Development of a diagnostic test set to assess agreement in breast pathology: practical application of the Guidelines for Reporting Reliability and Agreement Studies (GRRAS).

PubMed

Oster, Natalia V; Carney, Patricia A; Allison, Kimberly H; Weaver, Donald L; Reisch, Lisa M; Longton, Gary; Onega, Tracy; Pepe, Margaret; Geller, Berta M; Nelson, Heidi D; Ross, Tyler R; Tosteson, Aanna N A; Elmore, Joann G

2013-02-05

Diagnostic test sets are a valuable research tool that contributes importantly to the validity and reliability of studies that assess agreement in breast pathology. In order to fully understand the strengths and weaknesses of any agreement and reliability study, however, the methods should be fully reported. In this paper we provide a step-by-step description of the methods used to create four complex test sets for a study of diagnostic agreement among pathologists interpreting breast biopsy specimens. We use the newly developed Guidelines for Reporting Reliability and Agreement Studies (GRRAS) as a basis to report these methods. Breast tissue biopsies were selected from the National Cancer Institute-funded Breast Cancer Surveillance Consortium sites. We used a random sampling stratified according to woman's age (40-49 vs. ≥50), parenchymal breast density (low vs. high) and interpretation of the original pathologist. A 3-member panel of expert breast pathologists first independently interpreted each case using five primary diagnostic categories (non-proliferative changes, proliferative changes without atypia, atypical ductal hyperplasia, ductal carcinoma in situ, and invasive carcinoma). When the experts did not unanimously agree on a case diagnosis a modified Delphi method was used to determine the reference standard consensus diagnosis. The final test cases were stratified and randomly assigned into one of four unique test sets. We found GRRAS recommendations to be very useful in reporting diagnostic test set development and recommend inclusion of two additional criteria: 1) characterizing the study population and 2) describing the methods for reference diagnosis, when applicable.

A comparison of DSM-II and DSM-III in the diagnosis of childhood psychiatric disorders. I. Agreement with expected diagnosis.

PubMed

Cantwell, D P; Russell, A T; Mattison, R; Will, L

1979-10-01

This study was conducted to compare DSM-II and DSM-III in the diagnosis of childhood and adolescent psychiatric disorders. Twenty psychiatrist-raters completed standardized diagnostic questionnaires for 24 actual case histories. This report, the first of four, presents the rater agreement with the "expected diagnosis," ie, the diagnosis that we considered most appropriate for each case. The average rater agreement with the expected diagnosis was less than 50%. It was highest in cases of mental retardation, psychosis, hyperactivity, and conduct disorder. In only five cases did the most common diagnosis of the raters differ from the expected diagnosis. Analyses of these cases and those we selected to present specific diagnostic problems to the raters have produced suggestions to improve the reliability of DSM-III.

Multi-rater Agreement in the Assessment of Anterior Cruciate Ligament Reconstruction Failure. A Radiographic and Video Analysis of the MARS Cohort

PubMed Central

Matava, Matthew J.; Arciero, Robert A.; Baumgarten, Keith M.; Carey, James L.; DeBerardino, Thomas M.; Hame, Sharon L.; Hannafin, Jo A.; Miller, Bruce S.; Nissen, Carl W.; Taft, Timothy N.; Wolf, Brian R.; Wright, Rick W.

2015-01-01

Background ACL reconstruction failure occurs in up to 10% of cases. Technical errors are considered the most common cause of graft failure despite the absence of validated studies. There is limited data regarding the agreement among orthopedic surgeons in terms of the etiology of primary ACL reconstruction failure and accuracy of graft tunnel placement. Purpose The purpose of this study is to test the hypothesis that experienced knee surgeons have a high level of inter-observer reliability in the agreement of the etiology of the primary ACL reconstruction failure, anatomical graft characteristics, tunnel placement. Methods Twenty cases of revision ACL reconstruction were randomly selected from the MARS database. Each case included the patient's history, standardized radiographs, and a concise 30-second arthroscopic video taken at the time of revision demonstrating the graft remnant and location of the tunnel apertures. 10 MARS surgeons not involved with the primary surgery reviewed all 20 cases. Each surgeon completed a two-part questionnaire dealing with each surgeon's training and practice as well as the placement of the femoral and tibial tunnels, condition of the primary graft, and the surgeon's opinion as to the etiology of graft failure. Inter-rater agreement was determined for each question. Inter-rater agreement was determined for each question with the kappa coefficient and prevalence adjusted bias adjusted kappa (PABAK). Results The 10 reviewers were in practice an average of 14 years. All performed at least 25 ACL reconstructions per year and 9 were fellowship-trained in sports medicine. There was wide variability in agreement among knee experts as to the specific etiology of ACL graft failure. When specifically asked about technical error as the cause for failure, inter-observer agreement was only slight (prevalence adjusted bias adjusted kappa [PABAK]: 0.26). There was fair overall agreement on ideal femoral tunnel placement (PABAK: 0.55), but only slight agreement whether a femoral tunnel was too anterior (PABAK: 0.24) and fair agreement whether it was too vertical (PABAK: 0.46). There was poor overall agreement for ideal tibial tunnel placement (PABAK: 0.17). Conclusion This study suggests that more objective criteria are needed to accurately determine the etiology of primary ACL graft failure as well as the ideal femoral and tibial tunnel placement in patients undergoing revision ACL reconstruction. PMID:25537942

Retroperitoneal Sarcoma Target Volume and Organ at Risk Contour Delineation Agreement Among NRG Sarcoma Radiation Oncologists

DOE Office of Scientific and Technical Information (OSTI.GOV)

Baldini, Elizabeth H., E-mail: ebaldini@partners.org; Abrams, Ross A.; Bosch, Walter

Purpose: The purpose of this study was to evaluate the variability in target volume and organ at risk (OAR) contour delineation for retroperitoneal sarcoma (RPS) among 12 sarcoma radiation oncologists. Methods and Materials: Radiation planning computed tomography (CT) scans for 2 cases of RPS were distributed among 12 sarcoma radiation oncologists with instructions for contouring gross tumor volume (GTV), clinical target volume (CTV), high-risk CTV (HR CTV: area judged to be at high risk of resulting in positive margins after resection), and OARs: bowel bag, small bowel, colon, stomach, and duodenum. Analysis of contour agreement was performed using the simultaneousmore » truth and performance level estimation (STAPLE) algorithm and kappa statistics. Results: Ten radiation oncologists contoured both RPS cases, 1 contoured only RPS1, and 1 contoured only RPS2 such that each case was contoured by 11 radiation oncologists. The first case (RPS 1) was a patient with a de-differentiated (DD) liposarcoma (LPS) with a predominant well-differentiated (WD) component, and the second case (RPS 2) was a patient with DD LPS made up almost entirely of a DD component. Contouring agreement for GTV and CTV contours was high. However, the agreement for HR CTVs was only moderate. For OARs, agreement for stomach, bowel bag, small bowel, and colon was high, but agreement for duodenum (distorted by tumor in one of these cases) was fair to moderate. Conclusions: For preoperative treatment of RPS, sarcoma radiation oncologists contoured GTV, CTV, and most OARs with a high level of agreement. HR CTV contours were more variable. Further clarification of this volume with the help of sarcoma surgical oncologists is necessary to reach consensus. More attention to delineation of the duodenum is also needed.« less

Retroperitoneal Sarcoma Target Volume and Organ at Risk Contour Delineation Agreement Among NRG Sarcoma Radiation Oncologists

PubMed Central

Baldini, Elizabeth H.; Abrams, Ross A.; Bosch, Walter; Roberge, David; Haas, Rick L.M.; Catton, Charles N.; Indelicato, Daniel J.; Olsen, Jeffrey R.; Deville, Curtiland; Chen, Yen-Lin; Finkelstein, Steven E.; DeLaney, Thomas F.; Wang, Dian

2015-01-01

Purpose The purpose of this study was to evaluate the variability in target volume and organ at risk (OAR) contour delineation for retroperitoneal sarcoma (RPS) among 12 sarcoma radiation oncologists. Methods and Materials Radiation planning computed tomography (CT) scans for 2 cases of RPS were distributed among 12 sarcoma radiation oncologists with instructions for contouring gross tumor volume (GTV), clinical target volume (CTV), high-risk CTV (HR CTV: area judged to be at high risk of resulting in positive margins after resection), and OARs: bowel bag, small bowel, colon, stomach, and duodenum. Analysis of contour agreement was performed using the simultaneous truth and performance level estimation (STAPLE) algorithm and kappa statistics. Results Ten radiation oncologists contoured both RPS cases, 1 contoured only RPS1, and 1 contoured only RPS2 such that each case was contoured by 11 radiation oncologists. The first case (RPS 1) was a patient with a de-differentiated (DD) liposarcoma (LPS) with a predominant well-differentiated (WD) component, and the second case (RPS 2) was a patient with DD LPS made up almost entirely of a DD component. Contouring agreement for GTV and CTV contours was high. However, the agreement for HR CTVs was only moderate. For OARs, agreement for stomach, bowel bag, small bowel, and colon was high, but agreement for duodenum (distorted by tumor in one of these cases) was fair to moderate. Conclusions For preoperative treatment of RPS, sarcoma radiation oncologists contoured GTV, CTV, and most OARs with a high level of agreement. HR CTV contours were more variable. Further clarification of this volume with the help of sarcoma surgical oncologists is necessary to reach consensus. More attention to delineation of the duodenum is also needed. PMID:26194680

Inter- and Intrarater Agreement on the Outcome of Endovascular Treatment of Aneurysms Using MRA.

PubMed

Jamali, S; Fahed, R; Gentric, J-C; Letourneau-Guillon, L; Raoult, H; Bing, F; Estrade, L; Nguyen, T N; Tollard, É; Ferre, J-C; Iancu, D; Naggara, O; Chagnon, M; Weill, A; Roy, D; Fox, A J; Kallmes, D F; Raymond, J

2016-05-01

Patients treated with coiling are often followed by MR angiography. Our objective was to assess the inter- and intraobserver agreement in diagnosing aneurysm remnants and recurrences by using multimodality imaging, including TOF MRA. A portfolio composed of 120 selected images from 56 patients was sent to 15 neuroradiologists from 10 institutions. For each case, raters were asked to classify angiographic results (3 classes) of 2 studies (32 MRA-MRA and 24 DSA-MRA pairs) and to provide a final judgment regarding the presence of a recurrence (no, minor, major). Six raters were asked to independently review the portfolio twice. A second study, restricted to 4 raters having full access to all images, was designed to validate the results of the electronic survey. The proportion of cases judged to have a major recurrence varied between 16.1% and 71.4% (mean, 35.0% ± 12.7%). There was moderate agreement overall (κ = 0.474 ± 0.009), increasing to nearly substantial (κ = 0.581 ± 0.014) when the judgment was dichotomized (presence or absence of a major recurrence). Agreement on cases followed-up by MRA-MRA was similarly substantial (κ = 0.601 ± 0.018). The intrarater agreement varied between fair (κ = 0.257 ± 0.093) and substantial (κ= 0.699 ± 0.084), improving with a dichotomized judgment concerning MRA-MRA comparisons. Agreement was no better when raters had access to all images. There is an important variability in the assessment of angiographic outcomes of endovascular treatments. Agreement on the presence of a major recurrence when comparing 2 MRA studies or the MRA with the last catheter angiographic study can be substantial. © 2016 by American Journal of Neuroradiology.

Comparison of expert and job-exposure matrix-based retrospective exposure assessment of occupational carcinogens in The Netherlands Cohort Study.

PubMed

Offermans, Nadine S M; Vermeulen, Roel; Burdorf, Alex; Peters, Susan; Goldbohm, R Alexandra; Koeman, Tom; van Tongeren, Martie; Kauppinen, T; Kant, Ijmert; Kromhout, Hans; van den Brandt, Piet A

2012-10-01

Reliable retrospective exposure assessment continues to be a challenge in most population-based studies. Several methodologies exist for estimating exposures retrospectively, of which case-by-case expert assessment and job-exposure matrices (JEMs) are commonly used. This study evaluated the reliability of exposure estimates for selected carcinogens obtained through three JEMs by comparing the estimates with case-by-case expert assessment within the Netherlands Cohort Study (NLCS). The NLCS includes 58,279 men aged 55-69 years at enrolment in 1986. For a subcohort of these men (n=1630), expert assessment is available for exposure to asbestos, polycyclic aromatic hydrocarbons (PAHs) and welding fumes. Reliability of the different JEMs (DOMJEM (asbestos, PAHs), FINJEM (asbestos, PAHs and welding fumes) and Asbestos JEM (asbestos) was determined by assessing the agreement between these JEMs and the expert assessment. Expert assessment revealed the lowest prevalence of exposure for all three exposures (asbestos 9.3%; PAHs 5.3%; welding fumes 11.7%). The DOMJEM showed the highest level of agreement with the expert assessment for asbestos and PAHs (κs=0.29 and 0.42, respectively), closely followed by the FINJEM. For welding fumes, concordance between the expert assessment and FINJEM was high (κ=0.70). The Asbestos JEM showed poor agreement with the expert asbestos assessment (κ=0.10). This study shows case-by-case expert assessment to result in the lowest prevalence of occupational exposure in the NLCS. Furthermore, the DOMJEM and FINJEM proved to be rather similar in agreement when compared with the expert assessment. The Asbestos JEM appeared to be less appropriate for use in the NLCS.

Interobserver variability in target definition for hepatocellular carcinoma with and without portal vein thrombus: radiation therapy oncology group consensus guidelines.

PubMed

Hong, Theodore S; Bosch, Walter R; Krishnan, Sunil; Kim, Tae K; Mamon, Harvey J; Shyn, Paul; Ben-Josef, Edgar; Seong, Jinsil; Haddock, Michael G; Cheng, Jason C; Feng, Mary U; Stephans, Kevin L; Roberge, David; Crane, Christopher; Dawson, Laura A

2014-07-15

Defining hepatocellular carcinoma (HCC) gross tumor volume (GTV) requires multimodal imaging, acquired in different perfusion phases. The purposes of this study were to evaluate the variability in contouring and to establish guidelines and educational recommendations for reproducible HCC contouring for treatment planning. Anonymous, multiphasic planning computed tomography scans obtained from 3 patients with HCC were identified and distributed to a panel of 11 gastrointestinal radiation oncologists. Panelists were asked the number of HCC cases they treated in the past year. Case 1 had no vascular involvement, case 2 had extensive portal vein involvement, and case 3 had minor branched portal vein involvement. The agreement between the contoured total GTVs (primary + vascular GTV) was assessed using the generalized kappa statistic. Agreement interpretation was evaluated using Landis and Koch's interpretation of strength of agreement. The S95 contour, defined using the simultaneous truth and performance level estimation (STAPLE) algorithm consensus at the 95% confidence level, was created for each case. Of the 11 panelists, 3 had treated >25 cases in the past year, 2 had treated 10 to 25 cases, 2 had treated 5 to 10 cases, 2 had treated 1 to 5 cases, 1 had treated 0 cases, and 1 did not respond. Near perfect agreement was seen for case 1, and substantial agreement was seen for cases 2 and 3. For case 2, there was significant heterogeneity in the volume identified as tumor thrombus (range 0.58-40.45 cc). For case 3, 2 panelists did not include the branched portal vein thrombus, and 7 panelists contoured thrombus separately from the primary tumor, also showing significant heterogeneity in volume of tumor thrombus (range 4.52-34.27 cc). In a group of experts, excellent agreement was seen in contouring total GTV. Heterogeneity exists in the definition of portal vein thrombus that may impact treatment planning, especially if differential dosing is contemplated. Guidelines for HCC GTV contouring are recommended. Copyright © 2014. Published by Elsevier Inc.

Interobserver Variability in Target Definition for Hepatocellular Carcinoma With and Without Portal Vein Thrombus: Radiation Therapy Oncology Group Consensus Guidelines

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hong, Theodore S., E-mail: tshong1@mgh.harvard.edu; Bosch, Walter R.; Krishnan, Sunil

2014-07-15

Purpose: Defining hepatocellular carcinoma (HCC) gross tumor volume (GTV) requires multimodal imaging, acquired in different perfusion phases. The purposes of this study were to evaluate the variability in contouring and to establish guidelines and educational recommendations for reproducible HCC contouring for treatment planning. Methods and Materials: Anonymous, multiphasic planning computed tomography scans obtained from 3 patients with HCC were identified and distributed to a panel of 11 gastrointestinal radiation oncologists. Panelists were asked the number of HCC cases they treated in the past year. Case 1 had no vascular involvement, case 2 had extensive portal vein involvement, and case 3more » had minor branched portal vein involvement. The agreement between the contoured total GTVs (primary + vascular GTV) was assessed using the generalized kappa statistic. Agreement interpretation was evaluated using Landis and Koch's interpretation of strength of agreement. The S95 contour, defined using the simultaneous truth and performance level estimation (STAPLE) algorithm consensus at the 95% confidence level, was created for each case. Results: Of the 11 panelists, 3 had treated >25 cases in the past year, 2 had treated 10 to 25 cases, 2 had treated 5 to 10 cases, 2 had treated 1 to 5 cases, 1 had treated 0 cases, and 1 did not respond. Near perfect agreement was seen for case 1, and substantial agreement was seen for cases 2 and 3. For case 2, there was significant heterogeneity in the volume identified as tumor thrombus (range 0.58-40.45 cc). For case 3, 2 panelists did not include the branched portal vein thrombus, and 7 panelists contoured thrombus separately from the primary tumor, also showing significant heterogeneity in volume of tumor thrombus (range 4.52-34.27 cc). Conclusions: In a group of experts, excellent agreement was seen in contouring total GTV. Heterogeneity exists in the definition of portal vein thrombus that may impact treatment planning, especially if differential dosing is contemplated. Guidelines for HCC GTV contouring are recommended.« less

Crude versus case-mix-adjusted control charts for safety monitoring in thyroid surgery.

PubMed

Duclos, Antoine; Voirin, Nicolas; Touzet, Sandrine; Soardo, Pietro; Schott, Anne-Marie; Colin, Cyrille; Peix, Jean-Louis; Lifante, Jean-Christophe

2010-12-01

Patient-safety monitoring based on health-outcome indicators can lead to misinterpretation of changes in case mix. This study aimed to compare the detection of indicator variations between crude and case-mix-adjusted control charts using data from thyroid surgeries. The study population included each patient who underwent thyroid surgery in a teaching hospital from January 2006 to May 2008. Patient safety was monitored according to two indicators, which are immediately recognisable postoperative complications: recurrent laryngeal nerve palsy and hypocalcaemia. Each indicator was plotted monthly on a p-control chart using exact limits. The weighted κ statistic was calculated to measure the agreement between crude and case-mix-adjusted control charts. We evaluated the outcomes of 1405 thyroidectomies. The overall proportions of immediate recurrent laryngeal nerve palsy and hypocalcaemia were 7.4% and 20.5%, respectively. The proportion of agreement in the detection of indicator variations between the crude and case-mix-adjusted p-charts was 95% (95% CI 85% to 99%). The strength of the agreement was κ = 0.76 (95% CI 0.54 to 0.98). The single special cause of variation that occurred was only detected by the case-mix-adjusted p-chart. There was good agreement in the detection of indicator variations between crude and case-mix-adjusted p-charts. The joint use of crude and adjusted charts seems to be a reasonable approach to increase the accuracy of interpretation of variations in outcome indicators.

Combining Decision Rules from Classification Tree Models and Expert Assessment to Estimate Occupational Exposure to Diesel Exhaust for a Case-Control Study

PubMed Central

Friesen, Melissa C.; Wheeler, David C.; Vermeulen, Roel; Locke, Sarah J.; Zaebst, Dennis D.; Koutros, Stella; Pronk, Anjoeka; Colt, Joanne S.; Baris, Dalsu; Karagas, Margaret R.; Malats, Nuria; Schwenn, Molly; Johnson, Alison; Armenti, Karla R.; Rothman, Nathanial; Stewart, Patricia A.; Kogevinas, Manolis; Silverman, Debra T.

2016-01-01

Objectives: To efficiently and reproducibly assess occupational diesel exhaust exposure in a Spanish case-control study, we examined the utility of applying decision rules that had been extracted from expert estimates and questionnaire response patterns using classification tree (CT) models from a similar US study. Methods: First, previously extracted CT decision rules were used to obtain initial ordinal (0–3) estimates of the probability, intensity, and frequency of occupational exposure to diesel exhaust for the 10 182 jobs reported in a Spanish case-control study of bladder cancer. Second, two experts reviewed the CT estimates for 350 jobs randomly selected from strata based on each CT rule’s agreement with the expert ratings in the original study [agreement rate, from 0 (no agreement) to 1 (perfect agreement)]. Their agreement with each other and with the CT estimates was calculated using weighted kappa (κ w) and guided our choice of jobs for subsequent expert review. Third, an expert review comprised all jobs with lower confidence (low-to-moderate agreement rates or discordant assignments, n = 931) and a subset of jobs with a moderate to high CT probability rating and with moderately high agreement rates (n = 511). Logistic regression was used to examine the likelihood that an expert provided a different estimate than the CT estimate based on the CT rule agreement rates, the CT ordinal rating, and the availability of a module with diesel-related questions. Results: Agreement between estimates made by two experts and between estimates made by each of the experts and the CT estimates was very high for jobs with estimates that were determined by rules with high CT agreement rates (κ w: 0.81–0.90). For jobs with estimates based on rules with lower agreement rates, moderate agreement was observed between the two experts (κ w: 0.42–0.67) and poor-to-moderate agreement was observed between the experts and the CT estimates (κ w: 0.09–0.57). In total, the expert review of 1442 jobs changed 156 probability estimates, 128 intensity estimates, and 614 frequency estimates. The expert was more likely to provide a different estimate when the CT rule agreement rate was <0.8, when the CT ordinal ratings were low to moderate, or when a module with diesel questions was available. Conclusions: Our reliability assessment provided important insight into where to prioritize additional expert review; as a result, only 14% of the jobs underwent expert review, substantially reducing the exposure assessment burden. Overall, we found that we could efficiently, reproducibly, and reliably apply CT decision rules from one study to assess exposure in another study. PMID:26732820

Intra- and inter-observer agreement in histological assessment of canine soft tissue sarcoma.

PubMed

Yap, F W; Rasotto, R; Priestnall, S L; Parsons, K J; Stewart, J

2017-12-01

The diagnosis of canine soft tissue sarcoma (STS) is based on histological assessment. Assessment of criteria such as, degree of differentiation, necrosis score and mitotic score, gives rise to a final tumour grade, which is important in the recommendation of treatment and prognosis of patients. Previously diagnosed cases of STS were independently assessed by three board-certified veterinary pathologists. Participating pathologists were blinded to the original results. For the intra-observer study, the cases were assessed by a single pathologist six months apart and slides were randomized between readings. For the inter-observer study, the whole case series was assessed by a single pathologist before being passed onto the next pathologist. Intraclass correlation coefficient (ICC) and Fleiss's Kappa (ƙ) for the intra- (single observer) and inter-observer agreement. Strong agreement was observed for the intra-observer assessment in necrosis score, mitotic score, total score and tumour grading (ICC between 0.78 to 0.91). The intra-observer agreement for differentiation score was rated perfect (ICC 1.00). The agreement between pathologists for the diagnosis and grading of canine STS was moderate (ƙ = 0.60 and 0.43 respectively). Histological assessment of canine STS had high reproducibility by an individual pathologist. The agreement of diagnosis and grading of canine STS was moderate between pathologists. Future studies are required to investigate further assessment criteria to improve the specificity of STS diagnosis and the accuracy of the STS grading in dogs. © 2017 John Wiley & Sons Ltd.

Development and testing of a tool for assessing and resolving medication-related problems in older adults in an ambulatory care setting: the individualized medication assessment and planning (iMAP) tool.

PubMed

Crisp, Ginny D; Burkhart, Jena Ivey; Esserman, Denise A; Weinberger, Morris; Roth, Mary T

2011-12-01

Medication is one of the most important interventions for improving the health of older adults, yet it has great potential for causing harm. Clinical pharmacists are well positioned to engage in medication assessment and planning. The Individualized Medication Assessment and Planning (iMAP) tool was developed to aid clinical pharmacists in documenting medication-related problems (MRPs) and associated recommendations. The purpose of our study was to assess the reliability and usability of the iMAP tool in classifying MRPs and associated recommendations in older adults in the ambulatory care setting. Three cases, representative of older adults seen in an outpatient setting, were developed. Pilot testing was conducted and a "gold standard" key developed. Eight eligible pharmacists consented to participate in the study. They were instructed to read each case, make an assessment of MRPs, formulate a plan, and document the information using the iMAP tool. Inter-rater reliability was assessed for each case, comparing the pharmacists' identified MRPs and recommendations to the gold standard. Consistency of categorization across reviewers was assessed using the κ statistic or percent agreement. The mean κ across the 8 pharmacists in classifying MRPs compared with the gold standard was 0.74 (range, 0.54-1.00) for case 1 and 0.68 (range, 0.36-1.00) for case 2, indicating substantial agreement. For case 3, percent agreement was 63% (range, 40%-100%). The mean κ across the 8 pharmacists when classifying recommendations compared with the gold standard was 0.87 (range, 0.58-1.00) for case 1 and 0.88 (range, 0.75-1.00) for case 2, indicating almost perfect agreement. For case 3, percent agreement was 68% (range, 40%-100%). Clinical pharmacists found the iMAP tool easy to use. The iMAP tool provides a reliable and standardized approach for clinical pharmacists to use in the ambulatory care setting to classify MRPs and associated recommendations. Future studies will explore the predictive validity of the tool on clinical outcomes such as health care utilization. Copyright © 2011 Elsevier HS Journals, Inc. All rights reserved.

The effects of urgency to reach agreement on the process and outcome of multi-party natural resource negotiations

USGS Publications Warehouse

Lamb, B.L.; Taylor, J.G.; Burkardt, N.; Gillette, S.C.

2005-01-01

We studied seven hydropower license consultations to examine the role of a sense of urgency to reach agreement. Hydropower licensing consultations were studied because the statutory requirement for consultation encourages negotiation, all such consultations are similar, and a negotiated settlement is not a foregone result. Cases selected for analysis met screening criteria. Structured interviews were conducted with participants after the negotiations had been concluded. Respondent recollections were checked against the documentary record. A sense of urgency to reach agreement was a significant factor in the completion of these negotiations; where there was no shared sense of urgency, purposeful delay adversely affected the negotiations. Although a sense of urgency was experienced by at least one party in each case, only a shared sense of urgency at the end of the process proved significant. Delay did not prevent ultimate agreement but a shared sense of urgency brought speedier agreement and greater satisfaction with the negotiation.

Inter-observer variability in the classification of ovarian cancer cell type using microscopy: a pilot study

NASA Astrophysics Data System (ADS)

Gavrielides, Marios A.; Ronnett, Brigitte M.; Vang, Russell; Seidman, Jeffrey D.

2015-03-01

Studies have shown that different cell types of ovarian carcinoma have different molecular profiles, exhibit different behavior, and that patients could benefit from typespecific treatment. Different cell types display different histopathology features, and different criteria are used for each cell type classification. Inter-observer variability for the task of classifying ovarian cancer cell types is an under-examined area of research. This study served as a pilot study to quantify observer variability related to the classification of ovarian cancer cell types and to extract valuable data for designing a validation study of digital pathology (DP) for this task. Three observers with expertise in gynecologic pathology reviewed 114 cases of ovarian cancer with optical microscopy, with specific guidelines for classifications into distinct cell types. For 93 cases all 3 pathologists agreed on the same cell type, for 18 cases 2 out of 3 agreed, and for 3 cases there was no agreement. Across cell types with a minimum sample size of 10 cases, agreement between all three observers was {91.1%, 80.0%, 90.0%, 78.6%, 100.0%, 61.5%} for the high grade serous carcinoma, low grade serous carcinoma, endometrioid, mucinous, clear cell, and carcinosarcoma cell types respectively. These results indicate that unanimous agreement varied over a fairly wide range. However, additional research is needed to determine the importance of these differences in comparison studies. These results will be used to aid in the design and sizing of such a study comparing optical and digital pathology. In addition, the results will help in understanding the potential role computer-aided diagnosis has in helping to improve the agreement of pathologists for this task.

Benefits and costs of programmatic agreements

DOT National Transportation Integrated Search

2015-02-01

The performing organization, on behalf of the FHWA Office of Planning, Environment, and Realty, conducted a benefit-cost assessment of programmatic agreements and approaches. The assessment consisted of a case study approach that evaluated three agre...

3-Tesla MRI-assisted detection of compression points in ulnar neuropathy at the elbow in correlation with intraoperative findings.

PubMed

Hold, Alina; Mayr-Riedler, Michael S; Rath, Thomas; Pona, Igor; Nierlich, Patrick; Breitenseher, Julia; Kasprian, Gregor

2018-03-06

Releasing the ulnar nerve from all entrapments is the primary objective of every surgical method in ulnar neuropathy at the elbow (UNE). The aim of this retrospective diagnostic study was to validate preoperative 3-Tesla MRI results by comparing the MRI findings with the intraoperative aspects during endoscopic-assisted or open surgery. Preoperative MRI studies were assessed by a radiologist not informed about intraoperative findings in request for the exact site of nerve compression. The localizations of compression were then correlated with the intraoperative findings obtained from the operative records. Percent agreement and Cohen's kappa (κ) values were calculated. From a total of 41 elbows, there was a complete agreement in 27 (65.8%) cases and a partial agreement in another 12 (29.3%) cases. Cohen's kappa showed fair-to-moderate agreement. High-resolution MRI cannot replace thorough intraoperative visualization of the ulnar nerve and its surrounding structures but may provide valuable information in ambiguous cases or relapses. Copyright © 2018 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

An exercise in controversy. Case study: revising a physician employment agreement.

PubMed

Fitzgerald, Paul E; Burkett, Steven H; Key, Charles M

2003-01-01

The physician employment agreement at a faculty practice plan did not meet the needs of a modern health care employer or its medical staff. This article describes the communication among medical group management, medical leadership and the medical staff during the revision of the agreement, as well as the process used to develop a new document.

Approaches to ascertaining comorbidity information: validation of routine hospital episode data with clinician-based case note review.

PubMed

Soo, Martin; Robertson, Lynn M; Ali, Tariq; Clark, Laura E; Fluck, Nicholas; Johnston, Marjorie; Marks, Angharad; Prescott, Gordon J; Smith, William Cairns S; Black, Corri

2014-04-21

In clinical practice, research, and increasingly health surveillance, planning and costing, there is a need for high quality information to determine comorbidity information about patients. Electronic, routinely collected healthcare data is capturing increasing amounts of clinical information as part of routine care. The aim of this study was to assess the validity of routine hospital administrative data to determine comorbidity, as compared with clinician-based case note review, in a large cohort of patients with chronic kidney disease. A validation study using record linkage. Routine hospital administrative data were compared with clinician-based case note review comorbidity data in a cohort of 3219 patients with chronic kidney disease. To assess agreement, we calculated prevalence, kappa statistic, sensitivity, specificity, positive predictive value and negative predictive value. Subgroup analyses were also performed. Median age at index date was 76.3 years, 44% were male, 67% had stage 3 chronic kidney disease and 31% had at least three comorbidities. For most comorbidities, we found a higher prevalence recorded from case notes compared with administrative data. The best agreement was found for cerebrovascular disease (κ = 0.80) ischaemic heart disease (κ = 0.63) and diabetes (κ = 0.65). Hypertension, peripheral vascular disease and dementia showed only fair agreement (κ = 0.28, 0.39, 0.38 respectively) and smoking status was found to be poorly recorded in administrative data. The patterns of prevalence across subgroups were as expected and for most comorbidities, agreement between case note and administrative data was similar. Agreement was less, however, in older ages and for those with three or more comorbidities for some conditions. This study demonstrates that hospital administrative comorbidity data compared moderately well with case note review data for cerebrovascular disease, ischaemic heart disease and diabetes, however there was significant under-recording of some other comorbid conditions, and particularly common risk factors.

Agreement, the F-Measure, and Reliability in Information Retrieval

PubMed Central

Hripcsak, George; Rothschild, Adam S.

2005-01-01

Information retrieval studies that involve searching the Internet or marking phrases usually lack a well-defined number of negative cases. This prevents the use of traditional interrater reliability metrics like the κ statistic to assess the quality of expert-generated gold standards. Such studies often quantify system performance as precision, recall, and F-measure, or as agreement. It can be shown that the average F-measure among pairs of experts is numerically identical to the average positive specific agreement among experts and that κ approaches these measures as the number of negative cases grows large. Positive specific agreement—or the equivalent F-measure—may be an appropriate way to quantify interrater reliability and therefore to assess the reliability of a gold standard in these studies. PMID:15684123

[Quality assurance in coding expertise of hospital cases in the German DRG system. Evaluation of inter-rater reliability in MDK expertise].

PubMed

Huber, H; Brambrink, M; Funk, R; Rieger, M

2012-10-01

The purpose of this study was to evaluate differences in the D-DRG results of a hospital case by 2 independently coding MKD raters. Calculation of the 2-inter-rater reliability was performed by examination of the coding of individual hospital cases. The reasons for the non-agreement of the expert evaluations and suggestions to improve the process are discussed. From the expert evaluation pool of the MDK-WL a random sample of 0.7% of the 57,375 expertises was taken. Distribution equality with the basic total was tested by the χ² test or, respectively, Fisher's exact test. For the total of 402 individual hospital cases, the G-DRG case sums of 2 experts of the MDK were determined independently and the results checked for each individual case for agreement or non-agreement. The corresponding confidence intervals with standard errors were analysed to test if certain major diagnosis categories (MDC) were statistically significantly more affected by differing expertise results than others. In 280 of the total 402 tested hospital cases, the 2 MDK raters independently reached the same G-DRG results; in 122 cases the G-DRG case sums determined by the 2 raters differed (agreement 70%; CI 65.2-74.1). Different DRG results between the 2 experts occurred regularly in the entire MDC spectrum. No MDC chapter in which significant differences between the 2 raters arose could be identified. The results of our study demonstrate an almost 70% agreement in the evaluation of hospital cost accounts by 2 independently operating MDK. This result leaves room for improvement. Optimisation potentials can be recognised on the basis of the results. Potential for improvement was established in combination with regular further training and the expansion of binding internal code recommendations as well as exchange of code-relevant information among experts in internal forums. The presented model is in principle suitable for cross-border examinations within the MDK system with the advantage that further trends could be uncovered by more variety and larger numbers of the randomly selected cases. © Georg Thieme Verlag KG Stuttgart · New York.

Interobserver Agreement Among Uveitis Experts on Uveitic Diagnoses: The Standardization of Uveitis Nomenclature Experience.

PubMed

Jabs, Douglas A; Dick, Andrew; Doucette, John T; Gupta, Amod; Lightman, Susan; McCluskey, Peter; Okada, Annabelle A; Palestine, Alan G; Rosenbaum, James T; Saleem, Sophia M; Thorne, Jennifer; Trusko, Brett

2018-02-01

To evaluate the interobserver agreement among uveitis experts on the diagnosis of the specific uveitic disease. Interobserver agreement analysis. Five committees, each comprised of 9 individuals and working in parallel, reviewed cases from a preliminary database of 25 uveitic diseases, collected by disease, and voted independently online whether the case was the disease in question or not. The agreement statistic, κ, was calculated for the 36 pairwise comparisons for each disease, and a mean κ was calculated for each disease. After the independent online voting, committee consensus conference calls, using nominal group techniques, reviewed all cases not achieving supermajority agreement (>75%) on the diagnosis in the online voting to attempt to arrive at a supermajority agreement. A total of 5766 cases for the 25 diseases were evaluated. The overall mean κ for the entire project was 0.39, with disease-specific variation ranging from 0.23 to 0.79. After the formalized consensus conference calls to address cases that did not achieve supermajority agreement in the online voting, supermajority agreement overall was reached on approximately 99% of cases, with disease-specific variation ranging from 96% to 100%. Agreement among uveitis experts on diagnosis is moderate at best but can be improved by discussion among them. These data suggest the need for validated and widely used classification criteria in the field of uveitis. Copyright © 2017 Elsevier Inc. All rights reserved.

Agreement between image grading of conventional (45°) and ultra wide-angle (200°) digital images in the macula in the Reykjavik eye study.

PubMed

Csutak, A; Lengyel, I; Jonasson, F; Leung, I; Geirsdottir, A; Xing, W; Peto, T

2010-10-01

To establish the agreement between image grading of conventional (45°) and ultra wide-angle (200°) digital images in the macula. In 2008, the 12-year follow-up was conducted on 573 participants of the Reykjavik Eye Study. This study included the use of the Optos P200C AF ultra wide-angle laser scanning ophthalmoscope alongside Zeiss FF 450 conventional digital fundus camera on 121 eyes with or without age-related macular degeneration using the International Classification System. Of these eyes, detailed grading was carried out on five cases each with hard drusen, geographic atrophy and chorioretinal neovascularisation, and six cases of soft drusen. Exact agreement and κ-statistics were calculated. Comparison of the conventional and ultra wide-angle images in the macula showed an overall 96.43% agreement (κ=0.93) with no disagreement at end-stage disease; although in one eye chorioretinal neovascularisation was graded as drusenoid pigment epithelial detachment. Of patients with drusen only, the exact agreement was 96.1%. The detailed grading showed no clinically significant disagreement between the conventional 45° and 200° images. On the basis of our results, there is a good agreement between grading conventional and ultra wide-angle images in the macula.

Development and validation of a novel questionnaire for self-determination of the range of motion of wrist and elbow.

PubMed

Schnetzke, Marc; Schüler, Svenja; Keil, Holger; Aytac, Sara; Studier-Fischer, Stefan; Grützner, Paul-Alfred; Guehring, Thorsten

2016-07-26

The aim of this study was to develop and validate a novel self-administered questionnaire for assessing the patient's own range of motion (ROM) of the wrist and the elbow. In a prospective clinical study from January 2015 to June 2015, 101 consecutive patients were evaluated with a novel, self-administered, diagram-based, wrist motion assessment score (W-MAS) and elbow motion assessment score (E-MAS). The questionnaire was statistically evaluated for test-retest reliability, patient-physician agreement, comparison with healthy population, and influence of covariates (age, gender, affected side and involvement in workers' compensation cases). Assessment of patient-physician agreement demonstrated almost perfect agreement (k > 0.80) with regard to six out of eight items. There was substantial agreement with regard to two items: elbow extension (k = 0.76) and pronation (k = 0.75). The assessment of the test-retest reliability revealed at least substantial agreement (k = 0.70). The questionnaire revealed a high discriminative power when comparing the healthy population with the study group (p = 0.007 or lower for every item). Age, gender, affected side and involvement in workers' compensation cases did not in general significantly influence the patient-physician agreement for the questionnaire. The W-MAS and E-MAS are valid and reliable self-administered questionnaires that provide a high level of patient-physician agreement for the assessments of wrist and elbow ROM. Diagnostic study, Level II.

Effects of subject-case marking on agreement processing: ERP evidence from Basque.

PubMed

Chow, Wing-Yee; Nevins, Andrew; Carreiras, Manuel

2018-02-01

Previous cross-linguistic research has found that comprehenders are immediately sensitive to various kinds of agreement violations across languages. We focused on Basque, a verb-final ergative language with both subject-verb (SV) and object-verb (OV) agreement. We compared the effects of SV agreement violations on comprehenders' event-related brain potentials (ERPs) in transitive sentences (where OV agreement is present, and the subject is ergative) and intransitive sentences (where OV agreement is absent, and the subject is absolutive). We observed a P600 effect in both cases, but only violations with intransitive subjects elicited an early posterior negativity. Such a qualitative difference suggests that distinct neurocognitive mechanisms are involved in processing agreement with transitive subjects (which are marked with ergative case) versus intransitive subjects (which bear absolutive case). Building on theoretical proposals that in languages such as Basque, true agreement occurs with absolutive subjects but not with ergative subjects, we submit that the early posterior negativity may be an electrophysiological signature for true agreement. Copyright © 2017 Elsevier Ltd. All rights reserved.

Comparison of human papillomavirus detection between freshly frozen tissue and paraffin embedded tissue of invasive cervical cancer

PubMed Central

2010-01-01

Background Human Papillomavirus (HPV) detection results comparing paraffin embedded cervical tissue and other cervical specimens have been done with varying degrees of agreement. However, studies comparing freshly frozen specimens and paraffin embedded specimens of invasive cervical carcinomas are lacking. The aim of the study was to compare HPV detection using SPF10 broad-spectrum primers PCR followed by DEIA and genotyping by LiPA25 (version 1) between freshly frozen cervical tissue samples and paraffin embedded blocks of cervical tissue from the same patient. There were 171 pairs of paraffin embedded and freshly frozen samples analyzed from cervical carcinoma cases from Kampala, Uganda. Results 88.9% (95% CI: 83.2%-93.2%) of paraffin embedded samples were HPV positive compared with 90.1% (95% CI: 84.6%-94.1%) of freshly frozen samples, giving an overall agreement in HPV detection between fresh tissue and paraffin embedded tissue at 86.0% (95% CI: 79.8%-90.8%). Although the proportion of HPV positive cases in freshly frozen tissue was higher than those in paraffin blocks, the difference was not statistically significant (p > 0.05). In both types of tissues, single HPV infections were predominant, with HPV16 accounting for 47% of positive cases. Comparison in the overall agreement, taking into accounts not only positivity in general, but also HPV types, showed a 65% agreement (complete agreement of 59.7%, partial agreement of 5.3%) and complete disagreement of 35.0%. HPV detection in squamous cell carcinomas (SCC) and adenocarcinomas (ADC) was similar in fresh tissue or paraffin blocks (p ≥ 0.05). p16 immunostaining in samples that had at least one HPV negative results showed that 24 out of 25 cases had an over-expressed pattern. Conclusions HPV DNA detection was lower among ADC as compared to SCC. However, such differences were minimized when additional p16 testing was added, suggesting that the technical issues may largely explain the HPV negative cases. PMID:20846370

Ultrasonographic assessment of tendon thickness, Doppler activity and bony spurs of the elbow in patients with lateral epicondylitis and healthy subjects: a reliability and agreement study.

PubMed

Krogh, T P; Fredberg, U; Christensen, R; Stengaard-Pedersen, K; Ellingsen, T

2013-10-01

Tennis elbow, also known as lateral epicondylitis (LE), is a common disorder often assessed by ultrasound. The aim of this study was to evaluate the ultrasonographic outcomes and methods used in LE research and clinical practice. This study was designed as an intra- and interobserver reliability and agreement study. Ultrasonographic examination of the common extensor tendon of the elbow was performed. The intraobserver study examined tendon thickness twice in 20 right elbows from 20 healthy individuals at an interval of 7 to 12 days. The interobserver study examined tendon thickness, color Doppler activity, and bony spurs in 18 right elbows in 9 healthy individuals and 9 patients with LE. Two trained rheumatologists performed the interobserver examinations with the same scanner on the same day. The main outcomes were intra- and interclass correlation (ICC) and agreement. In the intraobserver study, the ICC with regard to tendon thickness ranged from 0.76 to 0.81, depending on the measurement techniques used. The agreement ranged from 0.06 to 0.13 mm. In the interobserver study, the tendon thickness ICC ranged from 0.45 to 0.65 and the agreement ranged from -0.17 to 0.13 mm. The ICC for color Doppler activity was 0.93, with agreement in 14/18 (78 %) of the cases. A perfect reliability was demonstrated for bony spurs, with an ICC of 1 and exact agreement in 18/18 (100 %) of the cases. Good to excellent reliability was obtained for all measurements. The ultrasonographic techniques evaluated in this trial can be recommended for use in both research and clinical practice. © Georg Thieme Verlag KG Stuttgart · New York.

2015 Clean Air Act Vehicle and Engine Enforcement Case Resolutions

EPA Pesticide Factsheets

2015 Enforcement case resolutions such as expedited settlement agreements, administrative settlement agreements, administrative penalty orders, consent agreements and final orders, and consent decrees are listed by respondent name below.

2016 Clean Air Act Vehicle and Engine Enforcement Case Resolutions

EPA Pesticide Factsheets

2016 Enforcement case resolutions such as expedited settlement agreements, administrative settlement agreements, administrative penalty orders, consent agreements and final orders, and consent decrees are listed by respondent name below.

2018 Clean Air Act Vehicle and Engine Enforcement Case Resolutions

EPA Pesticide Factsheets

2018 Enforcement case resolutions such as expedited settlement agreements, administrative settlement agreements, administrative penalty orders, consent agreements and final orders, and consent decrees are listed by respondent name below.

2017 Clean Air Act Vehicle and Engine Enforcement Case Resolutions

EPA Pesticide Factsheets

2017 Enforcement case resolutions such as expedited settlement agreements, administrative settlement agreements, administrative penalty orders, consent agreements and final orders, and consent decrees are listed by respondent name below.

Interobserver Variation in Response Evaluation Criteria in Solid Tumors 1.1.

PubMed

Karmakar, Arunabha; Kumtakar, Apeksha; Sehgal, Himanshu; Kumar, Savith; Kalyanpur, Arjun

2018-06-19

Response Evaluation Criteria in Solid Tumors (RECIST 1.1) is the gold standard for imaging response evaluation in cancer trials. We sought to evaluate consistency of applying RECIST 1.1 between 2 conventionally trained radiologists, designated as A and B; identify reasons for variation; and reconcile these differences for future studies. The study was approved as an institutional quality check exercise. Since no identifiable patient data was collected or used, a waiver of informed consent was granted. Imaging case report forms of a concluded multicentric breast cancer trial were retrospectively reviewed. Cohen's kappa was used to rate interobserver agreement in Response Evaluation Data (target response, nontarget response, new lesions, overall response). Significant variations were reassessed by a senior radiologist to extrapolate reasons for disagreement. Methods to improve agreement were similarly ascertained. Sixty one cases with total of 82 data-pairs were evaluated (35 data-pairs in visit 5, 47 in visit 9). Both radiologists showed moderate agreement in target response (n = 82; ĸ = 0.477; 95% confidence interval [CI]: 0.314-0.640-), nontarget response (n = 82; ĸ = 0.578; 95% CI: 0.213-0.944) and overall response evaluation in both visits (n = 82; ĸ = 0.510; 95% CI: 0.344-0.676). Further assessment demonstrated "Prevalence effect" of Kappa in some cases which led to underestimation of agreement. Percent agreement of overall response was 74.39% while percent variation was 25.6%. Differences in interpreting RECIST 1.1 and in radiological image interpretation were the primary sources of variation. The commonest overall response was "Partial Response" (Rad A:45/82; Rad B:63/82). Inspite of moderate interobserver agreement, qualitative interpretation differences in some cases increased interobserver variability. Protocols such as Adjudication, to reduce easily avoidable inconsistencies are or should be a part of the Standard Operating Procedure in imaging institutions. Based on our findings, a standard checklist has been developed to help reduce the interpretation error-margin for future studies. Such check-lists may improve interobserver agreement in the preadjudication phase thereby improving quality of results and reducing adjudication per case ratio. Improving data reliability when using RECIST 1.1 will reflect in better cancer clinical trial outcomes. A checklist can be of use to imaging centers to assess and improve their own processes. Copyright © 2018. Published by Elsevier Inc.

Deriving Case, Agreement and Voice Phenomena in Syntax

ERIC Educational Resources Information Center

Sigurdsson, Einar Freyr

2017-01-01

This dissertation places case, agreement and Voice phenomena in syntax. It argues that the derivation is driven by so-called derivational features, that is, structure-building features (Merge) and probe features (Agree) (Heck and Muller 2007 and Muller 2010; see also Chomsky 2000, 2001). Both types are essential in deriving case and agreement in…

Diagnostic Reproducibility: What Happens When the Same Pathologist Interprets the Same Breast Biopsy Specimen at Two Points in Time?

PubMed Central

Jackson, Sara L.; Frederick, Paul D.; Pepe, Margaret S.; Nelson, Heidi D.; Weaver, Donald L.; Allison, Kimberly H.; Carney, Patricia A.; Geller, Berta M.; Tosteson, Anna N. A.; Onega, Tracy; Elmore, Joann G.

2017-01-01

Background Surgeons may receive a different diagnosis when a breast biopsy is interpreted by a second pathologist. The extent to which diagnostic agreement by the same pathologist varies at two time points is unknown. Participants and Methods Pathologists from 8 U.S. states independently interpreted 60 breast specimens, one glass slide per case, on 2 occasions separated by ≥9 months. Reproducibility was assessed by comparing interpretations between the two time points; associations between reproducibility (intra-observer agreement rates) and characteristics of pathologists and cases were determined and also compared with inter-observer agreement of baseline interpretations. Results Sixty-five percent of invited, responding pathologists were eligible and consented; 49 interpreted glass slides in both study phases resulting in 2,940 interpretations. Intra-observer agreement rates between the two phases were 92% (95% CI 88%-95%) for invasive breast cancer, 84% (95% CI 81%-87%) for ductal carcinoma in situ (DCIS), 53% (95% CI 47%-59%) for atypia, and 84% (95% CI 81%-86%) for benign without atypia. When comparing all study participants' case interpretations at baseline, inter-observer agreement rates were 89% (95% CI 84%-92%) for invasive cancer, 79% (95% CI 76%-81%) for DCIS, 43% (95% CI 41%-45%) for atypia, and 77% (95% CI 74%-79%) for benign without atypia. Conclusions Interpretive agreement between two time points by the same individual pathologists was low for atypia, and similar to observed rates of agreement for atypia between different pathologists. Physicians and patients should be aware of the diagnostic challenges associated with a breast biopsy diagnosis of atypia when considering treatment and surveillance decisions. PMID:27913946

Diagnostic Reproducibility: What Happens When the Same Pathologist Interprets the Same Breast Biopsy Specimen at Two Points in Time?

PubMed

Jackson, Sara L; Frederick, Paul D; Pepe, Margaret S; Nelson, Heidi D; Weaver, Donald L; Allison, Kimberly H; Carney, Patricia A; Geller, Berta M; Tosteson, Anna N A; Onega, Tracy; Elmore, Joann G

2017-05-01

Surgeons may receive a different diagnosis when a breast biopsy is interpreted by a second pathologist. The extent to which diagnostic agreement by the same pathologist varies at two time points is unknown. Pathologists from eight U.S. states independently interpreted 60 breast specimens, one glass slide per case, on two occasions separated by ≥9 months. Reproducibility was assessed by comparing interpretations between the two time points; associations between reproducibility (intraobserver agreement rates); and characteristics of pathologists and cases were determined and also compared with interobserver agreement of baseline interpretations. Sixty-five percent of invited, responding pathologists were eligible and consented; 49 interpreted glass slides in both study phases, resulting in 2940 interpretations. Intraobserver agreement rates between the two phases were 92% [95% confidence interval (CI) 88-95] for invasive breast cancer, 84% (95% CI 81-87) for ductal carcinoma-in-situ, 53% (95% CI 47-59) for atypia, and 84% (95% CI 81-86) for benign without atypia. When comparing all study participants' case interpretations at baseline, interobserver agreement rates were 89% (95% CI 84-92) for invasive cancer, 79% (95% CI 76-81) for ductal carcinoma-in-situ, 43% (95% CI 41-45) for atypia, and 77% (95% CI 74-79) for benign without atypia. Interpretive agreement between two time points by the same individual pathologist was low for atypia and was similar to observed rates of agreement for atypia between different pathologists. Physicians and patients should be aware of the diagnostic challenges associated with a breast biopsy diagnosis of atypia when considering treatment and surveillance decisions.

Effect of Picture Archiving and Communication System Image Manipulation on the Agreement of Chest Radiograph Interpretation in the Neonatal Intensive Care Unit.

PubMed

Castro, Denise A; Naqvi, Asad Ahmed; Vandenkerkhof, Elizabeth; Flavin, Michael P; Manson, David; Soboleski, Donald

2016-01-01

Variability in image interpretation has been attributed to differences in the interpreters' knowledge base, experience level, and access to the clinical scenario. Picture archiving and communication system (PACS) has allowed the user to manipulate the images while developing their impression of the radiograph. The aim of this study was to determine the agreement of chest radiograph (CXR) impressions among radiologists and neonatologists and help determine the effect of image manipulation with PACS on report impression. Prospective cohort study included 60 patients from the Neonatal Intensive Care Unit undergoing CXRs. Three radiologists and three neonatologists reviewed two consecutive frontal CXRs of each patient. Each physician was allowed manipulation of images as needed to provide a decision of "improved," "unchanged," or "disease progression" lung disease for each patient. Each physician repeated the process once more; this time, they were not allowed to individually manipulate the images, but an independent radiologist presets the image brightness and contrast to best optimize the CXR appearance. Percent agreement and opposing reporting views were calculated between all six physicians for each of the two methods (allowing and not allowing image manipulation). One hundred percent agreement in image impression between all six observers was only seen in 5% of cases when allowing image manipulation; 100% agreement was seen in 13% of the cases when there was no manipulation of the images. Agreement in CXR interpretation is poor; the ability to manipulate the images on PACS results in a decrease in agreement in the interpretation of these studies. New methods to standardize image appearance and allow improved comparison with previous studies should be sought to improve clinician agreement in interpretation consistency and advance patient care.

Evaluation of Visual Field Progression in Glaucoma: Quasar Regression Program and Event Analysis.

PubMed

Díaz-Alemán, Valentín T; González-Hernández, Marta; Perera-Sanz, Daniel; Armas-Domínguez, Karintia

2016-01-01

To determine the sensitivity, specificity and agreement between the Quasar program, glaucoma progression analysis (GPA II) event analysis and expert opinion in the detection of glaucomatous progression. The Quasar program is based on linear regression analysis of both mean defect (MD) and pattern standard deviation (PSD). Each series of visual fields was evaluated by three methods; Quasar, GPA II and four experts. The sensitivity, specificity and agreement (kappa) for each method was calculated, using expert opinion as the reference standard. The study included 439 SITA Standard visual fields of 56 eyes of 42 patients, with a mean of 7.8 ± 0.8 visual fields per eye. When suspected cases of progression were considered stable, sensitivity and specificity of Quasar, GPA II and the experts were 86.6% and 70.7%, 26.6% and 95.1%, and 86.6% and 92.6% respectively. When suspected cases of progression were considered as progressing, sensitivity and specificity of Quasar, GPA II and the experts were 79.1% and 81.2%, 45.8% and 90.6%, and 85.4% and 90.6% respectively. The agreement between Quasar and GPA II when suspected cases were considered stable or progressing was 0.03 and 0.28 respectively. The degree of agreement between Quasar and the experts when suspected cases were considered stable or progressing was 0.472 and 0.507. The degree of agreement between GPA II and the experts when suspected cases were considered stable or progressing was 0.262 and 0.342. The combination of MD and PSD regression analysis in the Quasar program showed better agreement with the experts and higher sensitivity than GPA II.

Comparative Study of the Diagnostic Value of Panoramic and Conventional Radiography of the Wrist in Scaphoid Fractures

PubMed Central

Ezoddini Ardakani, Fatemeh; Zangoie Booshehri, Maryam; Banadaki, Seyed Hossein Saeed; Nafisi-Moghadam, Reza

2012-01-01

Background Scaphoid fractures are the most common type of carpal fractures. Objectives The aim of the study was to compare the diagnostic value of panoramic and conventional radiographs of the wrist in scaphoid fractures. Patients and Methods The panoramic and conventional radiographs of 122 patients with acute and chronic wrist trauma were studied. The radiographs were analyzed and examined by two independent radiologist observers; one physician radiologist and one maxillofacial radiologist. The final diagnosis was made by an orthopedic specialist. Kappa test was used for statistical calculations, inter- and intra-observer agreement and correlation between the two techniques. Results Wrist panoramic radiography was more accurate than conventional radiography for ruling out scaphoid fractures. There was an agreement in 85% or more of the cases. Agreement values were higher with better inter and intra observer agreement for panoramic examinations than conventional radiographic examinations. Conclusion The panoramic examination of the wrist is a useful technique for the diagnosis and follow-up of scaphoid fractures. Its use is recommended as a complement to conventional radiography in cases with inconclusive findings. PMID:23599708

75 FR 13421 - Federal Acquisition Regulation; FAR Case 2008-036, Trade Agreements-Costa Rica, Oman, and Peru

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-19

... 9000-AL23 Federal Acquisition Regulation; FAR Case 2008-036, Trade Agreements--Costa Rica, Oman, and... United States-Oman Free Trade Agreement, and the United States-Peru Trade Promotion Agreement. DATES... interim rule. The interim rule added Costa Rica, Oman, and Peru to the definition of ``Free Trade...

Comparison of victims' reports and court records of intimate partner violence perpetrators' criminal case outcomes.

PubMed

Bell, Margret E; Larsen, Sadie E; Goodman, Lisa A; Dutton, Mary Ann

2013-09-01

Intimate partner violence (IPV) victims often report feeling confused and uninformed about court proceedings, including even about the final disposition of the case against their partner. This is problematic because victims' decisions in responding to subsequent abuse may be significantly influenced by their beliefs about the outcomes of prior court experiences. Also, researchers often rely on victim report of court case outcomes; discrepancies between women's reports and official records may account for some of the conflicting findings in the empirical literature. In the current study, we compared the reports of case outcome given by 81 women recruited immediately after the final hearing of an IPV-related criminal case against their perpetrator with court records of case outcome. Findings revealed a fair level of agreement between women's reports and court files that was significantly different from the level of agreement expected by chance, but far from perfect. Level of agreement increased substantially when cases involving suspended sentences were removed. In reviewing these findings, we discuss the extent to which results can or cannot be interpreted as reflecting the accuracy of women's knowledge and review their implications for IPV researchers and court systems.

Legal considerations for cryopreservation of sperm and embryos.

PubMed

Schuster, Timothy G; Hickner-Cruz, Kathryn; Ohl, Dana A; Goldman, Edward; Smith, Gary D

2003-07-01

To summarize the case law for cryopreservation of sperm and embryos and make recommendations for desirable characteristics that should be included in a cryopreservation clinic's disposition agreements. A literature review of case law and legal review articles was performed. Academic research center. None. None. None. Two court cases involving cryopreserved semen and five cases involving cryopreserved embryos are reviewed. The state of the law surrounding cryopreservation is recent and unsettled. Disposition agreements can provide cryopreservation clinics some degree of certainty in this unsettled area of law. Those drafting cryopreservation disposition agreements are assisted by lessons learned from cryopreservation cases and insight gained from law review articles. It is evident that cryopreservation agreements will be most successful and most likely to be enforced if they are unambiguous, consistent with public policy, and include: a duration provision, each individual's contact information, the individual's provisions for use of their gametes in case of death, and responsibilities of cryopreservation clinic and individuals. Individuals must enter into agreements with a true understanding of the contained provisions.

Stability Operations in Somalia 1992-1993: A Case Study

DTIC Science & Technology

2016-07-01

164 Appendix N : Addis Ababa Agreement of the First Session of the Conference on National Reconciliation in Somalia (March 27, 1993...adopted the Addis Abba Agreement of the First Session of the Conference on National Reconciliation in Soma- lia (Appendix N ). In the agreement, all...reaches the starving inland town of Baidoa. December 21, 1992 A mine near Bardera kills Lawrence N . Freedman, a U.S. government civilian employee and

Pattern Classification of Endocervical Adenocarcinoma: Reproducibility and Review of Criteria

PubMed Central

Rutgers, Joanne K.L.; Roma, Andres; Park, Kay; Zaino, Richard J.; Johnson, Abbey; Alvarado, Isabel; Daya, Dean; Rasty, Golnar; Longacre, Teri; Ronnett, Brigitte; Silva, Elvio

2017-01-01

Previously, our international team proposed a 3-tiered pattern classification (Pattern Classification) system for endocervical adenocarcinoma of the usual type that correlates with nodal disease and recurrence. Pattern Classification- A have well demarcated glands lacking destructive stromal invasion or lymphovascular invasion (lymphovascular invasion), Pattern Classification- B show localized, limited destructive invasion arising from A-type glands, and Pattern Classification- C have diffuse destructive stromal invasion, significant (filling a 4× field) confluence, or solid architecture. 24 Pattern Classification-A, 22 Pattern Classification-B, 38 Pattern Classification-C from the tumor set used in the original description were chosen using the reference diagnosis (reference diagnosis) originally established. 1 H&E slide per case was reviewed by 7 gynecologic pathologists, 4 from the original study. Kappa statistics were prepared, and cases with discrepancies reviewed. We found a majority agreement with reference diagnosis in 81% of cases, with complete or near complete (6 of 7) agreement in 50%. Overall concordance was 74%. Overall Kappa (agreement among pathologists) was .488 (moderate agreement). Pattern Classification- B has lowest kappa, and agreement is not improved by combining B+C. 6 of 7 reviewers had substantial agreement by weighted kappas (>.6), with one reviewer accounting for the majority of cases under or overcalled by 2 tiers. Confluence filling a 4× field, labyrinthine glands, or solid architecture accounted for undercalling other reference diagnosis-C cases. Missing a few individually infiltrative cells was the most common cause of undercalling reference diagnosis- B. Small foci of inflamed, loose or desmoplastic stroma lacking infiltrative tumor cells in reference diagnosis-A appeared to account for those cases up-graded to Pattern Classification-B. In summary, an overall concordance of 74% indicates that the criteria can be reproducibly applied by gynecologic pathologists. Further refinement of criteria should allow use of this powerful classification system to delineate which cervical adenocarcinomas can be safely treated conservatively. PMID:27255163

Vaginal vault suspension during hysterectomy for benign indications: a prospective register study of agreement on terminology and surgical procedure.

PubMed

Bonde, Lisbeth; Noer, Mette Calundann; Møller, Lars Alling; Ottesen, Bent; Gimbel, Helga

2017-07-01

Several suspension methods are used to try to prevent pelvic organ prolapse (POP) after hysterectomy. We aimed to evaluate agreement on terminology and surgical procedure of these methods. We randomly chose 532 medical records of women with a history of hysterectomy from the Danish Hysterectomy and Hysteroscopy Database (DHHD). Additionally, we video-recorded 36 randomly chosen hysterectomies. The hysterectomies were registered in the DHHD. The material was categorized according to predefined suspension methods. Agreement compared suspension codes in DHHD (gynecologists' registrations) with medical records (gynecologists' descriptions) and with videos (reviewers' categorizations) respectively. Whether the vaginal vault was suspended (pooled suspension) or not (no suspension method + not described) was analyzed, in addition to each suspension method. Regarding medical records, agreement on terminology was good among patients undergoing pooled suspension in cases of hysterectomy via the abdominal and vaginal route (agreement 78.7, 92.3%). Regarding videos, agreement on surgical procedure was good among pooled suspension patients in cases of hysterectomy via the abdominal, laparoscopic, and vaginal routes (agreement 88.9, 97.8, 100%). Agreement on individual suspension methods differed regarding both medical records (agreement 0-90.1%) and videos (agreement 0-100%). Agreement on terminology and surgical procedure regarding suspension method was good in respect of pooled suspension. However, disagreement was observed when individual suspension methods and operative details were scrutinized. Better consensus of terminology and surgical procedure is warranted to enable further research aimed at preventing POP among women undergoing hysterectomy.

Terminology and definitions on groin pain in athletes: building agreement using a short Delphi method.

PubMed

Weir, Adam; Hölmich, Per; Schache, Anthony G; Delahunt, Eamonn; de Vos, Robert-Jan

2015-06-01

Groin pain in athletes occurs frequently and can be difficult to treat, which may partly be due to the lack of agreement on diagnostic terminology. To perform a short Delphi survey on terminology agreement for groin pain in athletes by a group of experts. A selected number of experts were invited to participate in a Delphi questionnaire. The study coordinator sent a questionnaire, which consisted of demographic questions and two 'real-life' case reports of athletes with groin pain. The experts were asked to complete the questionnaire and to provide the most likely diagnosis for each case. Questionnaire responses were analysed by an independent researcher. The Cohen's κ statistic was used to evaluate the level of agreement between the diagnostic terms provided by the experts. Twenty-three experts participated (96% of those invited). For case 1, experts provided 9 different terms to describe the most likely diagnosis; for case 2, 11 different terms were provided to describe the most likely diagnosis. With respect to the terms provided for the most likely diagnosis, the Cohen's κ was 0.06 and 0.002 for case 1 and 2, respectively. This heterogeneous taxonomy reflects only a slight agreement between the various diagnostic terms provided by the selected experts. This short Delphi survey of two 'typical, straightforward' cases demonstrated major inconsistencies in the diagnostic terminology used by experts for groin pain in athletes. These results underscore the need for consensus on definitions and terminology on groin pain in athletes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Discrepancy between colposcopy, punch biopsy and final histology of cone specimen: a prospective study.

PubMed

Petousis, Stamatios; Christidis, Panagiotis; Margioula-Siarkou, Chrysoula; Sparangis, Nikolaos; Athanasiadis, Apostolos; Kalogiannidis, Ioannis

2018-05-01

Τo estimate the discrepancy rate between colposcopy, punch biopsy histology and surgical specimen histology as well as the positive (PPV) and negative predictive value (NPV) of colposcopic diagnosis for high-grade squamous intraepithelial lesions (HGSIL). A prospective study was conducted during the period of 2012-2016. Αll cases in which surgical treatment had been applied and histopathological diagnosis of those surgical specimens was available were included. Cases in which ablation was performed and cases with incomplete data or conservative approach were excluded. Primary outcome was the agreement rate between histologic diagnosis of surgical specimen, histologic diagnosis of punch biopsy and colposcopic diagnosis according to REID Colposcopic Index. PPV and NPV of colposcopy and biopsy to diagnose HGSIL were also assessed. Τhere were 120 cases meeting our inclusion criteria, while biopsy was obtained in 104 cases. Mean age of women was 32.7 ± 9.0. Colposcopic diagnosis was CIN2 in 65 cases, CIN3 in 11 cases, CIN1 or less in 44 cases. Τhe level of agreement was fair between colposcopy-surgical specimen histology (κ value 0.443), fair between colposcopy-punch biopsy (κ value 0.34) and moderate between punch biopsy-cone specimen histology (κ value 0.443). PPV of colposcopy to detect HGSIL was 72.3%, while NPV was only 47.7%. Punch biopsy and surgical specimen histology present the highest agreement between the different diagnostic procedures. Colposcopy presented satisfying PPV for HGSIL cases, but its NPV was poor. In contrary, punch biopsy was characterized by both satisfying PPV and NPV for HGSIL cases.

Using Relative Improvement over Chance (RIOC) to Examine Agreement between Tests: Three Case Examples Using Studies of Developmental Coordination Disorder (DCD) in Children

ERIC Educational Resources Information Center

Cairney, John; Streiner, David L.

2011-01-01

Although statistics such as kappa and phi are commonly used to assess agreement between tests, in situations where the base rate of a disorder in a population is low or high, these statistics tend to underestimate actual agreement. This can occur even if the tests are good and the classification of subjects is adequate. Relative improvement over…

Inter-observer agreement for diagnostic classification of esophageal motility disorders defined in high-resolution manometry.

PubMed

Fox, M R; Pandolfino, J E; Sweis, R; Sauter, M; Abreu Y Abreu, A T; Anggiansah, A; Bogte, A; Bredenoord, A J; Dengler, W; Elvevi, A; Fruehauf, H; Gellersen, S; Ghosh, S; Gyawali, C P; Heinrich, H; Hemmink, M; Jafari, J; Kaufman, E; Kessing, K; Kwiatek, M; Lubomyr, B; Banasiuk, M; Mion, F; Pérez-de-la-Serna, J; Remes-Troche, J M; Rohof, W; Roman, S; Ruiz-de-León, A; Tutuian, R; Uscinowicz, M; Valdovinos, M A; Vardar, R; Velosa, M; Waśko-Czopnik, D; Weijenborg, P; Wilshire, C; Wright, J; Zerbib, F; Menne, D

2015-01-01

High-resolution esophageal manometry (HRM) is a recent development used in the evaluation of esophageal function. Our aim was to assess the inter-observer agreement for diagnosis of esophageal motility disorders using this technology. Practitioners registered on the HRM Working Group website were invited to review and classify (i) 147 individual water swallows and (ii) 40 diagnostic studies comprising 10 swallows using a drop-down menu that followed the Chicago Classification system. Data were presented using a standardized format with pressure contours without a summary of HRM metrics. The sequence of swallows was fixed for each user but randomized between users to avoid sequence bias. Participants were blinded to other entries. (i) Individual swallows were assessed by 18 practitioners (13 institutions). Consensus agreement (≤ 2/18 dissenters) was present for most cases of normal peristalsis and achalasia but not for cases of peristaltic dysmotility. (ii) Diagnostic studies were assessed by 36 practitioners (28 institutions). Overall inter-observer agreement was 'moderate' (kappa 0.51) being 'substantial' (kappa > 0.7) for achalasia type I/II and no lower than 'fair-moderate' (kappa >0.34) for any diagnosis. Overall agreement was somewhat higher among those that had performed >400 studies (n = 9; kappa 0.55) and 'substantial' among experts involved in development of the Chicago Classification system (n = 4; kappa 0.66). This prospective, randomized, and blinded study reports an acceptable level of inter-observer agreement for HRM diagnoses across the full spectrum of esophageal motility disorders for a large group of clinicians working in a range of medical institutions. Suboptimal agreement for diagnosis of peristaltic motility disorders highlights contribution of objective HRM metrics. © 2014 International Society for Diseases of the Esophagus.

Comparing Visual and Statistical Analysis of Multiple Baseline Design Graphs.

PubMed

Wolfe, Katie; Dickenson, Tammiee S; Miller, Bridget; McGrath, Kathleen V

2018-04-01

A growing number of statistical analyses are being developed for single-case research. One important factor in evaluating these methods is the extent to which each corresponds to visual analysis. Few studies have compared statistical and visual analysis, and information about more recently developed statistics is scarce. Therefore, our purpose was to evaluate the agreement between visual analysis and four statistical analyses: improvement rate difference (IRD); Tau-U; Hedges, Pustejovsky, Shadish (HPS) effect size; and between-case standardized mean difference (BC-SMD). Results indicate that IRD and BC-SMD had the strongest overall agreement with visual analysis. Although Tau-U had strong agreement with visual analysis on raw values, it had poorer agreement when those values were dichotomized to represent the presence or absence of a functional relation. Overall, visual analysis appeared to be more conservative than statistical analysis, but further research is needed to evaluate the nature of these disagreements.

75 FR 3187 - Defense Federal Acquisition Regulation Supplement: Inflation Adjustment of Acquisition-Related...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-20

... Davis-Bacon Act, Service Contract Act, and trade agreements thresholds. This case also reviews... Contract Act, and trade agreements thresholds. This case also reviews nonstatutory DFARS acquisition... Davis Bacon Act, the Service Contract Act, or trade agreements. The statute does not authorize DoD to...

Predicting Phonetic Transcription Agreement: Insights from Research in Infant Vocalizations

ERIC Educational Resources Information Center

Ramsdell, Heather L.; Oller, D. Kimbrough; Ethington, Corinna A.

2007-01-01

The purpose of this study is to provide new perspectives on correlates of phonetic transcription agreement. Our research focuses on phonetic transcription and coding of infant vocalizations. The findings are presumed to be broadly applicable to other difficult cases of transcription, such as found in severe disorders of speech, which similarly…

Assessing the "need to negotiate" in FERC licensing consultations: a study of two hydropower projects

USGS Publications Warehouse

Coughlan, Beth A. K.; Burkardt, Nina; Fulton, David

1993-01-01

We investigated the “need to negotiate” in a comparative case study of multi-agency negotiations in the FERC licensing process. Researchers interviewed participants in two cases involving environmental consultations and asked about parties' level of need to negotiate throughout the process. Participants identified a need to negotiate, and when this need was strongly felt, there was an increased opportunity for an agreement to be reached. An intense need to negotiate by all parties is not a prerequisite to successful agreements. When key participants have a strong need to negotiate, they can instigate negotiations and encourage the involvement of other parties.

Curriculum Change and Self-Governing Agreements: A Yukon First Nation Case Study

ERIC Educational Resources Information Center

Lewthwaite, Brian Ellis; Owen, Thomas; Doiron, Ashley

2015-01-01

Recent developments in Canada's Yukon Territory draw attention to how political changes have potential for accelerating practices in education that are responsive to Indigenous Peoples' cultural knowledge systems and practices. In this study, through the use of case study methodology, an account of the changes that have occurred in one First…

Assessment of the variation in American Society of Anesthesiologists [corrected] Physical Status Classification assignment in small animal anaesthesia.

