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Selected AbstractsIsolation of Shiga toxin-producing Escherichia coli O103 from sheep using automated immunomagnetic separation (AIMS) and AIMS-ELISA: sheep as the source of a clinical E. coli O103 case?LETTERS IN APPLIED MICROBIOLOGY, Issue 3 2002A.M. Urdahl Aims: To investigate whether a sheep flock was the original reservoir of a Shiga toxin-producing Escherichia coli (STEC) O103 strain causing a clinical human case and to compare the two diagnostic methods automated immunomagnetic separation (AIMS) and AIMS-ELISA. Methods and Results: AIMS detected Escherichia coli O103 in 36·5% of the samples and AIMS-ELISA detected E. coli O103 in 52·1% of the samples. Polymerase chain reaction detected stx1 and eae in three of 109 E. coli O103 isolates. Pulsed field gel electrophoresis showed that the sheep and human STEC O103 were characterized by distinctly different profiles. Conclusions: The sheep flock was shown to carry STEC O103, although an association between the sheep flock and the clinical human case could neither be proven nor eliminated. Substantial agreement was found between AIMS and AIMS-ELISA, but AIMS-ELISA was less time consuming and resulted in a higher recovery of E. coli O103. Significance and Impact of the Study: The study shows that sheep may be carriers of STEC that are associated with human disease and that the methods described can be used to increase the sensitivity of STEC detection. [source] Prevalence of apical periodontitis and frequency of root-filled teeth in an adult Spanish populationINTERNATIONAL ENDODONTIC JOURNAL, Issue 3 2004A. Jiménez-Pinzón Abstract Aim, To estimate the prevalence of teeth with apical periodontitis (AP) and root-filled teeth in an adult Spanish population. Methodology, A total of 180 subjects, aged 37.1 ± 15.7 years, presenting as new patients to the Faculty of Dentistry, Seville, Spain, were examined. All participants underwent a full-mouth radiographic survey (14 periapical radiographs). The frequency of root canal treatment and the periapical status of all teeth, using the periapical index (PAI) score, were assessed. An intraobserver agreement test on PAI scores produced a Cohen's kappa of 0.77 (substantial agreement). Results were analysed statistically using the Chi-square test. Results, Apical periodontitis in one or several teeth was found in 110 subjects (61.1% prevalence), and 73 (40.6% prevalence) had at least one root-filled tooth. Among subjects with root-filled teeth, 48 (65.8%) had AP affecting at least one root-filled tooth. A total of 4453 teeth were examined, of these 186 (4.2%) had AP. The total number of root-filled teeth was 93 (2.1%), of which 60 (64.5%) had AP. Among non-root filled teeth, only 2.9% had AP. The prevalence of AP in connection with molar teeth was higher (5.5%) than for premolar (4.5%) and anterior teeth (3.2%; P < 0.01). More premolar and molar teeth were root-filled (2.8 and 2.7%, respectively) than anterior teeth (1.3%; P < 0.01). The prevalence of AP increased with age. Conclusions, The prevalence of AP in root-filled and untreated teeth, and the frequency of root-filled teeth were comparable to those reported in previous similar studies carried out in European countries. The prevalence of root-filled teeth with AP was found to be higher compared to that demonstrated in other epidemiological studies. [source] Observer variability in the sonographic evaluation of thyroid nodulesJOURNAL OF CLINICAL ULTRASOUND, Issue 6 2010Chang Suk Park MD Abstract Objective. Inter- and intraobserver variabilities in the description and diagnostic categorization of sonographic (US) features of thyroid nodules were evaluated. Methods. The current study was conducted on 72 malignant nodules and 61 benign nodules. The US findings for each thyroid nodule were analyzed twice at a 6-week interval by five radiologists. The analyses were in accordance with the guidelines proposed bythe Thyroid Study Group of the Korean Society of Neuroradiology and Head and Neck Radiology (TSGKSNRHNR). Inter- and intraobserver variabilities were calculated using Cohen's kappa statistics. The sensitivity, specificity, positive-predictive value, and negative-predictive value in the assessment of the diagnostic accuracy using these guidelines were calculated. Result. The interobserver agreement was fair to substantial for US features and categorization. Of the US features of the thyroid nodules, internal content (solid versus cystic) showed substantial agreement (k= 0.64). There was moderate agreement