Standardized assessment of tumor-infiltrating lymphocytes in breast cancer: an evaluation of inter-observer agreement between pathologists.

PubMed

Tramm, Trine; Di Caterino, Tina; Jylling, Anne-Marie B; Lelkaitis, Giedrius; Lænkholm, Anne-Vibeke; Ragó, Péter; Tabor, Tomasz P; Talman, Maj-Lis M; Vouza, Emmanouela

2018-01-01

In breast cancer, there is a growing body of evidence that tumor-infiltrating lymphocytes (TILs) may have clinical utility and may be able to direct clinical decisions for subgroups of patients. Clinical utility is, however, not sufficient for warranting the implementation of a new biomarker in the routine practice, and evaluation of the analytical validity is needed, including testing the reproducibility of decentralized assessment of TILs. The aim of this study was to evaluate the inter-observer agreement of TILs assessment using a standardized method, as proposed by the International TILs Working Group 2014, applied to a cohort of breast cancers reflecting an average breast cancer population. Stromal TILs were assessed using full slide sections from 124 breast cancers with varying histology, malignancy grade and ER- and HER2 status. TILs were estimated by nine dedicated breast pathologists using scanned hematoxylin-eosin stainings. TILs results were categorized using various cutoffs, and the inter-observer agreement was evaluated using the intraclass coefficient (ICC), Kappa statistics as well as individual overall agreements with the median value of TILs. Evaluation of TILs led to an ICC of 0.71 (95% CI: 0.65-0.77) corresponding to an acceptable agreement. Kappa values were in the range of 0.38-0.46 corresponding to a fair to moderate agreement. The individual agreements increased, when using only two categories ('high' vs. 'low' TILs) and a cutoff of 50-60%. The results of the present study are in accordance with previous studies, and shows that the proposed methodology for standardized evaluation of TILs renders an acceptable inter-observer agreement. The findings, however, indicate that assessment of TILs needs further refinement, and is in support of the latest St. Gallen Consensus, that routine reporting of TILs for early breast cancer is not ready for implementation in a clinical setting.

Scoring haemophilic arthropathy on X-rays: improving inter- and intra-observer reliability and agreement using a consensus atlas.

PubMed

Foppen, Wouter; van der Schaaf, Irene C; Beek, Frederik J A; Verkooijen, Helena M; Fischer, Kathelijn

2016-06-01

The radiological Pettersson score (PS) is widely applied for classification of arthropathy to evaluate costly haemophilia treatment. This study aims to assess and improve inter- and intra-observer reliability and agreement of the PS. Two series of X-rays (bilateral elbows, knees, and ankles) of 10 haemophilia patients (120 joints) with haemophilic arthropathy were scored by three observers according to the PS (maximum score 13/joint). Subsequently, (dis-)agreement in scoring was discussed until consensus. Example images were collected in an atlas. Thereafter, second series of 120 joints were scored using the atlas. One observer rescored the second series after three months. Reliability was assessed by intraclass correlation coefficients (ICC), agreement by limits of agreement (LoA). Median Pettersson score at joint level (PSjoint) of affected joints was 6 (interquartile range 3-9). Using the consensus atlas, inter-observer reliability of the PSjoint improved significantly from 0.94 (95 % confidence interval (CI) 0.91-0.96) to 0.97 (CI 0.96-0.98). LoA improved from ±1.7 to ±1.1 for the PSjoint. Therefore, true differences in arthropathy were differences in the PSjoint of >2 points. Intra-observer reliability of the PSjoint was 0.98 (CI 0.97-0.98), intra-observer LoA were ±0.9 points. Reliability and agreement of the PS improved by using a consensus atlas. • Reliability of the Pettersson score significantly improved using the consensus atlas. • The presented consensus atlas improved the agreement among observers. • The consensus atlas could be recommended to obtain a reproducible Pettersson score.

AO Distal Radius Fracture Classification: Global Perspective on Observer Agreement.

PubMed

Jayakumar, Prakash; Teunis, Teun; Giménez, Beatriz Bravo; Verstreken, Frederik; Di Mascio, Livio; Jupiter, Jesse B

2017-02-01

Background  The primary objective of this study was to test interobserver reliability when classifying fractures by consensus by AO types and groups among a large international group of surgeons. Secondarily, we assessed the difference in inter- and intraobserver agreement of the AO classification in relation to geographical location, level of training, and subspecialty. Methods  A randomized set of radiographic and computed tomographic images from a consecutive series of 96 distal radius fractures (DRFs), treated between October 2010 and April 2013, was classified using an electronic web-based portal by an invited group of participants on two occasions. Results  Interobserver reliability was substantial when classifying AO type A fractures but fair and moderate for type B and C fractures, respectively. No difference was observed by location, except for an apparent difference between participants from India and Australia classifying type B fractures. No statistically significant associations were observed comparing interobserver agreement by level of training and no differences were shown comparing subspecialties. Intra-rater reproducibility was "substantial" for fracture types and "fair" for fracture groups with no difference accounting for location, training level, or specialty. Conclusion  Improved definition of reliability and reproducibility of this classification may be achieved using large international groups of raters, empowering decision making on which system to utilize. Level of Evidence  Level III.

AO Distal Radius Fracture Classification: Global Perspective on Observer Agreement

PubMed Central

Jayakumar, Prakash; Teunis, Teun; Giménez, Beatriz Bravo; Verstreken, Frederik; Di Mascio, Livio; Jupiter, Jesse B.

