Development of a Web-App for the Ecological Momentary Assessment of Dietary Habits among College Students: The HEALTHY-UNICT Project

The transition from adolescence to adulthood is a critical period for the development of healthy behaviors. Yet, it is often characterized by unhealthy food choices. Considering the current pandemic scenario, it is also essential to assess the effects of coronavirus disease-19 (COVID-19) on lifestyles and diet, especially among young people. However, the assessment of dietary habits and their determinants is a complex issue that requires innovative approaches and tools, such as those based on the ecological momentary assessment (EMA). Here, we describe the first phases of the “HEALTHY-UNICT” project, which aimed to develop and validate a web-app for the EMA of dietary data among students from the University of Catania, Italy. The pilot study included 138 students (mean age 24 years, SD = 4.2; 75.4% women), who used the web-app for a week before filling out a food frequency questionnaire with validation purposes. Dietary data obtained through the two tools showed moderate correlations, with the lowest value for butter and margarine and the highest for pizza (Spearman’s correlation coefficients of 0.202 and 0.699, respectively). According to the cross-classification analysis, the percentage of students classified into the same quartile ranged from 36.9% for vegetable oil to 58.1% for pizza. In line with these findings, the weighted-kappa values ranged from 0.15 for vegetable oil to 0.67 for pizza, and most food categories showed values above 0.4. This web-app showed good usability among students, assessed through a 19-item usability scale. Moreover, the web-app also had the potential to evaluate the effect of the COVID-19 pandemic on students’ behaviors and emotions, showing a moderate impact on sedentary activities, level of stress, and depression. These findings, although interesting, might be confirmed by the next phases of the HEALTHY-UNICT project, which aims to characterize lifestyles, dietary habits, and their relationship with anthropometric measures and emotions in a larger sample of students.

Causes of Death in End-Stage Kidney Disease: Comparison between the United States Renal Data System and a Large Integrated Health Care System

<b><i>Introduction:</i></b> Using a large diverse population of incident end-stage kidney disease (ESKD) patients from an integrated health system, we sought to evaluate the concordance of causes of death (CODs) between the underlying COD from the United States Renal Data System (USRDS) registry and CODs obtained from Kaiser Permanente Southern California (KPSC). <b><i>Methods:</i></b> A retrospective cohort study was performed among incident ESKD patients who had mortality records and CODs reported in both KPSC and USRDS databases between January 1, 2007, and December 31, 2016. Underlying CODs reported by the KPSC were compared to the CODs reported by USRDS. Overall and subcategory-specific COD agreements were assessed using Cohen’s weighted kappa statistic (95% CI). Proportions of positive and negative agreement were also determined. <b><i>Results:</i></b> Among 4,188 ESKD patient deaths, 4,118 patients had CODs recorded in both KPSC and USRDS. The most common KPSC CODs were circulatory system diseases (35.7%), endocrine/nutritional/metabolic diseases (24.2%), genitourinary diseases (12.9%), and neoplasms (9.6%). Most common USRDS CODs were cardiac disease (46.9%), withdrawal from dialysis (12.6%), and infection (10.1%). Of 2,593 records with causes listed NOT as “Other,” 453 (17.4%) had no agreement in CODs between the USRDS and the underlying, secondary, tertiary, or quaternary causes recorded by KPSC. In comparing CODs recorded within KPSC to the USRDS, Cohen’s weighted kappa (95% CI) was 0.20 (0.18–0.22) with overall agreement of 36.4%. <b><i>Conclusion:</i></b> Among an incident ESKD population with mortality records, we found that there was only fair or slight agreement between CODs reported between the USRDS registry and KPSC, a large integrated health care system.

Manual Testing of Respiratory Muscles in Adults with Asthma: A Intra and Interrater Reliability and Validity Study

Background: Manual Muscle Testing (MMT) is a useful tool to evaluate ventilatory mechanics in adults with asthma. However, in the reviewed literature, there are few studies that report psychometric features of this test. Therefore, the present study aimed to evaluate MMT reliability and validity in respiratory muscles in adults with asthma.Methods: It was a cross-sectional study. Muscle strength (MMT and static respiratory pressures), sociodemographic and anthropometric variables related to the disease were evaluated. Measurements were carried out by two independent evaluators The reliability of MMT was analyzed with the weighted kappa and the convergent validity was evaluated by comparing the MTT and the respiratory pressure measurements using Pearson's correlation coefficient. The level of significance was p <0.05. Results: Twenty-six adults with stable asthma participated in the study. The intrarater reliability for MMT was between moderate and substantial (kappa=0.45-0.88) for all evaluated muscles while the interrater reliability was slight and fair for intercostal muscles (kappa=0.07-0.24), and fair and substantial (kappa=0.36-0.75) for other muscles. The convergent validity of MMT and respiratory pressures was low (r=0.20-0.48).Conclusions: MMT is a reliable measurement that can be used to evaluate respiratory muscle strength in adults with asthma. This study support MMT application for respiratory muscles at clinical settings when more objective measures such as MIP and MEP are not available. Considering that the MMT is a useful, practical, low-cost tool commonly used by physiotherapists, future studies could evaluate the convergent validity compared with dynamometry or electromyography of the respiratory muscles.

