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Consistency of evaluators assessing inhaler technique.

Since correct inhaler technique is vital for maximum efficacy, the evaluation of technique in patients or health care professionals involved in education programs or research projects is essential. Inconsistency could lead to confused patients and inaccurate research findings. This study is the first to determine interrater consistency with assessing recitation and demonstration of inhaler technique and, if needed, was designed to improve consistency until 95% agreement was achieved. A checklist for correct inhaler technique was constructed by consolidating information from the literature and package inserts. Initially three evaluators were used, however, a fourth evaluator was added for the last two trials to create teams to improve consistency. Percent agreement, probability and kappa scores were calculated. Six trials evaluating inhaler technique of 56 health care professionals at five different sites, revisions of the checklist, and evaluator teams were required to increase overall percent agreement from 81% to 98%. Agreement increased substantially on the verbal component because of specific changes made in the checklist and the objective nature. Demonstration steps consistently had lower agreement than verbal steps. Agreement on the demonstration component was more difficult because of subjectivity involved in observing a subject actuate the inhaler at the correct time, inhale or exhale slowly, and hold one's breath. The relative rankings of percent agreement and kappa scores were the same, however, kappa scores allowed differentiation of agreement due to chance and ability. To achieve interrater consistency, training and practice are required. Interrater consistency should be achieved to ensure accurate reporting of research results on inhaler technique and education of patients.

Clinical Trials as Topic↗

[Study on clinical standard consistency of the luting cement].

Various properties of dental luting cement are influenced by powder/liquid ratio. The standard consistency of luting cement is determined in Japanese industrial standard and American dental association's specifications. However, it is not considered that a constant consistency is best for luting cement of all kinds. This study were performed on suitable consistency of individual cement with regard to bond strength and disintegration. Most suitable consistency was almost the same as standard consistency by the specification in the case of Zinc phosphate cement (GC's Elite cement 100). But, in the case of Polycarboxylate cement (Shofu's HY-Bond carbo cement) and Glass alkynoate cement (GC's Fuji ionomer Type I Liv), maximum bond strength can be obtained with a more powder/liquid ratio than standard consistency by the specification. Especially, Glass alkynoate cement shows this tendency strongly. Therefore, it must be manipulated quickly after mixing.

Dental Bonding↗

Effect of controlled dietary consistency and cage environment on the rat mandibular growth.

Forty Fischer strain inbred albino rats, evenly divided by sex, were obtained at 9 days of age. The animals were weaned at 21 days and randomly divided into the four experimental groups. Two variations on dietary consistency, hard and soft diet, as well as two variations on cage environment, normal and no biting surfaces, constituted the experimental groupings. The experimental period consisted of 16 weeks during which the animals were raised under the designated conditions. At the end of the experimental period the animals were killed with carbon dioxide, and the entire mandible, and both femurs, were dissected free. Weight and volumetric analysis were carried out in a standard fashion on the cleaned specimens. Area and linear measurements were performed and analyzed with a specially designed computer program. The results showed that there was sexual dimorphism in the Fischer rat both with respect to body weight and the weight, volume, area, and linear measurements of the mandible. The effects of dietary consistency had a greater influence on mandibular ramus size and form than did those caused by alteration in cage environment. The posterior region of the mandible, in association with the heavy muscles of mastication, was affected more by dietary consistency than was the anterior region. The entire region of the mandibular ramus acted as an area of adaptation and growth. The findings of this study indicate that dietary consistency has a small but significant effect on mandibular size in specific measurements. The cage environment used in this experiment did not limit function to the extent necessary to see measurable changes in mandibular measurements.

Animal Husbandry↗

Consistency of genetic analyses in longitudinal data: observations from the GAW13 Framingham Heart Study data.