PubMed

McMillan, Matthew; Brearley, Jacqueline

2013-05-01

To evaluate the interobserver variability in the assignment of the American Society of Anesthesiologists Physical Status Classification (ASA-PSC) to compromised small animal patients amongst a group of veterinary anaesthetists. Anonymous internet survey. Hypothetical case presentations. Sixteen hypothetical small animal cases with differing degrees of physiological or patho-physiological compromise were presented as part of an internet survey. Respondents were asked to assign a single ASA-PSC to each case and also to answer a number of demographic questions. ASA-PSC scores were considered separately and then grouped as scores of I-II and III-V. Agreement was analysed using the modified kappa statistic for multiple observers. Data were then sorted into various demographic groups for further analysis. There were 144 respondents of which 60 (~42%) were anaesthesia diplomates, 24 (~17%) were post-residency (nondiploma holders), 24 (~17%) were current anaesthesia residents, 21 (~15%) were general practitioners, 12 (~8%) were veterinary nurses or technicians, and 3 (~2%) were interns. Although there was a majority agreement (>50% in a single category) in 15 of the 16 cases, ASA-PSC were spread over at least three ASA-PS classifications for every case. Overall agreement was considered only fair (κ = 0.24, mean ± SD agreement 46 ± 7%). When comparing grouped data (ASA-PSC I-II versus III-V) overall agreement remained fair (κ = 0.36, mean ± SD agreement 69 ± 19%). There was no difference in ASA-PSC assignment between any of the demographic groups investigated. This study suggests major discrepancies can occur between observers given identical information when using the ASA-PSC to categorise health status in compromised small animal patients. The significant potential for interobserver variability in classification allocation should be borne in mind when the ASA-PSC is used for clinical, scientific and statistical purposes. © 2013 The Authors. Veterinary Anaesthesia and Analgesia © 2013 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesia and Analgesia.

An analytical study of the effect of coolant flow variables on the kinetic energy output of a cooled turbine blade row.

NASA Technical Reports Server (NTRS)

Prust, H. W., Jr.

1972-01-01

Demonstration that the change in output of a cooled turbine blade row relative to the specific output of the uncooled blade row can be positive, negative, or zero, depending on the velocity, injection location, injection angle, and temperature of the coolant. Comparisons between the analytical results and experimental results for four different cases of coolant discharge, all at a coolant temperature ratio of unity, show good agreement for three cases, and rather poor agreement for the other.

The Rhetoric of Industrial Espionage: The Case of "Starwood v. Hilton"

ERIC Educational Resources Information Center

Jameson, Daphne A.

2011-01-01

When Starwood Hotels charged Hilton Hotels with industrial espionage, the case hinged on an employment agreement that two executives had violated. The rhetoric of the employment agreement contrasted greatly with that of the corporation's own code of business conduct. Whereas the private agreement stressed narrow self-interest, the public code…

26 CFR 1.367(a)-8 - Gain recognition agreement requirements.

Code of Federal Regulations, 2014 CFR

2014-04-01

.... Paragraph (k) of this section provides exceptions for certain events that would otherwise require gain to be... certain cases where it is not appropriate for the gain recognition agreement to continue. See paragraph (k... paragraph (k)(14) of this section. In the case of a gain recognition agreement entered into pursuant to...

26 CFR 1.367(a)-8 - Gain recognition agreement requirements.

Code of Federal Regulations, 2013 CFR

2013-04-01

.... Paragraph (k) of this section provides exceptions for certain events that would otherwise require gain to be... certain cases where it is not appropriate for the gain recognition agreement to continue. See paragraph (k... paragraph (k)(14) of this section. In the case of a gain recognition agreement entered into pursuant to...

Inter-observer and intra-observer agreement between embryologists during selection of a single Day 5 embryo for transfer: a multicenter study.

PubMed

Storr, Ashleigh; Venetis, Christos A; Cooke, Simon; Kilani, Suha; Ledger, William

2017-02-01

What is the inter-observer and intra-observer agreement between embryologists when selecting a single Day 5 embryo for transfer? The inter-observer and intra-observer agreement between embryologists when selecting a single Day 5 embryo for transfer was generally good, although not optimal, even among experienced embryologists. Previous research on the morphological assessment of early stage (two pronuclei to Day 3) embryos has shown varying levels of inter-observer and intra-observer agreement. However, single blastocyst transfer is now becoming increasingly popular and there are no published data that assess inter-observer and intra-observer agreement when selecting a single embryo for Day 5 transfer. This was a prospective study involving 10 embryologists working at five different IVF clinics within a single organization between July 2013 and November 2015. The top 10 embryologists were selected based on their yearly Quality Assurance Program scores for blastocyst grading and were asked to morphologically grade all Day 5 embryos and choose a single embryo for transfer in a survey of 100 cases using 2D images. A total of 1000 decisions were therefore assessed. For each case, Day 5 images were shown, followed by a Day 3 and Day 5 image of the same embryo. Subgroup analyses were also performed based on the following characteristics of embryologists: the level of clinical embryology experience in the laboratory; amount of research experience; number of days per week spent grading embryos. The agreement between these embryologists and the one that scored the embryos on the actual day of transfer was also evaluated. Inter-observer and intra-observer variability was assessed using the kappa coefficient to evaluate the extent of agreement. This study showed that all 10 embryologists agreed on the embryo chosen for transfer in 50 out of 100 cases. In 93 out of 100 cases, at least 6 out of the 10 embryologists agreed. The inter-observer and intra-observer agreement among embryologists when selecting a single Day 5 embryo for transfer was generally good as assessed by the kappa scores (kappa = 0.734, 95% CI: 0.665-0.791 and 0.759, 95% CI: 0.622-0.833, respectively). The subgroup analyses did not substantially alter the inter-observer and intra-observer agreement among embryologists. The agreement when Day 3 images were included alongside Day 5 images of the same embryos resulted in a change of mind at least three times by each embryologist (on average for <10% of cases) and resulted in a small decrease in inter-observer and intra-observer agreement between embryologists (kappa = 0.676, 95% CI: 0.617-0.724 and 0.752, 95% CI: 0.656-808, respectively).The assessment of the inter-observer agreement with regard to morphological grading of Day 5 embryos showed only a fair-to-moderate agreement, which was observed across all subgroup analyses. The highest overall kappa coefficient was seen for the grading of the developmental stage of an embryo (0.513; 95% CI: 0.492-0.538). The findings were similar when the individual embryologists were compared with the embryologist who made the morphological assessments of the available embryos on the actual day of transfer. All embryologists had already completed their training and were working under one organization with similar policies between the five clinics. Therefore, the inter-observer agreement might not be as high between embryologists working in clinics with different policies or with different levels of training. The generally good, although not optimal uniformity between participating embryologists when selecting a Day 5 embryo for transfer, as well as, the surprisingly low agreement when morphologically grading Day 5 embryos could be improved, potentially resulting in increased pregnancy rates. Future studies need to be directed toward technologies that can help achieve this. None declared. Not applicable. © The Author 2016. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Intratumoral heterogeneity as a source of discordance in breast cancer biomarker classification.

PubMed

Allott, Emma H; Geradts, Joseph; Sun, Xuezheng; Cohen, Stephanie M; Zirpoli, Gary R; Khoury, Thaer; Bshara, Wiam; Chen, Mengjie; Sherman, Mark E; Palmer, Julie R; Ambrosone, Christine B; Olshan, Andrew F; Troester, Melissa A

2016-06-28

Spatial heterogeneity in biomarker expression may impact breast cancer classification. The aims of this study were to estimate the frequency of spatial heterogeneity in biomarker expression within tumors, to identify technical and biological factors contributing to spatial heterogeneity, and to examine the impact of discordant biomarker status within tumors on clinical record agreement. Tissue microarrays (TMAs) were constructed using two to four cores (1.0 mm) for each of 1085 invasive breast cancers from the Carolina Breast Cancer Study, which is part of the AMBER Consortium. Immunohistochemical staining for estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) was quantified using automated digital imaging analysis. The biomarker status for each core and for each case was assigned using clinical thresholds. Cases with core-to-core biomarker discordance were manually reviewed to distinguish intratumoral biomarker heterogeneity from misclassification of biomarker status by the automated algorithm. The impact of core-to-core biomarker discordance on case-level agreement between TMAs and the clinical record was evaluated. On the basis of automated analysis, discordant biomarker status between TMA cores occurred in 9 %, 16 %, and 18 % of cases for ER, PR, and HER2, respectively. Misclassification of benign epithelium and/or ductal carcinoma in situ as invasive carcinoma by the automated algorithm was implicated in discordance among cores. However, manual review of discordant cases confirmed spatial heterogeneity as a source of discordant biomarker status between cores in 2 %, 7 %, and 8 % of cases for ER, PR, and HER2, respectively. Overall, agreement between TMA and clinical record was high for ER (94 %), PR (89 %), and HER2 (88 %), but it was reduced in cases with core-to-core discordance (agreement 70 % for ER, 61 % for PR, and 57 % for HER2). Intratumoral biomarker heterogeneity may impact breast cancer classification accuracy, with implications for clinical management. Both manually confirmed biomarker heterogeneity and misclassification of biomarker status by automated image analysis contribute to discordant biomarker status between TMA cores. Given that manually confirmed heterogeneity is uncommon (<10 % of cases), large studies are needed to study the impact of heterogeneous biomarker expression on breast cancer classification and outcomes.

Randomized control trial follow-up: Online program and waiting period for unmarried parents in Title IV-D Court.

PubMed

Rudd, Brittany N; Poladian, Ani R; Holtzworth-Munroe, Amy; Applegate, Amy G; D'Onofrio, Brian M

2017-04-01

Despite a lack of research on parent programs for separating unmarried parents, many judicial officers mandate participation. Rudd, Holtzworth-Munroe, Reyome, Applegate, and D'Onofrio (2015) conducted the only randomized controlled trial of any online parent program for separating parents, ProudToParent.org (PTP), and related court processes (e.g., having a waiting period between the establishment of paternity and the court hearing regarding child related issues vs. having the hearing the same day). They recruited a unique sample of 182 cases in a Title IV-D Court (i.e., a court for primarily low income parents) (Authorization of Appropriations, 42 U.S.C. § 651, 2013), in which paternity was previously contested but subsequently established via court-ordered genetic testing. Unexpectedly, cases assigned to PTP and a waiting period were the least likely to reach agreement at their court hearing. In the current study, we extend these results to examine the impact of the study conditions on relitigation in the year following the court hearing; only 11.2% of cases filed a motion, and 7.8% had a hearing. The group that was least likely to reach full initial agreement (i.e., assigned to PTP and the waiting period) were the most likely to relitigate. Further, controlling for study conditions, reaching a full agreement in the Title IV-D court decreased the odds of having a court hearing in the following year. Reaching agreements on the specific issues involved in such cases (e.g., custody, child support) reduced the likelihood of both motions and hearings in the year after the Title IV-D hearings. The implications of these findings are discussed. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Assessment of the calibration of periodontal diagnosis and treatment planning among dental students at three dental schools.

PubMed

Lane, Brittany A; Luepke, Paul; Chaves, Eros; Maupome, Gerardo; Eckert, George J; Blanchard, Steven; John, Vanchit

2015-01-01

Calibration in diagnosis and treatment planning is difficult to achieve due to variations that exist in clinical interpretation. To determine if dental faculty members are consistent in teaching how to diagnose and treat periodontal disease, variations among dental students can be evaluated. A previous study reported high variability in diagnoses and treatment plans of periodontal cases at Indiana University School of Dentistry. This study aimed to build on that one by extending the research to two additional schools: Marquette University School of Dentistry and West Virginia University School of Dentistry. Diagnosis and treatment planning by 40 third- and fourth-year dental students were assessed at each of the schools. Students were asked to select the diagnosis and treatment plans on a questionnaire pertaining to 11 cases. Their responses were compared using chi-square tests, and multirater kappa statistics were used to assess agreement between classes and between schools. Logistic regression models were used to evaluate the effects of school, class year, prior experience, and GPA/class rank on correct responses. One case had a statistically significant difference in responses between third- and fourth-year dental students. Kappas for school agreement and class agreement were low. The students from Indiana University had higher diagnosis and treatment agreements than the Marquette University students, and the Marquette students fared better than the West Virginia University students. This study can help restructure future periodontal courses for a better understanding of periodontal diagnosis and treatment planning.

Agreement between TOAST and CCS ischemic stroke classification: the NINDS SiGN study.

PubMed

McArdle, Patrick F; Kittner, Steven J; Ay, Hakan; Brown, Robert D; Meschia, James F; Rundek, Tatjana; Wassertheil-Smoller, Sylvia; Woo, Daniel; Andsberg, Gunnar; Biffi, Alessandro; Brenner, David A; Cole, John W; Corriveau, Roderick; de Bakker, Paul I W; Delavaran, Hossein; Dichgans, Martin; Grewal, Raji P; Gwinn, Katrina; Huq, Mohammed; Jern, Christina; Jimenez-Conde, Jordi; Jood, Katarina; Kaplan, Robert C; Katschnig, Petra; Katsnelson, Michael; Labovitz, Daniel L; Lemmens, Robin; Li, Linxin; Lindgren, Arne; Markus, Hugh S; Peddareddygari, Leema R; Pedersén, Annie; Pera, Joanna; Redfors, Petra; Roquer, Jaume; Rosand, Jonathan; Rost, Natalia S; Rothwell, Peter M; Sacco, Ralph L; Sharma, Pankaj; Slowik, Agnieszka; Sudlow, Cathie; Thijs, Vincent; Tiedt, Steffen; Valenti, Raffaella; Worrall, Bradford B

2014-10-28

The objective of this study was to assess the level of agreement between stroke subtype classifications made using the Trial of Org 10172 Acute Stroke Treatment (TOAST) and Causative Classification of Stroke (CCS) systems. Study subjects included 13,596 adult men and women accrued from 20 US and European genetic research centers participating in the National Institute of Neurological Disorders and Stroke (NINDS) Stroke Genetics Network (SiGN). All cases had independently classified TOAST and CCS stroke subtypes. Kappa statistics were calculated for the 5 major ischemic stroke subtypes common to both systems. The overall agreement between TOAST and CCS was moderate (agreement rate, 70%; κ = 0.59, 95% confidence interval [CI] 0.58-0.60). Agreement varied widely across study sites, ranging from 28% to 90%. Agreement on specific subtypes was highest for large-artery atherosclerosis (κ = 0.71, 95% CI 0.69-0.73) and lowest for small-artery occlusion (κ = 0.56, 95% CI 0.54-0.58). Agreement between TOAST and CCS diagnoses was moderate. Caution is warranted when comparing or combining results based on the 2 systems. Replication of study results, for example, genome-wide association studies, should utilize phenotypes determined by the same classification system, ideally applied in the same manner. © 2014 American Academy of Neurology.

Interrater reliability of identifying indicators of posterior ligamentous complex disruption when plain films are indeterminate in thoracolumbar injuries.

PubMed

Schweitzer, Karl M; Vaccaro, Alexander R; Harrop, James S; Hurlbert, John; Carrino, John A; Rechtine, Glenn R; Schwartz, David G; Alanay, Ahmet; Sharma, Dinesh K; Anderson, D Greg; Lee, Joon Y; Arnold, Paul M

2007-09-01

The Spine Trauma Study Group (STSG) has proposed a novel thoracolumbar injury classification system and score (TLICS) in an attempt to define traumatic spinal injuries and direct appropriate management schemes objectively. The TLICS assigns specific point values based on three variables to generate a final severity score that guides potential treatment options. Within this algorithm, significant emphasis has been placed on posterior ligamentous complex (PLC) integrity. The purpose of this study was to determine the interrater reliability of indicators surgeons use when assessing PLC disruption on imaging studies, including computed tomography (CT) and magnetic resonance imaging (MRI). Orthopedic surgeons and neurosurgeons retrospectively reviewed a series of thoracolumbar injury case studies. Thirteen case studies, including images, were distributed to STSG members for individual, independent evaluation of the following three criteria: (1) diastasis of the facet joints on CT; (2) posterior edema-like signal in the region of PLC components on sagittal T2-weighted fat saturation (FAT SAT) MRI; and (3) disrupted PLC components on sagittal T1-weighted MRI. Interrater agreement on the presence or absence of each of the three criteria in each of the 13 cases was assessed. Absolute interrater percent agreement on diastasis of the facet joints on CT and posterior edema-like signal in the region of PLC components on sagittal T2-weighted FAT SAT MRI was similar (agreement 70.5%). Interrater agreement on disrupted PLC components on sagittal T1-weighted MRI was 48.9%. Facet joint diastasis on CT was the most reliable indicator of PLC disruption as assessed by both Cohen's kappa (kappa = 0.395) and intraclass correlation coefficient (ICC 0.430). The interrater reliability of assessing diastasis of the facet joints on CT had fair to moderate agreement. The reliability of assessing the posterior edema-like signal in the region of PLC components was lower but also fair, whereas the reliability of identifying disrupted PLC components was poor.

Tutor versus Peer Group Assessment of Student Performance in a Simulation Training Exercise.

ERIC Educational Resources Information Center

Kwan, Kam-por; Leung, Roberta

1996-01-01

Performance in a simulation exercise of 96 third-year college students studying the hotel and tourism industries was assessed separately by teacher and peers using an identical checklist. Although results showed some agreement between teacher and peers, when averaged marks were converted into grades, agreement occurred in under half the cases.…

Agreement between FRAX scores calculated with and without bone mineral density in women with osteopenia in Turkey.

PubMed

Olmez Sarikaya, Nese; Kapar Yavasi, Secil; Tan, Gulten; Satiroglu, Servet; Yildiz, Arife Hilal; Oz, Bengi; Yoleri, Ozlem; Memis, Asuman

2014-12-01

This study aimed to analyze the agreement between FRAX scores calculated with and without femoral neck (FN) bone mineral density (BMD) and to investigate the resultant treatment recommendations in women with osteopenia. A cross-sectional review of postmenopausal women who were referred for DXA evaluation was conducted. One hundred twenty-nine postmenopausal women aged 40 years and older with osteopenia [FN T-score between -1 and (-2.5)] were recruited for the study. Absolute agreement between FRAX scores calculated with and without BMD was analyzed by intraclass correlation analysis (ICC). Thresholds recommended by National Osteoporosis Foundation were used for treatment recommendations. Correlation between demographic factors and the difference in BMD+ and BMD- FRAX scores was analyzed by Spearman correlation test. Agreement levels and treatment recommendations were also analyzed in 112/129 patients without previous fracture. Agreement between BMD+ and BMD- MO and hip FRAX scores was good (ICC 0.867) and fair to good (ICC 0.641), respectively. In patients without previous fracture, agreement between MO and hip fracture probabilities was good (ICC = 0.838 and ICC = 0.778, respectively). Treatment recommendations with respect to treatment threshold of ≥3 for hip fracture probabilities were identical in 120/129 (93 %) cases. Difference between BMD+ and BMD- fracture probabilities was correlated with age and FN BMD. In most cases, FRAX without BMD provided the same treatment recommendations as FRAX with BMD in postmenopausal women with osteopenia. Exclusion of patients with previous fracture yielded better agreement levels.

Late L2ers can acquire grammatical features that do not occur in their L1: Evidence from the effect of animacy on verb agreement in L1 Chinese.

PubMed

Lempert, Henrietta

2016-05-01

Second language (L2) learners often have persistent difficulty with agreement between the number of the subject and the number of the verb. This study tested whether deviant L2 verb number agreement reflects maturational constraints on acquiring new grammatical features or resource limitations that impede access to the representations of L2 grammatical features. L1-Chinese undergraduate students at three age of arrival (AoA) levels were tested for online verb agreement accuracy by completing preambles in three animacy combinations: animate-inanimate [AI; e.g., The officer(s) from the station(s)], inanimate-animate [IA; e.g., The letters from the lawyer(s)], and inanimate-inanimate [II; e.g., The poster(s) from the museum(s)]. AI should be less costly to process than IA or II sequences, because animacy supports the subject in AI but competes with the subject for control of agreement in IA sequences, and is neutralized in II. Agreement accuracy was greater overall for AI than for IA or II, and although an AoA-related increase in erroneous agreement after plural subjects occurred for IA and II, there were no AoA effects for AI. Higher scores on memory tasks were associated with greater agreement accuracy, and the memory tasks significantly predicted variance in erroneous agreement when AoA was partialed out. The fact that even late learners can do verb agreement in the case of AI demonstrates that they can acquire new grammatical features. The greater difficulty with agreement in the case of IA or II than of AI, in conjunction with the results for the memory tasks, supports the resource limitation hypothesis.

Evaluation of the interpretative skills of participants of a limited transthoracic echocardiography training course (H.A.R.T.scan course).

PubMed

Royse, C F; Haji, D L; Faris, J G; Veltman, M G; Kumar, A; Royse, A G

2012-05-01

Limited transthoracic echocardiography performed by treating physicians may facilitate assessment of haemodynamic abnormalities in perioperative and critical care patients. The interpretative skills of one hundred participants who completed an education program in limited transthoracic echocardiography were assessed by reporting five pre-recorded case studies. A high level of agreement was observed in ventricular volume assessment (left 95%, right 96%), systolic function (left 99%, right 96%), left atrial pressure (96%) and haemodynamic state (97%). The highest failure to report answers (that is, no answer given) was for right ventricular volume and function. For moderate or severe valve lesions, agreement ranged from 90 to 98%, with failure to report <5% in all cases except for mitral stenosis (18%). For mild valve lesions, the range of agreement was lower (53 to 100%) due to overestimation of severity. Medical practitioners who completed the structured educational program showed good agreement with experts in interpretation of valve and ventricular function.

Investigating Actuation Force Fight with Asynchronous and Synchronous Redundancy Management Techniques

NASA Technical Reports Server (NTRS)

Hall, Brendan; Driscoll, Kevin; Schweiker, Kevin; Dutertre, Bruno

2013-01-01

Within distributed fault-tolerant systems the term force-fight is colloquially used to describe the level of command disagreement present at redundant actuation interfaces. This report details an investigation of force-fight using three distributed system case-study architectures. Each case study architecture is abstracted and formally modeled using the Symbolic Analysis Laboratory (SAL) tool chain from the Stanford Research Institute (SRI). We use the formal SAL models to produce k-induction based proofs of a bounded actuation agreement property. We also present a mathematically derived bound of redundant actuation agreement for sine-wave stimulus. The report documents our experiences and lessons learned developing the formal models and the associated proofs.

[Inter-observes agreement of Ishak and Metavir scores in histological evaluation of chronic viral hepatitis B and C].

PubMed

Rammeh, Soumaya; Khadra, Hajer Ben; Znaidi, Nadia Sabbegh; Romdhane, Neila Attia; Najjar, Taoufik; Bouzaidi, Slim; Zermani, Rachida

2014-01-01

Many classification systems are currently used for histological evaluation of the severity of chronic viral hepatitis, including the Ishak and Metavir scores, but there is not a consensus classification. The objective of this work was to study the intra and inter-observers agreement of these two scores in the histopathological analysis of liver biopsies in patients with chronic viral hepatitis B or C. Fifty nine patients were included in the study, 26 had chronic hepatitis C and 33 had chronic hepatitis B. To investigate the inter-observers agreement, the liver biopsies were analyzed separately by two pathologists without prior consensus reading. The two pathologists conducted then a consensual reading before reviewing all cases independently. Cohen's kappa coefficient was calculated and in case of asymmetry Spearman's rho coefficient. Before the consensus reading, the agreement was moderate for the analysis of histological activity with both scores (Metavir: kappa=0.41, Ishak: rho=0.58). For the analysis of fibrosis, the agreement was good with both scores (Metavir: kappa=0.61, Ishak: rho=0.86). The consensus reading has improved the reproducibility of the activity that has become good with both scores (Metavir: kappa=0.77, Ishak: rho=0.76). For fibrosis improvement was observed with the Ishak score which agreement became excellent (kappa=0.81). In conclusion, we recommend in routine practice, a combined score: Metavir for activity and Ishak for fibrosis and to make a double reading for each biopsy.

Comparison of two expert-based assessments of diesel exhaust exposure in a case-control study: programmable decision rules versus expert review of individual jobs.

PubMed

Pronk, Anjoeka; Stewart, Patricia A; Coble, Joseph B; Katki, Hormuzd A; Wheeler, David C; Colt, Joanne S; Baris, Dalsu; Schwenn, Molly; Karagas, Margaret R; Johnson, Alison; Waddell, Richard; Verrill, Castine; Cherala, Sai; Silverman, Debra T; Friesen, Melissa C

2012-10-01

Professional judgment is necessary to assess occupational exposure in population-based case-control studies; however, the assessments lack transparency and are time-consuming to perform. To improve transparency and efficiency, we systematically applied decision rules to questionnaire responses to assess diesel exhaust exposure in the population-based case-control New England Bladder Cancer Study. 2631 participants reported 14 983 jobs; 2749 jobs were administered questionnaires ('modules') with diesel-relevant questions. We applied decision rules to assign exposure metrics based either on the occupational history (OH) responses (OH estimates) or on the module responses (module estimates); we then combined the separate OH and module estimates (OH/module estimates). Each job was also reviewed individually to assign exposure (one-by-one review estimates). We evaluated the agreement between the OH, OH/module and one-by-one review estimates. The proportion of exposed jobs was 20-25% for all jobs, depending on approach, and 54-60% for jobs with diesel-relevant modules. The OH/module and one-by-one review estimates had moderately high agreement for all jobs (κ(w)=0.68-0.81) and for jobs with diesel-relevant modules (κ(w)=0.62-0.78) for the probability, intensity and frequency metrics. For exposed subjects, the Spearman correlation statistic was 0.72 between the cumulative OH/module and one-by-one review estimates. The agreement seen here may represent an upper level of agreement because the algorithm and one-by-one review estimates were not fully independent. This study shows that applying decision-based rules can reproduce a one-by-one review, increase transparency and efficiency, and provide a mechanism to replicate exposure decisions in other studies.

Agreement among healthcare professionals in ten European countries in diagnosing case-vignettes of surgical-site infections.

PubMed

Birgand, Gabriel; Lepelletier, Didier; Baron, Gabriel; Barrett, Steve; Breier, Ann-Christin; Buke, Cagri; Markovic-Denic, Ljiljana; Gastmeier, Petra; Kluytmans, Jan; Lyytikainen, Outi; Sheridan, Elizabeth; Szilagyi, Emese; Tacconelli, Evelina; Troillet, Nicolas; Ravaud, Philippe; Lucet, Jean-Christophe

2013-01-01

Although surgical-site infection (SSI) rates are advocated as a major evaluation criterion, the reproducibility of SSI diagnosis is unknown. We assessed agreement in diagnosing SSI among specialists involved in SSI surveillance in Europe. Twelve case-vignettes based on suspected SSI were submitted to 100 infection-control physicians (ICPs) and 86 surgeons in 10 European countries. Each participant scored eight randomly-assigned case-vignettes on a secure online relational database. The intra-class correlation coefficient (ICC) was used to assess agreement for SSI diagnosis on a 7-point Likert scale and the kappa coefficient to assess agreement for SSI depth on a three-point scale. Intra-specialty agreement for SSI diagnosis ranged across countries and specialties from 0.00 (95%CI, 0.00-0.35) to 0.65 (0.45-0.82). Inter-specialty agreement varied from 0.04 (0.00-0.62) in to 0.55 (0.37-0.74) in Germany. For all countries pooled, intra-specialty agreement was poor for surgeons (0.24, 0.14-0.42) and good for ICPs (0.41, 0.28-0.61). Reading SSI definitions improved agreement among ICPs (0.57) but not surgeons (0.09). Intra-specialty agreement for SSI depth ranged across countries and specialties from 0.05 (0.00-0.10) to 0.50 (0.45-0.55) and was not improved by reading SSI definition. Among ICPs and surgeons evaluating case-vignettes of suspected SSI, considerable disagreement occurred regarding the diagnosis, with variations across specialties and countries.

Agreement among Healthcare Professionals in Ten European Countries in Diagnosing Case-Vignettes of Surgical-Site Infections

PubMed Central

Birgand, Gabriel; Lepelletier, Didier; Baron, Gabriel; Barrett, Steve; Breier, Ann-Christin; Buke, Cagri; Markovic-Denic, Ljiljana; Gastmeier, Petra; Kluytmans, Jan; Lyytikainen, Outi; Sheridan, Elizabeth; Szilagyi, Emese; Tacconelli, Evelina; Troillet, Nicolas; Ravaud, Philippe; Lucet, Jean-Christophe

2013-01-01

Objective Although surgical-site infection (SSI) rates are advocated as a major evaluation criterion, the reproducibility of SSI diagnosis is unknown. We assessed agreement in diagnosing SSI among specialists involved in SSI surveillance in Europe. Methods Twelve case-vignettes based on suspected SSI were submitted to 100 infection-control physicians (ICPs) and 86 surgeons in 10 European countries. Each participant scored eight randomly-assigned case-vignettes on a secure online relational database. The intra-class correlation coefficient (ICC) was used to assess agreement for SSI diagnosis on a 7-point Likert scale and the kappa coefficient to assess agreement for SSI depth on a three-point scale. Results Intra-specialty agreement for SSI diagnosis ranged across countries and specialties from 0.00 (95%CI, 0.00–0.35) to 0.65 (0.45–0.82). Inter-specialty agreement varied from 0.04 (0.00–0.62) in to 0.55 (0.37–0.74) in Germany. For all countries pooled, intra-specialty agreement was poor for surgeons (0.24, 0.14–0.42) and good for ICPs (0.41, 0.28–0.61). Reading SSI definitions improved agreement among ICPs (0.57) but not surgeons (0.09). Intra-specialty agreement for SSI depth ranged across countries and specialties from 0.05 (0.00–0.10) to 0.50 (0.45–0.55) and was not improved by reading SSI definition. Conclusion Among ICPs and surgeons evaluating case-vignettes of suspected SSI, considerable disagreement occurred regarding the diagnosis, with variations across specialties and countries. PMID:23874690

[Multi-centre clinical assessment of the Russian language version of the Diagnostic Interview for Psychoses].

PubMed

Smirnova, D A; Petrova, N N; Pavlichenko, A V; Martynikhin, I A; Dorofeikova, M V; Eremkin, V I; Izmailova, O V; Osadshiy, Yu Yu; Romanov, D V; Ubeikon, D A; Fedotov, I A; Sheifer, M S; Shustov, A D; Yashikhina, A A; Clark, M; Badcock, J; Watterreus, A; Morgan, V; Jablensky, A

2018-01-01

The Diagnostic Interview for Psychoses (DIP) was developed to enhance the quality of diagnostic assessment of psychotic disorders. The aim of the study was the adaptation of the Russian language version and evaluation of its validity and reliability. Ninety-eight patients with psychotic disorders (89 video recordings) were assessed by 12 interviewers using the Russian version of DIP at 7 clinical sites (in 6 cities of the Russian Federation). DIP ratings on 32 cases of a randomized case sample were made by 9 interviewers and the inter-rater reliability was compared with the researchers' DIP ratings. Overall pairwise agreement and Cohen's kappa were calculated. Diagnostic validity was evaluated on the basis of comparing the researchers' ratings using the Russian version of DIP with the 'gold standard' ratings of the same 62 clinical cases from the Western Australia Family Study Schizophrenia (WAFSS). The mean duration of the interview was 47±21 minutes. The Kappa statistic demonstrated a significant or almost perfect level of agreement on the majority of DIP items (84.54%) and a significant agreement for the ICD-10 diagnoses generated by the DIP computer diagnostic algorithm (κ=0.68; 95% CI 0.53,0.93). The level of agreement on the researchers' diagnoses was considerably lower (κ=0.31; 95% CI 0.06,0.56). The agreement on affective and positive psychotic symptoms was significantly higher than agreement on negative symptoms (F(2,44)=20.72, p<0.001, η2=0.485). The diagnostic validity of the Russian language version of DIP was confirmed by 73% (45/62) of the Russian DIP diagnoses matching the original WAFSS diagnoses. Among the mismatched diagnoses were 80 cases with a diagnosis of F20 Schizophrenia in the medical documentation compared to the researchers' F20 diagnoses in only 68 patients and in 62 of the DIP computerized diagnostic outputs. The reported level of subjective difficulties experienced when using the DIP was low to moderate. The results of the study confirm the validity and reliability of the Russian version of the DIP for evaluating psychotic disorders. DIP can be recommended for use in education and training, clinical practice and research as an important diagnostic resource.

Studying the Supra-National in Education: GATS, Education and Teacher Union Policies

ERIC Educational Resources Information Center

Fredriksson, Ulf

2004-01-01

This article starts by putting the General Agreement on Trade in Services (GATS) into a general context of privatisation. It is noted that the privatisation process is in many cases complex and not only about full-scale privatisation of schools. The growing trade in education must be seen in this context. GATS is not an agreement which deals with…

Case Studies in Environment Integration

DTIC Science & Technology

1991-12-01

such as CADRE Teamwork and Frame Technology FrameMaker , are integrated. Future plans include integrating additional software development tools into...Pictures, Sabre C, and Interleaf or FrameMaker . Cad- re Technologies has announced integration agreements with Saber C and Pansophic, as well as offering...access to the Interleaf and FrameMaker documentation tools. While some of the current agreements between vendors to create tool coalitions are

Wheezes, crackles and rhonchi: simplifying description of lung sounds increases the agreement on their classification: a study of 12 physicians' classification of lung sounds from video recordings

PubMed Central

Melbye, Hasse; Garcia-Marcos, Luis; Brand, Paul; Everard, Mark; Priftis, Kostas; Pasterkamp, Hans

2016-01-01

Background The European Respiratory Society (ERS) lung sounds repository contains 20 audiovisual recordings of children and adults. The present study aimed at determining the interobserver variation in the classification of sounds into detailed and broader categories of crackles and wheezes. Methods Recordings from 10 children and 10 adults were classified into 10 predefined sounds by 12 observers, 6 paediatricians and 6 doctors for adult patients. Multirater kappa (Fleiss' κ) was calculated for each of the 10 adventitious sounds and for combined categories of sounds. Results The majority of observers agreed on the presence of at least one adventitious sound in 17 cases. Poor to fair agreement (κ<0.40) was usually found for the detailed descriptions of the adventitious sounds, whereas moderate to good agreement was reached for the combined categories of crackles (κ=0.62) and wheezes (κ=0.59). The paediatricians did not reach better agreement on the child cases than the family physicians and specialists in adult medicine. Conclusions Descriptions of auscultation findings in broader terms were more reliably shared between observers compared to more detailed descriptions. PMID:27158515

Correlation or Limits of Agreement? Applying the Bland-Altman Approach to the Comparison of Cognitive Screening Instruments.

PubMed

Larner, A J

2016-01-01

Calculation of correlation coefficients is often undertaken as a way of comparing different cognitive screening instruments (CSIs). However, test scores may correlate but not agree, and high correlation may mask lack of agreement between scores. The aim of this study was to use the methodology of Bland and Altman to calculate limits of agreement between the scores of selected CSIs and contrast the findings with Pearson's product moment correlation coefficients between the test scores of the same instruments. Datasets from three pragmatic diagnostic accuracy studies which examined the Mini-Mental State Examination (MMSE) vs. the Montreal Cognitive Assessment (MoCA), the MMSE vs. the Mini-Addenbrooke's Cognitive Examination (M-ACE), and the M-ACE vs. the MoCA were analysed to calculate correlation coefficients and limits of agreement between test scores. Although test scores were highly correlated (all >0.8), calculated limits of agreement were broad (all >10 points), and in one case, MMSE vs. M-ACE, was >15 points. Correlation is not agreement. Highly correlated test scores may conceal broad limits of agreement, consistent with the different emphases of different tests with respect to the cognitive domains examined. Routine incorporation of limits of agreement into diagnostic accuracy studies which compare different tests merits consideration, to enable clinicians to judge whether or not their agreement is close. © 2016 S. Karger AG, Basel.

European LeukemiaNet study on the reproducibility of bone marrow features in masked polycythemia vera and differentiation from essential thrombocythemia.

PubMed

Kvasnicka, Hans Michael; Orazi, Attilio; Thiele, Juergen; Barosi, Giovanni; Bueso-Ramos, Carlos E; Vannucchi, Alessandro M; Hasserjian, Robert P; Kiladjian, Jean-Jacques; Gianelli, Umberto; Silver, Richard; Mughal, Tariq I; Barbui, Tiziano

2017-10-01

The purpose of the study was to assess consensus and interobserver agreement among an international panel of six hematopathologists regarding characterization and reproducibility of bone marrow (BM) histologic features used to diagnose early stage myeloproliferative neoplasms, in particular differentiation of so-called masked/prodromal polycythemia vera (mPV) from JAK2-mutated essential thrombocythemia (ET). The six members of the hematopathology panel evaluated 98 BM specimens independently and in a blinded fashion without knowledge of clinical data. The specimens included 48 cases of mPV according to the originally published hemoglobin threshold values for this entity (male: 16.0-18.4 g/dL, female: 15.0-16.4 g/dL), 31 cases with overt PV according to the updated 2016 WHO criteria, and 19 control cases. The latter group included cases of JAK2-mutated ET, primary myelofibrosis, myelodysplastic syndrome, and various reactive conditions. Inter-rater agreement between the panelists was very high (overall agreement 92.6%, kappa 0.812), particularly with respect to separating mPV from ET. Virtually all cases of mPV were correctly classified as PV according to their BM morphology. In conclusion, a central blinded review of histology slides by six hematopathologists demonstrated that highly reproducible specific histological pattern characterize PV and confirmed the notion that there are no significant differences between mPV and overt PV in relation to BM morphology. © 2017 Wiley Periodicals, Inc.

Public participation for women's health: strange bedfellows or partners in a cause?

PubMed

Thurston, Wilfreda E; Vollman, Ardene Robinson; Meadows, Lynn M; Rutherford, Erin

2005-05-01

A major focus of health system reform in Canada has been the regionalization of health services administration. With a goal of bringing decision-making closer to the community, there has been a commitment to public participation in planning by some health authorities. Women, however, often feel that their participation is minimal or their needs are not addressed. During regionalization of the Alberta health system, the Calgary Health Region (CHR) negotiated an agreement with the Salvation Army to provide women's health services through the Grace Women's Health Centre, a major part of the region's women's health program. We present a case study exploring the process and final agreement and the impact of this agreement on women's participation in health policy development. The historical context and the nature and impact of the agreement are described and several participation strategies that occurred within the partnership are discussed. The development of a formal partnership agreement, a governance model, was a success for public participation in this case; however, the greatest success for women was maintenance of a political space in which women's health as a priority could be discussed in a context where the forces against gender equity talk are strong.

A Case Study of the Effects of the Gaskin Case on Seven School Districts in Southeastern Pennsylvania

ERIC Educational Resources Information Center

Bell, Suzanne H.

2010-01-01

This qualitative study investigated the impact of the Gaskin v. Pennsylvania Department of Education Court Settlement Agreement on school districts in Southeast Pennsylvania. This class action suit was brought on behalf of students with physical, behavioral and developmental delays, their parents and eleven national organizations. The lawsuit…

Characterization of Severe Arterial Phase Respiratory Motion Artifact on Gadoxetate Disodium-Enhanced MRI - Assessment of Interrater Agreement and Reliability.

PubMed

Ringe, Kristina Imeen; Luetkens, Julian A; Fimmers, Rolf; Hammerstingl, Renate Maria; Layer, Günter; Maurer, Martin H; Nähle, Claas Philip; Michalik, Sabine; Reimer, Peter; Schraml, Christina; Schreyer, Andreas G; Stumpp, Patrick; Vogl, Thomas J; Wacker, Frank K; Willinek, Winfried; Kukuk, Guido Mattias

2018-04-01

 To assess the interrater agreement and reliability of experienced abdominal radiologists in the characterization and grading of arterial phase gadoxetate disodium-related respiratory motion artifact on liver MRI.  This prospective multicenter study was initiated by the working group for abdominal imaging within the German Roentgen Society (DRG), and approved by the local IRB of each participating center. 11 board-certified radiologists independently reviewed 40 gadoxetate disodium-enhanced liver MRI datasets. Motion artifacts in the arterial phase were assessed on a 5-point scale. Interrater agreement and reliability were calculated using the intraclass correlation coefficient (ICC) and Kendall coefficient of concordance (W), with p < 0.05 deemed significant.  The ICC for interrater agreement and reliability were 0.983 (CI 0.973 - 0.990) and 0.985 (CI 0.978 - 0.991), respectively (both p < 0.0001), indicating excellent agreement and reliability. Kendall's W for interrater agreement was 0.865. A severe motion artifact, defined as a mean motion score ≥ 4 in the arterial phase was observed in 12 patients. In these specific cases, a motion score ≥ 4 was assigned by all readers in 75 % (n = 9/12 cases).  Differentiation and grading of arterial phase respiratory motion artifact is possible with a high level of inter-/intrarater agreement and interrater reliability, which is crucial for assessing the incidence of this phenomenon in larger multicenter studies.   · Inter- and intrarater agreement for motion artifact scoring is excellent among experienced readers.. · Interrater reliability for motion artifact scoring is excellent among experienced readers.. · Characterization of severe motion artifacts proved feasible in this multicenter study.. · Ringe KI, Luetkens JA, Fimmers R et al. Characterization of Severe Arterial Phase Respiratory Motion Artifact on Gadoxetate Disodium-Enhanced MRI - Assessment of Interrater Agreement and Reliability. Fortschr Röntgenstr 2017; 190: 341 - 347. © Georg Thieme Verlag KG Stuttgart · New York.

A comparison of DSM-II and DSM-III in the diagnosis of childhood psychiatric disorders. II. Interrater agreement.

PubMed

Mattison, R; Cantwell, D P; Russell, A T; Will, L

1979-10-01

A case-history format was utilized to compare interrater agreement on childhood and adolescent psychiatric disorders, using DSM-II and DSM-III. The average interrater agreement was 57% for DSM-II and 54% for axis I (clinical psychiatric syndrome) of DSM-III. There was high agreement in both systems on cases of psychosis, conduct disorder, hyperactivity, and mental retardation, with DSM-III appearing slightly better. There was noteworthy interrater disagreement in both systems for "anxiety" disorders, complex cases, and in the subtyping of depression. Overall, the reliability of DSM-III appears to be good and is comparable with that of DSM-II and other classification systems of childhood psychiatric disorders.

Learning the Ropes: A Case Study of the Academic and Social Experiences of College Transfer Students within a Developing University-College Articulation Framework

ERIC Educational Resources Information Center

Gawley, Timothy; McGowan, Rosemary A.

2006-01-01

The number of articulation agreements between Canadian colleges and universities has been increasing steadily since the early 2000s. Though various implications of these agreements have been discussed, missing are the students' grounded transfer experiences. This paper discusses the academic and social experiences of college transfer students at a…

Does a child's language ability affect the correspondence between parent and teacher ratings of ADHD symptoms?

PubMed

Gooch, Debbie; Maydew, Harriet; Sears, Claire; Norbury, Courtenay Frazier

2017-04-05

Rating scales are often used to identify children with potential Attention-Deficit/Hyperactivity Disorder (ADHD), yet there are frequently discrepancies between informants which may be moderated by child characteristics. The current study asked whether correspondence between parent and teacher ratings on the Strengths and Weakness of ADHD symptoms and Normal behaviour scale (SWAN) varied systematically with child language ability. Parent and teacher SWAN questionnaires were returned for 200 children (aged 61-81 months); 106 had low language ability (LL) and 94 had typically developing language (TL). After exploring informant correspondence (using Pearson correlation) and the discrepancy between raters, we report inter-class correlation coefficients, to assess inter-rater reliability, and Cohen's kappa, to assess agreement regarding possible ADHD caseness. Correlations between informant ratings on the SWAN were moderate. Children with LL were rated as having increased inattention and hyperactivity relative to children with TL; teachers, however, rated children with LL as having more inattention than parents. Inter-rater reliability of the SWAN was good and there were no systematic differences between the LL and TL groups. Case agreement between parent and teachers was fair; this varied by language group with poorer case agreement for children with LL. Children's language abilities affect the discrepancy between informant ratings of ADHD symptomatology and the agreement between parents and teachers regarding potential ADHD caseness. The assessment of children's core language ability would be a beneficial addition to the ADHD diagnostic process.

Predicting phonetic transcription agreement: Insights from research in infant vocalizations

PubMed Central

RAMSDELL, HEATHER L.; OLLER, D. KIMBROUGH; ETHINGTON, CORINNA A.

2010-01-01

The purpose of this study is to provide new perspectives on correlates of phonetic transcription agreement. Our research focuses on phonetic transcription and coding of infant vocalizations. The findings are presumed to be broadly applicable to other difficult cases of transcription, such as found in severe disorders of speech, which similarly result in low reliability for a variety of reasons. We evaluated the predictiveness of two factors not previously documented in the literature as influencing transcription agreement: canonicity and coder confidence. Transcribers coded samples of infant vocalizations, judging both canonicity and confidence. Correlation results showed that canonicity and confidence were strongly related to agreement levels, and regression results showed that canonicity and confidence both contributed significantly to explanation of variance. Specifically, the results suggest that canonicity plays a major role in transcription agreement when utterances involve supraglottal articulation, with coder confidence offering additional power in predicting transcription agreement. PMID:17882695

Evaluation of sensitivity and specificity of cytologic examination: 269 cases (1999-2000).

PubMed

Cohen, Michele; Bohling, Mark W; Wright, James C; Welles, Elizabeth A; Spano, Joseph S

2003-04-01

To determine sensitivity and specificity of cytologic examination used in a clinical setting. Retrospective study. 216 dogs, 44 cats, 4 horses, 2 ferrets, 1 llama, 1 rat, and 1 mouse. Records were reviewed of cases in which a cytologic diagnosis was followed by a surgical biopsy or postmortem examination within 3 days with subsequent histopathologic diagnosis. Diagnoses were compared for agreement at various levels, including complete agreement, partial agreement, no agreement, or no comparison possible because of insufficient or incorrect cytologic specimen. Levels of agreement were compared for different categories of lesions, including neoplastic, inflammatory, dysplastic-hyperplastic-other, and normal tissue. Additionally, levels of agreement for neoplastic lesions were categorized with regard to cell type, degree of malignancy, and location. Sensitivity and specificity of cytologic examination were calculated. At the level of general agreement (complete and partial agreement), the sensitivity of cytologic examination ranged from 33.3 to 66.1%, depending on the location of the lesion. Cytologic examination was most accurate when used to diagnose cutaneous and subcutaneous lesions and least accurate for diagnosis of liver lesions. Cytologic examination was most effective in diagnosis of neoplastic disease and least effective in diagnosis of dysplastic or hyperplastic conditions. Cytologic examination is a valuable diagnostic tool, although our results indicated lower accuracy than previously reported. False-negative results (missing a diagnosis) were far more common than false-positive results (categorizing a healthy animal as diseased): therefore, if the clinical index of suspicion is high, cytologic examination should be repeated or another technique should be selected to rule out the suspected condition.

31 CFR 535.441 - Settlement Agreement regarding small claims.

Code of Federal Regulations, 2014 CFR

2014-07-01

... of Less Than $250,000, Case No. 86 and Case No. B38, dated May 13, 1990 (the “Settlement Agreement... Stat. 437, applicable to en bloc settlements of claims of U.S. nationals against Iran. (b) Pursuant to... U.S. nationals, which claims are included in Cases Nos. 10001 through 12785, and which are still...

31 CFR 535.441 - Settlement Agreement regarding small claims.

Code of Federal Regulations, 2013 CFR

2013-07-01

... of Less Than $250,000, Case No. 86 and Case No. B38, dated May 13, 1990 (the “Settlement Agreement... Stat. 437, applicable to en bloc settlements of claims of U.S. nationals against Iran. (b) Pursuant to... U.S. nationals, which claims are included in Cases Nos. 10001 through 12785, and which are still...

31 CFR 535.441 - Settlement Agreement regarding small claims.

Code of Federal Regulations, 2012 CFR

2012-07-01

... of Less Than $250,000, Case No. 86 and Case No. B38, dated May 13, 1990 (the “Settlement Agreement... Stat. 437, applicable to en bloc settlements of claims of U.S. nationals against Iran. (b) Pursuant to... U.S. nationals, which claims are included in Cases Nos. 10001 through 12785, and which are still...

Abusive Administration: A Case Study

ERIC Educational Resources Information Center

Jefferson, Anne L.

2006-01-01

In the academic world, there is an assumption of reasonable administrative conduct. In fact, to ensure such conduct, universities, like other public institutions, may have collective agreements to reinforce this assumption. However, in some cases, the university as employer can very quick off the mark should any faculty member wander into what it…

Fluid Transient Analysis during Priming of Evacuated Line

NASA Technical Reports Server (NTRS)

Bandyopadhyay, Alak; Majumdar, Alok K.; Holt, Kimberley

2017-01-01

Water hammer analysis in pipe lines, in particularly during priming into evacuated lines is important for the design of spacecraft and other in-space application. In the current study, a finite volume network flow analysis code is used for modeling three different geometrical configurations: the first two being straight pipe, one with atmospheric air and other with evacuated line, and the third case is a representation of a complex flow network system. The numerical results show very good agreement qualitatively and quantitatively with measured data available in the literature. The peak pressure and impact time in case of straight pipe priming in evacuated line shows excellent agreement.

Glaucoma progression detection: agreement, sensitivity, and specificity of expert visual field evaluation, event analysis, and trend analysis.

PubMed

Antón, Alfonso; Pazos, Marta; Martín, Belén; Navero, José Manuel; Ayala, Miriam Eleonora; Castany, Marta; Martínez, Patricia; Bardavío, Javier

2013-01-01

To assess sensitivity, specificity, and agreement among automated event analysis, automated trend analysis, and expert evaluation to detect glaucoma progression. This was a prospective study that included 37 eyes with a follow-up of 36 months. All had glaucomatous disks and fields and performed reliable visual fields every 6 months. Each series of fields was assessed with 3 different methods: subjective assessment by 2 independent teams of glaucoma experts, glaucoma/guided progression analysis (GPA) event analysis, and GPA (visual field index-based) trend analysis. Kappa agreement coefficient between methods and sensitivity and specificity for each method using expert opinion as gold standard were calculated. The incidence of glaucoma progression was 16% to 18% in 3 years but only 3 cases showed progression with all 3 methods. Kappa agreement coefficient was high (k=0.82) between subjective expert assessment and GPA event analysis, and only moderate between these two and GPA trend analysis (k=0.57). Sensitivity and specificity for GPA event and GPA trend analysis were 71% and 96%, and 57% and 93%, respectively. The 3 methods detected similar numbers of progressing cases. The GPA event analysis and expert subjective assessment showed high agreement between them and moderate agreement with GPA trend analysis. In a period of 3 years, both methods of GPA analysis offered high specificity, event analysis showed 83% sensitivity, and trend analysis had a 66% sensitivity.

75 FR 33195 - Defense Federal Acquisition Regulation Supplement; New Designated Country-Taiwan-DFARS Case 2009...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-11

... Organization Government Procurement Agreement. DATES: Effective date: June 11, 2010. FOR FURTHER INFORMATION..., Taiwan became a designated country under the World Trade Organization Government Procurement Agreement... World Trade Organization Government Procurement Agreement countries in the trade agreement provisions...

Is the problem list in the eye of the beholder? An exploration of consistency across physicians.

PubMed

Krauss, John C; Boonstra, Philip S; Vantsevich, Anna V; Friedman, Charles P

2016-09-01

Quantify the variability of patients' problem lists - in terms of the number, type, and ordering of problems - across multiple physicians and assess physicians' criteria for organizing and ranking diagnoses. In an experimental setting, 32 primary care physicians generated and ordered problem lists for three identical complex internal medicine cases expressed as detailed 2- to 4-page abstracts and subsequently expressed their criteria for ordering items in the list. We studied variability in problem list length. We modified a previously validated rank-based similarity measure, with range of zero to one, to quantify agreement between pairs of lists and calculate a single consensus problem list that maximizes agreement with each physician. Physicians' reasoning for the ordering of the problem lists was recorded. Subjects' problem lists were highly variable. The median problem list length was 8 (range: 3-14) for Case A, 10 (range: 4-20) for Case B, and 7 (range: 3-13) for Case C. The median indices of agreement - taking into account the length, content, and order of lists - over all possible physician pairings was 0.479, 0.371, 0.509, for Cases A, B, and C, respectively. The median agreements between the physicians' lists and the consensus list for each case were 0.683, 0.581, and 0.697 (for Cases A, B, and C, respectively).Out of a possible 1488 pairings, 2 lists were identical. Physicians most frequently ranked problem list items based on their acuity and immediate threat to health. The problem list is a physician's mental model of a patient's health status. These mental models were found to vary significantly between physicians, raising questions about whether problem lists created by individual physicians can serve their intended purpose to improve care coordination. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Prenatal diagnosis of intra-abdominal cystic lesions by fetal ultrasonography: diagnostic agreement between prenatal and postnatal diagnosis.

PubMed

Marchitelli, Giulia; Stirnemann, Julien; Acanfora, Marta Maddalena; Rousseau, Veronique; Salomon, Laurent J; Ville, Yves

2015-09-01

The aim of this study was to assess the diagnostic agreement between the prenatal diagnosis of intra-abdominal cystic lesions made by ultrasound examination and the postnatal diagnosis. We reviewed all consecutive cases referred for an anechoic abdominal cyst from 2009 to 2013. Prenatal ultrasound diagnosis was compared with postnatal diagnosis. Prenatal diagnosis was defined as 'correct' if a specific prenatal diagnosis or one of the possible diagnoses was confirmed postnatally, as 'not confirmed' if the postnatal examination revealed no abnormalities and as 'incorrect' if the postnatal diagnosis was different from those suggested prenatally. Seventy-three cases were included, and prenatal diagnoses were made at a median gestational age of 27 weeks (range: 13-36). Correct diagnoses were made in 66 cases (90.4%), including four in which the lesion resolved spontaneously in utero; two diagnoses were 'not confirmed' postnatally, and one was incorrect (a prenatal diagnosis of intestinal duplication was in fact an anorectal malformation). Postnatal diagnosis was not achieved in four cases: None of them required surgery, and clinical follow-up was favorable. The abdominal cysts were isolated in 52 cases (71%) and associated with other anomalies in 21 cases (29%). Aneuploidies were diagnosed in three cases (all trisomy 21). Eight cases underwent termination of pregnancy; there were no fetal deaths and one neonatal death. Postnatal surgery was performed in 30 out of 65 liveborn infants (46.1%). Overall diagnostic agreement between prenatal and postnatal diagnosis of fetal intra-abdominal cystic lesions is high. © 2015 John Wiley & Sons, Ltd.

Acquisition of Gender Agreement in Lithuanian: Exploring the Effect of Diminutive Usage in an Elicited Production Task

ERIC Educational Resources Information Center

Savickiene, Ineta; Kempe, Vera; Brooks, Patricia J.

2009-01-01

This study examines Lithuanian children's acquisition of gender agreement using an elicited production task. Lithuanian is a richly inflected Baltic language, with two genders and seven cases. Younger (N = 24, mean 3 ; 1, 2 ; 5-3 ; 8) and older (N = 24, mean 6 ; 3, 5 ; 6-6 ; 9) children were shown pictures of animals and asked to describe them…

Strategic Sourcing and Spend Analysis: A Case Study of the Naval Postgraduate School

DTIC Science & Technology

2014-12-01

ABBREVIATIONS ADP Administrative Processing Data AFIT Air Force Institute of Technology AT&L Acquisition, Technology, and Logistics BPA Blanket...in awarding 74 blanket purchase agreements ( BPAs ) with various discounts less than the Federal Supply Schedule (FSS) pricing. While the cost savings...the NPS contracting office can tailor specific contract vehicles, whether blanket purchase agreements ( BPAs ) 43 or IDIQs, to suit the needs of the

7 CFR 634.15 - Agreements.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 6 2014-01-01 2014-01-01 false Agreements. 634.15 Section 634.15 Agriculture... Agreements. The State Conservationist, NRCS, upon receiving notice of an approved project, is to enter into a grant agreement with the administering agency, except in those cases where USDA is to administer the...

7 CFR 634.15 - Agreements.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 6 2012-01-01 2012-01-01 false Agreements. 634.15 Section 634.15 Agriculture... Agreements. The State Conservationist, NRCS, upon receiving notice of an approved project, is to enter into a grant agreement with the administering agency, except in those cases where USDA is to administer the...

7 CFR 634.15 - Agreements.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 6 2011-01-01 2011-01-01 false Agreements. 634.15 Section 634.15 Agriculture... Agreements. The State Conservationist, NRCS, upon receiving notice of an approved project, is to enter into a grant agreement with the administering agency, except in those cases where USDA is to administer the...

7 CFR 634.15 - Agreements.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 6 2013-01-01 2013-01-01 false Agreements. 634.15 Section 634.15 Agriculture... Agreements. The State Conservationist, NRCS, upon receiving notice of an approved project, is to enter into a grant agreement with the administering agency, except in those cases where USDA is to administer the...

7 CFR 634.15 - Agreements.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 6 2010-01-01 2010-01-01 false Agreements. 634.15 Section 634.15 Agriculture... Agreements. The State Conservationist, NRCS, upon receiving notice of an approved project, is to enter into a grant agreement with the administering agency, except in those cases where USDA is to administer the...

Comparison of two expert-based assessments of diesel exhaust exposure in a case-control study: Programmable decision rules versus expert review of individual jobs

PubMed Central

Pronk, Anjoeka; Stewart, Patricia A.; Coble, Joseph B.; Katki, Hormuzd A.; Wheeler, David C.; Colt, Joanne S.; Baris, Dalsu; Schwenn, Molly; Karagas, Margaret R.; Johnson, Alison; Waddell, Richard; Verrill, Castine; Cherala, Sai; Silverman, Debra T.; Friesen, Melissa C.

2012-01-01

Objectives Professional judgment is necessary to assess occupational exposure in population-based case-control studies; however, the assessments lack transparency and are time-consuming to perform. To improve transparency and efficiency, we systematically applied decision rules to the questionnaire responses to assess diesel exhaust exposure in the New England Bladder Cancer Study, a population-based case-control study. Methods 2,631 participants reported 14,983 jobs; 2,749 jobs were administered questionnaires (‘modules’) with diesel-relevant questions. We applied decision rules to assign exposure metrics based solely on the occupational history responses (OH estimates) and based on the module responses (module estimates); we combined the separate OH and module estimates (OH/module estimates). Each job was also reviewed one at a time to assign exposure (one-by-one review estimates). We evaluated the agreement between the OH, OH/module, and one-by-one review estimates. Results The proportion of exposed jobs was 20–25% for all jobs, depending on approach, and 54–60% for jobs with diesel-relevant modules. The OH/module and one-by-one review had moderately high agreement for all jobs (κw=0.68–0.81) and for jobs with diesel-relevant modules (κw=0.62–0.78) for the probability, intensity, and frequency metrics. For exposed subjects, the Spearman correlation statistic was 0.72 between the cumulative OH/module and one-by-one review estimates. Conclusions The agreement seen here may represent an upper level of agreement because the algorithm and one-by-one review estimates were not fully independent. This study shows that applying decision-based rules can reproduce a one-by-one review, increase transparency and efficiency, and provide a mechanism to replicate exposure decisions in other studies. PMID:22843440

The comparison of pyrosequencing molecular Gram stain, culture, and conventional Gram stain for diagnosing orthopaedic infections.

PubMed

Kobayashi, Naomi; Bauer, Thomas W; Tuohy, Marion J; Lieberman, Isador H; Krebs, Viktor; Togawa, Daisuke; Fujishiro, Takaaki; Procop, Gary W

2006-08-01

We have developed a combined real-time PCR and pyrosequencing assay that successfully differentiated the vast majority of gram-positive and gram-negative bacteria when bacterial isolates were tested. The purpose of this study was to evaluate this assay on clinical specimens obtained from orthopedic surgeries, and to prospectively compare the results of "molecular Gram stain" with culture and conventional direct Gram stain. Forty-five surgical specimens were obtained from patients who underwent orthopedic surgery procedures. The DNA was extracted and a set of broad-range PCR primers that targeted a part of the 16S rDNA gene was used for pan-bacterial PCR. The amplicons were submitted for pyrosequencing and the resulting molecular Gram stain characteristics were recorded. Culture and direct Gram staining were performed using standard methods for all cases. Surgical specimens were reviewed histologically for all cases that had a discrepancy between culture and molecular results. There was an 86.7% (39/45) agreement between the traditional and molecular methods. In 12/14 (85.7%) culture-proven cases of bacterial infection, molecular Gram stain characteristics were in agreement with the culture results, while the conventional Gram stain result was in agreement only for five cases (35.7%). In the 31 culture negative cases, 27 cases were also PCR negative, whereas 4 were PCR positive. Three of these were characterized as gram negative and one as gram positive by this molecular method. Molecular determination of the Gram stain characteristics of bacteria that cause orthopedic infections may be achieved, in most instances, by this method. Further studies are necessary to understand the clinical importance of PCR-positive/culture-negative results.

The decision to extract: Part 1--Interclinician agreement.

PubMed

Baumrind, S; Korn, E L; Boyd, R L; Maxwell, R

1996-03-01

As part of an ongoing prospective clinical trial of conventional orthodontic treatment, the decision making patterns of a representative group of orthodontic clinicians were examined. Data were available for 148 subjects (100 adolescents and 48 adults) who had presented at the University of California San Francisco Graduate Orthodontic Clinic requesting treatment for correction of a Class I or Class II malocclusion. The records for each subject were evaluated independently by each of five members of the clinical faculty, making available a total of 740 independent patient evaluations. With regard to the primary decision as to whether extraction or nonextraction treatment was to be preferred, agreement among clinicians was higher than had been anticipated. In almost two thirds of the cases, the decisions of all five clinicians were in agreement as to whether extraction or nonextraction was the preferred treatment modality. (This figure included 59 cases of complete agreement for extraction therapy (40%) and 38 cases of complete agreement for nonextraction therapy (26%)). In only 51 cases (34%), did the reviewing clinicians disagree as to whether extraction or nonextraction was the preferred modality of treatment. The clinicians were also asked to indicate their opinions as to whether orthognathic surgery was likely to be a part of the ultimate treatment course for each individual subject. Nine percent of the 740 patient evaluations contained a clinician judgement that surgery would be a probable or definite component of the orthodontic treatment plan. For 29% of the adult subjects (14 cases) and 23% of the adolescent subjects (23 cases), one or more of the five examining clinicians believed that adjunctive surgical intervention would probably or definitely be appropriate. These high values were unexpected, particularly because the sample had been prescreened by a single clinician to exclude subjects who might require orthognathic surgery. Clinician agreement of Angle classification was also evaluated. Disagreements were observed in 14 adult subjects (29%) and 27 adolescent subjects (27%). Little association was observed between clinician agreement on Angle classification and clinician agreement on whether or not to extract.

Comparing External Ventricular Drains-Related Ventriculitis Surveillance Definitions.

PubMed

Reyes, Maria M; Munigala, Satish; Church, Emily L; Kulik, Tobias B; Keyrouz, Salah G; Zipfel, Gregory J; Warren, David K

2017-05-01

OBJECTIVE To evaluate the agreement between the current National Healthcare Safety Network (NHSN) definition for ventriculitis and others found in the literature among patients with an external ventricular drain (EVD) DESIGN Retrospective cohort study from January 2009 to December 2014 SETTING Neurology and neurosurgery intensive care unit of a large tertiary-care center PATIENTS Patients with an EVD were included. Patients with an infection prior to EVD placement or a permanent ventricular shunt were excluded. METHODS We reviewed the charts of patients with positive cerebrospinal fluid (CSF) cultures and/or abnormal CSF results while they had an EVD in place and applied various ventriculitis definitions. RESULTS We identified 48 patients with a total of 52 cases of ventriculitis (41 CSF culture-positive cases and 11 cases based on abnormal CSF test results) using the NHSN definition. The most common organisms causing ventriculitis were gram-positive commensals (79.2%); however, 45% showed growth of only 1 colony on 1 piece of media. Approximately 60% of the ventriculitis cases by the NHSN definition met the Honda criteria, approximately 56% met the Gozal criteria, and 23% met Citerio's definition. Cases defined using Honda versus Gozal definitions had a moderate agreement (κ=0.528; P<.05) whereas comparisons of Honda versus Citerio definitions (κ=0.338; P<.05) and Citerio versus Gozal definitions (κ=0.384; P<.05) had only fair agreements. CONCLUSIONS The agreement between published ventriculostomy-associated infection (VAI) definitions in this cohort was moderate to fair. A VAI surveillance definition that better defines contaminants is needed for more homogenous application of surveillance definitions between institutions and better comparison of rates. Infect Control Hosp Epidemiol 2017;38:574-579.

Assessment of the reliability of data collected for the Department of Veterans Affairs national surgical quality improvement program.

PubMed

Davis, Chester L; Pierce, John R; Henderson, William; Spencer, C David; Tyler, Christine; Langberg, Robert; Swafford, Jennan; Felan, Gladys S; Kearns, Martha A; Booker, Brigitte

2007-04-01

The Office of the Medical Inspector of the Department of Veterans Affairs (VA) studied the reliability of data collected by the VA's National Surgical Quality Improvement Program (NSQIP). The study focused on case selection bias, accuracy of reports on patients who died, and interrater reliability measurements of patient risk variables and outcomes. Surgical data from a sample of 15 VA medical centers were analyzed. For case selection bias, reviewers applied NSQIP criteria to include or exclude 2,460 patients from the database, comparing their results with those of NSQIP staff. For accurate reporting of patients who died, reviewers compared Social Security numbers of 10,444 NSQIP records with those found in the VA Beneficiary Identification and Records Locator Subsystem, VA Patient Treatment Files, and Social Security Administration death files. For measurement of interrater reliability, reviewers reabstracted 59 variables in each of 550 patient medical records that also were recorded in the NSQIP database. On case selection bias, the reviewers agreed with NSQIP decisions on 2,418 (98%) of the 2,460 cases. Computer record matching identified 4 more deaths than the NSQIP total of 198, a difference of about 2%. For 52 of the categorical variables, agreement, uncorrected for chance, was 96%. For 48 of 52 categorical variables, kappas ranged from 0.61 to 1.0 (substantial to almost perfect agreement); none of the variables had kappas of less than 0.20 (slight to poor agreement). This sample of medical centers shows adherence to criteria in selecting cases for the NSQIP database, for reporting deaths, and for collecting patient risk variables.

An Independent Inter- and Intraobserver Agreement Evaluation of the AOSpine Subaxial Cervical Spine Injury Classification System.

PubMed

Urrutia, Julio; Zamora, Tomas; Yurac, Ratko; Campos, Mauricio; Palma, Joaquin; Mobarec, Sebastian; Prada, Carlos

2017-03-01

An agreement study. The aim of this study was to perform an independent interobserver and intraobserver agreement assessment of the AOSpine subaxial cervical spine injury classification system. The AOSpine subaxial cervical spine injury classification system was recently described. It showed substantial inter- and intraobserver agreement in the study describing it; however, an independent evaluation has not been performed. Anteroposterior and lateral radiographs, computed tomography scans, and magnetic resonance imaging of 65 patients with acute traumatic subaxial cervical spine injuries were selected and classified using the morphologic grading of the subaxial cervical spine injury classification system by 6 evaluators (3 spine surgeons and 3 orthopedic surgery residents). After a 6-week interval, the 65 cases were presented to the same evaluators in a random sequence for repeat evaluation. The kappa coefficient (κ) was used to determine the inter- and intraobserver agreement. The interobserver agreement was substantial when considering the fracture main types (A, B, C, or F), with κ = 0.61 (0.57-0.64), but moderate when considering the subtypes: κ = 0.57 (0.54-0.60). The intraobserver agreement was substantial considering the fracture types, with κ = 0.68 (0.62-0.74) and considering subtypes, κ = 0.62 (0.57-0.66). No significant differences were observed between spine surgeons and orthopedic residents in the overall inter- and intraobserver agreement, or in the inter- and intraobserver agreement of specific A, B, C, or F type of injuries. This classification allows adequate agreement among different observers and by the same observer on separate occasions. Future prospective studies should determine whether this classification allows surgeons to decide the best treatment for patients with subaxial cervical spine injuries. 3.

Professional Practice and Innovation: Level of Agreement between Coding Sources of Percentage Total Body Surface Area Burnt (%TBSA).

PubMed

Watterson, Dina; Cleland, Heather; Picton, Natalie; Simpson, Pam M; Gabbe, Belinda J

2011-03-01

The percentage of total body surface area burnt (%TBSA) is a critical measure of burn injury severity and a key predictor of burn injury outcome. This study evaluated the level of agreement between four sources of %TBSA using 120 cases identified through the Victorian State Trauma Registry. Expert clinician, ICD-10-AM, Abbreviated Injury Scale, and burns registry coding were compared using measures of agreement. There was near-perfect agreement (weighted Kappa statistic 0.81-1) between all sources of data, suggesting that ICD-10-AM is a valid source of %TBSA and use of ICD-10-AM codes could reduce the resource used by trauma and burns registries capturing this information.

The Pfirrmann classification of lumbar intervertebral disc degeneration: an independent inter- and intra-observer agreement assessment.

PubMed

Urrutia, Julio; Besa, Pablo; Campos, Mauricio; Cikutovic, Pablo; Cabezon, Mario; Molina, Marcelo; Cruz, Juan Pablo

2016-09-01

Grading inter-vertebral disc degeneration (IDD) is important in the evaluation of many degenerative conditions, including patients with low back pain. Magnetic resonance imaging (MRI) is considered the best imaging instrument to evaluate IDD. The Pfirrmann classification is commonly used to grade IDD; the authors describing this classification showed an adequate agreement using it; however, there has been a paucity of independent agreement studies using this grading system. The aim of this study was to perform an independent inter- and intra-observer agreement study using the Pfirrmann classification. T2-weighted sagittal images of 79 patients consecutively studied with lumbar spine MRI were classified using the Pfirrmann grading system by six evaluators (three spine surgeons and three radiologists). After a 6-week interval, the 79 cases were presented to the same evaluators in a random sequence for repeat evaluation. The intra-class correlation coefficient (ICC) and the weighted kappa (wκ) were used to determine the inter- and intra-observer agreement. The inter-observer agreement was excellent, with an ICC = 0.94 (0.93-0.95) and wκ = 0.83 (0.74-0.91). There were no differences between spine surgeons and radiologists. Likewise, there were no differences in agreement evaluating the different lumbar discs. Most differences among observers were only of one grade. Intra-observer agreement was also excellent with ICC = 0.86 (0.83-0.89) and wκ = 0.89 (0.85-0.93). In this independent study, the Pfirrmann classification demonstrated an adequate agreement among different observers and by the same observer on separate occasions. Furthermore, it allows communication between radiologists and spine surgeons.

Feasibility and reliability of remote assessment of PALS psychomotor skills via interactive videoconferencing.

PubMed

Weeks, Douglas L; Molsberry, Dianne M

2009-03-01

This study determined inter-rater agreement between skill assessments provided by on-site PALS evaluators with ratings from evaluators at a remote site viewing the same skill performance over a videoconferencing network. Judgments about feasibility of remote evaluation were also obtained from the evaluators and PALS course participants. Two remote and two on-site instructors independently rated performance of 27 course participants who performed cardiac and shock/respiratory emergency core cases. Inter-rater reliability was assessed with the intraclass correlation coefficient (ICC). Feasibility was assessed with surveys of evaluators and course participants. Core cases were under the direction of the remote evaluators. The ICC for overall agreement on pass/fail decisions was 0.997 for the cardiac cases and 0.998 for the shock/respiratory cases. Perfect agreement was reached on 52 of 54 pass/fail decisions. Across all evaluators, all core cases, and all participants, 2584 ratings of individual skill criteria were provided, of which 21 (0.8%) were ratings in which a single evaluator disagreed with the other three evaluators. No trends emerged for location of the disagreeing evaluator. Survey responses indicated that remote evaluation was acceptable and feasible to course participants and to the evaluators. Videoconferencing technology was shown to provide adequate spatial and temporal resolution for PALS evaluators at-a-distance from course participants to agree with ratings of on-site evaluators.

45 CFR 617.10 - Mediation.

Code of Federal Regulations, 2011 CFR

2011-10-01

... to reach an agreement or for a mediator to make an informed judgement that an agreement is not... participate in the mediation process. (c) If the complainant and the recipient reach an agreement, the... complaint unless the complainant or the recipient fails to comply with the agreement, in which case the...

An analytical study of the effect of coolant flow variables on the kinetic energy output of a cooled turbine blade flow

NASA Technical Reports Server (NTRS)

Prust, H. W., Jr.

1971-01-01

The results of an analytical study to determine the effect of changes in the amount, velocity, injection location, injection angle, and temperature of coolant flow on blade row performance are presented. The results show that the change in output of a cooled turbine blade row relative to the specific output of the uncooled blade row can be positive, negative, or zero. Comparisons between the analytical results and experimental results for four different cases of coolant discharge, all at a coolant temperature ratio of unity, show good agreement for three cases and rather poor agreement for the other. To further test the validity of the method, more experimental data is needed, particularly at different coolant temperature ratios.

