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Human recognition and automated image validation are the most widely used approaches to validate the output of binary segmentation methods but, as the number of pixels in an image easily exceeds several million, they become highly demanding from both practical and computational standpoint. We propose a method, called PARSEG, which stands for PArtitioning, Random Selection, Estimation, and Generalization; being the basic steps within this procedure. Suggested method enables us to perform statistical validation of binary images by selecting the minimum number of pixels from the original image to be used for validation without deteriorating the effectiveness of the validation procedure. It utilizes binary classifiers to accomplish image validation and selects the optimal sample of pixels according to a specific objective function. As a result, the computational complexity of the validation experiment is substantially reduced. The procedure's effectiveness is illustrated by considering images composed of approximately 13 million pixels from the field of seed recognition. PARSEG provides roughly the same precision of the validation process when extended to the entire image, but it utilizes only about 4% of the original number of pixels, thus reducing, by about 90%, the computing time required to validate a binary segmented image.

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Non-destructive, fast, and accurate methods of dating are highly desirable for many heritage objects. Here, we present and critically evaluate the use of near-infrared (NIR) spectroscopic data combined with three supervised machine learning methods to predict the publication year of paper books dated between 1851 and 2000. These methods provide different accuracies; however, we demonstrate that the underlying processes refer to common spectral features. Regardless of the machine learning method used, the most informative wavelength ranges can be associated with C-H and O-H stretching first overtone, typical of the cellulose structure, and N-H stretching first overtone from amide/protein structures. We find that the expected influence of degradation on the accuracy of prediction is not meaningful. The variance-bias decomposition of the reducible error reveals some differences among the three machine learning methods. Our results show that two out of the three methods allow predictions of publication dates in the period 1851-2000 from NIR spectroscopic data with an unprecedented accuracy of up to 2 years, better than any other non-destructive method applied to a real heritage collection.

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We investigated aspects of host activities that influence and enhance host performance in an effort to achieve best results in terms of the occupancy rate and the overall rating. The occupancy rate measures the percentage of reserved days with respect to available days. The overall rating identifies the satisfaction level of guests that booked an Airbnb accommodation. We used the proportional odds model to estimate the impact of the managerial variables and the characteristics of the accommodation on host performance. Five different levels of the occupancy and the overall rating were investigated to understand which features impact them and support the effort to move from the lowest to the highest level. The analysis was carried out for Italy's most visited cities: Rome, Milan, Venice, and Florence. We focused on the year 2016. Moreover, we investigated different impact levels in terms of the overall rating during the COVID-19 pandemic to evaluate possible differences. Our findings show the relevance of some variables, such as the number of reviews, services, and typology of the rented accommodation. Moreover, the results show differences among cities and in time for the relevant impact of the COVID-19 pandemic.

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This paper proposes a new methodology called TOpic modeling Based Index Assessment through Sentiment (TOBIAS). This method aims at modeling the effects of the topics, moods, and sentiments of the comments describing a phenomenon upon its overall rating. TOBIAS is built combining different techniques and methodologies. Firstly, Sentiment Analysis identifies sentiments, emotions, and moods, and Topic Modeling finds the main relevant topics inside comments. Then, Partial Least Square Path Modeling estimates how they affect an overall rating that summarizes the performance of the analyzed phenomenon. We carried out TOBIAS on a real case study on the university courses' quality evaluated by the University of Cagliari (Italy) students. We found TOBIAS able to provide interpretable results on the impact of discussed topics by students with their expressed sentiments, emotions, and moods and with the overall rating.

