Using Video Recording in Evaluating Skills of Medical Students in the Performance of the Orthopedic Examination

Objective. The study aims to assess the similarity between the results of the evaluation of students during an Objective Structured Clinical Examination (OSCE) and a video recording of the same OSCE (VOSCE). Methods. All Orthopedic surgeon preceptors in the actual OSCE were recruited to the study. Video recordings of the students taking the OSCE were collected and later reviewed and re-evaluated by the same preceptor after at least four weeks. The grades of actual OSCE and VOSCE were collected and analyzed using Cohen’s kappa coefficient. Results. High variability of intra-rater reliability was observed in different preceptors and station (slight agreement to perfect agreement). Overall intra-rater reliability between actual and video OSCE showed moderate agreement with Cohen’s kappa coefficient equal to 0.43 (n-219). Conclusion. Video OSCE is a reliable tool in assessing student clinical skills and knowledge in the musculoskeletal examination. Some factors have been suggested to further improve reliability.

Automatic Sleep Stage Classification Based on Two-channel EOG and One-channel EMG

The sleep monitoring with PSG severely degrades the sleep quality. In order to simplify the hygienic processing and reduce the load of sleep monitoring, an approach to automatic sleep stage classification without electroencephalogram (EEG) was explored. Totally 108 features from two-channel electrooculogram (EOG) and 6 features from one-channel electromyogram (EMG) were extracted. After feature normalization, the random forest (RF) was used to classify five stages, including wakefulness, REM sleep, N1 sleep, N2 sleep and N3 sleep. Using 114 normalized features from the combination of EOG (108 features) and EMG (6 features), the Cohen’s kappa coefficient was 0.749 and the accuracy was 80.8% by leave-one -out cross-validation (LOOCV) for 124 records from ISRUC-Sleep. As a reference for AASM standard, the Cohen’s kappa coefficient was 0.801 and the accuracy was 84.7% for the same dataset based on 438 normalized features from the combination of EEG (324 features), EOG (108 features) and EMG (6 features). In conclusion, the approach by EOG+EMG with the normalization can reduce the load of sleep monitoring, and achieves comparable performances with the "gold standard" EEG+EOG+EMG on sleep classification.

POS1436 EPIDEMIOLOGY OF LATENT TUBERCULOSIS INFECTION IN PATIENTS WITH RHEUMATIC IMMUNE-MEDIATED DISEASES. SINGLE UNIVERSITY STUDY OF 1117 PATIENTS

Background:Patients with rheumatologic immune-mediated diseases (R-IMID) with Latent tuberculosis infection (LTBI) requiring biologic therapy (BT) are at an increased risk of active tuberculosis (TB). Screening of LTBI with tuberculin skin test (TST) and/or Interferon (IFN)-γ release assays (IGRA) is recommended before starting of BT.Objectives:In patients with R-IMID previously to BT our aim was to assess a) prevalence of LTBI, b) importance of using a booster test in negative TST and c) to compare TST with the IGRA test.Methods:Cross-sectional single University Hospital study including all patients diagnosed with R-IMID who underwent a TST and/or IGRA in the last five years (2016-2020).TST was performed by a subcutaneous injection of 0.1 ml of purified protein derivative (PPD) with a reading after 72 hours. TST was considered positive with an induration of more than 5 mm of diameter. If the first TST was negative, a new TST (Booster) was performed between 1 and 2 weeks after the first TST.LTBI was diagnosed by a positive IGRA and/or TST and absence of active TB (Chest radiograph). Diagnosis with IGRA vs TST was compared (Cohen’s kappa coefficient).Results:We included 1117 patients (741 women/376 men), mean age 53±15 years with LTBI. Chest radiograph was normal in most of the patients, only 39 patients (3.5%) presented signs of previous TB infection, mostly granuloma. Total LTBI prevalence was 31.7% (354/1117). LTBI prevalence in different underlying R-IMID ranges from 35% in vasculitis up to 26.5% in conectivopathies (Figure 1).Booster was positive in 66 patients (7.7%) out of 859 patients with a negative simple TST. Results of TST (+booster) and IGRA tests are shown in Table 1. TST (+booster) was positive in 187 patients (22.9%) out of 817 with a negative or indeterminate IGRA test. IGRA test was positive in 30 (3.8%) out of 793 patients with a negative TST (+booster). Cohen’s Kappa coefficient between TST (+booster) and IGRA (QFT-plus), was 0.381.Conclusion:LTBI is frequent between patients with R-IMID. Booster after negative simple TST may be useful, since it can detect false negatives for LTBI. IGRA and TST(+booster) show a low grade of agreement. Therefore, performing both tests before BT may be recommendable.Table 1.Results of TST (+booster) and IGRA testIGRA (QFT-Plus)PositiveNegativeIndeterminateUnavailableTotalTST(+Booster)Positive891424548324Negative30500130133793Total1196421751811117* Cohen’s kappa coefficient: 0.381Figure 1.Prevalence of LTBI in different underlying R-IMIDLTBI: Latent tuberculosis infection, PsA: Psoriatic arthritis, RA: Rheumatoid arthritis, SpA: Axial spondyloarthritis.Diagnosis of LTBI: Positive TST(+booster) and/or IGRA test.Disclosure of Interests:David Martínez-López: None declared, Joy Osorio-Chavez: None declared, Carmen Álvarez-Reguera: None declared, Virginia Portilla: None declared, Miguel A González-Gay Speakers bureau: Abbvie, Pfizer, Roche, Sanofi and MSD, Consultant of: Abbvie, Pfizer, Roche, Sanofi and MSD, Grant/research support from: Abbvie, MSD, Jansen and Roche, Ricardo Blanco Speakers bureau: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen, Lilly and MSD, Consultant of: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen, Lilly and MSD, Grant/research support from: Abbvie, MSD, and Roche

