Repeatability of an automated fetal modified myocardial performance index

Introduction: The fetal modified myocardial performance index (Mod-MPI) is a non-invasive, pulsed-wave Doppler-derived measure of global myocardial function. The potential for the left ventricular Mod-MPI to clinically assess fetal cardiac function is well established. However, there are wide variations in published reference ranges, as (i) a standardised method of selecting cardiactime intervals used in Mod-MPI calculation has not been established and (ii) cardiac time interval measurement currently requires manual, inherently subjective placement of callipers on Doppler ultrasound waveforms. We have developed a novel automated Mod-MPI system in a collaboration between fetal medicine practitioners and biomedical engineers. This study compares the repeatability of the fetal left Mod-MPI when obtained using this automated system with that of its manual measurement. Methods: A multi centre international (USA, Saudi Arabia, Spain, Israel and Australia) evaluation was undertaken using online technology to compare automation with human evaluation for determination of the fetal Mod-MPI. Fetal ultrasound scans were performed of women with uncomplicated, singleton pregnancies at 16–38 weeks of gestation with normal morphology scans in a separate study, after local ethics committee approval. Individual Doppler ultrasound waveform images from the left ventricle of 25 cases from that dataset were chosen for this study. Each individual waveform was used in triplicate and placed into an arbitrary order (n = 75). One senior observer at each of the six centres involved in this study manually calculated the Mod-MPI for the75 waveforms through online means. Our automated system was used to also measure the Mod-MPI for those waveforms. Repeatability of automated and manual Mod-MPI measurements and the inter-operator reproducibility of the latter were assessed using intraclass correlation coefficients (ICC) and 95% confidence intervals (95% CI). Bland–Altmanplots, ICC and 95% CI were used to evaluate the agreement between each observer’s manual Mod-MPI measurements and the corresponding automated measurements. Results: Preliminary data analysed show that automated measurements have a superior intra-operator repeatability (ICC = 1.00) compared to the intra-operator repeatability (ICCranging from 0.572–0.945) and inter-operator reproducibility (ICC = 0.649) of manual measurements. There was good agreement between automated and manual measurements. Conclusion: The use of automated fetal Mod-MPI provides superior repeatability to the currently used subjective, manual methodology. Combined with the fact that automation will simplify Mod-MPI measurement amongst researchers with limited Mod-MPI experience, automation may facilitate the incorporation of the Mod-MPI into routine fetal cardiac functional assessment

Repeatability of an automated fetal modified myocardial performance index

Introduction: The fetal modified myocardial performance index (Mod-MPI) is a non-invasive, pulsed-wave Doppler-derived measure of global myocardial function. The potential for the left ventricular Mod-MPI to clinically assess fetal cardiac function is well established. However, there are wide variations in published reference ranges, as (i) a standardised method of selecting cardiactime intervals used in Mod-MPI calculation has not been established and (ii) cardiac time interval measurement currently requires manual, inherently subjective placement of callipers on Doppler ultrasound waveforms. We have developed a novel automated Mod-MPI system in a collaboration between fetal medicine practitioners and biomedical engineers. This study compares the repeatability of the fetal left Mod-MPI when obtained using this automated system with that of its manual measurement. Methods: A multi centre international (USA, Saudi Arabia, Spain, Israel and Australia) evaluation was undertaken using online technology to compare automation with human evaluation for determination of the fetal Mod-MPI. Fetal ultrasound scans were performed of women with uncomplicated, singleton pregnancies at 16–38 weeks of gestation with normal morphology scans in a separate study, after local ethics committee approval. Individual Doppler ultrasound waveform images from the left ventricle of 25 cases from that dataset were chosen for this study. Each individual waveform was used in triplicate and placed into an arbitrary order (n = 75). One senior observer at each of the six centres involved in this study manually calculated the Mod-MPI for the75 waveforms through online means. Our automated system was used to also measure the Mod-MPI for those waveforms. Repeatability of automated and manual Mod-MPI measurements and the inter-operator reproducibility of the latter were assessed using intraclass correlation coefficients (ICC) and 95% confidence intervals (95% CI). Bland–Altmanplots, ICC and 95% CI were used to evaluate the agreement between each observer’s manual Mod-MPI measurements and the corresponding automated measurements. Results: Preliminary data analysed show that automated measurements have a superior intra-operator repeatability (ICC = 1.00) compared to the intra-operator repeatability (ICCranging from 0.572–0.945) and inter-operator reproducibility (ICC = 0.649) of manual measurements. There was good agreement between automated and manual measurements. Conclusion: The use of automated fetal Mod-MPI provides superior repeatability to the currently used subjective, manual methodology. Combined with the fact that automation will simplify Mod-MPI measurement amongst researchers with limited Mod-MPI experience, automation may facilitate the incorporation of the Mod-MPI into routine fetal cardiac functional assessment

CATALISE: A multinational and multidisciplinary Delphi consensus study. Identifying language impairments in children

Delayed or impaired language development is a common developmental concern, yet there is little agreement about the criteria used to identify and classify language impairments in children. Children's language difficulties are at the interface between education, medicine and the allied professions, who may all adopt different approaches to conceptualising them. Our goal in this study was to use an online Delphi technique to see whether it was possible to achieve consensus among professionals on appropriate criteria for identifying children who might benefit from specialist services. We recruited a panel of 59 experts representing ten disciplines (including education, psychology, speech-language therapy/pathology, paediatrics and child psychiatry) from English-speaking countries (Australia, Canada, Ireland, New Zealand, United Kingdom and USA). The starting point for round 1 was a set of 46 statements based on articles and commentaries in a special issue of a journal focusing on this topic. Panel members rated each statement for both relevance and validity on a sevenpoint scale, and added free text comments. These responses were synthesised by the first two authors, who then removed, combined or modified items with a view to improving consensus. The resulting set of statements was returned to the panel for a second evaluation (round 2). Consensus (percentage reporting 'agree' or 'strongly agree') was at least 80 percent for 24 of 27 round 2 statements, though many respondents qualified their response with written comments. These were again synthesised by the first two authors. The resulting consensus statement is reported here, with additional summary of relevant evidence, and a concluding commentary on residual disagreements and gaps in the evidence base