2016-01-01

Background The primary objective of this study was to test interobserver reliability when classifying fractures by consensus by AO types and groups among a large international group of surgeons. Secondarily, we assessed the difference in inter- and intraobserver agreement of the AO classification in relation to geographical location, level of training, and subspecialty. Methods A randomized set of radiographic and computed tomographic images from a consecutive series of 96 distal radius fractures (DRFs), treated between October 2010 and April 2013, was classified using an electronic web-based portal by an invited group of participants on two occasions. Results Interobserver reliability was substantial when classifying AO type A fractures but fair and moderate for type B and C fractures, respectively. No difference was observed by location, except for an apparent difference between participants from India and Australia classifying type B fractures. No statistically significant associations were observed comparing interobserver agreement by level of training and no differences were shown comparing subspecialties. Intra-rater reproducibility was “substantial” for fracture types and “fair” for fracture groups with no difference accounting for location, training level, or specialty. Conclusion Improved definition of reliability and reproducibility of this classification may be achieved using large international groups of raters, empowering decision making on which system to utilize. Level of Evidence Level III PMID:28119795

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.

Inter-Observer Agreement of Whole-Body Computed Tomography in Staging and Response Assessment in Lymphoma: The Lugano Classification.

PubMed

Razek, Ahmed Abdel Khalek Abdel; Shamaa, Sameh; Lattif, Mahmoud Abdel; Yousef, Hanan Hamid

2017-01-01

To assess inter-observer agreement of whole-body computed tomography (WBCT) in staging and response assessment in lymphoma according to the Lugano classification. Retrospective analysis was conducted of 115 consecutive patients with lymphomas (45 females, 70 males; mean age of 46 years). Patients underwent WBCT with a 64 multi-detector CT device for staging and response assessment after a complete course of chemotherapy. Image analysis was performed by 2 reviewers according to the Lugano classification for staging and response assessment. The overall inter-observer agreement of WBCT in staging of lymphoma was excellent ( k =0.90, percent agreement=94.9%). There was an excellent inter-observer agreement for stage I ( k =0.93, percent agreement=96.4%), stage II ( k =0.90, percent agreement=94.8%), stage III ( k =0.89, percent agreement=94.6%) and stage IV ( k =0.88, percent agreement=94%). The overall inter-observer agreement in response assessment after a completer course of treatment was excellent ( k =0.91, percent agreement=95.8%). There was an excellent inter-observer agreement in progressive disease ( k =0.94, percent agreement=97.1%), stable disease ( k =0.90, percent agreement=95%), partial response ( k =0.96, percent agreement=98.1%) and complete response ( k =0.87, Percent agreement=93.3%). We concluded that WBCT is a reliable and reproducible imaging modality for staging and treatment assessment in lymphoma according to the Lugano classification.

Intra-observer and inter-observer agreements for the measurement of dual-input whole tumor computed tomography perfusion in patients with lung cancer: Influences of the size and inner-air density of tumors.

PubMed

Wang, Qingle; Zhang, Zhiyong; Shan, Fei; Shi, Yuxin; Xing, Wei; Shi, Liangrong; Zhang, Xingwei

2017-09-01

This study was conducted to assess intra-observer and inter-observer agreements for the measurement of dual-input whole tumor computed tomography perfusion (DCTP) in patients with lung cancer. A total of 88 patients who had undergone DCTP, which had proved a diagnosis of primary lung cancer, were divided into two groups: (i) nodules (diameter ≤3 cm) and masses (diameter >3 cm) by size, and (ii) tumors with and without air density. Pulmonary flow, bronchial flow, and pulmonary index were measured in each group. Intra-observer and inter-observer agreements for measurement were assessed using intraclass correlation coefficient, within-subject coefficient of variation, and Bland-Altman analysis. In all lung cancers, the reproducibility coefficient for intra-observer agreement (range 26.1-38.3%) was superior to inter-observer agreement (range 38.1-81.2%). Further analysis revealed lower agreements for nodules compared to masses. Additionally, inner-air density reduced both agreements for lung cancer. The intra-observer agreement for measuring lung cancer DCTP was satisfied, while the inter-observer agreement was limited. The effects of tumoral size and inner-air density to agreements, especially between two observers, should be emphasized. In future, an automatic computer-aided segment of perfusion value of the tumor should be developed. © 2017 The Authors. Thoracic Cancer published by China Lung Oncology Group and John Wiley & Sons Australia, Ltd.

Inter- and Intra-Observer Agreement in Ultrasound BI-RADS Classification and Real-Time Elastography Tsukuba Score Assessment of Breast Lesions.

PubMed

Schwab, Fabienne; Redling, Katharina; Siebert, Matthias; Schötzau, Andy; Schoenenberger, Cora-Ann; Zanetti-Dällenbach, Rosanna

2016-11-01

Our aim was to prospectively evaluate inter- and intra-observer agreement between Breast Imaging Reporting and Data System (BI-RADS) classifications and Tsukuba elasticity scores (TSs) of breast lesions. The study included 164 breast lesions (63 malignant, 101 benign). The BI-RADS classification and TS of each breast lesion was assessed by the examiner and twice by three reviewers at an interval of 2 months. Weighted κ values for inter-observer agreement ranged from moderate to substantial for BI-RADS classification (κ = 0.585-0.738) and was substantial for TS (κ = 0.608-0.779). Intra-observer agreement was almost perfect for ultrasound (US) BI-RADS (κ = 0.847-0.872) and TS (κ = 0.879-0.914). Overall, individual reviewers are highly self-consistent (almost perfect intra-observer agreement) with respect to BI-RADS classification and TS, whereas inter-observer agreement was moderate to substantial. Comprehensive training is essential for achieving high agreement and minimizing the impact of subjectivity. Our results indicate that breast US and real-time elastography can achieve high diagnostic performance. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Evaluation of inter-observer agreement when using a clinical respiratory scoring system in pre-weaned dairy calves.