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OBJECTIVES: To assess the periapical status in patients with osteoporosis (OP) treated with denosumab (D), bisphosphonates (BPs), or not on medication, and to understand if these conditions influence the prevalence and the progression of apical periodontitis (AP). MATERIAL AND METHODS: Seventy-six patients with OP alone or treated with D, or BPs, formed the study group (O), and those from 76 patients matched for age and sex, without diseases, and not taking medications, constituted the control (C) in this retrospective case-control study. The data from the complete clinical and radiographic examination, medical history, decayed, missing, and filled teeth (DMFT), and periapical index score (PAI) were recorded for each patient. Wilcoxon rank test, χ2 , and Student's t test were used as appropriate. RESULTS: The prevalence of AP was similar in O and C. Furthermore, AP was significantly more frequent in root canal-treated teeth in O patients (p = .03). CONCLUSIONS: OP does not appear to be associated with the development of AP. Moreover, the increased prevalence of AP in root canal-treated teeth in O patients highlights a possible relationship between the healing dynamics of the disease post-therapy and the patients' medication. A larger sample is needed to confirm these findings.

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PURPOSE: To culturally adapt and validate the Urogenital Distress Inventory-6 and Incontinence Impact Questionnaire-7 (short forms) for use in Italian-speaking women with urinary incontinence. METHODS: We developed Italian versions of the two questionnaires through forward-backward translation, expert review and cognitive interviews. We then administered them to 100 women with urinary incontinence (mean age 58.02 ± 11.9 years) to assess the internal consistency (Cronbach's alpha), test-retest reliability (intraclass correlation coefficient), standard error of measurement, minimum detectable change, and construct validity by hypothesis testing. RESULTS: No difficulties in acceptability emerged. Internal consistency was 0.61 for Urogenital Distress Inventory-6 and 0.88 for Incontinence Impact Questionnaire-7. Test-retest reliability was respectively 0.79 and 0.91. The minimum detectable change was respectively 22.9 and 18.1 points (on a 0-100 scale). Nine out of 10 a priori hypotheses regarding construct validity were confirmed. CONCLUSIONS: The Italian versions of the Urogenital Distress Inventory-6 and Incontinence Impact Questionnaire-7 showed reliability levels in line with the literature and good construct validity. Thus, we think that the present study extends the evidence for both questionnaires as useful tools for assessing women with urinary incontinence.Implications for rehabilitationThe Italian versions of the short forms of the Urogenital Distress Inventory and the Incontinence Impact Questionnaire have never been validated in Italian-speaking women with urinary incontinence.After translation and cross-cultural adaptation, the Italian versions of these two questionnaires showed reliability levels in line with the literature and good construct validity.The Urogenital Distress Inventory-6 produces a summary index of overall symptom distress, whereas the Incontinence Impact Questionnaire-7 is a unidimensional questionnaire measuring the adverse effects of urinary incontinence on health-related quality of life.

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BACKGROUND: The Fear-Avoidance Beliefs Questionnaire (FABQ) is a widely used outcome measure. There is still a lack of information concerning responsiveness and minimal clinically important difference (MCID), limiting its use for clinical and research purposes. AIM: The aim of this study was to examine reliability, responsiveness and MCID of the two FABQ scales in subjects with chronic low back pain. DESIGN: Methodological research based on a prospective single-group observational study. SETTING: Outpatient, Unit of rehabilitation. POPULATION: Chronic non-specific low back pain. METHODS: At the beginning and the end of a multidisciplinary program (8-week), 129 subjects completed the FABQ scales. Reliability was determined as internal consistency (Cronbach's alpha) and test-retest reliability (96-hour interval; N.=64; Interclass correlation coefficient [ICC 2.1]). Responsiveness was calculated both by distribution-based and anchor-based methods, using as external criterion the Global Perceived Effect Scale (GPE: 7 levels), rated by each individual. RESULTS: Cronbach's alpha and ICC(2,1) were respectively: 0.75 and 0.90 for FABQ-Physical Activity Scale (FABQ-PA), and 0.85 and 0.95 for FABQ-Work Scale (FABQ-W). Minimum detectable change (MDC95) values were 3.69 points for FABQ-PA, and 5.95 points for FABQ-W. In receiver-operating characteristic curves, splitting GPE data into null/minimal/moderate improvement vs. large improvement (GPE 0-2 vs. GPE 3): 1) for FABQ-PA, the area under the curve (AUC) was 0.97 and the best cutoff score identifying meaningful change in fear-avoidance beliefs about physical activity was a change of 4 points; 2) for FABQ-W, the AUC was 0.97 and the best cutoff score for meaningful change in fear-avoidance beliefs about work activities was a change of 7 points. CONCLUSIONS: After triangulation of the above results, a change of 4 points for FABQ-PA and 7 points for FABQ-W were selected as MCID. These two values represent cutoffs that seem to accurately identify meaningful change in fear-avoidance beliefs, according to subject's judgement. CLINICAL REHABILITATION IMPACT: The present study calculated - in a sample of people with chronic low back pain - the minimal clinically important change of the two FABQ scales (FABQ-Physical Activity Scale and FABQ-Work Scale). These values increase confidence in interpreting score changes, thus enhancing their meaningful use in both research and clinical contexts.