This paper examines the consistency of genetic analyses across time, both in the context of replicating results from one data collection point to the next, and from the perspective of modeling longitudinal processes. This summary originates from the examination of findings from nine papers from Genetic Analysis Workshop (GAW) 13 that reported on analyses of longitudinal data of a variety of traits from the Framingham Heart Study. These analyses include both assessments of consistency of aggregate genetic effects, in the form of estimation of heritability and relative risk of disease, as well as localization of quantitative trait loci (QTLs) by genome-wide linkage screens. Consistency varied widely by trait, possibly reflecting differences in measurement error, secular trends, or underlying biological features such as genotype x age interaction. Quantitatively, comparing magnitudes of estimates across age or time, heritability estimates showed greater consistency than LOD scores. However, qualitatively, the same regions of interest were often identified in genome scans from different time points or different ages. Estimates of sibling recurrence risk, on the other hand, showed little consistency. Heritabilities were greater when participants were matched by age than when they were matched by date of examination. Multivariate approaches, either in use of multiple traits or in use of multiple measures of the same trait, appeared to provide stronger genetic signals both for relative risk and for linkage. Finally, modeling of longitudinal processes provided evidence for genotype x age interactions that may partially explain variation in results of genetic analyses across time or age.

Age Factors↗

A chain of evidence with mixed comparisons: models for multi-parameter synthesis and consistency of evidence.

Multi-parameter evidence synthesis is a generalization of meta-analysis in which several parameters are estimated jointly. Here this approach is applied to a common form of data structure in which mixed pairwise comparisons are made between treatments in a 'chain of evidence' structure. The data set investigated here, which first appeared in the confidence profile method literature, features three types of data relating to thrombolytic treatment following acute myocardial infarction. There is information on reperfusion (coronary patency) following treatment, information on survival in reperfused and non-reperfused patients (conditional survival), and independent information on the effect of treatment on survival without specifying reperfusion state (overall survival). The objective of this study is to explore models for combining these three types of evidence within a single model, and some of the evidence consistency issues that arise. Bayesian Markov chain Monte Carlo methods are used to fit two models. The first, proposed in the confidence profile literature, assumes there are no differences between studies in baseline effects (equal study effects). The second model assumes fixed treatment effects but allows for study differences in baseline reperfusion and conditional survival rates by assuming random study effects. The equal study effects model fits the data poorly, and cross-validation shows that the overall survival evidence is not consistent with the reperfusion and conditional survival evidence under this model. The evidence appears to be consistent within the more loosely structured random study effects model, but results are sensitive to prior assumptions about the between-study variance. The inconsistency between the three evidence types relates to overall survival, rather than to the effect of treatment on survival. Multi-parameter evidence synthesis, with suitable checks for evidence consistency, can be used to help determine whether chains of evidence 'add up' epidemiologically within an overall model, and to construct parameter distributions for an entire model simultaneously, consistent with all the available data.

Bayes Theorem↗

Stochastic inverse consistency in medical image registration.

An essential goal in medical image registration is, the forward and reverse mapping matrices should be inverse to each other, i.e., inverse consistency. Conventional approaches enforce consistency in deterministic fashions, through incorporation of sub-objective cost function to impose source-destination symmetric property during the registration process. Assuming that the initial forward and reverse matching matrices have been computed and used as the inputs to our system, this paper presents a stochastic framework which yields perfect inverse consistency with the simultaneous considerations of the errors underneath the registration matrices and the imperfectness of the consistent constraint. An iterative generalized total least square (GTLS) strategy has been developed such that the inverse consistency is optimally imposed.

Algorithms↗

Consistency of optimal sequence alignments.

Pairwise optimal alignments between three or more sequences are not necessarily consistent as a whole, but consistent and inconsistent residues are usually distributed in clusters. An efficient method has been developed for locating consistent regions when each pairwise alignment is given in the form of a "skeletal representation" (Bull. math. Biol. 52, 359-373). This method is further extended so that the combination of pairwise alignments that gives the greatest consistency is found when possibly many alignments are equally optimal for each pairwise comparison. A method for acceleration of simultaneous multiple sequence alignment is proposed in which consistent regions serve as "anchor points" limiting application of direct multi-way alignment to the rest of "inconsistent" regions.

Algorithms↗

A comparison of consistency and taste of five commercial thickeners.

This study presents the results of a blinded test of the performance of five commercial thickners. Experimental variables considered are brand of commercial thickener, type of liquid, desired thickness, and thickening time. Success of outcome is defined by a numerical rating scale comparing the consistency and taste to actual liquid samples. The findings suggest that no one commercial thickener consistently produces a desired consistency or was consistently superior regarding taste. Success in producing certain liquid consistencies and "good taste" varied according to brand, type of liquid, desired thickness, and thickening time used. It is suggested that specific recipes be developed for each brand and liquid to be thickened. Flavorings should be tested to enhance taste.