PubMed

Buczinski, S; Faure, C; Jolivet, S; Abdallah, A

2016-07-01

To determine inter-observer agreement for a clinical scoring system for the detection of bovine respiratory disease complex in calves, and the impact of classification of calves as sick or healthy based on different cut-off values. Two third-year veterinary students (Observer 1 and 2) and one post-graduate student (Observer 3) received 4 hours of training on scoring dairy calves for signs of respiratory disease, including rectal temperature, cough, eye and nasal discharge, and ear position. Observers 1 and 2 scored 40 pre-weaning dairy calves 24 hours apart (80 observations) over three visits to a calf-rearing facility, and Observers 1, 2 and 3 scored 20 calves on one visit. Inter-observer agreement was assessed using percentage of agreement (PA) and Kappa statistics for individual clinical signs, comparing Observers 1 and 2. Agreement between the three observers for total clinical score was assessed using cut-off values of ≥4, ≥5 and ≥6 to indicate unhealthy calves. Inter-observer PA for rectal temperature was 0.68, for cough 0.78, for nasal discharge 0.62, for eye discharge 0.63, and for ear position 0.85. Kappa values for all clinical signs indicated slight to fair agreement (<0.4), except temperature that had moderate agreement (0.6). The Fleiss' Kappa for total score, using cut-offs of ≥4, ≥5 and ≥6 to indicate unhealthy calves, was 0.35, 0.06 and 0.13, respectively, indicating slight to fair agreement. There was important inter-observer discrepancies in scoring clinical signs of respiratory disease, using relatively inexperienced observers. These disagreements may ultimately mean increased false negative or false positive diagnoses and incorrect treatment of cases. Visual assessment of clinical signs associated with bovine respiratory disease needs to be thoroughly validated when disease monitoring is based on the use of a clinical scoring system.

Coronary artery disease reporting and data system (CAD-RADSTM): Inter-observer agreement for assessment categories and modifiers.

PubMed

Maroules, Christopher D; Hamilton-Craig, Christian; Branch, Kelley; Lee, James; Cury, Roberto C; Maurovich-Horvat, Pál; Rubinshtein, Ronen; Thomas, Dustin; Williams, Michelle; Guo, Yanshu; Cury, Ricardo C

The Coronary Artery Disease Reporting and Data System (CAD-RADS) provides a lexicon and standardized reporting system for coronary CT angiography. To evaluate inter-observer agreement of the CAD-RADS among an panel of early career and expert readers. Four early career and four expert cardiac imaging readers prospectively and independently evaluated 50 coronary CT angiography cases using the CAD-RADS lexicon. All readers assessed image quality using a five-point Likert scale, with mean Likert score ≥4 designating high image quality, and <4 designating moderate/low image quality. All readers were blinded to medical history and invasive coronary angiography findings. Inter-observer agreement for CAD-RADS assessment categories and modifiers were assessed using intra-class correlation (ICC) and Fleiss' Kappa (κ).The impact of reader experience and image quality on inter-observer agreement was also examined. Inter-observer agreement for CAD-RADS assessment categories was excellent (ICC 0.958, 95% CI 0.938-0.974, p < 0.0001). Agreement among expert readers (ICC 0.925, 95% CI 0.884-0.954) was marginally stronger than for early career readers (ICC 0.904, 95% CI 0.852-0.941), both p < 0.0001. High image quality was associated with stronger agreement than moderate image quality (ICC 0.944, 95% CI 0.886-0.974 vs. ICC 0.887, 95% CI 0.775-0.95, both p < 0.0001). While excellent inter-observer agreement was observed for modifiers S (stent) and G (bypass graft) (both κ = 1.0), only fair agreement (κ = 0.40) was observed for modifier V (high risk plaque). Inter-observer reproducibility of CAD-RADS assessment categories and modifiers is excellent, except for high-risk plaque (modifier V) which demonstrates fair agreement. These results suggest CAD-RADS is feasible for clinical implementation. Copyright © 2017. Published by Elsevier Inc.

Inter-observer agreement of a multi-parameter campsite monitoring program on the Dixie National Forest, Utah

Treesearch

Nicholas J. Glidden; Martha E. Lee

2007-01-01

Precision is crucial to campsite monitoring programs. Yet, little empirical research has ever been published on the level of precision of this type of monitoring programs. The purpose of this study was to evaluate the level of agreement between observers of campsite impacts using a multi-parameter campsite monitoring program. Thirteen trained observers assessed 16...

[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.

Morphology vs morphokinetics: a retrospective comparison of inter-observer and intra-observer agreement between embryologists on blastocysts with known implantation outcome.

PubMed

Adolfsson, Emma; Andershed, Anna Nowosad

2018-06-18

Our primary aim was to compare the morphology and morphokinetics on inter- and intra-observer agreement for blastocyst with known implantation outcome. Our secondary aim was to validate the morphokinetic parameters' ability to predict pregnancy using a previous published selection algorithm, and to compare this to standard morphology assessments. Two embryologists made independent blinded annotations on two occasions using time-lapse images and morphology evaluations using the Gardner Schoolcraft criteria of 99 blastocysts with known implantation outcome. Inter- and intra-observer agreement was calculated and compared using the two methods. The embryos were grouped based on their morphological score, and on their morphokinetic class using a previous published selection algorithm. The implantation rates for each group was calculated and compared. There was moderate agreement for morphology, with agreement on the same embryo score in 55 of 99 cases. The highest agreement rate was found for expansion grade, followed by trophectoderm and inner cell mass. Correlation with pregnancy was inconclusive. For morphokinetics, almost perfect agreement was found for early and late embryo development events, and strong agreement for day-2 and day-3 events. When applying the selection algorithm, the embryo distributions were uneven, and correlation to pregnancy was inconclusive. Time-lapse annotation is consistent and accurate, but our external validation of a previously published selection algorithm was unsuccessful.

