-person diagnostic autism evaluations by research reliable testers blind to screening results and using the ADOS-2 Toddler module, Mullen Scales of Early Learning (MSEL) per standard guidelines, and ADOS-T algorithm.Results: While the M-CHAT-R/F had higher specificity and PPV compared to M-CHAT-R as expected, performance characteristics, including improved sensitivity with similar PPV, favored Q-CHAT-10 (scoring adjusted to capture the full range of frequency items). Limitations: Many parents declined participation and the sample skewed toward higher educated parents. Results cannot be extended to older ages. Conclusions: The limitations of the M-CHAT-R/F at the 18-month-visit include low sensitivity with minimal balancing benefit of improved PPV from the follow-up interview. The Q-CHAT-10 shows advantages over M-CHAT-R/F including requiring half the number of items and no follow-up interview, yet it did not improve the low PPV at 18 months. Ordinal, rather than dichotomous, scoring of autism screening items appears to be beneficial at this age. The Q-CHAT-10 with adjusted scoring is thus a better alternative to the M-CHAT at the 18-month-visit, providing better detection of children who can be diagnosed at this age even though psychometrics of both approaches still fall below recommended standards, consistent with growing recognition that screening needs to also occur repeatedly beyond this age.

scholarly journals Autism screening at 18 months of age: a comparison of the Q-CHAT-10 and M-CHAT screeners

2022 ◽  
Vol 13 (1) ◽  
Author(s):  
Raymond Sturner ◽  
Barbara Howard ◽  
Paul Bergmann ◽  
Shana Attar ◽  
Lydia Stewart-Artz ◽  
...  
Keyword(s):  
Full Range ◽  
Autism Diagnostic Observation Schedule ◽  
Autism Symptoms ◽  
Two Stage ◽  
Response Options ◽  
Autism Screening ◽  
Low Sensitivity ◽  
Dichotomous Scoring ◽  
Higher Sensitivity

Abstract Background Autism screening is recommended at 18- and 24-month pediatric well visits. The Modified Checklist for Autism in Toddlers—Revised (M-CHAT-R) authors recommend a follow-up interview (M-CHAT-R/F) when positive. M-CHAT-R/F may be less accurate for 18-month-olds than 24-month-olds and accuracy for identification prior to two years is not known in samples that include children screening negative. Since autism symptoms may emerge gradually, ordinally scoring items based on the full range of response options, such as in the 10-item version of the Quantitative Checklist for Autism in Toddlers (Q-CHAT-10), might better capture autism signs than the dichotomous (i.e., yes/no) items in M-CHAT-R or the pass/fail scoring of Q-CHAT-10 items. The aims of this study were to determine and compare the accuracy of the M-CHAT-R/F and the Q-CHAT-10 and to describe the accuracy of the ordinally scored Q-CHAT-10 (Q-CHAT-10-O) for predicting autism in a sample of children who were screened at 18 months. Methods This is a community pediatrics validation study with screen positive (n = 167) and age- and practice-matched screen negative children (n = 241) recruited for diagnostic evaluations completed prior to 2 years old. Clinical diagnosis of autism was based on results of in-person diagnostic autism evaluations by research reliable testers blind to screening results and using the Autism Diagnostic Observation Schedule—Second Edition (ADOS-2) Toddler Module and Mullen Scales of Early Learning (MSEL) per standard guidelines. Results While the M-CHAT-R/F had higher specificity and PPV compared to M-CHAT-R, Q-CHAT-10-O showed higher sensitivity than M-CHAT-R/F and Q-CHAT-10. Limitations Many parents declined participation and the sample is over-represented by higher educated parents. Results cannot be extended to older ages. Conclusions Limitations of the currently recommended two-stage M-CHAT-R/F at the 18-month visit include low sensitivity with minimal balancing benefit of improved PPV from the follow-up interview. Ordinal, rather than dichotomous, scoring of autism screening items appears to be beneficial at this age. The Q-CHAT-10-O with ordinal scoring shows advantages to M-CHAT-R/F with half the number of items, no requirement for a follow-up interview, and improved sensitivity. Yet, Q-CHAT-10-O sensitivity is less than M-CHAT-R (without follow-up) and specificity is less than the two-stage procedure. Such limitations are consistent with recognition that screening needs to recur beyond this age.

scholarly journals Three dimensional assessment of segmented Le Fort I osteotomy planning and follow-up: a validation study