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BACKGROUND: The classification systems for proximal humeral fractures routinely used in clinical practice include the Neer and Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) 2007 systems. Currently used systems have low inter- and intraobserver reliability. In 2018, AO/OTA introduced a new classification system with the aim of simplifying the coding process, in which the Neer four-part classification was integrated into the fracture description. The aim of the present work is to assess the inter- and intraobserver agreement of the new AO/OTA 2018 compared with the Neer and AO/OTA 2007 classifications. MATERIALS AND METHODS: A total of 116 radiographs of consecutive patients with proximal humeral fracture were selected and classified by three observers with different levels of experience. All three observers independently reviewed and classified the images according to the Neer, AO/OTA 2007, and new AO/OTA 2018 systems. To determine the intraobserver agreement, the observers reviewed the same set of radiographs after an interval of 8 weeks. The inter- and intraobserver agreement were determined through Cohen's kappa coefficient analysis. RESULTS: The new AO/OTA 2018 classification showed substantial mean inter- (k = 0.67) and intraobserver (k = 0.75) agreement. These results are similar to the reliability observed for the Neer classification (interobserver, k = 0.67; intraobserver, k = 0.85) but better than those found for the AO/OTA 2007 system, which showed only moderate inter- (k = 0.57) and intraobserver (k = 0.58) agreement. The two more experienced observers showed better overall agreement, but no statistically significant difference was found. No differences were found between surgical experience and agreement regarding specific fracture types or groups. CONCLUSIONS: The results showed that the Neer system still represents the more reliable and reproducible classification. However, the new AO/OTA 2018 classification improved the agreement among observers compared with the AO/OTA 2007 system, while still maintaining substantial descriptive power and simplifying the coding process. The universal modifiers and qualifications, despite their possible complexity, allowed a more comprehensive fracture definition without negatively affecting the reliability or reproducibility of the classification system. LEVEL OF EVIDENCE: Level III, diagnostic studies.

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BACKGROUND AND AIM: Growing attention is being given to physical functioning measures to assess interventions for low back pain (LBP). The Quebec Back Pain Disability Questionnaire (QBPDS) has never been validated in Italian patients, and the aim of the study was culturally adapting and validating the Italian version of the QBPDS (QBPDS-I), to allow its use with Italian-speaking patients with chronic LBP. METHODS: The QBPDS-I was developed by means of forward-backward translation, a final review by an expert committee and a test of the prefinal version to evaluate its comprehensibility. The psychometric testing included structural validity by exploratory factor analysis (EFA), reliability by internal consistency (Cronbach's alpha) and test-retest reliability (intraclass correlation coefficient, ICC 2.1), measurement error by calculating the minimum detectable change (MDC), construct validity by assessing hypotheses of QBPDS correlations with the Roland Morris Disability Scale (RMDQ), the Oswestry Disability Questionnaire (ODI) and a pain numerical rating scale (NRS) (Spearman's correlations). RESULTS: It took one month to develop a consensus-based version of the QBPDS-I. The questionnaire was administered to 201 subjects with chronic LBP and was well accepted. EFA suggested a one-factor 20-item solution (first factor variance explained = 54.7%). Internal consistency (α = 0.95) and test-retest reliability (ICC = 0.90) were excellent. The MDC was 12 scale points. Construct validity was good as all of the hypotheses were met; correlations: RMDQ (r = 0.40), ODI (r = 0.48) and NRS (r = 0.44). CONCLUSIONS: The QBPDS-I is unidimensional, reliable and valid in patients with chronic LBP. Its use is recommended for clinical and research purposes.