Teacher and TA Ratings of Preschoolers' Externalizing Behavior: Agreement and Associations with Observed Classroom Behavior

ERIC Educational Resources Information Center

Wolcott, Catherine Sanger; Williford, Amanda P.

2015-01-01

The present study investigated teachers' and teacher aides' (TAs) agreement in their ratings of preschoolers' externalizing behavior and their associations with observed classroom behavior for a sample of children at risk of developing a disruptive behavior disorder. One hundred twenty-two teachers rated 360 students' externalizing behavior in the…

Examining Interrater Agreement Analyses of a Pilot Special Education Observation Tool

ERIC Educational Resources Information Center

Johnson, Evelyn S.; Semmelroth, Carrie L.

2012-01-01

This paper reports the results of interrater agreement analyses on a pilot special education teacher evaluation instrument, the Recognizing Effective Special Education Teachers (RESET) Observation Tool (OT). Using evidence-based instructional practices as the basis for the evaluation, the RESET OT is designed for the spectrum of different…

Interjudge agreement in videofluoroscopic studies of swallowing.

PubMed

Wilcox, F; Liss, J M; Siegel, G M

1996-02-01

Videofluoroscopic swallowing examinations of 3 patients with dysphagia were reviewed independently by 10 speech-language pathologists. Prior to viewing each video, clinicians were provided with information about the patient's history, the results of a bedside swallow examination, and oral-facial and oral motor control examinations. Clinicians completed a swallowing observation protocol as they viewed each video. They then recommended, from a list of treatment strategies, intervention techniques that would be most appropriate for each patient. Interjudge agreement was calculated by determining how many clinicians observed a given swallowing event or deficit, and how many recommended a given treatment strategy. Results suggest that the level of interjudge agreement for videofluoroscopic evaluations is not encouragingly high.

Computed Tomography Assessment of Hepatic Metastases of Breast Cancer with Revised Response Evaluation Criteria in Solid Tumors (RECIST) Criteria (Version 1.1): Inter-Observer Agreement.

PubMed

Ghobrial, Fady Emil Ibrahim; Eldin, Manal Salah; Razek, Ahmed Abdel Khalek Abdel; Atwan, Nadia Ibrahim; Shamaa, Sameh Sayed Ahmed

2017-01-01

To assess inter-observer agreement of revised RECIST criteria (version 1.1) for computed tomography assessment of hepatic metastases of breast cancer. A prospective study was conducted in 28 female patients with breast cancer and with at least one measurable metastatic lesion in the liver that was treated with 3 cycles of anthracycline-based chemotherapy. All patients underwent computed tomography of the abdomen with 64-row multi- detector CT at baseline and after 3 cycles of chemotherapy for response assessment. Image analysis was performed by 2 observers, based on the RECIST criteria (version 1.1). Computed tomography revealed partial response of hepatic metastases in 7 patients (25%) by one observer and in 10 patients (35.7%) by the other observer, with good inter-observer agreement (k=0.75, percent agreement of 89.29%). Stable disease was detected in 19 patients (67.8%) by one observer and in 16 patients (57.1%) by the other observer, with good agreement (k=0.774, percent agreement of 89.29%). Progressive disease was detected in 2 patients (7.2%) by both observers, with perfect agreement (k=1, percent agreement of 100%). The overall inter-observer agreement in the CT-based response assessment of hepatic metastasis between the two observers was good ( k =0.793, percent agreement of 89.29%). We concluded that computed tomography is a reliable and reproducible imaging modality for response assessment of hepatic metastases of breast cancer according to the RECIST criteria (version 1.1).

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.

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

Effects of Type of Agreement Violation and Utterance Position on the Auditory Processing of Subject-Verb Agreement: An ERP Study

PubMed Central

Dube, Sithembinkosi; Kung, Carmen; Peter, Varghese; Brock, Jon; Demuth, Katherine

2016-01-01

Previous ERP studies have often reported two ERP components—LAN and P600—in response to subject-verb (S-V) agreement violations (e.g., the boys *runs). However, the latency, amplitude and scalp distribution of these components have been shown to vary depending on various experiment-related factors. One factor that has not received attention is the extent to which the relative perceptual salience related to either the utterance position (verbal inflection in utterance-medial vs. utterance-final contexts) or the type of agreement violation (errors of omission vs. errors of commission) may influence the auditory processing of S-V agreement. The lack of reports on these effects in ERP studies may be due to the fact that most studies have used the visual modality, which does not reveal acoustic information. To address this gap, we used ERPs to measure the brain activity of Australian English-speaking adults while they listened to sentences in which the S-V agreement differed by type of agreement violation and utterance position. We observed early negative and positive clusters (AN/P600 effects) for the overall grammaticality effect. Further analysis revealed that the mean amplitude and distribution of the P600 effect was only significant in contexts where the S-V agreement violation occurred utterance-finally, regardless of type of agreement violation. The mean amplitude and distribution of the negativity did not differ significantly across types of agreement violation and utterance position. These findings suggest that the increased perceptual salience of the violation in utterance final position (due to phrase-final lengthening) influenced how S-V agreement violations were processed during sentence comprehension. Implications for the functional interpretation of language-related ERPs and experimental design are discussed. PMID:27625617

Effects of Type of Agreement Violation and Utterance Position on the Auditory Processing of Subject-Verb Agreement: An ERP Study.