2021 ◽  
pp. 103707
Author(s):  
Oliver da Costa Senior ◽  
Lukas Vaes ◽  
Delphine Mulier ◽  
Reinhilde Jacobs ◽  
Constantinus Politis ◽  
...  
Keyword(s):  
Validation Study ◽  
Three Dimensional ◽  
Le Fort I Osteotomy ◽  
Le Fort ◽  
Dimensional Assessment ◽  
Le Fort I

scholarly journals Choice of faecal immunochemical test matters: comparison of OC-Sensor and HM-JACKarc, in the assessment of patients at high risk of colorectal cancer

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Caroline J. Chapman ◽  
Ayan Banerjea ◽  
David J Humes ◽  
Jaren Allen ◽  
Simon Oliver ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Clinical Decision Making ◽  
Full Range ◽  
Clinical Decision ◽  
Detection Rates ◽  
Faecal Immunochemical Test ◽  
Specimen Collection ◽  
Increased Risk ◽  
Immunochemical Test

AbstractObjectivesCurrently, NICE recommends the use of faecal immunochemical test (FIT) at faecal haemoglobin concentrations (f-Hb) of 10 μg Hb/g faeces to stratify for colorectal cancer (CRC) risk in symptomatic populations. This f-Hb cut-off is advised across all analysers, despite the fact that a direct comparison of analyser performance, in a clinical setting, has not been performed.MethodsTwo specimen collection devices (OC-Sensor, OC-S; HM-JACKarc, HM-J) were sent to 914 consecutive individuals referred for follow up due to their increased risk of CRC. Agreement of f-Hb around cut-offs of 4, 10 and 150 µg Hb/g faeces and CRC detection rates were assessed. Two OC-S devices were sent to a further 114 individuals, for within test comparisons.ResultsA total of 732 (80.1%) individuals correctly completed and returned two different FIT devices, with 38 (5.2%) CRCs detected. Median f-Hb for individuals diagnosed with and without CRC were 258.5 and 1.8 µg Hb/g faeces for OC-S and 318.1 and 1.0 µg Hb/g faeces for HM-J respectively. Correlation of f-Hb results between OC-S/HM-J over the full range was rho=0.74, p<0.001. Using a f-Hb of 4 µg Hb/g faeces for both tests found an agreement of 88.1%, at 10 µg Hb/g faeces 91.7% and at 150 µg Hb/g faeces 96.3%. A total of 114 individuals completed and returned two OC-S devices; correlation across the full range was rho=0.98, p<0.001.ConclusionsWe found large variations in f-Hb when different FIT devices were used, but a smaller variation when the same FIT device was used. Our data suggest that analyser-specific f-Hb cut-offs are applied with regard to clinical decision making, especially at lower f-Hb.

Is Endoscopic Assessment of the Esophagus and Stomach Enough to Determine the Need for Biopsy at These Sites in Pediatric Patients Undergoing Endoscopy for Elevated TTG?

2021 ◽  
pp. 109352662199148
Author(s):  
M. Cristina Pacheco ◽  
Nicole Green ◽  
Jane Dickerson ◽  
Dale Lee
Keyword(s):  
Sensitivity And Specificity ◽  
Pediatric Patients ◽  
Tissue Transglutaminase ◽  
Immunoglobulin A ◽  
High Specificity ◽  
Visual Assessment ◽  
Pathology Report ◽  
Low Sensitivity ◽  
Endoscopic Assessment

Objectives The goal of our study was to determine whether visual assessment of the esophagus and stomach could predict abnormal histology and determine the frequency of interventions based on biopsies in patients undergoing endoscopy for elevated tissue transglutaminase immunoglobulin A antibody (TTG). Methods Pathology records were searched for patients with biopsy performed for elevated TTG. Pathology report, endoscopy report, and follow-up were obtained and slides from the duodenum reviewed. Pathology was considered gold standard for sensitivity and specificity calculations. Results 240 patients were included. 215 patients had esophageal biopsies performed. Esophageal endoscopic visual assessment had sensitivity of 47% and specificity of 93% for abnormal histology. 16(7%) patients had therapy or referral related to results and, of these, 6(38%) had visually normal endoscopy. 237 biopsies were performed of stomach. Gastric endoscopic visual assessment had a sensitivity and specificity of 20% and 87%. 24(10%) patients had therapy based on findings and, of these, 12 (50%) had visually normal endoscopy. Conclusions Endoscopic assessment of esophagus and stomach has low sensitivity and high specificity for pathologic abnormalities when indication for endoscopy is elevated TTG. When endoscopy is visually normal clinical interventions based on biopsy are rare, and foregoing biopsy may be considered.