Deep learning versus iterative image reconstruction algorithm for head CT in trauma

Purpose To compare the image quality between a deep learning–based image reconstruction algorithm (DLIR) and an adaptive statistical iterative reconstruction algorithm (ASiR-V) in noncontrast trauma head CT. Methods Head CT scans from 94 consecutive trauma patients were included. Images were reconstructed with ASiR-V 50% and the DLIR strengths: low (DLIR-L), medium (DLIR-M), and high (DLIR-H). The image quality was assessed quantitatively and qualitatively and compared between the different reconstruction algorithms. Inter-reader agreement was assessed by weighted kappa. Results DLIR-M and DLIR-H demonstrated lower image noise (p < 0.001 for all pairwise comparisons), higher SNR of up to 82.9% (p < 0.001), and higher CNR of up to 53.3% (p < 0.001) compared to ASiR-V. DLIR-H outperformed other DLIR strengths (p ranging from < 0.001 to 0.016). DLIR-M outperformed DLIR-L (p < 0.001) and ASiR-V (p < 0.001). The distribution of reader scores for DLIR-M and DLIR-H shifted towards higher scores compared to DLIR-L and ASiR-V. There was a tendency towards higher scores with increasing DLIR strengths. There were fewer non-diagnostic CT series for DLIR-M and DLIR-H compared to ASiR-V and DLIR-L. No images were graded as non-diagnostic for DLIR-H regarding intracranial hemorrhage. The inter-reader agreement was fair-good between the second most and the less experienced reader, poor-moderate between the most and the less experienced reader, and poor-fair between the most and the second most experienced reader. Conclusion The image quality of trauma head CT series reconstructed with DLIR outperformed those reconstructed with ASiR-V. In particular, DLIR-M and DLIR-H demonstrated significantly improved image quality and fewer non-diagnostic images. The improvement in qualitative image quality was greater for the second most and the less experienced readers compared to the most experienced reader.

Cardiovascular risk in primary care: comparison between Framingham Score and waist circumference

Objectives: To estimate and compare the cardiovascular risk using the Framingham risk score (FRS) and waist circumference (WC) in primary care individuals and, secondarily, determine the main factors associated with these scores. Methods: Cross-sectional study involving individuals of both sexes attended in a primary health unit and aging between 30 and 74 years. The cardiovascular risks (FRS and WC) were stratified as low, intermediate, and high. The weighted Kappa coefficient was used to assess agreements between scores. Results: Fifty-five individuals (52.8 ± 9.4 years, 70.9% women) were evaluated. Using the FRS, 40.0% of the sample presented a low risk, 45.5% intermediate risk, and 14.5% high risk of cardiovascular disease. Conversely, when analyzed using the WC score, the highest frequency (71%) was observed in the high-risk category. Also, no agreement (K= 0.36; p= 0.55) was found between scores. FRS was associated with hypertension (p<0.01), diabetes (p=0.01), and stress in women (p=0.01), while the WC score was associated with hypertension (p=0.02), obesity (p<0.01), and high-density lipoprotein cholesterol HDL-c (p=0.03). Conclusions: Primary care individuals presented intermediate cardiovascular risk in the FRS and high risk in the WC, with no agreement between scores. Hypertension, diabetes, stress, obesity, and HDL-c represented the factors that were most associated with these scores.