Seroprevalence of SARS-CoV-2 Assessed by Four Chemiluminescence Immunoassays and One Immunocromatography Test for SARS-Cov-2

The onset of the new SARS-CoV-2 coronavirus encouraged the development of new serologic tests that could be additional and complementary to real-time RT-PCR-based assays. In such a context, the study of performances of available tests is urgently needed, as their use has just been initiated for seroprevalence assessment. The aim of this study was to compare four chemiluminescence immunoassays and one immunochromatography test for SARS-Cov-2 antibodies for the evaluation of the degree of diffusion of SARS-CoV-2 infection in Salerno Province (Campania Region, Italy). A total of 3,185 specimens from citizens were tested for anti-SARS-CoV-2 antibodies as part of a screening program. Four automated immunoassays (Abbott and Liaison SARS-CoV-2 CLIA IgG and Roche and Siemens SARS-CoV-2 CLIA IgM/IgG/IgA assays) and one lateral flow immunoassay (LFIA Technogenetics IgG–IgM COVID-19) were used. Seroprevalence in the entire cohort was 2.41, 2.10, 1.82, and 1.85% according to the Liaison IgG, Abbott IgG, Siemens, and Roche total Ig tests, respectively. When we explored the agreement among the rapid tests and the serologic assays, we reported good agreement for Abbott, Siemens, and Roche (Cohen's Kappa coefficient 0.69, 0.67, and 0.67, respectively), whereas we found moderate agreement for Liaison (Cohen's kappa coefficient 0.58). Our study showed that Abbott and Liaison SARS-CoV-2 CLIA IgG, Roche and Siemens SARS-CoV-2 CLIA IgM/IgG/IgA assays, and LFIA Technogenetics IgG-IgM COVID-19 have good agreement in seroprevalence assessment. In addition, our findings indicate that the prevalence of IgG and total Ig antibodies against SARS-CoV-2 at the time of the study was as low as around 3%, likely explaining the amplitude of the current second wave.

Deep Learning in Automatic Sleep Staging With a Single Channel Electroencephalography

This study centers on automatic sleep staging with a single channel electroencephalography (EEG), with some significant findings for sleep staging. In this study, we proposed a deep learning-based network by integrating attention mechanism and bidirectional long short-term memory neural network (AT-BiLSTM) to classify wakefulness, rapid eye movement (REM) sleep and non-REM (NREM) sleep stages N1, N2 and N3. The AT-BiLSTM network outperformed five other networks and achieved an accuracy of 83.78%, a Cohen’s kappa coefficient of 0.766 and a macro F1-score of 82.14% on the PhysioNet Sleep-EDF Expanded dataset, and an accuracy of 81.72%, a Cohen’s kappa coefficient of 0.751 and a macro F1-score of 80.74% on the DREAMS Subjects dataset. The proposed AT-BiLSTM network even achieved a higher accuracy than the existing methods based on traditional feature extraction. Moreover, better performance was obtained by the AT-BiLSTM network with the frontal EEG derivations than with EEG channels located at the central, occipital or parietal lobe. As EEG signal can be easily acquired using dry electrodes on the forehead, our findings might provide a promising solution for automatic sleep scoring without feature extraction and may prove very useful for the screening of sleep disorders.

