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.

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 Validation of a menstrual pictogram and a daily bleeding diary for assessment of uterine fibroid treatment efficacy in clinical studies

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Claudia Haberland ◽  
Anna Filonenko ◽  
Christian Seitz ◽  
Matthias Börner ◽  
Christoph Gerlinger ◽  
...  
Keyword(s):  
Uterine Fibroid ◽  
Full Range ◽  
Intraclass Correlation ◽  
Phase Iii ◽  
Measurement Properties ◽  
Retest Reliability ◽  
Response Options ◽  
Patient Global Impression ◽  
Patient Reported ◽  
Test Retest Reliability

Abstract Background To evaluate the psychometric and measurement properties of two patient-reported outcome instruments, the menstrual pictogram superabsorbent polymer-containing version 3 (MP SAP-c v3) and Uterine Fibroid Daily Bleeding Diary (UF-DBD). Test-retest reliability, criterion, construct validity, responsiveness, missingness and comparability of the MP SAP-c v3 and UF-DBD versus the alkaline hematin (AH) method and a patient global impression of severity (PGI-S) were analyzed in post hoc trial analyses. Results Analyses were based on data from up to 756 patients. The full range of MP SAP-c v3 and UF-DBD response options were used, with score distributions reflecting the cyclic character of the disease. Test-retest reliability of MP SAP-c v3 and UF-DBD scores was supported by acceptable intraclass correlation coefficients when stability was defined by the AH method and Patient Global Impression of Severity (PGI-S) scores (0.80–0.96 and 0.42–0.94, respectively). MP SAP-c v3 and UF-DBD scores demonstrated strong and moderate-to-strong correlations with menstrual blood loss assessed by the AH method. Scores increased in monotonic fashion, with greater disease severities, defined by the AH method and PGI-S scores; differences between groups were mostly statistically significant (P < 0.05). MP SAP-c v3 and UF-DBD were sensitive to changes in disease severity, defined by the AH method and PGI-S. MP SAP-c v3 and UF-DBD showed a lower frequency of missing patient data versus the AH method, and good agreement with the AH method. Conclusions This evidence supports the use of the MP SAP-c v3 and UF-DBD to assess clinical efficacy endpoints in UF phase III studies replacing the AH method.

scholarly journals An empirical example of analysis using a two-stage modeling approach: within-subject association of outdoor context and physical activity predicts future daily physical activity levels

2020 ◽  
Author(s):  
Chih-Hsiang Yang ◽  
Jaclyn P Maher ◽  
Aditya Ponnada ◽  
Eldin Dzubur ◽  
Rachel Nordgren ◽  
...  
Keyword(s):  
Physical Activity ◽  
Vigorous Physical Activity ◽  
Wearable Sensors ◽  
Activity Levels ◽  
Two Stage ◽  
Modeling Approach ◽  
Source Program ◽  
Modeling Strategy ◽  
Stage Modeling

Abstract People differ from each other to the extent to which momentary factors, such as context, mood, and cognitions, influence momentary health behaviors. However, statistical models to date are limited in their ability to test whether the association between two momentary variables (i.e., subject-level slopes) predicts a subject-level outcome. This study demonstrates a novel two-stage statistical modeling strategy that is capable of testing whether subject-level slopes between two momentary variables predict subject-level outcomes. An empirical case study application is presented to examine whether there are differences in momentary moderate-to-vigorous physical activity (MVPA) levels between the outdoor and indoor context in adults and whether these momentary differences predict mean daily MVPA levels 6 months later. One hundred and eight adults from a multiwave longitudinal study provided 4 days of ecological momentary assessment (during baseline) and accelerometry data (both at baseline and 6 month follow-up). Multilevel data were analyzed using an open-source program (MixWILD) to test whether momentary strength between outdoor context and MVPA during baseline was associated with average daily MVPA levels measured 6 months later. During baseline, momentary MVPA levels were higher in outdoor contexts as compared to indoor contexts (b = 0.07, p &lt; .001). Participants who had more momentary MVPA when outdoors (vs. indoors) during baseline (i.e., a greater subject-level slope) had higher daily MVPA at the 6 month follow-up (b = 0.09, p &lt; .05). This empirical example shows that the subject-level momentary association between specific context (i.e., outdoors) and health behavior (i.e., physical activity) may contribute to overall engagement in that behavior in the future. The demonstrated two-stage modeling approach has extensive applications in behavioral medicine to analyze intensive longitudinal data collected from wearable sensors and mobile devices.

scholarly journals Long-term outcomes of two-stage, immediate and delayed breast reconstruction with polyurethane-covered versus textured implants: protocol of a prospective, multicentre randomised controlled trial (TIPI trial)

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e044219
Author(s):  
J X Harmeling ◽  
Kevin Peter Cinca ◽  
Eleni-Rosalina Andrinopoulou ◽  
Eveline M L Corten ◽  
M A Mureau
Keyword(s):  
Randomised Controlled Trial ◽  
Breast Reconstruction ◽  
Controlled Trial ◽  
Capsular Contracture ◽  
Tissue Expander ◽  
Complication Rates ◽  
Two Stage ◽  
Randomised Controlled