Limitations of diagnostic precision and predictive utility in the individual case: a challenge for forensic practice.

PubMed

Cooke, David J; Michie, Christine

2010-08-01

Knowledge of group tendencies may not assist accurate predictions in the individual case. This has importance for forensic decision making and for the assessment tools routinely applied in forensic evaluations. In this article, we applied Monte Carlo methods to examine diagnostic agreement with different levels of inter-rater agreement given the distributional characteristics of PCL-R scores. Diagnostic agreement and score agreement were substantially less than expected. In addition, we examined the confidence intervals associated with individual predictions of violent recidivism. On the basis of empirical findings, statistical theory, and logic, we conclude that predictions of future offending cannot be achieved in the individual case with any degree of confidence. We discuss the problems identified in relation to the PCL-R in terms of the broader relevance to all instruments used in forensic decision making.

The Art of a Deal: A Kyoto Protocol Simulation

ERIC Educational Resources Information Center

Cowlishaw, Richard; Hunter, Charles; Coy, Jason; Tessmer, Michael

2007-01-01

In this case study, groups of students represent countries as they negotiate an agreement to limit greenhouse-gas emissions. While initially developed for and used in an environmental-science course for first-year college students, the case could be applicable to other courses dealing with conflict resolution such as public policy, international…

Defense Infrastructure: The Enhanced Use Lease Program Requires Management Attention

DTIC Science & Technology

2011-06-01

included in our EUL case studies, the escrow agreements executed by the Army in connection with the EUL at Yuma Proving Ground , Arizona, and the EUL at...research park. 6 Army Redstone Arsenal, Alabama 2009 50 468 acres Site for office and research center development. 7 Army Yuma Proving Ground ...9The three Army EUL case studies were located at Aberdeen Proving Ground , Maryland; Fort

Using 4+ to grade near-normal muscle strength does not improve agreement.

PubMed

O'Neill, Søren; Jaszczak, Sofie Louise Thomsen; Steffensen, Anne Katrine Søndergaard; Debrabant, Birgit

2017-01-01

Manual assessment of muscle strength is often graded using the ordinal Medical Research Council (MRC) scale. The scale has a number of inherent weaknesses, including poorly defined limits between grades '4' and '5' and very large differences in the span of muscle strength encompassed by each of the six grades. It is not necessarily obvious how to convert a manual muscle test finding into an MRC grade. Several modifications which include intermediate grades have been suggested to improve the MRC scale and the current study examines whether agreement improves and variation in ratings decrease, with an intermediate grade between '4' and '5', in circumstances where such a grade would seem appropriate. The present study examined the hypothesis, that a modified MRC-scale which included the commonly used '4+' option, resulted in greater agreement between clinicians compared to the standard MRC-scale. A questionnaire containing five simple clinical cases were distributed to a large convenience sample of chiropractors in Northern Europe, with instructions to grade the described muscle strength findings using the MRC scale. The scale was adapted (with/without an intermediate '4+' grade) depending on the preference of the individual respondent. The cases were designed in such a way as to suggest a muscle weakness in the grey area between '4' and '5', i.e. grade '4+' on the modified MRC scale. A total of 225 questionnaires were returned (7% response rate). The average percentage agreement (across cases) in the standard MRC group was 64% [range 51%: 73%] (grade '4' in all cases). In the modified MRC group, the corresponding findings was 48% [38%: 74%] (grade '4' or '4+' in all cases). The mean average deviation analogue in the standard MRC group was 0.34 (range 0.34: 0.40), compared to 0.51 (range 0.39: 0.73) in the modified MRC group, indicating greater dispersion of scores in the modified MRC group. The Fleiss kappa was 0.02 ( p  < 0.001) and 0.13 ( p  < 0.001), respectively. Contrary to the original hypothesis, introduction of a '4+' grade did not clearly improve agreement or variability of ratings, despite eliminating the physical muscle testing by providing written descriptions of test findings and specifically designing these to suggest a weakness of grade '4+'.

Agreement between core laboratory and study investigators for imaging scores in a thrombectomy trial.

PubMed

Fahed, Robert; Ben Maacha, Malek; Ducroux, Célina; Khoury, Naim; Blanc, Raphaël; Piotin, Michel; Lapergue, Bertrand

2018-05-14

We aimed to assess the agreement between study investigators and the core laboratory (core lab) of a thrombectomy trial for imaging scores. The Alberta Stroke Program Early CT Score (ASPECTS), the European Collaborative Acute Stroke Study (ECASS) hemorrhagic transformation (HT) classification, and the Thrombolysis In Cerebral Infarction (TICI) scores as recorded by study investigators were compared with the core lab scores in order to assess interrater agreement, using Cohen's unweighted and weighted kappa statistics. There were frequent discrepancies between study sites and core lab for all the scores. Agreement for ASPECTS and ECASS HT classification was less than substantial, with disagreement occurring in more than one-third of cases. Agreement was higher on MRI-based scores than on CT, and was improved after dichotomization on both CT and MRI. Agreement for TICI scores was moderate (with disagreement occurring in more than 25% of patients), and went above the substantial level (less than 10% disagreement) after dichotomization (TICI 0/1/2a vs 2b/3). Discrepancies between scores assessed by the imaging core lab and those reported by study sites occurred in a significant proportion of patients. Disagreement in the assessment of ASPECTS and day 1 HT scores was more frequent on CT than on MRI. The agreement for the dichotomized TICI score (the trial's primary outcome) was substantial, with less than 10% of disagreement between study sites and core lab. NCT02523261, Post-results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Gleason grade 4 prostate adenocarcinoma patterns: an interobserver agreement study among genitourinary pathologists.

PubMed

Kweldam, Charlotte F; Nieboer, Daan; Algaba, Ferran; Amin, Mahul B; Berney, Dan M; Billis, Athanase; Bostwick, David G; Bubendorf, Lukas; Cheng, Liang; Compérat, Eva; Delahunt, Brett; Egevad, Lars; Evans, Andrew J; Hansel, Donna E; Humphrey, Peter A; Kristiansen, Glen; van der Kwast, Theodorus H; Magi-Galluzzi, Cristina; Montironi, Rodolfo; Netto, George J; Samaratunga, Hemamali; Srigley, John R; Tan, Puay H; Varma, Murali; Zhou, Ming; van Leenders, Geert J L H

2016-09-01

To assess the interobserver reproducibility of individual Gleason grade 4 growth patterns. Twenty-three genitourinary pathologists participated in the evaluation of 60 selected high-magnification photographs. The selection included 10 cases of Gleason grade 3, 40 of Gleason grade 4 (10 per growth pattern), and 10 of Gleason grade 5. Participants were asked to select a single predominant Gleason grade per case (3, 4, or 5), and to indicate the predominant Gleason grade 4 growth pattern, if present. 'Consensus' was defined as at least 80% agreement, and 'favoured' as 60-80% agreement. Consensus on Gleason grading was reached in 47 of 60 (78%) cases, 35 of which were assigned to grade 4. In the 13 non-consensus cases, ill-formed (6/13, 46%) and fused (7/13, 54%) patterns were involved in the disagreement. Among the 20 cases where at least one pathologist assigned the ill-formed growth pattern, none (0%, 0/20) reached consensus. Consensus for fused, cribriform and glomeruloid glands was reached in 2%, 23% and 38% of cases, respectively. In nine of 35 (26%) consensus Gleason grade 4 cases, participants disagreed on the growth pattern. Six of these were characterized by large epithelial proliferations with delicate intervening fibrovascular cores, which were alternatively given the designation fused or cribriform growth pattern ('complex fused'). Consensus on Gleason grade 4 growth pattern was predominantly reached on cribriform and glomeruloid patterns, but rarely on ill-formed and fused glands. The complex fused glands seem to constitute a borderline pattern of unknown prognostic significance on which a consensus could not be reached. © 2016 John Wiley & Sons Ltd.

Sailing The Calm And Rough Seas: The Influence Of Wealth And Sovereignty In Southeast Asian Maritime Disputes

DTIC Science & Technology

2016-03-01

joint-development in the Gulf of Thailand; the Pedra Branca dispute between Singapore and Malaysia ; and recurring violence in the South China Sea...Singapore and Malaysia ; and recurring violence in the South China Sea, involving multiple states in the region. After analyzing the case studies...31  1.  Burma-India Agreement in the Andaman Sea ..........................31  2.  Indonesia- Malaysia Agreement in the

Multiple-Respondent Anecdotal Assessments: An Analysis of Interrater Agreement and Correspondence with Analogue Assessment Outcomes

ERIC Educational Resources Information Center

Smith, Carla M.; Smith, Richard G.; Dracobly, Joseph D.; Pace, Amy Peterson

2012-01-01

We evaluated interrater agreement across multiple respondents on anecdotal assessments and compared cases in which agreement was obtained with outcomes of functional analyses. Experiment 1 evaluated agreement among multiple respondents on the function of problem behavior for 27 individuals across 42 target behaviors using the Motivation Assessment…

Power Purchase Agreements | Climate Neutral Research Campuses | NREL

Science.gov Websites

. Examples of how some research campuses have used PPAs are provided below. Power Purchase Agreements , primarily to implement on-site energy installations. The owner, in this case a research campus, is typically Power Purchase Agreements Research campuses can use power purchase agreements (PPAs), such as

45 CFR 1160.8 - Indemnity agreement.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 3 2010-10-01 2010-10-01 false Indemnity agreement. 1160.8 Section 1160.8 Public... ACT § 1160.8 Indemnity agreement. In cases where the requirements of §§ 1160.4 and 1160.5 have been met to the satisfaction of the Council, an Indemnity Agreement pledging the full faith and credit of...

45 CFR 1160.8 - Indemnity agreement.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 45 Public Welfare 3 2011-10-01 2011-10-01 false Indemnity agreement. 1160.8 Section 1160.8 Public... ACT § 1160.8 Indemnity agreement. In cases where the requirements of §§ 1160.4 and 1160.5 have been met to the satisfaction of the Council, an Indemnity Agreement pledging the full faith and credit of...

45 CFR 1160.8 - Indemnity agreement.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 45 Public Welfare 3 2013-10-01 2013-10-01 false Indemnity agreement. 1160.8 Section 1160.8 Public... ACT § 1160.8 Indemnity agreement. In cases where the requirements of §§ 1160.4 and 1160.5 have been met to the satisfaction of the Council, an Indemnity Agreement pledging the full faith and credit of...

Clinico-Histopathological Spectrum of Infectious Granulomatous Dermatoses in Western India- A Representative Study from Mumbai.

PubMed

Grover, Sumit; Agale, Shubhangi Vinayak; D'Costa, Grace F; Valand, Arvind G; Gupta, Vikram Kumar

2016-04-01

Infectious Granulomatous Dermatoses (IGDS) have various aetiological factors with a considerable overlap in the histopathological and clinical features, thus posing a diagnostic dilemma for dermatologists and pathologists. We aimed at determining the histopathological profile of IGDS correlating it with clinical features with an attempt to find the aetiology. In a cross-sectional study conducted in a tertiary referral center of Mumbai over two years, out of 1872 skin biopsies received, 239 histopathologically diagnosed cases of IGDS were studied for histopathological features of granuloma. A clinico-histopathological correlation was attempted. Chi-square test was used for comparison of proportions of different groups. Leprosy (211 cases) and tuberculosis (28 cases) were the commonest histopathologically diagnosed IGDS. Leprosy spectrum included BT (30.33% cases), followed by TT (21.32%), BL and LL and 21.79% cases of lepra reactions. Skin TB biopsies on histopathology showed lupus vulgaris (53.85% cases), scrofuloderma (15.38%), TBVC and papulonecrotic tuberculid (11.54% each). In leprosy maximum clinico-pathological agreement was seen at tuberculoid pole (TT 72.7% and BT 56.6%). Among tuberculosis cases, scrofuloderma (100%) and lupus vulgaris (53.8%) showed maximum agreement. Leprosy and skin TB are the commonest IGDS in Mumbai region though difficult to diagnose and subcategorize with certainty during initial stages. Histopathology plays the important role to elucidate the dilemma. This being a single center study, more such studies with a larger sample size are recommended to get more elaborate data and regional prevalence of these IGDS for a better overall approach to prevention, treatment and control.

Magnetic Resonance Imaging Interpretation in Patients With Symptomatic Lumbar Spine Disc Herniations

PubMed Central

Lurie, Jon D.; Doman, David M.; Spratt, Kevin F.; Tosteson, Anna N. A.; Weinstein, James N.

2009-01-01

Study Design Retrospective review of imaging data from a clinical trial. Objective To compare the interpretation of lumbar spine magnetic resonance imaging (MRIs) by clinical spine specialists and radiologists in patients with lumbar disc herniation. Summary of Background Data MRI is the imaging modality of choice for evaluation of the lumbar spine in patients with suspected lumbar disc herniation. Guidelines provide standardization of terms to more consistently describe disc herniation. The extent to which these guidelines are being followed in clinical practice is unknown. Methods We abstracted data from radiology reports from patients with lumbar intervertebral disc herniation enrolled in the Spine Patient Outcomes Research Trial. We evaluated the frequency with which morphology (e.g., protrusions, extrusions, or sequestrations) was reported as per guidelines and when present we compared the morphology ratings to those of clinicians who completed a structured data form as part of the trial. We assessed agreement using percent agreement and the κ statistic. Results There were 396 patients with sufficient data to analyze. Excellent agreement was observed between clinician and radiologist on the presence and level of herniation (93.4%), with 3.3% showing disagreement regarding level, of which a third could be explained by the presence of a transitional vertebra. In 3.3% of the cases in which the clinician reported a herniation (protrusion, extrusion, or sequestration), the radiologist reported no herniation on the MRI. The radiology reports did not clearly describe morphology in 42.2% of cases. In the 214 cases with clear morphologic descriptions, agreement was fair (κ = 0.24) and the disagreement was asymmetric (Bowker’s test of symmetry P < 0.0001) with clinicians more often rating more abnormal morphologic categories. Agreement on axial location of the herniation was excellent (κ = 0.81). There was disagreement between left or right side in only 3.3% of cases (κ = 0.93). Conclusion Radiology reports frequently fail to provide sufficient detail to describe disc herniation morphology. Agreement between MRI readings by clinical spine specialists and radiologists was excellent when comparing herniation vertebral level and location within level, but only fair comparing herniation morphology. PMID:19333103

Evaluation of previously embolized intracranial aneurysms: inter-and intra-rater reliability among neurosurgeons and interventional neuroradiologists.

PubMed

Zuckerman, Scott L; Lakomkin, Nikita; Magarik, Jordan A; Vargas, Jan; Stephens, Marcus; Akinpelu, Babatunde; Spiotta, Alejandro M; Ahmed, Azam; Arthur, Adam S; Fiorella, David; Hanel, Ricardo; Hirsch, Joshua A; Hui, Ferdinand K; James, Robert F; Kallmes, David F; Meyers, Philip M; Niemann, David B; Rasmussen, Peter; Turner, Raymond D; Welch, Babu G; Mocco, J

2018-05-01

The angiographic evaluation of previously coiled aneurysms can be difficult yet remains critical for determining re-treatment. The main objective of this study was to determine the inter-rater reliability for both the Raymond Scale and per cent embolization among a group of neurointerventionalists evaluating previously embolized aneurysms. A panel of 15 neurointerventionalists examined 92 distinct cases of immediate post-coil embolization and 1 year post-embolization angiographs. Each case was presented four times throughout the study, along with alterations in demographics in order to evaluate intra-rater reliability. All respondents were asked to provide the per cent embolization (0-100%) and Raymond Scale grade (1-3) for each aneurysm. Inter-rater reliability was evaluated by computing weighted kappa values (for the Raymond Scale) and intraclass correlation coefficients (ICC) for per cent embolization. 10 neurosurgeons and 5 interventional neuroradiologists evaluated 368 simulated cases. The agreement among all readers employing the Raymond Scale was fair (κ=0.35) while concordance in per cent embolization was good (ICC=0.64). Clinicians with fewer than 10 years of experience demonstrated a significantly greater level of agreement than the group with greater than 10 years (κ=0.39 and ICC=0.70 vs κ=0.28 and ICC=0.58). When the same aneurysm was presented multiple times, clinicians demonstrated excellent consistency when assessing per cent embolization (ICC=0.82), but moderate agreement when employing the Raymond classification (κ=0.58). Identifying the per cent embolization in previously coiled aneurysms resulted in good inter- and intra-rater agreement, regardless of years of experience. The strong agreement among providers employing per cent embolization may make it a valuable tool for embolization assessment in this patient population. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Does expert opinion match the operational definition of the Lupus Low Disease Activity State (LLDAS)? A case-based construct validity study.

PubMed

Golder, Vera; Huq, Molla; Franklyn, Kate; Calderone, Alicia; Lateef, Aisha; Lau, Chak Sing; Lee, Alfred Lok Hang; Navarra, Sandra Teresa V; Godfrey, Timothy; Oon, Shereen; Hoi, Alberta Yik Bun; Morand, Eric Francis; Nikpour, Mandana

2017-06-01

To evaluate the construct validity of the Lupus Low Disease Activity State (LLDAS), a treatment target in systemic lupus erythematosus (SLE). Fifty SLE case summaries based on real patients were prepared and assessed independently for meeting the operational definition of LLDAS. Fifty international rheumatologists with expertise in SLE, but with no prior involvement in the LLDAS project, responded to a survey in which they were asked to categorize the disease activity state of each case as remission, low, moderate, or high. Agreement between expert opinion and LLDAS was assessed using Cohen's kappa. Overall agreement between expert opinion and the operational definition of LLDAS was 77.96% (95% CI: 76.34-79.58%), with a Cohen's kappa of 0.57 (95% CI: 0.55-0.61). Of the cases (22 of 50) that fulfilled the operational definition of LLDAS, only 5.34% (59 of 22 × 50) of responses classified the cases as moderate/high activity. Of the cases that did not fulfill the operational definition of LLDAS (28 of 50), 35.14% (492 of 28 × 50) of responses classified the cases as remission/low activity. Common reasons for discordance were assignment to remission/low activity of cases with higher corticosteroid doses than defined in LLDAS (prednisolone ≤ 7.5mg) or with SLEDAI-2K >4 due to serological activity (high anti-dsDNA antibody and/or low complement). LLDAS has good construct validity with high overall agreement between the operational definition of LLDAS and expert opinion. Discordance of results suggests that the operational definition of LLDAS is more stringent than expert opinion at defining a low disease activity state. Copyright © 2017 Elsevier Inc. All rights reserved.

UV-CURED FINISHING WORKS FOR LANE

EPA Science Inventory

The Midwest Research Institute, under a cooperative agreement with the U.S. EPA, conducted a study to identify wood furniture manufacturing facilities that had converted to low-VOC/HAP wood furniture coatings and to develop case studies for those facilities. This article addresse...

Gender agreement and multiple referents.

PubMed

Finocchiaro, Chiara; Mahon, Bradford Z; Caramazza, Alfonso

2008-01-01

We report a new pattern of usage in current, spoken Italian that has implications for both psycholinguistic models of language production and linguistic theories of language change. In Italian, gender agreement is mandatory for both singular and plural nouns. However, when two or more nouns of different grammatical gender appear in a conjoined noun phrase (NP), masculine plural agreement is required. In this study, we combined on-line and off-line methodologies in order to assess the mechanisms involved in gender marking in the context of multiple referents. The results of two pronoun production tasks showed that plural feminine agreement was significantly more difficult than plural masculine agreement. In a separate study using offline judgements of acceptability, we found that agreement violations in Italian are tolerated more readily in the case of feminine conjoined noun phrases (e.g., la mela e la banana 'the:fem apple:fem and the: fem banana: fem') than masculine conjoined noun phrases (e.g., il fiore e il libro 'the:mas flower: mas and the:mas book:mas'). Implications of these results are discussed both at the level of functional architecture within the language production system and at the level of changes in language use.

Case Assignment in English-Speaking Children: A Paired Priming Paradigm

ERIC Educational Resources Information Center

Weil, Lisa Wisman; Leonard, Laurence B.

2017-01-01

This study employed a paired priming paradigm to ask whether input features influence a child's propensity to use non-nominative versus nominative case in subject position, and to use non-nominative forms even when verbs are marked for agreement. Thirty English-speaking children (ages 2;6 to 3;7) heard sentences with pronouns that had…

Pre- and postoperative radiotherapy for extremity soft tissue sarcoma: Evaluation of inter-observer target volume contouring variability among French sarcoma group radiation oncologists.

PubMed

Sargos, P; Charleux, T; Haas, R L; Michot, A; Llacer, C; Moureau-Zabotto, L; Vogin, G; Le Péchoux, C; Verry, C; Ducassou, A; Delannes, M; Mervoyer, A; Wiazzane, N; Thariat, J; Sunyach, M P; Benchalal, M; Laredo, J D; Kind, M; Gillon, P; Kantor, G

2018-04-01

The purpose of this study was to evaluate, during a national workshop, the inter-observer variability in target volume delineation for primary extremity soft tissue sarcoma radiation therapy. Six expert sarcoma radiation oncologists (members of French Sarcoma Group) received two extremity soft tissue sarcoma radiation therapy cases 1: one preoperative and one postoperative. They were distributed with instructions for contouring gross tumour volume or reconstructed gross tumour volume, clinical target volume and to propose a planning target volume. The preoperative radiation therapy case was a patient with a grade 1 extraskeletal myxoid chondrosarcoma of the thigh. The postoperative case was a patient with a grade 3 pleomorphic undifferentiated sarcoma of the thigh. Contour agreement analysis was performed using kappa statistics. For the preoperative case, contouring agreement regarding GTV, gross tumour volume GTV, clinical target volume and planning target volume were substantial (kappa between 0.68 and 0.77). In the postoperative case, the agreement was only fair for reconstructed gross tumour volume (kappa: 0.38) but moderate for clinical target volume and planning target volume (kappa: 0.42). During the workshop discussion, consensus was reached on most of the contour divergences especially clinical target volume longitudinal extension. The determination of a limited cutaneous cover was also discussed. Accurate delineation of target volume appears to be a crucial element to ensure multicenter clinical trial quality assessment, reproducibility and homogeneity in delivering RT. radiation therapy RT. Quality assessment process should be proposed in this setting. We have shown in our study that preoperative radiation therapy of extremity soft tissue sarcoma has less inter-observer contouring variability. Copyright © 2018 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.

MRI for appendicitis in pregnancy: is seeing believing? clinical outcomes in cases of appendix nonvisualization.

PubMed

Al-Katib, Sayf; Sokhandon, Farnoosh; Farah, Michael

2016-12-01

The primary objective of this study was to determine the clinical outcomes in cases of appendix nonvisualization with MRI in pregnant patients with suspected appendicitis and the implications of appendix nonvisualization for excluding appendicitis. Fifty-eight pregnant patients with suspected appendicitis evaluated with MRI at three centers from a single institution were retrospectively reviewed by three radiologists with varying levels of abdominal imaging experience. All scans were performed on a 1.5-Tesla Siemens unit. Cases were evaluated for diagnostic quality, visualization of the appendix, presence of appendicitis, and alternate diagnoses. Clinical outcomes were gathered from the electronic medical record. Of the 58 patients who underwent MRI for suspected appendicitis, 50 cases were considered adequate diagnostic quality by all three radiologists. The rate of appendix visualization among the three radiologists ranged from 60 to 76% (p = 0.44). The appendix was nonvisualized by at least one of the three radiologists in 25 cases (50%). Of these, none had a final diagnosis of appendicitis including one patient who underwent appendectomy. MRI suggested an alternate diagnosis in 6 (24%) patients with appendix nonvisualization. For the three reviewers, the agreement level on whether or not the appendix was visualized on the MRI had a Light's kappa value of 0.526, indicating a "moderate" level of agreement (p value < 0.01). Despite only moderate level of interobserver agreement for appendix visualization, appendix nonvisualization on MRI in pregnant patients with suspected appendicitis confers a significant reduction in the risk of appendicitis compared to all comers as long as the study is adequate diagnostic quality and there are no secondary signs of appendicitis present.

Investigation of Bohr Hamiltonian in presence of Killingbeck potential using bi-confluent Heun functions

NASA Astrophysics Data System (ADS)

Sobhani, Hadi; Hassanabadi, Hassan; Chung, Won Sang

2018-05-01

In this study, Bohr Hamiltonian is studied for the triaxial and rotational cases. In both cases, Killingbeck potential is used as interaction. The wave function and energy of these cases are found using bi-confluent Heun functions. The results are examined by reproducing experimental data of some isotopes for each case. Energy levels of the isotopes are shown graphically as well as theoretical results for staggering in γ bands of the isotopes is discussed. In the next step, we argue about B (E 2) transition rates of the isotopes for each case. The results have a good agreement with experimental data.

Noise Computation of a Shock-Containing Supersonic Axisymmetric Jet by the CE/SE Method

NASA Technical Reports Server (NTRS)

Loh, Ching Y.; Hultgren, Lennart S.; Chang, Sin-Chung; Jorgenson, Philip C. E.

1999-01-01

The space-time conservation element solution element (CE/SE) method is employed to numerically study the near-field of a typical under-expanded jet. For the computed case-a circular jet with Mach number M(j) = 1.19-the shock-cell structure is in good agreement with experimental results. The computed noise field is in general agreement with the experiment, although further work is needed to properly close the screech feedback loop.

West German Military Modernization Goals, Resources, and Conventional Arms Control

DTIC Science & Technology

1991-01-01

34 sponsored by the U.S. Air Force’s Deputy Chief of Staff for Plans and Operations. These projects were performed jointly under the National Security Studies...aggregate German defense budgets under a first-stage CFE agreement are assumed to remain flat in real terms. (This probably overstates budget levels... under CFE assumptions. A CFE agreement reduces defense budget shortfalls from 19 percent (the estimated middle-case figure in the absence of arms

Multireader multicase reader studies with binary agreement data: simulation, analysis, validation, and sizing.

PubMed

Chen, Weijie; Wunderlich, Adam; Petrick, Nicholas; Gallas, Brandon D

2014-10-01

We treat multireader multicase (MRMC) reader studies for which a reader's diagnostic assessment is converted to binary agreement (1: agree with the truth state, 0: disagree with the truth state). We present a mathematical model for simulating binary MRMC data with a desired correlation structure across readers, cases, and two modalities, assuming the expected probability of agreement is equal for the two modalities ([Formula: see text]). This model can be used to validate the coverage probabilities of 95% confidence intervals (of [Formula: see text], [Formula: see text], or [Formula: see text] when [Formula: see text]), validate the type I error of a superiority hypothesis test, and size a noninferiority hypothesis test (which assumes [Formula: see text]). To illustrate the utility of our simulation model, we adapt the Obuchowski-Rockette-Hillis (ORH) method for the analysis of MRMC binary agreement data. Moreover, we use our simulation model to validate the ORH method for binary data and to illustrate sizing in a noninferiority setting. Our software package is publicly available on the Google code project hosting site for use in simulation, analysis, validation, and sizing of MRMC reader studies with binary agreement data.

Multireader multicase reader studies with binary agreement data: simulation, analysis, validation, and sizing

PubMed Central

Chen, Weijie; Wunderlich, Adam; Petrick, Nicholas; Gallas, Brandon D.

2014-01-01

Abstract. We treat multireader multicase (MRMC) reader studies for which a reader’s diagnostic assessment is converted to binary agreement (1: agree with the truth state, 0: disagree with the truth state). We present a mathematical model for simulating binary MRMC data with a desired correlation structure across readers, cases, and two modalities, assuming the expected probability of agreement is equal for the two modalities (P1=P2). This model can be used to validate the coverage probabilities of 95% confidence intervals (of P1, P2, or P1−P2 when P1−P2=0), validate the type I error of a superiority hypothesis test, and size a noninferiority hypothesis test (which assumes P1=P2). To illustrate the utility of our simulation model, we adapt the Obuchowski–Rockette–Hillis (ORH) method for the analysis of MRMC binary agreement data. Moreover, we use our simulation model to validate the ORH method for binary data and to illustrate sizing in a noninferiority setting. Our software package is publicly available on the Google code project hosting site for use in simulation, analysis, validation, and sizing of MRMC reader studies with binary agreement data. PMID:26158051

A Comparative Analysis of Polymerase Chain Reaction and Direct Fluorescent Antibody Test for Diagnosis of Genital Herpes.

PubMed

Patwardhan, Vrushali; Bhalla, Preena; Rawat, Deepti; Garg, Vijay Kumar; Sardana, Kabir; Sethi, Sumit

2017-01-01

To compare laboratory tests that can simultaneously detect and type herpes simplex virus (HSV) directly from the genital ulcer specimens in clinically suspected cases of genital herpes. A study was conducted over 10 months and 44 adult male and female patients clinically suspected with genital herpes were recruited. Genital ulcer swab specimens were subjected to glycoprotein-G gene-based conventional polymerase chain reaction (PCR) and commercially available direct fluorescent antibody (DFA) test and the results were compared. PCR for HSV was positive in 82% (36/44) cases. DFA was positive in 68.2% (30/44) cases. There was 100% agreement between HSV types detected by DFA and PCR. The strength of agreement between the results was better in primary genital herpes than recurrent cases. PCR was found to be better in the detection of HSV in recurrent genital herpes patients. It is a better modality, especially when genital herpes clinically presents with ulcerative or crusted lesions, and is also a cheaper alternative as compared to DFA.

Mortality Measures to Profile Hospital Performance for Patients With Septic Shock.

PubMed

Walkey, Allan J; Shieh, Meng-Shiou; Liu, Vincent X; Lindenauer, Peter K

2018-04-30

Sepsis care is becoming a more common target for hospital performance measurement, but few studies have evaluated the acceptability of sepsis or septic shock mortality as a potential performance measure. In the absence of a gold standard to identify septic shock in claims data, we assessed agreement and stability of hospital mortality performance under different case definitions. Retrospective cohort study. U.S. acute care hospitals. Hospitalized with septic shock at admission, identified by either implicit diagnosis criteria (charges for antibiotics, cultures, and vasopressors) or by explicit International Classification of Diseases, 9th revision, codes. None. We used hierarchical logistic regression models to determine hospital risk-standardized mortality rates and hospital performance outliers. We assessed agreement in hospital mortality rankings when septic shock cases were identified by either explicit International Classification of Diseases, 9th revision, codes or implicit diagnosis criteria. Kappa statistics and intraclass correlation coefficients were used to assess agreement in hospital risk-standardized mortality and hospital outlier status, respectively. Fifty-six thousand six-hundred seventy-three patients in 308 hospitals fulfilled at least one case definition for septic shock, whereas 19,136 (33.8%) met both the explicit International Classification of Diseases, 9th revision, and implicit septic shock definition. Hospitals varied widely in risk-standardized septic shock mortality (interquartile range of implicit diagnosis mortality: 25.4-33.5%; International Classification of Diseases, 9th revision, diagnosis: 30.2-38.0%). The median absolute difference in hospital ranking between septic shock cohorts defined by International Classification of Diseases, 9th revision, versus implicit criteria was 37 places (interquartile range, 16-70), with an intraclass correlation coefficient of 0.72, p value of less than 0.001; agreement between case definitions for identification of outlier hospitals was moderate (kappa, 0.44 [95% CI, 0.30-0.58]). Risk-standardized septic shock mortality rates varied considerably between hospitals, suggesting that septic shock is an important performance target. However, efforts to profile hospital performance were sensitive to septic shock case definitions, suggesting that septic shock mortality is not currently ready for widespread use as a hospital quality measure.

Evaluation of three different methods of distance learning for postgraduate diagnostic imaging education: A pilot study.

PubMed

Poirier, Jean-Nicolas; Cooley, Jeffrey R; Wessely, Michelle; Guebert, Gary M; Petrocco-Napuli, Kristina

2014-10-01

Objective : The purpose of this study was to evaluate the perceived effectiveness and learning potential of 3 Web-based educational methods in a postgraduate radiology setting. Methods : Three chiropractic radiology faculty from diverse geographic locations led mini-courses using asynchronous discussion boards, synchronous Web conferencing, and asynchronous voice-over case presentations formatted for Web viewing. At the conclusion of each course, participants filled out a 14-question survey (using a 5-point Likert scale) designed to evaluate the effectiveness of each method in achieving specified course objectives and goals and their satisfaction when considering the learning potential of each method. The mean, standard deviation, and percentage agreements were tabulated. Results : Twenty, 15, and 10 participants completed the discussion board, Web conferencing, and case presentation surveys, respectively. All educational methods demonstrated a high level of agreement regarding the course objective (total mean rating >4.1). The case presentations had the highest overall rating for achieving the course goals; however, all but one method still had total mean ratings >4.0 and overall agreement levels of 70%-100%. The strongest potential for interactive learning was found with Web conferencing and discussion boards, while case presentations rated very low in this regard. Conclusions : The perceived effectiveness in achieving the course objective and goals was high for each method. Residency-based distance education may be a beneficial adjunct to current methods of training, allowing for international collaboration. When considering all aspects tested, there does not appear to be a clear advantage to any one method. Utilizing various methods may be most appropriate.

Efficiency and measurements agreement between swept-source OCT and low-coherence interferometry biometry systems.

PubMed

Calvo-Sanz, Jorge A; Portero-Benito, Alejandro; Arias-Puente, Alfonso

2018-03-01

To compare and evaluate the agreement between the measurements obtained with a swept-source optical coherence tomography (OCT)-based biometer, the IOLMaster® 700 (IOLM), and those obtained by an optical biometer based on optical low-coherence interferometry (OLCI), the Aladdin (ALD); To evaluate the ability to perform biometric measurements in those eyes with transparency alterations. Fifty-five eyes of 55 subjects were included in this study. Axial length (AL), corneal power (K, in diopters) and its astigmatism, anterior chamber depth (ACD), central corneal thickness (CCT), and lens thickness (LT) measures were obtained within both biometers, Zeiss IOLMaster 700 and Topcon Aladdin. Results were analyzed and compared using the Student's paired samples t-test, Bland-Altman analysis and intraclass correlation coefficient (ICC). Mean age was 73.12 ± 2.63 (62-89 years). The IOLM mean AL, K, and LT values did not show a statistically significant difference from ALD values and showed excellent agreement and correlation (ICC = 1.000, 0.970, 0.952). IOLM measured a lower mean ACD (-0.036 mm) and higher CCT measurements (9.296 μm). Those results were statistically different (p < 0.001 in both cases) but showed an excellent correlation coefficients (ICC = 0.994, 0.938). IOLM was able to obtain measures from all the eyes examined, while ALD did not measure in two cases with dense nuclear cataract. ALD showed spherical K measures in 7.27% of cases. Overall a quite good agreement between IOLM and ALD was found. ALD showed spherical keratometry measures in 7.27% of cases. IOLMaster 700 was more effective in obtaining AL measurements in eyes with dense cataracts.

An evaluation of ICD-11 posttraumatic stress disorder criteria in two samples of adolescents and young adults exposed to mass shootings: factor analysis and comparisons to ICD-10 and DSM-IV.

PubMed

Haravuori, Henna; Kiviruusu, Olli; Suomalainen, Laura; Marttunen, Mauri

2016-05-12

The proposed posttraumatic stress disorder (PTSD) criteria for the International Classification of Diseases (ICD) 11th revision are simpler than the criteria in ICD-10, DSM-IV or DSM-5. The aim of this study was to evaluate the ICD-11 PTSD factor structure in samples of young people, and to compare PTSD prevalence rates and diagnostic agreement between the different diagnostic systems. Possible differences in clinical characteristics of the PTSD cases identified by ICD-11, ICD-10 and DSM-IV are explored. Two samples of adolescents and young adults were followed after exposure to similar mass shooting incidents in their schools. Semi-structured diagnostic interviews were performed to assess psychiatric diagnoses and PTSD symptom scores (N = 228, mean age 17.6 years). PTSD symptom item scores were used to compose diagnoses according to the different classification systems. Confirmatory factor analyses indicated that the proposed ICD-11 PTSD symptoms represented two rather than three factors; re-experiencing and avoidance symptoms comprised one factor and hyperarousal symptoms the other factor. In the studied samples, the three-factor ICD-11 criteria identified 51 (22.4%) PTSD cases, the two-factor ICD-11 identified 56 (24.6%) cases and the DSM-IV identified 43 (18.9%) cases, while the number of cases identified by ICD-10 was larger, being 85 (37.3%) cases. Diagnostic agreement of the ICD-11 PTSD criteria with ICD-10 and DSM-IV was moderate, yet the diagnostic agreement turned to be good when an impairment criterion was imposed on ICD-10. Compared to ICD-11, ICD-10 identified cases with less severe trauma exposure and posttraumatic symptoms and DSM-IV identified cases with less severe trauma exposure. The findings suggest that the two-factor model of ICD-11 PTSD is preferable to the three-factor model. The proposed ICD-11 criteria are more restrictive compared to the ICD-10 criteria. There were some differences in the clinical characteristics of the PTSD cases identified by ICD-11, when compared to ICD-10 and DSM-IV.

Identifying and processing the gap between perceived and actual agreement in breast pathology interpretation.

PubMed

Carney, Patricia A; Allison, Kimberly H; Oster, Natalia V; Frederick, Paul D; Morgan, Thomas R; Geller, Berta M; Weaver, Donald L; Elmore, Joann G

2016-07-01

We examined how pathologists' process their perceptions of how their interpretations on diagnoses for breast pathology cases agree with a reference standard. To accomplish this, we created an individualized self-directed continuing medical education program that showed pathologists interpreting breast specimens how their interpretations on a test set compared with a reference diagnosis developed by a consensus panel of experienced breast pathologists. After interpreting a test set of 60 cases, 92 participating pathologists were asked to estimate how their interpretations compared with the standard for benign without atypia, atypia, ductal carcinoma in situ and invasive cancer. We then asked pathologists their thoughts about learning about differences in their perceptions compared with actual agreement. Overall, participants tended to overestimate their agreement with the reference standard, with a mean difference of 5.5% (75.9% actual agreement; 81.4% estimated agreement), especially for atypia and were least likely to overestimate it for invasive breast cancer. Non-academic affiliated pathologists were more likely to more closely estimate their performance relative to academic affiliated pathologists (77.6 vs 48%; P=0.001), whereas participants affiliated with an academic medical center were more likely to underestimate agreement with their diagnoses compared with non-academic affiliated pathologists (40 vs 6%). Before the continuing medical education program, nearly 55% (54.9%) of participants could not estimate whether they would overinterpret the cases or underinterpret them relative to the reference diagnosis. Nearly 80% (79.8%) reported learning new information from this individualized web-based continuing medical education program, and 23.9% of pathologists identified strategies they would change their practice to improve. In conclusion, when evaluating breast pathology specimens, pathologists do a good job of estimating their diagnostic agreement with a reference standard, but for atypia cases, pathologists tend to overestimate diagnostic agreement. Many participants were able to identify ways to improve.

Multicentre evaluation of multidisciplinary team meeting agreement on diagnosis in diffuse parenchymal lung disease: a case-cohort study.

PubMed

Walsh, Simon L F; Wells, Athol U; Desai, Sujal R; Poletti, Venerino; Piciucchi, Sara; Dubini, Alessandra; Nunes, Hilario; Valeyre, Dominique; Brillet, Pierre Y; Kambouchner, Marianne; Morais, António; Pereira, José M; Moura, Conceição Souto; Grutters, Jan C; van den Heuvel, Daniel A; van Es, Hendrik W; van Oosterhout, Matthijs F; Seldenrijk, Cornelis A; Bendstrup, Elisabeth; Rasmussen, Finn; Madsen, Line B; Gooptu, Bibek; Pomplun, Sabine; Taniguchi, Hiroyuki; Fukuoka, Junya; Johkoh, Takeshi; Nicholson, Andrew G; Sayer, Charlie; Edmunds, Lilian; Jacob, Joseph; Kokosi, Maria A; Myers, Jeffrey L; Flaherty, Kevin R; Hansell, David M

2016-07-01

Diffuse parenchymal lung disease represents a diverse and challenging group of pulmonary disorders. A consistent diagnostic approach to diffuse parenchymal lung disease is crucial if clinical trial data are to be applied to individual patients. We aimed to evaluate inter-multidisciplinary team agreement for the diagnosis of diffuse parenchymal lung disease. We did a multicentre evaluation of clinical data of patients who presented to the interstitial lung disease unit of the Royal Brompton and Harefield NHS Foundation Trust (London, UK; host institution) and required multidisciplinary team meeting (MDTM) characterisation between March 1, 2010, and Aug 31, 2010. Only patients whose baseline clinical, radiological, and, if biopsy was taken, pathological data were undertaken at the host institution were included. Seven MDTMs, consisting of at least one clinician, radiologist, and pathologist, from seven countries (Denmark, France, Italy, Japan, Netherlands, Portugal, and the UK) evaluated cases of diffuse parenchymal lung disease in a two-stage process between Jan 1, and Oct 15, 2015. First, the clinician, radiologist, and pathologist (if lung biopsy was completed) independently evaluated each case, selected up to five differential diagnoses from a choice of diffuse lung diseases, and chose likelihoods (censored at 5% and summing to 100% in each case) for each of their differential diagnoses, without inter-disciplinary consultation. Second, these specialists convened at an MDTM and reviewed all data, selected up to five differential diagnoses, and chose diagnosis likelihoods. We compared inter-observer and inter-MDTM agreements on patient first-choice diagnoses using Cohen's kappa coefficient (κ). We then estimated inter-observer and inter-MDTM agreement on the probability of diagnosis using weighted kappa coefficient (κw). We compared inter-observer and inter-MDTM confidence of patient first-choice diagnosis. Finally, we evaluated the prognostic significance of a first-choice diagnosis of idiopathic pulmonary fibrosis (IPF) versus not IPF for MDTMs, clinicians, and radiologists, using univariate Cox regression analysis. 70 patients were included in the final study cohort. Clinicians, radiologists, pathologists, and the MDTMs assigned their patient diagnoses between Jan 1, and Oct 15, 2015. IPF made up 88 (18%) of all 490 MDTM first-choice diagnoses. Inter-MDTM agreement for first-choice diagnoses overall was moderate (κ=0·50). Inter-MDTM agreement on diagnostic likelihoods was good for IPF (κw=0·71 [IQR 0·64-0·77]) and connective tissue disease-related interstitial lung disease (κw=0·73 [0·68-0·78]); moderate for non-specific interstitial pneumonia (NSIP; κw=0·42 [0·37-0·49]); and fair for hypersensitivity pneumonitis (κw=0·29 [0·24-0·40]). High-confidence diagnoses (>65% likelihood) of IPF were given in 68 (77%) of 88 cases by MDTMs, 62 (65%) of 96 cases by clinicians, and in 57 (66%) of 86 cases by radiologists. Greater prognostic separation was shown for an MDTM diagnosis of IPF than compared with individual clinician's diagnosis of this disease in five of seven MDTMs, and radiologist's diagnosis of IPF in four of seven MDTMs. Agreement between MDTMs for diagnosis in diffuse lung disease is acceptable and good for a diagnosis of IPF, as validated by the non-significant greater prognostic separation of an IPF diagnosis made by MDTMs than the separation of a diagnosis made by individual clinicians or radiologists. Furthermore, MDTMs made the diagnosis of IPF with higher confidence and more frequently than did clinicians or radiologists. This difference is of particular importance, because accurate and consistent diagnoses of IPF are needed if clinical outcomes are to be optimised. Inter-multidisciplinary team agreement for a diagnosis of hypersensitivity pneumonitis is low, highlighting an urgent need for standardised diagnostic guidelines for this disease. National Institute of Health Research, Imperial College London. Copyright © 2016 Elsevier Ltd. All rights reserved.

Recommendations and Privacy Requirements for a Bring-Your-Own-Device User Policy and Agreement

DTIC Science & Technology

2015-03-01

manipulate data from non-traditional workplaces to support mission requirements. The United States Marine Corps (USMC) has started a pilot BYOD program, but...contrasted to obtain a starting point to develop a user agreement for the USMC. The security controls identified within these case studies were also...participating in a BYOD program. A. MARINE CORPS PILOT PROGRAM Starting in January 2015 and at the behest of the USMC, the Marine Corps Network Operations and

A sequential test for assessing observed agreement between raters.

PubMed

Bersimis, Sotiris; Sachlas, Athanasios; Chakraborti, Subha

2018-01-01

Assessing the agreement between two or more raters is an important topic in medical practice. Existing techniques, which deal with categorical data, are based on contingency tables. This is often an obstacle in practice as we have to wait for a long time to collect the appropriate sample size of subjects to construct the contingency table. In this paper, we introduce a nonparametric sequential test for assessing agreement, which can be applied as data accrues, does not require a contingency table, facilitating a rapid assessment of the agreement. The proposed test is based on the cumulative sum of the number of disagreements between the two raters and a suitable statistic representing the waiting time until the cumulative sum exceeds a predefined threshold. We treat the cases of testing two raters' agreement with respect to one or more characteristics and using two or more classification categories, the case where the two raters extremely disagree, and finally the case of testing more than two raters' agreement. The numerical investigation shows that the proposed test has excellent performance. Compared to the existing methods, the proposed method appears to require significantly smaller sample size with equivalent power. Moreover, the proposed method is easily generalizable and brings the problem of assessing the agreement between two or more raters and one or more characteristics under a unified framework, thus providing an easy to use tool to medical practitioners. © 2017 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Description and pilot results from a novel method for evaluating return of incidental findings from next-generation sequencing technologies.

PubMed

Goddard, Katrina A B; Whitlock, Evelyn P; Berg, Jonathan S; Williams, Marc S; Webber, Elizabeth M; Webster, Jennifer A; Lin, Jennifer S; Schrader, Kasmintan A; Campos-Outcalt, Doug; Offit, Kenneth; Feigelson, Heather Spencer; Hollombe, Celine

2013-09-01

The aim of this study was to develop, operationalize, and pilot test a transparent, reproducible, and evidence-informed method to determine when to report incidental findings from next-generation sequencing technologies. Using evidence-based principles, we proposed a three-stage process. Stage I "rules out" incidental findings below a minimal threshold of evidence and is evaluated using inter-rater agreement and comparison with an expert-based approach. Stage II documents criteria for clinical actionability using a standardized approach to allow experts to consistently consider and recommend whether results should be routinely reported (stage III). We used expert opinion to determine the face validity of stages II and III using three case studies. We evaluated the time and effort for stages I and II. For stage I, we assessed 99 conditions and found high inter-rater agreement (89%), and strong agreement with a separate expert-based method. Case studies for familial adenomatous polyposis, hereditary hemochromatosis, and α1-antitrypsin deficiency were all recommended for routine reporting as incidental findings. The method requires <3 days per topic. We establish an operational definition of clinically actionable incidental findings and provide documentation and pilot testing of a feasible method that is scalable to the whole genome.

Agreement and disagreement on health care quality concepts among academic health professionals: the Saudi case.

PubMed

Mahrous, Mohamed Saad

2014-01-01

A systematic and rigorous implementation of quality improvement processes is likely to improve the well-being of staff members and heighten their job satisfaction. Assessing professionals' perceptions of health care quality should lead to the betterment of health care services. In Saudi Arabia, no previous studies examine how university health professionals view health care quality concepts. A cross-sectional analytical study employing a self-administered questionnaire with 43 statements assessing quality perceptions of academic health care professionals was used. Despite the agreement of health professionals on numerous quality concepts addressed in this study, there was insufficient agreement on 10 core quality concepts, 3 of which were the following: "quality focuses on customers" (50%), "quality is tangible and therefore measurable" (29.3%), and "quality is data-driven" (62%). Hence, providing health professionals with relevant training likely will generate a better understanding of quality concepts and optimize their performance.

Inter- and intra-rater reliability and agreement in determining subcutaneous tumour margins in dogs.

PubMed

Ranganathan, B; Milovancev, M; Leeper, H; Townsend, K L; Bracha, S; Curran, K

2018-03-01

The objective of this prospective study was to evaluate agreement and reliability of calliper-based measurements of locally invasive subcutaneous malignant tumours in dogs. Four raters measured the longest diameter of 12 subcutaneous tumours (7 soft tissue sarcomas and 5 mast cell tumours) from 11 client-owned dogs during 3 randomized, blinded measurement trials, both pre- and post-sedation. Inter- and intra-rater reliability was evaluated using intra-class correlation coefficient (ICC) and agreement was evaluated using Bland-Altman plots. Inter- and intra-rater reliability was good (ICC range of 0.8694-0.89520) and excellent (ICC range of 0.9720-0.9966), respectively. For agreement calculations, an a priori clinically relevant limit of agreement of 10 mm was set. Inter- and intra-rater agreement was unacceptable with inter-rater limits of agreement ranging from 15.9 to 55.6 mm and intra-rater limit of agreement ranging from 11.9 to 28.1 mm. Review of the measurement trial photographs revealed that calliper orientation changes were frequent, occurring in 9/12 (75%) and 8/12 (67%) pre- and post-sedation cases. No significant correlation was found between inter-rater measurement standard deviations and calliper orientation changes or dog body condition score. These findings suggest veterinarians may have poor agreement in determining the gross edge of tumours, which is expected to introduce bias and inconsistency in tumour staging, assessing response to therapy, and surgical margin planning. Due to the potential consequences for veterinary cancer patients, future studies are needed to validate the present findings. © 2018 John Wiley & Sons Ltd.

Assessment of Interradiologist Agreement Regarding Mammographic Breast Density Classification Using the Fifth Edition of the BI-RADS Atlas.

PubMed

Ekpo, Ernest U; Ujong, Ujong Peter; Mello-Thoms, Claudia; McEntee, Mark F

2016-05-01

The objective of the present study was to assess interradiologist agreement regarding mammographic breast density assessment performed using the rating scale outlined in the fifth edition of the BI-RADS atlas of the American College of Radiology. Breast density assessments of 1000 cases were conducted by five radiologists from the same institution who together had recently undergone retraining in mammographic breast density classification based on the fifth edition of BI-RADS. The readers assigned breast density grades (A-D) on the basis of the BI-RADS classification scheme. Repeat assessment of 100 cases was performed by all readers 1 month after the initial assessment. A weighted kappa was used to calculate intrareader and interreader agreement. Intrareader agreement ranged from a kappa value of 0.86 (95% CI, 0.77-0.93) to 0.89 (95% CI, 0.81-0.95) on a four-category scale (categories A-D) and from 0.89 (95% CI, 0.86-0.92) to 0.94 (95% CI, 0.89-0.97) on a two-category scale (category A-B vs category C-D). Interreader agreement ranged from substantial (κ = 0.76; 95% CI, 0.73-0.78) to almost perfect (κ = 0.87; 95% CI, 0.86-0.89) on a four-category scale, and the overall weighted kappa value was substantial (0.79; 95% CI, 0.78-0.83). Interreader agreement on a two-category scale ranged from a kappa value of 0.85 (95% CI, 0.83-0.86) to 0.91 (95% CI, 0.90-0.92), and the overall weighted kappa was 0.88 (95% CI, 0.87-0.89). Overall, with regard to mammographic breast density classification, radiologists had substantial interreader agreement when a four-category scale was used and almost perfect interreader agreement when a dichotomous scale was used.

78 FR 65221 - Defense Federal Acquisition Regulation Supplement: New Free Trade Agreement-Panama (DFARS Case...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-31

... Supplement (DFARS) to implement the United States--Panama Trade Promotion Agreement. This Trade Promotion...--Panama Trade Promotion Agreement. No respondents submitted public comments in response to the interim... effects, distributive impacts, and equity). E.O. 13563 emphasizes the importance of quantifying both costs...

Telecytology: Is it possible with smartphone images?

PubMed

Sahin, Davut; Hacisalihoglu, Uguray Payam; Kirimlioglu, Saime Hale

2018-01-01

This study aimed to discuss smartphone usage in telecytology and determine intraobserver concordance between microscopic cytopathological diagnoses and diagnoses derived via static smartphone images. The study was conducted with 172 cytologic material. A pathologist captured static images of the cytology slides from the ocular lens of a microscope using a smartphone. The images were transferred via WhatsApp® to a cytopathologist working in another center who made all the microscopic cytopathological diagnoses 5-27 months ago. The cytopathologist diagnosed images on a smartphone without knowledge of their previous microscopic diagnoses. The Kappa agreement between microscopic cytopathological diagnoses and smartphone image diagnoses was determined. The average image capturing, transfer, and remote cytopathological diagnostic time for one case was 6.20 minutes. The percentage of cases whose microscopic and smartphone image diagnoses were concordant was 84.30%, and the percentage of those whose diagnoses were discordant was 15.69%. The highest Kappa agreement was observed in endoscopic ultrasound-guided fine needle aspiration (1.000), and the lowest agreement was observed in urine cytology (0.665). Patient management changed with smart phone image diagnoses at 11.04%. This study showed that easy, fast, and high-quality image capturing and transfer is possible from cytology slides using smartphones. The intraobserver Kappa agreement between the microscopic cytopathological diagnoses and remote smartphone image diagnoses was high. It was found that remote diagnosis due to difficulties in telecytology might change patient management. The developments in the smartphone camera technology and transfer software make them efficient telepathology and telecytology tools. © 2017 Wiley Periodicals, Inc.

Increasing consistency of disease biomarker prediction across datasets.

PubMed

Chikina, Maria D; Sealfon, Stuart C

2014-01-01

Microarray studies with human subjects often have limited sample sizes which hampers the ability to detect reliable biomarkers associated with disease and motivates the need to aggregate data across studies. However, human gene expression measurements may be influenced by many non-random factors such as genetics, sample preparations, and tissue heterogeneity. These factors can contribute to a lack of agreement among related studies, limiting the utility of their aggregation. We show that it is feasible to carry out an automatic correction of individual datasets to reduce the effect of such 'latent variables' (without prior knowledge of the variables) in such a way that datasets addressing the same condition show better agreement once each is corrected. We build our approach on the method of surrogate variable analysis but we demonstrate that the original algorithm is unsuitable for the analysis of human tissue samples that are mixtures of different cell types. We propose a modification to SVA that is crucial to obtaining the improvement in agreement that we observe. We develop our method on a compendium of multiple sclerosis data and verify it on an independent compendium of Parkinson's disease datasets. In both cases, we show that our method is able to improve agreement across varying study designs, platforms, and tissues. This approach has the potential for wide applicability to any field where lack of inter-study agreement has been a concern.

76 FR 9722 - Endangered and Threatened Wildlife and Plants; 12-Month Finding on a Petition To List Solanum...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-22

... settlement agreement resolving that case, signed April 27, 2005, we agreed to submit our 12-month finding for... for Biological Diversity v. Hamilton, Case No. 1:08-CV-02830-CAP). In a settlement agreement approved... urban and tourism development at Nanny Point, most of the natural population has been transferred to the...

75 FR 57720 - Endangered and Threatened Wildlife and Plants; 12-Month Finding on a Petition to List Agave...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-22

... agreement resolving that case, signed April 27, 2005, we agreed to submit our 12-month finding for A... (Center for Biological Diversity v. Hamilton, Case No. 1:08-cv-02830 -CAP). In a settlement agreement... already developed and managed as tourism and residential projects. Based on information reported by the...

When do parents and child health professionals agree on child's psychosocial problems? Cross-sectional study on parent-child health professional dyads.

PubMed

Crone, Mathilde R; Zeijl, Elke; Reijneveld, Sijmen A

2016-05-19

About one third of all parents have concerns about their child's psychosocial development. Agreement between child health professionals (CHPs) and parents about such concerns may improve treatment adherence and outcomes. This study investigates which child, parenting and/or environmental stressors are associated with (dis)agreement in concerns regarding psychosocial problems in children, in parent-CHP dyads. During routine child health assessments, data were collected from a sample of children aged 14 months to 12 years (n = 3,870). CHPs registered the psychosocial problems that they identified, and parents reported their concerns. Child psychosocial stressors were measured with the ITSEA/CBCL, and the child's history of psychosocial problems. Environmental stressors referred to stressful family/contextual situations in the past year, and parenting stressors to perceived parenting efficacy. The CHPs and parents disagreed on 36.4 % of the children. CHPs based their identification of problems mainly on children's history of past problem (OR = 5.85, 95% CI = 4.74-7.22). Parental concerns were most likely in case of an increased ITSEA/CBCL score (OR = 7.69, CI = 5.39-10.97). CHP-parent agreement was more likely in case of a combination of child psychosocial, parenting and environmental stressors (OR = 35.58, CI = 24.11-52.48). Parental concerns not confirmed by the CHP were associated with higher educated parents, originating from an industrialized country, and younger children. The CHP-identified problems not confirmed by parental concerns were associated with older children. Agreement between CHPs and parents is associated with a co-occurrence of child, parenting and environmental stressors. Improved agreement between CHP and parents will increase the likelihood of shared decision-making regarding follow-up care and compliance with advice.

Log-Linear Modeling of Agreement among Expert Exposure Assessors

PubMed Central

Hunt, Phillip R.; Friesen, Melissa C.; Sama, Susan; Ryan, Louise; Milton, Donald

2015-01-01

Background: Evaluation of expert assessment of exposure depends, in the absence of a validation measurement, upon measures of agreement among the expert raters. Agreement is typically measured using Cohen’s Kappa statistic, however, there are some well-known limitations to this approach. We demonstrate an alternate method that uses log-linear models designed to model agreement. These models contain parameters that distinguish between exact agreement (diagonals of agreement matrix) and non-exact associations (off-diagonals). In addition, they can incorporate covariates to examine whether agreement differs across strata. Methods: We applied these models to evaluate agreement among expert ratings of exposure to sensitizers (none, likely, high) in a study of occupational asthma. Results: Traditional analyses using weighted kappa suggested potential differences in agreement by blue/white collar jobs and office/non-office jobs, but not case/control status. However, the evaluation of the covariates and their interaction terms in log-linear models found no differences in agreement with these covariates and provided evidence that the differences observed using kappa were the result of marginal differences in the distribution of ratings rather than differences in agreement. Differences in agreement were predicted across the exposure scale, with the likely moderately exposed category more difficult for the experts to differentiate from the highly exposed category than from the unexposed category. Conclusions: The log-linear models provided valuable information about patterns of agreement and the structure of the data that were not revealed in analyses using kappa. The models’ lack of dependence on marginal distributions and the ease of evaluating covariates allow reliable detection of observational bias in exposure data. PMID:25748517

VASCULAR ABNORMALITIES IN DIABETIC RETINOPATHY ASSESSED WITH SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY WIDEFIELD IMAGING.

PubMed

Schaal, Karen B; Munk, Marion R; Wyssmueller, Iris; Berger, Lieselotte E; Zinkernagel, Martin S; Wolf, Sebastian

2017-11-10

To detect vascular abnormalities in diabetic retinopathy using swept-source optical coherence tomography angiography (SS-OCTA) widefield images, and to compare the findings with color fundus photographs (CFPs) using Early Treatment Diabetic Retinopathy Study severity grading. 3 mm × 3 mm and 12 mm × 12 mm scans were acquired to cover 70° to 80° of the posterior pole using a 100-kHz SS-OCTA instrument. Two masked graders assessed the presence of vascular abnormalities on SS-OCTA and the Early Treatment Diabetic Retinopathy Study level on CFP. The grading results were then compared. A total of 120 diabetic eyes (60 patients) were imaged with the SS-OCTA instrument. Cohort 1 (91 eyes; SS-OCTA grading only) showed microaneurysms in 91% (n = 83), intraretinal microvascular abnormalities in 79% (n = 72), and neovascularization in 21% (n = 19) of cases. Cohort 2 (52 eyes; CFP grading compared with SS-OCTA) showed microaneurysms on CFP in 90% (n = 47) and on SS-OCTA in 96% (n = 50) of cases. Agreement in intraretinal microvascular abnormality detection was fair (k = 0.2). Swept-source optical coherence tomography angiography detected 50% of intraretinal microvascular abnormality cases (n = 26), which were missed on CFP. Agreement in detecting neovascularization was moderate (k = 0.5). Agreement in detection of diabetic retinopathy features on CFP and SS-OCTA varies depending on the vascular changes examined. Swept-source optical coherence tomography angiography shows a higher detection rate of intraretinal microvascular abnormalities (P = 0.039), compared with Early Treatment Diabetic Retinopathy Study grading.

Communication Among Melanoma Family Members

PubMed Central

Bowen, Deborah J; Albrecht, Terrance; Hay, Jennifer; Eggly, Susan; Harris-Wei, Julie; Meischke, Hendrika; Burke, Wylie

2017-01-01

Interventions to improve communication among family members may facilitate information flow about familial risk and preventive health behaviors. This is a secondary analysis of the effects of an interactive website intervention aimed at increasing communication frequency and agreement about health risk among melanoma families. Participants were family units, consisting of one family member with melanoma identified from a previous research study (the case) and an additional first degree relative and a parent of a child 0–17. Family triads were randomized to receive access to the website intervention or to serve as control families. Family communication frequency and agreement about melanoma prevention behaviors and beliefs were measured at baseline and again at one year post randomization. Intervention participants of all three types significantly increased the frequency of communication to their first degree relatives (Parents, siblings, children; range =14–18 percentage points; all p<0.05). At baseline approximately two-thirds of all three family members talked with at least some member of the family about cancer risk. Agreement between Cases and First Degree Relatives and between Cases and Parents increased from pre to post intervention in the intervention participants compared to the control participants (p<0.05). These findings provide support for interventions to improve family communication about cancer risk. PMID:28248624

Communication Among Melanoma Family Members.

PubMed

Bowen, Deborah J; Albrecht, Terrance; Hay, Jennifer; Eggly, Susan; Harris-Wei, Julie; Meischke, Hendrika; Burke, Wylie

2017-03-01

Interventions to improve communication among family members may facilitate information flow about familial risk and preventive health behaviors. This is a secondary analysis of the effects of an interactive website intervention aimed at increasing communication frequency and agreement about health risk among melanoma families. Participants were family units, consisting of one family member with melanoma identified from a previous research study (the Case) and an additional first degree relative and a parent of a child 0-17. Family triads were randomized to receive access to the website intervention or to serve as control families. Family communication frequency and agreement about melanoma prevention behaviors and beliefs were measured at baseline and again at 1 year post randomization. Intervention participants of all three types significantly increased the frequency of communication to their first degree relatives (Parents, siblings, children; range = 14-18 percentage points; all p < .05). At baseline, approximately two-thirds of all three family members talked with at least some member of the family about cancer risk. Agreement between Cases and First Degree Relatives and between Cases and Parents increased from pre to post intervention in the intervention participants compared to the control participants (p < .05). These findings provide support for interventions to improve family communication about cancer risk.

The Problems with the Kappa Statistic as a Metric of Interobserver Agreement on Lesion Detection Using a Third-reader Approach When Locations Are Not Prespecified.

PubMed

Shih, Joanna H; Greer, Matthew D; Turkbey, Baris

2018-03-16

To point out the problems with Cohen kappa statistic and to explore alternative metrics to determine interobserver agreement on lesion detection when locations are not prespecified. Use of kappa and two alternative methods, namely index of specific agreement (ISA) and modified kappa, for measuring interobserver agreement on the location of detected lesions are presented. These indices of agreement are illustrated by application to a retrospective multireader study in which nine readers detected and scored prostate cancer lesions in 163 consecutive patients (n = 110 cases, n = 53 controls) using the guideline of Prostate Imaging Reporting and Data System version 2 on multiparametric magnetic resonance imaging. The proposed modified kappa, which properly corrects for the amount of agreement by chance, is shown to be approximately equivalent to the ISA. In the prostate cancer data, average kappa, modified kappa, and ISA equaled 30%, 55%, and 57%, respectively, for all lesions and 20%, 87%, and 87%, respectively, for index lesions. The application of kappa could result in a substantial downward bias in reader agreement on lesion detection when locations are not prespecified. ISA is recommended for assessment of reader agreement on lesion detection. Published by Elsevier Inc.

Intra- and interobserver agreement among obstetric experts in court regarding the review of abnormal fetal heart rate tracings and obstetrical management.

PubMed

Sabiani, Laura; Le Dû, Renaud; Loundou, Anderson; d'Ercole, Claude; Bretelle, Florence; Boubli, Léon; Carcopino, Xavier

2015-12-01

The objective of the study was to evaluate the intra- and interobserver agreement among obstetric experts in court regarding the retrospective review of abnormal fetal heart rate tracings and obstetrical management of patients with abnormal fetal heart rate during labor. A total of 22 French obstetric experts in court reviewed 30 cases of term deliveries of singleton pregnancies diagnosed with at least 1 hour of abnormal fetal heart rate, including 10 cases with adverse neonatal outcome. The experts reviewed all cases twice within a 3-month interval, with the first review being blinded to neonatal outcome. For each case reviewed, the experts were provided with the obstetric data and copies of the complete fetal heart rate recording and the partogram. The experts were asked to classify the abnormal fetal heart rate tracing and to express whether they agreed with the obstetrical management performed. When they disagreed, the experts were asked whether they concluded that an error had been made and whether they considered the obstetrical management as the cause of cerebral palsy in children if any. Compared with blinded review, the experts were significantly more likely to agree with the obstetric management performed (P < .001) and with the mode of delivery (P < .001) when informed about the neonatal outcome and were less likely to conclude that an error had been made (P < .001) or to establish a link with potential cerebral palsy (P = .003). The experts' intraobserver agreement for the review of abnormal fetal heart rate tracing and obstetrical management were both mediocre (kappa = 0.46-0.51 and kappa = 0.48-0.53, respectively). The interobserver agreement for the review of abnormal fetal heart rate tracing was low and was not improved by knowledge of the neonatal outcome (kappa = 0.11-0.18). The interobserver agreement for the interpretation of obstetrical management was also low (kappa = 0.08-0.19) but appeared to be improved by knowledge of the neonatal outcome (kappa = 0.15-0.32). The intra- and interobserver agreement among obstetric experts in court for the review of abnormal fetal heart rate tracing and the appropriateness of obstetrical care is poor, suggesting a lack of objectivity of obstetrical expertise as currently performed in court. Copyright © 2015 Elsevier Inc. All rights reserved.

Design-build agreements : a case study review of the included handover requirements.

DOT National Transportation Integrated Search

2009-04-01

Road infrastructure is a key component of any regions transportation system. It allows : unprecedented levels of mobility, accessibility, and economic growth. On the other hand, the cost : associated with inadequate road infrastructure can amount ...

Comparison of different criteria for periodontitis case definition in head and neck cancer individuals.

PubMed

Bueno, Audrey Cristina; Ferreira, Raquel Conceição; Cota, Luis Otávio Miranda; Silva, Guilherme Carvalho; Magalhães, Cláudia Silami; Moreira, Allyson Nogueira

2015-09-01

Different periodontitis case definitions have been used in clinical research and epidemiology. The aim of this study was to determine more accurate criterion for the definition of mild and moderate periodontitis case to be applied to head and neck cancer individuals before radiotherapy. The frequency of periodontitis in a sample of 84 individuals was determined according to different diagnostic criteria: (1) Lopez et al. (2002);(2) Hujoel et al. (2006); (3) Beck et al. (1990); (4) Machtei et al. (1992); (5) Tonetti and Claffey (2005); (6) and Page and Eke (2007). All diagnosis were based on the clinical parameters obtained by a single calibrated examiner (Kw = 0.71). The individuals were evaluated before radiotherapy. They received oral hygiene instructions, and the cases diagnosed with periodontitis (Page and Eke 2007) were treated. The gold standard was the definition 6, and the others were compared by means of agreement, sensitivity (SS), specificity (SP), and the area under ROC curve. The kappa test evaluated the agreement between definitions. The frequency of periodontitis at baseline was 53.6 % (definition 1), 81.0 % (definition 2), 40.5 % (definition 3), 26.2 % (definition 4), 13.1 % (definition 5), and 70.2 % (definition 6). The kappa test showed a moderate agreement between definitions 6 and 2 (59.0 %) and definitions 6 and 1 (56.0 %). The criterion with higher SS (0.92) and SP (0.73) was definition 1. Definition 1 was the most accurate criterion to case periodontitis definition to be applied to head and neck cancer individuals.

The Stillbirth Classification System for the Safe Passage Study: Incorporating Mechanism, Etiology, and Recurrence

PubMed Central

Boyd, Theonia K.; Wright, Colleen A.; Odendaal, Hein J.; Elliott, Amy J.; Sens, Mary Ann; Folkerth, Rebecca D.; Roberts, Drucilla J.; Kinney, Hannah C.

2017-01-01

OBJECTIVE Describe the classification system for the assignment of the cause of death for stillbirth in the Safe Passage Study, an international, multi-institutional, prospective analysis conducted by the NIAAA/NICHD funded PASS Network (The Prenatal Alcohol in SIDS and Stillbirth (PASS) Research Network). The study mission is to determine the role of prenatal alcohol and/or cigarette smoke exposure in adverse pregnancy outcomes, including stillbirth, in a high-risk cohort of 12,000 maternal/fetal dyads. METHODS The PASS Network classification system is based upon 5 ‘sites of origin’ for cause of stillbirth (Fetal, Placental, Maternal, External/Environmental, or Undetermined), further subdivided into mechanism subcategories (e.g., Placental Perfusion Failure). Both site of origin and mechanism stratification are employed to assign an ultimate cause of death. Each PASS stillbirth (n=19) in the feasibility study was assigned a cause of death, and status of sporadic versus recurrent. Adjudication involved review of the maternal and obstetrical records, and fetal autopsy and placental findings, with complete consensus in each case. Two published classification systems, i.e., INCODE and ReCoDe, were used for comparison. RESULTS Causes of stillbirth classified were: fetal (n=5, 26%), placental (n=10, 53%), external (n=1, 5%), and undetermined (n=3, 16%). Nine cases (47%) had placental causes of death due to maternal disorders that carry recurrence risks. There was complete agreement for the cause of death across the three classification systems in 26% of cases, and a combination of partial or complete agreement in 68% of cases. Complete vs. partial agreements were predicated upon the classification schemes used for comparison. CONCLUSIONS The proposed PASS system is a user-friendly classification system that provides comparable information to previously published systems. Advantages include its simplicity, mechanistic formulations, tight clinicopathologic integration, provision for an undetermined category, and its wide applicability for use by perinatal mortality review boards with access to information routinely collected during clinicopathologic evaluations. PMID:27116324

Inter-observer agreement on a checklist to evaluate scientific publications in the field of animal reproduction.

PubMed

Simoneit, Céline; Heuwieser, Wolfgang; Arlt, Sebastian P

2012-01-01

This study's objective was to determine respondents' inter-observer agreement on a detailed checklist to evaluate three exemplars (one case report, one randomized controlled study without blinding, and one blinded, randomized controlled study) of the scientific literature in the field of bovine reproduction. Fourteen international scientists in the field of animal reproduction were provided with the three articles, three copies of the checklist, and a supplementary explanation. Overall, 13 responded to more than 90% of the items. Overall repeatability between respondents using Fleiss's κ was 0.35 (fair agreement). Combining the "strongly agree" and "agree" responses and the "strongly disagree" and "disagree" responses increased κ to 0.49 (moderate agreement). Evaluation of information given in the three articles on housing of the animals (35% identical answers) and preconditions or pretreatments (42%) varied widely. Even though the overall repeatability was fair, repeatability concerning the important categories was high (e.g., level of agreement=98%). Our data show that the checklist is a reasonable and practical supporting tool to assess the quality of publications. Therefore, it may be used in teaching and practicing evidence-based veterinary medicine. It can support training in systematic and critical appraisal of information and in clinical decision making.

Review of the Bethesda System for Reporting Thyroid Cytopathology: a local study in Bohol Island, Philippines.

PubMed

Salillas, Annette L; Sun, Faye Candice S; Almocera, Emelisa G

2015-01-01

The aim of this study was to evaluate the adaptability and reproducibility of the Bethesda System for Reporting Thyroid Cytopathology (BSRTC) in a local setting and to determine the risk of malignancy for each category. A retrospective cross-sectional study of 80 thyroid fine-needle aspiration cytology cases using the BSRTC with corresponding histopathology was done between September 2009 and December 2012. Agreement scores were calculated using kappa statistics. Consensus among two readers was attained for 73 cases (91.25%). No disagreement was noted for the malignant cases. The strength of agreement was very good, with a kappa statistic of 0.90. The risk of malignancy observed histologically was as follows: benign 3%, atypia of undetermined significance (AUS) 50%, suspicious for follicular/Hürthle cell neoplasm 50%, suspicious for malignancy 78%, and malignant 100%. In this study, there is an outstanding reproducibility for the classification scheme. The application of the BSRTC as the standardized reporting is readily adaptable and therefore its application in larger medical centers is highly recommended. Our findings of a higher risk of malignancy seen in AUS (50%) and malignant (100%) categories in those who underwent surgical resection corroborated other published studies. Conveying this risk to clinical colleagues is important and will facilitate optimal patient care. © 2015 S. Karger AG, Basel.