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BACKGROUND: This study aims to explore if the arthroscopically assisted reduction and internal fixation (ARIF) technique is superior to the traditional open reduction and internal fixation (ORIF) technique in the treatment of tibial lateral plateau fractures. METHODS: Forty patients with tibial plateau fractures (Schatzker type I-III) treated with ARIF or ORIF from 2012 to 2017 were included in this retrospective study. All patients received pre-operative radiographs and CT scans. The patients were divided into two groups (ARIF or ORIF). All patients had a minimum follow-up of 12 months and an average follow-up of 44.4 months. The clinical and radiographic outcomes were evaluated according to the Knee Society Score (KSS) and the modified Rasmussen radiological score. RESULTS: Satisfactory clinical and radiological results were found in 39 out of 40 (97.5%) patients. KSS and modified Rasmussen radiological score were significantly better in ARIF group. The mean KSS was 92.37 (± 6.3) for the ARIF group and 86.29 (± 11.54) for the ORIF group (p < 0.05). The mean modified Rasmussen radiographic score was 8.42 (± 2.24) for the ARIF group and 7.33 (± 1.83) for the ORIF group (p = 0.104). Worst clinical and radiological results were related to concomitant intra-articular lesions (p < 0.05). Meniscal tears were found and treated in 17 out of 40 (42.5%) patients. The overall complication rate was 10%. CONCLUSIONS: Both ARIF and ORIF provided a satisfactory outcome for the treatment of Schatzker I-III tibial plateau fractures. However, ARIF led to better clinical results than ORIF. No statistically significant differences were found in perioperative complications, radiological results, and post-traumatic knee osteoarthritis. LEVEL OF EVIDENCE: Level III.

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[Purpose] Oswestry Disability Index includes an item (Oswestry Disability Index-8) aiming to assess sexual disability associated to low back pain. The aim of this study is to investigate the percentage of participants who answered the Oswestry Disability Index-8, and the relevance and characteristics of sexual disability due to low back pain in Italian patients. [Participants and Methods] Design: multicenter retrospective analysis. Population: six hundred and ninety-seven outpatients with non-specific low back pain. Variables: pain characteristics (amount, localization, and duration of perceived pain), disability, and psychological variables (anxiety, depression, catastrophizing, kinesiophobia, pain acceptance, and pain vigilance and awareness). [Results] Seventy-seven participants (11.05%) did not answer the Oswestry Disability Index-8. The odds of being not responding to the Oswestry Disability Index-8 item appeared related to age (odds=7.50 for over 60), gender (odds=2.65 for females), and marital status (odds=2.33 for not married). Concerning the psychological variables, Activity Avoidance (coefficient=0.071), Depression (coefficient=0.068), and Rumination (coefficient=0.031) showed a positive impact on sexual disability. [Conclusion] In Italian patients, the percentage of not-responding to Oswestry Disability Index-8 was relatively low. In addition, sexual disability was related to depression, activity avoidance, and rumination.