PubMed

Dube, Sithembinkosi; Kung, Carmen; Peter, Varghese; Brock, Jon; Demuth, Katherine

2016-01-01

Previous ERP studies have often reported two ERP components-LAN and P600-in response to subject-verb (S-V) agreement violations (e.g., the boys (*) runs). However, the latency, amplitude and scalp distribution of these components have been shown to vary depending on various experiment-related factors. One factor that has not received attention is the extent to which the relative perceptual salience related to either the utterance position (verbal inflection in utterance-medial vs. utterance-final contexts) or the type of agreement violation (errors of omission vs. errors of commission) may influence the auditory processing of S-V agreement. The lack of reports on these effects in ERP studies may be due to the fact that most studies have used the visual modality, which does not reveal acoustic information. To address this gap, we used ERPs to measure the brain activity of Australian English-speaking adults while they listened to sentences in which the S-V agreement differed by type of agreement violation and utterance position. We observed early negative and positive clusters (AN/P600 effects) for the overall grammaticality effect. Further analysis revealed that the mean amplitude and distribution of the P600 effect was only significant in contexts where the S-V agreement violation occurred utterance-finally, regardless of type of agreement violation. The mean amplitude and distribution of the negativity did not differ significantly across types of agreement violation and utterance position. These findings suggest that the increased perceptual salience of the violation in utterance final position (due to phrase-final lengthening) influenced how S-V agreement violations were processed during sentence comprehension. Implications for the functional interpretation of language-related ERPs and experimental design are discussed.

Home safety practices in an urban low-income population: level of agreement between parental self-report and observed behaviors.

PubMed

Lee, Lois K; Walia, Taranjeev; Forbes, Peter W; Osganian, Stavroula K; Samuels, Ronald; Cox, Joanne E; Mooney, David P

2012-12-01

Home-related injuries are overrepresented in children from low-income households. The objectives of this study were to determine frequencies of home safety behaviors and the level of agreement between parental self-report and observed safety practices in low-income homes. In a prospective, interventional home injury prevention study of 49 low-income families with children <5 years old, a trained home visitor administered baseline parental home safety behavior questionnaires and assessments. There was high agreement between caregiver self-report and home visitor observation for lack of cabinet latch (99%, 95% confidence interval [CI] = 88%-99%) and stair gate use (100%, 95% CI = 88-100%). There was lower agreement for the safe storage of cleaning supplies (62%, 95% CI = 46%-75%), sharps (74%, 95% CI = 59%-85%), and medicines/vitamins (83%, 95% CI = 69%-92%) because of the overreporting of safe practices. Self-reports of some home safety behaviors are relatively accurate, but certain practices may need to be verified by direct assessment.

How to determine leg dominance: The agreement between self-reported and observed performance in healthy adults

PubMed Central

Meddeler, Bart M.; Hoogeboom, Thomas J.; Nijhuis-van der Sanden, Maria W. G.; van Cingel, Robert E. H.

2017-01-01

Context Since decades leg dominance is suggested to be important in rehabilitation and return to play in athletes with anterior cruciate ligament injuries. However, an ideal method to determine leg dominance in relation to task performance is still lacking. Objective To test the agreement between self-reported and observed leg dominance in bilateral mobilizing and unilateral stabilizing tasks, and to assess whether the dominant leg switches between bilateral mobilizing tasks and unilateral stabilizing tasks. Design Cross-sectional study. Participants Forty-one healthy adults: 21 men aged 36 ± 17 years old and 20 women aged 36 ±15 years old. Measurement and analysis Participants self-reported leg dominance in the Waterloo Footedness Questionnaire-Revised (WFQ-R), and leg dominance was observed during performance of four bilateral mobilizing tasks and two unilateral stabilizing tasks. Descriptive statistics and crosstabs were used to report the percentages of agreement. Results The leg used to kick a ball had 100% agreement between the self-reported and observed dominant leg for both men and women. The dominant leg in kicking a ball and standing on one leg was the same in 66.7% of the men and 85.0% of the women. The agreement with jumping with one leg was lower: 47.6% for men and 70.0% for women. Conclusions It is appropriate to ask healthy adults: “If you would shoot a ball on a target, which leg would you use to shoot the ball?” to determine leg dominance in bilateral mobilizing tasks. However, a considerable number of the participants switched the dominant leg in a unilateral stabilizing task. PMID:29287067

Inter-observer agreement of standard joint count examination and disease global assessment in a cohort of Egyptian Rheumatoid Arthritis patients.

PubMed

El-Hadidi, Khaled; Gamal, Sherif M; Saad, Sahar

2017-12-21

To assess the inter-observer agreement of standard joint count between experienced Rheumatology professor (Prof) and young Rheumatology fellow (candidate), and to compare disease global assessment between professor, young candidate and patients. This study included one hundred rheumatoid arthritis patients. For all patients independent clinical evaluation was done by two rheumatologists (professor and candidate) for detection of tenderness in 28 joints and swelling in 26 joints. The study also involved global assessment of disease activity by the provider (Prof and candidate) (EGA) as well as by the patient (PGA). The EGA was determined without previous knowledge of the patient's laboratory test results. A highly significant accordance (correlation) between professor and candidate was found in both the number of tender joints (p<0.001) (r=0.946), and the number of swollen joints (p<0.001) (r=0.797). Regarding swollen joints, the highest agreement was in right knee (0.929), while poor agreement was found in the right 5th MCP (0.049). Regarding tender joints, the highest analogy was in the right elbow (0.899), in contrast to the left 3rd PIP (0.462) which showed the least congruence. Agreement study using kappa measurement for disease global assessment showed: moderate agreement (between professor and candidate) (0.405), fair agreement between (professor and patient) (0.213), fair agreement between (candidate and patient) (0.367). Inter-observer reliability was better for TJCs than SJCs. Regarding SJCs agreement was better in large joints such as the knees compared to the small joints such as the MCPs. Disease global assessment may show discrepancy between patients and physicians. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

Inter-Observer Agreement on Subjects' Race and Race-Informative Characteristics

PubMed Central

Edgar, Heather J. H.; Daneshvari, Shamsi; Harris, Edward F.; Kroth, Philip J.