IntroductionTwo-stage implant-based breast reconstruction is the most commonly performed postmastectomy reconstructive technique. During the first stage, a tissue expander creates a sufficiently large pocket for the definite breast implant placed in the second stage. Capsular contracture is a common long-term complication associated with implant-based breast reconstruction, causing functional complaints and often requiring reoperation. The exact aetiology is still unknown, but a relationship between the outer surface of the implant and the probability of developing capsular contracture has been suggested. The purpose of this study is to determine whether polyurethane-covered implants result in a different capsular contracture rate than textured implants.Methods and analysisThe Textured Implants versus Polyurethane-covered Implants (TIPI) trial is a multicentre randomised controlled trial with a 1:1 allocation rate and a follow-up of 10 years. A total of 321 breasts of female adults undergoing a two-stage breast reconstruction will be enrolled. The primary outcome is capsular contracture at 10-year follow-up which is graded with the modified Baker classification. It is analysed with survival analysis using a frailty model for clustered interval-censored data, with both an intention-to-treat and per-protocol approach. Secondary outcomes are other complication rates, surgical revision rate, patient satisfaction and quality of life and user-friendliness. Outcomes are measured 2 weeks, 6 months, 1, 2, 3, 5 and 10 years postoperatively. Interim analysis is performed when 1-year, 3-year and 5-year follow-up is completed.Ethics and disseminationThe trial has been reviewed and approved by the Medical Research Ethics Committee of the Erasmus MC, University Medical Centre Rotterdam (MEC-2018-126) and locally by each participating centre. Written informed consent will be obtained from each study participant. The results will be disseminated by publication in peer-reviewed journals.Trial registrationNTR7265.

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.

scholarly journals Molecular Dynamics Simulation of the Influence of RDX Internal Defects on Sensitivity

Crystals ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. 329
Author(s):  
Pengmin Yan ◽  
Xue Zhao ◽  
Jiuhou Rui ◽  
Juan Zhao ◽  
Min Xu ◽  
...  
Keyword(s):  
Energetic Materials ◽  
Low Cost ◽  
Relative Sensitivity ◽  
Dynamics Simulation ◽  
Safety Properties ◽  
Internal Defects ◽  
X Ray ◽  
X Ray Computed ◽  
Low Sensitivity ◽  
Higher Sensitivity

The internal defect is an important factor that could influence the energy and safety properties of energetic materials. RDX samples of two qualities were characterized and simulated to reveal the influence of different defects on sensitivity. The internal defects were characterized with optical microscopy, Raman spectroscopy and microfocus X-ray computed tomography technology. The results show that high-density RDX has fewer defects and a more uniform distribution. Based on the characterization results, defect models with different defect rates and distribution were established. The simulation results show that the models with fewer internal defects lead to shorter N-NO2 maximum bond lengths and greater cohesive energy density (CED). The maximum bond length and CED can be used as the criterion for the relative sensitivity of RDX, and therefore defect models doped with different solvents are established. The results show that the models doped with propylene carbonate and acetone lead to higher sensitivity. This may help to select the solvent to prepare low-sensitivity RDX. The results reported in this paper are aiming at the development of a more convenient and low-cost method for studying the influence of internal defects on the sensitivity of energetic materials.

Surgery of tympanosclerosis

1997 ◽  
Vol 111 (10) ◽  
pp. 917-923 ◽  
Author(s):  
Syed Akhtar Kamal
Keyword(s):  
Middle Ear ◽  
Radical Surgery ◽  
Stapes Surgery ◽  
Hearing Improvement ◽  
Short Term ◽  
Two Stage ◽  
Chi Square ◽  
Physiological Basis

AbstractEighty-five cases with tympanosclerosis of the middle ear were treated surgically in this series from 1984 to 1995. Twelve of them were associated with cholesteatoma and had radical surgery performed. An attempt is made here to classify the tympanosclerosis on a patho-physiological basis. A planned two-stage procedure was performed in 36 cases after an interval of 18 months. The majority of patients had stapes surgery carried out by a two-stage procedure. One of the patients who did not have stapes surgery developed anacusis after 18 months post-operatively and in another patient recurrence was observed. Post-operative hearing improvement was found to be satisfactory in the short-term follow-up period of two to five years. The hearing improvement was analysed by using Chi-square value (x2) and also plotted in the Glasgow Benefit Plot.

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 NONCOMPLICATED UNSTABLE SPINE INJURIES IN CHILDREN

2005 ◽  
pp. 008-012 ◽  
Author(s):  
Eduard Vladimirovich Ulrikh ◽  
Sergey Valentinivich Vissarionov ◽  
Aleksandr Yuryevich Mushkin
Keyword(s):  
Surgical Treatment ◽  
Posterior Instrumentation ◽  
Spinal Injuries ◽  
Anterior Decompression ◽  
Two Stage ◽  
Spinal Stabilization ◽  
Spine Injuries ◽  
Group A ◽  
Bone Autograft

Thirty-four patients aged from 3 to 17 years were operated on for noncomplicated unstable injuries of the spine. The operation was performed within the next few hours or days after trauma in 15 cases and significantly later (in 2 to 6 months) in 19 cases. In the first group the surgery included indirect posterior instrumental reduction and stabilization of the spine. In the second group a two-stage surgery was performed simultaneously. The first stage included anterior decompression and stabilization, and the second – posterior instrumentation. In both groups the posterior fusion with bone autograft was done. The post-op follow-up was 5 years. The correction of deformity, spinal stabilization and pain arrest were achieved in all cases. The surgical treatment of unstable noncomplicated spinal injuries in children must be conducted by emergency indications within the first hours and days after trauma.

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.

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