with regard to shape, echogenicity, calcification, and diagnostic categories (k = 0.42, 0.57, 0.55, and 0.55, respectively). There was fair agreement for margin, echotexture, and capsule invasion (k = 0.34, 0.26, and 0.32, respectively). With regard to intraobserver agreement, there was moderate to substantial agreement for all US features except for echotexture and capsule invasion, which showed fair agreement. In particular, there was moderate to almost perfect agreement for the diagnostic category. The sensitivity, specificity, positive-predictive value, and negative-predictive value were 65.3%,81.9%, 60.7%,68.9%, 69.7%,73.8%, and 66.6%,75.5%, respectively. Conclusion. There were high degrees of inter- and intraobserver agreement using the "Guidelines for diagnostic thyroid ultrasonography," of the TSGKSNRHNR in the description and categorization of thyroid nodules. © 2010 Wiley Periodicals, Inc. J Clin Ultrasound, 2010 [source] Development, standardization, and testing of a lexicon for reporting contrast-enhanced breast magnetic resonance imaging studiesJOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 6 2001Debra M. Ikeda MD Abstract The purpose of this study was to develop, standardize, and test reproducibility of a lexicon for reporting contrast-enhanced breast magnetic resonance imaging (MRI) examinations. To standardize breast MRI lesion description and reporting, seven radiologists with extensive breast MRI experience developed consensus on technical detail, clinical history, and terminology reporting to describe kinetic and architectural features of lesions detected on contrast-enhanced breast MR images. This lexicon adapted American College of Radiology Breast Imaging and Data Reporting System terminology for breast MRI reporting, including recommendations for reporting clinical history, technical parameters for breast MRI, descriptions for general breast composition, morphologic and kinetic characteristics of mass lesions or regions of abnormal enhancement, and overall impression and management recommendations. To test morphology reproducibility, seven radiologists assessed morphology characteristics of 85 contrast-enhanced breast MRI studies. Data from each independent reader were used to compute weighted and unweighted kappa (,) statistics for interobserver agreement among readers. The MR lexicon differentiates two lesion types, mass and non-mass-like enhancement based on morphology and geographical distribution, with descriptors of shape, margin, and internal enhancement. Lexicon testing showed substantial agreement for breast density (, = 0.63) and moderate agreement for lesion type (, = 0.57), mass margins (, = 0.55), and mass shape (, = 0.42). Agreement was fair for internal enhancement characteristics. Unweighted kappa statistics showed highest agreement for the terms dense in the breast composition category, mass in lesion type, spiculated and smooth in mass margins, irregular in mass shape, and both dark septations and rim enhancement for internal enhancement characteristics within a mass. The newly developed breast MR lexicon demonstrated moderate interobserver agreement. While breast density and lesion type appear reproducible, other terms require further refinement and testing to lead to a uniform standard language and reporting system for breast MRI. J. Magn. Reson. Imaging 2001;13:889,895. © 2001 Wiley-Liss, Inc. [source] A Taxonomy of Passive Behaviors in People with Alzheimer's DiseaseJOURNAL OF NURSING SCHOLARSHIP, Issue 3 2000Kathleen Byrne Colling Purpose: To construct a taxonomy of passive behaviors for understanding people with Alzheimer's disease. Passive behaviors are those associated with decreased motor movements, decreasing interactions with the environment, and feelings of apathy and listlessness. Little is known about behaviors associated with passivity, and these behaviors have not been categorized. Organizing Construct: Taxonomy construction. Passive behaviors in people with Alzheimer's disease were conceptualized as disturbing behaviors, patterns of personality change, and negative symptoms. Methods: The taxonomy was developed using critical reviews of 15 empirical studies published 1985 through 1998. Procedures included listing behaviors; clustering behaviors into inductively derived groupings; conducting an expert panel-review, making revisions, and conduting a second review; establishing global and category-by-category reliability using Cohen's Kappa. Findings: The nonhierarchic, natural taxonomy indicated five categories of behaviors