scholarly journals Multisite Validation Study to Determine Performance Characteristics of a 92-Gene Molecular Cancer Classifier

2012 ◽  
Vol 18 (14) ◽  
pp. 3952-3960 ◽  
Author(s):  
Sarah E. Kerr ◽  
Catherine A. Schnabel ◽  
Peggy S. Sullivan ◽  
Yi Zhang ◽  
Veena Singh ◽  
...  
Keyword(s):  
Validation Study ◽  
Performance Characteristics

scholarly journals Quantitative measurement of IgG to SARS-CoV-2 proteins using ImmunoCAP

2020 ◽  
Author(s):  
Behnam Keshavarz ◽  
Joesph R. Wiencek ◽  
Lisa J. Workman ◽  
Matthew D. Straesser ◽  
Lyndsey M. Muehling ◽  
...  
Keyword(s):  
Nucleocapsid Protein ◽  
Quantitative Measurement ◽  
Solid Phase ◽  
Performance Characteristics ◽  
Quantitative Assay ◽  
Receptor Binding Domain ◽  
Serum Samples ◽  
Detailed Understanding ◽  
Antibody Assays

AbstractBackgroundDetailed understanding of the immune response to SARS-CoV-2, the cause of coronavirus disease 2019 (COVID-19), has been hampered by a lack of quantitative antibody assays.ObjectiveTo develop a quantitative assay for IgG to SARS-CoV-2 proteins that could readily be implemented in clinical and research laboratories.MethodsThe biotin-streptavidin technique was used to conjugate SARS-CoV-2 spike receptor-binding-domain (RBD) or nucleocapsid protein to the solid-phase of the ImmunoCAP resin. Plasma and serum samples from patients with COVID-19 (n=51) and samples from donors banked prior to the emergence of COVID-19 (n=109) were used in the assay. SARS-CoV-2 IgG levels were followed longitudinally in a subset of samples and were related to total IgG and IgG to reference antigens using an ImmunoCAP 250 platform.ResultsPerformance characteristics demonstrated 100% sensitivity and 99% specificity at a cut-off level of 2.5 µg/mL for both SARS-CoV-2 proteins. Among 36 patients evaluated in a post-hospital follow-up clinic, median levels of IgG to spike-RBD and nucleocapsid were 34.7 µg/mL (IQR 18-52) and 24.5 µg/mL (IQR 9-59), respectively. Among 17 patients with longitudinal samples there was a wide variation in the magnitude of IgG responses, but generally the response to spike-RBD and to nucleocapsid occurred in parallel, with peak levels approaching 100 µg/mL, or 1% of total IgG.ConclusionsWe have described a quantitative assay to measure IgG to SARS-CoV-2 that could be used in clinical and research laboratories and implemented at scale. The assay can easily be adapted to measure IgG to novel antigens, has good performance characteristics and a read-out in standardized units.

scholarly journals Quadriceps reconstruction with suture anchor and Achilles allograft combination in quadriceps tendon re-rupture after primary surgical repair: A novel technique

2021 ◽  
Author(s):  
Erhan Okay ◽  
Mehmet Cenk Turgut ◽  
Abbas Tokyay
Keyword(s):  
Suture Anchor ◽  
Surgical Repair ◽  
Primary Repair ◽  
Full Range ◽  
Knee Extensor ◽  
Quadriceps Tendon ◽  
Extensor Mechanism ◽  
Surgical Options ◽  
Knee Extensor Mechanism

Quadriceps ruptures are one of the pathological conditions of the knee extensor mechanism, accounting for 3% of all tendon injuries. These injuries cause substantial disability of the extensor mechanism. Primary repair is the treatment of choice in acute presentation. In the setting of chronic conditions, the treatment becomes more challenging. Available surgical options include lengthening procedures, and reconstruction with auto graft or allografts. The traditional Scuderi and Codivilla techniques are challenging to perform in degenerative or traumatic retracted ruptures. There is no standard effective treatment in these patients, which yields the best clinical and biomechanical outcomes. An 18 - year-old male patient with quadriceps re-rupture after a primary repair was managed with allograft reconstruction using suture anchors. At six years of follow-up, the patient gained a full range of motion with excellent clinical outcomes. He returned to his previous work. In conclusion, quadriceps reconstruction using suture anchor and Achilles allograft combination is a feasible technique in neglected cases who present with quadriceps tendon re-rupture after primary surgical repair.