FAST Model Calibration and Validation of the OC5-DeepCwind Floating Offshore Wind System Against Wave Tank Test Data

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wendt, Fabian F; Robertson, Amy N; Jonkman, Jason

During the course of the Offshore Code Comparison Collaboration, Continued, with Correlation (OC5) project, which focused on the validation of numerical methods through comparison against tank test data, the authors created a numerical FAST model of the 1:50-scale DeepCwind semisubmersible system that was tested at the Maritime Research Institute Netherlands ocean basin in 2013. This paper discusses several model calibration studies that were conducted to identify model adjustments that improve the agreement between the numerical simulations and the experimental test data. These calibration studies cover wind-field-specific parameters (coherence, turbulence), hydrodynamic and aerodynamic modeling approaches, as well as rotor model (blade-pitchmore » and blade-mass imbalances) and tower model (structural tower damping coefficient) adjustments. These calibration studies were conducted based on relatively simple calibration load cases (wave only/wind only). The agreement between the final FAST model and experimental measurements is then assessed based on more-complex combined wind and wave validation cases.« less

Using Water Transfers to Manage Supply Risk

NASA Astrophysics Data System (ADS)

Characklis, G. W.

2007-12-01

Most cities currently rely on water supplies with sufficient capacity to meet demand under almost all conditions. However, the rising costs of water supply development make the maintenance of infrequently used excess capacity increasingly expensive, and more utilities are considering the use of water transfers as a means of more cost effectively meeting demand under drought conditions. Transfers can take place between utilities, as well as different user groups (e.g., municipal and agricultural), and can involve both treated and untreated water. In cases where both the "buyer" and "seller" draw water from the same supply, contractual agreements alone can facilitate a transfer, but in other cases new infrastructure (e.g., pipelines) will be required. Developing and valuing transfer agreements and/or infrastructure investments requires probabilistic supply/demand analyses that incorporate elements of both hydrology and economics. The complexity of these analyses increases as more sophisticated types of agreements (e. g., options) are considered, and as utilities begin to consider how to integrate transfers into long-term planning efforts involving a more diversified portfolio of supply assets. This discussion will revolve around the methods used to develop minimum (expected) cost portfolios of supply assets that meet specified reliability goals. Two different case studies, one in both the eastern and western U.S., will be described with attention to: the role that transfers can play in reducing average supply costs; tradeoffs between costs and supply reliability, and; the effects of different transfer agreement types on the infrastructure capacity required to complete the transfers. Results will provide insights into the cost savings potential of more flexible water supply strategies.

Added value of second biopsy target in screen-detected widespread suspicious breast calcifications.

PubMed

Falkner, Nathalie M; Hince, Dana; Porter, Gareth; Dessauvagie, Ben; Jeganathan, Sanjay; Bulsara, Max; Lo, Glen

2018-06-01

There is controversy on the optimal work-up of screen-detected widespread breast calcifications: whether to biopsy a single target or multiple targets. This study evaluates agreement between multiple biopsy targets within the same screen-detected widespread (≥25 mm) breast calcification to determine if the second biopsy adds value. Retrospective observational study of women screened in a statewide general population risk breast cancer mammographic screening program from 2009 to 2016. Screening episodes recalled for widespread calcifications where further views indicated biopsy, and two or more separate target areas were sampled within the same lesion were included. Percentage agreement and Cohen's Kappa were calculated. A total of 293317 women were screened during 761124 separate episodes with recalls for widespread calcifications in 2355 episodes. In 171 women, a second target was biopsied within the same lesion. In 149 (86%) cases, the second target biopsy result agreed with the first biopsy (κ = 0.6768). Agreement increased with increasing mammography score (85%, 86% and 92% for score 3, 4 and 5 lesions). Same day multiple biopsied lesions were three times more likely to yield concordant results compared to post-hoc second target biopsy cases. While a single target biopsy is sufficient to discriminate a benign vs. malignant diagnosis in most cases, in 14% there is added value in performing a second target biopsy. Biopsies performed prospectively are more likely to yield concordant results compared to post-hoc second target biopsy cases, suggesting a single prospective biopsy may be sufficient when results are radiological-pathological concordant; discordance still requires repeat sampling. © 2018 The Royal Australian and New Zealand College of Radiologists.

Interobserver agreement on Poser's and the new McDonald's diagnostic criteria for multiple sclerosis.

PubMed

Zipoli, V; Portaccio, E; Siracusa, G; Pracucci, G; Sorbi, S; Amato, M P

2003-10-01

We assessed the interobserver agreement on the diagnosis of multiple sclerosis (MS) in a study sample consisting of 41 MS (15 relapsing remitting, two secondary progressive, five primary progressive and 19 presenting their first clinical attack) and three non-MS cases. Clinical and paraclinical information was recorded in standardized forms. Four neurologists were asked to make a diagnosis using Poser's and McDonald's criteria and to assess MRI scans according to the McDonald's guidelines. In terms of the kappa statistic (kappa), we found a moderate agreement on the overall diagnosis using both Poser's and McDonald's criteria (kappa, respectively 0.57 and 0.52). As for distinct diagnostic categories, we observed a moderate to substantial agreement for the three McDonald categories (range of kappa values 0.49-0.64) and a fair to substantial agreement for the nine Poser categories (range of kappa values 0.37-0.67). Taking into account clinical information, the agreement on dissemination over time was substantially higher (kappa = 0.69) than that found on dissemination over space (kappa = 0.46). In contrast, for MRI assessment, the agreement for spatial dissemination was substantial (kappa = 0.74) compared with the fair agreement (kappa = 0.25) yielded by dissemination over time. The new McDonald's criteria yield a good overall diagnostic reliability, and compare favourably with Poser's classification in terms of agreement on distinct diagnostic categories.

75 FR 13411 - Federal Acquisition Regulation; Federal Acquisition Circular 2005-39; Introduction

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-19

... Defense Authorization Act. V Trade Agreements--Costa Rica, Oman, and Peru. 2008-036 Sakalos. VI Payments...--Costa Rica, Oman, and Peru (FAR Case 2008- 036) The Councils have adopted as final, without change, an... Rica, the United States-Oman Free Trade Agreement, and the United States-Peru Trade Promotion Agreement...

39 CFR 955.11 - Prehearing or presubmission conference.

Code of Federal Regulations, 2010 CFR

2010-07-01

... to be submitted pursuant to § 955.12, or heard pursuant to §§ 955.18 through 955.25, the Board may..., admissions, agreements on documents, understandings on matters already of record, or similar agreements which... similar cumulative evidence, if the case is to be heard; (4) The possibility of agreement disposing of all...

26 CFR 1.367(a)-8 - Gain recognition agreement requirements.

Code of Federal Regulations, 2010 CFR

2010-04-01

.... Paragraph (k) of this section provides exceptions for certain events that would otherwise require gain to be... gain recognition agreement to continue. See paragraph (k) of this section for exceptions available for... filed pursuant to paragraph (k)(14) of this section. In the case of a gain recognition agreement entered...

26 CFR 1.367(a)-8 - Gain recognition agreement requirements.

Code of Federal Regulations, 2012 CFR

2012-04-01

.... Paragraph (k) of this section provides exceptions for certain events that would otherwise require gain to be... gain recognition agreement to continue. See paragraph (k) of this section for exceptions available for... filed pursuant to paragraph (k)(14) of this section. In the case of a gain recognition agreement entered...

26 CFR 1.367(a)-8 - Gain recognition agreement requirements.

Code of Federal Regulations, 2011 CFR

2011-04-01

.... Paragraph (k) of this section provides exceptions for certain events that would otherwise require gain to be... gain recognition agreement to continue. See paragraph (k) of this section for exceptions available for... filed pursuant to paragraph (k)(14) of this section. In the case of a gain recognition agreement entered...

PRESENT CONDITION AND MEASURES TO EXPAND OF VOLUNTARY AGREEMENT ON PLASTIC SHOPPING BAGS REDUCTION AT THE PREFECTURAL LEVEL

NASA Astrophysics Data System (ADS)

Mori, Mayuka; Kanaya, Ken

Purpose of this research is to clear present condition and measures to expand of voluntary agreement on plastic shopping bags reduction at the prefectural level. Methods of this research are questionnaire survey to prefectures implementing the agreement and survey by i town page to the number of stores of companies and the number of companies in the prefectures. Findings of this research are as follows: 1. The refusal rate of plastic shopping bags was 10-40% before the implementation of voluntary agreements. And the rate is approximately 70-90% after the implementation. Therefore, before and after the implementation of voluntary agreements, the refusal rate of plastic shopping bags is approximately 40-70% less. 2. It is suggested that the time and number of meetings from proposal to conclusion of the agreement are related in some way, to the ratio of stores participating. On the participation of administration, the ratio of stores participating in the case in which prefecture and cities participate is higher than in the case in which prefecture participates.

Naming games in two-dimensional and small-world-connected random geometric networks.

PubMed

Lu, Qiming; Korniss, G; Szymanski, B K

2008-01-01

We investigate a prototypical agent-based model, the naming game, on two-dimensional random geometric networks. The naming game [Baronchelli, J. Stat. Mech.: Theory Exp. (2006) P06014] is a minimal model, employing local communications that captures the emergence of shared communication schemes (languages) in a population of autonomous semiotic agents. Implementing the naming games with local broadcasts on random geometric graphs, serves as a model for agreement dynamics in large-scale, autonomously operating wireless sensor networks. Further, it captures essential features of the scaling properties of the agreement process for spatially embedded autonomous agents. Among the relevant observables capturing the temporal properties of the agreement process, we investigate the cluster-size distribution and the distribution of the agreement times, both exhibiting dynamic scaling. We also present results for the case when a small density of long-range communication links are added on top of the random geometric graph, resulting in a "small-world"-like network and yielding a significantly reduced time to reach global agreement. We construct a finite-size scaling analysis for the agreement times in this case.

Validity of a family-centered approach for assessing infants' social-emotional wellbeing and their developmental context: a prospective cohort study.

PubMed

Hielkema, Margriet; De Winter, Andrea F; Reijneveld, Sijmen A

2017-06-15

Family-centered care seems promising in preventive pediatrics, but evidence is lacking as to whether this type of care is also valid as a means to identify risks to infants' social-emotional development. We aimed to examine the validity of such a family-centered approach. We conducted a prospective cohort study. During routine well-child visits (2-15 months), Preventive Child Healthcare (PCH) professionals used a family-centered approach, assessing domains as parents' competence, role of the partner, social support, barriers within the care-giving context, and child's wellbeing for 2976 children as protective, indistinct or a risk. If, based on the overall assessment (the families were labeled as "cases", N = 87), an intervention was considered necessary, parents filled in validated questionnaires covering the aforementioned domains. These questionnaires served as gold standards. For each case, two controls, matched by child-age and gender, also filled in questionnaires (N = 172). We compared PCH professionals' assessments with the parent-reported gold standards. Moreover, we evaluated which domain mostly contributed to the overall assessment. Spearman's rank correlation coefficients between PCH professionals' assessments and gold standards were overall reasonable (Spearman's rho 0.17-0.39) except for the domain barriers within the care-giving context. Scores on gold standards were significantly higher when PCH assessments were rated as "at risk" (overall and per domain).We found reasonable to excellent agreement regarding the absence of risk factors (negative agreement rate: 0.40-0.98), but lower agreement regarding the presence of risk factors (positive agreement rate: 0.00-0.67). An "at risk" assessment for the domain Barriers or life events within the care-giving context contributed most to being overall at risk, i.e. a case, odds ratio 100.1, 95%-confidence interval: 22.6 - infinity. Findings partially support the convergent validity of a family-centered approach in well-child care to assess infants' social-emotional wellbeing and their developmental context. Agreement was reasonable to excellent regarding protective factors, but lower regarding risk factors. Netherlands Trialregister, NTR2681. Date of registration: 05-01-2011, URL: http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2681 .

A comparative agreement evaluation of two subaxial cervical spine injury classification systems: the AOSpine and the Allen and Ferguson schemes.

PubMed

Urrutia, Julio; Zamora, Tomas; Campos, Mauricio; Yurac, Ratko; Palma, Joaquin; Mobarec, Sebastian; Prada, Carlos

2016-07-01

We performed an agreement study using two subaxial cervical spine classification systems: the AOSpine and the Allen and Ferguson (A&F) classifications. We sought to determine which scheme allows better agreement by different evaluators and by the same evaluator on different occasions. Complete imaging studies of 65 patients with subaxial cervical spine injuries were classified by six evaluators (three spine sub-specialists and three senior orthopaedic surgery residents) using the AOSpine subaxial cervical spine classification system and the A&F scheme. The cases were displayed in a random sequence after a 6-week interval for repeat evaluation. The Kappa coefficient (κ) was used to determine inter- and intra-observer agreement. Inter-observer: considering the main AO injury types, the agreement was substantial for the AOSpine classification [κ = 0.61 (0.57-0.64)]; using AO sub-types, the agreement was moderate [κ = 0.57 (0.54-0.60)]. For the A&F classification, the agreement [κ = 0.46 (0.42-0.49)] was significantly lower than using the AOSpine scheme. Intra-observer: the agreement was substantial considering injury types [κ = 0.68 (0.62-0.74)] and considering sub-types [κ = 0.62 (0.57-0.66)]. Using the A&F classification, the agreement was also substantial [κ = 0.66 (0.61-0.71)]. No significant differences were observed between spine surgeons and orthopaedic residents in the overall inter- and intra-observer agreement, or in the inter- and intra-observer agreement of specific type of injuries. The AOSpine classification (using the four main injury types or at the sub-types level) allows a significantly better agreement than the A&F classification. The A&F scheme does not allow reliable communication between medical professionals.

Evaluation of nonequilibrium boundary conditions for hypersonic rarefied gas flows

NASA Astrophysics Data System (ADS)

Le, N. T. P.; Greenshields, Ch. J.; Reese, J. M.

2012-01-01

A new Computational Fluid Dynamics (CFD) solver for high-speed viscous §ows in the OpenFOAM code is validated against published experimental data and Direct Simulation Monte Carlo (DSMC) results. The laminar §at plate and circular cylinder cases are studied for Mach numbers, Ma, ranging from 6 to 12.7, and with argon and nitrogen as working gases. Simulation results for the laminar §at plate cases show that the combination of accommodation coefficient values σu = 0.7 and σT = 1.0 in the Maxwell/Smoluchowski conditions, and the coefficient values A1 = 1.5 and A2 = 1.0 in the second-order velocity slip condition, give best agreement with experimental data of surface pressure. The values σu = 0.7 and σT = 1.0 also give good agreement with DSMC data of surface pressure at the stagnation point in the circular cylinder case at Kn = 0.25. The Langmuir surface adsorption condition is also tested for the laminar §at plate case, but initial results were not as good as the Maxwell/Smoluchowski boundary conditions.

Associated Roles of Perioperative Medical Directors and Anesthesia: Hospital Agreements for Operating Room Management.

PubMed

Dexter, Franklin; Epstein, Richard H

2015-12-01

As reviewed previously, decision making can be made systematically shortly before the day of surgery based on reducing the hours of overutilized operating room (OR) time and tardiness of case starts (i.e., patient waiting). We subsequently considered in 2008 that such decision making depends on rational anesthesia-hospital agreements specifying anesthesia staffing. Since that prior study, there has been a substantial increase in understanding of the timing of decision making to reduce overutilized OR time. Most decisions substantively influencing overutilized OR time are those made within 1 workday before the day of surgery and on the day of surgery, because only then are ORs sufficiently full that case scheduling and staff assignment decisions affect overutilized OR time. Consequently, anesthesiologists can easily be engaged in such decisions, because generally they must be involved to ensure that the corresponding anesthesia staff assignments are appropriate. Despite this, at hospitals with >8 hours of OR time used daily in each OR, computerized recommendations are superior to intuition because of cognitive biases. Decisions need to be made by a Perioperative Medical Director who has knowledge of the principles of perioperative managerial decision making published in the scientific literature rather than by a committee lacking this competency. Education in the scientific literature, and when different analytical methods should be used, is important. The addition that we make in this article is to show that an agreement between an anesthesia group and a hospital can both reduce overutilized OR time and patient waiting: The anesthesia group and hospital will ensure, hourly, that, when there are case(s) waiting to start, the number of ORs in use for each service will be at least the number that maximizes the efficiency of use of OR time. Neither the anesthesia group nor the hospital will be expected to run more than that number of ORs without mutual agreement. Agreements assure that processes mutually beneficial to organizations, but not necessarily to individuals at each point in time, are performed as designed, especially in the setting of cognitive biases.

Fluorescein angiography versus optical coherence tomography for diagnosis of uveitic macular edema.

PubMed

Kempen, John H; Sugar, Elizabeth A; Jaffe, Glenn J; Acharya, Nisha R; Dunn, James P; Elner, Susan G; Lightman, Susan L; Thorne, Jennifer E; Vitale, Albert T; Altaweel, Michael M

2013-09-01

To evaluate agreement between fluorescein angiography (FA) and optical coherence tomography (OCT) results for diagnosis of macular edema in patients with uveitis. Multicenter cross-sectional study. Four hundred seventy-nine eyes with uveitis from 255 patients. The macular status of dilated eyes with intermediate uveitis, posterior uveitis, or panuveitis was assessed via Stratus-3 OCT and FA. To evaluate agreement between the diagnostic approaches, κ statistics were used. Macular thickening (MT; center point thickness, ≥ 240 μm per reading center grading of OCT images) and macular leakage (ML; central subfield fluorescein leakage, ≥ 0.44 disc areas per reading center grading of FA images), and agreement between these outcomes in diagnosing macular edema. Optical coherence tomography (90.4%) more frequently returned usable information regarding macular edema than FA (77%) or biomicroscopy (76%). Agreement in diagnosis of MT and ML (κ = 0.44) was moderate. Macular leakage was present in 40% of cases free of MT, whereas MT was present in 34% of cases without ML. Biomicroscopic evaluation for macular edema failed to detect 40% and 45% of cases of MT and ML, respectively, and diagnosed 17% and 17% of cases with macular edema that did not have MT or ML, respectively; these results may underestimate biomicroscopic errors (ophthalmologists were not explicitly masked to OCT and FA results). Among eyes free of ML, phakic eyes without cataract rarely (4%) had MT. No factors were found that effectively ruled out ML when MT was absent. Optical coherence tomography and FA offered only moderate agreement regarding macular edema status in uveitis cases, probably because what they measure (MT and ML) are related but nonidentical macular pathologic characteristics. Given its lower cost, greater safety, and greater likelihood of obtaining usable information, OCT may be the best initial test for evaluation of suspected macular edema. However, given that ML cannot be ruled out if MT is absent and vice versa, obtaining the second test after negative results on the first seems justified when detection of ML or MT would alter management. Given that biomicroscopic evaluation for macular edema erred frequently, ancillary testing for macular edema seems indicated when knowledge of ML or MT status would affect management. Proprietary or commercial disclosure may be found after the references. Copyright © 2013 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Fluorescein angiography vs. optical coherence tomography for diagnosis of uveitic macular edema

PubMed Central

Kempen, John H.; Sugar, Elizabeth A.; Jaffe, Glenn J.; Acharya, Nisha R.; Dunn, James P.; Elner, Susan G.; Lightman, Susan L.; Thorne, Jennifer E.; Vitale, Albert T.; Altaweel, Michael M.

2013-01-01

Objective To evaluate agreement between fluorescein angiography (FA) and optical coherence tomography (OCT) for diagnosis of macular edema in patients with uveitis. Design Multicenter cross-sectional study Participants Four hundred seventy-nine eyes with uveitis of 255 patients Methods The macular status of dilated eyes with intermediate, posterior or panuveitis was assessed via Stratus-3 OCT and FA. Kappa statistics evaluated agreement between the diagnostic approaches. Main Outcome Measures Macular thickening (center point thickness ≥240 μm per reading center grading of OCT images-“MT”) and macular leakage (central subfield fluorescein leakage ≥0.44 disk areas per reading center grading of FA images-“ML”); agreement amongst these outcomes in diagnosing “macular edema.” Results OCT (90.4%) more frequently returned usable information regarding macular edema than FA (77%) and biomicroscopy (76%). Agreement in diagnosis of MT and ML (κ=0.44) was moderate. ML was present in 40% of cases free of MT, whereas MT was present in 34% of cases without ML. Biomicroscopic evaluation for macular edema failed to detect 40% and 45% of cases of MT and ML respectively and diagnosed 17% and 17% of cases with macular edema which did not have MT or ML respectively; these results may underestimate biomicroscopic errors (ophthalmologists were not explicitly masked to OCT and FA results). Among eyes free of ML, phakic eyes without cataract rarely (4%) had MT. No factors were found that effectively ruled out ML when MT was absent. Conclusion OCT and FA offered only moderate agreement regarding macular edema status in uveitis cases, probably because what they measure (MT and ML) are related but non-identical macular pathologies. Given its lower cost, greater safety, and greater likelihood of obtaining usable information, OCT may be the best initial test for evaluation of suspected macular edema. However, given that ML cannot be ruled out if MT is absent and vice versa, obtaining the second test after a negative result on the first seems justified when detection of ML or MT would alter management. Given that biomicroscopic evaluation for macular edema frequently erred, ancillary testing for macular edema seems indicated when knowledge of ML or MT status would affect management. PMID:23706700

A tool for assessing case history and feedback skills in audiology students working with simulated patients.

PubMed

Hughes, Jane; Wilson, Wayne J; MacBean, Naomi; Hill, Anne E

2016-12-01

To develop a tool for assessing audiology students taking a case history and giving feedback with simulated patients (SP). Single observation, single group design. Twenty-four first-year audiology students, five simulated patients, two clinical educators, and three evaluators. The Audiology Simulated Patient Interview Rating Scale (ASPIRS) was developed consisting of six items assessing specific clinical skills, non-verbal communication, verbal communication, interpersonal skills, interviewing skills, and professional practice skills. These items are applied once for taking a case history and again for giving feedback. The ASPIRS showed very high internal consistency (α = 0.91-0.97; mean inter-item r = 0.64-0.85) and fair-to-moderate agreement between evaluators (29.2-54.2% exact and 79.2-100% near agreement; κ weighted up to 0.60). It also showed fair-to-moderate absolute agreement amongst evaluators for single evaluator scores (intraclass correlation coefficient [ICC] r = 0.35-0.59) and substantial consistency of agreement amongst evaluators for three-evaluator averaged scores (ICC r = 0.62-0.81). Factor analysis showed the ASPIRS' 12 items fell into two components, one containing all feedback items and one containing all case history items. The ASPIRS shows promise as the first published tool for assessing audiology students taking a case history and giving feedback with an SP.

The reticulin algorithm for adrenocortical tumor diagnosis: a multicentric validation study on 245 unpublished cases.

PubMed

Duregon, Eleonora; Fassina, Ambrogio; Volante, Marco; Nesi, Gabriella; Santi, Raffaella; Gatti, Gaia; Cappellesso, Rocco; Dalino Ciaramella, Paolo; Ventura, Laura; Gambacorta, Marcello; Dei Tos, Angelo Paolo; Loli, Paola; Mannelli, Massimo; Mantero, Franco; Berruti, Alfredo; Terzolo, Massimo; Papotti, Mauro

2013-09-01

The pathologic diagnosis of adrenocortical carcinoma (ACC) still needs to be improved, because the renowned Weiss Score (WS) system has a poor reproducibility of some parameters and is difficult to apply in borderline cases and in ACC variants. The "reticulin algorithm" (RA) defines malignancy through an altered reticulin framework associated with 1 of the 3 following parameter: necrosis, high mitotic rate, and vascular invasion. This study aimed at validating the interobserver reproducibility of reticulin stain evaluation in an unpublished series of 245 adrenocortical tumors (61 adenomas and 184 carcinomas) from 5 Italian centers, classified according to the WS. Eight pathologists reviewed all reticulin-stained slides. After training, a second round of evaluation on discordant cases was performed 10 weeks later. The RA reclassified 67 cases (27%) as adenomas, including 44 with no reticulin alterations and 23 with an altered reticulin framework but lacking the subsequent parameters of the triad. The other 178 cases (73%) were carcinomas according to the above-mentioned criteria. A complete (8/8 pathologists) interobserver agreement was reached in 75% of cases (κ=0.702), irrespective of case derivation, pathologists' experience, and histologic variants, and was further improved when only those cases with high WS and clinically malignant behavior were considered. After the training, the overall agreement increased to 86%. We conclude that reticulin staining is a reliable technique and an easy-to-interpret system in adrenocortical tumors; moreover, it has a high interobserver reproducibility, which supports the notion of using such a method in the proposed 2-step RA approach for ACC diagnosis.

Acute recreational drug toxicity

PubMed Central

Liakoni, Evangelia; Yates, Christopher; Dines, Alison M.; Dargan, Paul I.; Heyerdahl, Fridtjof; Hovda, Knut Erik; Wood, David M.; Eyer, Florian; Liechti, Matthias E.

2018-01-01

Abstract The aim of the study was to compare self-reported and analytically confirmed substance use in cases of acute recreational drug toxicity. We performed a retrospective analysis of emergency department presentations of acute recreational drug toxicity over 2 years (October 2013 to September 2015) within the European Drug Emergencies Network Plus project. Among the 10,956 cases of acute recreational drug toxicity during the study period, 831 could be included. Between the self-reported substance use and the toxicological results, the highest agreement was found for heroin (86.1%) and cocaine (74.1%), whereas inhalants, poppers, and magic mushrooms were self-reported but not analytically detected. Cathinones and other new psychoactive substances (NPS) could be detected using additional analytical methods. Among cases with both immunoassay (IA) and confirmation with mass spectrometry (MS), the results were consistent for methadone (100%) and cocaine (95.5%) and less consistent for amphetamines (81.8%). In cases with a positive IA for amphetamines (n = 54), MS confirmed the presence of 3,4-methylenedioxymethamphetamine (MDMA), amphetamine, methamphetamine, and NPS in 37, 20, 10, and 6 cases, respectively, also revealing use of more than 1 substance in some cases. MS yielded positive results in 21 cases with a negative IA for amphetamines, including amphetamine, MDMA, methamphetamine, and NPS, in 14, 7, 2, and 2 cases, respectively. In conclusion, the highest agreement was found between self-reports and analytical findings for heroin and cocaine. The diagnosis of NPS use was mainly based on self-report. The IAs accurately identified methadone and cocaine, and MS had advantages for the detection of NPS and amphetamine derivatives. PMID:29384873

Measuring quality of care in syncope: case definition affects reported electrocardiogram use but does not bias reporting.

PubMed

Schuur, Jeremiah D; Justice, Amy

2009-01-01

The objective was to calculate agreement between syncope as a reason for visiting (RFV) an emergency department (ED) and as a discharge diagnosis (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9]), to determine whether syncope case definition biases reported electrocardiogram (ECG) usage, a national quality measure. The authors analyzed the ED portion of the National Hospital Ambulatory Medical Care Survey (NHAMCS), 1993-2004, for patients age >or=18 years. A visit was defined as being for syncope if it received one of three RFV or ICD-9 codes. Agreement between RFV and ICD-9 codes was calculated, and the percentages of syncope patients (RFV vs. ICD-9) who had an ECG were compared using chi-square and multivariate logistic regression. Raw agreement between syncope as an RFV and as an ICD-9 diagnosis code was 30.1% (95% confidence interval [CI] = 32.6% to 35.5%), representing only moderate agreement beyond chance (kappa = 0.50). ECG utilization was lower among visits defined by RFV (64.1%; 95% CI = 62.0% to 66.3%) than for ICD-9 diagnosis (73.6%; 95% CI = 71.4% to 75.8%). There was no meaningful variation in adjusted ECG use by patient, visit, or hospital characteristics between case definitions. Adjusted ECG use was lower under both case definitions among female patients and discharged patients and increased with age (p < 0.05). Despite only moderate agreement, syncope case definition should not bias reported ECG rate by patient, visit, or hospital characteristics. Among ED patients with syncope, ECG is performed less frequently in women, a potentially important disparity.

Laser velocimeter measurements of dynamic stall. [conducted in the Ames two foot wind tunnel

NASA Technical Reports Server (NTRS)

Owen, F. K.

1984-01-01

Laser velocimeter measurements were made during the study of a two-dimensional NACA 0012 airfoil undergoing conditions of dynamic stall. The measurements, which were obtained in the Ames 2 foot wind tunnel at reduced frequencies of 0.12 and 1.2, show significant flow field hysteresis around the static stall angle. Comparisons were also made with dual-plate interferograms and good agreement was found for the attached flow cases. For separated flow, characteristic vortex shedding caused poor agreement and significantly increased the measured Reynolds shear stresses.

A Monte Carlo–Based Bayesian Approach for Measuring Agreement in a Qualitative Scale

PubMed Central

Pérez Sánchez, Carlos Javier

2014-01-01

Agreement analysis has been an active research area whose techniques have been widely applied in psychology and other fields. However, statistical agreement among raters has been mainly considered from a classical statistics point of view. Bayesian methodology is a viable alternative that allows the inclusion of subjective initial information coming from expert opinions, personal judgments, or historical data. A Bayesian approach is proposed by providing a unified Monte Carlo–based framework to estimate all types of measures of agreement in a qualitative scale of response. The approach is conceptually simple and it has a low computational cost. Both informative and non-informative scenarios are considered. In case no initial information is available, the results are in line with the classical methodology, but providing more information on the measures of agreement. For the informative case, some guidelines are presented to elicitate the prior distribution. The approach has been applied to two applications related to schizophrenia diagnosis and sensory analysis. PMID:29881002

Interobserver variability and feasibility of polymerase chain reaction-based assay in distinguishing ischemic colitis from Clostridium difficile colitis in endoscopic mucosal biopsies.

PubMed

Wiland, Homer O; Procop, Gary W; Goldblum, John R; Tuohy, Marion; Rybicki, Lisa; Patil, Deepa T

2013-06-01

Polymerase chain reaction (PCR)-based assays using stool samples are currently the most effective method of detecting Clostridium difficile. This study examines the feasibility of this assay using mucosal biopsy samples and evaluates the interobserver reproducibility in diagnosing and distinguishing ischemic colitis from C difficile colitis. Thirty-eight biopsy specimens were reviewed and classified by 3 observers into C difficile and ischemic colitis. The findings were correlated with clinical data. PCR was performed on 34 cases using BD GeneOhm C difficile assay. The histologic interobserver agreement was excellent (κ= 0.86) and the agreement between histologic and clinical diagnosis was good (κ = 0.84). All 19 ischemic colitis cases tested negative (100% specificity) and 3 of 15 cases of C difficile colitis tested positive (20% sensitivity). C difficile colitis can be reliably distinguished from ischemic colitis using histologic criteria. The C difficile PCR test on endoscopic biopsy specimens has excellent specificity but limited sensitivity.

30 CFR 229.105 - Evidence of Indian agreement to delegation.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 2 2010-07-01 2010-07-01 false Evidence of Indian agreement to delegation. 229... Evidence of Indian agreement to delegation. In the case of a State seeking a delegation of authority for Indian lands as well as Federal lands, the State petition to the Secretary must be supported by an...

75 FR 13425 - Federal Acquisition Regulation; Federal Acquisition Circular 2005-39; Small Entity Compliance Guide

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-19

... 2008 National Defense Authorization Act. V Trade Agreements--Costa Rica, Oman, and Peru. 2008-036..., Oman, and Peru (FAR Case 2008- 036) The Councils have adopted as final, without change, an interim rule... United States-Oman Free Trade Agreement, and the United States-Peru Trade Promotion Agreement. This final...

The Perceived Effect of Hidden Costs on the Operational Management of Information Technology Outsourcing: A Qualitative Study

ERIC Educational Resources Information Center

Swift, Ian

2011-01-01

Information technology (IT) outsourcing is a business trend aimed at reducing costs and enabling companies to concentrate on their core competencies. This qualitative multiple case design research study explored the effects of hidden costs on the operational management of IT outsourcing. The study involved analyzing IT outsourcing agreements as…

Multiple scattering of 13 and 20 MeV electrons by thin foils: a Monte Carlo study with GEANT, Geant4, and PENELOPE.

PubMed

Vilches, M; García-Pareja, S; Guerrero, R; Anguiano, M; Lallena, A M

2009-09-01

In this work, recent results from experiments and simulations (with EGSnrc) performed by Ross et al. [Med. Phys. 35, 4121-4131 (2008)] on electron scattering by foils of different materials and thicknesses are compared to those obtained using several Monte Carlo codes. Three codes have been used: GEANT (version 3.21), Geant4 (version 9.1, patch03), and PENELOPE (version 2006). In the case of PENELOPE, mixed and fully detailed simulations have been carried out. Transverse dose distributions in air have been obtained in order to compare with measurements. The detailed PENELOPE simulations show excellent agreement with experiment. The calculations performed with GEANT and PENELOPE (mixed) agree with experiment within 3% except for the Be foil. In the case of Geant4, the distributions are 5% narrower compared to the experimental ones, though the agreement is very good for the Be foil. Transverse dose distribution in water obtained with PENELOPE (mixed) is 4% wider than those calculated by Ross et al. using EGSnrc and is 1% narrower than the transverse dose distributions in air, as considered in the experiment. All the codes give a reasonable agreement (within 5%) with the experimental results for all the material and thicknesses studied.

Inter-rater agreement for a retrospective exposure assessment of asbestos, chromium, nickel and welding fumes in a study of lung cancer and ionizing radiation.

PubMed

Seel, E A; Zaebst, D D; Hein, M J; Liu, J; Nowlin, S J; Chen, P

2007-10-01

A retrospective exposure assessment of asbestos, welding fumes, chromium and nickel (in welding fumes) was conducted at the Portsmouth Naval Shipyard for a nested case-control study of lung cancer risk from external ionizing radiation. These four contaminants were included because of their potential to confound or modify the effect of a lung cancer-radiation relationship. The exposure assessment included three experienced industrial hygienists from the shipyard who independently assessed exposures for 3519 shop/job/time period combinations. A consensus process was used to resolve estimates with large differences. Final exposure estimates were linked to employment histories of the 4388 study subjects to calculate their cumulative exposures. Inter-rater agreement analyses were performed on the original estimates to better understand the estimation process. Although concordance was good to excellent (78-99%) for intensity estimates and excellent (96-99%) for frequency estimates, overall simple kappa statistics indicated only slight agreement beyond chance (kappa < 0.2). Unbalanced distributions of exposure estimates partly contributed to the weak observed overall inter-rater agreement. Pairwise weighted kappa statistics revealed better agreement between two of the three panelists (kappa = 0.19-0.65). The final consensus estimates were similar to the estimates made by these same two panelists. Overall welding fume exposures were fairly stable across time at the shipyard while asbestos exposures were higher in the early years and fell in the mid-1970s. Mean cumulative exposure for all study subjects was 520 fiber-days cc(-1) for asbestos and 1000 mg-days m(-3) for welding fumes. Mean exposure was much lower for nickel (140 microg-days m(-3)) and chromium (45 microg-days m(-3)). Asbestos and welding fume exposure estimates were positively associated with lung cancer in the nested case-control study. The radiation-lung cancer relationship was attenuated by the inclusion of these two confounders. This exposure assessment provided exposure estimates that aided in understanding of the lung cancer-radiation relationship at the shipyard.

Test set readings predict clinical performance to a limited extent: preliminary findings

NASA Astrophysics Data System (ADS)

Soh, BaoLin P.; Lee, Warwick M.; Kench, Peter L.; Reed, Warren M.; McEntee, Mark F.; Brennan, Patrick C.

2013-03-01

Aim: To investigate the level of agreement between test sets and actual clinical reading Background: The performance of screen readers in detecting breast cancer is being assessed in some countries by using mammographic test sets. However, previous studies have provided little evidence that performance assessed by test sets strongly correlate to performance in clinical reading. Methods: Five clinicians from BreastScreen New South Wales participated in this study. Each clinician was asked to read 200 de-identified mammographic examinations gathered from their own case history within the BreastScreen NSW Digital Imaging Library. All test sets were designed with specific proportions of true positive, true negative, false positive and false negative examinations from the previous actual clinical reads of each reader. A prior mammogram examination for comparison (when available) was also provided for each case. Results: Preliminary analyses have shown that there is a moderate level of agreement (Kappa 0.42-0.56, p < 0.001) between laboratory test sets and actual clinical reading. In addition, a mean increase of 38% in sensitivity in the laboratory test sets as compared to their actual clinical readings was demonstrated. Specificity is similar between the laboratory test sets and actual clinical reading. Conclusion: This study demonstrated a moderate level of agreement between actual clinical reading and test set reading, which suggests that test sets have a role in reflecting clinical performance.

"EEOC v. Board of Governors of State Colleges and Universities": Collective Bargaining Agreements and Age Discrimination in Employment Act Claims: What Counts as Retaliation under ADEA Section 4(D)?

ERIC Educational Resources Information Center

Lyons, Edward C.

1993-01-01

Court litigation in which the claim (to the Equal Employment Opportunity Commission) that a faculty collective bargaining agreement violated the Age Discrimination in Employment Act is examined. Focus is on arbitration of wrongful termination cases. Conflicting judicial rationales applied in two cases are discussed, and a practical solution is…

Teaching about Contracts.

ERIC Educational Resources Information Center

Froman, Michael; Kosnoff, Kathy

1978-01-01

Presents teaching strategies for introducing high school students to contract law. Offers as a case study a contract agreement between pro football players and team owners. Stresses basic elements of contracts (offer, acceptance, consideration, and understanding the bargaining process). Journal available from the American Bar Association, 1155…

Comparison between microscopic examination, ELISA and quantitative buffy coat analysis in the diagnosis of falciparum malaria in an endemic population.

PubMed

Tanpradist, S; Tharavanij, S; Yamokgul, P; Bualombai, P; Wongchotigul, V; Singhasivanon, P; Patarapotikul, J; Thammapalerd, N; Prasittisuk, C; Tantanasrikul, S

1995-03-01

Monoclonal antibody-based ELISA and QBC (quantitative buffy coat analysis) were tested in two endemic areas with low and high incidence of malaria in Kanchanaburi Province, West Thailand with annual parasite incidence in 1992 of 119 and 5 per 1,000 population, respectively. The numbers of individuals positive by thick blood film examination (TBF) for P. falciparum with or without P. vivax, and P. vivax only were 82 and 69, respectively. The detection limit of ELISA was 10 parasites/10(6) red blood cells (RBC) (0.001% parasitemia). Of 1,095 individuals involved in the study at the beginning of the study, ELISA showed sensitivity, specificity, positive predictive value and negative predictive value of 78.1%, 94.9%, 72% and 98.1%, respectively. Nine of 18 (50%) TBF-positive but ELISA-positive individuals had parasitemia of less than 10 parasites/10(6) RBC. High and low incidence areas did not affect the validity of our result. Regression analysis showed good correlation between log parasitemia and ELISA percent OD increase (Y = 0 + 64.9*logX, r = 0.65), and agreement between TBF and ELISA results was 95.9%. In a fortnightly follow-up, in 82 TBF-positive individuals, both ELISA and TBF positive rates correlatively declined with agreement of 96.3%. With samples taken on the first day of the study, the TBF and QBC results were also correlated with agreement of 95.8% for P. falciparum, 95.6% for P. vivax. During 8 week follow-up involving altogether 191 samples, agreement between TBF and QBC results were 87.4% for P. falciparum. QBC detected more cases with P. falciparum infections but detected smaller number of cases with P. vivax infections.

Evaluation of missing value methods for predicting ambient BTEX concentrations in two neighbouring cities in Southwestern Ontario Canada

NASA Astrophysics Data System (ADS)

Miller, Lindsay; Xu, Xiaohong; Wheeler, Amanda; Zhang, Tianchu; Hamadani, Mariam; Ejaz, Unam

2018-05-01

High density air monitoring campaigns provide spatial patterns of pollutant concentrations which are integral in exposure assessment. Such analysis can assist with the determination of links between air quality and health outcomes, however, problems due to missing data can threaten to compromise these studies. This research evaluates four methods; mean value imputation, inverse distance weighting (IDW), inter-species ratios, and regression, to address missing spatial concentration data ranging from one missing data point up to 50% missing data. BTEX (benzene, toluene, ethylbenzene, and xylenes) concentrations were measured in Windsor and Sarnia, Ontario in the fall of 2005. Concentrations and inter-species ratios were generally similar between the two cities. Benzene (B) was observed to be higher in Sarnia, whereas toluene (T) and the T/B ratios were higher in Windsor. Using these urban, industrialized cities as case studies, this research demonstrates that using inter-species ratios or regression of the data for which there is complete information, along with one measured concentration (i.e. benzene) to predict for missing concentrations (i.e. TEX) results in good agreement between predicted and measured values. In both cities, the general trend remains that best agreement is observed for the leave-one-out scenario, followed by 10% and 25% missing, and the least agreement for the 50% missing cases. In the absence of any known concentrations IDW can provide reasonable agreement between observed and estimated concentrations for the BTEX species, and was superior over mean value imputation which was not able to preserve the spatial trend. The proposed methods can be used to fill in missing data, while preserving the general characteristics and rank order of the data which are sufficient for epidemiologic studies.

Proposed Terminology for Anal Squamous Lesions: Its Application and Interobserver Agreement Among Pathologists in Academic and Community Hospitals.

PubMed

Roma, Andres A; Liu, Xiuli; Patil, Deepa T; Xie, Hao; Allende, Daniela

2017-07-01

To analyze interobserver reproducibility and compare practice patterns between academic and community settings of Lower Anogenital Squamous Terminology (LAST). In total, 132 anal biopsy slides were revised as well as p16 immunostains. LAST was used in 49% of cases (academic center, 68%; satellite hospitals [community practice setting], 32%). After pathology review and consensus interpretation, 23 (17%) case diagnoses were reclassified: eight (34.8%) cases (benign or low-grade squamous intraepithelial lesion [LSIL]) were upgraded to high-grade squamous intraepithelial lesion (HSIL) (p16 confirmed ordered during review); four (17.4%) cases originally classified as HSIL were downgraded to LSIL (p16 originally ordered in one case). There was no significant difference in discrepancies between original and consensus diagnosis in the community vs academic setting or by subspecialty (gynecological vs gastrointestinal). Overall interobserver agreement among reviewers was substantial (κ = 0.63) and improved with the use of p16 immunostain in challenging cases (κ = 0.71; P < .001). This new terminology is not yet uniformly used by pathologists in anal/perianal biopsy specimens; this two-tier system has a good interobserver agreement and is further improved with p16 use in appropriate cases. © American Society for Clinical Pathology, 2017. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

A comparison between self-reported and GIS-based proxies of residential exposure to environmental pollution in a case-control study on lung cancer.

PubMed

Cordioli, M; Ranzi, A; Freni Sterrantino, A; Erspamer, L; Razzini, G; Ferrari, U; Gatti, M G; Bonora, K; Artioli, F; Goldoni, C A; Lauriola, P

2014-06-01

In epidemiological studies both questionnaire results and GIS modeling have been used to assess exposure to environmental risk factors. Nevertheless, few studies have used both these techniques to evaluate the degree of agreement between different exposure assessment methodologies. As part of a case-control study on lung cancer, we present a comparison between self-reported and GIS-derived proxies of residential exposure to environmental pollution. 649 subjects were asked to fill out a questionnaire and give information about residential history and perceived exposure. Using GIS, for each residence we evaluated land use patterns, proximity to major roads and exposure to industrial pollution. We then compared the GIS exposure-index values among groups created on the basis of questionnaire responses. Our results showed a relatively high agreement between the two methods. Although none of these methods is the "exposure gold standard", understanding similarities, weaknesses and strengths of each method is essential to strengthen epidemiological evidence. Copyright © 2014 Elsevier Ltd. All rights reserved.

[General Agreement on Trade in Services and its implications for public health].

PubMed

Umaña-Peña, Román; Alvarez-Dardet, Carlos

2005-01-01

Due to the economic importance of the service sector and its trade potential, in 1995 the World Trade Organization (WTO) launched the General Agreement on Trade in Services with the objective of liberalizing trade in services worldwide and of establishing rules and disciplines to regulate it. Until now, the Agreement has produced few case laws on its rules and some of them are in the process of being developed, which makes the Agreement ambiguous and hampers accurate forecasting of its implications. Nevertheless, some analysts consider that certain characteristics and rules represent a threat to the funding mechanisms of public services and to the sovereignty of governments to generate their own rules. Moreover, the Agreement would lead to irreversible formalization of commitments, without the possibility of returning to previous conditions in the case of failure of the market and/or private participation. In addition, the Agreement acts against exclusive monopolies and providers and to a certain extent this will affect subsidies to local providers. The ability of the European Communities Court of Justice to enforce the implementation of competitive measures in public services has produced uncertainty because of the implications for health services. The Spanish Agreement with the WTO contains many questions that remain open, representing an opportunity for the participation of the health sector in the next negotiation rounds.

Corporate integrity agreements: making the best of a tough situation.

PubMed

Ramsey, Robert B

2002-03-01

Healthcare providers increasingly are entering into corporate integrity agreements as part of settlements with the Federal government in fraud-and-abuse cases. Providers pursue these settlements to avoid the costs of defending themselves against fraud charges. However, the costs relating to the long-term compliance activity mandated in the settlement's corporate integrity agreement also can be substantial. These costs include significant staff resources that must be devoted to compliance efforts demanded by the agreement and the required engagement of consultants to monitor the organization's compliance. Healthcare financial managers should be familiar with the elements of a typical corporate integrity agreement and understand strategies for negotiating such an agreement. Effective negotiations can help minimize the organization's costs of compliance with the agreement and facilitate its ongoing implementation of the agreement.

Epidemiological and Clinical Features of Brucellosis in the Country of Georgia

PubMed Central

Akhvlediani, Tamar; Bautista, Christian T.; Garuchava, Natalia; Sanodze, Lia; Kokaia, Nora; Malania, Lile; Chitadze, Nazibrola; Sidamonidze, Ketevan; Rivard, Robert G.; Hepburn, Matthew J.; Nikolich, Mikeljon P.; Imnadze, Paata; Trapaidze, Nino

2017-01-01

Background Brucellosis is an endemic disease in the country of Georgia. According to the National Center for Disease Control and Public Health of Georgia (NCDC), the average annual number of brucellosis cases was 161 during 2008–2012. However, the true number of cases is thought to be higher due to underreporting. The aim of this study was to provide current epidemiological and clinical information and evaluate diagnostic methods used for brucellosis in Georgia. Methodology Adult patients were eligible for participation if they met the suspected or probable case definition for brucellosis. After consent participants were interviewed using a standardized questionnaire to collect information on socio-demographic characteristics, epidemiology, history of present illness, and clinical manifestation. For the diagnosis of brucellosis, culture and serological tests were used. Results A total of 81 participants were enrolled, of which 70 (86%) were from rural areas. Seventy-four percent of participants reported consuming unpasteurized milk products and 62% consuming undercooked meat products before symptom onset. Forty-one participants were positive by the Wright test and 33 (41%) were positive by blood culture. There was perfect agreement between the Huddelston and Wright tests (k = 1.0). Compared with blood culture (the diagnostic gold standard), ELISA IgG and total ELISA (IgG + IgM), the Wright test had fair (k = 0.12), fair (k = 0.24), and moderate (k = 0.52) agreement, respectively. Conclusions Consumption of unpasteurized milk products and undercooked meat were among the most common risk factors in brucellosis cases. We found poor agreement between ELISA tests and culture results. This report also serves as an initial indication that the suspected case definition for brucellosis surveillance purposes needs revision. Further research is needed to characterize the epidemiology and evaluate the performance of the diagnostic methods for brucellosis in Georgia. PMID:28107444

An articulated rotating brush for office endometrial evaluation of climacteric outpatients.

PubMed

Bocanera, A R; Roncoroni, E C; Schlaen, I; Ben, J; Monteverde, R; González García, M; Puche, R C; Tozzini, R

1994-05-01

This paper reports the experience obtained in the last 8 years with an instrument (articulated rotative brush) that allows access to the entire endometrial surface, obtaining material for both histological and cytological study. The latter has the advantage of reducing the number of cases in which insufficient material frustrates endometrial assessment. In addition to the overall experience gained with this instrument, the proportion of agreement with anatomo-pathological diagnosis after hysterectomy in 61 patients was high (96%) and the unweighted kappa statistic (0.862) indicated very good accordance between these techniques. Comparison between the present method and hysteroscopic observations in 84 patients with perimenopausal bleeding revealed a general conformity of 0.65 and an unweighted kappa statistic of 0.368 (fair agreement). In a group of 72 cases with postmenopausal bleeding a general conformity value of 0.92 was obtained, with an unweighted kappa statistic of 0.84 (very good agreement). In 90% of the cases the procedure was well accepted. In 57.3% of the cases, no difficulties were encountered using the brushing technique; in 25.9% slight dilatation was deemed necessary, whereas in 16.8% technical difficulties could not be overcome and general anesthesia was indicated. A total of 769 outpatients were investigated, 75.3% of which had normal endometria, 12.7% benign hyperplasias, 2.6% precursor lesions, 1.7% suspect carcinoma, and 4.2% carcinomas. Insufficient material for diagnosis occurred in 3.5% of cases tested. The combined cytohistological and hysteroscopic assessment of the endometrium provides satisfactory results in the etiological diagnosis of peri and postmenopausal bleeding, and in the follow up of patients undergoing hormonal replacement therapy (HRT).

The value of core lab stress echocardiography interpretations: observations from the ISCHEMIA Trial.

PubMed

Kataoka, Akihisa; Scherrer-Crosbie, Marielle; Senior, Roxy; Gosselin, Gilbert; Phaneuf, Denis; Guzman, Gabriela; Perna, Gian; Lara, Alfonso; Kedev, Sasko; Mortara, Andrea; El-Hajjar, Mohammad; Shaw, Leslee J; Reynolds, Harmony R; Picard, Michael H

2015-12-18

Stress echocardiography (SE) is dependent on subjective interpretations. As a prelude to the International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) Trial, potential sites were required to submit two SE, one with moderate or severe left ventricular (LV) myocardial ischemia and one with mild ischemia. We evaluated the concordance of site and core lab interpretations. Eighty-one SE were submitted from 41 international sites. Ischemia was classified by the number of new or worsening segmental LV wall motion abnormalities (WMA): none, mild (1 or 2) or moderate or severe (3 or more) by the sites and the core lab. Core lab classified 6 SE as no ischemia, 35 mild and 40 moderate or greater. There was agreement between the site and core in 66 of 81 total cases (81%, weighted kappa coefficient [K] =0.635). Agreement was similar for SE type - 24 of 30 exercise (80%, K = 0.571) vs. 41 of 49 pharmacologic (84%, K = 0.685). The agreement between poor or fair image quality (27 of 36 cases, 75%, K = 0.492) was not as good as for the good or excellent image quality cases (39 of 45 cases, 87%, K = 0.755). Differences in concordance were noted for degree of ischemia with the majority of discordant interpretations (87%) occurring in patients with no or mild LV myocardial ischemia. While site SE interpretations are largely concordant with core lab interpretations, this appears dependent on image quality and the extent of WMA. Thus core lab interpretations remain important in clinical trials where consistency of interpretation across a range of cases is critical. ClinicalTrials.gov NCT01471522.

Epidemiological and Clinical Features of Brucellosis in the Country of Georgia.

PubMed

Akhvlediani, Tamar; Bautista, Christian T; Garuchava, Natalia; Sanodze, Lia; Kokaia, Nora; Malania, Lile; Chitadze, Nazibrola; Sidamonidze, Ketevan; Rivard, Robert G; Hepburn, Matthew J; Nikolich, Mikeljon P; Imnadze, Paata; Trapaidze, Nino

2017-01-01

Brucellosis is an endemic disease in the country of Georgia. According to the National Center for Disease Control and Public Health of Georgia (NCDC), the average annual number of brucellosis cases was 161 during 2008-2012. However, the true number of cases is thought to be higher due to underreporting. The aim of this study was to provide current epidemiological and clinical information and evaluate diagnostic methods used for brucellosis in Georgia. Adult patients were eligible for participation if they met the suspected or probable case definition for brucellosis. After consent participants were interviewed using a standardized questionnaire to collect information on socio-demographic characteristics, epidemiology, history of present illness, and clinical manifestation. For the diagnosis of brucellosis, culture and serological tests were used. A total of 81 participants were enrolled, of which 70 (86%) were from rural areas. Seventy-four percent of participants reported consuming unpasteurized milk products and 62% consuming undercooked meat products before symptom onset. Forty-one participants were positive by the Wright test and 33 (41%) were positive by blood culture. There was perfect agreement between the Huddelston and Wright tests (k = 1.0). Compared with blood culture (the diagnostic gold standard), ELISA IgG and total ELISA (IgG + IgM), the Wright test had fair (k = 0.12), fair (k = 0.24), and moderate (k = 0.52) agreement, respectively. Consumption of unpasteurized milk products and undercooked meat were among the most common risk factors in brucellosis cases. We found poor agreement between ELISA tests and culture results. This report also serves as an initial indication that the suspected case definition for brucellosis surveillance purposes needs revision. Further research is needed to characterize the epidemiology and evaluate the performance of the diagnostic methods for brucellosis in Georgia.

External validation of the Society of Thoracic Surgeons General Thoracic Surgery Database.

PubMed

Magee, Mitchell J; Wright, Cameron D; McDonald, Donna; Fernandez, Felix G; Kozower, Benjamin D

2013-11-01

The Society of Thoracic Surgeons (STS) General Thoracic Surgery Database (GTSD) reports outstanding results for lung and esophageal cancer resection. However, a major weakness of the GTSD has been the lack of validation of this voluntary registry. The purpose of this study was to perform an external, independent audit to assess the accuracy of the data collection process and the quality of the database. An independent firm was contracted to audit 5% of sites randomly selected from the GTDB in 2011. Audits were performed remotely to maximize the number of audits performed and reduce cost. Auditors compared lobectomy cases submitted to the GTSD with the hospital operative logs to evaluate completeness of the data. In addition, 20 lobectomy records from each site were audited in detail. Agreement rates were calculated for 32 individual data elements, 7 data categories pertaining to patient status or care delivery, and an overall agreement rate for each site. Six process variables were also evaluated to assess best practice for data collection and submission. Ten sites were audited from the 222 participants. Comparison of the 559 submitted lobectomy cases with operative logs from each site identified 28 omissions, a 94.6% agreement rate (discrepancies/site range, 2 to 27). Importantly, cases not submitted had no mortality or major morbidity, indicating a lack of purposeful omission. The aggregate agreement rates for all categories were greater than 90%. The overall data accuracy was 94.9%. External audits of the GTSD validate the accuracy and completeness of the data. Careful examination of unreported cases demonstrated no purposeful omission or gaming. Although these preliminary results are quite good, it is imperative that the audit process is refined and continues to expand along with the GTSD to insure reliability of the database. The audit results are currently being incorporated into educational and quality improvement processes to add further value. Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Summary of Data from the Sixth AIAA CFD Drag Prediction Workshop: CRM Cases 2 to 5

NASA Technical Reports Server (NTRS)

Tinoco, Edward N.; Brodersen, Olaf P.; Keye, Stefan; Laflin, Kelly R.; Feltrop, Edward; Vassberg, John C.; Mani, Mori; Rider, Ben; Wahls, Richard A.; Morrison, Joseph H.;

Collaborative Drug Therapy Management: Case Studies of Three Community-Based Models of Care

PubMed Central

Snyder, Margie E.; Earl, Tara R.; Greenberg, Michael; Heisler, Holly; Revels, Michelle; Matson-Koffman, Dyann

2015-01-01

Collaborative drug therapy management agreements are a strategy for expanding the role of pharmacists in team-based care with other providers. However, these agreements have not been widely implemented. This study describes the features of existing provider–pharmacist collaborative drug therapy management practices and identifies the facilitators and barriers to implementing such services in community settings. We conducted in-depth, qualitative interviews in 2012 in a federally qualified health center, an independent pharmacy, and a retail pharmacy chain. Facilitators included 1) ensuring pharmacists were adequately trained; 2) obtaining stakeholder (eg, physician) buy-in; and 3) leveraging academic partners. Barriers included 1) lack of pharmacist compensation; 2) hesitation among providers to trust pharmacists; 3) lack of time and resources; and 4) existing informal collaborations that resulted in reduced interest in formal agreements. The models described in this study could be used to strengthen clinical–community linkages through team-based care, particularly for chronic disease prevention and management. PMID:25811494

Interrater reliability among epilepsy centers: multicenter study of epilepsy surgery.

PubMed

Haut, Sheryl R; Berg, Anne T; Shinnar, Shlomo; Cohen, Hillel W; Bazil, Carl W; Sperling, Michael R; Langfitt, John T; Pacia, Steven V; Walczak, Thaddeus S; Spencer, Susan S

2002-11-01

To measure the interrater reliability of presurgical testing and surgical decisions among epilepsy centers. Seven centers participating in an ongoing, prospective multicenter study of resective epilepsy surgery agreed to conform to a detailed protocol regarding presurgical evaluation and surgery. To assess quality assurance, each center independently reviewed 21 randomly selected surgical cases for preoperative study lateralization and localization, and surgical decisions. Interrater reliability was assessed by using intraclass correlation coefficients (ICCs), validated for use with multiple raters, and calculated in a two-way random model based on absolute agreement. Agreement for ICC values: > or = 0.75, excellent; 0.60-0.74, good; 0.40-0.59, fair; < or = 0.39, poor. One center was excluded for missing data. Agreement was excellent for extracranial EEG lateralization (0.8039), magnetic resonance imaging (MRI) lateralization (0.9521) and localization (0.9130), Wada lateralization (0.9453), and intracranial EEG localization (0.7905). Agreement was good for extracranial EEG localization (0.7384) and neuropsychological testing lateralization (0.7178) and localization (0.6891). Consensus about the decision to perform intracranial monitoring was fair (0.5397), in part reflecting one center's tendency toward intracranial monitoring. Overall agreements on whether to perform surgery (0.8311) and specific surgery recommended (0.8164) were excellent. High interrater reliability among six epilepsy centers was present for interpretation of most components of presurgical testing. Although consensus for the decision to perform intracranial monitoring was only fair, agreements for the ultimate decision about resective surgery and specific choice of resection were excellent. We believe that this study demonstrates the feasibility of implementing multicenter protocols for neurologic management, especially those involving localization, as well as protocols combining study results with clinical decision making.

Falls documentation in nursing homes: agreement between the minimum data set and chart abstractions of medical and nursing documentation.

PubMed

Hill-Westmoreland, Elizabeth E; Gruber-Baldini, Ann L

2005-02-01

To assess the agreement between falls as recorded in the Minimum Data Set (MDS) and fall events abstracted from chart documentation of elderly nursing home (NH) residents. Secondary analysis of data from a longitudinal panel study. Fifty-six randomly selected NHs in Maryland stratified by facility size and geographic region. Four hundred sixty-two NH residents, aged 65 and older, in NHs for 1 year. Falls were abstracted from resident charts and compared with MDS fall variables. Fall events data obtained from other sources of chart documentation were matched for the corresponding periods of 30 and 180 days before the 1-year MDS assessment date. For a 30-day period, concordance between the MDS and chart abstractions of falls occurred in 65% of cases, with a kappa coefficient of 0.29 (P<.001), indicating fair agreement. Concordance occurred between the sources for 75% of cases for a 180-day period, with a kappa of 0.50 (P<.001), indicating moderate agreement. During the 180-day period, chart abstractions showed that 49% of the sample fell, whereas the MDS revealed that only 28% fell. An analysis of residents whose falls the MDS missed indicated that these residents had significantly more activity of daily living impairment and significantly less unsteady gait and cane/walker use. The MDS underreported falls. Nurses completing MDS assessments must carefully review residents' medical records for falls documentation. Future studies should use caution when employing MDS data as the only indicator of falls.

Challenges in Pathologic Staging of Renal Cell Carcinoma: A Study of Interobserver Variability Among Urologic Pathologists.

PubMed

Williamson, Sean R; Rao, Priya; Hes, Ondrej; Epstein, Jonathan I; Smith, Steven C; Picken, Maria M; Zhou, Ming; Tretiakova, Maria S; Tickoo, Satish K; Chen, Ying-Bei; Reuter, Victor E; Fleming, Stewart; Maclean, Fiona M; Gupta, Nilesh S; Kuroda, Naoto; Delahunt, Brett; Mehra, Rohit; Przybycin, Christopher G; Cheng, Liang; Eble, John N; Grignon, David J; Moch, Holger; Lopez, Jose I; Kunju, Lakshmi P; Tamboli, Pheroze; Srigley, John R; Amin, Mahul B; Martignoni, Guido; Hirsch, Michelle S; Bonsib, Stephen M; Trpkov, Kiril

2018-06-06

Staging criteria for renal cell carcinoma differ from many other cancers, in that renal tumors are often spherical with subtle, finger-like extensions into veins, renal sinus, or perinephric tissue. We sought to study interobserver agreement in pathologic stage categories for challenging cases. An online survey was circulated to urologic pathologists interested in kidney tumors, yielding 89% response (31/35). Most questions included 1 to 4 images, focusing on: vascular and renal sinus invasion (n=24), perinephric invasion (n=9), and gross pathology/specimen handling (n=17). Responses were collapsed for analysis into positive and negative/equivocal for upstaging. Consensus was regarded as an agreement of 67% (2/3) of participants, which was reached in 20/33 (61%) evaluable scenarios regarding renal sinus, perinephric, or vein invasion, of which 13/33 (39%) had ≥80% consensus. Lack of agreement was especially encountered regarding small tumor protrusions into a possible vascular lumen, close to the tumor leading edge. For gross photographs, most were interpreted as suspicious but requiring histologic confirmation. Most participants (61%) rarely used special stains to evaluate vascular invasion, usually endothelial markers (81%). Most agreed that a spherical mass bulging well beyond the kidney parenchyma into the renal sinus (71%) or perinephric fat (90%) did not necessarily indicate invasion. Interobserver agreement in pathologic staging of renal cancer is relatively good among urologic pathologists interested in kidney tumors, even when selecting cases that test the earliest and borderline thresholds for extrarenal extension. Disagreements remain, however, particularly for tumors with small, finger-like protrusions, closely juxtaposed to the main mass.

Use of Web-based training for quality improvement between a field immunohistochemistry laboratory in Nigeria and its United States-based partner institution.

PubMed

Oluwasola, Abideen O; Malaka, David; Khramtsov, Andrey Ilyich; Ikpatt, Offiong Francis; Odetunde, Abayomi; Adeyanju, Oyinlolu Olorunsogo; Sveen, Walmy Elisabeth; Falusi, Adeyinka Gloria; Huo, Dezheng; Olopade, Olufunmilayo Ibironke

2013-12-01

The importance of hormone receptor status in assigning treatment and the potential use of human epidermal growth factor receptor 2 (HER2)-targeted therapy have made it beneficial for laboratories to improve detection techniques. Because interlaboratory variability in immunohistochemistry (IHC) tests may also affect studies of breast cancer subtypes in different countries, we undertook a Web-based quality improvement training and a comparative study of accuracy of immunohistochemical tests of breast cancer biomarkers between a well-established laboratory in the United States (University of Chicago) and a field laboratory in Ibadan, Nigeria. Two hundred and thirty-two breast tumor blocks were evaluated for estrogen receptors (ERs), progesterone receptors (PRs), and HER2 status at both laboratories using tissue microarray technique. Initially, concordance analysis revealed κ scores of 0.42 (moderate agreement) for ER, 0.41 (moderate agreement) for PR, and 0.39 (fair agreement) for HER2 between the 2 laboratories. Antigen retrieval techniques and scoring methods were identified as important reasons for discrepancy. Web-based conferences using Web conferencing tools such as Skype and WebEx were then held periodically to discuss IHC staining protocols and standard scoring systems and to resolve discrepant cases. After quality assurance and training, the agreement improved to 0.64 (substantial agreement) for ER, 0.60 (moderate agreement) for PR, and 0.75 (substantial agreement) for HER2. We found Web-based conferences and digital microscopy useful and cost-effective tools for quality assurance of IHC, consultation, and collaboration between distant laboratories. Quality improvement exercises in testing of tumor biomarkers will reduce misclassification in epidemiologic studies of breast cancer subtypes and provide much needed capacity building in resource-poor countries. © 2013.

When calibration is not enough

NASA Astrophysics Data System (ADS)

Kingsley, Jeffrey R.; Johnson, Leslie

1999-12-01

When added CD (Critical Dimension) capacity is needed there are several routes that can be taken -- add shifts and people to existing equipment, obtain additional equipment and staff or use an outside service provider for peak and emergency work. In all but the first scenario the qualification of the 'new' equipment, and correlation to the existing measurements, is key to meaningful results. In many cases simply calibrating the new tool with the same reference material or standard used to calibrate the existing tools will provide the level of agreement required. In fact, calibrating instruments using different standards can provide an acceptable level of agreement in cases where accuracy is a second tier consideration. However, there are also situations where factors outside of calibration can influence the results. In this study CD measurements from a mask sample being used to qualify an outside service provider showed good agreement for the narrower linewidths, but significant deviation occurred with increasing CD. In the course of a root cause investigation, it was found that there are a variety of factors that may influence the agreement found between two tools. What are these 'other factors' and how are they found? In the present case the results of a 'round robin' consensus from a variety of tools was used to initially determine which tool needed to be investigated. The instrument parameters felt to be the most important causes of the disagreement were identified and experiments run to test their influence. The factors investigated as the cause of the disagreement included (1) Type of detector and location with respect to sample, (2) Beam Voltage, (3) Scan Rotation/Sample Orientation issues and (4) Edge Detection Algorithm.

Interobserver reproducibility in pathologist interpretation of columnar-lined esophagus.

PubMed

Mastracci, Luca; Piol, Nataniele; Molinaro, Luca; Pitto, Francesca; Tinelli, Carmine; De Silvestri, Annalisa; Fiocca, Roberto; Grillo, Federica

2016-02-01

Confirmation of endoscopically suspected esophageal metaplasia (ESEM) requires histology, but confusion in the histological definition of columnar-lined esophagus (CLE) is a longstanding problem. The aim of this study is to evaluate interpathologist variability in the interpretation of CLE. Thirty pathologists were invited to review three ten-case sets of CLE biopsies. In the first set, the cases were provided with descriptive endoscopy only; in the second and the third sets, ESEM extent using Prague criteria was provided. Moreover, participants were required to refer to a diagnostic chart for evaluation of the third set. Agreement was statistically assessed using Randolph's free-marginal multirater kappa. While substantial agreement in recognizing columnar epithelium (K = 0.76) was recorded, the overall concordance in clinico-pathological diagnosis was low (K = 0.38). The overall concordance rate improved from the first (K = 0.27) to the second (K = 0.40) and third step (K = 0.46). Agreement was substantial when diagnosing Barrett's esophagus (BE) with intestinal metaplasia or inlet patch (K = 0.65 and K = 0.89), respectively, in the third step, while major problems in interpretation of CLE were observed when only cardia/cardia-oxyntic atrophic-type epithelium was present (K = 0.05-0.29). In conclusion, precise endoscopic description and the use of a diagnostic chart increased consistency in CLE interpretation of esophageal biopsies. Agreement was substantial for some diagnostic categories (BE with intestinal metaplasia and inlet patch) with a well-defined clinical profile. Interpretation of cases with cardia/cardia-oxyntic atrophic-type epithelium, with or without ESEM, was least consistent, which reflects lack of clarity of definition and results in variable management of this entity.

Opinion formation in time-varying social networks: The case of the naming game

NASA Astrophysics Data System (ADS)

Maity, Suman Kalyan; Manoj, T. Venkat; Mukherjee, Animesh

2012-09-01

We study the dynamics of the naming game as an opinion formation model on time-varying social networks. This agent-based model captures the essential features of the agreement dynamics by means of a memory-based negotiation process. Our study focuses on the impact of time-varying properties of the social network of the agents on the naming game dynamics. In particular, we perform a computational exploration of this model using simulations on top of real networks. We investigate the outcomes of the dynamics on two different types of time-varying data: (1) the networks vary on a day-to-day basis and (2) the networks vary within very short intervals of time (20 sec). In the first case, we find that networks with strong community structure hinder the system from reaching global agreement; the evolution of the naming game in these networks maintains clusters of coexisting opinions indefinitely leading to metastability. In the second case, we investigate the evolution of the naming game in perfect synchronization with the time evolution of the underlying social network shedding new light on the traditional emergent properties of the game that differ largely from what has been reported in the existing literature.

Instability of the capillary bridge

NASA Astrophysics Data System (ADS)

Pare, Gounseti; Hoepffner, Jerome

2014-11-01

Capillary adhesion is a physical mechanism that maintains two bodies in contact by capillarity through a liquid ligament. The capillary bridge is an idealization of this capillary adhesion. In this study we first focus on the classical case of the stability of the capillary bridge. Secondly we study a slightly more complex configuration, imagining a flow in the capillary bridge as in the case of the dynamics of the neck of a liquid ligament, in its withdrawal under the effect of capillarity. Inspired by the experiments on soap films of Plateau, the configuration analyzed consists of an initially axisymmetric, mass of fluid held by surface tension forces between two parallel, coaxial, solid pipes of the same diameter. The results presented are obtained by numerical simulations using the free software, Gerris Flow Solver. We first focus on the capillary Venturi. In the static configuration the stability diagram of the capillary bridge obtained is in perfect agreement with the results of Lev A. Slobozhanin. In the dynamic case we develop a matlab code based on the one dimensional equations of Eggers and Dupont. The comparison of the bifurcation diagram obtained and the numerical simulations shows a good agreement.

The reproducibility of CIN diagnoses among different pathologists: data from histology reviews from a multicenter randomized study.

PubMed

Dalla Palma, Paolo; Giorgi Rossi, Paolo; Collina, Guido; Buccoliero, Anna Maria; Ghiringhello, Bruno; Gilioli, Eliana; Onnis, Gian Libero; Aldovini, Daniela; Galanti, Giuseppe; Casadei, Gianpiero; Aldi, Mirella; Gomes, Vito V; Giubilato, Pamela; Ronco, Guglielmo

2009-07-01

The reproducibility of cervical histology diagnoses is critical for efficient screening and to evaluate the effectiveness of new technologies. The vast majority of cervical intraepithelial neoplasia (CIN) diagnoses reported in the New Technologies for Cervical Cancer study were blindly reviewed by 2 independent pathologists. Only H&E-stained slides were used for the review. The reviewers were asked to reclassify cases using the following categories: normal CIN 1, CIN 2, CIN 3, and squamous and glandular invasive cancer. We reviewed 1,003 cases. The interobserver agreement was 0.36 (95% confidence interval [CI], 0.32-0.40) with an unweighted kappa and 0.54 with a weighted kappa (95% CI, 0.50-0.58). The kappa values from dichotomous classifications with the threshold at CIN 2 were 0.69 (95% CI, 0.64-0.73) and 0.57 (95% CI, 0.51-0.63) with the threshold at CIN 3. The CIN 2 diagnosis had the lowest class-specific agreement, with fewer than 50% of cases confirmed by the panel members, which supports the fact that CIN 2 is not a well-defined stage in the pathogenesis of cervical neoplasia.

Inter-rater agreement among orthodontists in a blocked experiment.

PubMed

Korn, E L; Baumrind, S

1985-01-01

Five orthodontists were asked to predict for 64 patients a particular dichotomous outcome of treatment based on pre-treatment X-ray films. The orthodontists rated the cases in blocks of size 4-6 with the knowledge of the number of positive outcomes in each block. We discuss the reasons why this blocked design is appropriate whenever clinicians are asked to rate cases which have not been randomly selected from a clinical practice similar to their own. We give a simple description of the inter-rater agreement for this type of blocked experiment as well as a procedure to test that the agreement is no better than that expected by random independent assignment.

Comparing Visual and Statistical Analysis in Single-Case Studies Using Published Studies

PubMed Central

Harrington, Magadalena; Velicer, Wayne F.