associated with passivity in Alzheimer's disease: diminutions of cognition, psychomotor activity, emotions, interactions with people, and interactions with the environment. Analysis indicated substantial agreement beyond chance and showed statistically significant agreement among the six nurse-expert raters. Areas of synchrony between the taxonomy and the Need-Driven Dementia Compromised Behavior Model were identified. Conclusions: This taxonomy of passive behaviors in patients with Alzheimer's disease showed empirical rigor and compatibility with a middle-range theory and can be viewed as a sensitizing analytic scheme to guide future practice, research, and theory development. [source] Prediction of global VLE for mixtures with improved renormalization group theoryAICHE JOURNAL, Issue 1 2006Jianguo Mi Abstract The recently proposed renormalization group (RG) theory is reformulated within the context of density functional theory and applied to predicting global vapor,liquid equilibria (VLE) of Lennard,Jones chain pure fluids and fluid mixtures. An accurate equation based on the solution of the first-order mean-sphere approximation (FMSA) is adopted outside the critical region. Inside the critical region, the direct correlation function of FMSA is incorporated into the new RG transformation to describe the long-range fluctuation, which is conformal to general inhomogeneous studies. The new RG theory is applied to correcting real mixture phase envelopes, as well as corresponding phase diagrams of pure compounds for the critical region. The calculated results are in substantial agreement with those from experiment and molecular simulation both inside and outside the critical region. The new method is highly predictive because no adjustable parameters and no mixing rule are needed for both model and real fluid mixtures. © 2005 American Institute of Chemical Engineers AIChE J, 2006 [source] Monitoring adherence to beclomethasone in asthmatic children and adolescents through four different methodsALLERGY, Issue 10 2009N. S. Jentzsch Background:, Suboptimal adherence to inhaled steroids is a known problem in children and adolescents, even when medications are administered under parental supervision. This study aimed to verify the adherence rate to beclomethasone dipropionate (BDP) by four currently available methods. Methods:, In this concurrent cohort study, 102 randomly selected asthmatic children and adolescents aged 3,14 years were followed for 12 months. Adherence rate was assessed every 2 months by self and/or parent report, pharmacy dispensing data, electronic device (Doser®; Meditrack Products, Hudson, MA, USA) monitor, and canister weight. Results:, Mean adherence rates to BDP by self and/or parent report, pharmacy records, Doser, and canister weight were 97.9% (95% CI 88.0,98.6), 70.0% (95% CI 67.6,72.4), 51.5% (95% CI 48.3,54.6), and 46.3% (95% CI 44.1,48.4), respectively. Agreement analysis between (Doser) and canister weight revealed a weighted kappa equal to 0.76 (95% CI 0.65,0.87). Conclusions:, Adherence was a dynamic event and rates decreased progressively for all methods over the 12-month follow-up. Canister weight and electronic monitoring measures were more accurate than self/parent reports and pharmacy records. Rates obtained by these two methods were very close and statistical analysis also showed a substantial agreement between them. As measurements by canister weight are less costly compared with currently available electronic devices, it should be considered as an alternative method to assess adherence in both clinical research and practice. [source] Modelling the distributions of Culicoides bluetongue virus vectors in Sicily in relation to satellite-derived climate variablesMEDICAL AND VETERINARY ENTOMOLOGY, Issue 2 2004B. V. Purse Abstract., Surveillance data from 268 sites in Sicily are used to develop climatic models for prediction of the distribution of the main European bluetongue virus (BTV) vector Culicoides imicola Kieffer (Diptera: Ceratopogonidae) and of potential novel vectors, Culicoides pulicaris Linnaeus, Culicoides obsoletus group Meigen and Culicoides newsteadi Austen. The models containing the ,best' climatic predictors of distribution for each species, were selected from combinations of 40 temporally Fourier-processed remotely sensed variables and altitude at a 1 km spatial resolution using discriminant analysis. Kappa values of around 0.6 for all species models indicated substantial levels of agreement between model predictions and observed data. Whilst the