scholarly journals Outcome after Two Sequential Revision Hip Arthroplasties for CoC Bearing Fracture with 10 Years Follow-up: A Case Report

2021 ◽  
Vol 11 (7) ◽  
Author(s):  
Matevž Topolovec ◽  
Ingrid Milošev ◽  
Andrej Cör
Keyword(s):  
Case Report ◽  
Hip Prosthesis ◽  
Full Range ◽  
Revision Operation ◽  
Term Survival ◽  
Ceramic Liner ◽  
Bearing Couple ◽  
Hip Arthroplasties

Introduction: Revisions due to the fracture of ceramic-on-ceramic (CoC) bearing are rare, however when they occur, they represent a major challenge to an orthopedic surgeon for ensuring safe and long-term survival of the replaced bearing. Case Report: We present a case of fractured ceramic liner of total hip prosthesis that underwent revision to a metal-on-polyethylene (MoP) bearing couple, with consequent huge periprosthetic metallosis. Shortly after, the second revision operation followed using the third bearing couple of ceramic-on-polyethylene (CoP). At 10 years follow-up after the operation due to ceramic fracture, the patient is now pain free with full range of motion of the revised hip. Conclusion: Establishment of diagnostic routes and recommended protocols for CoC bearing fracture would allow easier recognition of potential fracture and diminish its consequences for the patients. Keywords: Tribology, Revision Hip Arthroplasty, Ceramic Bearing Fracture.

scholarly journals Recurrent anterior shoulder dislocation with glenoid fracture managed by modified Boytchev procedure: a rare case report

2019 ◽  
Vol 5 (5) ◽  
pp. 958
Author(s):  
Ashish Devgan ◽  
Umesh Yadav ◽  
Rajesh Rohilla ◽  
Pankaj Sharma ◽  
Varun Goel ◽  
...  
Keyword(s):  
Shoulder Dislocation ◽  
Full Range ◽  
Anterior Dislocation ◽  
Bone Block ◽  
Anterior Shoulder Dislocation ◽  
Glenoid Fracture ◽  
Rare Case Report ◽  
Muscle Actions ◽  
Recurrent Anterior Dislocation

<p class="abstract">Surgical procedures for recurrent anterior dislocation of the shoulder include using capsuloligamentous or bone blocks to create barriers and active interventions using muscle actions. Fracture of glenoid acts as a barrier for bone block procedures. Boytchev procedure, though outmoded, yet acts as simple and effective procedure in this condition. Here we report a 44 year old male with recurrent anterior dislocation with glenoid fracture treated by Boytchev procedure. The patient is on regular follow up since 3 years with no episode of shoulder dislocation till now with full range of movements. To conclude, Boytchev procedure is technically simple and effective method in patients with recurrent anterior shoulder dislocation with fracture of glenoid.</p>

scholarly journals Internal Trauma, Humeral Fracture, and Radial Nerve Paralysis: How Could it Occur in the Sport Setting? A Case Report and Review of the Literature

2020 ◽  
Vol 8 (1) ◽  
pp. 1
Author(s):  
Elghoul Naoufal ◽  
Elantri Ismail ◽  
Bouya Ayoub ◽  
Bennis Azzelarab ◽  
Zaddoug Omar ◽  
...  
Keyword(s):  
Radial Nerve ◽  
Full Range ◽  
Humeral Fracture ◽  
Imaging Findings ◽  
Review Of The Literature ◽  
Significant Morbidity ◽  
Nerve Paralysis ◽  
Pathologic Fractures ◽  
Type Of Fracture

Thrower’s fractures are Spiral fractures of the humerus in the ball. They represent very uncommon clinical entities that can simulate pathologic fractures. Moreover, the concomitant neurologic deficient is rare. Herein we report a 27 years old muscular man presented a spiral fracture of the humerus following a forceful throw of the ball during an amateur throwing challenge. Clinical and imaging findings showed a displaced Thrower fracture with radial nerve neurapraxia (known as Holstein Lewis fracture) prompting the patient to undergo surgery. The intraoperative aspect found that the nerve was near to the beveled distal humeral fragment with no incarceration. We performed an internal fixation using the Leicester plate and the nerve was kept away from the plate by the interposition of a soft tissue sheet. At the last follow up, the fracture united and radial nerve neurapraxia resolved and the patient regained the full range of motion of his right upper limb with no pain. In conclusion, although this type of fracture is rare, given their significant morbidity, we emphasize that the reactional throwers should undergo appropriate preseason training before practicing a throwing challenge or generally a throwing sport.

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