2011-01-01

Health and socioeconomic disparities tend to be experienced along racial and ethnic lines, but investigators are not sure how individuals are assigned to groups, or how consistent this process is. To address these issues, 1,919 orthodontic patient records were examined by at least two observers who estimated each individual's race and the characteristics that influenced each estimate. Agreement regarding race is high for African and European Americans, but not as high for Asian, Hispanic, and Native Americans. The indicator observers most often agreed upon as important in estimating group membership is name, especially for Asian and Hispanic Americans. The observers, who were almost all European American, most often agreed that skin color is an important indicator of race only when they also agreed the subject was European American. This suggests that in a diverse community, light skin color is associated with a particular group, while a range of darker shades can be associated with members of any other group. This research supports comparable studies showing that race estimations in medical records are likely reliable for African and European Americans, but are less so for other groups. Further, these results show that skin color is not consistently the primary indicator of an individual's race, but that other characteristics such as facial features add significant information. PMID:21897865

Inter- and intra-observer agreement of BI-RADS-based subjective visual estimation of amount of fibroglandular breast tissue with magnetic resonance imaging: comparison to automated quantitative assessment.

PubMed

Wengert, G J; Helbich, T H; Woitek, R; Kapetas, P; Clauser, P; Baltzer, P A; Vogl, W-D; Weber, M; Meyer-Baese, A; Pinker, Katja

2016-11-01

To evaluate the inter-/intra-observer agreement of BI-RADS-based subjective visual estimation of the amount of fibroglandular tissue (FGT) with magnetic resonance imaging (MRI), and to investigate whether FGT assessment benefits from an automated, observer-independent, quantitative MRI measurement by comparing both approaches. Eighty women with no imaging abnormalities (BI-RADS 1 and 2) were included in this institutional review board (IRB)-approved prospective study. All women underwent un-enhanced breast MRI. Four radiologists independently assessed FGT with MRI by subjective visual estimation according to BI-RADS. Automated observer-independent quantitative measurement of FGT with MRI was performed using a previously described measurement system. Inter-/intra-observer agreements of qualitative and quantitative FGT measurements were assessed using Cohen's kappa (k). Inexperienced readers achieved moderate inter-/intra-observer agreement and experienced readers a substantial inter- and perfect intra-observer agreement for subjective visual estimation of FGT. Practice and experience reduced observer-dependency. Automated observer-independent quantitative measurement of FGT was successfully performed and revealed only fair to moderate agreement (k = 0.209-0.497) with subjective visual estimations of FGT. Subjective visual estimation of FGT with MRI shows moderate intra-/inter-observer agreement, which can be improved by practice and experience. Automated observer-independent quantitative measurements of FGT are necessary to allow a standardized risk evaluation. • Subjective FGT estimation with MRI shows moderate intra-/inter-observer agreement in inexperienced readers. • Inter-observer agreement can be improved by practice and experience. • Automated observer-independent quantitative measurements can provide reliable and standardized assessment of FGT with MRI.

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.

An observational study of agreement between percentage pain reduction calculated from visual analog or numerical rating scales versus that reported by parturients during labor epidural analgesia.

PubMed

Pratici, E; Nebout, S; Merbai, N; Filippova, J; Hajage, D; Keita, H

2017-05-01

This study aimed to determine the level of agreement between calculated percentage pain reduction, derived from visual analog or numerical rating scales, and patient-reported percentage pain reduction in patients having labor epidural analgesia. In a prospective observational study, parturients were asked to rate their pain intensity on a visual analog scale and numerical rating scale, before and 30min after initiation of epidural analgesia. The percentage pain reduction 30min after epidural analgesia was calculated by the formula: 100×(score before epidural analgesia-score 30min after epidural analgesia)/score before epidural analgesia. To evaluate agreement between calculated percentage pain reduction and patient-reported percentage pain reduction, we computed the concordance correlation coefficient and performed Bland-Altman analysis. Ninety-seven women in labor were enrolled in the study, most of whom were nulliparous, with a singleton fetus and in spontaneous labor. The concordance correlation coefficient with patient-reported percentage pain reduction was 0.76 (95% CI 0.6 to 0.8) and 0.77 (95% CI 0.6 to 0.8) for the visual analog and numerical rating scale, respectively. The Bland-Altman mean difference between calculated percentage pain reduction and patient-reported percentage pain reduction for the visual analog and numerical rating scales was -2.0% (limits of agreement at 29.8%) and 0 (limits of agreement at 28.2%), respectively. The agreement between calculated percentage pain reduction from a visual analog or numerical rating scale and patient-reported percentage pain reduction in the context of labor epidural analgesia was moderate. The difference could range up to 30%. Patient-reported percentage pain reduction has advantages as a measurement tool for assessing pain management for childbirth but differences compared with other assessment methods should be taken into account. Copyright © 2017 Elsevier Ltd. All rights reserved.