distributions of C. obsoletus group and C. newsteadi were predicted by temperature variables, those of C. pulicaris and C. imicola were determined mainly by normalized difference vegetation index (NDVI), a variable correlated with soil moisture and vegetation biomass and productivity. These models were used to predict species presence in unsampled pixels across Italy and for C. imicola across Europe and North Africa. The predicted continuous presence of C. pulicaris along the appenine mountains, from north to south Italy, suggests BTV transmission may be possible in a large proportion of this region and that seasonal transhumance (seasonal movement of livestock between upland and lowland pastures) even in C. imicola -free areas should not generally be considered safe. The predicted distribution of C. imicola distribution shows substantial agreement with observed surveillance data from Greece and Iberia (including the Balearics) and parts of mainland Italy (Lazio, Tuscany and areas of the Ionian coast) but is generally much more restricted than the observed distribution (in Sardinia, Corsica and Morocco). The low number of presence sites for C. imicola in Sicily meant that only a restricted range of potential C. imicola habitats were included in the training set and that predictions could only be made within this range. Future modelling exercises will use abundance data collected according to a standardized protocol across the Mediterranean and, for Sicily in particular, should include non-climatic environmental variables that may influence breeding site suitability such as soil type. [source] Identifying cumulative trauma disorders of the upper extremity in workers' compensation databasesAMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 5 2003Dianne Zakaria MSc (PT), PhD (Candidate) Abstract Background Impeding the use of workers' compensation databases for surveillance of cumulative trauma disorder of the upper extremity (CTDUE) is the lack of valid and reliable extraction strategies. Methods Using the Z795-96 Coding of Work Injury or Disease Information standard, analgorithm was developed to classify claims as definite, possible, or non-CTDUE. Reliability was assessed with standardized claim reviews. Results Moderate to substantial agreement (Kappa,=,0.48, 95% CI 0.42,0.54, n,=,328; weighted Kappa,=,0.75, 95% CI 0.70,0.80, n,=,328) was demonstrated. The algorithm produced relatively homogeneous groups of definite and non-CTDUE claims but 29.1% of the possible CTDUE claims were categorized as definite CTDUE by claim review. Part of body agreement was almost perfect (Kappa,=,0.81,1.00) when determining whether the upper extremity or specific parts of the upper extremity were involved. Conclusions The algorithm can be used to estimate the number of CTDUE and extract homogeneous groups of definite and non-CTDUE claims. Furthermore, certain upper extremity part of body codes can be used to target anatomically defined claims. Am. J. Ind. Med. 43:507,518, 2003. © 2003 Wiley-Liss, Inc. [source] The Development and Well-Being Assessment: Description and Initial Validation of an Integrated Assessment of Child and Adolescent PsychopathologyTHE JOURNAL OF CHILD PSYCHOLOGY AND PSYCHIATRY AND ALLIED DISCIPLINES, Issue 5 2000Robert Goodman The Development and Well-Being Assessment (DAWBA) is a novel package of questionnaires, interviews, and rating techniques designed to generate ICD-10 and DSM-IV psychiatric diagnoses on 5-ldyear-olds. Nonclinical interviewers administer a structured interview to parents about psychiatric symptoms and resultant impact. When definite symptoms are identified by the structured questions, interviewers use open-ended questions and supplementary prompts to get parents to describe the problems in their own words. These descriptions are transcribed verbatim by the interviewers but are not rated by them. A similar interview is administered to 1 l-16-year-olds. Teachers complete a brief questionnaire covering the main conduct, emotional, and hyperactivity symptoms and any resultant impairment. The different sorts of information are brought together by a computer program that also predicts likely diagnoses. These computer-generated summary sheets and diagnoses form a convenient starting point for experienced clinical raters, who decide whether to accept or overturn the computer diagnosis (or lack of diagnosis) in the light of their review of all the data, including transcripts. In the present study, the DAWBA was administered to community (N= 491) and clinic (N= 39) samples. There