Deglutition↗

Emergent perceptual features in the benefit of consistent stimulus-response mappings on dual-task performance.

Duncan (1979) examined all combinations of compatible and incompatible stimulus-response mappings for two spatial three-choice tasks in the psychological refractory period paradigm. Performance was better when the mappings for the tasks were consistent than when they were not, even when both mappings were incompatible. He attributed the benefit for the consistent incompatible mapping to an emergent choice between mappings when they are inconsistent that slows performance. Consistent incompatible mappings also may benefit from emergent perceptual features. The present study examined the role of emergent perceptual and mapping-choice features in two experiments that used pairs of two-choice tasks. Results similar to Duncan's were obtained with visual stimuli mapped to keypresses at short (stimulus onset asynchrony) SOAs. However, the benefit of the consistent incompatible mapping condition over the inconsistent mapping conditions was eliminated at an SOA of 1,000 ms. Furthermore, this benefit was not evident when the stimuli were auditory for Task 1 and visual for Task 2. With two-choice tasks, the benefit for consistent mappings apparently is due primarily to an emergent perceptual feature.

Attention↗

Tissue consistency perception in laparoscopy to define the level of fidelity in virtual reality simulation.

BACKGROUND: What degree of fidelity must a laparoscopic simulator have to achieve a training objective? This difficult question is addressed by studying the sensory interaction of surgeons in terms of a surgical skill: tissue consistency perception. METHODS: A method for characterizing surgeon sensory interaction has been defined and applied in an effort to determine the relative importance of three components of perceptual surgical skill: visual cues, haptic information, and previous surgical knowledge and experience. Expert, intermediate, and novel surgeons were enrolled in the study. Users were asked to rank tissue consistency in four different conditions: a description of the tissue alone (Q), visual information alone (VI), tactile information alone (TI), and both visual and tactile information (VTI). Agreement between these stages was assessed by a coefficient of determination (R2). RESULTS: Tissue is a determinant factor (p < 0.001) in the perception of tissue consistency, whereas the expertise of the surgeon is not (p = 0.289). Tissue consistency perception is based mainly on tactile information (TI-VTI agreement is high, R2 = 0.873), although little sensory substitution is present (VI-VTI agreement is low, R2 = 0.509). Agreement of Q-VI increases with experience (R2 = 0.050, 0.290, and 0.573, corresponding with to novel, intermediate, and expert surgeons), which has been associated with the "visual haptics" concept. CONCLUSIONS: Virtual reality simulators need haptic devices with force feedback capability if tissue consistency information is to be delivered. On the other hand, the visual haptics concept has been associated with a kind of tactile memory developed by surgical experience.

Clinical Competence↗

Consistency of meal patterns in laboratory rats.

Meal pattern measures (e.g., bout length and bout number) provide a detailed description of the elements of ingestion, and as a result they are theoretically more sensitive to experimental manipulation than simple measurements of total consumption over a fixed time period. For this reason, meal pattern measures are often used as a way to infer how rodents respond to tastants or how pharmacological or surgical treatments modify ingestive behavior. This approach relies on the assumption that under normal conditions, the meal patterns of individual rats are consistent across consecutive light-dark (L-D) cycles. If these patterns are inconsistent, then experimental designs involving meal patterns would have limited power, and thus require relatively large sample sizes. The present study critically evaluates the consistency assumption in Sprague-Dawley and Fisher-344 rats by monitoring meal patterns over 10 consecutive L-D cycles. For each rat, the following feeding and drinking measures were determined: total daily intake, duration of night bouts, number of night bouts, and number of licks per night bout. The analysis excluded daytime ingestive measures owing to their infrequent occurrence. Ingestive measures were highly consistent across time in all Sprague-Dawleys, but in only a minority of the Fisher-344s. The distribution of feeding and drinking activity throughout each night was also determined in the same rats. Whereas Sprague-Dawleys displayed lights-off and lights-on peaks of ingestive activity, only a minority of Fisher-344s displayed a consistent lights-on peak of ingestive activity. It is concluded that rat strains can differ with respect to the consistency of meal patterning, and that such strain differences should be considered in future comparative studies of meal patterns in rats.