MRMC analysis of agreement studies

NASA Astrophysics Data System (ADS)

Gallas, Brandon D.; Anam, Amrita; Chen, Weijie; Wunderlich, Adam; Zhang, Zhiwei

2016-03-01

The purpose of this work is to present and evaluate methods based on U-statistics to compare intra- or inter-reader agreement across different imaging modalities. We apply these methods to multi-reader multi-case (MRMC) studies. We measure reader-averaged agreement and estimate its variance accounting for the variability from readers and cases (an MRMC analysis). In our application, pathologists (readers) evaluate patient tissue mounted on glass slides (cases) in two ways. They evaluate the slides on a microscope (reference modality) and they evaluate digital scans of the slides on a computer display (new modality). In the current work, we consider concordance as the agreement measure, but many of the concepts outlined here apply to other agreement measures. Concordance is the probability that two readers rank two cases in the same order. Concordance can be estimated with a U-statistic and thus it has some nice properties: it is unbiased, asymptotically normal, and its variance is given by an explicit formula. Another property of a U-statistic is that it is symmetric in its inputs; it doesn't matter which reader is listed first or which case is listed first, the result is the same. Using this property and a few tricks while building the U-statistic kernel for concordance, we get a mathematically tractable problem and efficient software. Simulations show that our variance and covariance estimates are unbiased.

Effect of clinical information and previous exam execution on observer agreement and reliability in the analysis of hysteroscopic video-recordings.

PubMed

Martinho, Margarida Suzel Lopes; da Costa Santos, Cristina Maria Nogueira; Silva Carvalho, João Luís Mendonça; Bernardes, João Francisco Montenegro Andrade Lima

2018-02-01

Inter-observer agreement and reliability in hysteroscopic image assessment remain uncertain and the type of factors that may influence it has only been studied in relation to the experience of hysteroscopists. We aim to assess the effect of clinical information and previous exam execution on observer agreement and reliability in the analysis of hysteroscopic video-recordings. Ninety hysteroscopies were video-recorded and randomized into a group without (Group 1) and with clinical information (Group 2). The videos were independently analyzed by three hysteroscopists, regarding lesion location, dimension, and type, as well as decision to perform a biopsy. One of the hysteroscopists had executed all the exams before. Proportions of agreement (PA) and kappa statistics (κ) with 95% confidence intervals (95% CI) were used. In Group 2, there was a higher proportion of a normal diagnosis (p < 0.001) and a lower proportion of biopsies recommended (p = 0.027). Observer agreement and reliability were better in Group 2, with the PA and κ ranging, respectively, from 0.73 (95% CI 0.62, 0.83) and 0.44 (95% CI 0.26, 0.63), for image quality, to 0.94 (95% CI 0.88, 0.99) and 0.85 (95% CI 0.65, 0.95), for the decision to perform a biopsy. Execution of the exams before the analysis of the video-recordings did not significantly affect the results. With clinical information, agreement and reliability in the overall analysis of hysteroscopic video-recordings may reach almost perfect results and this was not significantly affected by the execution of the exams before the analysis. However, there is still uncertainty in the analysis of specific endometrial cavity abnormalities.

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

Observer agreement for detection of cardiac arrhythmias on telemetric ECG recordings obtained at rest, during and after exercise in 10 Warmblood horses.

PubMed

Trachsel, D S; Bitschnau, C; Waldern, N; Weishaupt, M A; Schwarzwald, C C

2010-11-01

Frequent supraventricular or ventricular arrhythmias during and after exercise are considered pathological in horses. Prevalence of arrhythmias seen in apparently healthy horses is still a matter of debate and may depend on breed, athletic condition and exercise intensity. To determine intra- and interobserver agreement for detection of arrhythmias at rest, during and after exercise using a telemetric electrocardiography device. The electrocardiogram (ECG) recordings of 10 healthy Warmblood horses (5 of which had an intracardiac catheter in place) undergoing a standardised treadmill exercise test were analysed at rest (R), during warm-up (W), during exercise (E), as well as during 0-5 min (PE(0-5)) and 6-45 min (PE(6-45)) recovery after exercise. The number and time of occurrence of physiological and pathological 'rhythm events' were recorded. Events were classified according to origin and mode of conduction. The agreement of 3 independent, blinded observers with different experience in ECG reading was estimated considering time of occurrence and classification of events. For correct timing and classification, intraobserver agreement for observer 1 was 97% (R), 100% (W), 20% (E), 82% (PE(0-5)) and 100% (PE(6-45)). Interobserver agreement between observer 1 vs. observer 2 and between observer 1 vs. 3, respectively, was 96 and 92.6% (R), 83 and 31% (W), 0 and 13% (E), 23 and 18% (PE(0-5)), and 67 and 55% (PE(6-45)). When including the events with correct timing but disagreement for classification, the intraobserver agreement increased to 94% during PE(0-5) and the interobserver agreement reached 83 and 50% (W), 20 and 50% (E), 41 and 47% (PE(0-5)), and 83.5 and 65% (PE(6-45)). The interobserver agreement increased with observer experience. Intra- and interobserver agreement for recognition and classification of events was good at R, but poor during E and poor-moderate during recovery periods. These results highlight the limitations of stress ECG in horses and the

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.

Does experience in hysteroscopy improve accuracy and inter-observer agreement in the management of abnormal uterine bleeding?