was excellent discrimination between community and clinic samples in rates of diagnosed disorder. Within the community sample, subjects with and without diagnosed disorders differed markedly in external characteristics and prognosis. In the clinic sample, there was substantial agreement between DAWBA and case note diagnoses, though the DAWBA diagnosed more comorbid disorders. The use of screening questions and skip rules greatly reduced interview length by allowing many sections to be omitted with very little loss of positive information. Overall, the DAWBA successfully combined the cheapness and simplicity of respondent-based measures with the clinical persuasiveness of investigator-based diagnoses. The DAWBA has considerable potential as an epidemiological measure, and may prove to be of clinical value too. [source] Public Health Rural Health Priorities in America: Where You Stand Depends on Where You SitTHE JOURNAL OF RURAL HEALTH, Issue 3 2003Larry Gamm PhD Methods: Analysis of responses to a mail survey sent to 999 rural health leaders, with 501 responses. Respondents were asked to rank importance to rural health of focus areas named in Healthy People 2010 Findings: There was substantial agreement on top rural health priorities among state and local rural health leaders across the 50 states. "Access to quality health services" was the top priority among leaders of state-level rural agencies and health associations, local rural public health agencies, rural health clinics and community health centers, and rural hospitals. It was the top priority across all 4 major census regions of the nation as well. The next 4 top-ranking rural priorities,"heart disease and stroke,""diabetes,""mental health and mental disorders," and "oral health",were selected as 1 of the top 5 rural priorities by one third or more of respondents across most groups and regions. At the same time, some observed differences in rural health priorities suggest opportunities for community partnership strategies or for regional multistate policy initiatives by states sharing similar rural health priorities. [source] Intermethod Reliability of Real-time Versus Delayed Videotaped Evaluation of a High-fidelity Medical Simulation Septic Shock ScenarioACADEMIC EMERGENCY MEDICINE, Issue 9 2009Justin B. Williams MD Abstract Objectives:, High-fidelity medical simulation (HFMS) is increasingly utilized in resident education and evaluation. No criterion standard of assessing performance currently exists. This study compared the intermethod reliability of real-time versus videotaped evaluation of HFMS participant performance. Methods:, Twenty-five emergency medicine residents and one transitional resident participated in a septic shock HFMS scenario. Four evaluators assessed the performance of participants on technical (26-item yes/no completion) and nontechnical (seven item, five-point Likert scale assessment) scorecards. Two evaluators provided assessment in real time, and two provided delayed videotape review. After 13 scenarios, evaluators crossed over and completed the scenarios in the opposite method. Real-time evaluations were completed immediately at the end of the simulation; videotape reviewers were allowed to review the scenarios with no time limit. Agreement between raters was tested using the intraclass correlation coefficient (ICC), with Cronbach's alpha used to measure consistency among items on the scores on the checklists. Results:, Bland-Altman plot analysis of both conditions revealed substantial agreement between the real-time and videotaped review scores by reviewers. The mean difference between the reviewers was 0.0 (95% confidence interval [CI] = ,3.7 to 3.6) on the technical evaluation and ,1.6 (95% CI = ,11.4 to 8.2) on the nontechnical scorecard assessment. Comparison of evaluations for the videotape technical scorecard demonstrated a Cronbach's alpha of 0.914, with an ICC of 0.842 (95% CI = 0.679 to 0.926), and the real-time technical scorecard demonstrated a Cronbach's alpha of 0.899, with an ICC of 0.817 (95% CI = 0.633 to 0.914), demonstrating excellent intermethod reliability. Comparison of evaluations for the videotape nontechnical scorecard demonstrated a Cronbach's alpha of 0.888, with an ICC of 0.798 (95% CI = 0.600 to 0.904), and the real-time nontechnical scorecard demonstrated a Cronbach's alpha of 0.833, with an ICC of 0.714 (95% CI = 0.457 to 0.861), demonstrating substantial interrater reliability. The raters were consistent in agreement on performance within each level of training, as the analysis