2015-01-01

Little is known about the extent to which interrupted time-series analysis (ITSA) can be applied to short, single-case study designs and whether those applications produce results consistent with visual analysis (VA). This paper examines the extent to which ITSA can be applied to single-case study designs and compares the results based on two methods: ITSA and VA, using papers published in the Journal of Applied Behavior Analysis in 2010. The study was made possible by the development of software called UnGraph® which facilitates the recovery of raw data from the graphs. ITSA was successfully applied to 94% of the examined graphs with the number of observations ranging from 8 to 136. Moderate to high lag 1 autocorrelations (> .50) were found for 46% of the data series. Effect sizes similar to group-level Cohen’s d were identified based on the tertile distribution. Effects ranging from 0.00 to 0.99 were classified as small, those ranging from 1.00 to 2.49 as medium, and large effect sizes were defined as 2.50 or greater. Comparison of the conclusions from VA and ITSA had a low level of agreement (Kappa = .14, accounting for the agreement expected by chance). The results demonstrate that ITSA can be broadly implemented in applied behavior analysis research. These two methods should be viewed as complimentary and used concurrently. PMID:26609876

Agreement between diagnoses reached by clinical examination and available reference standards: a prospective study of 216 patients with lumbopelvic pain

PubMed Central

Laslett, Mark; McDonald, Barry; Tropp, Hans; Aprill, Charles N; Öberg, Birgitta

2005-01-01

Background The tissue origin of low back pain (LBP) or referred lower extremity symptoms (LES) may be identified in about 70% of cases using advanced imaging, discography and facet or sacroiliac joint blocks. These techniques are invasive and availability varies. A clinical examination is non-invasive and widely available but its validity is questioned. Diagnostic studies usually examine single tests in relation to single reference standards, yet in clinical practice, clinicians use multiple tests and select from a range of possible diagnoses. There is a need for studies that evaluate the diagnostic performance of clinical diagnoses against available reference standards. Methods We compared blinded clinical diagnoses with diagnoses based on available reference standards for known causes of LBP or LES such as discography, facet, sacroiliac or hip joint blocks, epidurals injections, advanced imaging studies or any combination of these tests. A prospective, blinded validity design was employed. Physiotherapists examined consecutive patients with chronic lumbopelvic pain and/or referred LES scheduled to receive the reference standard examinations. When diagnoses were in complete agreement regardless of complexity, "exact" agreement was recorded. When the clinical diagnosis was included within the reference standard diagnoses, "clinical agreement" was recorded. The proportional chance criterion (PCC) statistic was used to estimate agreement on multiple diagnostic possibilities because it accounts for the prevalence of individual categories in the sample. The kappa statistic was used to estimate agreement on six pathoanatomic diagnoses. Results In a sample of chronic LBP patients (n = 216) with high levels of disability and distress, 67% received a patho-anatomic diagnosis based on available reference standards, and 10% had more than one tissue origin of pain identified. For 27 diagnostic categories and combinations, chance clinical agreement (PCC) was estimated at 13%. "Exact" agreement between clinical and reference standard diagnoses was 32% and "clinical agreement" 51%. For six pathoanatomic categories (disc, facet joint, sacroiliac joint, hip joint, nerve root and spinal stenosis), PCC was 33% with actual agreement 56%. There was no overlap of 95% confidence intervals on any comparison. Diagnostic agreement on the six most common patho-anatomic categories produced a kappa of 0.31. Conclusion Clinical diagnoses agree with reference standards diagnoses more often than chance. Using available reference standards, most patients can have a tissue source of pain identified. PMID:15943873

Return-to-work success despite conflicts: an exploration of decision-making during a work rehabilitation program.

PubMed

Gouin, Marie-Michelle; Coutu, Marie-France; Durand, Marie-José

2017-11-12

Collective decision-making by stakeholders appears important to return-to-work success, yet few studies have explored the processes involved. This study aims to explore the influence of decision-making on return-to-work for workers with musculoskeletal or common mental disorders. This study is a secondary analysis using data from three earlier multiple-case studies that documented decision-making during similar and comparable work rehabilitation programs. Individual interviews were conducted at the end of the program with stakeholders, namely, the disabled workers and representatives of health care professionals, employers, unions and insurers. Verbatims were analysed inductively. The 28 decision-making processes (cases) led to 115 different decisions-making instances and included the following components: subjects of the decisions, stakeholders' concerns and powers, and types of decision-making. No differences were found in decision-making processes relative to the workers' diagnoses or return-to-work status. However, overall analysis of decision-making revealed that stakeholder agreement on a return-to-work goal and acceptance of an intervention plan in which the task demands aligned with the worker's capacities were essential for return-to-work success. These results support the possibility of return-to-work success despite conflictual decision-making processes. In addition to facilitating consensual decisions, future studies should be aimed at facilitating negotiated decisions. Implications for rehabilitation Facilitating decision-making, with the aim of obtaining agreement from all stakeholders on a return-to-work goal and their acceptance of an intervention plan that respects the worker's capacities, is important for return-to-work success. Rehabilitation professionals should constantly be on the lookout for potential conflicts, which may either complicate the reach of an agreement between the stakeholders or constrain return-to-work possibilities. Rehabilitation professionals should also be constantly watching for workers' and employers' return-to-work concerns, as they may change during work rehabilitation, potentially challenging a reached agreement.

Impact of specimen adequacy on the assessment of renal allograft biopsy specimens.

PubMed

Cimen, S; Geldenhuys, L; Guler, S; Imamoglu, A; Molinari, M

2016-01-01

The Banff classification was introduced to achieve uniformity in the assessment of renal allograft biopsies. The primary aim of this study was to evaluate the impact of specimen adequacy on the Banff classification. All renal allograft biopsies obtained between July 2010 and June 2012 for suspicion of acute rejection were included. Pre-biopsy clinical data on suspected diagnosis and time from renal transplantation were provided to a nephropathologist who was blinded to the original pathological report. Second pathological readings were compared with the original to assess agreement stratified by specimen adequacy. Cohen's kappa test and Fisher's exact test were used for statistical analyses. Forty-nine specimens were reviewed. Among these specimens, 81.6% were classified as adequate, 6.12% as minimal, and 12.24% as unsatisfactory. The agreement analysis among the first and second readings revealed a kappa value of 0.97. Full agreement between readings was found in 75% of the adequate specimens, 66.7 and 50% for minimal and unsatisfactory specimens, respectively. There was no agreement between readings in 5% of the adequate specimens and 16.7% of the unsatisfactory specimens. For the entire sample full agreement was found in 71.4%, partial agreement in 20.4% and no agreement in 8.2% of the specimens. Statistical analysis using Fisher's exact test yielded a P value above 0.25 showing that - probably due to small sample size - the results were not statistically significant. Specimen adequacy may be a determinant of a diagnostic agreement in renal allograft specimen assessment. While additional studies including larger case numbers are required to further delineate the impact of specimen adequacy on the reliability of histopathological assessments, specimen quality must be considered during clinical decision making while dealing with biopsy reports based on minimal or unsatisfactory specimens.

Treatment outcomes in 3 modes of orthodontic practice.

PubMed

Poulton, Donald R; Baumrind, Sheldon; Vlaskalic, Vicki

2002-02-01

This study examined differences in pretreatment severity and treatment outcome among orthodontic patients treated in 3 different practice-management modes. Samples of pretreatment (T1) and end of treatment (T2) study casts were selected from traditional private practices (TPP, 3 offices, 81 cases), a dental corporation (COMP, 2 offices, 53 cases), and a dental management service organization (DMSO, 1 office, 36 cases). Orthodontic specialists had treated all patients. Cases were initially selected on a consecutive start basis. From each practice, the first 30 cases satisfying the study criteria were included in the sample. The T1 and T2 study casts were evaluated with the PAR and HLD indexes. The PAR and HLD indexes showed a high level of agreement on T1 cast scores but not on the T2 casts. Mean T1 scores were highest in the COMP cases, followed by the DMSO and the TPP cases. T2 scores were lowest in the TPP cases, followed by the DMSO and the COMP cases. The percentage of PAR score reduction showed that, in all 3 modes, patients were treated to a high standard.

Are distal radius fracture classifications reproducible? Intra and interobserver agreement.

PubMed

Belloti, João Carlos; Tamaoki, Marcel Jun Sugawara; Franciozi, Carlos Eduardo da Silveira; Santos, João Baptista Gomes dos; Balbachevsky, Daniel; Chap Chap, Eduardo; Albertoni, Walter Manna; Faloppa, Flávio

2008-05-01

Various classification systems have been proposed for fractures of the distal radius, but the reliability of these classifications is seldom addressed. For a fracture classification to be useful, it must provide prognostic significance, interobserver reliability and intraobserver reproducibility. The aim here was to evaluate the intraobserver and interobserver agreement of distal radius fracture classifications. This was a validation study on interobserver and intraobserver reliability. It was developed in the Department of Orthopedics and Traumatology, Universidade Federal de São Paulo - Escola Paulista de Medicina. X-rays from 98 cases of displaced distal radius fracture were evaluated by five observers: one third-year orthopedic resident (R3), one sixth-year undergraduate medical student (UG6), one radiologist physician (XRP), one orthopedic trauma specialist (OT) and one orthopedic hand surgery specialist (OHS). The radiographs were classified on three different occasions (times T1, T2 and T3) using the Universal (Cooney), Arbeitsgemeinschaft für Osteosynthesefragen/Association for the Study of Internal Fixation (AO/ASIF), Frykman and Fernández classifications. The kappa coefficient (kappa) was applied to assess the degree of agreement. Among the three occasions, the highest mean intraobserver k was observed in the Universal classification (0.61), followed by Fernández (0.59), Frykman (0.55) and AO/ASIF (0.49). The interobserver agreement was unsatisfactory in all classifications. The Fernández classification showed the best agreement (0.44) and the worst was the Frykman classification (0.26). The low agreement levels observed in this study suggest that there is still no classification method with high reproducibility.

Does parent-child agreement vary based on presenting problems? Results from a UK clinical sample.

PubMed

Cleridou, Kalia; Patalay, Praveetha; Martin, Peter

2017-01-01

Discrepancies are often found between child and parent reports of child psychopathology, nevertheless the role of the child's presenting difficulties in relation to these is underexplored. This study investigates whether parent-child agreement on the conduct and emotional scales of the Strengths and Difficulties Questionnaire (SDQ) varied as a result of certain child characteristics, including the child's presenting problems to clinical services, age and gender. The UK-based sample consisted of 16,754 clinical records of children aged 11-17, the majority of which were female (57%) and White (76%). The dataset was provided by the Child Outcomes Research Consortium , which collects outcome measures from child services across the UK. Clinicians reported the child's presenting difficulties, and parents and children completed the SDQ. Using correlation analysis, the main findings indicated that agreement varied as a result of the child's difficulties for reports of conduct problems, and this seemed to be related to the presence or absence of externalising difficulties in the child's presentation. This was not the case for reports of emotional difficulties. In addition, agreement was higher when reporting problems not consistent with the child's presentation; for instance, agreement on conduct problems was greater for children presenting with internalising problems. Lastly, the children's age and gender did not seem to have an impact on agreement. These findings demonstrate that certain child presenting difficulties, and in particular conduct problems, may be related to informant agreement and need to be considered in clinical practice and research. Trial Registration This study was observational and as such did not require trial registration.

Detection of Mycoplasma pneumoniae in adult community-acquired pneumonia by PCR and serology.

PubMed

Martínez, María A; Ruiz, Mauricio; Zunino, Enna; Luchsinger, Vivian; Avendaño, Luis F

2008-12-01

Diagnosis of pneumonia caused by Mycoplasma pneumoniae in adults is hampered by a lack of rapid and standardized tests for detection. This prospective study was conducted to compare the diagnostic values of an indirect immunofluorescence assay and a 16S rRNA gene PCR for the diagnosis of M. pneumoniae pneumonia in adults. From February 2005 to January 2008, 357 patients (53.8 % males, median age 63 years, range 18-94) admitted for community-acquired pneumonia (CAP) to two hospitals in Santiago, Chile, were enrolled in the study. Thirty-two patients (9.0 %) met the criteria of current or recent M. pneumoniae infection, and laboratory diagnosis was definitive in 26 cases (81.2 %) and presumptive in six cases (18.8 %). Among the 32 M. pneumoniae infections, the PCR assay was positive in 23 (71.9 %) and the serology in 27 (84.4 %) of the cases. IgM was positive in acute-phase serum specimens in 13 cases (40.6 %) of M. pneumoniae infections. Using serology as the gold standard, the sensitivity, specificity, and positive and negative predictive values of the PCR were 66.7, 98.5, 78.3 and 97.3 %, respectively, whereas the global agreement of the methods was 343/357 (96.1 %). The frequency of M. pneumoniae CAP cases declined significantly during the second year of study, suggesting the end of an epidemic period. In conclusion, although good global agreement was found between PCR and serology, the lower sensitivity of the PCR leads us to recommend the use of both procedures in parallel to confirm M. pneumoniae in CAP in adults.

Governance, Leadership, and Management in Federations of Schools

ERIC Educational Resources Information Center

Chapman, Christopher; Lindsay, Geoff; Muijs, Daniel; Harris, Alma; Arweck, Elisabeth; Goodall, Janet

2010-01-01

In England, federations are defined as groups of schools that have a formal agreement to collaborate with the aim of raising achievement and promoting inclusion and innovation. This paper presents a number of findings from the case study strand of a 3-year study investigating the impact of 37 federations (see Lindsay et al., 2007). Maximum…

Identifying a National Death Index Match

PubMed Central

Burchett, Bruce M.; Blazer, Dan G.

2009-01-01

Data from the National Death Index (NDI) are frequently used to determine survival status in epidemiologic or clinical studies. On the basis of selected information submitted by the investigator, NDI returns a file containing a set of candidate matches. Although NDI deems some matches as perfect, multiple candidate matches may be available for other cases. Working across data from the Duke University site of the Established Populations for Epidemiologic Studies of the Elderly (EPESE), NDI, and the Social Security Death Index (SSDI), the authors found that, for this Established Populations for Epidemiologic Studies of the Elderly cohort of 1,896 cases born before 1922 and alive as of January 1, 1999, a match on Social Security number plus additional personal information (specific combinations of last name, first name, month of birth, day of birth) resulted in agreement between NDI and Social Security Death Index dates of death 94.7% of the time, while comparable agreement was found for only 12.3% of candidate decedents who did not have the required combination of information. Thus, an easy to apply algorithm facilitates accurate identification of NDI matches. PMID:19567777

FAST Model Calibration and Validation of the OC5- DeepCwind Floating Offshore Wind System Against Wave Tank Test Data: Preprint

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wendt, Fabian F; Robertson, Amy N; Jonkman, Jason

During the course of the Offshore Code Comparison Collaboration, Continued, with Correlation (OC5) project, which focused on the validation of numerical methods through comparison against tank test data, the authors created a numerical FAST model of the 1:50-scale DeepCwind semisubmersible system that was tested at the Maritime Research Institute Netherlands ocean basin in 2013. This paper discusses several model calibration studies that were conducted to identify model adjustments that improve the agreement between the numerical simulations and the experimental test data. These calibration studies cover wind-field-specific parameters (coherence, turbulence), hydrodynamic and aerodynamic modeling approaches, as well as rotor model (blade-pitchmore » and blade-mass imbalances) and tower model (structural tower damping coefficient) adjustments. These calibration studies were conducted based on relatively simple calibration load cases (wave only/wind only). The agreement between the final FAST model and experimental measurements is then assessed based on more-complex combined wind and wave validation cases.« less

A case study of three methods used in detecting bridge deck deterioration associated with spalling.

DOT National Transportation Integrated Search

1973-01-01

The three most widely used current methods for detecting deterioration of concrete bridge decks associated with spalling were compared with a visual inspection of the reinforcing steel and to each other in order to determine the degree of agreement a...

Successful Strategies: Building a School-to-Careers System.

ERIC Educational Resources Information Center

Thiers, Naomi, Ed.

The following papers are included: "Building a Broad-Based Partnership" (Randy Wallace); "Creating a Partnership Agreement" (M. Amos Clifford, Robyn Flores); "Forming True Partnerships with Employers" (Lee W. Sloan); "Choosing a Model for Your School-to-Careers System" (Patty Williamson); "Case Study: Career Academy Model" (Shirley Earlise…

Chemical models of interstellar gas-grain processes. II - The effect of grain-catalysed methane on gas phase evolution

NASA Technical Reports Server (NTRS)

Brown, Paul D.; Charnley, S. B.

1991-01-01

The effects on gas phase chemistry which result from the continuous desorption of methane molecules from grain surfaces are studied. Significant and sustained enhancements in the abundances of several complex hydrocarbon molecules are found, in good agreement with their observed values in TMC-1. The overall agreement is, however, just as good for the case of zero CH4 desorption efficiency. It is thus impossible to determine from the models whether or not the grain-surface production of methane is responsible for the observed abundances of some hydrocarbon molecules.

[Record linkage of a large clinical practice patient cohort with the Cancer Registry Schleswig-Holstein].

PubMed

Obi, N; Waldmann, A; Babaev, V; Katalinic, A

2011-07-01

A precondition for the evaluation of outcomes in cohort studies and screening programmes is the availability of follow-up data. In Germany, established cancer registries provide such data for incident primary cancer diseases and mortality. To utilise these cancer registry data a person's identifying code has to be correctly linked to study or programme records, a procedure which, up to date, has been only rarely used in Germany. Exemplarily, the feasibility and validity of record linkage of a cohort of 173 050 patients from the Quality-assured Mamma Diagnostic programme (QuaMaDi) to the cancer registry Schleswig-Holstein was assessed by the accuracy of the classified outcome. Name, date of birth and address of the QuaMaDi cohort members were coded in the confidential administration center of the registry. These codes were passed by the codes of 129 455 female cancer registry records. Datasets were synchronised for each match, so that QuaMaDi participants could be identified in the registry file. In a next step epidemiological registry records were linked to the QuaMaDi study records. The accuracy of classifying outcome was assessed by agreement measures, i. e., Cohen's kappa. In cases of disagreement, a questionnaire has been sent to QuaMaDi patients' gynaecologists to validate the final diagnosis. Synchronisation of both cohorts resulted in 18 689 one to one matches with any kind of malignant tumour, therein 8 449 breast cancers (ICD-10 C50, D05). Absolute agreement between files according to diagnosed or suspected breast cancer was 97.6% with a kappa value of 0.79. When suspicious BIRADS 4 cases from QuaMaDi were excluded, agreement and kappa rose to 99.5% and 0.948, respectively. After correction of the final diagnosis according to the physician's responses, agreement measures slightly improved in both groups of ascertained diagnosis including and excluding the suspected cases. Within QuaMaDi the diagnosed breast cancer cases were predominantly notified in the cancer registry. Discordant matches (false negatives and false positives) may have resulted due to various causes, thereof a very low percentage of record linkages from different persons. In conclusion, synchronisation of study cohort files to registry files using pseudonymous personal data is feasible and valid. The generated combined datasets can be used for comparative analysis of several objectives. One of them will be the evaluation of screening programmes in the near future. © Georg Thieme Verlag KG Stuttgart · New York.

Parent-youth agreement on symptoms and diagnosis: assessment with a diagnostic interview in an adolescent inpatient clinical population.

PubMed

Lauth, Bertrand; Arnkelsson, Guðmundur B; Magnússon, Páll; Skarphéðinsson, Guðmundur Á; Ferrari, Pierre; Pétursson, Hannes

2010-12-01

Diagnostic information on adolescents may be elicited from both youths and their parents, especially for depressive and suicidal symptomatology. The objective of this study was to examine the degree of agreement between parent and adolescent reports of major psychiatric disorders, at the diagnostic and at the symptom level, in a severely affected inpatient clinical population. 64 parent-adolescent pairs were interviewed separately with the semi-structured diagnostic interview Kiddie-SADS-PL. Symptomatology was also assessed with 11 self-report and parent-report scales, all translated, adapted and in most cases validated in Iceland. A total of 25 subscales were included to assess emotional dimensions such as depression or anxiety and cognitive dimensions such as attention deficit or self-concept. Good agreement was found for social phobia and fair agreement for generalized anxiety disorder. Although parent-youth agreement was poor in most cases at the symptoms level, significant correlations indicated consistency for most severity scores, except those related to depressive symptomatology, attention deficit, separation anxiety or conduct disorder. The low agreement between reports of suicidal ideation is in line with results from previous studies and suggests that parents might under- or over-estimate this symptomatology. The combination of data obtained with diagnostic interviews and rating-scales confirmed results from prior empirical work, giving greater weight to parents' reports of observable behavior and to adolescents' reports of subjective experiences, especially depressive symptomatology. Our findings suggest that both parent and child informants are necessary to obtain adequate assessments in adolescents. Further research should explore the correspondence between discrepant diagnoses and external criteria such as parental psychopathology or parent-child relationships and attachment. Psychoanalysis could benefit from cognitive neuroscience and use cognitive assessments as interesting tools. Thus, cognitive assessments can show discrepant results according to parents' or adolescents' reports and can therefore shed light on the parent-child interaction and relational dynamics. Inversely, cognitive neuroscience could benefit from psychoanalysis by taking into account, when interpretating the scores, the relational dynamics and the personal history of the rater. Copyright © 2010 Elsevier Ltd. All rights reserved.

Gender Agreement Attraction in Russian: Production and Comprehension Evidence

PubMed Central

Slioussar, Natalia; Malko, Anton

2016-01-01

Agreement attraction errors (such as the number error in the example “The key to the cabinets are rusty”) have been the object of many studies in the last 20 years. So far, almost all production experiments and all comprehension experiments looked at binary features (primarily at number in Germanic, Romance, and some other languages, in several cases at gender in Romance languages). Among other things, it was noted that both in production and in comprehension, attraction effects are much stronger for some feature combinations than for the others: they can be observed in the sentences with singular heads and plural dependent nouns (e.g.,“The key to the cabinets…”), but not in the sentences with plural heads and singular dependent nouns (e.g., “The keys to the cabinet…”). Almost all proposed explanations of this asymmetry appeal to feature markedness, but existing findings do not allow teasing different approaches to markedness apart. We report the results of four experiments (one on production and three on comprehension) studying subject-verb gender agreement in Russian, a language with three genders. Firstly, we found attraction effects both in production and in comprehension, but, unlike in the case of number agreement, they were not parallel (in production, feminine gender triggered strongest effects, while neuter triggered weakest effects, while in comprehension, masculine triggered weakest effects). Secondly, in the comprehension experiments attraction was observed for all dependent noun genders, but only for a subset of head noun genders. This goes against the traditional assumption that the features of the dependent noun are crucial for attraction, showing the features of the head are more important. We demonstrate that this approach can be extended to previous findings on attraction and that there exists other evidence for it. In total, these findings let us reconsider the question which properties of features are crucial for agreement attraction in production and in comprehension. PMID:27867365

Gender Agreement Attraction in Russian: Production and Comprehension Evidence.

PubMed

Slioussar, Natalia; Malko, Anton

2016-01-01

Agreement attraction errors (such as the number error in the example "The key to the cabinets are rusty") have been the object of many studies in the last 20 years. So far, almost all production experiments and all comprehension experiments looked at binary features (primarily at number in Germanic, Romance, and some other languages, in several cases at gender in Romance languages). Among other things, it was noted that both in production and in comprehension, attraction effects are much stronger for some feature combinations than for the others: they can be observed in the sentences with singular heads and plural dependent nouns (e.g.,"The key to the cabinets…"), but not in the sentences with plural heads and singular dependent nouns (e.g., "The keys to the cabinet…"). Almost all proposed explanations of this asymmetry appeal to feature markedness, but existing findings do not allow teasing different approaches to markedness apart. We report the results of four experiments (one on production and three on comprehension) studying subject-verb gender agreement in Russian, a language with three genders. Firstly, we found attraction effects both in production and in comprehension, but, unlike in the case of number agreement, they were not parallel (in production, feminine gender triggered strongest effects, while neuter triggered weakest effects, while in comprehension, masculine triggered weakest effects). Secondly, in the comprehension experiments attraction was observed for all dependent noun genders, but only for a subset of head noun genders. This goes against the traditional assumption that the features of the dependent noun are crucial for attraction, showing the features of the head are more important. We demonstrate that this approach can be extended to previous findings on attraction and that there exists other evidence for it. In total, these findings let us reconsider the question which properties of features are crucial for agreement attraction in production and in comprehension.

Comparison of exposure assessment methods in a lung cancer case-control study: performance of a lifelong task-based questionnaire for asbestos and PAHs.

PubMed

Bourgkard, Eve; Wild, Pascal; Gonzalez, Maria; Févotte, Joëlle; Penven, Emmanuelle; Paris, Christophe

2013-12-01

To describe the performance of a lifelong task-based questionnaire (TBQ) in estimating exposures compared with other approaches in the context of a case-control study. A sample of 93 subjects was randomly selected from a lung cancer case-control study corresponding to 497 jobs. For each job, exposure assessments for asbestos and polycyclic aromatic hydrocarbons (PAHs) were obtained by expertise (TBQ expertise) and by algorithm using the TBQ (TBQ algorithm) as well as by expert appraisals based on all available occupational data (REFERENCE expertise) considered to be the gold standard. Additionally, a Job Exposure Matrix (JEM)-based evaluation for asbestos was also obtained. On the 497 jobs, the various evaluations were contrasted using Cohen's κ coefficient of agreement. Additionally, on the total case-control population, the asbestos dose-response relationship based on the TBQ algorithm was compared with the JEM-based assessment. Regarding asbestos, the TBQ-exposure estimates agreed well with the REFERENCE estimate (TBQ expertise: level-weighted κ (lwk)=0.68; TBQ algorithm: lwk=0.61) but less so with the JEM estimate (TBQ expertise: lwk=0.31; TBQ algorithm: lwk=0.26). Regarding PAHs, the agreements between REFERENCE expertise and TBQ were less good (TBQ expertise: lwk=0.43; TBQ algorithm: lwk=0.36). In the case-control study analysis, the dose-response relationship between lung cancer and cumulative asbestos based on the JEM is less steep than with the TBQ-algorithm exposure assessment and statistically non-significant. Asbestos-exposure estimates based on the TBQ were consistent with the REFERENCE expertise and yielded a steeper dose-response relationship than the JEM. For PAHs, results were less clear.

A Randomized Study Comparing Digital Imaging to Traditional Glass Slide Microscopy for Breast Biopsy and Cancer Diagnosis.

PubMed

Elmore, Joann G; Longton, Gary M; Pepe, Margaret S; Carney, Patricia A; Nelson, Heidi D; Allison, Kimberly H; Geller, Berta M; Onega, Tracy; Tosteson, Anna N A; Mercan, Ezgi; Shapiro, Linda G; Brunyé, Tad T; Morgan, Thomas R; Weaver, Donald L

2017-01-01

Digital whole slide imaging may be useful for obtaining second opinions and is used in many countries. However, the U.S. Food and Drug Administration requires verification studies. Pathologists were randomized to interpret one of four sets of breast biopsy cases during two phases, separated by ≥9 months, using glass slides or digital format (sixty cases per set, one slide per case, n = 240 cases). Accuracy was assessed by comparing interpretations to a consensus reference standard. Intraobserver reproducibility was assessed by comparing the agreement of interpretations on the same cases between two phases. Estimated probabilities of confirmation by a reference panel (i.e., predictive values) were obtained by incorporating data on the population prevalence of diagnoses. Sixty-five percent of responding pathologists were eligible, and 252 consented to randomization; 208 completed Phase I (115 glass, 93 digital); and 172 completed Phase II (86 glass, 86 digital). Accuracy was slightly higher using glass compared to digital format and varied by category: invasive carcinoma, 96% versus 93% ( P = 0.04); ductal carcinoma in situ (DCIS), 84% versus 79% ( P < 0.01); atypia, 48% versus 43% ( P = 0.08); and benign without atypia, 87% versus 82% ( P < 0.01). There was a small decrease in intraobserver agreement when the format changed compared to when glass slides were used in both phases ( P = 0.08). Predictive values for confirmation by a reference panel using glass versus digital were: invasive carcinoma, 98% and 97% (not significant [NS]); DCIS, 70% and 57% ( P = 0.007); atypia, 38% and 28% ( P = 0.002); and benign without atypia, 97% and 96% (NS). In this large randomized study, digital format interpretations were similar to glass slide interpretations of benign and invasive cancer cases. However, cases in the middle of the spectrum, where more inherent variability exists, may be more problematic in digital format. Future studies evaluating the effect these findings exert on clinical practice and patient outcomes are required.

Agreement between T2 and haste sequences in the evaluation of thoracolumbar intervertebral disc disease in dogs.

PubMed

Mankin, Joseph M; Hecht, Silke; Thomas, William B

2012-01-01

The purpose of this study was to compare half-Fourier-acquisition single-shot turbo spin-echo (HASTE) and T2-weighted (T2-W) sequences in dogs with thoracolumbar disc extrusion. MRI studies in 60 dogs (767 individual intervertebral disc spaces) were evaluated. Agreement between T2-W and HASTE sequences was assessed for two criteria: presence of an extradural lesion and treatment recommendation. There was moderate agreement between T2-W and HASTE sequences as to presence of an extradural lesion (kappa = 0.575). HASTE was in agreement in 96.1% of the sites where no extradural lesion was identified on T2-W images, but only in 58.1% of the sites where extradural lesions were identified on T2-W images. There was also moderate agreement between T2-W and HASTE sequences as to treatment recommendations (kappa = 0.476). HASTE was in agreement in 98.4% of the sites where a lesion was considered nonsurgical on T2 but only 82.1% of sites a lesion was considered surgical on T2. In 1.0% of sites considered not surgical and in 9.8% of sites considered equivocal based on T2-W images, a surgical lesion was identified on HASTE. Acquisition of a HASTE sequence in addition to conventional sequences may be beneficial in determining the severity of spinal cord compression in some cases when evaluating the canine spine.

19 CFR 10.222 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-04-01

... ARTICLES CONDITIONALLY FREE, SUBJECT TO A REDUCED RATE, ETC. United States-Caribbean Basin Trade..., coin purses, coin holders, compacts, currency cases, key cases, letter cases, license cases, money.... “NAFTA” means the North American Free Trade Agreement entered into by the United States, Canada, and...

19 CFR 10.222 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-04-01

... ARTICLES CONDITIONALLY FREE, SUBJECT TO A REDUCED RATE, ETC. United States-Caribbean Basin Trade..., coin purses, coin holders, compacts, currency cases, key cases, letter cases, license cases, money.... “NAFTA” means the North American Free Trade Agreement entered into by the United States, Canada, and...

24 CFR Appendix II to Subpart B of... - Homebuyers Ownership Opportunity Agreement (Turnkey III)

Code of Federal Regulations, 2012 CFR

2012-04-01

... Authority's own staff and resources, existing community resources, a private agency under contract with the... shall be free to act without the HBA action required by this Agreement. 2 There may be cases, such as...

24 CFR Appendix II to Subpart B of... - Homebuyers Ownership Opportunity Agreement (Turnkey III)

Code of Federal Regulations, 2013 CFR

2013-04-01

... Authority's own staff and resources, existing community resources, a private agency under contract with the... shall be free to act without the HBA action required by this Agreement. 2 There may be cases, such as...

24 CFR Appendix II to Subpart B of... - Homebuyers Ownership Opportunity Agreement (Turnkey III)

Code of Federal Regulations, 2014 CFR

2014-04-01

... Authority's own staff and resources, existing community resources, a private agency under contract with the... shall be free to act without the HBA action required by this Agreement. 2 There may be cases, such as...

32 CFR 720.6 - Agreement required prior to delivery to State authorities.

Code of Federal Regulations, 2014 CFR

2014-07-01

... transportation (under escort in cases of delivery in accordance with § 720.12) to a naval or Marine Corps activity as set forth in the agreement; (2) The member is provided cash to cover incidental expenses en...

32 CFR 720.6 - Agreement required prior to delivery to State authorities.

Code of Federal Regulations, 2012 CFR

2012-07-01

... transportation (under escort in cases of delivery in accordance with § 720.12) to a naval or Marine Corps activity as set forth in the agreement; (2) The member is provided cash to cover incidental expenses en...

32 CFR 720.6 - Agreement required prior to delivery to State authorities.

Code of Federal Regulations, 2010 CFR

2010-07-01

... transportation (under escort in cases of delivery in accordance with § 720.12) to a naval or Marine Corps activity as set forth in the agreement; (2) The member is provided cash to cover incidental expenses en...

32 CFR 720.6 - Agreement required prior to delivery to State authorities.

Code of Federal Regulations, 2013 CFR

2013-07-01

... transportation (under escort in cases of delivery in accordance with § 720.12) to a naval or Marine Corps activity as set forth in the agreement; (2) The member is provided cash to cover incidental expenses en...

32 CFR 720.6 - Agreement required prior to delivery to State authorities.

Code of Federal Regulations, 2011 CFR

2011-07-01

... transportation (under escort in cases of delivery in accordance with § 720.12) to a naval or Marine Corps activity as set forth in the agreement; (2) The member is provided cash to cover incidental expenses en...

Intraobserver and interobserver agreement on the radiographical diagnosis of canine cranial cruciate ligament rupture.

PubMed

Bogaerts, Evelien; Van der Vekens, Elke; Verhoeven, Geert; de Rooster, Hilde; Van Ryssen, Bernadette; Samoy, Yves; Putcuyps, Ingrid; Van Tilburg, Johan; Devriendt, Nausikaa; Weekers, Frederik; Bertal, Mileva; Houdellier, Blandine; Scheemaeker, Stephanie; Versteken, Jeroen; Lamerand, Maryline; Feenstra, Laurien; Peelman, Luc; Nieuwerburgh, Filip Van; Saunders, Jimmy H; Broeckx, Bart J G

2018-04-28

Even though radiography is one of the most frequently used imaging techniques for orthopaedic disorders, it has been demonstrated that the interpretation can vary between assessors. As such, the purpose of this study was to examine the intraobserver and interobserver agreement and the influence of level of expertise on the interpretation of radiographs of the stifle in dogs with and without cranial cruciate ligament rupture (CCLR). Sixteen observers, divided in four groups according to their level of experience, evaluated 30 radiographs (15 cases with CCLR and 15 control stifles) twice. Each observer was asked to evaluate joint effusion, presence and location of degenerative joint disease, joint instability and whether CCLR was present or absent. Overall, intraobserver and interobserver agreement ranged from fair to almost perfect with a trend towards increased agreement for more experienced observers. Additionally, it was found that stifles that were classified with high agreement have either overt disease characteristics or no disease characteristics at all, in comparison to the ones that are classified with a low agreement. Overall, the agreement on radiographic interpretation of CCLR was high, which is important, as it is the basis of a correct diagnosis and treatment. © British Veterinary Association (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Review of knee arthroscopic practice and coding at a major metropolitan centre.

PubMed

Lisik, James P; Dowsey, Michelle M; Petterwood, Joshua; Choong, Peter F M

2017-05-01

Arthroscopic knee surgery has been a topic of significant controversy in recent orthopaedic literature. Multiple studies have used administrative (Victorian Admitted Episodes Dataset and Centre for Health Record Linkage) data to identify trends in practice. This study explored the usage and reporting of arthroscopic knee surgery by conducting a detailed audit at a major Victorian public hospital. A database of orthopaedic procedures at St Vincent's Hospital Melbourne was used to retrospectively identify cases of knee arthroscopy from 1 December 2011 to 1 April 2014. Procedures were categorized as diagnostic or interventional, and native and prosthetic joints were analysed separately. Procedure codes were reviewed by comparing a registrar, auditor and hospital coders for agreement. Of the 401 cases for analysis, 375 were conducted in native knees and 26 in prosthetic joints. Of native knees, 369 (98.4%) were considered interventional. The majority of these were conducted for meniscal pathology (n = 263, 70.1%), osteoarthritis (OA) (n = 25, 6.7%) and infection (n = 28, 7.6%). Comparison of codes assigned by different parties were found to be between 57% (k = 0.324) and 70% (k = 0.572) agreement, but not statistically significant. In this study, the most common indication for arthroscopy was meniscal pathology. Arthroscopy was rarely performed for OA in the absence of meniscal pathology. Diagnostic arthroscopy was rarely performed in the native knee, and fair to moderate agreement existed between parties in assigning Medicare Benefits Schedule procedure codes. © 2016 Royal Australasian College of Surgeons.

Techno-Political Space Cooperation: A Longitudinal Analysis of NASA's Bilateral and Multilateral Agreements

NASA Technical Reports Server (NTRS)

Hudiburg, John J.

2004-01-01

NASA's international programs are both numerous and successful, with over two thousand international agreements forming a foundation of U.S. government cooperation that involved over half the United Nation's membership. Previous research, by the author, into these agreements has identified five variables underlying NASA's international cooperation efforts and these variables form a framework for explaining international cooperation behavior on a macro-level. This paper builds upon that research to effectively explain lower-level patterns of cooperation in NASA's experience. Two approaches for analyzing the space agency's history are used: aggregation of all agreements and a cluster (disaggregated) analysis of four key segments. While researchers of NASA's international cooperation often considered individual cases first, and then generalize to macro-level explanations. This study, in contrast, begins by considering all agreements together in order to explain as much as possible at the macro level before proceeding to lower tier explanations. These lower tier assessments are important to understanding regional and political influences on bilateral and multilateral cooperation. In order to accomplish this lower-tier analysis, the 2000 agreements are disaggregated into logical groupings enabling an analysis of important questions and clearer focus on key patterns concerning developing states, such as the role of international institutions or privatization on international cooperation in space technology.

Confidence building in Northeast Asia: Possible first steps for cooperation on the Korean peninsula

DOE Office of Scientific and Technical Information (OSTI.GOV)

Vannoni, M.; Biringer, K.

International relations are often devoted to establishing agreements that define, control, or regulate issues of potential conflict or dispute. These agreements span a full range of national and international issues from human rights to resource allocations and national security. The scope of these agreements can vary from bilateral arrangements to global treaties or control regimes. In many cases, elements of the agreement are monitored to verify compliance or increase confidence among parties that the terms of the agreement are being met. This article outlines options for cooperation on the Korean peninsula that could build confidence and reduce tension. The rolemore » of monitoring technology in helping to implement such agreements is also described.« less

Impact of radiation attenuation by a carbon fiber couch on patient dose verification

NASA Astrophysics Data System (ADS)

Yu, Chun-Yen; Chou, Wen-Tsae; Liao, Yi-Jen; Lee, Jeng-Hung; Liang, Ji-An; Hsu, Shih-Ming

2017-02-01

The aim of this study was to understand the difference between the measured and calculated irradiation attenuations obtained using two algorithms and to identify the influence of couch attenuation on patient dose verification. We performed eight tests of couch attenuation with two photon energies, two longitudinal couch positions, and two rail positions. The couch attenuation was determined using a radiation treatment planning system. The measured and calculated attenuations were compared. We also performed 12 verifications of head-and-neck and rectum cases by using a Delta phantom. The dose deviation (DD), distance to agreement (DTA), and gamma index of pencil-beam convolution (PBC) verifications were nearly the same. The agreement was least consistent for the anisotropic analytical algorithm (AAA) without the couch for the head-and-neck case, in which the DD, DTA, and gamma index were 74.4%, 99.3%, and 89%, respectively; for the rectum case, the corresponding values were 56.2%, 95.1%, and 92.4%. We suggest that dose verification should be performed using the following three metrics simultaneously: DD, DTA, and the gamma index.

Can phronesis save the life of medical ethics?

PubMed

Beresford, E B

1996-09-01

There has been a growing interest in casuistry since the ground breaking work of Jonsen and Toulmin. Casuistry, in their view, offers the possibility of securing the moral agreement that policy makers desire but which has proved elusive to theory driven approaches to ethics. However, their account of casuistry is dependent upon the exercise of phronesis. As recent discussions of phronesis make clear, this requires attention not only to the particulars of the case, but also to the substantive goods at stake in the case. Without agreement on these goods attention to cases is unlikely to secure the productive consensus that Jonson and Toulmin seek.

Reliability of dietary information from surrogate respondents.

PubMed

Hislop, T G; Coldman, A J; Zheng, Y Y; Ng, V T; Labo, T

1992-01-01

A self-administered food frequency questionnaire was included as part of a case-control study of breast cancer in 1980-82. In 1986-87, a second food frequency questionnaire was sent to surviving cases and husbands of deceased cases; 30 spouses (86% response rate) and 263 surviving cases (88% response rate) returned questionnaires. The dietary questions concerned consumption of specific food items by the case before diagnosis of breast cancer. Missing values were less common in the second questionnaire; there was no significant difference in missing values between surviving cases and spouses of deceased cases. Kappa statistics comparing responses in the first and second questionnaires were significantly lower for spouses of deceased cases than for surviving cases. Reported level of confidence by the husbands regarding knowledge about their wives' eating habits did not influence the kappa statistics or the frequencies of missing values. The lack of good agreement has important implications for the use of proxy interviews from husbands in retrospective dietary studies.

A comparison of delirium diagnosis in elderly medical inpatients using the CAM, DRS-R98, DSM-IV and DSM-5 criteria.

PubMed

Adamis, Dimitrios; Rooney, Siobhan; Meagher, David; Mulligan, Owen; McCarthy, Geraldine

2015-06-01

The recently published DSM-5 criteria for delirium may lead to different case identification and rates of delirium than previous classifications. The aims of this study are to determine how the new DSM-5 criteria compare with DSM-IV in identification of delirium in elderly medical inpatients and to investigate the agreement between different methods, using CAM, DRS-R98, DSM-IV, and DSM-5 criteria. Prospective, observational study of elderly patients aged 70+ admitted under the acute medical teams in a regional general hospital. Each participant was assessed within 3 days of admission using the DSM-5, and DSM-IV criteria plus the DRS-R98, and CAM scales. We assessed 200 patients [mean age 81.1±6.5; 50% female; pre-existing cognitive impairment in 63%]. The prevalence rates of delirium for each diagnostic method were: 13.0% (n = 26) for DSM-5; 19.5% (n = 39) for DSM-IV; 13.5% (n = 27) for DRS-R98 and 17.0%, (n = 34) for CAM. Using tetrachoric correlation coefficients the agreement between DSM-5 and DSM-IV was statistically significant (ρtetr = 0.64, SE = 0.1, p < 0.0001). Similar significant agreement was found between the four methods. DSM-IV is the most inclusive diagnostic method for delirium, while DSM-5 is the most restrictive. In addition, these classification systems identify different cases of delirium. This could have clinical, financial, and research implications. However, both classification systems have significant agreement in the identification of the same concept (delirium). Clarity of diagnosis is required for classification but also further research considering the relevance in predicting outcomes can allow for more detailed evaluation of the DSM-5 criteria.

Interobserver agreement of interim and end-of-treatment 18F-FDG PET/CT in diffuse large B-cell lymphoma (DLBCL): impact on clinical practice and trials.

PubMed

Burggraaff, Coreline N; Cornelisse, Alexander C; Hoekstra, Otto S; Lugtenburg, Pieternella J; de Keizer, Bart; Arens, Anne I J; Celik, Filiz; Huijbregts, Julia E; De Vet, Henrica C W; Zijlstra, Josee M

2018-05-04

We aimed to assess the interobserver agreement of Interim PET (I-PET) and End-of-Treatment PET (EoT-PET) using the Deauville 5-point scale (DS) in first-line DLBCL patients. Methods: I-PET and EoT-PET scans of DLBCL patients were performed in the HOVON84 study (2007-2012), an international multicenter randomized controlled trial. Patients received R-CHOP14 and were randomized to receive rituximab intensification in the first 4 cycles or not. I-PET was made after 4 cycles (for observational purposes), and EoT-PET scan after 6 or 8 cycles. Two independent central reviewers retrospectively scored all scans according to the DS-system, blinded to clinical outcomes. Results were dichotomised as 'negative' (DS: 1-3) or 'positive' (DS: 4-5). Besides percentage overall agreement we calculated agreement for positive and negative scores, expressed as positive agreement (PA) and negative agreement (NA), respectively. Results: 465 I-PET and 457 EoT-PET scans were centrally reviewed; baseline 18 F-FDG PET(/CT) was available in 75-77%, and CT in the remaining cases. Percentage overall agreement for I-PET and EoT-PET were 87.7% and 91.7% ( P =0.049), with NA of 92.0% and 95.0% ( P =0.091), and PA of 73.7% and 76.3% ( P =0.656), respectively. Conclusion: Interobserver agreement using DS in DLBCL patients in I-PET and EoT-PET yields high overall and negative agreement. The lower positive agreement suggests that EoT-PET/CT treatment evaluation in daily practice and I-PET adapted trials may benefit from dual reads and central review, respectively. Copyright © 2018 by the Society of Nuclear Medicine and Molecular Imaging, Inc.

Echocardiographic agreement in the diagnostic evaluation for infective endocarditis.

PubMed

Lauridsen, Trine Kiilerich; Selton-Suty, Christine; Tong, Steven; Afonso, Luis; Cecchi, Enrico; Park, Lawrence; Yow, Eric; Barnhart, Huiman X; Paré, Carlos; Samad, Zainab; Levine, Donald; Peterson, Gail; Stancoven, Amy Butler; Johansson, Magnus Carl; Dickerman, Stuart; Tamin, Syahidah; Habib, Gilbert; Douglas, Pamela S; Bruun, Niels Eske; Crowley, Anna Lisa

2016-07-01

Echocardiography is essential for the diagnosis and management of infective endocarditis (IE). However, the reproducibility for the echocardiographic assessment of variables relevant to IE is unknown. Objectives of this study were: (1) To define the reproducibility for IE echocardiographic variables and (2) to describe a methodology for assessing quality in an observational cohort containing site-interpreted data. IE reproducibility was assessed on a subset of echocardiograms from subjects enrolled in the International Collaboration on Endocarditis registry. Specific echocardiographic case report forms were used. Intra-observer agreement was assessed from six site readers on ten randomly selected echocardiograms. Inter-observer agreement between sites and an echocardiography core laboratory was assessed on a separate random sample of 110 echocardiograms. Agreement was determined using intraclass correlation (ICC), coverage probability (CP), and limits of agreement for continuous variables and kappa statistics (κweighted) and CP for categorical variables. Intra-observer agreement for LVEF was excellent [ICC = 0.93 ± 0.1 and all pairwise differences for LVEF (CP) were within 10 %]. For IE categorical echocardiographic variables, intra-observer agreement was best for aortic abscess (κweighted = 1.0, CP = 1.0 for all readers). Highest inter-observer agreement for IE categorical echocardiographic variables was obtained for vegetation location (κweighted = 0.95; 95 % CI 0.92-0.99) and lowest agreement was found for vegetation mobility (κweighted = 0.69; 95 % CI 0.62-0.86). Moderate to excellent intra- and inter-observer agreement is observed for echocardiographic variables in the diagnostic assessment of IE. A pragmatic approach for determining echocardiographic data reproducibility in a large, multicentre, site interpreted observational cohort is feasible.

Federal Register: Proposed Revisions to the Consolidated Permit Regulations in Accordance with the Settlement Agreement

EPA Pesticide Factsheets

On November 16, 1981, EPA entered into a settlement agreement with numerous industry petitioners In the consolidated permit regulations litigation (NRDC v. EPA and consolidated cases, No. 80-1607 (D.C. Cir., filed June 2, 1980)).

Concordance of occupational and environmental exposure information elicited from patients with Alzheimer's disease and surrogate respondents

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chong, J.P.; Turpie, I.; Haines, T.

Identification of risk factors for Alzheimer's disease through the use of well designed case-control studies has been described as a research priority. Increasing recognition of the neurotoxic potential of many industrial chemicals such as organic solvents raises the question of the occupational and environmental contribution to the etiology of this high-priority health problem. The intention of this study was to develop and evaluate a methodology that could be used in a large scale case-control study of the occupational and environmental risk factors for dementia or a population-based surveillance system for neurotoxic disorders. The specific objectives of this study were tomore » investigate: (1) the reliability of exposure-eliciting, interviewer-administered questionnaires given to patients with Alzheimer's disease (SDAT); (2) the reliability of exposure-eliciting interviewer-administered questionnaires given to the family of patients with SDAT and the agreement with the responses of the patient or surrogate respondents; (3) the reliability and agreement of responses of age- and sex-matched control patients and their families selected from geriatric care institutions and the community, with respect to the same exposure-eliciting and interviewer-administered questionnaire; and (4) the reliability of agent-based exposure ascertainment by a single, trained rater. The results of the study demonstrate that occupational and environmental histories from which exposure information can be derived is most reliably elicited from job descriptions of cases and control subjects rather than job titles alone or detailed probes for potential neurotoxic exposures. This will necessitate the use of standardized interviewer-administered instruments to derive this information in case-control studies of Alzheimer's disease or population-based surveillance systems for occupational and environmental neurotoxicity.« less

A new SPECT/CT reconstruction algorithm: reliability and accuracy in clinical routine for non-oncologic bone diseases.

PubMed

Delcroix, Olivier; Robin, Philippe; Gouillou, Maelenn; Le Duc-Pennec, Alexandra; Alavi, Zarrin; Le Roux, Pierre-Yves; Abgral, Ronan; Salaun, Pierre-Yves; Bourhis, David; Querellou, Solène

2018-02-12

xSPECT Bone® (xB) is a new reconstruction algorithm developed by Siemens® in bone hybrid imaging (SPECT/CT). A CT-based tissue segmentation is incorporated into SPECT reconstruction to provide SPECT images with bone anatomy appearance. The objectives of this study were to assess xB/CT reconstruction diagnostic reliability and accuracy in comparison with Flash 3D® (F3D)/CT in clinical routine. Two hundred thirteen consecutive patients referred to the Brest Nuclear Medicine Department for non-oncological bone diseases were evaluated retrospectively. Two hundred seven SPECT/CT were included. All SPECT/CT were independently interpreted by two nuclear medicine physicians (a junior and a senior expert) with xB/CT then with F3D/CT three months later. Inter-observer agreement (IOA) and diagnostic confidence were determined using McNemar test, and unweighted Kappa coefficient. The study objectives were then re-assessed for validation through > 18 months of clinical and paraclinical follow-up. No statistically significant differences between IOA xB and IOA F3D were found (p = 0.532). Agreement for xB after categorical classification of the diagnoses was high (κ xB = 0.89 [95% CI 0.84 -0.93]) but without statistically significant difference F3D (κ F3D = 0.90 [95% CI 0.86 - 0.94]). Thirty-one (14.9%) inter-reconstruction diagnostic discrepancies were observed of which 21 (10.1%) were classified as major. The follow-up confirmed the diagnosis of F3D in 10 cases, xB in 6 cases and was non-contributory in 5 cases. xB reconstruction algorithm was found reliable, providing high interobserver agreement and similar diagnostic confidence to F3D reconstruction in clinical routine.

Investigation of Coefficient of Individual Agreement in Terms of Sample Size, Random and Monotone Missing Ratio, and Number of Repeated Measures

ERIC Educational Resources Information Center

Temel, Gülhan Orekici; Erdogan, Semra; Selvi, Hüseyin; Kaya, Irem Ersöz

2016-01-01

Studies based on longitudinal data focus on the change and development of the situation being investigated and allow for examining cases regarding education, individual development, cultural change, and socioeconomic improvement in time. However, as these studies require taking repeated measures in different time periods, they may include various…

Reproducibility of the World Health Organization 2008 criteria for myelodysplastic syndromes

PubMed Central

Senent, Leonor; Arenillas, Leonor; Luño, Elisa; Ruiz, Juan C.; Sanz, Guillermo; Florensa, Lourdes

2013-01-01

The reproducibility of the World Health Organization 2008 classification for myelodysplastic syndromes is uncertain and its assessment was the major aim of this study. The different peripheral blood and bone marrow variables required for an adequate morphological classification were blindly evaluated by four cytomorphologists in samples from 50 patients with myelodysplastic syndromes. The degree of agreement among observers was calculated using intraclass correlation coefficient and the generalized kappa statistic for multiple raters. The degree of agreement for the percentages of blasts in bone marrow and peripheral blood, ring sideroblasts in bone marrow, and erythroid, granulocytic and megakaryocytic dysplastic cells was strong (P<0.001 in all instances). After stratifying the percentages according to the categories required for the assignment of World Health Organization subtypes, the degree of agreement was not statistically significant for cases with 5-9% blasts in bone marrow (P=0.07), 0.1-1% blasts in peripheral blood (P=0.47), or percentage of erythroid dysplastic cells (P=0.49). Finally, the interobserver concordance for World Health Organization-defined subtypes showed a moderate overall agreement (P<0.001), the reproducibility being lower for cases with refractory anemia with excess of blasts type 1 (P=0.05) and refractory anemia with ring sideroblasts (P=0.09). In conclusion, the reproducibility of the World Health Organization 2008 classification for myelodysplastic syndromes is acceptable but the defining criteria for blast cells and features of erythroid dysplasia need to be refined. PMID:23065505

Reproducibility of the World Health Organization 2008 criteria for myelodysplastic syndromes.

PubMed

Senent, Leonor; Arenillas, Leonor; Luño, Elisa; Ruiz, Juan C; Sanz, Guillermo; Florensa, Lourdes

2013-04-01

The reproducibility of the World Health Organization 2008 classification for myelodysplastic syndromes is uncertain and its assessment was the major aim of this study. The different peripheral blood and bone marrow variables required for an adequate morphological classification were blindly evaluated by four cytomorphologists in samples from 50 patients with myelodysplastic syndromes. The degree of agreement among observers was calculated using intraclass correlation coefficient and the generalized kappa statistic for multiple raters. The degree of agreement for the percentages of blasts in bone marrow and peripheral blood, ring sideroblasts in bone marrow, and erythroid, granulocytic and megakaryocytic dysplastic cells was strong (P<0.001 in all instances). After stratifying the percentages according to the categories required for the assignment of World Health Organization subtypes, the degree of agreement was not statistically significant for cases with 5-9% blasts in bone marrow (P=0.07), 0.1-1% blasts in peripheral blood (P=0.47), or percentage of erythroid dysplastic cells (P=0.49). Finally, the interobserver concordance for World Health Organization-defined subtypes showed a moderate overall agreement (P<0.001), the reproducibility being lower for cases with refractory anemia with excess of blasts type 1 (P=0.05) and refractory anemia with ring sideroblasts (P=0.09). In conclusion, the reproducibility of the World Health Organization 2008 classification for myelodysplastic syndromes is acceptable but the defining criteria for blast cells and features of erythroid dysplasia need to be refined.

Retroperitoneal sarcoma (RPS) high risk gross tumor volume boost (HR GTV boost) contour delineation agreement among NRG sarcoma radiation and surgical oncologists.

PubMed

Baldini, Elizabeth H; Bosch, Walter; Kane, John M; Abrams, Ross A; Salerno, Kilian E; Deville, Curtiland; Raut, Chandrajit P; Petersen, Ivy A; Chen, Yen-Lin; Mullen, John T; Millikan, Keith W; Karakousis, Giorgos; Kendrick, Michael L; DeLaney, Thomas F; Wang, Dian

2015-09-01

Curative intent management of retroperitoneal sarcoma (RPS) requires gross total resection. Preoperative radiotherapy (RT) often is used as an adjuvant to surgery, but recurrence rates remain high. To enhance RT efficacy with acceptable tolerance, there is interest in delivering "boost doses" of RT to high-risk areas of gross tumor volume (HR GTV) judged to be at risk for positive resection margins. We sought to evaluate variability in HR GTV boost target volume delineation among collaborating sarcoma radiation and surgical oncologist teams. Radiation planning CT scans for three cases of RPS were distributed to seven paired radiation and surgical oncologist teams at six institutions. Teams contoured HR GTV boost volumes for each case. Analysis of contour agreement was performed using the simultaneous truth and performance level estimation (STAPLE) algorithm and kappa statistics. HRGTV boost volume contour agreement between the seven teams was "substantial" or "moderate" for all cases. Agreement was best on the torso wall posteriorly (abutting posterior chest abdominal wall) and medially (abutting ipsilateral para-vertebral space and great vessels). Contours varied more significantly abutting visceral organs due to differing surgical opinions regarding planned partial organ resection. Agreement of RPS HRGTV boost volumes between sarcoma radiation and surgical oncologist teams was substantial to moderate. Differences were most striking in regions abutting visceral organs, highlighting the importance of collaboration between the radiation and surgical oncologist for "individualized" target delineation on the basis of areas deemed at risk and planned resection.

Ethical decisions in dental treatment planning using the Ozar model: a descriptive study of fifty-two consecutive patients.

PubMed

Schuman, N J; Turner, J E

1997-01-01

Chairside dental ethics necessitates special consideration by the faculty member-dentist, the dental student, and the patient. The patient must always be aware of treatment options, in addition to learning the health status of the oral hard and soft tissues, costs, and time to be involved to accomplish proposed treatment. What may seem like a burden to an individual practitioner is actually only the necessities incurred by any self governing profession. Fifty-two consecutive dental patients had their cases reviewed for the ethical behavior of the dentist-practitioner, student, and patient. Categories reviewed were informed consent (100%), agreement, compromise, economic issues, conflict, and institutional issues. The results were: 1. Agreement: 17 cases, 2. Compromise: 21 cases, 3. Economic Issues: 4 cases, 4. Conflict: 6 cases, and 5. Institutional Issues: 4 cases. Fourteen percent of all patients were minors. Ninety percent of the patients were treated. Of those 10% not treated, five percent were for medical reasons, and five percent of the patients refused treatment. These results were placed in the Ozar Model 9 and were categorized as follows: 1. Appropriate pain free oral function: 22 cases, 2. Patient Autonomy: 14 cases, 3. Life and health: 9 cases, 4. Preferred practice values: 6 cases, and 5. Other external considerations: 1 case. This template demonstrated appropriate ethical behavior on the part of dentists, students, and patients, especially with a 90% treatment group, and only 5% refusing treatment. The 52 consecutive patients were characteristic of the University of Tennessee's overall patient pool. No identifiable differences were found between patients regardless of gender, age, or race.

Pero Vaz de Caminha: an-interchange program for quality control between Brazil and Portugal.

PubMed

Utagawa, Maria Lúcia; di Loreto, Celso; de Freitas, Cristina; Milanezi, Fernanda; Longatto Filho, Adhemar; Pereira, Sónia Maria Miranda; Maeda, Marina Yoshiê Sakamoto; Schmitt, Fernando C

2006-01-01

To start an interexchange program for quality control in cervical cytology and discuss conceptual criteria for diagnosis. Slides were selected in the archives of the 2 institutes and included cases with unsatisfactory, negative and positive results. Sets of slides were changed between the partners every 3 months. At the end of each year a senior cytopathologist was invited to discuss the major discrepancies found in the study. A total of 1,041 cases were analyzed. Full concordance was obtained in 74.4% (774) of cases and discrepancies in 25.6% (267 cases). Full agreement was achieved in 276 (39%) of 707 cases categorized as negative. In 421 negative cases from laboratory A, this concordance represents 65.5% and 96.5% for laboratory B, which submitted 286 negative cases. The main discordance was the high number of atypical squamous cells of undetermined significance cases: 3.1% for A and 128 (33.2%) for B. Samples with discrepancies related to the quality of the material was another controversial issue: of 16 cases from laboratory A, 6 (37.5%) unsatisfactory cases were the same and 10 (62.5%) different. Laboratory B presented 20 unsatisfactory cases, and 14 (70.0%) had other diagnoses. Low grade squamous intraepithelial lesion and high grade squamous intraepithelial lesion concordance ranged from 75% to 80%, and invasive carcinoma has 4 discordances (28.5%), 3 previously screened as high grade squamous intraepithelial lesion and 1 as atypical squamous cells of undetermined significance. The kappa value obtained was 0.65, indicating substantial agreement. Our results indicated that atypical squamous cells of undetermined significance diagnoses are the crucial point of controversies and concern the quality of routine diagnosis in cytopathology.

Variation of SNOMED CT coding of clinical research concepts among coding experts.

PubMed

Andrews, James E; Richesson, Rachel L; Krischer, Jeffrey

2007-01-01

To compare consistency of coding among professional SNOMED CT coders representing three commercial providers of coding services when coding clinical research concepts with SNOMED CT. A sample of clinical research questions from case report forms (CRFs) generated by the NIH-funded Rare Disease Clinical Research Network (RDCRN) were sent to three coding companies with instructions to code the core concepts using SNOMED CT. The sample consisted of 319 question/answer pairs from 15 separate studies. The companies were asked to select SNOMED CT concepts (in any form, including post-coordinated) that capture the core concept(s) reflected in the question. Also, they were asked to state their level of certainty, as well as how precise they felt their coding was. Basic frequencies were calculated to determine raw level agreement among the companies and other descriptive information. Krippendorff's alpha was used to determine a statistical measure of agreement among the coding companies for several measures (semantic, certainty, and precision). No significant level of agreement among the experts was found. There is little semantic agreement in coding of clinical research data items across coders from 3 professional coding services, even using a very liberal definition of agreement.

Assessment of Intraobserver and Interobserver Agreement of a New Classification System for Retrograde Periimplantitis.

PubMed

Shah, Rucha; Thomas, Raison; Kumar, Tarun; Mehta, Dhoom Singh

2016-12-01

Retrograde periimplantitis (RPI) is the inflammatory disease that affects the apical part of an osseointegrated implant while the coronal portion of the implant sustains a normal bone-to-implant interface. The aim of the current study was to assess the intraexaminer and interexaminer reliability of a proposed new classification system for RPI. After thorough electronic literature search, 56 intraoral periapical radiographs (IOPA) of implants with RPI were collected and were classified by 2 independent reviewers as per the new classification system into one of the 3-mild, moderate, and advanced-classes based on the amount of bone loss from the apex of the implant to the most coronal part as a percentage of the total implant length. The IOPAs were assessed twice by the same examiners and both were blinded to each other's observations. The intraobserver agreement ranged from 0.85 to 0.91, which falls under the category of almost perfect agreement. The interexaminer agreement was found to be 0.83, also considered as almost perfect agreement. The proposed classification shows good intraexaminer and interexaminer reliability and can be used for treatment planning and prognosis in cases of RPI.

Agreement between a self-administered questionnaire on musculoskeletal disorders of the neck-shoulder region and a physical examination

PubMed Central

Perreault, Nathalie; Brisson, Chantal; Dionne, Clermont E; Montreuil, Sylvie; Punnett, Laura

2008-01-01

Background In epidemiological studies on neck-shoulder disorders, physical examination by health professionals, although more expensive, is usually considered a better method of data collection than self-administered questionnaires on symptoms. However, little is known on the comparison of these two methods of data collection. The agreement between self-administered questionnaires and the physical examination on the presence of neck-shoulders disorders was assessed in the present study. Methods This study was conducted among clerical workers using video display units. Prevalent cases were workers for whom neck-shoulder symptoms were present for at least 3 days during the previous 7 days and for whom pain intensity was greater than 50 mm on a 100 mm visual analogue scale. All 85 workers meeting this definition and a random sample of 102 workers who did not meet this definition were selected. Physical examination included measures of active range of motion and musculoskeletal strength. Cohen's kappa and global percent agreement were calculated to compare the two methods of data collection. The effect on the agreement of different question and physical examination definitions and the importance of the time interval elapsed between the administrations of the tests were also evaluated. Results Kappa coefficients ranged from 0.19 to 0.54 depending on the definitions used to ascertain disorders. The agreement was highest when the two instruments were administered 21 days apart or less (Kappa = 0.54, global agreement = 77%). It was not substantially improved by the addition of criteria related to functional limitations or when comparisons were made with alternative physical examination definitions. Pain intensity recorded during physical examination maneuvers was an important element of the agreement between questionnaire and physical examination findings. Conclusion These results suggest a fair to good agreement between the presence of musculoskeletal disorders ascertained by self-administered questionnaire and physical examination that may reflect differences in the constructs measured. Shorter time lags result in better agreement. Investigators should consider these results before choosing a method to measure the presence of musculoskeletal disorders in the neck-shoulder region. PMID:18366656

Inclusion of particle-vibration coupling in the Fayans functional: Odd-even mass differences of semimagic nuclei

NASA Astrophysics Data System (ADS)

Saperstein, E. E.; Baldo, M.; Pankratov, S. S.; Tolokonnikov, S. V.

2018-05-01

A method is presented to evaluate the particle-phonon coupling (PC) corrections to the single-particle energies in semimagic nuclei, based on the direct solution of the Dyson equation with PC-corrected mass operator. It is used for finding the odd-even mass difference between even Pb and Sn isotopes and their odd-proton neighbors. The Fayans energy density functional DF3-a is used, which gives rather highly accurate predictions for these mass differences already at the mean-field level. In the case of the lead chain, account for the PC corrections induced by the low-lying phonons 21+ and 31- makes agreement of the theory with the experimental data significantly better. For the tin chain, the situation is not so definite. In this case, the PC corrections make agreement better in the case of the addition mode but they spoil the agreement for the removal mode. We discuss the reason for such a discrepancy.

Variation in the Gross Tumor Volume and Clinical Target Volume for Preoperative Radiotherapy of Primary Large High-Grade Soft Tissue Sarcoma of the Extremity Among RTOG Sarcoma Radiation Oncologists

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wang Dian, E-mail: dwang@mcw.edu; Bosch, Walter; Kirsch, David G.

Purpose: To evaluate variability in the definition of preoperative radiotherapy gross tumor volume (GTV) and clinical target volume (CTV) delineated by sarcoma radiation oncologists. Methods and Materials: Extremity sarcoma planning CT images along with the corresponding diagnostic MRI from two patients were distributed to 10 Radiation Therapy Oncology Group sarcoma radiation oncologists with instructions to define GTV and CTV using standardized guidelines. The CT data with contours were then returned for central analysis. Contours representing statistically corrected 95% (V95) and 100% (V100) agreement were computed for each structure. Results: For the GTV, the minimum, maximum, mean (SD) volumes (mL) weremore » 674, 798, 752 {+-} 35 for the lower extremity case and 383, 543, 447 {+-} 46 for the upper extremity case. The volume (cc) of the union, V95 and V100 were 882, 761, and 752 for the lower, and 587, 461, and 455 for the upper extremity, respectively. The overall GTV agreement was judged to be almost perfect in both lower and upper extremity cases (kappa = 0.9 [p < 0.0001] and kappa = 0.86 [p < 0.0001]). For the CTV, the minimum, maximum, mean (SD) volumes (mL) were 1145, 1911, 1605 {+-} 211 for the lower extremity case and 637, 1246, 1006 {+-} 180 for the upper extremity case. The volume (cc) of the union, V95, and V100 were 2094, 1609, and 1593 for the lower, and 1533, 1020, and 965 for the upper extremity cases, respectively. The overall CTV agreement was judged to be almost perfect in the lower extremity case (kappa = 0.85 [p < 0.0001]) but only substantial in the upper extremity case (kappa = 0.77 [p < 0.0001]). Conclusions: Almost perfect agreement existed in the GTV of these two representative cases. Tshere was no significant disagreement in the CTV of the lower extremity, but variation in the CTV of upper extremity was seen, perhaps related to the positional differences between the planning CT and the diagnostic MRI.« less

77 FR 23278 - Notice of Lodging of Settlement Agreement Pursuant to the Comprehensive Environmental Response...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-18

... Delaware in In re W.R. Grace & Co., Case No. 01-01139 (JFK). The proposed Settlement Agreement would...-01139 (JFK), and D.J. Ref. No. 90-11-2-07106/5. During the public comment period, the settlement...

On June 7, 1982, EPA entered into a settlement agreement on ...

EPA Pesticide Factsheets

On June 7, 1982, EPA entered into a settlement agreement on Clean Water Act issues with numerous industry petitioners in the consolidated permit regulations litigation (NRDC v. EPA and consolidated cases, No. 80-1607 (D.C. Cir. filed June 2, 1980)).

Adjustment of Jacobs' formulation to the case of Mercury

NASA Astrophysics Data System (ADS)

Chiappini, M.; de Santis, A.

1991-04-01

Magnetic investigations play an important role in studies on the constitution of planetary interiors. One of these techniques (the so-called Jacobs' formulation), appropriately modified, has been applied to the case of Mercury. According to the results found, the planet, supposed to be divided internally as the earth (crust-mantle-core), would have a core/planet volume ratio of 28 percent, much greater than the earth's core percentage (16 percent). This result is in agreement with previous work which used other independent methods.

Portable gamma camera guidance in sentinel lymph node biopsy: prospective observational study of consecutive cases.

PubMed

Peral Rubio, F; de La Riva, P; Moreno-Ramírez, D; Ferrándiz-Pulido, L

2015-06-01

Sentinel lymph node biopsy is the most important tool available for node staging in patients with melanoma. To analyze sentinel lymph node detection and dissection with radio guidance from a portable gamma camera. To assess the number of complications attributable to this biopsy technique. Prospective observational study of a consecutive series of patients undergoing radioguided sentinel lymph node biopsy. We analyzed agreement between nodes detected by presurgical lymphography, those detected by the gamma camera, and those finally dissected. A total of 29 patients (17 women [62.5%] and 12 men [37.5%]) were enrolled. The mean age was 52.6 years (range, 26-82 years). The sentinel node was dissected from all patients; secondary nodes were dissected from some. In 16 cases (55.2%), there was agreement between the number of nodes detected by lymphography, those detected by the gamma camera, and those finally dissected. The only complications observed were seromas (3.64%). No cases of wound dehiscence, infection, hematoma, or hemorrhage were observed. Portable gamma-camera radio guidance may be of use in improving the detection and dissection of sentinel lymph nodes and may also reduce complications. These goals are essential in a procedure whose purpose is melanoma staging. Copyright © 2014 Elsevier España, S.L.U. and AEDV. All rights reserved.

How reliable are forensic evaluations of legal sanity?

PubMed

Gowensmith, W Neil; Murrie, Daniel C; Boccaccini, Marcus T

2013-04-01

When different clinicians evaluate the same criminal defendant's legal sanity, do they reach the same conclusion? Because Hawaii law requires multiple, independent evaluations when questions about legal sanity arise, Hawaii allows for the first contemporary study of the reliability of legal sanity opinions in routine practice in the United States. We examined 483 evaluation reports, addressing 165 criminal defendants, in which up to three forensic psychiatrists or psychologists offered independent opinions on a defendant's legal sanity. Evaluators reached unanimous agreement regarding legal sanity in only 55.1% of cases. Evaluators tended to disagree more often when a defendant was under the influence of drugs or alcohol at the time of the offense. But evaluators tended to agree more often when they agreed about diagnosing a psychotic disorder, or when the defendant had been psychiatrically hospitalized shortly before the offense. In court, judges followed the majority opinion among evaluators in 91% of cases. But when judges disagreed with the majority opinion, they usually did so to find defendants legally sane, rather than insane. Overall, this study indicates that reliability among practicing forensic evaluators addressing legal sanity may be poorer than the field has tended to assume. Although agreement appears more likely in some cases than others, the frequent disagreements suggest a need for improved training and practice.

Reliability of the MDi Psoriasis® Application to Aid Therapeutic Decision-Making in Psoriasis.

PubMed

Moreno-Ramírez, D; Herrerías-Esteban, J M; Ojeda-Vila, T; Carrascosa, J M; Carretero, G; de la Cueva, P; Ferrándiz, C; Galán, M; Rivera, R; Rodríguez-Fernández, L; Ruiz-Villaverde, R; Ferrándiz, L

2017-09-01

Therapeutic decisions in psoriasis are influenced by disease factors (e.g., severity or location), comorbidity, and demographic and clinical features. We aimed to assess the reliability of a mobile telephone application (MDi-Psoriasis) designed to help the dermatologist make decisions on how to treat patients with moderate to severe psoriasis. We analyzed interobserver agreement between the advice given by an expert panel and the recommendations of the MDi-Psoriasis application in 10 complex cases of moderate to severe psoriasis. The experts were asked their opinion on which treatments were most appropriate, possible, or inappropriate. Data from the same 10 cases were entered into the MDi-Psoriasis application. Agreement was analyzed in 3 ways: paired interobserver concordance (Cohen's κ), multiple interobserver concordance (Fleiss's κ), and percent agreement between recommendations. The mean percent agreement between the total of 1210 observations was 51.3% (95% CI, 48.5-54.1%). Cohen's κ statistic was 0.29 and Fleiss's κ was 0.28. Mean agreement between pairs of human observers only, excluding the MDi-Psoriasis recommendations, was 50.5% (95% CI, 47.6-53.5%). Paired agreement between the recommendations of the MDi-Psoriasis tool and the majority opinion of the expert panel (Cohen's κ) was 0.44 (68.2% agreement). The MDi-Psoriasis tool can generate recommendations that are comparable to those of experts in psoriasis. Copyright © 2017 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.

Evolution of Snow-Size Spectra in Cyclonic Storms. Part I: Snow Growth by Vapor Deposition and Aggregation.

NASA Astrophysics Data System (ADS)

Mitchell, David L.

1988-11-01

Based on the stochastic collection equation, height- and time-dependent snow growth models were developed for unrimed stratiform snowfall. Moment conservation equations were parameterized and solved by constraining the size distribution to be of the form N(D)dD = N0 exp(D)dD, yielding expressions for the slope parameter, , and the y-intercept parameters, NO, as functions of height or time. The processes of vapor deposition and aggregation were treated analytically without neglecting changes in ice crystal habits, while the ice particle breakup process was dealt with empirically.The models were compared against vertical profiles of snow-size spectra, obtained from aircraft measurements, for three case studies. The predicted spectra are in good agreement with the observed evolution of snow-size spectra in all three cases, indicating the proposed scheme for ice particle aggregation was successful. The temperature dependence of aggregation was assumed to result from differences in ice crystal habit. Using data from an earlier study, the aggregation efficiency between two levels in a cloud was calculated. Finally, other height-dependent, steady-state snowfall models in the literature were compared against spectra from one of the above case studies. The agreement between the predicted and observed spectra regarding these models was less favorable than was obtained from the models presented here.