Acclimatization↗

Naming consistency in Alzheimer's disease.

Although lexical semantic deficits are postulated to play a prominent role in the anomia of Alzheimer's disease, it is unclear whether the primary disturbance is one of lexical access or one of lexical semantic loss. Response consistency on a naming task is one means of evaluating the underlying source of naming impairment. Access dysfunction usually implies variable word-finding difficulty, while a theory of lexical loss predicts that many word names would be consistently unavailable. Nineteen Alzheimer's disease patients were administered a visual confrontation naming task (the Boston Naming Test) on two occasions 6 months apart. Eighty percent of errors occurred consistently at both times; only 20% of errors occurred on only one occasion. Response consistency occurred significantly more often than expected under the assumption of no response consistency. Findings support the hypothesis that anomia in Alzheimer's disease is in part due to a loss of lexical semantic information.

Aged↗

Consistency of hand preference: predictions to intelligence and school achievement.

Gottfried and Bathurst (1983) reported that hand preference consistency measured over time during infancy and early childhood predicts intellectual precocity for females, but not for males. In the present study longitudinal assessments of children previously classified by Gottfried and Bathurst as consistent or nonconsistent in cross-time hand preference were conducted during middle childhood (ages 5 to 9). Findings show that (a) early measurement of hand preference consistency for females predicts school-age intellectual precocity, (b) the locus of the difference between consistent vs. nonconsistent females is in verbal intelligence, and (c) the precocity of the consistent females was also revealed on tests of school achievement, particularly tests of reading and mathematics.

Child↗

The emergence of fetal behaviour. III. Individual differences and consistencies.

Intra- and inter-fetal consistencies and differences in motor activity were studied in 12 healthy nulliparous women during the first half of gestation. Real-time ultrasound observations, lasting 60 min, were performed weekly from 7 to 15 weeks of gestation and at 17 and 19 weeks. The various types of movements were categorized according to a previously developed classification system. Data on general movements during the second half of gestation were carried out on the same group of women and these results are also included in this study. Intra-individually there appeared to be a relative week-to-week consistency in the amount of total motor activity, i.e. the sum of all the movement patterns. There was a slight tendency of intra-fetal consistency when the incidence of general movements during the first half of gestation was compared to that during the second half. The other movement patterns did not show these consistencies, namely, each fetus showed large fluctuations in the week-to-week incidences. Inter-individually there were large differences in the amount of the different types of movements at the various ages, which resulted in wide ranges. The sum of the rank orders which for total activity and general movements, were found weekly, were compared to those which could be expected to occur in a homogeneous population. Two fetuses appeared to be significantly different from the others on mathematical grounds. One consistently showed a high and one a low motor output. Week-to-week stability in the rank orders of the various movement patterns was studied by adding up a sum score of all the weekly changes in ranks. Three fetuses were found to be stable and three showed large fluctuations. The others were in between these extremes. The ranks of the movements from high to low frequency, appeared to be strictly age dependent, whereby all the fetuses followed the same developmental trend. There were no differences between female and male fetuses in any of the movement patterns.

Embryonic and Fetal Development↗

Callosal agenesis affects consistency of laterality in a paw preference task in BALB/cCF mice.

We tested the hypothesis that the ontogenetic development of the corpus callosum (CC) affects the consistency of laterality in a paw preference task. Adult male mice (55 normal and 29 acallosal) of the BALB/cCF strain were initially tested (twice; inter-test interval: 72 h) in an unbiased setup in which both forepaws could easily perform a reaching movement. In a subsequent test, animals were placed in a biased setup that favored the use of the non-preferred paw. Acallosal and normal mice were strongly lateralized in the unbiased setup. Additionally, while normal mice did not present a populational bias favoring one of the paws, acallosal mice presented a significant bias favoring the left paw. In the biased setup, left- and right-pawed normal mice were equally consistent (approximately 65% of the animals, in both groups, used the preferred paw of the initial two tests, in spite of the bias). Conversely, while left-pawed acallosal mice were as consistent (65%) as normal mice, only 20% of right-pawed mice were consistent. These results suggest that the development of the CC affects consistency of laterality in a side-dependent manner. These results are discussed considering the role of the CC in the establishment of behavioral lateralization.