of variance demonstrated no significant differences between the technical scorecard (p = 0.176) and nontechnical scorecard (p = 0.367). Conclusions:, Real-time and videotaped-based evaluations of resident performance of both technical and nontechnical skills during an HFMS septic shock scenario provided equally reliable methods of assessment. [source] Spousal concordance and reliability of the ,Prudence Score' as a summary of diet and lifestyleAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 4 2009Sanjoti Parekh Abstract Objectives: This paper describes a composite ,Prudence Score' summarising self-reported behavioural risk factors for non-communicable diseases. If proved robust, the ,Prudence score' might be used widely to encourage large numbers of individuals to adopt and maintain simple, healthy changes in their lifestyle. Methods: We calculated the ,Prudence Score' based on responses collected in late 2006 to a postal questionnaire sent to 225 adult patients aged 25 to 75 years identified from the records of two general medical practices in Brisbane, Australia. Participants completed the behavioural, dietary and lifestyle items in relation to their spouse as well as themselves. The spouse or partner of each addressee completed their own copy of the study questionnaire. Results: Kappa scores for spousal concordance with probands' reports (n = 45 pairs) on diet-related items varied between 0.35 (for vegetable intake) to 0.77 (for usual type of milk consumed). Spousal concordance values for other behaviours were 0.67 (physical activity), 0.82 (alcohol intake) and 1.0 (smoking habits). Kappa scores for test-retest reliability (n = 53) varied between 0.47 (vegetable intake) and 0.98 (smoking habits). Conclusion: The veracity of self-reported data is a challenge for studies of behavioural change. Our results indicate moderate to substantial agreement from life partners regarding individuals' self-reports for most of the behavioural risk items included in the ,Prudence Score'. This increases confidence that key aspects of diet and lifestyle can be assessed by self-report. Implications: The ,Prudence Score' potentially has wide application as a simple and robust tool for health promotion programs. [source] Chain stiffness of heteropolysaccharide from Aeromonas gum in dilute solution by dynamic light scatteringBIOPOLYMERS, Issue 6 2002Xiaojuan Xu Abstract Dynamic light scattering measurements have been made on 15 fractions of aeromonas (A) gum, an extracellular heteropolysaccharide produced by the strain Aeromonas nichidenii, with dimethylsulfoxide containing 0.2M lithium chloride as the solvent at 25°C. Data for the translational diffusion coefficient D covering a molecular weight range from 4.5 × 105 to 2.1 × 106 and ratios of the z -average radius of gyration ,s2,z1/2 to the hydrodynamic radius RH (calculated with previous ,s2,z data) suggest that the polymer behaves like a semiflexible chain in this solvent similar to the stiffness of cellulose derivatives. Thus the D data are analyzed on the basis of the Yamakawa,Fujii theory for the translational friction coefficient of a wormlike cylinder by coarse-graining the heteropolysaccharide molecule. Excluded-volume effects are taken into account in the quasi-two-parameter scheme, as was done previously for ,s2,z and [,] (the intrinsic viscosity) of A gum in the same solvent. The molecular weight dependence of RH is found to be explained by the perturbed wormlike chain with a persistence length of 10 nm, a linear mass density of 1350 nm,1, an excluded-volume strength parameter of 1.3 nm, and a chain diameter of 2.8 nm. These parameters are in substantial agreement with those estimated previously from ,s2,z and [,] data, demonstrating that the solution properties (D, ,s2,z, and [,]) of the heteropolysaccharide are almost quantitatively described by the current theories for wormlike chains in the molecular weight range studied. © 2002 Wiley Periodicals, Inc. Biopolymers 65: 387,394, 2002 [source] Resolving Deadlock: Why International Organisations Introduce Soft LawEUROPEAN LAW JOURNAL, Issue 2 2006Armin Schäfer Instead the EU relies on soft law that does not legally bind governments in the same way as the Community Method used to. The literature assumes that soft law is chosen to achieve common objectives given considerable diversity among the Member States. In contrast, this paper suggests that non-binding coordination is first and foremost a means to foster compromises in the absence of substantial agreements. Three case studies demonstrate