Triple differential study of ionization of H2 by proton impact for varying electron ejection geometries

NASA Astrophysics Data System (ADS)

Hasan, A.; Sharma, S.; Arthanayaka, T. P.; Lamichhane, B. R.; Remolina, J.; Akula, S.; Madison, D. H.; Schulz, M.

2014-11-01

We have performed a kinematically complete experiment on ionization of H2 by 75 keV proton impact. The triple differential cross sections (TDCS) extracted from the measurement were compared to a molecular 3-body distorted wave (M3DW) calculation for three different electron ejection geometries. Overall, the agreement between experiment and theory is better than in the case of a helium target for the same projectile. Nevertheless, significant quantitative discrepancies remain, which probably result from the capture channel, which may be strongly coupled to the ionization channel. Therefore, improved agreement could be expected from a non-perturbative coupled-channel approach.

SAM International Case Studies: DPV Analysis in Mexico

DOE Office of Scientific and Technical Information (OSTI.GOV)

McCall, James D

Presentation demonstrates the use of the System Advisor Model (SAM) in international analyses, specifically Mexico. Two analyses are discussed with relation to SAM modelling efforts: 1) Customer impacts from changes to net metering and billing agreements and 2) Potential benefits of PV for Mexican solar customers, the Mexican Treasury, and the environment. Along with the SAM analyses, integration of the International Utility Rate Database (I-URDB) with SAM and future international SAM work are discussed. Presentation was created for the International Solar Energy Society's (ISES) webinar titled 'International use of the NREL System Advisor Model (SAM) with case studies'.

A juridical review of partnership agreements that have the elements of work agreements in Indonesia

NASA Astrophysics Data System (ADS)

Nugroho, A.; Sulistyowati, E.; Hikmah, N.

2018-01-01

The Partnership Agreements place the parties in an equal position each party has something as the bargaining power. In some cases, employers prefer to use Partnership Agreements to some individuals to complete the work in their company than Work agreements. Practicality and the absence of obligations to fulfil workers’ rights such as the right to join a Union and to get social security are some of the reasons why employers use the Partnership Agreements. Sometimes Partnership Agreement contains jobs, wages and orders which is the characteristic of work agreement. Based on the fact above, the legal issues arise whether the Partnership Agreement can be considered as the Work Agreement or not and which court is authorized to hear in the event of a dispute. To analyze the above legal issues, this research uses normative legal research type with the statute approach. The technique of legal material analysis uses prescriptive techniques to assess the issue and make recommendations. Based on the analysis, it can be concluded that the Partnership Agreement, of which the elements are: wages and orders can be categorized as Work Agreement and therefore in the event of a dispute, the authorized court is Industrial Relations Court.

45 CFR 1620.6 - Signed written agreement.

Code of Federal Regulations, 2011 CFR

2011-10-01

... IN USE OF RESOURCES § 1620.6 Signed written agreement. All staff who handle cases or matters, or are...; (b) Has read and is familiar with the definition of an emergency situation and the procedures for... matter for the recipient that is not a priority or an emergency. ...

45 CFR 1620.6 - Signed written agreement.

Code of Federal Regulations, 2014 CFR

2014-10-01

... IN USE OF RESOURCES § 1620.6 Signed written agreement. All staff who handle cases or matters, or are...; (b) Has read and is familiar with the definition of an emergency situation and the procedures for... matter for the recipient that is not a priority or an emergency. ...

45 CFR 1620.6 - Signed written agreement.

Code of Federal Regulations, 2012 CFR

2012-10-01

... IN USE OF RESOURCES § 1620.6 Signed written agreement. All staff who handle cases or matters, or are...; (b) Has read and is familiar with the definition of an emergency situation and the procedures for... matter for the recipient that is not a priority or an emergency. ...

45 CFR 1620.6 - Signed written agreement.

Code of Federal Regulations, 2010 CFR

2010-10-01

... IN USE OF RESOURCES § 1620.6 Signed written agreement. All staff who handle cases or matters, or are...; (b) Has read and is familiar with the definition of an emergency situation and the procedures for... matter for the recipient that is not a priority or an emergency. ...

The Haldimand Agreement: A Continuing Covenant.

ERIC Educational Resources Information Center

Simon, Michael P. P.

1983-01-01

Puts forth the case for the inherent sovereign right of the Iroquois to extensive tracts of land on the banks of the Grand River in Ontario, Canada, granted by the Haldimand agreement of 1784 to Iroquois siding with the British at the time of the American Revolution. (JHZ)

7 CFR 1956.96 - Delinquent adjustment agreements.

Code of Federal Regulations, 2010 CFR

2010-01-01

... BUSINESS-COOPERATIVE SERVICE, RURAL UTILITIES SERVICE, AND FARM SERVICE AGENCY, DEPARTMENT OF AGRICULTURE...-Family Housing § 1956.96 Delinquent adjustment agreements. A 90-day extension for making the payments may be given by the Agency when the circumstances of the case justify an extension. A decision not to...

Histopathological grading of breast ductal carcinoma in situ: validation of a web-based survey through intra-observer reproducibility analysis.

PubMed

Schuh, Fernando; Biazús, Jorge Villanova; Resetkova, Erika; Benfica, Camila Zanella; Ventura, Alessandra de Freitas; Uchoa, Diego; Graudenz, Márcia; Edelweiss, Maria Isabel Albano

2015-07-10

Histopathological grading diagnosis of ductal carcinoma in situ (DCIS) of the breast may be very difficult even for experts, and it is important for therapeutic decisions. The challenge may be due to the inaccurate and/or subjective application of the diagnosis criteria. The aim of this study was to investigate the intra-observer agreement between a traditional method and a developed web-based questionnaire for scoring breast DCIS. A cross-sectional study was carried out to evaluate the diagnostic agreement of an electronic questionnaire and its point scoring system with the subjective reading of digital images for 3 different DCIS grading systems: Holland, Van Nuys and modified Black nuclear grade system. Three pathologists analyzed the same set of digitized images from 43 DCIS cases using two different web-based programs. In the first phase, they accessed a website with a newly created questionnaire and scoring system developed to allow the determination of the histological grade of the cases. After at least 6 months, the pathologists read again the same images, but without the help of the questionnaire, indicating subjectively the diagnoses. The intra-observer agreement analysis was employed to validate this innovative web-based survey. Overall, diagnostic reproducibility was similar for all histologic grading classification systems, with kappa values of 0.57 ± 0.10, 0.67 ± 0.09 and 0.67 ± 0.09 for Holland, Van Nuys classification and modified Black nuclear grade system respectively. Only two 2-step diagnostic disagreements were found, one for Holland and another for Van Nuys. Both cases were superestimated by the web-based survey. The diagnostic agreement between the web-based questionnaire and a traditional method, both using digital images, is moderate to good for Holland, Van Nuys and modified Black nuclear grade system. The use of a scoring point system does not appear to pose a major risk of presenting large (2-step) diagnostic disagreements. These findings indicate that the use of this point scoring system in this web-based survey to grade objectively DCIS lesions is a useful diagnostic tool.

Teaching, Technology, and the Art of the Deal

ERIC Educational Resources Information Center

Schieberl, Jeffrey; Rainey, Michael; Palmer, Lynda

2014-01-01

This paper illustrates a teaching innovation that took a traditional role playing exercise based on a case study and added some nuances that amplified the learning experience. The example illustrated in this paper was a didactic negotiation exercise intended to teach simple, basic negotiation principles like zone of possible agreement (ZOPA),…

Differentiation and Collaboration in a Competitive Environment: A Case Study of Ontario Postsecondary Education System

ERIC Educational Resources Information Center

Jafar, Hayfa

2015-01-01

The essay explores how the dynamics of competition and collaboration among Ontario's higher education institutions contribute to the system's differentiation strategy. The essay implements a content analysis approach to the Strategic Mandate Agreement submissions signed between the Ontario Government and the Ontario Colleges and Universities in…

Sub-Saharan Africa report, [January 29, 1987

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

1987-01-29

Partial Contents: Subsaharan Africa, resolution, settlement, leaderships, election fraud, political, propaganda war, guerrilla war, commonwealth president, warns officers, national youth corps, diversity, unemployment, fuel consumption, journalists, cultural agreement, steel plants, foreign investment, energy, fuel shortage, fertilizer, export, telecommunication, defense workers, farming, private school, educational, scholarships, case study, government, economics, political philosophy, sociopolitical, industrial.

Critical discussion of evaluation parameters for inter-observer variability in target definition for radiation therapy.

PubMed

Fotina, I; Lütgendorf-Caucig, C; Stock, M; Pötter, R; Georg, D

2012-02-01

Inter-observer studies represent a valid method for the evaluation of target definition uncertainties and contouring guidelines. However, data from the literature do not yet give clear guidelines for reporting contouring variability. Thus, the purpose of this work was to compare and discuss various methods to determine variability on the basis of clinical cases and a literature review. In this study, 7 prostate and 8 lung cases were contoured on CT images by 8 experienced observers. Analysis of variability included descriptive statistics, calculation of overlap measures, and statistical measures of agreement. Cross tables with ratios and correlations were established for overlap parameters. It was shown that the minimal set of parameters to be reported should include at least one of three volume overlap measures (i.e., generalized conformity index, Jaccard coefficient, or conformation number). High correlation between these parameters and scatter of the results was observed. A combination of descriptive statistics, overlap measure, and statistical measure of agreement or reliability analysis is required to fully report the interrater variability in delineation.

Australians are not equally protected from industrial air pollution

NASA Astrophysics Data System (ADS)

Dobbie, B.; Green, D.

2015-05-01

Australian air pollution standards are set at national and state levels for a number of chemicals harmful to human health. However, these standards do not need to be met when ad hoc pollution licences are issued by state environment agencies. This situation results in a highly unequal distribution of air pollution between towns and cities, and across the country. This paper examines these pollution regulations through two case studies, specifically considering the ability of the regulatory regime to protect human health from lead and sulphur dioxide pollution in the communities located around smelters. It also considers how the proposed National Clean Air Agreement, once enacted, might serve to reduce this pollution equity problem. Through the case studies we show that there are at least three discrete concerns relating to the current licencing system. They are: non-onerous emission thresholds for polluting industry; temporal averaging thresholds masking emission spikes; and ineffective penalties for breaching licence agreements. In conclusion, we propose a set of new, legally-binding national minimum standards for industrial air pollutants must be developed and enforced, which can only be modified by more (not less) stringent state licence arrangements.

Incorporating teledermatology into emergency medicine.

PubMed

Muir, Jim; Xu, Cathy; Paul, Sanjoy; Staib, Andrew; McNeill, Iain; Singh, Philip; Davidson, Samantha; Soyer, H Peter; Sinnott, Michael

2011-10-01

The aim of the present study was to investigate the feasibility of using a store-and-forward Skin Emergency Telemedicine Service (SETS) to provide rapid specialist diagnostic and management advice for dermatological cases in an ED. This pilot study was conducted at the Princess Alexandra Hospital between August 2008 and August 2009. Study subjects were consenting patients over 18 years of age who presented with a dermatological condition to the ED. The ED doctor sent the patient's history, examination findings and the digital images of the skin conditions to a secure email address, which automatically forwarded this to the teledermatologist. The teledermatologist reviewed the cases and sent advice on diagnosis and management to the referring ED doctor via email and/or telephone. Face-to-face follow-up consultations with the patients were conducted within 2 weeks. The diagnostic and management concordance between ED doctors, teledermatologists and reviewing dermatologists were analysed. A total of 60 patients participated in the present study. SETS provided a rapid response with 56 (93%) of ED consultations receiving a dermatology opinion within 2 h. Face-to-face follow up occurred in 50 patients (83%). Statistical analysis showed significant levels of agreement between tele-diagnosis and ED diagnosis of 71.2% (Kappa 0.42) and tele-diagnosis and final clinical diagnosis of 98% (Kappa: 0.93). The clinical management concordance was 96% in complete agreement and 4% in relative agreement between the teledermatologists and reviewing dermatologists, based on chart review. The present study has shown that SETS can provide rapid and accurate diagnostic and treatment advice from a specialist for dermatological presentations to the ED. © 2011 The Authors. EMA © 2011 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Medical death certification by forensic physicians in the Netherlands: Validity and interdoctorvariation.

PubMed

Dorn, Tina; Ceelen, Manon; Reijnders, Udo; Das, Kees

2016-10-01

The aim of the study was to assess interdoctorvariation and validity in death certification by forensic physicians using 19 written scenarios. The scenarios described typical cases from forensic-medical practice. Physicians were asked to determine the manner of death (natural/unnatural) and to provide an ICD-10 code for the cause of death. In contrast to most studies on this topic, the measure of agreement among physicians was chance-corrected and a standard was used to assess the correctness of the assigned cause and manner of death. Forty-seven physicians participated in the survey. The study demonstrated that forensic physicians varied widely in their conclusions. With respect to manner of death, adequate agreement (defined as kappa>0.70) was achieved in six scenarios (32% of all scenarios). Concerning the underlying cause of death, adequate agreement was reached in three cases (16% of all scenarios). Furthermore, predictors for the correctness of manner and cause of death were studied using logistic regression. Years of experience as a forensic physician significantly predicted the correctness of cause of death (p < 0.05). Other predictors remained insignificant. With regard to manner of death, none of the studied predictors proved to be significant. To conclude, there appears to be a lack of consistency among forensic physicians regarding death certification. The ICD-10 coding of causes of death applied by forensic physicians is questionable. Less experienced physicians need supervision by more experienced colleagues when making judgments concerning the cause of death. Altogether, there is an urgent need to work out consensus-based guidelines for forensic physicians on how to certify deaths. Copyright © 2016 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

Investigating Autism-Related Symptoms in Children with Prader-Willi Syndrome: A Case Study

PubMed Central

Bennett, Jeffrey A.; Hodgetts, Sandra; Mackenzie, Michelle L.; Haqq, Andrea M.; Zwaigenbaum, Lonnie

2017-01-01

Prader-Willi syndrome (PWS), a rare genetic disorder caused by the lack of expression of paternal genes from chromosome 15q11-13, has been investigated for autism spectrum disorder (ASD) symptomatology in various studies. However, previous findings have been variable, and no studies investigating ASD symptomatology in PWS have exclusively studied children. We aimed to characterize social communication functioning and other ASD-related symptoms in children with PWS, and assessed agreement across measures and rates of ASD diagnosis. Measures included the Autism Diagnostic Observation Schedule-2 (ADOS-2), the Social Communication Questionnaire (SCQ), Social Responsiveness Scale-2 (SRS-2), Social Skills Improvement System-Rating Scales (SSIS-RS), and the Vineland Adaptive Behavioral Scales-II (VABS-II). General adaptive and intellectual skills were also assessed. Clinical best estimate (CBE) diagnosis was determined by an experienced developmental pediatrician, based on history and review of all available study measures, and taking into account overall developmental level. Participants included 10 children with PWS, aged 3 to 12 years. Three of the 10 children were male and genetic subtypes were two deletion (DEL) and eight uniparental disomy (UPD) (with a total of 6 female UPD cases). Although 8 of the 10 children exceeded cut-offs on at least one of the ASD assessments, agreement between parent questionnaires (SCQ, SRS-2, SSIS-RS) and observational assessment (ADOS-2) was very poor. None of the children were assigned a CBE diagnosis of ASD, with the caveat that the risk may have been lower because of the predominance of girls in the sample. The lack of agreement between the assessments emphasizes the complexity of interpreting ASD symptom measures in children with PWS. PMID:28264487

Investigating Autism-Related Symptoms in Children with Prader-Willi Syndrome: A Case Study.

PubMed

Bennett, Jeffrey A; Hodgetts, Sandra; Mackenzie, Michelle L; Haqq, Andrea M; Zwaigenbaum, Lonnie

2017-02-28

Prader-Willi syndrome (PWS), a rare genetic disorder caused by the lack of expression of paternal genes from chromosome 15q11-13, has been investigated for autism spectrum disorder (ASD) symptomatology in various studies. However, previous findings have been variable, and no studies investigating ASD symptomatology in PWS have exclusively studied children. We aimed to characterize social communication functioning and other ASD-related symptoms in children with PWS, and assessed agreement across measures and rates of ASD diagnosis. Measures included the Autism Diagnostic Observation Schedule-2 (ADOS-2), the Social Communication Questionnaire (SCQ), Social Responsiveness Scale-2 (SRS-2), Social Skills Improvement System-Rating Scales (SSIS-RS), and the Vineland Adaptive Behavioral Scales-II (VABS-II). General adaptive and intellectual skills were also assessed. Clinical best estimate (CBE) diagnosis was determined by an experienced developmental pediatrician, based on history and review of all available study measures, and taking into account overall developmental level. Participants included 10 children with PWS, aged 3 to 12 years. Three of the 10 children were male and genetic subtypes were two deletion (DEL) and eight uniparental disomy (UPD) (with a total of 6 female UPD cases). Although 8 of the 10 children exceeded cut-offs on at least one of the ASD assessments, agreement between parent questionnaires (SCQ, SRS-2, SSIS-RS) and observational assessment (ADOS-2) was very poor. None of the children were assigned a CBE diagnosis of ASD, with the caveat that the risk may have been lower because of the predominance of girls in the sample. The lack of agreement between the assessments emphasizes the complexity of interpreting ASD symptom measures in children with PWS.

Four centuries later: how to close the Galileo case?

PubMed

Segre, Michael

The "Galileo case" is still open: John Paul II's 1979 initiative to "recognize wrongs from whatever side they come" was carried out in an unsatisfactory manner. The task would have been easy had the Pontifical Study Commission created for that purpose concentrated on the 1616 decree alone and declared it not in line with the hermeneutical guidelines of the Council of Trent, in agreement with Galileo and not with Saint Robert Bellarmine. A possible avenue to closing the "Galileo case" on the part of the Church of Rome could, thus, be to change its current defensive attitude and declare itself no longer what it was in 1616, since another such "case" is, hopefully, no longer conceivable.

Agreement between Dietary Intake of Older Adults and Proxy Respondents Assessed by a Food Frequency Questionnaire.

PubMed

Dias Medici Saldiva, S R; Bassani, L; da Silva Castro, A L; Gonçalves, I B; de Oliveira Sales, C R; Lobo Marchioni, D M

2017-01-01

To evaluate the degree of agreement of dietary intake reported by the patient subject with the dietary intake reported by a respondent (a next-of-kin or a caregiver), collected by a validated Food Frequency Questionnaire (FFQ). 126 adults, both sexes, the average age was 65.9 years for patients and 54.4 years for respondents. They were recruited from the General Practice Clinic at the Clinical Hospital of São Paulo (AGD-FMUSP). The agreement between the responses given by patients and respondents was assessed using Spearman, weighted Kappa and Bland Altman tests. The analysis for accuracy between responses (Spearman test) showed a moderate degree of agreement (0.31-0.39) for Energy, Total fat, Total Saturated Fatty Acids (SFA), Total Monounsaturated Fatty Acids (MUFA). Regarding food groups a moderate agreement was found for the majority of the foods (fruits (0.30), dairy products (0.50), natural juices (0.45), beans (0.48), butter/margarine (0.55), coffee (0.41) and soda (0.45), with the exception of vegetables (0.12) and rice (0.63). The ingestion differences did not exceeded the limit of the two standard deviations for the majority of the pairs (Bland Altman). A respondent subsample composed only of husband/wives (N = 36) revealed a moderate agreement concordance for most macronutrients studied (0.30 - 0.58), except polyunsaturated fats (0.25). The results of this study show that, the FFQ may be used in cases where is impossible to get the answers directly from the patients.

Electrophysiological Correlates of Second-Language Syntactic Processes Are Related to Native and Second Language Distance Regardless of Age of Acquisition

PubMed Central

Díaz, Begoña; Erdocia, Kepa; de Menezes, Robert F.; Mueller, Jutta L.; Sebastián-Gallés, Núria; Laka, Itziar

2016-01-01

In the present study, we investigate how early and late L2 learners process L2 grammatical traits that are either present or absent in their native language (L1). Thirteen early (AoA = 4 years old) and 13 late (AoA = 18 years old) Spanish learners of Basque performed a grammatical judgment task on auditory Basque sentences while their event-related brain potentials (ERPs) were recorded. The sentences contained violations of a syntactic property specific to participants' L2, i.e., ergative case, or violations of a syntactic property present in both of the participants' languages, i.e., verb agreement. Two forms of verb agreement were tested: subject agreement, found in participants' L1 and L2, and object agreement, present only in participants' L2. Behaviorally, early bilinguals were more accurate in the judgment task than late L2 learners. Early bilinguals showed native-like ERPs for verb agreement, which differed from the late learners' ERP pattern. Nonetheless, approximation to native-likeness was greater for the subject-verb agreement processing, the type of verb-agreement present in participants' L1, compared to object-verb agreement, the type of verb-agreement present only in participants' L2. For the ergative argument alignment, unique to L2, the two non-native groups showed similar ERP patterns which did not correspond to the natives' ERP pattern. We conclude that non-native syntactic processing approximates native processing for early L2 acquisition and high proficiency levels when the syntactic property is common to the L1 and L2. However, syntactic traits that are not present in the L1 do not rely on native-like processing, despite early AoA and high proficiency. PMID:26903930

Intra- and inter-observer agreement in MRI assessment of rotator cuff healing using the Sugaya classification 10years after surgery.

PubMed

Niglis, L; Collin, P; Dosch, J-C; Meyer, N; Kempf, J-F

2017-10-01

The long-term outcomes of rotator cuff repair are unclear. Recurrent tears are common, although their reported frequency varies depending on the type and interpretation challenges of the imaging method used. The primary objective of this study was to assess the intra- and inter-observer reproducibility of the MRI assessment of rotator cuff repair using the Sugaya classification 10years after surgery. The secondary objective was to determine whether poor reproducibility, if found, could be improved by using a simplified yet clinically relevant classification. Our hypothesis was that reproducibility was limited but could be improved by simplifying the classification. In a retrospective study, we assessed intra- and inter-observer agreement in interpreting 49 magnetic resonance imaging (MRI) scans performed 10years after rotator cuff repair. These 49 scans were taken at random among 609 cases that underwent re-evaluation, with imaging, for the 2015 SoFCOT symposium on 10-year and 20-year clinical and anatomical outcomes of rotator cuff repair for full-thickness tears. Each of three observers read each of the 49 scans on two separate occasions. At each reading, they assessed the supra-spinatus tendon according to the Sugaya classification in five types. Intra-observer agreement for the Sugaya type was substantial (κ=0.64) but inter-observer agreement was only fair (κ=0.39). Agreement improved when the five Sugaya types were collapsed into two categories (1-2-3 and 4-5) (intra-observer κ=0.74 and inter-observer κ=0.68). Using the Sugaya classification to assess post-operative rotator cuff healing was associated with substantial intra-observer and fair inter-observer agreement. A simpler classification into two categories improved agreement while remaining clinically relevant. II, prospective randomised low-power study. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Expert disagreement in bitemark casework.

PubMed

Bowers, C Michael; Pretty, Iain A

2009-07-01

Bitemark cases continue to raise controversy due to the degree of expert disagreement which is frequently seen. Using a case mix of 49 bitemark cases from 2000 to 2007 each injury was independently assessed for its forensic significance using a previously described bitemark severity scale. Following the assessment, the mean value for the bites was categorized according to the crime type, the degree of expert agreement, and the judicial outcome. Results suggest that bitemarks found in child abuse cases have statistically significantly lower forensic value than those in other crime types, that bites where there is mutual agreement between experts will have higher forensic value than those where there is disagreement at trial, and that cases in which DNA has provided an exoneration will demonstrate similar quality to those where a conviction was secured. Forensic odontologists should carefully assess bitemark evidence and ensure that it meets certain minimums in relation to the presence of class and unique features before undertaking an analysis.

Modeling the effect of control on the wake of a utility-scale turbine via large-eddy simulation

NASA Astrophysics Data System (ADS)

Yang, Xiaolei; Annoni, Jennifer; Seiler, Pete; Sotiropoulos, Fotis

2014-06-01

A model of the University of Minnesota EOLOS research turbine (Clipper Liberty C96) is developed, integrating the C96 torque control law with a high fidelity actuator line large- eddy simulation (LES) model. Good agreement with the blade element momentum theory is obtained for the power coefficient curve under uniform inflow. Three different cases, fixed rotor rotational speed ω, fixed tip-speed ratio (TSR) and generator torque control, have been simulated for turbulent inflow. With approximately the same time-averaged ω, the time- averaged power is in good agreement with measurements for all three cases. Although the time-averaged aerodynamic torque is nearly the same for the three cases, the root-mean-square (rms) of the aerodynamic torque fluctuations is significantly larger for the case with fixed ω. No significant differences have been observed for the time-averaged flow fields behind the turbine for these three cases.

Factoring economic costs into conservation planning may not improve agreement over priorities for protection.

PubMed

Armsworth, Paul R; Jackson, Heather B; Cho, Seong-Hoon; Clark, Melissa; Fargione, Joseph E; Iacona, Gwenllian D; Kim, Taeyoung; Larson, Eric R; Minney, Thomas; Sutton, Nathan A

2017-12-21

Conservation organizations must redouble efforts to protect habitat given continuing biodiversity declines. Prioritization of future areas for protection is hampered by disagreements over what the ecological targets of conservation should be. Here we test the claim that such disagreements will become less important as conservation moves away from prioritizing areas for protection based only on ecological considerations and accounts for varying costs of protection using return-on-investment (ROI) methods. We combine a simulation approach with a case study of forests in the eastern United States, paying particular attention to how covariation between ecological benefits and economic costs influences agreement levels. For many conservation goals, agreement over spatial priorities improves with ROI methods. However, we also show that a reliance on ROI-based prioritization can sometimes exacerbate disagreements over priorities. As such, accounting for costs in conservation planning does not enable society to sidestep careful consideration of the ecological goals of conservation.

Language disorders as a window on universal grammar: an abstract theory of agreement for IP, DP, and V-PP.

PubMed

Roeper, T; Ramos, E; Seymour, H; Abdul-Karim, L

2001-06-01

A new concept of Agreement (AGR) has been represented as a Formal Feature that can appear in a wide range of different configurations (Chomsky, 1998). A case study from language disorders supports and extends this abstract concept. The child shows no agreement in Inflectional Phrase me can and Determiner Phrase them eyes. We then extend the notion of AGR to include verb-Prepositional Phrase relations, where the child also systematically avoids certain prepositions (go beach). The analysis is supported by intuitional data from compounds (sweep with broom --> broom-swept). We also define a systematic notion of Possible deficit as a premature fixation of functional items which normally require additional Phi-features. The notion of Maximization of Formal Features then emerges as a significant feature of learnability from both a normal and disordered perspective. Copyright 2001 Academic Press.

Knowledge, beliefs and use of nursing methods in preventing pressure sores in Dutch hospitals.

PubMed

Halfens, R J; Eggink, M

1995-02-01

Different methods have been developed in the past to prevent patients from developing pressure sores. The consensus guidelines developed in the Netherlands make a distinction between preventive methods useful for all patients, methods useful only in individual cases, and methods which are not useful at all. This study explores the extent of use of the different methods within Dutch hospitals, and the knowledge and beliefs of nurses regarding the usefulness of these methods. A mail questionnaire was sent to a representative sample of nurses working within Dutch hospitals. A total of 373 questionnaires were returned and used for the analyses. The results showed that many methods judged by the consensus report as not useful, or only useful in individual cases, are still being used. Some methods which are judged as useful, like the use of a risk assessment scale, are used on only a few wards. The opinion of nurses regarding the usefulness of the methods differ from the guidelines of the consensus committee. Although there is agreement about most of the useful methods, there is less agreement about the methods which are useful in individual cases or methods which are not useful at all. In particular the use of massage and cream are, in the opinion of the nurses, useful in individual or in all cases.

Diagnostic and Treatment Reproducibility of Cervical Intraepithelial Neoplasia / Squamous Intraepithelial Lesion and Factors Affecting the Diagnosis.

PubMed

Sağlam, Arzu; Usubütün, Alp; Dolgun, Anıl; Mutter, George L; Salman, M Coşkun; Kurtulan, Olcay; Akyol, Aytekin; Özkan, Eylem Akar; Baykara, Sema; Bülbül, Dilek; Calay, Zerrin; Eren, Funda; Gümürdülü, Derya; Haberal, Nihan; Ilvan, Şennur; Karaveli, Şeyda; Koyuncuoğlu, Meral; Müezzinoğlu, Bahar; Müftüoğlu, Kamil Hakan; Özen, Özlem; Özdemir, Necmettin; Peştereli, Elif; Ulukuş, Çağnur; Zekioğlu, Osman

2017-01-01

Inter-observer differences in the diagnosis of HPV related cervical lesions are problematic and response of gynecologists to these diagnostic entities is non-standardized. This study evaluated the diagnostic reproducibility of "cervical intraepithelial neoplasia" (CIN) and "squamous intraepithelial lesion" (SIL) diagnoses. 19 pathologists evaluated 66 cases once using H&E slides and once with immunohistochemical studies (p16, Ki-67 and Pro-ExC). Management response to diagnoses was evaluated amongst 12 gynecologists. Pathologists and gynecologists were also given a questionnaire about how additional information like smear results and age modify diagnosis and management. We show moderate interobserver diagnostic reproducibility amongst pathologists. The overall kappa value was 0.50 and 0.59 using the CIN and SIL classifications respectively. Impact of immunohistochemical evaluation on interpretation of cases differed and there was lack of statistically significant improvement of interobserver diagnostic reproducibility with the addition of immunohistochemistry. We saw that choice of treatment methods amongst gynecologists varied and overall concordance was only fair to moderate. The CIN2 diagnostic category was seen to have the lowest percentage agreement amongst both pathologists and gynecologists. We showed that pathologists had diagnostic "styles" and gynecologists had management "styles". In summary each pathologist had different diagnostic tendencies which were affected not only by histopathology and marker studies, but also by the patient management tendencies of the gynecologist that the pathologist worked with. The two-tiered modified Bethesda system improved diagnostic agreement. We concluded that immunohistochemistry should be used only to resolve problems in select cases and not for every case.

The Interrater and Intrarater Agreement of a Modified Neer Classification System and Associated Treatment Choice for Lateral Clavicle Fractures.

PubMed

Cho, Chul-Hyun; Oh, Joo Han; Jung, Gu-Hee; Moon, Gi-Hyuk; Rhyou, In Hyeok; Yoon, Jong Pil; Lee, Ho Min

2015-10-01

As there is substantial variation in the classification and diagnosis of lateral clavicle fractures, proper management can be challenging. Although the Neer classification system modified by Craig has been widely used, no study has assessed its validity through inter- and intrarater agreement. To determine the inter- and intrarater agreement of the modified Neer classification system and associated treatment choice for lateral clavicle fractures and to assess whether 3-dimensional computed tomography (3D CT) improves the level of agreement. Cohort study (diagnosis); Level of evidence, 3. Nine experienced shoulder specialists and 9 orthopaedic fellows evaluated 52 patients with lateral clavicle fractures, completing fracture typing according to the modified Neer classification system and selecting a treatment choice for each case. Web-based assessment was performed using plain radiographs only, followed by the addition of 3D CT images 2 weeks later. This procedure was repeated 4 weeks later. Fleiss κ values were calculated to estimate the inter- and intrarater agreement. Based on plain radiographs only, the inter- and intrarater agreement of the modified Neer classification system was regarded as fair (κ = 0.344) and moderate (κ = 0.496), respectively; the inter- and intrarater agreement of treatment choice was both regarded as moderate (κ = 0.465 and 0.555, respectively). Based on the plain radiographs and 3D CT images, the inter- and intrarater agreement of the classification system was regarded as fair (κ = 0.317) and moderate (κ = 0.508), respectively; the inter- and intrarater agreement of treatment choice was regarded as moderate (κ = 0.463) and substantial (κ = 0.623), respectively. There were no significant differences in the level of agreement between the plain radiographs only and plain radiographs plus 3D CT images for any κ values (all P > .05). The level of interrater agreement of the modified Neer classification system for lateral clavicle fractures was fair. Additional 3D CT did not improve the overall level of interrater or intrarater agreement of the modified Neer classification system or associated treatment choice. To eliminate a common source of disagreement among surgeons, a new classification system to focus on unclassifiable fracture types is needed. © 2015 The Author(s).

77 FR 76941 - Defense Federal Acquisition Regulation Supplement: New Qualifying Country-Poland (DFARS Case 2012...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-31

... discriminatory barriers to procurements of supplies and services produced by industrial enterprises of the other... a designated country under the World Trade Organization Government Procurement Agreement. II..., the U.S. Secretary of Defense signed a new reciprocal defense procurement agreement with the Polish...

District Consolidation: Rivals Coming Together

ERIC Educational Resources Information Center

Mart, Dan

2011-01-01

District consolidation is a highly emotional process. One key to success is sticking to the facts. In Iowa, school districts facing financial difficulties or enrollment concerns do not have to move directly to consolidation. In many cases, districts begin by developing sharing agreements. These sharing agreements may start with simple sharing of…

Computer versus Counselor Interpretation of Interest Inventories: The Case of the Self-Directed Search.

ERIC Educational Resources Information Center

Gati, Itamar; Blumberg, Dani

1991-01-01

Examined interpretations of 100 career counselee's responses to Self-Directed Search (SDS). Found that agreement between scales identified as relevant was as high as agreement among counselors, insignificant correlations between counselors' judgments of counselee's degree of interest crystallization and Holland's (1985) measure of consistency, and…

Caseworker assessments of risk for recurrent maltreatment: association with case-specific risk factors and re-reports.

PubMed

Dorsey, Shannon; Mustillo, Sarah A; Farmer, Elizabeth M Z; Elbogen, Eric

2008-03-01

This article focuses on caseworkers' assessments of risk of maltreatment recurrence among families in contact with social services. Specifically, the article has two primary goals: (1) to examine the association between caseworkers' risk assessments and demographic, child, parent and family-level risk factors; and (2) to examine agreement between caseworkers' risk assessments and any subsequent report, or reports, of maltreatment. Data are from the baseline, 12-month, and 18-month assessments of the National Survey for Child and Adolescent Well-Being (NSCAW), a nationally representative sample of youth and families who were the subjects of allegations of maltreatment investigated by child welfare agencies. The sample consisted of a subset of NSCAW participants: cases with a report of child physical abuse or neglect who were not placed in out-of-home care (N=2,139). Analyses indicated that parent-level risk factors and a prior report of maltreatment were most strongly associated with caseworkers' assessments of risk for both physical abuse and neglect cases. A smaller set of factors, which varied by the type of maltreatment, were associated with a subsequent report of maltreatment. Despite some overlap in correlates of risk assessment and subsequent reports, analyses indicated that agreement between caseworkers' assessments of risk and re-reports was low. Findings suggest that although caseworkers' assessments were associated with a limited set of risk factors from the literature, few of these factors also were associated with a recurrent report of maltreatment. Correspondence between caseworkers' assessments of risk and a subsequent report of maltreatment was low, suggesting that considerable work may be needed to improve accuracy and identification of cases most at risk. This study provides information to assist caseworkers, administrators, and policymakers in thinking critically about risk assessment policies and procedures. Although caseworkers' assessments of risk were associated with some of the empirical predictors of recurrent maltreatment, their assessments were only slightly better than guessing. Agreement between caseworkers' risk assessments and actual subsequent reports was better for low-risk cases, but primarily because the majority of cases did not have a subsequent report during the study period. Clearly, considerable improvement in risk assessment is needed so that at-risk families can be better identified and the limited services available can be directed toward those most in need.

Interobserver Agreement in Clinical Grading of Vitreous Haze Using Alternative Grading Scales

PubMed Central

Hornbeak, Dana M; Payal, Abhishek; Pistilli, Maxwell; Biswas, Jyotirmay; Ganesh, Sudha K; Gupta, Vishali; Rathinam, Sivakumar R; Davis, Janet L; Kempen, John H

2014-01-01

Purpose To evaluate the reliability of clinical grading of vitreous haze using a new 9-step ordinal scale vs. the existing 6-step ordinal scale. Design Evaluation of Diagnostic Test (interobserver agreement study). Participants 119 consecutive patients (204 uveitic eyes) presenting for uveitis subspecialty care on the study day at one of three large uveitis centers. Methods Five pairs of uveitis specialists clinically graded vitreous haze in the same eyes, one after the other using the same equipment, using the 6- and 9-step scales. Main Outcome Measures Agreement in vitreous haze grade between each pair of specialists was evaluated by the κ statistic (exact agreement and agreement within one or two grades). Results The scales correlated well (Spearman’s ρ=0.84). Exact agreement was modest using both the 6-step and 9-step scales: average κ=0.46 (range 0.28–0.81) and κ=0.40 (range 0.15–0.63), respectively. Within-1-grade agreement was slightly more favorable for the scale with fewer steps, but values were excellent for both scales: κ=0.75 (range 0.66–0.96) and κ=0.62 (range 0.38–0.87), respectively. Within-2-grade agreement for the 9-step scale also was excellent [κ=0.85 (range 0.79–0.92)]. Two-fold more cases were potentially clinical trial eligible based on the 9- than the 6-step scale (p<0.001). Conclusions Both scales are sufficiently reproducible using clinical grading for clinical and research use with the appropriate threshold (a ≥2 and ≥3 step differences for the 6-step and 9-step scales respectively). The results suggest that more eyes are likely to meet eligibility criteria for trials using the 9-step scale. The 9-step scale appears to have higher reproducibility with Reading Center grading than clinical grading, suggesting Reading Center grading may be preferable for clinical trials. PMID:24697913

Interobserver variability in target volume delineation of hepatocellular carcinoma : An analysis of the working group "Stereotactic Radiotherapy" of the German Society for Radiation Oncology (DEGRO).

PubMed

Gkika, E; Tanadini-Lang, S; Kirste, S; Holzner, P A; Neeff, H P; Rischke, H C; Reese, T; Lohaus, F; Duma, M N; Dieckmann, K; Semrau, R; Stockinger, M; Imhoff, D; Kremers, N; Häfner, M F; Andratschke, N; Nestle, U; Grosu, A L; Guckenberger, M; Brunner, T B

2017-10-01

Definition of gross tumor volume (GTV) in hepatocellular carcinoma (HCC) requires dedicated imaging in multiple contrast medium phases. The aim of this study was to evaluate the interobserver agreement (IOA) in gross tumor delineation of HCC in a multicenter panel. The analysis was performed within the "Stereotactic Radiotherapy" working group of the German Society for Radiation Oncology (DEGRO). The GTVs of three anonymized HCC cases were delineated by 16 physicians from nine centers using multiphasic CT scans. In the first case the tumor was well defined. The second patient had multifocal HCC (one conglomerate and one peripheral tumor) and was previously treated with transarterial chemoembolization (TACE). The peripheral lesion was adjacent to the previous TACE site. The last patient had an extensive HCC with a portal vein thrombosis (PVT) and an inhomogeneous liver parenchyma due to cirrhosis. The IOA was evaluated according to Landis and Koch. The IOA for the first case was excellent (kappa: 0.85); for the second case moderate (kappa: 0.48) for the peripheral tumor and substantial (kappa: 0.73) for the conglomerate. In the case of the peripheral tumor the inconsistency is most likely explained by the necrotic tumor cavity after TACE caudal to the viable tumor. In the last case the IOA was fair, with a kappa of 0.34, with significant heterogeneity concerning the borders of the tumor and the PVT. The IOA was very good among the cases were the tumor was well defined. In complex cases, where the tumor did not show the typical characteristics, or in cases with Lipiodol (Guerbet, Paris, France) deposits, IOA agreement was compromised.

Listening panel agreement and characteristics of lung sounds digitally recorded from children aged 1-59 months enrolled in the Pneumonia Etiology Research for Child Health (PERCH) case-control study.

PubMed

McCollum, Eric D; Park, Daniel E; Watson, Nora L; Buck, W Chris; Bunthi, Charatdao; Devendra, Akash; Ebruke, Bernard E; Elhilali, Mounya; Emmanouilidou, Dimitra; Garcia-Prats, Anthony J; Githinji, Leah; Hossain, Lokman; Madhi, Shabir A; Moore, David P; Mulindwa, Justin; Olson, Dan; Awori, Juliet O; Vandepitte, Warunee P; Verwey, Charl; West, James E; Knoll, Maria D; O'Brien, Katherine L; Feikin, Daniel R; Hammit, Laura L

2017-01-01

Paediatric lung sound recordings can be systematically assessed, but methodological feasibility and validity is unknown, especially from developing countries. We examined the performance of acoustically interpreting recorded paediatric lung sounds and compared sound characteristics between cases and controls. Pneumonia Etiology Research for Child Health staff in six African and Asian sites recorded lung sounds with a digital stethoscope in cases and controls. Cases aged 1-59 months had WHO severe or very severe pneumonia; age-matched community controls did not. A listening panel assigned examination results of normal, crackle, wheeze, crackle and wheeze or uninterpretable, with adjudication of discordant interpretations. Classifications were recategorised into any crackle, any wheeze or abnormal (any crackle or wheeze) and primary listener agreement (first two listeners) was analysed among interpretable examinations using the prevalence-adjusted, bias-adjusted kappa (PABAK). We examined predictors of disagreement with logistic regression and compared case and control lung sounds with descriptive statistics. Primary listeners considered 89.5% of 792 case and 92.4% of 301 control recordings interpretable. Among interpretable recordings, listeners agreed on the presence or absence of any abnormality in 74.9% (PABAK 0.50) of cases and 69.8% (PABAK 0.40) of controls, presence/absence of crackles in 70.6% (PABAK 0.41) of cases and 82.4% (PABAK 0.65) of controls and presence/absence of wheeze in 72.6% (PABAK 0.45) of cases and 73.8% (PABAK 0.48) of controls. Controls, tachypnoea, >3 uninterpretable chest positions, crying, upper airway noises and study site predicted listener disagreement. Among all interpretable examinations, 38.0% of cases and 84.9% of controls were normal (p<0.0001); wheezing was the most common sound (49.9%) in cases. Listening panel and case-control data suggests our methodology is feasible, likely valid and that small airway inflammation is common in WHO pneumonia. Digital auscultation may be an important future pneumonia diagnostic in developing countries.

[Interobserver agreement on electrocardiographic diagnosis of left ventricular hypertrophy in hypertensive patients in Andalusia. PREHVIA study].

PubMed

Martín-Rioboó, Enrique; López Granados, Amador; Cea Calvo, Luis; Pérula De Torres, Luis Angel; García Criado, Emilio; Anguita Sánchez, Manuel P; García Matarín, Lisardo; Molina Díaz, Rafael; Ureña Fernández, Tomas

2009-05-01

To assess the agreement between Primary Care (PC) doctors and a cardiology specialist in diagnosing left ventricular hypertrophy in the electrocardiograph (LVH-ECG) in hypertensive patients. Cross-sectional, multicentre study. Andalusian Primary Care Centres. A total of 120 PC doctors who using a random sample selected patients of 35 years or more with AHT of at least 6 months of progression. PRIMARY VARIABLES: Demographic data, risk factors and cardiovascular diseases were recorded. The LVH-ECG was evaluated by applying Cornell voltage criteria, Cornell and Sokolow-Lyon product. The PC researchers read the ECG first and the cardiologist made a second reading blind. A total of 570 patients (mean +/- SD of age, 65 +/- 11 years; 54.5% females); the LVH-ECG prevalence was 13.7% (95% CI, 10.8-16.6; 12.6% by Cornell and 1.6% by Sokolow-Lyon). The agreement in the diagnosis between the PC doctors and the cardiologist was 0.378 (95% CI, 0.272-0.486; disagreements in 15.5% of cases). The PC doctors slightly underestimated the LVH-ECG prevalence by Cornell and slightly overestimated it by the Sokolow-Lyon criteria. The agreement was also low for all of them (kappa = 0.367; 95% CI, 0.252-0.482, for Cornell, and kappa = 0.274; 95% CI: 0.093-0.454 for Sokolow-Lyon). The agreement between the diagnosis by the PC doctors and the cardiologist was low. The implications of this study suggest the need to improve the reading of ECG among PC doctors. The use of computerised systems could be a good option.

The make or buy debate: considering the limitations of domestic production in Tanzania.

PubMed

Wilson, Kinsley Rose; Kohler, Jillian Clare; Ovtcharenko, Natalia

2012-06-29

In order to ensure their population's regular access to essential medicines, many least developed countries and developing countries are faced with the policy question of whether to import or manufacture drugs locally, in particular for life-saving antiretroviral medicines for HIV/AIDS patients. In order for domestic manufacturing to be viable and cost-effective, the local industry must be able to compete with international suppliers of medicines by producing sufficiently low cost ARVs. This paper considers the 'make-or-buy' dilemma by using Tanzania as a case study. Key informant interviews, event-driven observation, and purposive sampling of documents were used to evaluate the case study. The case study focused on Tanzania's imitation technology transfer agreement to locally manufacture a first-line ARV (3TC + d4T + NVP), reverse engineering the ARV. Tanzania is limited by weak political support for the use of TRIPS flexibilities, limited production capacity for ARVs and limited competitiveness in both domestic and regional markets. The Ministry of Health and Social Welfare encourages the use of flexibilities while others push for increased IP protection. Insufficient production capacity and lack of access to donor-financed tenders make it difficult to obtain economies of scale and provide competitive prices. Within the "make-or-buy" context, it was determined that there are significant limitations in domestic manufacturing for developing countries. The case study highlights the difficulty of governments to make use of economies of scale and produce low-cost medicines, attract technology transfer, and utilize the flexibilities of the WTO Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS). The results demonstrate the importance of evaluating barriers to the use of TRIPS flexibilities and long-term planning across sectors in future technology transfer and manufacturing initiatives.

Retrospective cost adaptive Reynolds-averaged Navier-Stokes k-ω model for data-driven unsteady turbulent simulations

NASA Astrophysics Data System (ADS)

Li, Zhiyong; Hoagg, Jesse B.; Martin, Alexandre; Bailey, Sean C. C.

2018-03-01

This paper presents a data-driven computational model for simulating unsteady turbulent flows, where sparse measurement data is available. The model uses the retrospective cost adaptation (RCA) algorithm to automatically adjust the closure coefficients of the Reynolds-averaged Navier-Stokes (RANS) k- ω turbulence equations to improve agreement between the simulated flow and the measurements. The RCA-RANS k- ω model is verified for steady flow using a pipe-flow test case and for unsteady flow using a surface-mounted-cube test case. Measurements used for adaptation of the verification cases are obtained from baseline simulations with known closure coefficients. These verification test cases demonstrate that the RCA-RANS k- ω model can successfully adapt the closure coefficients to improve agreement between the simulated flow field and a set of sparse flow-field measurements. Furthermore, the RCA-RANS k- ω model improves agreement between the simulated flow and the baseline flow at locations at which measurements do not exist. The RCA-RANS k- ω model is also validated with experimental data from 2 test cases: steady pipe flow, and unsteady flow past a square cylinder. In both test cases, the adaptation improves agreement with experimental data in comparison to the results from a non-adaptive RANS k- ω model that uses the standard values of the k- ω closure coefficients. For the steady pipe flow, adaptation is driven by mean stream-wise velocity measurements at 24 locations along the pipe radius. The RCA-RANS k- ω model reduces the average velocity error at these locations by over 35%. For the unsteady flow over a square cylinder, adaptation is driven by time-varying surface pressure measurements at 2 locations on the square cylinder. The RCA-RANS k- ω model reduces the average surface-pressure error at these locations by 88.8%.

Strongly Correlated Electron Systems: An Operatorial Perspective

NASA Astrophysics Data System (ADS)

Di Ciolo, Andrea; Avella, Adolfo

2018-05-01

We discuss the operatorial approach to the study of strongly correlated electron systems and show how the exact solution of target models on small clusters chosen ad-hoc (minimal models) can suggest very efficient bulk approximations. We use the Hubbard model as case study (target model) and we analyze and discuss the crucial role of spin fluctuations in its 2-site realization (minimal model). Accordingly, we devise a novel three-pole approximation for the 2D case, including in the basic field an operator describing the dressing of the electronic one by the nearest-neighbor spin-fluctuations. Such a solution is in very good agreement with the exact one in the minimal model (2-site case) and performs very well once compared to advanced (semi-)numerical methods in the 2D case, being by far less computational-resource demanding.

Learning from Adverse Events in Obstetrics: Is a Standardized Computer Tool an Effective Strategy for Root Cause Analysis?

PubMed

Murray-Davis, Beth; McDonald, Helen; Cross-Sudworth, Fiona; Ahmed, Rashid; Simioni, Julia; Dore, Sharon; Marrin, Michael; DeSantis, Judy; Leyland, Nicholas; Gardosi, Jason; Hutton, Eileen; McDonald, Sarah

2015-08-01

Adverse events occur in up to 10% of obstetric cases, and up to one half of these could be prevented. Case reviews and root cause analysis using a structured tool may help health care providers to learn from adverse events and to identify trends and recurring systems issues. We sought to establish the reliability of a root cause analysis computer application called Standardized Clinical Outcome Review (SCOR). We designed a mixed methods study to evaluate the effectiveness of the tool. We conducted qualitative content analysis of five charts reviewed by both the traditional obstetric quality assurance methods and the SCOR tool. We also determined inter-rater reliability by having four health care providers review the same five cases using the SCOR tool. The comparative qualitative review revealed that the traditional quality assurance case review process used inconsistent language and made serious, personalized recommendations for those involved in the case. In contrast, the SCOR review provided a consistent format for recommendations, a list of action points, and highlighted systems issues. The mean percentage agreement between the four reviewers for the five cases was 75%. The different health care providers completed data entry and assessment of the case in a similar way. Missing data from the chart and poor wording of questions were identified as issues affecting percentage agreement. The SCOR tool provides a standardized, objective, obstetric-specific tool for root cause analysis that may improve identification of risk factors and dissemination of action plans to prevent future events.

Extending WS-Agreement with Multi-round Negotiation Capability

NASA Astrophysics Data System (ADS)

Rumpl, Angela; Wäldrich, Oliver; Ziegler, Wolfgang

The WS-Agreement specification of the Open Grid Forum defines a language and a protocol for advertising the capabilities of service providers and creating agreements based on templates, and for monitoring agreement compliance at runtime. While the specification, which currently is in the process of transition from a proposed recommendation of the Open Grid Forum to a full recommendation, has been widely used after the initial publication in May 2007, it became obvious that the missing possibility to negotiate an agreement rather than just accepting an offer is limiting or inhibiting the use of WS-Agreement for a number of use-cases. Therefore, the Grid Resource Allocation Agreement Working Group of the Open Grid Forum started in 2008 to prepare an extension of WS-Agreement that adds negotiation capabilities without changing the current specification in a way, which leads to an incompatible new version of WS-Agreement. In this paper we present the results of this process with an updated version of the specification in mind and the first implementation in the European project SmartLM.

The Orientation of Gastric Biopsy Samples Improves the Inter-observer Agreement of the OLGA Staging System.

PubMed

Cotruta, Bogdan; Gheorghe, Cristian; Iacob, Razvan; Dumbrava, Mona; Radu, Cristina; Bancila, Ion; Becheanu, Gabriel

2017-12-01

Evaluation of severity and extension of gastric atrophy and intestinal metaplasia is recommended to identify subjects with a high risk for gastric cancer. The inter-observer agreement for the assessment of gastric atrophy is reported to be low. The aim of the study was to evaluate the inter-observer agreement for the assessment of severity and extension of gastric atrophy using oriented and unoriented gastric biopsy samples. Furthermore, the quality of biopsy specimens in oriented and unoriented samples was analyzed. A total of 35 subjects with dyspeptic symptoms addressed for gastrointestinal endoscopy that agreed to enter the study were prospectively enrolled. The OLGA/OLGIM gastric biopsies protocol was used. From each subject two sets of biopsies were obtained (four from the antrum, two oriented and two unoriented, two from the gastric incisure, one oriented and one unoriented, four from the gastric body, two oriented and two unoriented). The orientation of the biopsy samples was completed using nitrocellulose filters (Endokit®, BioOptica, Milan, Italy). The samples were blindly examined by two experienced pathologists. Inter-observer agreement was evaluated using kappa statistic for inter-rater agreement. The quality of histopathology specimens taking into account the identification of lamina propria was analyzed in oriented vs. unoriented samples. The samples with detectable lamina propria mucosae were defined as good quality specimens. Categorical data was analyzed using chi-square test and a two-sided p value <0.05 was considered statistically significant. A total of 350 biopsy samples were analyzed (175 oriented / 175 unoriented). The kappa index values for oriented/unoriented OLGA 0/I/II/III and IV stages have been 0.62/0.13, 0.70/0.20, 0.61/0.06, 0.62/0.46, and 0.77/0.50, respectively. For OLGIM 0/I/II/III stages the kappa index values for oriented/unoriented samples were 0.83/0.83, 0.88/0.89, 0.70/0.88 and 0.83/1, respectively. No case of OLGIM IV stage was found in the present case series. Good quality histopathology specimens were described in 95.43% of the oriented biopsy samples, and in 89.14% of the unoriented biopsy samples, respectively (p=0.0275). The orientation of gastric biopsies specimens improves the inter-observer agreement for the assessment of gastric atrophy.

Agreement between patients and general practitioners on quality deviations during the cancer diagnostic pathway and associations with time to diagnosis.

PubMed

Jensen, Henry; Sperling, Cecilie; Sandager, Mette; Vedsted, Peter

2015-06-01

High quality and minimal delay are crucial and anticipated elements in the diagnostic cancer pathway as delay in the diagnosis may worsen the prognosis and cause lower patient satisfaction. The aim of this study was to describe agreement in reported quality deviations (QDs) between general practitioners (GPs) and cancer patients during the diagnostic pathway in primary care and to estimate the association between length of diagnostic interval and level of agreement on reported QDs. The study was carried out as a Danish cross-sectional study of incident cancer patients identified in the Danish National Patient Registry. Data were collected by independent questionnaires from patients (response rate: 53.0%) and their GPs (response rate: 73.8%), and 2177 pairs of questionnaires were subsequently combined. Agreement between GP- and patient-reported QDs was estimated using Cohen's Kappa, whereas the association between level of agreement and time to diagnosis was estimated using quantile regression. Patients reported QDs in 29.0% and GPs in 28.5% of the cases, but agreed only slightly on QD presence (Kappas between -0.08 and 0.26). Agreement on 'QD presence' was associated with a 54-day (95%CI: 44-64) longer time to diagnosis than agreement on 'no QD presence'. The association with a longer diagnostic interval was stronger when only GP reported a QD the association than when only patient reported a QD. Included GPs and patients agreed only slightly on QD presence although they reported the same amount of QDs; this suggests that GPs and patients see QDs as two different concepts. QD presence had a stronger impact on time to diagnosis when reported by the GP (alone or in agreement with the patient) than when reported by the patient alone. The GP may thus be the most important source of information on QD and diagnostic interval, while the patient information tends to underpin this assessment. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

The relationship between time spent communicating and communication outcomes on a hospital medicine service.

PubMed

Rothberg, Michael B; Steele, John R; Wheeler, John; Arora, Ashish; Priya, Aruna; Lindenauer, Peter K

2012-02-01

Quality care depends on effective communication between caregivers, but it is unknown whether time spent communicating is associated with communication outcomes. To assess the association between time spent communicating, agreement on plan of care, and patient satisfaction. Time-motion study with cross-sectional survey. Academic medical center. Physicians, patients, and nurses on a hospital medicine service. Hospitalists' forms of communication were timed with a stopwatch. Physician-nurse agreement on the plan of care and patient satisfaction with physician communication were assessed via survey. Eighteen hospitalists were observed caring for 379 patients. On average, physicians spent more time per patient on written than verbal communication (median: 9.2 min. vs. 6.3 min, p<0.001). Verbal communication was greatest with patients (mean time 5.3 min, range 0-37 min), then other physicians (1.4 min), families (1.1 min), nurses (1.1 min), and case managers (0.4 min). There was no verbal communication with nurses in 30% of cases. Nurses and physicians agreed most about planned procedures (87%), principal diagnosis (74%), tests ordered (73%), anticipated discharge date (69%) and least regarding medication changes (59%). There was no association between time spent communicating and agreement on plan of care. Among 123 patients who completed surveys (response rate 32%), time physicians spent talking to patients was not correlated with patients' satisfaction with physician communication (Pearson correlation coefficient = 0.09, p=0.30). Hospitalists vary in the amount of time they spend communicating, but we found no association between time spent and either patient satisfaction or nurse-physician agreement on plan of care.

Reconstructing past occupational exposures: how reliable are women's reports of their partner's occupation?

PubMed

Tagiyeva, Nara; Semple, Sean; Devereux, Graham; Sherriff, Andrea; Henderson, John; Elias, Peter; Ayres, Jon G

2011-06-01

Most of the evidence on agreement between self- and proxy-reported occupational data comes from interview-based studies. The authors aimed to examine agreement between women's reports of their partner's occupation and their partner's own description using questionnaire-based data collected as a part of the prospective, population-based Avon Longitudinal Study of Parents and Children. Information on present occupation was self-reported by women's partners and proxy-reported by women through questionnaires administered at 8 and 21 months after the birth of a child. Job titles were coded to the Standard Occupational Classification (SOC2000) using software developed by the University of Warwick (Computer-Assisted Structured Coding Tool). The accuracy of proxy-report was expressed as percentage agreement and kappa coefficients for four-, three- and two-digit SOC2000 codes obtained in automatic and semiautomatic (manually improved) coding modes. Data from 6016 couples at 8 months and 5232 couples at 21 months postnatally were included in the analyses. The agreement between men's self-reported occupation and women's report of their partner's occupation in fully automatic coding mode at four-, three- and two-digit code level was 65%, 71% and 77% at 8 months and 68%, 73% and 76% at 21 months. The accuracy of agreement was slightly improved by semiautomatic coding of occupations: 73%/73%, 78%/77% and 83%/80% at 8/21 months respectively. While this suggests that women's description of their partners' occupation can be used as a valuable tool in epidemiological research where data from partners are not available, this study revealed no agreement between these young women and their partners at the two-digit level of SOC2000 coding in approximately one in five cases. Proxy reporting of occupation introduces a statistically significant degree of error in classification. The effects of occupational misclassification by proxy reporting in retrospective occupational epidemiological studies based on questionnaire data should be considered.

Applying the Paris System for Reporting Urine Cytology Increases the Rate of Atypical Urothelial Cells in Benign Cases: A Need for Patient Management Recommendations.

PubMed

Granados, Rosario; Duarte, Joanny A; Corrales, Teresa; Camarmo, Encarnación; Bajo, Paloma

2017-01-01

The Paris System (TPS) for reporting urinary cytology attempts to unify the terminology in this field. To analyze the impact of adopting TPS by measuring nomenclature agreement and cytohistological correlation. Voided urine liquid-based cytology samples corresponding to 149 biopsy-proven cases (76 high-grade carcinomas, 40 low-grade carcinomas, and 33 benign lesions), were reclassified by the same pathologist using TPS. Diagnostic agreement and sensitivity for both nomenclature systems was measured. When using TPS, the rate of atypical samples increased 8 times (from 3 to 24.2%) in benign cases, 10 times (from 2.5 to 25%) in low-grade carcinomas, and 2.4 times (from 6.6 to 15.8%) in high-grade carcinomas. The false-positive rate (abnormal cytology in negative or low-grade carcinoma cases) increased from 11 to 34.2%. Sensitivity was higher (63 vs. 49%) with TPS at the expense of a lower specificity (73 vs. 91%). The agreement between both nomenclatures was moderate for negative and high-grade carcinoma cases (k = 0.42 and 0.56, respectively) and weak for low-grade tumors (k = 0.35). Adopting TPS for reporting urine cytology results in a considerable increase in atypical diagnoses, improving sensitivity but lowering specificity. Appropriate management recommendations for patients with an atypical cytological diagnosis are required. © 2016 S. Karger AG, Basel.

Individual differences in adult foreign language learning: the mediating effect of metalinguistic awareness.

PubMed

Brooks, Patricia J; Kempe, Vera

2013-02-01

In this study, we sought to identify cognitive predictors of individual differences in adult foreign-language learning and to test whether metalinguistic awareness mediated the observed relationships. Using a miniature language-learning paradigm, adults (N = 77) learned Russian vocabulary and grammar (gender agreement and case marking) over six 1-h sessions, completing tasks that encouraged attention to phrases without explicitly teaching grammatical rules. The participants' ability to describe the Russian gender and case-marking patterns mediated the effects of nonverbal intelligence and auditory sequence learning on grammar learning and generalization. Hence, even under implicit-learning conditions, individual differences stemmed from explicit metalinguistic awareness of the underlying grammar, which, in turn, was linked to nonverbal intelligence and auditory sequence learning. Prior knowledge of languages with grammatical gender (predominantly Spanish) predicted learning of gender agreement. Transfer of knowledge of gender from other languages to Russian was not mediated by awareness, which suggests that transfer operates through an implicit process akin to structural priming.

Volatile profile in the accurate labelling of monofloral honey. The case of lavender and thyme honey.

PubMed

Escriche, Isabel; Sobrino-Gregorio, Lara; Conchado, Andrea; Juan-Borrás, Marisol

2017-07-01

The proliferation of hybrid plant varieties without pollen, such as lavender, has complicated the classification of specific types of honey. This study evaluated the correlation between the proclaimed type of monofloral honey (lavender or thyme) as appears on the label with the actual percentage of pollen. In addition, physicochemical parameters, colour, olfacto-gustatory profile, and volatile compounds were tested. All of the samples labelled as lavender were wrongly classified according to the usual commercial criteria (minimum 10% of pollen Lavandula spp.). In the case of lavender honey, there was significant agreement between commercial labelling and classification through organoleptic perception (81.8%), and above all between the commercial labelling and the volatile compounds (90.9%). For thyme honey, agreement for both parameters was 90.0%. These results offer compelling evidence that the volatile compounds are useful for the classification of lavender honey with low levels of pollen since this technique agrees well with the organoleptic analysis. Copyright © 2017 Elsevier Ltd. All rights reserved.

Earth-observing satellite intercomparison using the Radiometric Calibration Test Site at Railroad Valley

NASA Astrophysics Data System (ADS)

Czapla-Myers, Jeffrey; McCorkel, Joel; Anderson, Nikolaus; Biggar, Stuart

2018-01-01

This paper describes the current ground-based calibration results of Landsat 7 Enhanced Thematic Mapper Plus (ETM+), Landsat 8 Operational Land Imager (OLI), Terra and Aqua Moderate Resolution Imaging Spectroradiometer (MODIS), Suomi National Polar orbiting Partnership Visible Infrared Imaging Radiometer Suite (VIIRS), and Sentinel-2A Multispectral Instrument (MSI), using an automated suite of instruments located at Railroad Valley, Nevada, USA. The period of this study is 2012 to 2016 for MODIS, VIIRS, and ETM+, 2013 to 2016 for OLI, and 2015 to 2016 for MSI. The current results show that all sensors agree with the Radiometric Calibration Test Site (RadCaTS) to within ±5% in the solar-reflective regime, except for one band on VIIRS that is within ±6%. In the case of ETM+ and OLI, the agreement is within ±3%, and, in the case of MODIS, the agreement is within ±3.5%. MSI agrees with RadCaTS to within ±4.5% in all applicable bands.

Our School at Blair Grocery: A Case Study in Promoting Environmental Action through Critical Environmental Education

ERIC Educational Resources Information Center

Ceaser, Donovon

2012-01-01

Despite wide agreement on the goals of environmental education (EE), the promotion of action is still considered contentious. Critical environmental education (critical EE) teaches students to combine critical reflection with the ability to engage in local action to address social/environmental problems. This article examines a critical urban…

Professional Support of Self-Help Groups: A Support Group Project for Chronic Fatigue Syndrome Patients.

ERIC Educational Resources Information Center

Carlsen, Benedicte

2003-01-01

Study follows a collaborative support group project between a team of health professionals and a Chronic Fatigue Syndrome patients' group. While advantageous for professionals to decide upon the aim of a joint intervention in dialogue with participants, simply asking participants what their aims are does not guarantee actual agreement. Case study…

Providers' Reported and Actual Use of Coaching Strategies in Natural Environments

ERIC Educational Resources Information Center

Salisbury, Christine; Cambray-Engstrom, Elizabeth; Woods, Juliann

2012-01-01

This case study examined the agreement between reported and actual use of coaching strategies based on home visit data collected on a diverse sample of providers and families. Paired videotape and contact note data of and from providers during home visits were collected over a six month period and analyzed using structured protocols. Results of…

National Income, Income Inequality, and the Importance of Schools: A Hierarchical Cross-National Comparison

ERIC Educational Resources Information Center

Chudgar, Amita; Luschei, Thomas F.

2009-01-01

The international and comparative education literature is not in agreement over the role of schools in student learning. The authors reexamine this debate across 25 diverse countries participating in the fourth-grade application of the 2003 Trends in International Mathematics and Science Study. The authors find the following: (a) In most cases,…

Placing a Value on Academic Work: The Development and Implementation of a Time-Based Academic Workload Model

ERIC Educational Resources Information Center

Kenny, John; Fluck, Andrew; Jetson, Tim

2012-01-01

This paper presents a detailed case study of the development and implementation of a quantifiable academic workload model in the education faculty of an Australian university. Flowing from the enterprise bargaining process, the Academic Staff Agreement required the implementation of a workload allocation model for academics that was quantifiable…

Gender Discrimination in Educational Personnel: A Case Study of Gweru Urban District Secondary Schools, Zimbabwe

ERIC Educational Resources Information Center

Matope, Nogget

2012-01-01

Gender discrimination in educational institutions persists, despite the vigorous pursuit of policies and programmes to reduce the varying degrees of gender inequity in Zimbabwe. Zimbabwe is a signatory to international agreements and conventions which promote gender equity with a thrust towards increased access to education for girls and females.…

Gifted Students' Profiles and Their Attitudes towards a Gifted Program: The Case of Vietnam

ERIC Educational Resources Information Center

Vu, Phu

2011-01-01

This study describes a gifted program and examines issues related to gifted students' profiles and their attitudes towards an English specialized program in Vietnam. The data were collected via an online survey and analyzed through descriptive statistics in order to identify patterns of agreement and disagreement between two groups of 60 current…

The Status of Women at Canadian Universities and the Role of Faculty Unions

ERIC Educational Resources Information Center

Varpalotai, Aniko

2010-01-01

This paper reviews the status of women in Canadian universities historically and from the perspective of faculty associations, with a focus on a case study of the author's own University and faculty union. Collective bargaining has enabled the formalization of some equity provisions within the collective agreement. A network of status of women…

What Are the Capabilities of Graduates Who Study Outdoor Education in Australian Universities? The Case for a Threshold Concepts Framework

ERIC Educational Resources Information Center

Polley, Scott; Thomas, Glyn J.

2017-01-01

Research has indicated that some stakeholders in the Australian outdoor education profession are uncertain about the capabilities of students graduating from university outdoor education programmes. Unfortunately, there is currently no formal or informal agreement amongst university programmes regarding the knowledge, skills, and experience that…

Clock Agreement Among Parallel Supercomputer Nodes

DOE Data Explorer

Jones, Terry R.; Koenig, Gregory A.

2014-04-30

This dataset presents measurements that quantify the clock synchronization time-agreement characteristics among several high performance computers including the current world's most powerful machine for open science, the U.S. Department of Energy's Titan machine sited at Oak Ridge National Laboratory. These ultra-fast machines derive much of their computational capability from extreme node counts (over 18000 nodes in the case of the Titan machine). Time-agreement is commonly utilized by parallel programming applications and tools, distributed programming application and tools, and system software. Our time-agreement measurements detail the degree of time variance between nodes and how that variance changes over time. The dataset includes empirical measurements and the accompanying spreadsheets.

Comparison of Six Automated Treponema-Specific Antibody Assays.

PubMed

Park, Borae G; Yoon, Jihoon G; Rim, John Hoon; Lee, Anna; Kim, Hyon-Suk

2016-01-01

Six different Treponema (TP)-specific immunoassays were compared to the fluorescent treponemal antibody absorption (FTA-ABS) test. A total of 615 samples were tested. The overall percent agreement, analytical sensitivity, and analytical specificity of each assay compared to the FTA-ABS test were as follows: Architect Syphilis TP, 99.2%, 96.8%, and 100%; Cobas Syphilis, 99.8%, 99.4%, and 100%; ADVIA Centaur Syphilis, 99.8%, 99.4%, and 100%; HISCL Anti-TP assay kit, 99.7%, 98.7%, and 100%; Immunoticles Auto3 TP, 99.0%, 97.5%, and 99.6%; Mediace TPLA, 98.0%, 98.1%, and 98.0%. All results that were discrepant between the TP-specific assays were associated with samples from noninfectious cases (11 immunoassay false positives and 7 from previous syphilis cases). Our study demonstrated that TP-specific immunoassays generally showed high sensitivities, specificities, and percentages of agreement compared to FTA-ABS, with rare cases of false-positive or false-negative results. Therefore, most TP-specific immunoassays are acceptable for use in screening for syphilis. However, it is important to perform a thorough review of a patient's clinical and treatment history for interpreting the results of syphilis serology. Copyright © 2015, American Society for Microbiology. All Rights Reserved.

Exploring the variability of aerosol particle composition in the Arctic: a study from the springtime ACCACIA campaign

NASA Astrophysics Data System (ADS)

Young, G.; Jones, H. M.; Darbyshire, E.; Baustian, K. J.; McQuaid, J. B.; Bower, K. N.; Connolly, P. J.; Gallagher, M. W.; Choularton, T. W.

2015-10-01

Single-particle compositional analysis of filter samples collected on-board the FAAM BAe-146 aircraft is presented for six flights during the springtime Aerosol-Cloud Coupling and Climate Interactions in the Arctic (ACCACIA) campaign (March-April 2013). Scanning electron microscopy was utilised to derive size distributions and size-segregated particle compositions. These data were compared to corresponding data from wing-mounted optical particle counters and reasonable agreement between the calculated number size distributions was found. Significant variability in composition was observed, with differing external and internal mixing identified, between air mass trajectory cases based on HYSPLIT analyses. Dominant particle classes were silicate-based dusts and sea salts, with particles notably rich in K and Ca detected in one case. Source regions varied from the Arctic Ocean and Greenland through to northern Russia and the European continent. Good agreement between the back trajectories was mirrored by comparable compositional trends between samples. Silicate dusts were identified in all cases, and the elemental composition of the dust was consistent for all samples except one. It is hypothesised that long-range, high-altitude transport was primarily responsible for this dust, with likely sources including the Asian arid regions.

Fluorescence Imaging of Underexpanded Jets and Comparison with CFD

NASA Technical Reports Server (NTRS)

Wilkes, Jennifer A.; Glass, Christopher E.; Danehy, Paul M.; Nowak, Robert J.

2006-01-01

An experimental study of underexpanded and highly underexpanded axisymmetric nitrogen free jets seeded with 0.5% nitric oxide (NO) and issuing from a sonic orifice was conducted at NASA Langley Research Center. Reynolds numbers based on nozzle exit conditions ranged from 770 to 35,700, and nozzle exit-to-ambient jet pressure ratios ranged from 2 to 35. These flows were non-intrusively visualized with a spatial resolution of approximately 0.14 mm x 0.14 mm x 1 mm thick and a temporal resolution of 1 s using planar laser-induced fluorescence (PLIF) of NO, with the laser tuned to the strongly-fluorescing UV absorption bands of the Q1 band head near 226.256 nm. Three laminar cases were selected for comparison with computational fluid dynamics (CFD). The cases were run using GASP (General Aerodynamic Simulation Program) Version 4. Comparisons of the fundamental wavelength of the jet flow showed good agreement between CFD and experiment for all three test cases, while comparisons of Mach disk location and Mach disk diameter showed good agreement at lower jet pressure ratios, with a tendency to slightly underpredict these parameters with increasing jet pressure ratio.

The effectiveness of low-cost teleconsultation for emergency head computer tomography in patients with suspected stroke.