A Food Frequency Questionnaire for Hemodialysis Patients in Bangladesh (BDHD-FFQ): Development and Validation

Diet is a recognized risk factor and cornerstone for chronic kidney disease (CKD) management; however, a tool to assess dietary intake among Bangladeshi dialysis patients is scarce. This study aims to validate a prototype Bangladeshi Hemodialysis Food Frequency Questionnaire (BDHD-FFQ) against 3-day dietary recall (3DDR) and corresponding serum biomarkers. Nutrients of interest were energy, macronutrients, potassium, phosphate, iron, sodium and calcium. The BDHD-FFQ, comprising 132 food items, was developed from 606 24-h recalls and had undergone face and content validation. Comprehensive facets of relative validity were ascertained using six statistical tests (correlation coefficient, percent difference, paired t-test, cross-quartiles classification, weighted kappa, and Bland-Altman analysis). Overall, the BDHD-FFQ showed acceptable to good correlations (p < 0.05) with 3DDR for the concerned nutrients in unadjusted and energy-adjusted models, but this correlation was diminished when adjusted for other covariates (age, gender, and BMI). Phosphate and potassium intake, estimated by the BDHD-FFQ, also correlated well with the corresponding serum biomarkers (p < 0.01) when compared to 3DDR (p > 0.05). Cross-quartile classification indicated that <10% of patients were incorrectly classified. Weighted kappa statistics showed agreement with all but iron. Bland-Altman analysis showed positive mean differences were observed for all nutrients when compared to 3DDR, whilst energy, carbohydrates, fat, iron, sodium, and potassium had percentage data points within the limit of agreement (mean ± 1.96 SD), above 95%. In summary, the BDHD-FFQ demonstrated an acceptable relative validity for most of the nutrients as four out of the six statistical tests fulfilled the cut-off standard in assessing dietary intake of CKD patients in Bangladesh.

Detection of pancreatic fibrosis using magnetic resonance imaging: correlation with histopathology

Background and Hypothesis: Diagnosis of chronic pancreatitis (CP) is challenging and controversial. Magnetic Resonance Imaging (MRI) offers a noninvasive modality to diagnose CP, but its findings have been rarely correlated with histopathology. We aimed to assess the correlation of T1 signal intensity ratio of pancreas to spleen (T1 SIRp/s) and arterio-venous ratio (AVR) of the parenchyma on MRI and Cambridge score on MRCP with surgical histopathology in patients who underwent pancreatic resection. Methods: We identified 160 pancreatic resections performed in adults between 2017 and 2019 by searching our institution’s surgery database. Seventy-one of them had surgical pathology specimens available and 59 of them had MRI/MRCP within 3 months prior to the surgery. Histologic grading was performed by a gastrointestinal pathologist using Ammann’s fibrosis score. Two image analysts blinded to the clinical information and fibrosis score measured T1 SIRp/s from unenhanced T1-weighted fat-saturated gradient-echo images and arterio-venous ratio (AVR) from post-contrast dynamic phase. Cambridge score was also recorded from MRCP. Statistical analysis included Pearson’s correlation coefficient of the T1 SIRp/s, AVR, and Cambridge score with the fibrosis score and weighted kappa for interobserver agreement. Results: Correlations between T1 SIRp/s and AVR with the fibrosis score were (r= -0.30, p=0.02, 95%CI: -0.51 to -0.04 and r= -0.36, p=0.01, 95%CI: -0.58 to -0.09, respectively). In comparison, there is less correlation between the Cambridge grade and the fibrosis (r= 0.17, p=0.15, 95% CI for r= -0.07 to 0.39). Interobserver agreement was good (kappa=0.80). Conclusion: There is moderate correlation between the T1 signal intensity and enhancement ratio of the pancreas with pancreatic fibrosis. This is higher than the correlation between the Cambridge grade and fibrosis. Multi-institutional, prospective studies are needed to verify T1 SIR and AVR as potential imaging biomarkers of pancreatic fibrosis.

Reliability and Validity of the Japanese Version of the 12-Item Psychosocial Safety Climate Scale (PSC-12J)

The 12-item psychosocial safety climate scale (PSC-12) has been used extensively in previous research, but its reliability and validity in a Japanese context are still unknown. We examined the psychometrics of the Japanese version of the PSC-12 (PSC-12J). The PSC-12J and scales on the relevant variables were administered to 2200 employees registered with an online survey company. A follow-up survey with 1400 of the respondents was conducted two weeks later. Internal consistency and test–retest reliability were examined via Cronbach’s alpha and Cohen’s weighted kappa coefficients, respectively. Structural, convergent, and known-group validities were examined using confirmatory factor analysis (CFA) and item response theory (IRT) analysis, correlation analysis, and Kruskal–Wallis test, respectively. Cronbach’s alpha and Cohen’s weighted kappa coefficients were 0.97 and 0.53, respectively. CFA based on the four-factor structure established in the previous literature showed an acceptable model fit. IRT analysis showed that each item was an adequate measure of the respondent’s latent trait. Correlations of the PSC-12J with the relevant variables and distribution of scores by demographic characteristics were also observed in the theoretically expected directions, supporting the construct validity of the PSC-12J. Our findings establish the PSC-12J as a reliable and valid measure of the psychosocial safety climate construct in the Japanese context.