that international organisations have repeatedly relied on soft law to overcome disagreements among their members. The IMF, the OECD, and the EU introduced soft coordination at times of institutional crisis to prevent a breakdown of negotiations. [source] The validation of a rating scale to assess dietitians' use of behaviour change skillsJOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 4 2008G. Bonner Background:, Evidence suggests that education alone is unlikely to elicit dietary-behavioural change (Contento, 1995). Consequently, many dietitians are moving from a traditional advice-giving role to one which utilises ,behaviour change skills' (BCS) in dietary counselling. BCS is an umbrella term used to cover a wide range of skills and techniques drawn from the fields of counselling, motivational interviewing (MI) and cognitive behavioural therapy (CBT). In order to assess the efficacy of this approach, a means of quantifying BCS-use is required. This two-stage study aimed to validate a newly-devised scale to assess dietitians' BCS-use in one-to-one dietary counselling. Methods:, Items for the scale were generated by drawing on the literature, syllabi for training in BCS and its parent disciplines (counselling, MI and CBT), and specialist dietitians. The resulting scale and manual were revised following assessment of content validity by expert panel and piloting. In stage one, 21 dietetic consultations were audiotaped and rated for BCS-use by three BCS-trained dietitians. Inter-rater agreement was calculated using the kappa statistic and intra-class correlation (ICC), to give a ,chance corrected' measure of agreement. Validity was tested using a psychologist's subjective assessment of BCS-use as a proxy ,gold-standard' compared with the dietitians' ratings, again using kappa and ICC. In stage two the scale was further revised before an additional 20 audiotaped consultations were analysed using the same procedure. Ethical approval for the study was given by the appropriate NHS and university research ethics committees. Results:, At stage one, although kappas were fairly poor for agreement on individual criteria, the ICC for overall scores indicated a ,fair' level of agreement, according to Shrout's (1998) classifications: ICC = 0.584 (CI 0.339,0.784). Results for validity were poor with the psychologist frequently rating higher than the dietitians. At stage two, following scale revision, results for inter-rater agreement improved with more criteria showing ,moderate' or ,substantial' agreement. Ten out of the 21 criteria achieved levels of agreement classified as ,fair' or higher for all three rater pairs. The ICC for overall scores improved to indicate ,moderate' agreement: ICC = 0.640 (CI 0.404,0.821). Validity results remained poor. Discussion:, The moderate level of overall inter-rater agreement observed in the revised scale is considered acceptable (Jones, 2006) and indicates this tool is useful. This measure is more relevant to the purpose of the tool than agreement on individual criteria given it is intended to classify consultations overall as low/medium/high use of BCS rather than to examine individual skills. However, in terms of validity, the discrepancy between dietitian and psychologist ratings requires further investigation. It is hypothesized that the dietitians had higher expectations of what a dietitian could achieve in terms of proficiency in BCS and, as such, rated more stringently than the psychologist. Achieving a clear picture of validity usually necessitates a series of assessments (Murphy & Davidshofer, 2005); the BCS rating scale is no exception with further testing required. Conclusions:, The revised scale shows acceptable inter-rater reliability and robust content validity in our study sample. However, quantitative examination of validity gave poor results and further assessment is required to provide a tool with which we can confidently assess dietitians' use of BCS. References, Contento, I., Balch, G.I., Bronner, Y.L. et al. (1995) The effectiveness of nutrition education and implications for nutrition education policy, programs, and research: a review of the research. J. Nutr. Educ.27, 355,364. Jones, J.M. (2006) Nutritional Screening and Assessment Tools. New York: Nova Science Publishers. Murphy, K.R. & Davidshofer, C.O. (2005) Psychological Testing , Principles and Applications, 6th edn. New Jersey: Pearson Education Inc. Shrout, P. (1998) Measurement reliability and agreement in psychiatry. Stat. Methods Med. Res. 7, 301,317. [source] | ||||||||||||||||