PubMed

Phabphal, Kanitpong; Hirunpatch, Siriporn

2008-01-01

Teleradiology in an emergency situation can be used to support rapid neurological decision-making when specialists are remote from the hospital concerned. We have developed a low-cost system using a PDA phone as the receiving equipment. The experimental system was based on a notebook PC to send the images and a PDA phone to receive them. We used commercially available toolbar software for transmitting the information through the mobile phone network. A total of 100 images from clinically suspected strokes within the previous 24 hours were transmitted to a neurologist. The mean size of the original picture was 20.9 kByte and the images were compressed by approximately 2:1 before transmission. The mean transmission time was 48 s per image. The diagnosis from the PDA phone image was in complete agreement with the diagnosis from the original image in cases of acute ischaemic stroke, intracerebral haemorrhage, metastasis and in normal scans. However, there was agreement in only 7 of the 8 cases (88%) of subarachnoid haemorrhage. The overall transmission cost was 400 Thai baht per case. The study showed that good accuracy can be achieved with a low-cost system for teleradiology consultation in stroke.

[Digital angiography and lipiodol computerized tomography in the anatomopathological framework of hepatocarcinoma].

PubMed

Pozzi-Mucelli, R; Pozzi-Mucelli, R; Pagnan, L; Dalla Palma, L

1994-12-01

The introduction of therapies other than conventional surgery of hepatocellular carcinoma (HCC) requires an accurate pathologic classification, which is important because it is well known that HCC may have multicentric growth. The Liver Cancer Study Group of Japan has proposed a classification dividing HCCs into three macroscopic forms from the pathologic point of view: nodular, massive and infiltrating HCCs. The nodular type is subdivided into four types: single nodular type, single nodular type with surrounding proliferation, multinodular fused type and multinodular type. Forty-six HCC patients were examined with Lipiodol Computed Tomography (LCT) to investigate the agreement between pathologic and imaging findings. LCT proved to be in close agreement with pathologic findings. Sixteen cases were classified as type I (single nodular type), 8 as type II (single nodular type with limited foci), 1 as type III (multinodular fused type), 18 as type IV (multiple nodular type with diffuse foci) and 3 cases as type V (massive form). No cases of infiltrative forms were observed in our series. Based on LCT findings, the capabilities of digital subtraction angiography (DSA) were studied in the pathologic classification of HCCs. DSA exhibited some limitations in the pathologic classification of HCCs in 5 of 16 patients with type I lesions. In these cases DSA suggested false-positive diagnoses because of regenerative nodules in cirrhotic liver in 3 cases and of daughter nodules (not confirmed at LCT) in 2 cases. In 7 of 8 patients with type II HCCs, DSA failed to show the daughter nodules surrounding the main nodule. In the 18 patients with multiple distant nodules (type IV), DSA was less sensitive in defining nodule number and site. In the massive form, the information obtained with LCT and DSA was comparable. In conclusion, LCT should be considered a basic examination in the study of HCC extent. Based on LCT findings, the most appropriate treatment can be selected, be it surgery, alcohol injection, or intraarterial chemoembolization.

ACHP | Working with Section 106

Science.gov Websites

Federal Review webpage. State-by-State List of ACHP Signed Agreement Documents In hundreds of cases cases. Use the OFAP Agency Organizational Chart to identify the appropriate OFAP contact for assistance of federal historic preservation cases Updated February 13, 2018 Return to Top

Patient-doctor agreement on recall of clinical trial discussion across cultures.

PubMed

Bernhard, J; Aldridge, J; Butow, P N; Zoller, P; Brown, R; Smith, A; Juraskova, I

2013-02-01

The purpose was to investigate patient-doctor agreement on clinical trial discussion cross-culturally. In the International Breast Cancer Study Group Trial 33-03 on shared decision-making for early breast cancer in Australian/New Zealand (ANZ) and Swiss/German/Austrian (SGA) centers, doctor and patient characteristics plus doctor stress and burnout were assessed. Within 2 weeks post-consultation about treatment options, the doctor and patient reported independently, whether a trial was discussed. Odds ratios of agreement for covariables were estimated by generalized estimating equations for each language cohort, with doctor as a random effect. In ANZ, 21 doctors and 339 patients were eligible; in SGA, 41 doctors and 427 patients. In cases where the doctor indicated 'no trial discussed', 82% of both ANZ and SGA patients agreed; if the doctor indicated 'trial discussed', 50% of ANZ and 38% of SGA patients agreed, respectively. Factors associated with higher agreement were: low tumor grade and fewer patients recruited into clinical trials in SGA; public institution, patient born in ANZ (versus other), higher doctor depersonalization and personal accomplishment in ANZ. There is discordance between oncologists and their patients regarding clinical trial discussion, particularly when the doctor indicates that a trial was discussed. Factors contributing to this agreement vary by culture.

DOE Office of Scientific and Technical Information (OSTI.GOV)

De La Pierre, Marco, E-mail: cedric.carteret@univ-lorraine.fr, E-mail: marco.delapierre@unito.it; Maschio, Lorenzo; Orlando, Roberto

Powder and single crystal Raman spectra of the two most common phases of calcium carbonate are calculated with ab initio techniques (using a “hybrid” functional and a Gaussian-type basis set) and measured both at 80 K and room temperature. Frequencies of the Raman modes are in very good agreement between calculations and experiments: the mean absolute deviation at 80 K is 4 and 8 cm{sup −1} for calcite and aragonite, respectively. As regards intensities, the agreement is in general good, although the computed values overestimate the measured ones in many cases. The combined analysis permits to identify almost all themore » fundamental experimental Raman peaks of the two compounds, with the exception of either modes with zero computed intensity or modes overlapping with more intense peaks. Additional peaks have been identified in both calcite and aragonite, which have been assigned to {sup 18}O satellite modes or overtones. The agreement between the computed and measured spectra is quite satisfactory; in particular, simulation permits to clearly distinguish between calcite and aragonite in the case of powder spectra, and among different polarization directions of each compound in the case of single crystal spectra.« less

A Randomized Study Comparing Digital Imaging to Traditional Glass Slide Microscopy for Breast Biopsy and Cancer Diagnosis

PubMed Central

Elmore, Joann G.; Longton, Gary M.; Pepe, Margaret S.; Carney, Patricia A.; Nelson, Heidi D.; Allison, Kimberly H.; Geller, Berta M.; Onega, Tracy; Tosteson, Anna N. A.; Mercan, Ezgi; Shapiro, Linda G.; Brunyé, Tad T.; Morgan, Thomas R.; Weaver, Donald L.

2017-01-01

Background: Digital whole slide imaging may be useful for obtaining second opinions and is used in many countries. However, the U.S. Food and Drug Administration requires verification studies. Methods: Pathologists were randomized to interpret one of four sets of breast biopsy cases during two phases, separated by ≥9 months, using glass slides or digital format (sixty cases per set, one slide per case, n = 240 cases). Accuracy was assessed by comparing interpretations to a consensus reference standard. Intraobserver reproducibility was assessed by comparing the agreement of interpretations on the same cases between two phases. Estimated probabilities of confirmation by a reference panel (i.e., predictive values) were obtained by incorporating data on the population prevalence of diagnoses. Results: Sixty-five percent of responding pathologists were eligible, and 252 consented to randomization; 208 completed Phase I (115 glass, 93 digital); and 172 completed Phase II (86 glass, 86 digital). Accuracy was slightly higher using glass compared to digital format and varied by category: invasive carcinoma, 96% versus 93% (P = 0.04); ductal carcinoma in situ (DCIS), 84% versus 79% (P < 0.01); atypia, 48% versus 43% (P = 0.08); and benign without atypia, 87% versus 82% (P < 0.01). There was a small decrease in intraobserver agreement when the format changed compared to when glass slides were used in both phases (P = 0.08). Predictive values for confirmation by a reference panel using glass versus digital were: invasive carcinoma, 98% and 97% (not significant [NS]); DCIS, 70% and 57% (P = 0.007); atypia, 38% and 28% (P = 0.002); and benign without atypia, 97% and 96% (NS). Conclusions: In this large randomized study, digital format interpretations were similar to glass slide interpretations of benign and invasive cancer cases. However, cases in the middle of the spectrum, where more inherent variability exists, may be more problematic in digital format. Future studies evaluating the effect these findings exert on clinical practice and patient outcomes are required. PMID:28382226

Custody Evaluators' Beliefs about Domestic Violence Allegations during Divorce: Feminist and Family Violence Perspectives

ERIC Educational Resources Information Center

Haselschwerdt, Megan L.; Hardesty, Jennifer L.; Hans, Jason D.

2011-01-01

Approximately, 20% of divorcing couples in the United States require judicial intervention to reach a custody agreement. In such cases, courts often call on child custody evaluators to conduct comprehensive evaluations and recommend custody agreements and services that meet children's best interests. Estimates suggest that allegations of domestic…

42 CFR 476.80 - Coordination with Medicare fiscal intermediaries and carriers.

Code of Federal Regulations, 2011 CFR

2011-10-01

... fiscal intermediary or carrier must negotiate in good faith in an effort to reach written agreement. If they cannot reach agreement, CMS will assist them in resolving matters in dispute. (2) The QIO must... denials with respect to cases subject to preadmission review, and outlier claims in hospitals under a...

Propagation, cascades, and agreement dynamics in complex communication and social networks

NASA Astrophysics Data System (ADS)

Lu, Qiming

Many modern and important technological, social, information and infrastructure systems can be viewed as complex systems with a large number of interacting components. Models of complex networks and dynamical interactions, as well as their applications are of fundamental interests in many aspects. Here, several stylized models of multiplex propagation and opinion dynamics are investigated on complex and empirical social networks. We first investigate cascade dynamics in threshold-controlled (multiplex) propagation on random geometric networks. We find that such local dynamics can serve as an efficient, robust, and reliable prototypical activation protocol in sensor networks in responding to various alarm scenarios. We also consider the same dynamics on a modified network by adding a few long-range communication links, resulting in a small-world network. We find that such construction can further enhance and optimize the speed of the network's response, while keeping energy consumption at a manageable level. We also investigate a prototypical agent-based model, the Naming Game, on two-dimensional random geometric networks. The Naming Game [A. Baronchelli et al., J. Stat. Mech.: Theory Exp. (2006) P06014.] is a minimal model, employing local communications that captures the emergence of shared communication schemes (languages) in a population of autonomous semiotic agents. Implementing the Naming Games with local broadcasts on random geometric graphs, serves as a model for agreement dynamics in large-scale, autonomously operating wireless sensor networks. Further, it captures essential features of the scaling properties of the agreement process for spatially-embedded autonomous agents. Among the relevant observables capturing the temporal properties of the agreement process, we investigate the cluster-size distribution and the distribution of the agreement times, both exhibiting dynamic scaling. We also present results for the case when a small density of long-range communication links are added on top of the random geometric graph, resulting in a "small-world"-like network and yielding a significantly reduced time to reach global agreement. We construct a finite-size scaling analysis for the agreement times in this case. When applying the model of Naming Game on empirical social networks, this stylized agent-based model captures essential features of agreement dynamics in a network of autonomous agents, corresponding to the development of shared classification schemes in a network of artificial agents or opinion spreading and social dynamics in social networks. Our study focuses on the impact that communities in the underlying social graphs have on the outcome of the agreement process. We find that networks with strong community structure hinder the system from reaching global agreement; the evolution of the Naming Game in these networks maintains clusters of coexisting opinions indefinitely. Further, we investigate agent-based network strategies to facilitate convergence to global consensus.

Reliability of classification for post-traumatic ankle osteoarthritis.

PubMed

Claessen, Femke M A P; Meijer, Diederik T; van den Bekerom, Michel P J; Gevers Deynoot, Barend D J; Mallee, Wouter H; Doornberg, Job N; van Dijk, C Niek

2016-04-01

The purpose of this study was to identify the most reliable classification system for clinical outcome studies to categorize post-traumatic-fracture-osteoarthritis. A total of 118 orthopaedic surgeons and residents-gathered in the Ankle Platform Study Collaborative Science of Variation Group-evaluated 128 anteroposterior and lateral radiographs of patients after a bi- or trimalleolar ankle fracture on a Web-based platform in order to rate post-traumatic osteoarthritis according to the classification systems coined by (1) van Dijk, (2) Kellgren, and (3) Takakura. Reliability was evaluated with the use of the Siegel and Castellan's multirater kappa measure. Differences between classification systems were compared using the two-sample Z-test. Interobserver agreement of surgeons who participated in the survey was fair for the van Dijk osteoarthritis scale (k = 0.24), and poor for the Takakura (k = 0.19) and the Kellgren systems (k = 0.18) according to the categorical rating of Landis and Koch. This difference in one categorical rating was found to be significant (p < 0.001, CI 0.046-0.053) with the high numbers of observers and cases available. This study documents fair interobserver agreement for the van Dijk osteoarthritis scale, and poor interobserver agreement for the Takakura and Kellgren osteoarthritis classification systems. Because of the low interobserver agreement for the van Dijk, Kellgren, and Takakura classification systems, those systems cannot be used for clinical decision-making. Development of diagnostic criteria on basis of consecutive patients, Level II.

A Study in Child Care (Case Study from Volume II-A): "A Rolls-Royce of Day Care." Day Care Programs Reprint Series.

ERIC Educational Resources Information Center

O'Farrell, Brigid

The Amalgamated Day Care Center is an independent trust established through a collective bargaining agreement between the Amalgamated Clothing Workers of America, AFL-CIO, and the employers of the garment industry. The free center, open from 6:00 a.m. to 6:00 p.m., is located near the Chicago garment industries to minimize transportation problems…

Quality assurance study of caries risk assessment performance by clinical faculty members in a school of dentistry.

PubMed

Rechmann, Peter; Featherstone, John D B

2014-09-01

The goal of this quality assurance study was to explore the decision making of clinical faculty members at the University of California, San Francisco School of Dentistry predoctoral dental clinic in terms of caries risk level assignment using the caries risk assessment (CRA) as part of the Caries Management by Risk Assessment (CAMBRA) concept. This research was done in part to determine if additional training and calibration were needed for these faculty members. The study tested the reliability and reproducibility of the caries risk levels assigned by different clinical teachers who completed CRA forms for simulated patients. In the first step, five clinical teachers assigned caries risk levels for thirteen simulated patients. Six months later, the same five plus an additional nine faculty members assigned caries risk levels to the same thirteen simulated and nine additional cases. While the intra-examiner reliability with weighted kappa strength of agreement was very high, the inter-examiner agreements with a gold standard were on average only moderate. In total, 20 percent of the presented high caries risk cases were underestimated at caries levels too low, even when obvious caries disease indicators were present. This study suggests that more consistent training and calibration of clinical faculty members as well as students are needed.

Valley splitting of single-electron Si MOS quantum dots

DOE PAGES

Gamble, John King; Harvey-Collard, Patrick; Jacobson, N. Tobias; ...

2016-12-19

Here, silicon-based metal-oxide-semiconductor quantum dots are prominent candidates for high-fidelity, manufacturable qubits. Due to silicon's band structure, additional low-energy states persist in these devices, presenting both challenges and opportunities. Although the physics governing these valley states has been the subject of intense study, quantitative agreement between experiment and theory remains elusive. Here, we present data from an experiment probing the valley states of quantum dot devices and develop a theory that is in quantitative agreement with both this and a recently reported experiment. Through sampling millions of realistic cases of interface roughness, our method provides evidence that the valley physicsmore » between the two samples is essentially the same.« less

A Numerical Simulation of a Normal Sonic Jet into a Hypersonic Cross-Flow

NASA Technical Reports Server (NTRS)

Jeffries, Damon K.; Krishnamurthy, Ramesh; Chandra, Suresh

1997-01-01

This study involves numerical modeling of a normal sonic jet injection into a hypersonic cross-flow. The numerical code used for simulation is GASP (General Aerodynamic Simulation Program.) First the numerical predictions are compared with well established solutions for compressible laminar flow. Then comparisons are made with non-injection test case measurements of surface pressure distributions. Good agreement with the measurements is observed. Currently comparisons are underway with the injection case. All the experimental data were generated at the Southampton University Light Piston Isentropic Compression Tube.

Satellite Orbit Under Influence of a Drag - Analytical Approach

NASA Astrophysics Data System (ADS)

Martinović, M. M.; Šegan, S. D.

2017-12-01

The report studies some changes in orbital elements of the artificial satellites of Earth under influence of atmospheric drag. In order to develop possibilities of applying the results in many future cases, an analytical interpretation of the orbital element perturbations is given via useful, but very long expressions. The development is based on the TD88 air density model, recently upgraded with some additional terms. Some expressions and formulae were developed by the computer algebra system Mathematica and tested in some hypothetical cases. The results have good agreement with iterative (numerical) approach.

5 CFR 1820.2 - Requirements for making FOIA requests.

Code of Federal Regulations, 2011 CFR

2011-01-01

..., such as the date, title or name, author, recipient, and subject matter. (c) Agreement to pay fees... records about an OSC case file, the case file number, name, and type (for example, prohibited personnel...

5 CFR 1820.2 - Requirements for making FOIA requests.

Code of Federal Regulations, 2010 CFR

2010-01-01

..., such as the date, title or name, author, recipient, and subject matter. (c) Agreement to pay fees... records about an OSC case file, the case file number, name, and type (for example, prohibited personnel...

The North American Free Trade Agreement (NAFTA) and Mexican Nursing

PubMed Central

2011-01-01

In the context of nurse migration, experts view trade agreements as either vehicles for facilitating migration or as contributing to brain-drain phenomena. Using a case study design, this study explored the effects of the North American Free Trade Agreement (NAFTA) on the development of Mexican nursing. Drawing results from a general thematic analysis of 48 interviews with Mexican nurses and 410 primary and secondary sources, findings show that NAFTA changed the relationship between the State and Mexican nursing. The changed relationship improved the infrastructure capable of producing and monitoring nursing human resources in Mexico. It did not lead to the mass migration of Mexican nurses to the United States and Canada. At the same time, the economic instability provoked by the peso crisis of 1995 slowed the implementation of planned advances. Subsequent neoliberal reforms decreased nurses’ security as workers by minimizing access to full-time positions with benefits, and decreased wages. This article discusses the linkages of these events and the effects on Mexican nurses and the development of the profession. The findings have implications for nursing human resources policy-making and trade in services. PMID:20595330

The North American Free Trade Agreement (NAFTA) and Mexican nursing.

PubMed

Squires, Allison

2011-03-01

In the context of nurse migration, experts view trade agreements as either vehicles for facilitating migration or as contributing to brain-drain phenomena. Using a case study design, this study explored the effects of the North American Free Trade Agreement (NAFTA) on the development of Mexican nursing. Drawing results from a general thematic analysis of 48 interviews with Mexican nurses and 410 primary and secondary sources, findings show that NAFTA changed the relationship between the State and Mexican nursing. The changed relationship improved the infrastructure capable of producing and monitoring nursing human resources in Mexico. It did not lead to the mass migration of Mexican nurses to the United States and Canada. At the same time, the economic instability provoked by the peso crisis of 1995 slowed the implementation of planned advances. Subsequent neoliberal reforms decreased nurses' security as workers by minimizing access to full-time positions with benefits, and decreased wages. This article discusses the linkages of these events and the effects on Mexican nurses and the development of the profession. The findings have implications for nursing human resources policy-making and trade in services.

Agreement between photographic screening and hospital biomicroscopy grading of diabetic retinopathy and maculopathy.

PubMed

Healy, Rachel; Sallam, Ahmed; Jones, Vanessa; Donachie, Paul H J; Scanlon, Peter H; Stratton, Irene M; Johnston, Robert L

2014-01-01

To examine the level of agreement and reasons for disagreement between grading of diabetic retinopathy and maculopathy using mydriatic digital photographs in a diabetic retinopathy screening service (DRSS) and hospital eye service (HES). English NHS Diabetic Eye Screening Programme grades for diabetic retinopathy prospectively recorded on a hospital electronic medical record were compared to the grades from the DRSS event that prompted referral. In cases of disagreement, images were reviewed. Data for 1,501 patients (3,002 eyes) referred between 2008 and 2011 were analyzed. The HES retinopathy grades were R0 (no retinopathy) in 341 eyes, R1 (background retinopathy) in 1,712 eyes, R2 (pre-proliferative retinopathy) in 821 eyes, and R3 (proliferative retinopathy) in 128 eyes. The DRSS grades were in agreement in 2,309 eyes (76.9%), recorded a lower grade in 227 eyes, and recorded a higher grade in 466 eyes. Agreement was substantial (κ = 0.65). The commonest cause for disagreement was overgrading of R1 as R2 by hospital clinicians. The HES maculopathy grades were M0 (no maculopathy) in 2,267 eyes and M1 (maculopathy) in 735 eyes. The DRSS were in agreement in 2,111 eyes (70.2%), recorded a lower grade in 106 eyes, and recorded a higher grade in 785 eyes. Agreement was fair (κ = 0.39). The commonest cause for disagreement was hospital clinicians missing fine exudates. This study establishes a benchmark standard for agreement between HES and DRSS grading. Review of DRSS and grading reports images for newly referred patients is likely to improve levels of agreement, particularly for diabetic retinopathy, and should be strongly encouraged.

Digital image analysis of Ki67 proliferation index in breast cancer using virtual dual staining on whole tissue sections: clinical validation and inter-platform agreement.

PubMed

Koopman, Timco; Buikema, Henk J; Hollema, Harry; de Bock, Geertruida H; van der Vegt, Bert

2018-05-01

The Ki67 proliferation index is a prognostic and predictive marker in breast cancer. Manual scoring is prone to inter- and intra-observer variability. The aims of this study were to clinically validate digital image analysis (DIA) of Ki67 using virtual dual staining (VDS) on whole tissue sections and to assess inter-platform agreement between two independent DIA platforms. Serial whole tissue sections of 154 consecutive invasive breast carcinomas were stained for Ki67 and cytokeratin 8/18 with immunohistochemistry in a clinical setting. Ki67 proliferation index was determined using two independent DIA platforms, implementing VDS to identify tumor tissue. Manual Ki67 score was determined using a standardized manual counting protocol. Inter-observer agreement between manual and DIA scores and inter-platform agreement between both DIA platforms were determined and calculated using Spearman's correlation coefficients. Correlations and agreement were assessed with scatterplots and Bland-Altman plots. Spearman's correlation coefficients were 0.94 (p < 0.001) for inter-observer agreement between manual counting and platform A, 0.93 (p < 0.001) between manual counting and platform B, and 0.96 (p < 0.001) for inter-platform agreement. Scatterplots and Bland-Altman plots revealed no skewness within specific data ranges. In the few cases with ≥ 10% difference between manual counting and DIA, results by both platforms were similar. DIA using VDS is an accurate method to determine the Ki67 proliferation index in breast cancer, as an alternative to manual scoring of whole sections in clinical practice. Inter-platform agreement between two different DIA platforms was excellent, suggesting vendor-independent clinical implementability.

Searching for the hospital yardstick: a case study of private hospital productivity bargaining.

PubMed

Timo, N

1997-01-01

The decentralisation of Australia's centralised wage fixation system has been seen as providing opportunities for employers and trade unions to tailor working arrangements to suit the needs of the workplace and to provide better paid long-term jobs. This paper details the productivity bargaining between the Private Hospitals' Association of Queensland and The Australian Workers' Union in 1995-97 in Queensland that led to the introduction of a number of productivity-based enterprise agreements. The case study shows that productivity bargaining in the private hospitals studied remains focused on 'bottom line' issues where cashable savings can readily be generated. The paper concludes with an examination of the lessons drawn from the productivity bargaining process.

Using Google Blogs and Discussions to Recommend Biomedical Resources: A Case Study

PubMed Central

Reed, Robyn B.; Chattopadhyay, Ansuman; Iwema, Carrie L.

2013-01-01

This case study investigated whether data gathered from discussions within the social media provide a reliable basis for a biomedical resources recommendation system. Using a search query to mine text from Google Blogs and Discussions, a ranking of biomedical resources was determined based on those most frequently mentioned. To establish quality, these results were compared to rankings by subject experts. An overall agreement between the frequency of social media discussions and subject expert recommendations was observed when identifying key bioinformatics and consumer health resources. Testing the method in more than one biomedical area implies this procedure could be employed across different subjects. PMID:24180648

Relative properties of smooth terminating bands

NASA Astrophysics Data System (ADS)

Afanasjev, A. V.; Ragnarsson, I.

1998-01-01

The relative properties of smooth terminating bands observed in the A ∼ 110 mass region are studied within the effective alignment approach. Theoretical values of ietf are calculated using the configuration-dependent shell-correction model with the cranked Nilsson potential. Reasonable agreement with experiment shows that previous interpretations of these bands are consistent with the present study. Contrary to the case of superdeformed bands, the effective alignments of these bands deviate significantly from the pure single-particle alignments of the corresponding orbitals. This indicates that in the case of smooth terminating bands, the effects associated with changes in equilibrium deformations contribute significantly to the effective alignment.

Reversible island nucleation and growth with anomalous diffusion

NASA Astrophysics Data System (ADS)

Sabbar, Ehsan H.; Amar, Jacques G.

2017-10-01

Motivated by recent experiments on submonolayer organic film growth with anomalous diffusion, a general rate-equation (RE) theory of submonolayer island nucleation and growth was developed (Amar and Semaan, 2016) [23], which takes into account the critical island-size i, island fractal dimension df, substrate dimension d, and diffusion exponent μ, and good agreement with simulations was found for the case of irreversible growth corresponding to a critical island-size i = 1 with d = 2 . However, since many experiments correspond to a critical island-size larger than 1, it is of interest to determine if the RE predictions also hold in the case of reversible island nucleation with anomalous diffusion. Here we present the results of simulations of submonolayer growth with i = 2 (d = 2) which were carried out for both the case of superdiffusion (μ > 1) and subdiffusion (μ < 1) as well as for both ramified islands (df ≃ 2) and point-islands (df = ∞) . In the case of superdiffusion, corresponding to 'hot' freshly deposited monomers, excellent agreement is obtained with the predictions of the generalized RE theory for the exponents χ(μ) and χ1(μ) which describe the dependence of the island and monomer densities at fixed coverage on deposition rate F. In addition, the exponents do not depend on whether or not monomers remain superdiffusive or are thermalized (e.g. undergo regular diffusion) after detaching from a dimer. However, we also find that, as was previously found in the case of irreversible growth, the exponent χ only approaches its asymptotic value logarithmically with increasing 1/F. This result has important implications for the interpretation of experiments. Good agreement with the RE theory is also found in the case of subdiffusion for point-islands. However, in the case of ramified islands with subdiffusion and i = 2 , the exponents are significantly higher than predicted due to the fact that monomer capture dominates in the nucleation regime. A modified RE theory which takes this into account is presented, and excellent agreement is found with our simulations.

Electrophysiology of subject-verb agreement mediated by speakers' gender.

PubMed

Hanulíková, Adriana; Carreiras, Manuel

2015-01-01

An important property of speech is that it explicitly conveys features of a speaker's identity such as age or gender. This event-related potential (ERP) study examined the effects of social information provided by a speaker's gender, i.e., the conceptual representation of gender, on subject-verb agreement. Despite numerous studies on agreement, little is known about syntactic computations generated by speaker characteristics extracted from the acoustic signal. Slovak is well suited to investigate this issue because it is a morphologically rich language in which agreement involves features for number, case, and gender. Grammaticality of a sentence can be evaluated by checking a speaker's gender as conveyed by his/her voice. We examined how conceptual information about speaker gender, which is not syntactic but rather social and pragmatic in nature, is interpreted for the computation of agreement patterns. ERP responses to verbs disagreeing with the speaker's gender (e.g., a sentence including a masculine verbal inflection spoken by a female person 'the neighbors were upset because I (∗)stoleMASC plums') elicited a larger early posterior negativity compared to correct sentences. When the agreement was purely syntactic and did not depend on the speaker's gender, a disagreement between a formally marked subject and the verb inflection (e.g., the womanFEM (∗)stoleMASC plums) resulted in a larger P600 preceded by a larger anterior negativity compared to the control sentences. This result is in line with proposals according to which the recruitment of non-syntactic information such as the gender of the speaker results in N400-like effects, while formally marked syntactic features lead to structural integration as reflected in a LAN/P600 complex.

Electrophysiology of subject-verb agreement mediated by speakers’ gender

PubMed Central

Hanulíková, Adriana; Carreiras, Manuel

2015-01-01

An important property of speech is that it explicitly conveys features of a speaker’s identity such as age or gender. This event-related potential (ERP) study examined the effects of social information provided by a speaker’s gender, i.e., the conceptual representation of gender, on subject–verb agreement. Despite numerous studies on agreement, little is known about syntactic computations generated by speaker characteristics extracted from the acoustic signal. Slovak is well suited to investigate this issue because it is a morphologically rich language in which agreement involves features for number, case, and gender. Grammaticality of a sentence can be evaluated by checking a speaker’s gender as conveyed by his/her voice. We examined how conceptual information about speaker gender, which is not syntactic but rather social and pragmatic in nature, is interpreted for the computation of agreement patterns. ERP responses to verbs disagreeing with the speaker’s gender (e.g., a sentence including a masculine verbal inflection spoken by a female person ‘the neighbors were upset because I ∗stoleMASC plums’) elicited a larger early posterior negativity compared to correct sentences. When the agreement was purely syntactic and did not depend on the speaker’s gender, a disagreement between a formally marked subject and the verb inflection (e.g., the womanFEM ∗stoleMASC plums) resulted in a larger P600 preceded by a larger anterior negativity compared to the control sentences. This result is in line with proposals according to which the recruitment of non-syntactic information such as the gender of the speaker results in N400-like effects, while formally marked syntactic features lead to structural integration as reflected in a LAN/P600 complex. PMID:26441771

Poster - Thur Eve - 45: Commissioning of the Varian ECLIPSE eMC algorithm for clinical electron treatment planning.

PubMed

Serban, M; Ruo, R; Sarfehnia, A; Parker, W; Evans, M

2012-07-01

Fast electron Monte Carlo systems have been developed commercially, and implemented for clinical practice in radiation therapy clinics. In this work the Varian eMC (electron Monte Carlo) algorithm was commissioned for clinical electron beams of energies between 6 MeV and 20 MeV. Beam outputs, PDDs and profiles were measured for 29 regular and irregular cutouts using the IC-10 (Wellhöfer) ionization chamber. Detailed percentage depth dose comparisons showed that the agreement between measurement and eMC for different characteristic points on the PDD are generally less than 1 mm and always less than 2 mm, with the eMC calculated values being lower than the measured values. Of the 145 measured output factors, 19 cases fail a ±2% agreement but only 8 cases fail a ±3% agreement between calculation and measurement. Comparison of central axis dose distributions for two electron energies (9, and 20 MeV) for a 10 × 10 cm 2 field, centrally shielded with Pb of width 0 cm (open), 1, 2 and 3 cm, shows agreement to within 3% except near the surface. Comparison of central axis dose distributions for 9 MeV in heterogeneous phantoms including bone and lung inserts showed agreement of 1 mm and 3 mm respectively with measured TLD data. The overall agreement between measurement and eMC calculation has enabled us to begin implementing this calculation model for clinical use. © 2012 American Association of Physicists in Medicine.

Listening panel agreement and characteristics of lung sounds digitally recorded from children aged 1–59 months enrolled in the Pneumonia Etiology Research for Child Health (PERCH) case–control study

PubMed Central

Park, Daniel E; Watson, Nora L; Buck, W Chris; Bunthi, Charatdao; Devendra, Akash; Ebruke, Bernard E; Elhilali, Mounya; Emmanouilidou, Dimitra; Garcia-Prats, Anthony J; Githinji, Leah; Hossain, Lokman; Madhi, Shabir A; Moore, David P; Mulindwa, Justin; Olson, Dan; Awori, Juliet O; Vandepitte, Warunee P; Verwey, Charl; West, James E; Knoll, Maria D; O'Brien, Katherine L; Feikin, Daniel R; Hammit, Laura L

2017-01-01

Introduction Paediatric lung sound recordings can be systematically assessed, but methodological feasibility and validity is unknown, especially from developing countries. We examined the performance of acoustically interpreting recorded paediatric lung sounds and compared sound characteristics between cases and controls. Methods Pneumonia Etiology Research for Child Health staff in six African and Asian sites recorded lung sounds with a digital stethoscope in cases and controls. Cases aged 1–59 months had WHO severe or very severe pneumonia; age-matched community controls did not. A listening panel assigned examination results of normal, crackle, wheeze, crackle and wheeze or uninterpretable, with adjudication of discordant interpretations. Classifications were recategorised into any crackle, any wheeze or abnormal (any crackle or wheeze) and primary listener agreement (first two listeners) was analysed among interpretable examinations using the prevalence-adjusted, bias-adjusted kappa (PABAK). We examined predictors of disagreement with logistic regression and compared case and control lung sounds with descriptive statistics. Results Primary listeners considered 89.5% of 792 case and 92.4% of 301 control recordings interpretable. Among interpretable recordings, listeners agreed on the presence or absence of any abnormality in 74.9% (PABAK 0.50) of cases and 69.8% (PABAK 0.40) of controls, presence/absence of crackles in 70.6% (PABAK 0.41) of cases and 82.4% (PABAK 0.65) of controls and presence/absence of wheeze in 72.6% (PABAK 0.45) of cases and 73.8% (PABAK 0.48) of controls. Controls, tachypnoea, >3 uninterpretable chest positions, crying, upper airway noises and study site predicted listener disagreement. Among all interpretable examinations, 38.0% of cases and 84.9% of controls were normal (p<0.0001); wheezing was the most common sound (49.9%) in cases. Conclusions Listening panel and case–control data suggests our methodology is feasible, likely valid and that small airway inflammation is common in WHO pneumonia. Digital auscultation may be an important future pneumonia diagnostic in developing countries. PMID:28883927

International Spine Radiosurgery Consortium Consensus Guidelines for Target Volume Definition in Spinal Stereotactic Radiosurgery

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cox, Brett W., E-mail: coxb@mskcc.org; Spratt, Daniel E.; Lovelock, Michael

2012-08-01

Purpose: Spinal stereotactic radiosurgery (SRS) is increasingly used to manage spinal metastases. However, target volume definition varies considerably and no consensus target volume guidelines exist. This study proposes consensus target volume definitions using common scenarios in metastatic spine radiosurgery. Methods and Materials: Seven radiation oncologists and 3 neurological surgeons with spinal radiosurgery expertise independently contoured target and critical normal structures for 10 cases representing common scenarios in metastatic spine radiosurgery. Each set of volumes was imported into the Computational Environment for Radiotherapy Research. Quantitative analysis was performed using an expectation maximization algorithm for Simultaneous Truth and Performance Level Estimation (STAPLE)more » with kappa statistics calculating agreement between physicians. Optimized confidence level consensus contours were identified using histogram agreement analysis and characterized to create target volume definition guidelines. Results: Mean STAPLE agreement sensitivity and specificity was 0.76 (range, 0.67-0.84) and 0.97 (range, 0.94-0.99), respectively, for gross tumor volume (GTV) and 0.79 (range, 0.66-0.91) and 0.96 (range, 0.92-0.98), respectively, for clinical target volume (CTV). Mean kappa agreement was 0.65 (range, 0.54-0.79) for GTV and 0.64 (range, 0.54-0.82) for CTV (P<.01 for GTV and CTV in all cases). STAPLE histogram agreement analysis identified optimal consensus contours (80% confidence limit). Consensus recommendations include that the CTV should include abnormal marrow signal suspicious for microscopic invasion and an adjacent normal bony expansion to account for subclinical tumor spread in the marrow space. No epidural CTV expansion is recommended without epidural disease, and circumferential CTVs encircling the cord should be used only when the vertebral body, bilateral pedicles/lamina, and spinous process are all involved or there is extensive metastatic disease along the circumference of the epidural space. Conclusions: This report provides consensus guidelines for target volume definition for spinal metastases receiving upfront SRS in common clinical situations.« less

32 CFR 37.705 - What standards do I include for purchasing systems of for-profit firms?

Code of Federal Regulations, 2011 CFR

2011-07-01

... SECRETARY OF DEFENSE DoD GRANT AND AGREEMENT REGULATIONS TECHNOLOGY INVESTMENT AGREEMENTS Award Terms... programmatic or business reasons to do otherwise (in which case you must document the reasons in the award file... orders or Governmentwide regulations (see appendix E to this part for a list of those requirements). (c...

The Use of Tense and Agreement by Hungarian-Speaking Children with Language Impairment

ERIC Educational Resources Information Center

Lukacs, Agnes; Leonard, Laurence B.; Kas, Bence; Pleh, Csaba

2009-01-01

Purpose: Hungarian is a null-subject language with both agglutinating and fusional elements in its verb inflection system, and agreement between the verb and object as well as between the verb and subject. These characteristics make this language a good test case for alternative accounts of the grammatical deficits of children with language…

76 FR 56455 - DaVita, Inc.; Analysis of Agreement Containing Consent Orders To Aid Public Comment

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-13

... agreement package can be obtained from the FTC Home Page (for September 2, 2011), on the World Wide Web, at... to ongoing dialysis treatments. The relevant geographic markets for the provision of dialysis... case in many of the geographic markets identified in the Commission's complaint. Each of the geographic...

Comparative Assessment of a Self-sampling Device and Gynecologist Sampling for Cytology and HPV DNA Detection in a Rural and Low Resource Setting: Malaysian Experience.

PubMed

Latiff, Latiffah A; Ibrahim, Zaidah; Pei, Chong Pei; Rahman, Sabariah Abdul; Akhtari-Zavare, Mehrnoosh

2015-01-01

This study was conducted to assess the agreement and differences between cervical self-sampling with a Kato device (KSSD) and gynecologist sampling for Pap cytology and human papillomavirus DNA (HPV DNA) detection. Women underwent self-sampling followed by gynecologist sampling during screening at two primary health clinics. Pap cytology of cervical specimens was evaluated for specimen adequacy, presence of endocervical cells or transformation zone cells and cytological interpretation for cells abnormalities. Cervical specimens were also extracted and tested for HPV DNA detection. Positive HPV smears underwent gene sequencing and HPV genotyping by referring to the online NCBI gene bank. Results were compared between samplings by Kappa agreement and McNemar test. For Pap specimen adequacy, KSSD showed 100% agreement with gynecologist sampling but had only 32.3% agreement for presence of endocervical cells. Both sampling showed 100% agreement with only 1 case detected HSIL favouring CIN2 for cytology result. HPV DNA detection showed 86.2%agreement (K=0.64, 95% CI 0.524-0.756, p=0.001) between samplings. KSSD and gynaecologist sampling identified high risk HPV in 17.3% and 23.9% respectively (p= 0.014). The self-sampling using Kato device can serve as a tool in Pap cytology and HPV DNA detection in low resource settings in Malaysia. Self-sampling devices such as KSSD can be used as an alternative technique to gynaecologist sampling for cervical cancer screening among rural populations in Malaysia.

Agreement between the caudal fold test and serological tests for the detection of Mycobacterium bovis infection in bison.

PubMed

Chapinal, Núria; Elkin, Brett T; Joly, Damien O; Schumaker, Brant A; Stephen, Craig

2012-08-01

The objective of this study was to estimate agreement between the caudal fold test (CFT) and different serological tests for the detection of Mycobacterium bovis infection in bison by using prevalence-adjusted bias-adjusted kappa (PABAK). A total of 212 of wild wood bison from Wood Buffalo National Park were tested with the CFT as well as several serological tests: fluorescent polarization assay (FPA), multiantigen print immunoassay (MAPIA), rapid lateral-flow test (RT) and dual path platform test (DPP). For RT, 3 variations were conducted using 30μl of serum (RT 30), 20μl of serum (RT 20) and 20μl of serum considering only a strong reaction as positive (RT 20 ST). The McNemar's χ(2) test was conducted to assess whether the proportion of positive test results to 2 different tests differed. Two measures of agreement between pair of tests were estimated: the Cohen's kappa statistic and PABAK. The apparent prevalence of tuberculosis in the sampled animals varied depending on the diagnostic test from 6.1% (FPA and DPP) to 47.2% (CFT). The prevalence estimated by CFT differed from the prevalence estimated by the other tests, whereas the prevalence estimated by FPA, MAPIA, RT 20 ST and DPP were not significantly different. The kappa and PABAK estimates calculated between CFT and the rest of the tests suggested poor to slight agreement between tests (k and PABAK<0.25 in all cases). The PABAK estimates for the pairwise combinations among serological tests were numerically greater than the kappa estimates (and significantly greater when FPA was compared to the rest of serological tests), and suggested substantial to almost perfect agreement (PABAK>0.75 in all cases). The disagreement between the skin and serological tests for the detection of M. bovis infection could be partly because the tests measure different immunological responses (cell-mediated vs. humoral) that are predominant at different stages of the infection, and partly due to inaccuracy of the tests. Further research is needed to evaluate the accuracy of diagnostic tests in order to establish a reliable case definition, combining different tests, to be used in the surveillance and control of tuberculosis in free-ranging bison populations. Copyright © 2012 Elsevier B.V. All rights reserved.

Self-report versus direct measurement for assessment of fluid intake during a 70.3-mile triathlon.

PubMed

Wilson, Patrick B; Rhodes, Gregory S; Ingraham, Stacy J

2015-07-01

Self-report (SR) has been the primary method used to assess fluid intake during endurance events, but unfortunately, little is known about the validity of SR. The purpose of this study was to compare SR fluid intake with direct measurement (DM) during a 70.3-mile triathlon. Fifty-three (42 men, 11 women) individuals competing in a 70.3-mile triathlon participated in the study. On the 13.1-mile-run section of the triathlon, 11 research stations provided fluid in bottles filled with 163 mL of water or carbohydrate-electrolyte beverage (CEB). Participants submitted bottles 25 m past aid stations to be reweighed postrace. Participants also answered questions regarding fluid intake postrace. Bland-Altman plots and 95% limits of agreement were used to assess precision of the measures, while least-squares regression assessed linear agreement. SR intakes during the run ranged from 0-1793, 0-1837, and 0-2628 mL for water, CEB, and total fluid, with corresponding DM intakes of 0-1599, 0-1642, and 0-2250 mL. DM and SR showed strong linear agreement for water, CEB, and total fluid (R2=.71, .80, and .80). Mean differences between the measures on the Bland-Altman plots were small (13-41 mL), but relatively large differences (±500 mL) between the measures were apparent for some participants. SR is the predominant methodology used in field studies assessing hydration, despite little to no data confirming its validity. The results herein suggest that fluid-intake-assessment methodology should be chosen on a case-by-case basis and that caution should be used when interpreting data based on SR.

Standardized Interpretation of Chest Radiographs in Cases of Pediatric Pneumonia From the PERCH Study.

PubMed

Fancourt, Nicholas; Deloria Knoll, Maria; Barger-Kamate, Breanna; de Campo, John; de Campo, Margaret; Diallo, Mahamadou; Ebruke, Bernard E; Feikin, Daniel R; Gleeson, Fergus; Gong, Wenfeng; Hammitt, Laura L; Izadnegahdar, Rasa; Kruatrachue, Anchalee; Madhi, Shabir A; Manduku, Veronica; Matin, Fariha Bushra; Mahomed, Nasreen; Moore, David P; Mwenechanya, Musaku; Nahar, Kamrun; Oluwalana, Claire; Ominde, Micah Silaba; Prosperi, Christine; Sande, Joyce; Suntarattiwong, Piyarat; O'Brien, Katherine L

2017-06-15

Chest radiographs (CXRs) are a valuable diagnostic tool in epidemiologic studies of pneumonia. The World Health Organization (WHO) methodology for the interpretation of pediatric CXRs has not been evaluated beyond its intended application as an endpoint measure for bacterial vaccine trials. The Pneumonia Etiology Research for Child Health (PERCH) study enrolled children aged 1-59 months hospitalized with WHO-defined severe and very severe pneumonia from 7 low- and middle-income countries. An interpretation process categorized each CXR into 1 of 5 conclusions: consolidation, other infiltrate, both consolidation and other infiltrate, normal, or uninterpretable. Two members of a 14-person reading panel, who had undertaken training and standardization in CXR interpretation, interpreted each CXR. Two members of an arbitration panel provided additional independent reviews of CXRs with discordant interpretations at the primary reading, blinded to previous reports. Further discordance was resolved with consensus discussion. A total of 4172 CXRs were obtained from 4232 cases. Observed agreement for detecting consolidation (with or without other infiltrate) between primary readers was 78% (κ = 0.50) and between arbitrators was 84% (κ = 0.61); agreement for primary readers and arbitrators across 5 conclusion categories was 43.5% (κ = 0.25) and 48.5% (κ = 0.32), respectively. Disagreement was most frequent between conclusions of other infiltrate and normal for both the reading panel and the arbitration panel (32% and 30% of discordant CXRs, respectively). Agreement was similar to that of previous evaluations using the WHO methodology for detecting consolidation, but poor for other infiltrates despite attempts at a rigorous standardization process. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.

Assessment of Response to Lithium Maintenance Treatment in Bipolar Disorder: A Consortium on Lithium Genetics (ConLiGen) Report

PubMed Central

Manchia, Mirko; Adli, Mazda; Akula, Nirmala; Ardau, Raffaella; Aubry, Jean-Michel; Backlund, Lena; Banzato, Claudio EM.; Baune, Bernhard T.; Bellivier, Frank; Bengesser, Susanne; Biernacka, Joanna M.; Brichant-Petitjean, Clara; Bui, Elise; Calkin, Cynthia V.; Cheng, Andrew Tai Ann; Chillotti, Caterina; Cichon, Sven; Clark, Scott; Czerski, Piotr M.; Dantas, Clarissa; Zompo, Maria Del; DePaulo, J. Raymond; Detera-Wadleigh, Sevilla D.; Etain, Bruno; Falkai, Peter; Frisén, Louise; Frye, Mark A.; Fullerton, Jan; Gard, Sébastien; Garnham, Julie; Goes, Fernando S.; Grof, Paul; Gruber, Oliver; Hashimoto, Ryota; Hauser, Joanna; Heilbronner, Urs; Hoban, Rebecca; Hou, Liping; Jamain, Stéphane; Kahn, Jean-Pierre; Kassem, Layla; Kato, Tadafumi; Kelsoe, John R.; Kittel-Schneider, Sarah; Kliwicki, Sebastian; Kuo, Po-Hsiu; Kusumi, Ichiro; Laje, Gonzalo; Lavebratt, Catharina; Leboyer, Marion; Leckband, Susan G.; López Jaramillo, Carlos A.; Maj, Mario; Malafosse, Alain; Martinsson, Lina; Masui, Takuya; Mitchell, Philip B.; Mondimore, Frank; Monteleone, Palmiero; Nallet, Audrey; Neuner, Maria; Novák, Tomás; O’Donovan, Claire; Ösby, Urban; Ozaki, Norio; Perlis, Roy H.; Pfennig, Andrea; Potash, James B.; Reich-Erkelenz, Daniela; Reif, Andreas; Reininghaus, Eva; Richardson, Sara; Rouleau, Guy A.; Rybakowski, Janusz K.; Schalling, Martin; Schofield, Peter R.; Schubert, Oliver K.; Schweizer, Barbara; Seemüller, Florian; Grigoroiu-Serbanescu, Maria; Severino, Giovanni; Seymour, Lisa R.; Slaney, Claire; Smoller, Jordan W.; Squassina, Alessio; Stamm, Thomas; Steele, Jo; Stopkova, Pavla; Tighe, Sarah K.; Tortorella, Alfonso; Turecki, Gustavo; Wray, Naomi R.; Wright, Adam; Zandi, Peter P.; Zilles, David; Bauer, Michael; Rietschel, Marcella; McMahon, Francis J.

2013-01-01

Objective The assessment of response to lithium maintenance treatment in bipolar disorder (BD) is complicated by variable length of treatment, unpredictable clinical course, and often inconsistent compliance. Prospective and retrospective methods of assessment of lithium response have been proposed in the literature. In this study we report the key phenotypic measures of the “Retrospective Criteria of Long-Term Treatment Response in Research Subjects with Bipolar Disorder” scale currently used in the Consortium on Lithium Genetics (ConLiGen) study. Materials and Methods Twenty-nine ConLiGen sites took part in a two-stage case-vignette rating procedure to examine inter-rater agreement [Kappa (κ)] and reliability [intra-class correlation coefficient (ICC)] of lithium response. Annotated first-round vignettes and rating guidelines were circulated to expert research clinicians for training purposes between the two stages. Further, we analyzed the distributional properties of the treatment response scores available for 1,308 patients using mixture modeling. Results Substantial and moderate agreement was shown across sites in the first and second sets of vignettes (κ = 0.66 and κ = 0.54, respectively), without significant improvement from training. However, definition of response using the A score as a quantitative trait and selecting cases with B criteria of 4 or less showed an improvement between the two stages (ICC1 = 0.71 and ICC2 = 0.75, respectively). Mixture modeling of score distribution indicated three subpopulations (full responders, partial responders, non responders). Conclusions We identified two definitions of lithium response, one dichotomous and the other continuous, with moderate to substantial inter-rater agreement and reliability. Accurate phenotypic measurement of lithium response is crucial for the ongoing ConLiGen pharmacogenomic study. PMID:23840348

Telephone triage by nurses in primary care out-of-hours services in Norway: an evaluation study based on written case scenarios

PubMed Central

Hunskaar, Steinar

2011-01-01

Background The use of nurses for telephone-based triage in out-of-hours services is increasing in several countries. No investigations have been carried out in Norway into the quality of decisions made by nurses regarding our priority degree system. There are three levels: acute, urgent and non-urgent. Methods Nurses working in seven casualty clinics in out-of-hours districts in Norway (The Watchtowers) were all invited to participate in a study to assess priority grade on 20 written medical scenarios validated by an expert group. 83 nurses (response rate 76%) participated in the study. A one-out-of-five sample of the nurses assessed the same written cases after 3 months (n=18, response rate 90%) as a test–retest assessment. Results Among the acute, urgent and non-urgent scenarios, 82%, 74% and 81% were correctly classified according to national guidelines. There were significant differences in the proportion of correct classifications among the casualty clinics, but neither employment percentage nor profession or work experience affected the triage decision. The mean intraobserver variability measured by the Cohen kappa was 0.61 (CI 0.52 to 0.70), and there were significant differences in kappa with employment percentage. Casualty clinics and work experience did not affect intrarater agreement. Conclusion Correct classification of acute and non-urgent cases among nurses was quite high. Work experience and employment percentage did not affect triage decision. The intrarater agreement was good and about the same as in previous studies performed in other countries. Kappa increased significantly with increasing employment percentage. PMID:21262792

Telephone triage by nurses in primary care out-of-hours services in Norway: an evaluation study based on written case scenarios.

PubMed

Hansen, Elisabeth Holm; Hunskaar, Steinar

2011-05-01

The use of nurses for telephone-based triage in out-of-hours services is increasing in several countries. No investigations have been carried out in Norway into the quality of decisions made by nurses regarding our priority degree system. There are three levels: acute, urgent and non-urgent. Nurses working in seven casualty clinics in out-of-hours districts in Norway (The Watchtowers) were all invited to participate in a study to assess priority grade on 20 written medical scenarios validated by an expert group. 83 nurses (response rate 76%) participated in the study. A one-out-of-five sample of the nurses assessed the same written cases after 3 months (n = 18, response rate 90%) as a test-retest assessment. Among the acute, urgent and non-urgent scenarios, 82%, 74% and 81% were correctly classified according to national guidelines. There were significant differences in the proportion of correct classifications among the casualty clinics, but neither employment percentage nor profession or work experience affected the triage decision. The mean intraobserver variability measured by the Cohen kappa was 0.61 (CI 0.52 to 0.70), and there were significant differences in kappa with employment percentage. Casualty clinics and work experience did not affect intrarater agreement. Correct classification of acute and non-urgent cases among nurses was quite high. Work experience and employment percentage did not affect triage decision. The intrarater agreement was good and about the same as in previous studies performed in other countries. Kappa increased significantly with increasing employment percentage.

Computed tomography (CT) in the selection of treatment for root-filled maxillary molars with apical periodontitis

PubMed Central

Huumonen, Sisko; Molander, Anders; Öhman, Anders; Kvist, Thomas

2016-01-01

Objectives: The aims of this study were to evaluate whether the use of CT facilitates agreement among endodontists in selecting treatments for root-filled maxillary molars with apical periodontitis and to assess the efficacy of CT in choosing a treatment for such teeth. Methods: 39 root-filled maxillary molars from 34 patients with suspected apical periodontitis were independently evaluated by 4 endodontists and 1 postgraduate student (decision-makers). Treatment decisions were made based on intra-oral radiographs and a fictive clinical history. After 1–3 months, the same decision-makers repeated the examination of the same teeth but with additional information from a CT examination. Agreement between decision-makers with or without the availability of the CT results was measured with Cohen's kappa coefficient. Differences in selected treatments with or without accessibility to the CT results were plotted for the same endodontists using descriptive statistics. Results: The agreement in assessments among endodontists was slight or fair before the CT results were available (range: 0.081–0.535). No increase was observed after reviewing the CT results (range: 0.116–0.379). After the use of CT, the treatment plan was changed 38–76% of the time by all decision-makers, and the changes affected 57.8% of the cases in the study. Conclusions: The endodontists in this study exhibited a low degree of agreement when choosing a treatment for root-filled maxillary molars with apical periodontitis. A CT examination of the investigated teeth did not result in a significantly higher degree of agreement, and CT frequently contributed to a shift in the selected therapy. PMID:26985980

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gaffney, David K., E-mail: david.gaffney@hci.utah.edu; King, Bronwyn; Viswanathan, Akila N.

Purpose: The purpose of this study was to develop a radiation therapy (RT) contouring atlas and recommendations for women with postoperative and locally advanced vulvar carcinoma. Methods and Materials: An international committee of 35 expert gynecologic radiation oncologists completed a survey of the treatment of vulvar carcinoma. An initial set of recommendations for contouring was discussed and generated by consensus. Two cases, 1 locally advanced and 1 postoperative, were contoured by 14 physicians. Contours were compared and analyzed using an expectation-maximization algorithm for simultaneous truth and performance level estimation (STAPLE), and a 95% confidence interval contour was developed. The levelmore » of agreement among contours was assessed using a kappa statistic. STAPLE contours underwent full committee editing to generate the final atlas consensus contours. Results: Analysis of the 14 contours showed substantial agreement, with kappa statistics of 0.69 and 0.64 for cases 1 and 2, respectively. There was high specificity for both cases (≥99%) and only moderate sensitivity of 71.3% and 64.9% for cases 1 and 2, respectively. Expert review and discussion generated consensus recommendations for contouring target volumes and treatment for postoperative and locally advanced vulvar cancer. Conclusions: These consensus recommendations for contouring and treatment of vulvar cancer identified areas of complexity and controversy. Given the lack of clinical research evidence in vulvar cancer radiation therapy, the committee advocates a conservative and consistent approach using standardized recommendations.« less

The University Inventor's Obligation to Assign: A Review of US Case Law on the Enforceability of University Patent Policies

ERIC Educational Resources Information Center

Ohashi, Naoko

2004-01-01

Until recently, it was unclear under US case law whether university patent policies were sufficient to obligate university personnel to assign their inventions to the university without a signed invention-assignment agreement. This paper examines the question through recent case law. These cases indicate a trend in support of university claims…

Engaging Teacher Educators with the Sustainability Agenda: A Case Study of a Pilot Professional Development Program from Ethiopia

ERIC Educational Resources Information Center

Amado, Addise; Dalelo, Aklilu; Adomßent, Maik; Fischer, Daniel

2017-01-01

Purpose: There is broad consensus that the implementation of education for sustainable development (ESD) requires the consideration of geographical and cultural contexts. Despite such an agreement at a theoretical level, there is so far an apparent lack of practical experiences and solid research on approaches that effectively manage to engage…

Ohio State University Extension Competency Study: Developing a Competency Model for a 21st Century Extension Organization

ERIC Educational Resources Information Center

Cochran, Graham Ralph

2009-01-01

The literature on competency-based human resource (HR) management provides a strong case for moving from a jobs-based to a competency-based approach to human resources. There is agreement in the literature (Dubois, Rothwell, Stern, & Kemp, 2004; Lucia & Lepsinger, 1999) on the benefits of using competencies throughout HR systems and impact…

Place Matters: A Mixed Methods Case Study of Institutional Place-Building in Higher Education

ERIC Educational Resources Information Center

Raykes, Jeffrey Stuart

2017-01-01

Colleges and universities are being increasingly recognized as key contributors to the well-being of the places in which they are located. However, in spite of the promise and potential of place-based engagement, there is little agreement about what place and place-building means or how these concepts can be operationalized in within the context…

Addressing Campus-Wide Communication Incivility in the Basic Course: A Case Study.

ERIC Educational Resources Information Center

Heinemann, Robert L.

The degree of incivility varies, but there seems to be general agreement that it is on the rise on college campuses across the country. A number of key elements are involved in the communication aspects of civility: a lack of respect for another human being; name calling and dehumanization; disqualification from dialogue; threats and incitation;…

Textbooks on Argumentative Writing Display Much Agreement, though Each Has Own Slant.

ERIC Educational Resources Information Center

Beason, Larry

1995-01-01

A study of 10 freshman composition argumentative textbooks shows that there is a common core, grounded in but not dependent on classical rhetoric (Aristotelian rhetoric in particular). A cursory glance--which is all that many teachers can afford to give such books--might suggest they are all clones. But such is not the case. The authors forefront…

Agreement on Child Maltreatment Decisions: A Nonrandomized Study on the Effects of Structured Decision-Making

ERIC Educational Resources Information Center

Bartelink, C.; van Yperen, T. A.; ten Berge, I. J.; de Kwaadsteniet, L.; Witteman, C. L. M.

2014-01-01

Background: Practitioners investigating cases of suspected child maltreatment often disagree whether a child is subject to or at risk of abuse or neglect in the family and, if so, what to do about such abuse or neglect. Structured decision-making is considered to be a solution to the problem of subjective judgments and decisions. Objective: This…

Do School Incentives and Accountability Measures Improve Skills in the Middle East and North Africa? The Cases of Jordan and Tunisia

ERIC Educational Resources Information Center

Shafiq, M. Najeeb

2011-01-01

There is general agreement that skill-enhancing school reforms in the Middle East and North Africa (MENA) region are necessary for economic, political and social reasons. Using student-level data from Jordan and Tunisia, this study assesses the relationship between skills and the following school incentive and accountability measures: pedagogical…

Spirituality as a Universal Experience of Music: A Case Study of North Americans' Approaches to Japanese Music

ERIC Educational Resources Information Center

Matsunobu, Koji

2011-01-01

Ethnomusicologists and music educators are in broad agreement that what makes each cultural expression of music unique are differences, not commonalities, and that these should be understood in culturally sensitive ways. Relevant to the debate was the emphasis on the socio-cultural context of music making over the traditional "sound-only"…

Grammatical Morphology in Monolingual and Bilingual Children with and without Language Impairment: The Case of Dutch Plurals and Past Participles

ERIC Educational Resources Information Center

Boerma, Tessel; Wijnen, Frank; Leseman, Paul; Blom, Elma

2017-01-01

Purpose: Grammatical morphology is often a locus of difficulty for both children with language impairment (LI) and bilingual children. In contrast to previous research that mainly focused on verbal tense and agreement markings, the present study investigated whether plural and past participle formation can disentangle the effects of LI and…

The validation index: a new metric for validation of segmentation algorithms using two or more expert outlines with application to radiotherapy planning.

PubMed

Juneja, Prabhjot; Evans, Philp M; Harris, Emma J

2013-08-01

Validation is required to ensure automated segmentation algorithms are suitable for radiotherapy target definition. In the absence of true segmentation, algorithmic segmentation is validated against expert outlining of the region of interest. Multiple experts are used to overcome inter-expert variability. Several approaches have been studied in the literature, but the most appropriate approach to combine the information from multiple expert outlines, to give a single metric for validation, is unclear. None consider a metric that can be tailored to case-specific requirements in radiotherapy planning. Validation index (VI), a new validation metric which uses experts' level of agreement was developed. A control parameter was introduced for the validation of segmentations required for different radiotherapy scenarios: for targets close to organs-at-risk and for difficult to discern targets, where large variation between experts is expected. VI was evaluated using two simulated idealized cases and data from two clinical studies. VI was compared with the commonly used Dice similarity coefficient (DSCpair - wise) and found to be more sensitive than the DSCpair - wise to the changes in agreement between experts. VI was shown to be adaptable to specific radiotherapy planning scenarios.

Atypia on breast core needle biopsies: reproducibility and significance.

PubMed

Darvishian, Farbod; Singh, Baljit; Simsir, Aylin; Ye, Weimin; Cangiarella, Joan F

2009-01-01

This study analyzes the interobserver variability in interpreting atypia on breast core needle biopsies and in each category of atypia calculates the upgrade risk of carcinoma in the subsequent surgical excision. We identified 51 cases of atypia on breast core needle biopsies performed at our institution from January 2003 to August 2006. The atypia was classified into 4 categories: atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH), flat epithelial atypia (FEA), and atypia of undetermined significance (AUS). After a tutorial session, these cases were independently reviewed by four pathologists, whose overall multi-rater kappa value for agreement on different categories of atypia was 0.79 (95% CI, 0.69-0.89), which is within the substantial agreement range. The upgrade risk in each category of atypia was as follows: ADH 20% (p = 0.04); ALH 10% (p = 0.6); FEA 16.6% (p = 0.23), and AUS 100% (p = 0.96). Based on our findings, we conclude that follow-up excision should be performed after a diagnosis of ADH. The upgrade risk did not reach statistical significance in ALH or FEA. Although follow-up excision cannot be strongly recommended in ALH and FEA, it should be considered since the upgrade risk is not negligible. Strict adherence to the diagnostic criteria and tutorial sessions can help pathologists to achieve substantial agreement in interpreting atypia on breast core needle biopsies.

The ability of orthodontists and oral/maxillofacial surgeons to predict eruption of lower third molar.

PubMed

Bastos, Aline do Carmo; de Oliveira, Joelma Bezerra; Mello, Karina Flexa Ribeiro; Leão, Patrícia Botelho; Artese, Flavia; Normando, David

2016-12-01

The aim of this study was to evaluate the ability of oral/maxillofacial surgeons (OMFSs) and orthodontists to predict third molar eruption by examining a simple panoramic radiograph in cases where full spontaneous eruption occurred. Panoramic radiographs of 17 patients, 13-16 years of age, were obtained just after orthodontic treatment (T1), when the third molars were intraosseous. The radiographs at T1 were presented to 28 OMFSs and 28 orthodontists-who were asked to give a prognosis for the lower third molars on both sides (n = 34). The full spontaneous eruption of all third molars was clinically observed when patients were older than 18 years (T2). These teeth were clinically asymptomatic at T1 and T2. OMFSs decided by extractions in 49.6 % of cases while orthodontists in 37.8 % (p < 0.001), when the radiographs were examined at T1. Agreement between OMFSs and orthodontists was excellent (Kappa = 0.76, p < 0.0001), as well as intragroup agreement for both OMFSs (Kappa = 0.83) and orthodontists (Kappa = 0.96). Despite a remarkable agreement for third molar prognosis, orthodontists and OMFSs were unable to predict lower third molar eruption by examining a simple panoramic radiograph. Both indicated extractions of a considerable number of spontaneously erupted asymptomatic teeth.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lim, Karen; Small, William; Portelance, Lorraine

Purpose: Accurate target definition is vitally important for definitive treatment of cervix cancer with intensity-modulated radiotherapy (IMRT), yet a definition of clinical target volume (CTV) remains variable within the literature. The aim of this study was to develop a consensus CTV definition in preparation for a Phase 2 clinical trial being planned by the Radiation Therapy Oncology Group. Methods and Materials: A guidelines consensus working group meeting was convened in June 2008 for the purposes of developing target definition guidelines for IMRT for the intact cervix. A draft document of recommendations for CTV definition was created and used to aidmore » in contouring a clinical case. The clinical case was then analyzed for consistency and clarity of target delineation using an expectation maximization algorithm for simultaneous truth and performance level estimation (STAPLE), with kappa statistics as a measure of agreement between participants. Results: Nineteen experts in gynecological radiation oncology generated contours on axial magnetic resonance images of the pelvis. Substantial STAPLE agreement sensitivity and specificity values were seen for gross tumor volume (GTV) delineation (0.84 and 0.96, respectively) with a kappa statistic of 0.68 (p < 0.0001). Agreement for delineation of cervix, uterus, vagina, and parametria was moderate. Conclusions: This report provides guidelines for CTV definition in the definitive cervix cancer setting for the purposes of IMRT, building on previously published guidelines for IMRT in the postoperative setting.« less

Client-therapist agreement in the termination process and its association with therapeutic relationship.

PubMed

Olivera, Julieta; Challú, Laura; Gómez Penedo, Juan Martín; Roussos, Andrés

2017-03-01

There is no consensus among different therapeutic approaches on the process of termination when therapy does not have a prefixed duration. Moreover, both clinicians and researchers are still exploring decision making in the termination of treatment. The present study assessed former client's perspective of therapy termination in a nonprobabilistic sample from Buenos Aires, Argentina. Seventy-three semistructured interviews, lasting ∼60 min each, were conducted with participants that had finished a therapeutic treatment or dropped out. They were asked about several aspects of therapy, including their experience of termination, specifically who decided to terminate, if there was agreement on termination or not, and their thoughts on the termination process. All interviews were transcribed and analyzed using an adaptation of Consensual Qualitative Research (CQR). Quantitative analyses were also conducted to examine associations between variables. Two main factors emerged from the analysis: client/therapist initiative on termination; and level of agreement between client and therapist regarding termination. Whereas nearly all (95%) of therapist-initiated termination cases agreed on termination, client-initiated termination cases could be sorted in agreed (49%) and disagreed (51%) terminations. Both therapist-initiated terminations and agreed upon terminations presented more categories of positive termination motives, better therapeutic bond, and higher overall satisfaction with treatment. Implications for research and clinical practice are discussed. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

The reliability of cause-of-death coding in The Netherlands.

PubMed

Harteloh, Peter; de Bruin, Kim; Kardaun, Jan

2010-08-01

Cause-of-death statistics are a major source of information for epidemiological research or policy decisions. Information on the reliability of these statistics is important for interpreting trends in time or differences between populations. Variations in coding the underlying cause of death could hinder the attribution of observed differences to determinants of health. Therefore we studied the reliability of cause-of-death statistics in The Netherlands. We performed a double coding study. Death certificates from the month of May 2005 were coded again in 2007. Each death certificate was coded manually by four coders. Reliability was measured by calculating agreement between coders (intercoder agreement) and by calculating the consistency of each individual coder in time (intracoder agreement). Our analysis covered an amount of 10,833 death certificates. The intercoder agreement of four coders on the underlying cause of death was 78%. In 2.2% of the cases coders agreed on a change of the code assigned in 2005. The (mean) intracoder agreement of four coders was 89%. Agreement was associated with the specificity of the ICD-10 code (chapter, three digits, four digits), the age of the deceased, the number of coders and the number of diseases reported on the death certificate. The reliability of cause-of-death statistics turned out to be high (>90%) for major causes of death such as cancers and acute myocardial infarction. For chronic diseases, such as diabetes and renal insufficiency, reliability was low (<70%). The reliability of cause-of-death statistics varies by ICD-10 code/chapter. A statistical office should provide coders with (additional) rules for coding diseases with a low reliability and evaluate these rules regularly. Users of cause-of-death statistics should exercise caution when interpreting causes of death with a low reliability. Studies of reliability should take into account the number of coders involved and the number of codes on a death certificate.

Theoretical Calculations for Electron Impact Ionization of Atoms and Molecules

NASA Astrophysics Data System (ADS)

Amami, Sadek Mohamed Fituri

In the last twenty years, significant progress has been made for the theoretical treatment of electron impact ionization (e,2e) of atoms and molecules and, for some cases, very nice agreement between experiment and theory has been achieved. In particular, excellent agreement between theory and experiment and theory has been achieved for ionization of hydrogen and helium. However, agreement between experiment and theory is not nearly as good for ionization of larger atoms and molecules. In the first part of this dissertation, different theoretical approaches will be employed to study the triply differential cross section (TDCS) for low and intermediate energy electron-impact ionization of Neon and Argon for different orbital states. There is a very recent interest in studying ionization of Laser aligned atoms in order to get a better understanding about electron impact ionization of molecules. In the next part of this dissertation, results will be presented for electron-impact ionization of three laser aligned atoms, Mg, Ca, and Na. The comparison between the theory and experiment showed that our three body distorted wave (3DW) model gave excellent agreement with experiment in the scattering plane but very poor agreement perpendicular to the scattering plane. An explanation for this poor agreement out of the scattering plane has been provided by comparing our theoretical results with those of the time depended close coupling (TDCC) model and this explanation is also provided in this dissertation. Recently, significant attention has been directed towards obtaining a better under-standing of electron-impact ionization of molecules which are significantly more challenging than atoms. In the last part of this dissertation, results will be presented for electron-impact ionization of three different molecules (N2 , H2O, and CH4) which have been studied comprehensively using different theoretical approximations for different types of geometries. The published papers in section two contain a detailed analysis and discussion for each of these topics.

Photograph-based diagnosis of burns in patients with dark-skin types: the importance of case and assessor characteristics.

PubMed

Boissin, C; Laflamme, L; Wallis, L; Fleming, J; Hasselberg, M

2015-09-01

This study assessed whether photographs of burns on patients with dark-skin types could be used for accurate diagnosing and if the accuracy was affected by physicians' clinical background or case characteristics. 21 South-African cases (Fitzpatrick grades 4-6) of varying complexity were photographed using a camera phone and uploaded on a web-survey. Respondents were asked to assess wound depth (3 categories) and size (in percentage). A sample of 24 burn surgeons and emergency physicians was recruited in South-Africa, USA and Sweden. Measurements of accuracy (using percentage agreement with bedside diagnosis), inter- (n=24), and intra-rater (n=6) reliability (using percentage agreement and kappa) were computed for all cases aggregated and by case characteristic. Overall diagnostic accuracy was 67.5% and 66.0% for burn size and depth, respectively. It was comparable between burn surgeons and emergency physicians and between countries of practice. However, the standard deviations were smaller, showing higher similarities in diagnoses for burn surgeons and South-African clinicians compared to emergency physicians and clinicians from other countries. Case characteristics (child/adult, simple/complex wound, partial/full thickness) affected the results for burn size but not for depth. Inter- and intra-rater reliability for burn depth was 55% and 77%. Size and depth of burns on patients with dark-skin types could be assessed at least as well using photographs as at bedside with 67.5% and 66.0% average accuracy rates. Case characteristics significantly affected the accuracy for burn size, but medical specialty and country of practice seldom did in a statistically significant manner. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

77 FR 50506 - Proposed Settlement Agreement, Clean Air Act Citizen Suit

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-21

... February 17, 2012, the Court issued an Order that referred the case to mediation and stayed further proceedings on the case pending such mediation. Thus, at the suggestion of the Court, EPA, the District, and...

Extending, and repositioning, a thermochemical ladder: high-level quantum chemical calculations on the sodium cation affinity scale.

PubMed

Bloomfield, Jolyon; Davies, Erin; Gatt, Phillip; Petrie, Simon

2006-01-26

High-level ab initio quantum chemical calculations, at the CP-dG2thaw level of theory, are reported for coordination of Na+ to a wide assortment of small organic and inorganic ligands. The ligands range in size from H to C6H6, and include 22 of the ligands for which precise relative sodium ion binding free energies have been determined by recent Fourier transform ion cyclotron resonance and guided ion beam studies. Agreement with the relative experimental values is excellent (+/-1.1 kJ mol(-1)), and agreement with the absolute scale (obtained when these relative values are pegged to the CH3NH2 "anchor" value measured in a high-pressure mass spectrometric study) is only marginally poorer, with CP-dG2thaw values exceeding the absolute experimental DeltaG(298) values by an average of 2.1 kJ mol(-1). The excellent agreement between experiment and the CP-dG2thaw technique also suggests that the additional 97 ligands surveyed here (which, in many cases, are not readily susceptible to laboratory investigation) can also be reliably fitted to the existing experimental scale. However, while CP-dG2thaw and the experimental ladder are in close accord, a small set of higher level ab initio calculations on sodium ion/ligand complexes (including several values obtained here using the W1 protocol) suggests that the CP-dG2thaw values are themselves too low by approximately 2.5 kJ mol(-1), thereby implying that the accepted laboratory values are typically 4.6 kJ mol(-1) too low. The present work also highlights the importance of Na+/ligand binding energy determinations (whether by experimental or theoretical approaches) on a case-by-case basis: trends in increasing binding energy along homologous series of compounds are not reliably predictable, nor are binding site preferences or chelating tendencies in polyfunctional compounds.

Impact on access to medicines from TRIPS-Plus: a case study of Thai-US FTA.