RNA Sequencing-Based Single Sample Predictors of Molecular Subtype and Risk of Recurrence for Clinical Assessment of Early-Stage Breast Cancer

ABSTRACTBackgroundMultigene expression assays for molecular subtypes and biomarkers can aid clinical management of early breast cancer. Based on RNA-sequencing we aimed to develop robust single-sample predictor (SSP) models for conventional clinical markers as well as molecular intrinsic subtype and risk of recurrence (ROR) that provide clinically relevant prognostic stratification.MethodsA uniformly accrued breast cancer cohort of 7743 patients with RNA-sequencing data from fresh tissue was divided into a training set (n=5250) and a reserved test set (n=2412). We trained SSPs for PAM50 molecular subtypes and ROR assigned by nearest-centroid (NC) methods and SSPs for conventional clinical markers from histopathology data. Additionally, SSP classifications were compared with Prosigna in two external clinical series (ABiM, n=100 and OSLO2-EMIT0, n=103 cases).ResultsIn the test set, agreement between SSP and NC classifications for PAM50 (five subtypes) and Subtype (four subtypes) was high (85%, Kappa=0.78) and very high (90%, Kappa=0.84) respectively. Accuracy for ROR risk category was high (84%, Kappa=0.75, weighted Kappa=0.90). The prognostic value for SSP and NC classification was assessed as equivalent and added clinically relevant prognostic information. Agreement for SSP and histopathology was very high or high for receptor status, while moderate and poor for Ki67 status and Nottingham histological grade (NHG), respectively. SSP concordance with Prosigna was high for subtype (OSLO=83% and ABiM=80%, Kappa=0.73 and 0.72, respectively) and moderate and high for ROR risk category (68% and 84%, Kappa=0.50 and 0.70, weighted Kappa=0.70 and 0.78). In pooled analysis, concordance between SSP and Prosigna for emulated treatment recommendation dichotomized for chemotherapy (yes vs. no) was high (85%, Kappa=0.66). In postmenopausal ER+/ HER2-/N0 patients SSP application suggested changed treatment recommendations for up to 17% of patients, with nearly balanced escalation and de-escalation of therapy.ConclusionsRobust SSP models, mimicking histopathological variables, PAM50, and ROR classifications can be derived from RNA-sequencing that closely matches clinical tests. Agreement and outcome analyses suggest that NC and SSP models are interchangeable on a group-level and nearly so on a patient level. Retrospective evaluation in ER+/HER2-/ N0 early breast cancer suggested that molecular testing could lead to a changed therapy recommendation for about one-fifth of patients.

Interobserver and Intraobserver Reproducibility and Reliability of the Huashan Clinical Classification System for Hirayama Disease

Purpose: The Huashan clinical classification system for Hirayama disease has recently been proposed and has been found useful for diagnosis and treatment. So far, however, there has been little in-depth evaluation of its reliability. Thus, this study aimed to assess the reproducibility and reliability of the system.Methods: Patients diagnosed with Hirayama disease between 2019 and 2020 were recruited. Seven spine surgeons from four different institutions, including an experienced group of three and an inexperienced group of four, were trained as observers of the Huashan clinical classification system for Hirayama disease, and these surgeons classified the recruited patients using the system. Then, 2 months later, they repeated the classification on the same patients in a different order. The interobserver and intraobserver agreement between the results was analyzed using percentage agreement and weighted kappa (κ) statistics.Results: A total of 60 patients were included in the analysis. For all the observers, experienced observers, and inexperienced observers, the agreement percentages were, respectively, 78.5% (κ = 0.76), 80.0% (κ = 0.78), and 78.9% (κ = 0.77), indicating substantial interobserver reproducibility. For distinguishing typical (Types I and II) and atypical (Type III) Hirayama disease among the different groups of observers, the percentage agreement ranged from 95.6 to 98.9% (κ = 0.74–0.92), indicating substantial to nearly perfect reproducibility. For suggesting conservative treatment (Types I and III) or surgery (Type II), the percentage agreement ranged from 93.3 to 96.4% (κ = 0.81–0.90), indicating nearly perfect reproducibility. As for intraobserver agreement, the percentage agreement ranged from 68.3 to 81.7% (κ = 0.65–0.79), indicating substantial reliability.Conclusion: The Huashan clinical classification system for Hirayama disease was easy to learn and apply in a clinical environment, showing excellent reproducibility and reliability. Therefore, it would be promising to apply and promote this system for the precise and individualized future treatment of Hirayama disease.