Correlation between PlateletWorks® and PFA-100® for Measuring Platelet Function before Urgent Surgery in Patients with Chronic Antiplatelet Therapy

Hemostasis is crucial for reducing bleeding during surgical procedures. The points-of-care based on the platelet function test could be useful to minimize the complications related to chronic antiplatelet therapy during surgery. The present study is aimed at comparing two point-of-care platelet function devices—Platelet Function Analyzer PFA-100® (Siemens Canada, Mississauga, ON, Canada) and Plateletworks®(Helena Laboratories, Beaumont, TX, USA). Our objective is to evaluate if they provide comparable and useful information to manage anti-aggregate patients before surgery. We included patients with a femoral fracture receiving chronic antiplatelet therapy and a median age of 89 years (range from 70 to 98). A platelet function evaluation was performed on all patients before surgery using both devices—Plateletworks® and PFA-100®. The correlation between Plateletworks® and PFA-100® was performed using Cohen’s Kappa coefficient. Twenty consecutive patients participated in the trial; 16 patients were under treatment with 75 mg/day of clopidogrel, three with >300 mg/day of acetylsalicylic acid (ASA), and only one was in treatment with both antiplatelet agents. Cohen’s Kappa coefficient was 0.327 comparing PFA-100®-ADP (adenosine diphosphate) and Plateletworks® and, 0.200 comparing PFA-100®-EPI (epinephrine) and Plateletworks®. In conclusion, we found a weak concordance comparing PFA-100® and Plateletworks®. This could partially be due to the advanced age of the included patients. However, given the limited sample size, more studies are necessary to confirm these results.

Developing geriatric face makeup enrichment book for students of Skin Beauty program in vocational high school

This research aims to: (1) produce a Geriatric Makeup Enrichment book as a teaching material of geriatric makeup for students of Purworejo 3 Vocational High School majoring in Beauty that is feasible and effective . This research is research and development applying the four-D. The product feasibility tests were carried out by two material experts and two media experts by validated the enrichment book through a questionnaire using a Likert scale was analyzed using conversion scores into four quantitative categories then tested the agreement between experts through the Cohen's Kappa test and its effectiveness was tested with a one-group case study technique and analyzed with gain scores. The subjects of this research trial were students of class XI Beauty in Purworejo 3 Vocational High School The data collection instruments used are observation guidelines, interview guidelines, experts’ validation questionnaire, teachers’ response questionnaire, students’ response questionnaire and ability test The research results are as follows. The enrichment book developed met the feasibility criteria according to material experts with a score of 3.59 (excellent) and there was agreement between material expert with a Cohen’s Kappa coefficient of 0.64 (good) Tthen, met the feasibility criteria according to media experts with a score of 3.70 (excellent) and there was an agreement between media with a Cohen’s Kappa coefficient value of 1.00 (excellent). Enrichment book developed was declared effective for use in XI grade students of Purworejo 3 Vocational High School majoring in Beauty and was included in medium category for value understanding with the gain score 0.5 and in a high category in skill value with the gain score 0.71.

Prevalence and Risk Factors for Bilateral Meniscal Tears Identified during Treatment for Cranial Cruciate Ligament Disease Via Tibial Plateau Levelling Osteotomy in Dogs

Objective The aim of this study was to report the prevalence and risk factors of bilateral meniscal tears during a tibial plateau levelling osteotomy (TPLO). Methods Data from 362 dogs that underwent staged or simultaneous TPLO between January 2006 and April 2019 were retrospectively collected. Variables such as breed, sex, weight change and intervals between surgeries were analysed with logistic regression. Preoperative tibial plateau angle, age, cranial cruciate ligament status and body weight were analysed with a generalized linear mixed model. All analyses were performed to assess the likelihood of bilateral meniscal tears versus unilateral tears and no tears. Correlation of meniscal tears between stifles was assessed with Cohen's kappa coefficient. Results Prevalence of bilateral meniscal tears was 48.0% (95% confidence interval [CI]: 43.0–53.0%). There was moderate agreement of the presence of meniscal tears between stifles (Cohen's kappa coefficient = 0.41, 95% CI: 0.31–0.51).The odds for bilateral meniscal tears were higher for Rottweilers (odds ratio [OR:] 4.5 [95% CI 1.1–30.3], p = 0.033), older dogs (OR: 1.2 [95% CI: 1.1–1.4 per year], p < 0.0001), smaller dogs (OR: 0.98 [95% CI: 0.97–0.99 per 0.45-kg], p = 0.001), stifles with complete cranial cruciate ligament tears (OR: 21.1 [95% CI: 7.1–62.4], p < 0.0001). Conclusion Contralateral meniscal tears, breed, older age, lower patient weight and complete cranial cruciate ligament tear were significant risk factors for bilateral meniscal tears. Surgeons can use these results to determine prognoses and propensities for meniscal tears in at-risk dogs.