PubMed

Kessomboon, Nusaraporn; Limpananont, Jiraporn; Kulsomboon, Vidhaya; Maleewong, Usawadee; Eksaengsri, Achara; Paothong, Prinya

2010-05-01

This study assessed the impact of the Thai-US Free Trade Agreement (FTA) on access to medicines in Thailand. We first interpreted the text of the sixth round of Thai-US negotiations in 2006 on intellectual property rights (IPR). The impact was estimated using a macroeconomic model of the impact of changes in IPR. The estimated impact is based on a comparison between the current IPR situation and the proposed changes to IPR. The FTA text involves the period of patent extension from the Trade-Related Aspects of Intellectual Property Rights Agreement (TRIPS Agreement). The provisions involve the period of patent extension, which have to do with compensation for delays in patent registration and/or drug registration, data exclusivity that would result in a delay in generic drug entry, and the enforcing role of the Thai Food and Drug Administration of patent linkages. As a worst case scenario for this single provision, a 10 year patent extension would be given to compensate for delays in patent registration and/or drug registration. The impact on access to medicine, in the year 2027, would be: 1) A 32% increase in the medicine price index, 2) spending on medicines would increase to approximately USD 11,191 million, (USD1 = THB 33.9 on September 2, 2009), and 3) the domestic industry could loss USD 3.3 million. These results suggest there would be a severe restriction on the access to medicines under the TRIPS-Plus proposal. IPR protection of pharmaceuticals per the TRIPS-Plus proposal should be excluded from FTA negotiations.

A Corporate Veto on Health Policy? Global Constitutionalism and Investor-State Dispute Settlement.

PubMed

Hawkins, Benjamin; Holden, Chris

2016-10-01

The importance of trade and investment agreements for health is now widely acknowledged in the literature, with much attention now focused on the impact of investor-state dispute settlement (ISDS) mechanisms. However, much of the analysis of such agreements in the health field remains largely descriptive. We theorize the implications of ISDS mechanisms for health policy by integrating the concept of global constitutionalism with veto point theory. It is argued that attempts to constitutionalize investment law, through a proliferation of International Investment Agreements (IIAs), has created a series of new veto points at which corporations may seek to block new policies aimed at protecting or enhancing public health. The multiplicity of new veto points in this global "spaghetti bowl" of IIAs creates opportunities for corporations to venue shop; that is, to exploit the agreements, and associated veto points, through which they are most likely to succeed in blocking or deterring new regulation. These concepts are illustrated with reference to two case studies of investor-state disputes involving a transnational tobacco company, but the implications of the analysis are of equal relevance for a range of other industries and health issues. Copyright © 2016 by Duke University Press.

A Corporate Veto on Health Policy? Global Constitutionalism and Investor-State Dispute Settlement

PubMed Central

Hawkins, Benjamin; Holden, Chris

2016-01-01

The importance of trade and investment agreements for health is now widely acknowledged in the literature, with much attention now focused on the impact of investor-state dispute settlement (ISDS) mechanisms. However, much of the analysis of such agreements in the health field remains largely descriptive. We theorise the implications of ISDS mechanisms for health policy by integrating the concept of global constitutionalism with veto point theory. It is argued that attempts to ‘constitutionalise’ investment law, through a proliferation of International Investment Agreements (IIAs), has created a series of new veto points at which corporations may seek to block new policies aimed at protecting or enhancing public health. The multiplicity of new veto points in this global ‘spaghetti bowl’ of IIAs creates opportunities for corporations to ‘venue shop’; to exploit the agreements, and associated veto points, through which they are most likely to succeed in blocking or deterring new regulation. These concepts are illustrated with reference to two case studies of investor-state disputes involving a transnational tobacco company, but the implications of the analysis are of equal relevance for a range of other industries and health issues. PMID:27256810

Computation of Three-Dimensional Compressible Flow From a Rectangular Nozzle with Delta Tabs

NASA Technical Reports Server (NTRS)

Reddy, D. R.; Steffen, C. J., Jr.; Zaman, K. B. M. Q.

1999-01-01

A three-dimensional viscous flow analysis is performed using a time-marching Reynolds-averaged Navier-Stokes code for a 3:1 rectangular nozzle with two delta tabs located at the nozz1e exit plane to enhance mixing. Two flow configurations, a subsonic jet case and a supersonic jet case using the same rate configuration, which were previously studied experimentally, are computed and compared with the experimental data. The experimental data include streamwise velocity and vorticity distributions for the subsonic case, and Mach number distributions for the supersonic case, at various axial locations downstream of the nozzle exit. The computational results show very good agreement with the experimental data. In addition, the effect of compressibility on vorticity dynamics is examined by comparing the vorticity contours of the subsonic jet case with those of the supersonic jet case which were not measured in the experiment.

Improved reliability in skeletal age assessment using a pediatric hand MR scanner with a 0.3T permanent magnet.

PubMed

Terada, Yasuhiko; Kono, Saki; Uchiumi, Tomomi; Kose, Katsumi; Miyagi, Ryo; Yamabe, Eiko; Fujinaga, Yasunari; Yoshioka, Hiroshi

2014-01-01

The purpose of this study was to improve the reliability and validity of skeletal age assessment using an open and compact pediatric hand magnetic resonance (MR) imaging scanner. We used such a scanner with 0.3-tesla permanent magnet to image the left hands of 88 healthy children (aged 3.4 to 15.7 years, mean 8.8 years), and 3 raters (2 orthopedic specialists and a radiologist) assessed skeletal age using those images. We measured the strength of agreement in ratings by values of weighted Cohen's κ and the proportion of cases excluded from rating because of motion artifact and inappropriate positioning. We compared the current results with those of a previous study in which 93 healthy children (aged 4.1 to 16.4 years, mean 9.7 years) were examined with an adult hand scanner. The κ values between raters exceeded 0.80, which indicates almost perfect agreement, and most were higher than those of the previous study. The proportion of cases excluded from rating because of motion artifact or inappropriate positioning was also reduced. The results indicate that use of the compact pediatric hand scanner improved the reliability and validity of skeletal age assessments.

Comparison of auricular and rectal temperature measurement in normothermic, hypothermic, and hyperthermic dogs.

PubMed

Konietschke, U; Kruse, B D; Müller, R; Stockhaus, C; Hartmann, K; Wehner, A

2014-01-01

Measurement of rectal temperature is the most common method and considered gold standard for obtaining body temperature in dogs. So far, no study has been performed comparing agreement between rectal and auricular measurements in a large case series. The purpose of the study was to assess agreement between rectal and auricular temperature measurement in normothermic, hypothermic, and hyperthermic dogs with consideration of different environmental conditions and ear conformations. Reference values for both methods were established using 62 healthy dogs. Three hundred dogs with various diseases (220 normothermic, 32 hypothermic, 48 hyperthermic) were enrolled in this prospective study. Rectal temperature was compared to auricular temperature and differences in agreement with regard to environmental temperature, relative humidity, and different ear conformations (pendulous versus prick ears) were evaluated using Pearson's correlation coefficient and Bland-Altman analysis. Correlation between rec- tal and auricular temperature was significant (r: 0.892; p  <  0.01). However, Bland-Altman plots showed an inacceptable variation of values (bias: 0.300 °C; limits of agreement: -0.606 to 1.206 °C). This variation was above a maximal clinical tolerance of 0.3 °C, which was established by experts' opinion (n = 16). Relative humidity had a significant influence (p   =   0.001), whereas environmental temperature did not. Variation between the two methods of measuring body temperature was clinically unacceptable. Although measurement of auricular temperature is fast, simple, and well tolerated, this method provides a clinically unacceptable difference to the rectal measurement.

Quality assurance methodology for Varian RapidArc treatment plans

PubMed Central

Cirino, Eileen T.; Xiong, Li; Mower, Herbert W.

2010-01-01

With the commercial introduction of the Varian RapidArc, a new modality for treatment planning and delivery, the need has arisen for consistent and efficient techniques for performing patient‐specific quality assurance (QA) tests. In this paper we present our methodology for a RapidArc treatment plan QA procedure. For our measurements we used a 2D diode array (MapCHECK) embedded at 5 cm water equivalent depth in MapPHAN 5 phantom and an Exradin A16 ion chamber placed in six different positions in a cylindrical homogeneous phantom (QUASAR). We also checked the MUs for the RapidArc plans by using independent software (RadCalc). The agreement between Eclipse calculations and MapCHECK/MapPHAN 5 measurements was evaluated using both absolute distance‐to‐agreement (DTA) and gamma index with 10% dose threshold (TH), 3% dose difference (DD), and 3 mm DTA. The average agreement was 94.4% for the DTA approach and 96.3% for the gamma index approach. In high‐dose areas, the discrepancy between calculations and ion chamber measurements using the QUASAR phantom was within 4.5% for prostate cases. For the RadCalc calculations, we used the average SSD along the arc; however, for some patients the agreement for the MUs obtained with RadCalc versus Eclipse was inadequate (discrepancy>5%). In these cases, the plan was divided into partial arc plans so that RadCalc could perform a better estimation of the MUs. The discrepancy was further reduced to within ~4% using this approach. Regardless of the variation in prescribed dose and location of the treated areas, we obtained very good results for all patients studied in this paper. PACS number: 87.55.Qr

68Ga-PSMA-11 PET/CT Interobserver Agreement for Prostate Cancer Assessments: An International Multicenter Prospective Study.

PubMed

Fendler, Wolfgang Peter; Calais, Jeremie; Allen-Auerbach, Martin; Bluemel, Christina; Eberhardt, Nina; Emmett, Louise; Gupta, Pawan; Hartenbach, Markus; Hope, Thomas A; Okamoto, Shozo; Pfob, Christian Helmut; Pöppel, Thorsten D; Rischpler, Christoph; Schwarzenböck, Sarah; Stebner, Vanessa; Unterrainer, Marcus; Zacho, Helle D; Maurer, Tobias; Gratzke, Christian; Crispin, Alexander; Czernin, Johannes; Herrmann, Ken; Eiber, Matthias

2017-10-01

The interobserver agreement for 68 Ga-PSMA-11 PET/CT study interpretations in patients with prostate cancer is unknown. Methods: 68 Ga-PSMA-11 PET/CT was performed in 50 patients with prostate cancer for biochemical recurrence ( n = 25), primary diagnosis ( n = 10), biochemical persistence after primary therapy ( n = 5), or staging of known metastatic disease ( n = 10). Images were reviewed by 16 observers who used a standardized approach for interpretation of local (T), nodal (N), bone (Mb), or visceral (Mc) involvement. Observers were classified as having a low (<30 prior 68 Ga-PSMA-11 PET/CT studies; n = 5), intermediate (30-300 studies; n = 5), or high level of experience (>300 studies; n = 6). Histopathology ( n = 25, 50%), post-external-beam radiation therapy prostate-specific antigen response ( n = 15, 30%), or follow-up PET/CT ( n = 10, 20%) served as a standard of reference. Observer groups were compared by overall agreement (% patients matching the standard of reference) and Fleiss' κ with mean and corresponding 95% confidence interval (CI). Results: Agreement among all observers was substantial for T (κ = 0.62; 95% CI, 0.59-0.64) and N (κ = 0.74; 95% CI, 0.71-0.76) staging and almost perfect for Mb (κ = 0.88; 95% CI, 0.86-0.91) staging. Level of experience positively correlated with agreement for T (κ = 0.73/0.66/0.50 for high/intermediate/low experience, respectively), N (κ = 0.80/0.76/0.64, respectively), and Mc staging (κ = 0.61/0.46/0.36, respectively). Interobserver agreement for Mb was almost perfect irrespective of prior experience (κ = 0.87/0.91/0.88, respectively). Observers with low experience, when compared with intermediate and high experience, demonstrated significantly lower median overall agreement (54% vs. 66% and 76%, P = 0.041) and specificity for T staging (73% vs. 88% and 93%, P = 0.032). Conclusion: The interpretation of 68 Ga-PSMA-11 PET/CT for prostate cancer staging is highly consistent among observers with high levels of experience, especially for nodal and bone assessments. Initial training on at least 30 patient cases is recommended to ensure acceptable performance. © 2017 by the Society of Nuclear Medicine and Molecular Imaging.

The Use of Central Pathology Review With Digital Slide Scanning in Advanced-stage Mycosis Fungoides and Sézary Syndrome: A Multi-institutional and International Pathology Study.

PubMed

Gru, Alejandro A; Kim, Jinah; Pulitzer, Melissa; Guitart, Joan; Battistella, Maxime; Wood, Gary S; Cerroni, Lorenzo; Kempf, Werner; Willemze, Rein; Pawade, Joya; Querfeld, Christiane; Schaffer, Andras; Pincus, Laura; Tetzlaff, Michael; Duvic, Madeleine; Scarisbrick, Julia; Porcu, Pierluigi; Mangold, Aaron R; DiCaudo, David J; Shinohara, Michi; Hong, Eric K; Horton, Bethany; Kim, Youn H

2018-06-01

This pathology PILOT study aims to define the role and feasibility of centralized pathology review in a cohort of 75 patients from different centers in the United States and Europe using digital slide scanning. The pathologic material from 75 patients who had been diagnosed with mycosis fungoides/Sézary syndrome and were clinically staged as IIb or above was retrieved from 11 participating centers. Each pathology reviewer was provided with the pathologic diagnosis (by the referring pathologist), and the following list of histopathologic criteria (presence or absence) from the initial report: epidermotropism, folliculotropism (FT), large cell transformation, syringotropism, and granulomas. Patients with advance stage were selected for this study as this is a population where there is significant variability in the diagnosis of pathologic prognostic and predictive biomarkers. The slides were digitally scanned with an Aperio scanner and consensus review of cases occurred when major or minor discrepancies between the referral diagnosis and central pathology review occurred. Among the 75 cases, 70 (93.3%) had a final consensus diagnosis between the 3 central review pathologists. The overall agreement between the consensus review and the referring pathologist was 60%. The overall agreement was also higher between the reviewers and consensus review, compared with the referring pathologist and consensus. 65.3% of cases had some type of discrepancy (major or minor) between the outside and consensus review. Major discrepancies were seen in 34 of 73 cases (46.6%; 73 cases indicated a yes or no response). Minor discrepancies were seen in 32 of 75 (42.7%) of cases. Most of the major discrepancies were accounted by a difference in interpretation in the presence or absence of large cell transformation or FT. Most minor discrepancies were explained by a different interpretation in the expression of CD30. We found digital slide scanning to be a beneficial, reliable, and practical for a methodical approach to perform central pathology review in the context of a large clinical prospective study.

[Usefulness of conventional polymerase chain reaction for the detection of Mycoplasma hominis, Ureaplasma spp. and Trichomonas vaginalis in female outpatient's genital samples].

PubMed

Alarcón, Gonzalo; Barraza, Gabriela; Vera, Andrea; Wozniak, Aniela; García, Patricia

2016-02-01

Trichomonas vaginalis, Mycoplasma hominis and Ureaplasma spp. are microorganisms responsible for genitourinary and pregnancy pathologies. Nucleic acid amplification methods have shown several advantages, but have not been widely studied for the detection of these microorganisms. To implement a conventional polymerase chain reaction (PCR) for the detection of the microorganisms and to compare its results versus the methods currently used at our laboratory. 91 available samples were processed by PCR, culture (M. hominis y Ureaplasma spp.) and wet mount (T vaginalis). Results were compared and statistically analyzed by kappa agreement test. 85, 80 and 87 samples resulted in agreement for the detection of M. hominis, Ureaplasma spp. y T. vaginalis, respectively. For M. hominis and Ureaplasma spp., agreement was substantial, whereas for T. vaginalis it was moderate, however, for the latter, PCR detected more cases than wet mount. We recommend the implementation of PCR for detection of T. vaginalis whereas culture kit is still a useful method for the other microorganisms.

An investigation of rotor noise generation by aerodynamic disturbance. [aeroacoustic transfer functions

NASA Technical Reports Server (NTRS)

Whitfield, C. E.

1977-01-01

An open rotor was considered as a process for converting an unsteady velocity inflow into sound radiation. With the aid of crude assumptions, aero-acoustic transfer functions were defined theoretically for both discrete frequency and broad band noise. A study of the validity of these transfer functions yielded results which show good agreement at discrete frequencies though slightly less good for broad band noise. Agreement in both cases holds over three or more decades of the relevant parameters. A rotating hot wire anemometry system consisting of a single hot wire probe mounted in the nose cone of the rotor was used to quantify fluctuations in the airflow onto a single rotor blade for the transfer function results. Further theoretical analysis revealed that the sound field can be expressed in terms of blade-to-blade correlations in the airflow, and results from two probes rotating simultaneously were modelled mathematically and inserted in the theory. Preliminary results snow encouraging agreement with experimental data.

Evaluation of data obtained from military disability medical administrative databases for service members with schizophrenia or bipolar disorder.

PubMed

Millikan, Amy M; Weber, Natalya S; Niebuhr, David W; Torrey, E Fuller; Cowan, David N; Li, Yuanzhang; Kaminski, Brenda

2007-10-01

We are studying associations between selected biomarkers and schizophrenia or bipolar disorder among military personnel. To assess potential diagnostic misclassification and to estimate the date of illness onset, we reviewed medical records for a subset of cases. Two psychiatrists independently reviewed 182 service medical records retrieved from the Department of Veterans Affairs. Data were evaluated for diagnostic concordance between database diagnoses and reviewers. Interreviewer variability was measured by using proportion of agreement and the kappa statistic. Data were abstracted to estimate date of onset. High levels of agreement existed between database diagnoses and reviewers (proportion, 94.7%; kappa = 0.88) and between reviewers (proportion, 92.3%; kappa = 0.87). The median time between illness onset and initiation of medical discharge was 1.6 and 1.1 years for schizophrenia and bipolar disorder, respectively. High levels of agreement between investigators and database diagnoses indicate that diagnostic misclassification is unlikely. Discharge procedure initiation date provides a suitable surrogate for disease onset.

Poor-to-moderate agreement between self and proxy interviews of mobile phone use.

PubMed

Hutter, Hans-Peter; Ehrenhöfer, Lisa; Freuis, Edith; Hartl, Patrik; Kundi, Michael

2012-10-01

In epidemiological studies, cases cannot always be interviewed due to them being too ill or already deceased. Under these circumstances, proxy interviews are often conducted; however, the veridicality of information about mobile phone use gained by proxy interviews has been doubted. The issue is undecided due to the lack of empirical data. We conducted a study of 119 heterosexual couples. Both partners answered two questionnaires about mobile phone use, one about their own use and one about their partner's use. Overall agreement assessed using Cohen's kappa, Passing and Bablok regression, and concordance coefficients between self and proxy data was poor to moderate (e.g., concordance coefficients of 0.55 for duration of use). The only item with good agreement was whether or not a prepaid phone was used (Cohen's kappa 0.78 and 0.63 for male and female estimates, respectively), and to a lesser degree, the onset of mobile phone use (concordance coefficients of 0.66 and 0.61). Poorest agreement was obtained for the side of the head the mobile phone was held during calls (kappa coefficients of 0.20 and 0.24 for female and male estimates, respectively). We conclude that the assessment of mobile phone use by proxy data cannot be relied on except for information about onset of mobile phone use, use of prepaid or contract phones, and, to a lesser degree, duration of daily use. Agreement concerning the important information about side of the head the mobile phone is held during calls was poorest and only slightly better than chance. Copyright © 2012 Wiley Periodicals, Inc.

How orthodontic records can influence torque choice decisions?

PubMed Central

Mavreas, Dimitrios; Kuppens, Enya; Buyl, Ronald

2016-01-01

Summary Introduction: The aim of this study was to investigate whether the addition of records can influence intra- and inter-rated agreement on torque choices made to treat a group of patients with various malocclusions. Methods: Forty-eight patients were presented to five orthodontic specialists in three different occasions. During the first session, the participants were shown only the models and intraoral photos of the patients; extraoral photos were added during the second session, and cephalometric X-rays were further supplemented during the third session. Mean weighted kappa coefficients were calculated to measure agreement. Results: The inter-observer agreement was low with the mean coefficients measured:κ1 = 0.34 (SD ± 0.09), κ2 = 0.57 (SD ± 0.12), and κ3 = 0.54 (SD ± 0.28) for the three attempts, respectively. The mean kappa coefficients for the intra-rater agreement were also low ranging from 0.18 to 0.66 and the mean coefficients were 0.27 (SD ± 0.11) between first and second, and 0.53 (SD ± 0.11) between second and third attempt, respectively. Conclusions: This study shows that the addition of extraoral photographs, and subsequently cephalograms to plaster models and intraoral photos, does affect intra-, and inter-rater agreement on torque selection. It seems that the addition of extraoral photos plays a more important role in torque selection decisions than lateral cephalograms. Different clinicians do not have a uniform opinion on the size of torque required to treat cases. Further research is required to define rules on torque choices. PMID:26409048

14 CFR 1274.912 - Patent rights-retention by the recipient (large business).

Code of Federal Regulations, 2010 CFR

2010-01-01

...; to practice, in the case of a process or method; or to operate, in case of a machine or system; and... complied with the procedures. (2) If the Agreement Officer learns of an unreported Recipient invention that...

14 CFR 1274.912 - Patent rights-retention by the recipient (large business).

Code of Federal Regulations, 2013 CFR

2013-01-01

...; to practice, in the case of a process or method; or to operate, in case of a machine or system; and... complied with the procedures. (2) If the Agreement Officer learns of an unreported Recipient invention that...

14 CFR 1274.912 - Patent rights-retention by the recipient (large business).

Code of Federal Regulations, 2012 CFR

2012-01-01

...; to practice, in the case of a process or method; or to operate, in case of a machine or system; and... complied with the procedures. (2) If the Agreement Officer learns of an unreported Recipient invention that...

Surface tension modelling of liquid Cd-Sn-Zn alloys

NASA Astrophysics Data System (ADS)

Fima, Przemyslaw; Novakovic, Rada

2018-06-01

The thermodynamic model in conjunction with Butler equation and the geometric models were used for the surface tension calculation of Cd-Sn-Zn liquid alloys. Good agreement was found between the experimental data for limiting binaries and model calculations performed with Butler model. In the case of ternary alloys, the surface tension variation with Cd content is better reproduced in the case of alloys lying on vertical sections defined by high Sn to Zn molar fraction ratio. The calculated surface tension is in relatively good agreement with the available experimental data. In addition, the surface segregation of liquid ternary Cd-Sn-Zn and constituent binaries has also been calculated.

76 FR 32841 - Defense Federal Acquisition Regulation Supplement; Foreign Acquisition Amendments (DFARS Case...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-06

... 2009-D012 to paragraph (d) of Alternate I of DFARS clause 252.225-7021. C. Trade Agreements--Peru The... Rica and Peru, that was published as an interim rule with a request for public comment (74 FR 37650... July 29, 2009 (75 FR 179). This final rule added Peru to the definition of ``Free Trade Agreement...

22 CFR 19.7-3 - Agreement with former spouse.

Code of Federal Regulations, 2014 CFR

2014-04-01

... affecting a regular survivor annuity must be filed before the end of the 12-month period after the divorce... to adjust, other than by court order, a regular survivor annuity for a former spouse when the divorce... spouse in such case is fixed by any spousal agreement entered into prior to the divorce, by § 19.11-2 or...

22 CFR 19.7-3 - Agreement with former spouse.

Code of Federal Regulations, 2012 CFR

2012-04-01

... affecting a regular survivor annuity must be filed before the end of the 12-month period after the divorce... to adjust, other than by court order, a regular survivor annuity for a former spouse when the divorce... spouse in such case is fixed by any spousal agreement entered into prior to the divorce, by § 19.11-2 or...

22 CFR 19.7-3 - Agreement with former spouse.

Code of Federal Regulations, 2010 CFR

2010-04-01

... affecting a regular survivor annuity must be filed before the end of the 12-month period after the divorce... to adjust, other than by court order, a regular survivor annuity for a former spouse when the divorce... spouse in such case is fixed by any spousal agreement entered into prior to the divorce, by § 19.11-2 or...

22 CFR 19.7-3 - Agreement with former spouse.

Code of Federal Regulations, 2013 CFR

2013-04-01

... affecting a regular survivor annuity must be filed before the end of the 12-month period after the divorce... to adjust, other than by court order, a regular survivor annuity for a former spouse when the divorce... spouse in such case is fixed by any spousal agreement entered into prior to the divorce, by § 19.11-2 or...

22 CFR 19.7-3 - Agreement with former spouse.

Code of Federal Regulations, 2011 CFR

2011-04-01

... affecting a regular survivor annuity must be filed before the end of the 12-month period after the divorce... to adjust, other than by court order, a regular survivor annuity for a former spouse when the divorce... spouse in such case is fixed by any spousal agreement entered into prior to the divorce, by § 19.11-2 or...

Do thoraco-lumbar spinal injuries classification systems exhibit lower inter- and intra-observer agreement than other fractures classifications?: A comparison using fractures of the trochanteric area of the proximal femur as contrast model.

PubMed

Urrutia, Julio; Zamora, Tomas; Klaber, Ianiv; Carmona, Maximiliano; Palma, Joaquin; Campos, Mauricio; Yurac, Ratko

2016-04-01

It has been postulated that the complex patterns of spinal injuries have prevented adequate agreement using thoraco-lumbar spinal injuries (TLSI) classifications; however, limb fracture classifications have also shown variable agreements. This study compared agreement using two TLSI classifications with agreement using two classifications of fractures of the trochanteric area of the proximal femur (FTAPF). Six evaluators classified the radiographs and computed tomography scans of 70 patients with acute TLSI using the Denis and the new AO Spine thoraco-lumbar injury classifications. Additionally, six evaluators classified the radiographs of 70 patients with FTAPF using the Tronzo and the AO schemes. Six weeks later, all cases were presented in a random sequence for repeat assessment. The Kappa coefficient (κ) was used to determine agreement. Inter-observer agreement: For TLSI, using the AOSpine classification, the mean κ was 0.62 (0.57-0.66) considering fracture types, and 0.55 (0.52-0.57) considering sub-types; using the Denis classification, κ was 0.62 (0.59-0.65). For FTAPF, with the AO scheme, the mean κ was 0.58 (0.54-0.63) considering fracture types and 0.31 (0.28-0.33) considering sub-types; for the Tronzo classification, κ was 0.54 (0.50-0.57). Intra-observer agreement: For TLSI, using the AOSpine scheme, the mean κ was 0.77 (0.72-0.83) considering fracture types, and 0.71 (0.67-0.76) considering sub-types; for the Denis classification, κ was 0.76 (0.71-0.81). For FTAPF, with the AO scheme, the mean κ was 0.75 (0.69-0.81) considering fracture types and 0.45 (0.39-0.51) considering sub-types; for the Tronzo classification, κ was 0.64 (0.58-0.70). Using the main types of AO classifications, inter- and intra-observer agreement of TLSI were comparable to agreement evaluating FTAPF; including sub-types, inter- and intra-observer agreement evaluating TLSI were significantly better than assessing FTAPF. Inter- and intra-observer agreements using the Denis classification were also significantly better than agreement using the Tronzo scheme. Copyright © 2015 Elsevier Ltd. All rights reserved.

A Study of the Risks in an Information System Outsourcing Partnership

NASA Astrophysics Data System (ADS)

Ajitkumar, Shabareesh; Bunker, Deborah; Smith, Stephen; Winchester, Donald

The objective of this paper is to report the findings of a case study into the risks involved in an information systems outsourcing partnership between a retail bank client and the vendor, an information technology service provider. By drawing on the case study, the paper proposes a theoretical development of shared benefits and shared risks in IT outsourcing partnerships. The paper argues that the longevity and success of the outsourcing partnership depends largely on managing shared risks and goals in the outsourcing partnership, which may gradually deteriorate over time without frequent, open interactions between partnership members. The outsourcing partnership contractual agreements alone may have limited scope in contributing to shared risk reduction in the IT outsourcing partnership if relationships deteriorate.

Rules for success in environmental negotiation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Taylor, J.G.; Burkardt, N.; Lamb, B.L.

Scientists at the Mid-Continent Ecological Science Center of the National Biological Service conducted a series of case studies of FERC license consultations. The goal of these studies was to test hypotheses about factors that contribute to success in interagency negotiations. Based on their analysis of six case studies, the researchers constructed a list of ten rules for success. Examples include: (1) analyze the incentives of each party to negotiate, (2) paying special attention to parties who gain by not negotiating, (3) clarifying the technical issues so that all parties and that they coincide with resource management objectives, and (4) makingmore » sure that the final agreement is feasible from both a physical and a policy perspective so that it can actually be implemented.« less

Using the reference framework for good measles management in practice--a case study from North Rhine-Westphalia.

PubMed

Schröter, Matthias; Schröder-Bäck, Peter; Brand, Helmut

2009-12-01

In 2005, WHO Europe reconfirmed the objective of eradicating measles and fixed a strategy plan for the years 2005 up to 2010. While a downward trend of measles infections in Germany between 2001 and 2004 could be observed, as many as 780 cases of measles were reported in 2005 and in 2006 even 2.281 cases. These high figures in 2006 were almost exclusively caused by an outbreak in the German region of North Rhine-Westphalia. This case study describes how a reference framework for good health management of measles prevention was applied for this region. As a result, various recommendations for action could be given, among them the recommendation to implement individual vaccination reminder systems for parents and bonus systems for parents. Based on these results, a comprehensive policy concept has been drawn up and has become the subject of a political agreement process in this region. Thus this case study shows a paradigm how reference frameworks for good health management can be utilised in practice.

Technical note on the validation of a semi-automated image analysis software application for estrogen and progesterone receptor detection in breast cancer.

PubMed

Krecsák, László; Micsik, Tamás; Kiszler, Gábor; Krenács, Tibor; Szabó, Dániel; Jónás, Viktor; Császár, Gergely; Czuni, László; Gurzó, Péter; Ficsor, Levente; Molnár, Béla

2011-01-18

The immunohistochemical detection of estrogen (ER) and progesterone (PR) receptors in breast cancer is routinely used for prognostic and predictive testing. Whole slide digitalization supported by dedicated software tools allows quantization of the image objects (e.g. cell membrane, nuclei) and an unbiased analysis of immunostaining results. Validation studies of image analysis applications for the detection of ER and PR in breast cancer specimens provided strong concordance between the pathologist's manual assessment of slides and scoring performed using different software applications. The effectiveness of two connected semi-automated image analysis software (NuclearQuant v. 1.13 application for Pannoramic™ Viewer v. 1.14) for determination of ER and PR status in formalin-fixed paraffin embedded breast cancer specimens immunostained with the automated Leica Bond Max system was studied. First the detection algorithm was calibrated to the scores provided an independent assessors (pathologist), using selected areas from 38 small digital slides (created from 16 cases) containing a mean number of 195 cells. Each cell was manually marked and scored according to the Allred-system combining frequency and intensity scores. The performance of the calibrated algorithm was tested on 16 cases (14 invasive ductal carcinoma, 2 invasive lobular carcinoma) against the pathologist's manual scoring of digital slides. The detection was calibrated to 87 percent object detection agreement and almost perfect Total Score agreement (Cohen's kappa 0.859, quadratic weighted kappa 0.986) from slight or moderate agreement at the start of the study, using the un-calibrated algorithm. The performance of the application was tested against the pathologist's manual scoring of digital slides on 53 regions of interest of 16 ER and PR slides covering all positivity ranges, and the quadratic weighted kappa provided almost perfect agreement (κ = 0.981) among the two scoring schemes. NuclearQuant v. 1.13 application for Pannoramic™ Viewer v. 1.14 software application proved to be a reliable image analysis tool for pathologists testing ER and PR status in breast cancer.

Nuclear medicine technologists are able to accurately determine when a myocardial perfusion rest study is necessary

PubMed Central

2012-01-01

Background In myocardial perfusion scintigraphy (MPS), typically a stress and a rest study is performed. If the stress study is considered normal, there is no need for a subsequent rest study. The aim of the study was to determine whether nuclear medicine technologists are able to assess the necessity of a rest study. Methods Gated MPS using a 2-day 99mTc protocol for 121 consecutive patients were studied. Visual interpretation by 3 physicians was used as gold standard for determining the need for a rest study based on the stress images. All nuclear medicine technologists performing MPS had to review 82 training cases of stress MPS images with comments regarding the need for rest studies, and thereafter a test consisting of 20 stress MPS images. After passing this test, the nuclear medicine technologists in charge of a stress MPS study assessed whether a rest study was needed or not or if he/she was uncertain and wanted to consult a physician. After that, the physician in charge interpreted the images and decided whether a rest study was required or not. Results The nuclear medicine technologists and the physicians in clinical routine agreed in 103 of the 107 cases (96%) for which the technologists felt certain regarding the need for a rest study. In the remaining 14 cases the technologists were uncertain, i.e. wanted to consult a physician. The agreement between the technologists and the physicians in clinical routine was very good, resulting in a kappa value of 0.92. There was no statistically significant difference in the evaluations made by technicians and physicians (P = 0.617). Conclusions The nuclear medicine technologists were able to accurately determine whether a rest study was necessary. There was very good agreement between nuclear medicine technologists and physicians in the assessment of the need for a rest study. If the technologists can make this decision, the effectiveness of the nuclear medicine department will improve. PMID:22947251

Protocol to monitor trade agreement food-related aspects: the Fiji case study.

PubMed

Ravuvu, Amerita; Friel, Sharon; Thow, Anne Marie; Snowdon, Wendy; Wate, Jillian

2017-04-26

Despite the growing rates of obesity and diet-related non-communicable diseases, globally, public health attention has only relatively recently turned to the links between trade agreements and the nutritional risks associated with it. Specific trade agreements appear to have played an influential role in the volume and types of foods entering different countries, yet there is currently no systematic and objective monitoring of trade agreements for their impacts on food environments. Recently, INFORMAS was set up to monitor and benchmark food environments, government policies and private sector actions within countries and globally. One of its projects/modules focuses on trade policy and in particular the food-related aspects of trade agreements. This paper describes the INFORMAS trade protocol, an approach to collecting food-related information about four domains of trade: trade in goods; trade in services and foreign direct investment; domestic supports, and policy space. Specifically, the protocol is tested in Fiji. The development and testing of this protocol in Fiji represents the first effort to set out a framework and process for objectively monitoring trade agreements and their impacts on national food supply and the wider food environment. It has shown that entry into WTO trade agreements contributed to the nutrition transition in Fiji through the increased availability of imported foods with varying nutritional quality. We observed an increase in imports of both healthy and less healthy foods. The application of the monitoring protocol also highlights challenges for data collection associated with each trade domain that should be considered for future data collection and analysis in other low and middle income countries. © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Debye screening of dislocations.

PubMed

Groma, I; Györgyi, G; Kocsis, B

2006-04-28

Debye-like screening by edge dislocations of some externally given stress is studied by means of a variational approach to coarse grained field theory. Explicitly given are the force field and the induced geometrically necessary dislocation (GND) distribution, in the special case of a single glide axis in 2D, for (i) a single edge dislocation and (ii) a dislocation wall. Numerical simulation demonstrates that the correlation in relaxed dislocation configurations is in good agreement with the induced GND in case (i). Furthermore, the result (ii) well predicts the experimentally observed decay length for the GND developing close to grain boundaries.

Variation in Treatment Recommendations for Dupuytren Disease.

PubMed

McMillan, Catherine; Yeung, Celine; Binhammer, Paul

2017-12-01

To examine agreement on Dupuytren disease (DD) treatment recommendations in an international sample of hand surgeons. A survey was developed to determine expertise in needle aponeurotomy, surgery, and collagenase injection to treat DD and to examine treatment recommendations for 16 case scenarios. Case scenarios were predeveloped using expert input. Each case represented a unique combination of 4 dichotomous variables including cord thickness, contracture severity, patient age, and joint involvement. Interrater reliability statistics were calculated and multinomial logistic regression modeling and analysis of variance were used to examine the impact of surgeon- and case-related variables on treatment recommendations. A total of 36 hand surgeons from 9 countries (mean experience, 17 years) participated. Average pairwise percent agreement and Krippendorff's alpha were 26% and .012, respectively. Predictors of a recommendation for surgery over multiple options were a total contracture of greater than 70°, a thick precentral cord, involvement of the metacarpophalangeal and proximal interphalangeal joints, and greater years in practice. A greater number of years in practice predicted recommendation for collagenase injection and the presence of a thick precentral cord predicted a recommendation for needle aponeurotomy. Little agreement exists on treatment recommendations for common presentations of DD in this sample. Further investigation into the sources of potential widespread discrepancies in the management of DD may improve the capacity to make evidence-based recommendations. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

An Agent-Based Model for the Role of Short-Term Memory Enhancement in the Emergence of Grammatical Agreement.

PubMed

Vera, Javier

2018-01-01

What is the influence of short-term memory enhancement on the emergence of grammatical agreement systems in multi-agent language games? Agreement systems suppose that at least two words share some features with each other, such as gender, number, or case. Previous work, within the multi-agent language-game framework, has recently proposed models stressing the hypothesis that the emergence of a grammatical agreement system arises from the minimization of semantic ambiguity. On the other hand, neurobiological evidence argues for the hypothesis that language evolution has mainly related to an increasing of short-term memory capacity, which has allowed the online manipulation of words and meanings participating particularly in grammatical agreement systems. Here, the main aim is to propose a multi-agent language game for the emergence of a grammatical agreement system, under measurable long-range relations depending on the short-term memory capacity. Computer simulations, based on a parameter that measures the amount of short-term memory capacity, suggest that agreement marker systems arise in a population of agents equipped at least with a critical short-term memory capacity.

[Market access agreements: Definition and features. Could MAA be defined as a solution for immunotherapy funding by French health system?

PubMed

Ceyrac, T; Corny, J; Raybaut, C; Degrassat-Théas, A; Paubel, P

2018-03-21

Over the last few years, many therapeutic innovations have been approved and marketed in France, within a strained financial setting. Legal dispositions allowed manufacturers (LEEM - les enterprises du medicament) and the economic committee for health products (CEPS) to contract various confidential market access agreements to contain health product expenses. The purposes of this article are to define and describe these different existing market access agreements and to open discussion on their applicability to the problematic of immune-oncology drugs financing. Financial agreements, which led to major savings (discounts refunded to the public payer), have not responded completely to the therapeutic innovations financing problems. Performance agreements (funding based on real-life data and effectiveness of the drug) constitute a hope for health products financing, but major methodological challenges for their use in routine restrict them to rare cases only today. Even though several financial agreements could partly respond to this problematic, use of performance agreements could really constitute an interesting track to tackle this issue. Copyright © 2018. Published by Elsevier Masson SAS.

Characterization of Metal Matrix Composites

NASA Technical Reports Server (NTRS)

Daniel, I. M.; Chun, H. J.; Karalekas, D.

1994-01-01

Experimental methods were developed, adapted, and applied to the characterization of a metal matrix composite system, namely, silicon carbide/aluminim (SCS-2/6061 Al), and its constituents. The silicon carbide fiber was characterized by determining its modulus, strength, and coefficient of thermal expansion. The aluminum matrix was characterized thermomechanically up to 399 C (750 F) at two strain rates. The unidirectional SiC/Al composite was characterized mechanically under longitudinal, transverse, and in-plane shear loading up to 399 C (750 F). Isothermal and non-isothermal creep behavior was also measured. The applicability of a proposed set of multifactor thermoviscoplastic nonlinear constitutive relations and a computer code was investigated. Agreement between predictions and experimental results was shown in a few cases. The elastoplastic thermomechanical behavior of the composite was also described by a number of new analytical models developed or adapted for the material system studied. These models include the rule of mixtures, composite cylinder model with various thermoelastoplastic analyses and a model based on average field theory. In most cases satisfactory agreement was demonstrated between analytical predictions and experimental results for the cases of stress-strain behavior and thermal deformation behavior at different temperatures. In addition, some models yielded detailed three-dimensional stress distributions in the constituents within the composite.

Any value in a specialist review of liver biopsies? Conclusions of a 4-year review.

PubMed

Paterson, Anna L; Allison, Michael E D; Brais, Rebecca; Davies, Susan E

2016-08-01

Liver pathology is a challenging subspeciality, with histopathologists frequently seeking specialist opinions. This study aims to determine the impact of specialist reviews on the final diagnosis and patient management. Agreement with the initial reporting centre in the histopathological diagnosis of 1265 liver biopsies was determined. The nature of differences was explored in more depth for 103 discrepant cases. Differences in the histopathological interpretation were present in 749 of 1265 (59%) biopsies, of which 505 of 749 (67%) were predicted at the time of reporting to impact upon patient management. Agreement was good in cases with chronic viral hepatitis, fatty liver disease, malignancy and minimal pathological changes, while diagnostic differences occurred in more than 70% with biliary disease, autoimmune hepatitis or vascular/architectural changes. A clinical review of a subset of reports with histopathological differences predicted changes in patient management in 63 of 103 (61%). Clinically significant differences in liver biopsy interpretation between local pathologists and subspecialists are common. Diagnoses with frequent discrepancies, such as biliary disease, may benefit from a specialist review as standard when diagnosed initially, while cases requiring specialist advice from disease subgroups where discrepancies are less common, such as chronic viral hepatitis, could be selected during the clinicopathological conference process. © 2016 John Wiley & Sons Ltd.

Comparison of urine and bladder or urethral mucosal biopsy culture obtained by transurethral cystoscopy in dogs with chronic lower urinary tract disease: 41 cases (2002 to 2011).

PubMed

Sycamore, K F; Poorbaugh, V R; Pullin, S S; Ward, C R

2014-07-01

To compare aerobic bacterial culture of urine to cystoscopically obtained mucosal biopsies of the lower urinary tract in dogs. Retrospective review of case records from dogs that had transurethral cystoscopy at a veterinary teaching hospital between 2002 and 2011. Dogs that had culture results from cystocentesis obtained urine and transurethral cystoscopically obtained mucosal samples were included in the study. Pathogens identified were compared between sampling methods. Forty dogs underwent transurethral cystoscopy for lower urinary tract disease on 41 occasions. There was significant (P = 0 · 0003) agreement between urine and mucosal biopsy cultures. Both cultures were negative in 66% and positive in 17% of dogs. There was a 17% disagreement between the sampling methods. Although not statistically significant, more mucosal samples than urine cultures were positive for Escherichia coli. There was a good agreement between pathogen identification from urine and lower urinary tract mucosal cultures. These results do not support the utilisation of transurethral cystoscopy to obtain biopsy samples for culture in dogs with urinary tract infection and positive urine culture. Individual cases with possible chronic urinary tract infection and negative urine culture may benefit from transurethral cystoscopy to obtain biopsies for culture. © 2014 British Small Animal Veterinary Association.

Cross-cultural adaptation into Punjabi of the English version of the Hospital Anxiety and Depression Scale.

PubMed

Lane, Deirdre A; Jajoo, Jagdish; Taylor, Rod S; Lip, Gregory Yh; Jolly, Kate

2007-01-26

We wanted to use a Punjabi version of the Hospital Anxiety and Depression Scale (HADS) to enable non-English speaking patients to participate in a clinical trial. The aim of the study was to translate and validate the Hospital Anxiety and Depression Scale into Punjabi. The HADS was translated into Punjabi by a multidisciplinary team, verified against the original version, and administered to 73 bilingual patients attending an outpatient clinic. One sample t-tests and the Bland-Altman plots demonstrated acceptable linguistic agreement between the two versions of the HADS. Spearman's rank-order correlation coefficients (p < 0.0001) demonstrate excellent conceptual agreement between each item and its corresponding subscale score, for both versions. Concordance rates revealed that the Punjabi HADS adequately identified borderline cases of anxiety (80.8%), definite cases of anxiety (91.8%) and depression (91.8%), but was less reliable in identifying borderline cases of depression (65.8%). Cronbach alpha coefficients revealed high levels of internal consistency for both the Punjabi and English versions (0.81 and 0.86 for anxiety and 0.71 and 0.85 for depression, respectively). The Punjabi HADS is an acceptable, reliable and valid measure of anxiety and depression among physically ill Punjabi speaking people in the United Kingdom.

The Determination of Jurisdiction in Grid and Cloud Service Level Agreements

NASA Astrophysics Data System (ADS)

Parrilli, Davide Maria

Service Level Agreements in Grid and Cloud scenarios can be a source of disputes particularly in case of breach of the obligations arising under them. It is then important to determine where parties can litigate in relation with such agreements. The paper deals with this question in the peculiar context of the European Union, and so taking into consideration Regulation 44/2001. According to the rules on jurisdiction provided by the Regulation, two general distinctions are drawn in order to determine which (European) courts are competent to adjudicate disputes arising out of a Service Level Agreement. The former is between B2B and B2C transactions, and the latter regards contracts which provide a jurisdiction clause and contracts which do not.

Experimental analysis of the boundary layer transition with zero and positive pressure gradient

NASA Technical Reports Server (NTRS)

Arnal, D.; Jullen, J. C.; Michel, R.

1980-01-01

The influence of a positive pressure gradient on the boundary layer transition is studied. The mean velocity and turbulence profiles of four cases are examined. As the intensity of the pressure gradient is increased, the Reynolds number of the transition onset and the length of the transition region are reduced. The Tollmein-Schlichting waves disturb the laminar regime; the amplification of these waves is in good agreement with the stability theory. The three dimensional deformation of the waves leads finally to the appearance of turbulence. In the case of zero pressure gradient, the properties of the turbulent spots are studied by conditional sampling of the hot-wire signal; in the case of positive pressure gradient, the turbulence appears in a progressive manner and the turbulent spots are much more difficult to characterize.

Comparison of the activity of three antibiotic regimens in severe Legionnaires' disease.

PubMed

Dournon, E; Mayaud, C; Wolff, M; Schlemmer, B; Samuel, D; Sollet, J P; Levasseur-Rajagopalan, P

1990-10-01

Comparison of the activity of different antibiotic regimens in Legionnaire's disease has never been made because of the rarity of well documented cases of that disease. We have retrospectively compared severe cases of Legionnaires' disease treated with pefloxacin alone or in combination with erythromycin and/or rifampicin using computer-matched cases treated either with erythromycin or with erythromycin in combination with rifampicin. This study suggests that: (1) combined therapy including erythromycin, rifampicin and/or pefloxacin is superior to therapy with erythromycin alone; (2) combinations including pefloxacin may be the most active ones; and (3) pefloxacin alone may be as active as combination therapy. Although these results are in agreement with data obtained in cell and in animal models of legionella infection they need to be further confirmed by the study of larger number of patients.

45 CFR 303.15 - Agreements to use the Federal Parent Locator Service (PLS) in parental kidnapping and child...

Code of Federal Regulations, 2010 CFR

2010-10-01

... Service (PLS) in parental kidnapping and child custody or visitation cases. 303.15 Section 303.15 Public... parental kidnapping and child custody or visitation cases. (a) Definitions. The following definitions apply... responsibilities require access in connection with child custody and parental kidnapping cases; (ii) Store the...

45 CFR 303.15 - Agreements to use the Federal Parent Locator Service (PLS) in parental kidnapping and child...

Code of Federal Regulations, 2014 CFR

2014-10-01

... Service (PLS) in parental kidnapping and child custody or visitation cases. 303.15 Section 303.15 Public... parental kidnapping and child custody or visitation cases. (a) Definitions. The following definitions apply... responsibilities require access in connection with child custody and parental kidnapping cases; (ii) Store the...

45 CFR 303.15 - Agreements to use the Federal Parent Locator Service (PLS) in parental kidnapping and child...

Code of Federal Regulations, 2011 CFR

2011-10-01

... Service (PLS) in parental kidnapping and child custody or visitation cases. 303.15 Section 303.15 Public... parental kidnapping and child custody or visitation cases. (a) Definitions. The following definitions apply... responsibilities require access in connection with child custody and parental kidnapping cases; (ii) Store the...

45 CFR 303.15 - Agreements to use the Federal Parent Locator Service (PLS) in parental kidnapping and child...

Code of Federal Regulations, 2013 CFR

2013-10-01

... Service (PLS) in parental kidnapping and child custody or visitation cases. 303.15 Section 303.15 Public... parental kidnapping and child custody or visitation cases. (a) Definitions. The following definitions apply... responsibilities require access in connection with child custody and parental kidnapping cases; (ii) Store the...

45 CFR 303.15 - Agreements to use the Federal Parent Locator Service (PLS) in parental kidnapping and child...

Code of Federal Regulations, 2012 CFR

2012-10-01

... Service (PLS) in parental kidnapping and child custody or visitation cases. 303.15 Section 303.15 Public... parental kidnapping and child custody or visitation cases. (a) Definitions. The following definitions apply... responsibilities require access in connection with child custody and parental kidnapping cases; (ii) Store the...

Examining Charging Agreement between Police and Prosecutors in Rape Cases

ERIC Educational Resources Information Center

Holleran, David; Beichner, Dawn; Spohn, Cassia

2010-01-01

Although prior research has contributed to understanding of the factors that influence sexual assault case processing, it has primarily been viewed through the prosecutorial lens. The authors assert that a prosecutor's charging decision involves not only a decision to file or reject the charge but, assuming that the case is not rejected, also a…

A Case Study in Interagency Collaboration: Colorado Migrant Health Program--Colorado Migrant Education Program. Final Report Migrant Education Health Program, 1987.

ERIC Educational Resources Information Center

Colorado State Dept. of Health, Denver.

This report of Colorado's 1987 Migrant Education Health Program details activities under the program, a cooperative undertaking by the state Health and Education departments. The report was written to provide: (1) assurance that the program's services have been within the scope and financial estimates of the interagency agreement; (2) a body of…

Reaching Agreement in Uncertain Circumstances: The Practice of Evidence-Based Policy in the Case of the Swedish National Guidelines for Heart Diseases

ERIC Educational Resources Information Center

Eckard, Nathalie; Nedlund, Ann-Charlotte; Janzon, Magnus; Levin, Lars-Åke

2017-01-01

This paper explores the practice of evidence-based policy in a Swedish healthcare context. The study focused on how policymakers in the specific working group, the Priority-Setting Group (PSG), handled the various forms of evidence and values and their competing rationalities, when producing the Swedish National Guidelines for heart diseases that…

Promoting a Culture of Engaged Scholarship and Mentoring Junior Faculty in the Reappointment, Tenure, and Promotion Process at a "Teaching First" University

ERIC Educational Resources Information Center

Boehm, Lisa Krissoff; Larrivee, Linda S.

2016-01-01

This paper analyzes the processes and outcomes involved with mentoring junior faculty in the reappointment, promotion, and tenure (RPT) process at a comprehensive state university and creating a culture supportive of engaged research. Although the university in this case study is governed by a collective bargaining agreement that prohibits the…

Impact of Clinical History on Maximum PI-RADS Version 2 Score: A Six-Reader 120-Case Sham History Retrospective Evaluation.

PubMed

Shankar, Prasad R; Kaza, Ravi K; Al-Hawary, Mahmoud M; Masch, William R; Curci, Nicole E; Mendiratta-Lala, Mishal; Sakala, Michelle D; Johnson, Timothy D; Davenport, Matthew S

2018-04-17

Purpose To assess the impact of clinical history on the maximum Prostate Imaging Recording and Data System (PI-RADS) version 2 (v2) score assigned to multiparametric magnetic resonance (MR) imaging of the prostate. Materials and Methods This retrospective cohort study included 120 consecutively selected multiparametric prostate MR imaging studies performed between November 1, 2016, and December 31, 2016. Sham clinical data in four domains (digital rectal examination, prostate-specific antigen level, plan for biopsy, prior prostate cancer history) were randomly assigned to each case by using a balanced orthogonal design. Six fellowship-trained abdominal radiologists independently reviewed the sham data, actual patient age, and each examination while they were blinded to interreader scoring, true clinical data, and histologic findings. Readers were told the constant sham histories were true, believed the study to be primarily investigating interrater agreement, and were asked to assign a maximum PI-RADS v2 score to each case. Linear regression was performed to assess the association between clinical variables and maximum PI-RADS v2 score designation. Intraclass correlation coefficients (ICCs) were obtained to compare interreader scoring. Results Clinical information had no significant effect on maximum PI-RADS v2 scoring for any of the six readers (P = .09-.99, 42 reader-variable pairs). Distributions of maximum PI-RADS v2 scores in the research context were similar to the distribution of the scores assigned clinically and had fair-to-excellent pairwise interrater agreement (ICC range: 0.53-0.76). Overall interrater agreement was good (ICC: 0.64; 95% confidence interval: 0.57, 0.71). Conclusion Clinical history does not appear to be a substantial bias in maximum PI-RADS v2 score assignment. This is potentially important for clinical nomograms that plan to incorporate PI-RADS v2 score and clinical data into their algorithms (ie, PI-RADS v2 scoring is not confounded by clinical data). © RSNA, 2018 Online supplemental material is available for this article.

20 CFR 411.115 - Definitions of terms used in this part.

Code of Federal Regulations, 2013 CFR

2013-04-01

... network or EN means a qualified public or private entity that has entered into an agreement with us to... (§§ 411.300-411.330). A State vocational rehabilitation agency may choose, on a case-by-case basis, to...

14 CFR § 1274.912 - Patent rights-retention by the recipient (large business).

Code of Federal Regulations, 2014 CFR

2014-01-01

...; to practice, in the case of a process or method; or to operate, in case of a machine or system; and... complied with the procedures. (2) If the Agreement Officer learns of an unreported Recipient invention that...

Low Interrater Reliability in Grading of Rectal Bleeding Using National Cancer Institute Common Toxicity Criteria and Radiation Therapy Oncology Group Toxicity Scales: A Survey of Radiation Oncologists

DOE Office of Scientific and Technical Information (OSTI.GOV)

Huynh-Le, Minh-Phuong; Zhang, Zhe; Tran, Phuoc T.

2014-12-01

Purpose: To measure concordance among genitourinary radiation oncologists in using the National Cancer Institute Common Toxicity Criteria (NCI CTC) and Radiation Therapy Oncology Group (RTOG) grading scales to grade rectal bleeding. Methods and Materials: From June 2013 to January 2014, a Web-based survey was sent to 250 American and Canadian academic radiation oncologists who treat prostate cancer. Participants were provided 4 case vignettes in which patients received radiation therapy and developed rectal bleeding and were asked for management plans and to rate the bleeding according to NCI CTC v.4 and RTOG late toxicity grading (scales provided). In 2 cases, participantsmore » were also asked whether they would send the patient for colonoscopy. A multilevel, random intercept modeling approach was used to assess sources of variation (case, respondent) in toxicity grading to calculate the intraclass correlation coefficient (ICC). Agreement on a dichotomous grading scale (low grades 1-2 vs high grades 3-4) was also assessed, using the κ statistic for multiple respondents. Results: Seventy-two radiation oncologists (28%) completed the survey. Forty-seven (65%) reported having either written or been principal investigator on a study using these scales. Agreement between respondents was moderate (ICC 0.52, 95% confidence interval [CI] 0.47-0.58) when using NCI CTC and fair using the RTOG scale (ICC 0.28, 95% CI 0.20-0.40). Respondents who chose an invasive management were more likely to select a higher toxicity grade (P<.0001). Using the dichotomous scale, we observed moderate agreement (κ = 0.42, 95% CI 0.40-0.44) with the NCI CTC scale, but only slight agreement with the RTOG scale (κ = 0.19, 95% CI 0.17-0.21). Conclusion: Low interrater reliability was observed among radiation oncologists grading rectal bleeding using 2 common scales. Clearer definitions of late rectal bleeding toxicity should be constructed to reduce this variability and avoid ambiguity in both reporting and interpretation.« less

Infant polysomnography: reliability and validity of infant arousal assessment.

PubMed

Crowell, David H; Kulp, Thomas D; Kapuniai, Linda E; Hunt, Carl E; Brooks, Lee J; Weese-Mayer, Debra E; Silvestri, Jean; Ward, Sally Davidson; Corwin, Michael; Tinsley, Larry; Peucker, Mark

2002-10-01

Infant arousal scoring based on the Atlas Task Force definition of transient EEG arousal was evaluated to determine (1). whether transient arousals can be identified and assessed reliably in infants and (2). whether arousal and no-arousal epochs scored previously by trained raters can be validated reliably by independent sleep experts. Phase I for inter- and intrarater reliability scoring was based on two datasets of sleep epochs selected randomly from nocturnal polysomnograms of healthy full-term, preterm, idiopathic apparent life-threatening event cases, and siblings of Sudden Infant Death Syndrome infants of 35 to 64 weeks postconceptional age. After training, test set 1 reliability was assessed and discrepancies identified. After retraining, test set 2 was scored by the same raters to determine interrater reliability. Later, three raters from the trained group rescored test set 2 to assess inter- and intrarater reliabilities. Interrater and intrarater reliability kappa's, with 95% confidence intervals, ranged from substantial to almost perfect levels of agreement. Interrater reliabilities for spontaneous arousals were initially moderate and then substantial. During the validation phase, 315 previously scored epochs were presented to four sleep experts to rate as containing arousal or no-arousal events. Interrater expert agreements were diverse and considered as noninterpretable. Concordance in sleep experts' agreements, based on identification of the previously sampled arousal and no-arousal epochs, was used as a secondary evaluative technique. Results showed agreement by two or more experts on 86% of the Collaborative Home Infant Monitoring Evaluation Study arousal scored events. Conversely, only 1% of the Collaborative Home Infant Monitoring Evaluation Study-scored no-arousal epochs were rated as an arousal. In summary, this study presents an empirically tested model with procedures and criteria for attaining improved reliability in transient EEG arousal assessments in infants using the modified Atlas Task Force standards. With training based on specific criteria, substantial inter- and intrarater agreement in identifying infant arousals was demonstrated. Corroborative validation results were too disparate for meaningful interpretation. Alternate evaluation based on concordance agreements supports reliance on infant EEG criteria for assessment. Results mandate additional confirmatory validation studies with specific training on infant EEG arousal assessment criteria.

Identification of cranial nerves around trigeminal schwannomas using diffusion tensor tractography: a technical note and report of 3 cases.

PubMed

Wei, Peng-Hu; Qi, Zhi-Gang; Chen, Ge; Li, Ming-Chu; Liang, Jian-Tao; Guo, Hong-Chuan; Bao, Yu-Hai; Hao, Qiang

2016-03-01

There are no large series studies identifying the locations of cranial nerves (CNs) around trigeminal schwannomas (TSs); however, surgically induced cranial neuropathies are commonly observed after surgeries to remove TSs. In this study, we preoperatively identified the location of CNs near TSs using diffusion tensor tractography (DTT). An observational study of the DTT results and intraoperative findings was performed. We preoperatively completed tractography from images of patients with TSs who received surgical therapy. The result was later validated during tumorectomy. A total of three consecutive patients were involved in this study. The locations of CNs V-VIII in relation to the tumor was clearly revealed in all cases, except for CN VI in case 3.The predicted fiber tracts were in agreement with intraoperative observations. In this study, preoperative DTT accurately predicted the location of the majority of the nerves of interest. This technique can be applied by surgeons to preoperatively visualize nerve arrangements.

Implications of bilateral free trade agreements on access to medicines.

PubMed Central

Correa, Carlos María

2006-01-01

The TRIPS Agreement of the World Trade Organization (WTO) mandated the introduction of protection of intellectual property rights, notably patents, for pharmaceutical products. While the implications for the access to medicines contained in the terms of this Agreement raised significant concerns, a recent new wave of free trade agreements, negotiated outside the WTO, requires even higher levels of intellectual property protection for medicines than those mandated by that Agreement. The measures involved include the extension of the patent term beyond 20 years; prohibition of use of test data on drug efficacy and safety for certain periods for the approval of generic products; the linkage between drug registration and patent protection; in some cases, limitations to the grounds for granting compulsory licences. This article reviews some of these measures that further limit the competition of generic products and discusses their possible implication for access to medicines. PMID:16710551

Good Agreements Make Good Friends

PubMed Central

Han, The Anh; Pereira, Luís Moniz; Santos, Francisco C.; Lenaerts, Tom

2013-01-01

When starting a new collaborative endeavor, it pays to establish upfront how strongly your partner commits to the common goal and what compensation can be expected in case the collaboration is violated. Diverse examples in biological and social contexts have demonstrated the pervasiveness of making prior agreements on posterior compensations, suggesting that this behavior could have been shaped by natural selection. Here, we analyze the evolutionary relevance of such a commitment strategy and relate it to the costly punishment strategy, where no prior agreements are made. We show that when the cost of arranging a commitment deal lies within certain limits, substantial levels of cooperation can be achieved. Moreover, these levels are higher than that achieved by simple costly punishment, especially when one insists on sharing the arrangement cost. Not only do we show that good agreements make good friends, agreements based on shared costs result in even better outcomes. PMID:24045873

International jurisprudence on trade and environmental health: one step forward, two steps back?

PubMed

Timmermans, Karin

2008-01-01

Since the creation of the World Trade Organization (WTO), there has been considerable debate regarding the impact of its rules on public health. By contrast, the role of the WTO dispute settlement mechanism has received little attention, even though the bodies responsible for settling disputes are the ultimate interpreters of WTO rules and agreements. To date, three WTO disputes that relate to occupational and/or environmental health have been fully litigated. A review of the decisions and reasoning in these cases indicates that WTO jurisprudence is evolving, as Panels and the Appellate Body try--with varying degrees of success--to balance countries' rights and obligations under international trade agreements with their right to protect occupational and environmental health. Disputes between nations can have an impact beyond the parties concerned, and raise questions about the relationship between trade agreements and other international agreements, especially multilateral environmental agreements (MEAs).

Recall bias in the assessment of exposure to mobile phones.

PubMed

Vrijheid, Martine; Armstrong, Bruce K; Bédard, Daniel; Brown, Julianne; Deltour, Isabelle; Iavarone, Ivano; Krewski, Daniel; Lagorio, Susanna; Moore, Stephen; Richardson, Lesley; Giles, Graham G; McBride, Mary; Parent, Marie-Elise; Siemiatycki, Jack; Cardis, Elisabeth

2009-05-01

Most studies of mobile phone use are case-control studies that rely on participants' reports of past phone use for their exposure assessment. Differential errors in recalled phone use are a major concern in such studies. INTERPHONE, a multinational case-control study of brain tumour risk and mobile phone use, included validation studies to quantify such errors and evaluate the potential for recall bias. Mobile phone records of 212 cases and 296 controls were collected from network operators in three INTERPHONE countries over an average of 2 years, and compared with mobile phone use reported at interview. The ratio of reported to recorded phone use was analysed as measure of agreement. Mean ratios were virtually the same for cases and controls: both underestimated number of calls by a factor of 0.81 and overestimated call duration by a factor of 1.4. For cases, but not controls, ratios increased with increasing time before the interview; however, these trends were based on few subjects with long-term data. Ratios increased by level of use. Random recall errors were large. In conclusion, there was little evidence for differential recall errors overall or in recent time periods. However, apparent overestimation by cases in more distant time periods could cause positive bias in estimates of disease risk associated with mobile phone use.

Do differences in profiling criteria bias performance measurements? Economic profiling of medical clinics under the Korea National Health Insurance program: an observational study using claims data.

PubMed

Kang, Hee-Chung; Hong, Jae-Seok

2011-08-16

With a greater emphasis on cost containment in many health care systems, it has become common to evaluate each physician's relative resource use. This study explored the major factors that influence the economic performance rankings of medical clinics in the Korea National Health Insurance (NHI) program by assessing the consistency between cost-efficiency indices constructed using different profiling criteria. Data on medical care benefit costs for outpatient care at medical clinics nationwide were collected from the NHI claims database. We calculated eight types of cost-efficiency index with different profiling criteria for each medical clinic and investigated the agreement between the decile rankings of each index pair using the weighted kappa statistic. The exclusion of pharmacy cost lowered agreement between rankings to the lowest level, and differences in case-mix classification also lowered agreement considerably. A medical clinic may be identified as either cost-efficient or cost-inefficient, even when using the same index, depending on the profiling criteria applied. Whether a country has a single insurance or a multiple-insurer system, it is very important to have standardized profiling criteria for the consolidated management of health care costs.

A multinational case-control study on childhood brain tumours, anthropogenic factors, birth characteristics and prenatal exposures: A validation of interview data.

PubMed

Vienneau, Danielle; Infanger, Denis; Feychting, Maria; Schüz, Joachim; Schmidt, Lisbeth Samsø; Poulsen, Aslak Harbo; Tettamanti, Giorgio; Klæboe, Lars; Kuehni, Claudia E; Tynes, Tore; Von der Weid, Nicolas; Lannering, Birgitta; Röösli, Martin

2016-02-01

Little is known about the aetiology of childhood brain tumours. We investigated anthropometric factors (birth weight, length, maternal age), birth characteristics (e.g. vacuum extraction, preterm delivery, birth order) and exposures during pregnancy (e.g. maternal: smoking, working, dietary supplement intake) in relation to risk of brain tumour diagnosis among 7-19 year olds. The multinational case-control study in Denmark, Sweden, Norway and Switzerland (CEFALO) included interviews with 352 (participation rate=83.2%) eligible cases and 646 (71.1%) population-based controls. Interview data were complemented with data from birth registries and validated by assessing agreement (Cohen's Kappa). We used conditional logistic regression models matched on age, sex and geographical region (adjusted for maternal age and parental education) to explore associations between birth factors and childhood brain tumour risk. Agreement between interview and birth registry data ranged from moderate (Kappa=0.54; worked during pregnancy) to almost perfect (Kappa=0.98; birth weight). Neither anthropogenic factors nor birth characteristics were associated with childhood brain tumour risk. Maternal vitamin intake during pregnancy was indicative of a protective effect (OR 0.75, 95%-CI: 0.56-1.01). No association was seen for maternal smoking during pregnancy or working during pregnancy. We found little evidence that the considered birth factors were related to brain tumour risk among children and adolescents. Copyright © 2015 Elsevier Ltd. All rights reserved.

Agreement between gastrointestinal panel testing and standard microbiology methods for detecting pathogens in suspected infectious gastroenteritis: Test evaluation and meta-analysis in the absence of a reference standard.

PubMed

Freeman, Karoline; Tsertsvadze, Alexander; Taylor-Phillips, Sian; McCarthy, Noel; Mistry, Hema; Manuel, Rohini; Mason, James

2017-01-01

Multiplex gastrointestinal pathogen panel (GPP) tests simultaneously identify bacterial, viral and parasitic pathogens from the stool samples of patients with suspected infectious gastroenteritis presenting in hospital or the community. We undertook a systematic review to compare the accuracy of GPP tests with standard microbiology techniques. Searches in Medline, Embase, Web of Science and the Cochrane library were undertaken from inception to January 2016. Eligible studies compared GPP tests with standard microbiology techniques in patients with suspected gastroenteritis. Quality assessment of included studies used tailored QUADAS-2. In the absence of a reference standard we analysed test performance taking GPP tests and standard microbiology techniques in turn as the benchmark test, using random effects meta-analysis of proportions. No study provided an adequate reference standard with which to compare the test accuracy of GPP and conventional tests. Ten studies informed a meta-analysis of positive and negative agreement. Positive agreement across all pathogens was 0.93 (95% CI 0.90 to 0.96) when conventional methods were the benchmark and 0.68 (95% CI: 0.58 to 0.77) when GPP provided the benchmark. Negative agreement was high in both instances due to the high proportion of negative cases. GPP testing produced a greater number of pathogen-positive findings than conventional testing. It is unclear whether these additional 'positives' are clinically important. GPP testing has the potential to simplify testing and accelerate reporting when compared to conventional microbiology methods. However the impact of GPP testing upon the management, treatment and outcome of patients is poorly understood and further studies are needed to evaluate the health economic impact of GPP testing compared with standard methods. The review protocol is registered with PROSPERO as CRD42016033320.

Multicenter accuracy and interobserver agreement of spot sign identification in acute intracerebral hemorrhage.

PubMed

Huynh, Thien J; Flaherty, Matthew L; Gladstone, David J; Broderick, Joseph P; Demchuk, Andrew M; Dowlatshahi, Dar; Meretoja, Atte; Davis, Stephen M; Mitchell, Peter J; Tomlinson, George A; Chenkin, Jordan; Chia, Tze L; Symons, Sean P; Aviv, Richard I

2014-01-01

Rapid, accurate, and reliable identification of the computed tomography angiography spot sign is required to identify patients with intracerebral hemorrhage for trials of acute hemostatic therapy. We sought to assess the accuracy and interobserver agreement for spot sign identification. A total of 131 neurology, emergency medicine, and neuroradiology staff and fellows underwent imaging certification for spot sign identification before enrolling patients in 3 trials targeting spot-positive intracerebral hemorrhage for hemostatic intervention (STOP-IT, SPOTLIGHT, STOP-AUST). Ten intracerebral hemorrhage cases (spot-positive/negative ratio, 1:1) were presented for evaluation of spot sign presence, number, and mimics. True spot positivity was determined by consensus of 2 experienced neuroradiologists. Diagnostic performance, agreement, and differences by training level were analyzed. Mean accuracy, sensitivity, and specificity for spot sign identification were 87%, 78%, and 96%, respectively. Overall sensitivity was lower than specificity (P<0.001) because of true spot signs incorrectly perceived as spot mimics. Interobserver agreement for spot sign presence was moderate (k=0.60). When true spots were correctly identified, 81% correctly identified the presence of single or multiple spots. Median time needed to evaluate the presence of a spot sign was 1.9 minutes (interquartile range, 1.2-3.1 minutes). Diagnostic performance, interobserver agreement, and time needed for spot sign evaluation were similar among staff physicians and fellows. Accuracy for spot identification is high with opportunity for improvement in spot interpretation sensitivity and interobserver agreement particularly through greater reliance on computed tomography angiography source data and awareness of limitations of multiplanar images. Further prospective study is needed.

Comparative Study of IS6110 Restriction Fragment Length Polymorphism and Variable-Number Tandem-Repeat Typing of Mycobacterium tuberculosis Isolates in the Netherlands, Based on a 5-Year Nationwide Survey

PubMed Central

de Beer, Jessica L.; van Ingen, Jakko; de Vries, Gerard; Erkens, Connie; Sebek, Maruschka; Mulder, Arnout; Sloot, Rosa; van den Brandt, Anne-Marie; Enaimi, Mimount; Kremer, Kristin; Supply, Philip

2013-01-01

In order to switch from IS6110 and polymorphic GC-rich repetitive sequence (PGRS) restriction fragment length polymorphism (RFLP) to 24-locus variable-number tandem-repeat (VNTR) typing of Mycobacterium tuberculosis complex isolates in the national tuberculosis control program in The Netherlands, a detailed evaluation on discriminatory power and agreement with findings in a cluster investigation was performed on 3,975 tuberculosis cases during the period of 2004 to 2008. The level of discrimination of the two typing methods did not differ substantially: RFLP typing yielded 2,733 distinct patterns compared to 2,607 in VNTR typing. The global concordance, defined as isolates labeled unique or identically distributed in clusters by both methods, amounted to 78.5% (n = 3,123). Of the remaining 855 cases, 12% (n = 479) of the cases were clustered only by VNTR, 7.7% (n = 305) only by RFLP typing, and 1.8% (n = 71) revealed different cluster compositions in the two approaches. A cluster investigation was performed for 87% (n = 1,462) of the cases clustered by RFLP. For the 740 cases with confirmed or presumed epidemiological links, 92% were concordant with VNTR typing. In contrast, only 64% of the 722 cases without an epidemiological link but clustered by RFLP typing were also clustered by VNTR typing. We conclude that VNTR typing has a discriminatory power equal to IS6110 RFLP typing but is in better agreement with findings in a cluster investigation performed on an RFLP-clustering-based cluster investigation. Both aspects make VNTR typing a suitable method for tuberculosis surveillance systems. PMID:23363841

Satisfaction in the Intensive Care Unit (ICU). Patient opinion as a cornerstone.

PubMed

Holanda Peña, M S; Talledo, N Marina; Ots Ruiz, E; Lanza Gómez, J M; Ruiz Ruiz, A; García Miguelez, A; Gómez Marcos, V; Domínguez Artiga, M J; Hernández Hernández, M Á; Wallmann, R; Llorca Díaz, J

2017-03-01

To study the agreement between the level of satisfaction of patients and their families referred to the care and attention received during admission to the ICU. A prospective, 5-month observational and descriptive study was carried out. ICU of Marqués de Valdecilla University Hospital, Santander (Spain). Adult patients with an ICU stay longer than 24h, who were discharged to the ward during the period of the study, and their relatives. Instrument: FS-ICU 34 for assessing family satisfaction, and an adaptation of the FS-ICU 34 for patients. The Cohen kappa index was calculated to assess agreement between answers. An analysis was made of the questionnaires from one same family unit, obtaining 148 pairs of surveys (296 questionnaires). The kappa index ranged between 0.278-0.558, which is indicative of mild to moderate agreement. The families of patients admitted to the ICU cannot be regarded as good proxies, at least for competent patients. In such cases, we must refer to these patients in order to obtain first hand information on their feelings, perceptions and experiences during admission to the ICU. Only when patients are unable to actively participate in the care process should their relatives be consulted. Copyright © 2016 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.