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BACKGROUND: The number of physically active individuals who develop knee and hip arthritis and who undergo arthroplasties of these joints ie ever increasing. It has become necessary to develop evaluation scales which address the specific issues raised by such individuals. The High Activity Arthroplasty Score is one such scales, originally developed in English. METHODS: The HAAS-I was developed by means of forward-backward translation, a final review by an expert committee and a test of the pre-final version to establish its correspondence with the original English version. The psychometric testing included reliability by means of internal consistency (Cronbach's alpha) and test-retest reliability (intraclass correlation coefficients) and construct validity by Pearson's correlations with a pain intensity numerical rating scale (NRS), the Western Ontario and McMaster University index (WOMAC, for THA subjects), the Knee injury and Osteoarthritis Outcome Scale (KOOS; for TKA subjects) and the Short-Form 36 Health Survey (SF-36). RESULTS: The questionnaire was administered to 67 subjects with THA and 61 with TKA and proved to be acceptable. The questionnaire showed good internal consistency (0.85 for THA and 0.91 for TKA) and a high level of test-retest reliability (ICC = 0.97 with 95% CI 0.95-0.98 for THA; ICC = 0.95 with 95% CI 0.92-0.98 for TKA). There was a moderate correlation between the HAAS-I and NRS (r = - 0.40), there was a high correlation between the HAAS-I and WOMAC (r = - 0.68) and there were moderate to high correlations between the HAAS-I and SF-36 subscales (r = 0.34 to 0.63) for THA. There was a moderate correlation between the HAAS-I and NRS (r = - 0.77); there was a high correlation between the HAAS-I and KOOS subscales (r = - 0.79 to r = - 0.91); and there were low correlations between the HAAS-I and SF-36 subscales (r = 0.01 to 0.29) for TKA. CONCLUSIONS: The HAAS-I was successfully translated into Italian and proved to have good psychometric properties that replicated the results of existing versions. Its use is recommended for clinical and research purposes.

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PURPOSE: The NeckPix© is a simple and rapid means of measuring the beliefs of subjects with chronic neck pain concerning pain-related fears of a specific set of activities of daily living. The original version showed satisfactory psychometric properties. This observational study is aimed at evaluating its responsiveness and minimal important changes (MICs) in subjects with chronic neck pain. METHODS: At the beginning, at the end of an 8-week rehabilitation programme as well as at the one-year follow-up, 153 subjects completed the NeckPix©. After the programme and at follow-up, subjects and physiotherapists also completed the global perceived effect (GPE) scale, which was divided to produce a dichotomous outcome. Responsiveness was calculated by distribution [effect size (ES); standardised response mean (SRM)] and anchor-based methods [receiver-operating characteristics (ROC) curves; correlations between change scores of the NeckPix© and GPEs]. ROC curves were also used to compute MICs. RESULTS: The ES ranged from 0.95 to 1.26 and the SRM from 0.84 to 0.98 at post-treatment and follow-up based on subjects' and physiotherapists' perspective. The ROC analyses revealed AUCs of 0.89 and 0.97 at post-treatment and follow-up, respectively; MICs (sensitivity; specificity) were of 6 (0.82; 0.88) and 8 (0.80; 0.92) at post-treatment and of 8 (0.95; 0.90 based on subjects and 0.95; 0.92 based on physiotherapists perspective) at follow-up. The correlations between change scores of the NeckPix© and GPEs ranged from -0.69 to -0.82. CONCLUSIONS: The NeckPix© was sensitive in detecting clinical changes in subjects with chronic neck pain undergoing rehabilitation. We recommend taking the MICs provided into account when assessing subjects' improvement or planning studies in this clinical context.

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BOLD fMRI is often used for the study of human language. However, there are still very few attempts to conduct longitudinal fMRI studies in the study of language acquisition by measuring auditory comprehension and reading. The following paper is the first in a series concerning a unique longitudinal study devoted to the analysis of bi- and multilingual subjects who are: (1) already proficient in at least two languages; or (2) are acquiring Russian as a second/third language. The focus of the current analysis is to present data from the auditory sections of a set of three scans acquired from April, 2011 through April, 2012 on a five-person subject pool who are learning Russian during the study. All subjects were scanned using the same protocol for auditory comprehension on the same General Electric LX 3T Signa scanner in Duke University Hospital. Using a multivariate analysis of covariance (MANCOVA) for statistical analysis, proficiency measurements are shown to correlate significantly with scan results in the Russian conditions over time. The importance of both the left and right hemispheres in language processing is discussed. Special attention is devoted to the importance of contextualizing imaging data with corresponding behavioral and empirical testing data using a multivariate analysis of variance. This is the only study to date that includes: (1) longitudinal fMRI data with subject-based proficiency and behavioral data acquired in the same time frame; and (2) statistical modeling that demonstrates the importance of covariate language proficiency data for understanding imaging results of language acquisition.