Bayesian network-based methodology for selecting a cost-effective sewer asset management model

This paper presents a methodology based on Bayesian Networks (BN) to prioritise and select the minimal number of variables that allows predicting the structural condition of sewer assets to support the strategies in proactive management. The integration of BN models, statistical measures of agreement (Cohen's Kappa coefficient) and a statistical test (Wilcoxon test) were useful for a robust and straightforward selection of a minimum number of variables (qualitative and quantitative) that ensure a suitable prediction level of the structural conditions of sewer pipes. According to the application of the methodology to a specific case study (Bogotás sewer network, Colombia), it found that with only two variables (age and diameter) the model could achieve the same capacity of prediction (Cohen's Kappa coefficient = 0.43) as a model considering several variables. Furthermore, the methodology allows finding the calibration and validation percentage subsets that best fit (80% for calibration and 20% for validation data in the case study) in the model to increase the capacity of prediction with low variations. Furthermore, it found that a model, considering only pipes in critical and excellent conditions, increases the capacity of successful predictions (Cohen's Kappa coefficient from 0.2 to 0.43) for the proposed case study.

Lung MRI to predict lack of response to treatment in interstitial lung disease: initial observations on SSFSE/PROPELLER T2 mismatch

BackgroundHigh-resolution chest computed tomography (HRCT) signs of interstitial lung disease (ILD) are varied, some corresponding to irreparable parenchymal destruction and fibrosis, others representing potentially reversible changes, such as fine reticulation and ground-glass opacities (GGO). GGO frequently correspond to sites of active inflammation that may be responsive to steroids or immunosuppressive agents, but they might also represent intralobular interstitial fibrosis not resolved by current HRCT technique. Our aim was to investigate the ability of lung MRI to predict treatment response in individuals with ILD presenting with predominant GGO.MethodsIn this prospective cohort, 15 participants (4 male and 11 female) aged 38–84 years, presenting with ILD manifested as predominant GGO and referred for a new treatment regimen with a systemic glucocorticoid and/or an immunosuppressive agent, underwent 1.5 T lung MRI with breath-hold (SSFSE) and respiratory-gated (PROPELLER) T2-weighted pulse sequences, and with dynamic contrast-enhanced fat-suppressed T1-weighted pulse sequence (LAVA). Relative signal intensity on T2-weighted images and relative enhancement of lung lesions were compared to functional response in a dichotomous fashion (response versus non-response) with t test for independent samples. SSFSE/PROPELLER T2 mismatch was compared to response with Fisher’s exact test. Inter-rater agreement was evaluated with Cohen’s kappa coefficient. The primary endpoint for response was a greater than 10% increase in forced vital capacity in 10 weeks.ResultsResponders (4/15, 27%) and non-responders (11/15, 73%) showed similar relative signal intensity on T2-weighted images and relative enhancement measurements. SSFSE/PROPELLER T2 mismatch was able to discriminate responders from non-responders in 12 of 15 participants (80% accuracy, p = 0.026) for readers 1 and 2, and in 13 of 15 participants (87% accuracy, p = 0.011) for reader 3, with inter-rater agreement of 87% between readers 1 and 2 (Cohen’s kappa coefficient of 0.732) and 93% between readers 1/2 and 3 (Cohen’s kappa coefficient of 0.865).ConclusionsSSFSE-PROPELLER T2 mismatch was predictive of lack of response to treatment in this small group of ILD patients presenting with predominant GGO at HRCT.Key PointSSFSE/PROPELLER T2 mismatch may help predict lack of response to anti-inflammatory/immunosuppressive treatment in interstitial lung disease, with high accuracy and high inter-rater agreement.