Agenesis of Corpus Callosum↗

Long-term stability and consistency of EEG event-related (de-)synchronization across different cognitive tasks.

OBJECTIVE: We examined whether task-related band power changes (event-related desynchronization/synchronization; ERD/ERS) that have been linked to individual differences in cognitive ability demonstrate satisfying temporal stability and cross-situational consistency. METHODS: Multi-channel EEG recordings from 29 adults, assessed at three different occasions over 2 years were examined. Between-session correlations and consistency coefficients (Cronbach's alpha) across the three experiments were evaluated for both, spectral power features of the resting EEG and ERD/ERS estimates while the participants performed some cognitive task (i.e. different elementary cognitive tasks that put comparable demands on the participants). RESULTS: ERD/ERS values, while subjects performed a cognitive task, demonstrated satisfactory stability and consistency (i.e. >0.7), whereby the degree of consistency varied as a function of frequency band and brain region. Highest consistency was found for the 8-10 Hz ERD in parieto-occipital recording sites (i.e. >0.9). In resting EEG, mean alpha (gravity) frequency was the most stable EEG feature. CONCLUSIONS: The present data suggest that ERD/ERS phenomena in different narrow frequency bands are rather stable over time and across different situations. The relatively high reproducibility of ERD/ERS promotes the usefulness of this measure in assessing individual differences of physiological activation patterns accompanying cognitive performance. SIGNIFICANCE: This study addresses the issue of reproducibility of EEG in general and ERD/ERS experiments in particular, which is a prerequisite for both basic research and clinical studies.

Adolescent↗

The consistency of false suggestions moderates children's reports of a single instance of a repeated event: predicting increases and decreases in suggestibility.

Participants (6- and 7-year-olds, N=130) participated in classroom activities four times. Children were interviewed about the final occurrence (target event) either 1 week or 4 weeks later, during which half of the event items were described inaccurately. Half of these suggestions were consistent with the theme of the detail across the occurrences (e.g., always sat on a kind of floor mat) or were inconsistent (e.g., sat on a chair). When memory for the target event was tested 1 day later, children falsely recognized fewer inconsistent suggestions than consistent suggestions, especially compared with a control group of children who experienced the event just one time. Furthermore, the longer delay reduced accuracy only for consistent suggestions. Source-monitoring ability was strongly and positively related to resistance to suggestions, and encouraging children to identify the source of false suggestions allowed them to retract a significant proportion of their reports of inconsistent suggestions but not of consistent suggestions. The results suggest that the gist consistency of suggestions determines whether event repetition increases or decreases suggestibility.

Analysis of Variance↗

Risky, aggressive, or emotional driving: addressing the need for consistent communication in research.

PROBLEM: Researchers agree that a consistent definition for aggressive driving is lacking. Such definitional ambiguity in the literature impedes the accumulation of accurate and precise information, and prevents researchers from communicating clearly about findings and implications for future research directions. This dramatically slows progress in understanding the causes and maintenance factors of aggressive driving. SUMMARY: This article critiques prevailing definitions of driver aggression and generates a definition that, if used consistently, can improve the utility of future research. Pertinent driving behaviors have been variably labeled in the literature as risky, aggressive, or road rage. The authors suggest that the term "road rage" be eliminated from research because it has been used inconsistently and has little probability of being clarified and applied consistently. Instead, driving behaviors that endanger or have the potential to endanger others should be considered as lying on a behavioral spectrum of dangerous driving. Three dimensions of dangerous driving are delineated: (a). intentional acts of aggression toward others, (b). negative emotions experienced while driving, and (c). risk-taking. IMPACT ON INDUSTRY: The adoption of a standardized definition for aggressive driving should spark researchers to use more explicit operational definitions that are consistent with theoretical foundations. The use of consistent and unambiguous operational definitions will increase the precision of measurement in research and enhance authors' ability to communicate clearly about findings and conclusions. As this occurs over time, industry will reap benefits from more carefully conducted research. Such benefits may include the development of more valid and reliable means of selecting safe professional drivers, conducting accurate risk assessments, and creating preventative and remedial dangerous driving safety programs.

Accidents, Traffic↗