PubMed

Bourdel, Nicolas; Modaffari, Paola; Tognazza, Enrica; Pertile, Riccardo; Chauvet, Pauline; Botchorishivili, Revaz; Savary, Dennis; Pouly, Jean Luc; Rabischong, Benoit; Canis, Michel

2016-12-01

Hysteroscopic reliability may be influenced by the experience of the operator and by a lack of morphological diagnostic criteria for endometrial malignant pathologies. The aim of this study was to evaluate the diagnostic accuracy and the inter-observer agreement (IOA) in the management of abnormal uterine bleeding (AUB) among different experienced gynecologists. Each gynecologist, without any other clinical information, was asked to evaluate the anonymous video recordings of 51 consecutive patients who underwent hysteroscopy and endometrial resection for AUB. Experts (>500 hysteroscopies), seniors (20-499 procedures) and junior (≤19 procedures) gynecologists were asked to judge endometrial macroscopic appearance (benign, suspicious or frankly malignant). They also had to propose the histological diagnosis (atrophic or proliferative endometrium; simple, glandulocystic or atypical endometrial hyperplasia and endometrial carcinoma). Observers were free to indicate whether the quality of recordings were not good enough for adequate assessment. IOA (k coefficient), sensitivity, specificity, predictive value and the likelihood ratio were calculated. Five expert, five senior and six junior gynecologists were involved in the study. Considering endometrial cancer and endometrial atypical hyperplasia, sensitivity and specificity were respectively 55.5 % and 84.5 % for juniors, 66.6 % and 81.2 % for seniors and 86.6 % and 87.3 % for experts. Concerning endometrial macroscopic appearance, IOA was poor for juniors (k = 0.10) and fair for seniors and experts (k = 0.23 and 0.22, respectively). IOA was poor for juniors and experts (k = 0.18 and 0.20, respectively) and fair for seniors (k = 0.30) in predicting the histological diagnosis. Sensitivity improves with the observer's experience, but inter-observer agreement and reproducibility of hysteroscopy for endometrial malignancies are not satisfying no matter the level of expertise. Therefore, an accurate and

Agreements between ground-based and satellite-based observations. [of earth magnetospheric currents

NASA Technical Reports Server (NTRS)

Akasofu, S.-I.; Weimer, D.; Iijima, T.; Ahn, B.-H.; Kamide, Y.

1990-01-01

The polar ionospheric parameters obtained by the meridian chain of magnetometers are compared with those obtained by satellites, and a number of ionospheric quantities including the distribution of the electric potential, field-aligned currents, ionospheric currents and their equatorial counterparts, and the relationship between the AE index and the cross-polar cap potential is determined. It is noted that the agreement observed between the ground-based and satellite-based results allows to reduce the search for the driving mechanism of the ionospheric Pedersen current to identifying the driving mechanism of the Pedersen counterpart current in the equatorial plane.

Ethical and Legal Observations on Contract Cheating Services as an Agreement

ERIC Educational Resources Information Center

Tauginiene, Loreta; Jurkevicius, Vaidas

2017-01-01

In this paper we cast light on one form of dishonest behaviour in academia--contract cheating services. We examine how an agreement between a student and a contract cheating services provider is viewed from ethical and legal perspectives. For this purpose we carried out an analysis of contract cheating services as an agreement which, in Lithuania,…

Institutional ethics review of clinical study agreements

PubMed Central

DuVal, G

2004-01-01

Accordingly, it is necessary that some independent body have the authority both to review research contracts for compliance with norms of subject protection and ethical integrity, and to reject studies that fail to meet ethical standards. Such review should take place prior to the start of research, not later. Because of its expertise and authority, the institutional ethics review board (IRB or REB) is the appropriate body to undertake such review. Much recent commentary has focused on contractual restrictions on the investigator's freedom to publish research findings. The Olivieri experience, and that of other investigators, has brought freedom of publication issues into sharp focus. Clinical study agreements also raise a number of other ethical issues relating to human subjects and research integrity, however, including disclosures relating to patient safety, data analysis and reporting, budget, confidentiality, and premature termination of the study. This paper describes the ethical issues at stake in structuring such agreements and suggests ethical standards to guide institutional ethics review. PMID:14872068

An inter-observer agreement study of autofluorescence endoscopy in Barrett's esophagus among expert and non-expert endoscopists.

PubMed

Mannath, J; Subramanian, V; Telakis, E; Lau, K; Ramappa, V; Wireko, M; Kaye, P V; Ragunath, K

2013-02-01

Autofluorescence imaging (AFI), which is a "red flag" technique during Barrett's surveillance, is associated with significant false positive results. The aim of this study was to assess the inter-observer agreement (IOA) in identifying AFI-positive lesions and to assess the overall accuracy of AFI. Anonymized AFI and high resolution white light (HRE) images were prospectively collected. The AFI images were presented in random order, followed by corresponding AFI + HRE images. Three AFI experts and 3 AFI non-experts scored images after a training presentation. The IOA was calculated using kappa and accuracy was calculated with histology as gold standard. Seventy-four sets of images were prospectively collected from 63 patients (48 males, mean age 69 years). The IOA for number of AF positive lesions was fair when AFI images were presented. This improved to moderate with corresponding AFI and HRE images [experts 0.57 (0.44-0.70), non-experts 0.47 (0.35-0.62)]. The IOA for the site of AF lesion was moderate for experts and fair for non-experts using AF images, which improved to substantial for experts [κ = 0.62 (0.50-0.72)] but remained at fair for non-experts [κ = 0.28 (0.18-0.37)] with AFI + HRE. Among experts, the accuracy of identifying dysplasia was 0.76 (0.7-0.81) using AFI images and 0.85 (0.79-0.89) using AFI + HRE images. The accuracy was 0.69 (0.62-0.74) with AFI images alone and 0.75 (0.70-0.80) using AFI + HRE among non-experts. The IOA for AF positive lesions is fair to moderate using AFI images which improved with addition of HRE. The overall accuracy of identifying dysplasia was modest, and was better when AFI and HRE images were combined.

Evaluation of Multiclass Model Observers in PET LROC Studies

NASA Astrophysics Data System (ADS)

Gifford, H. C.; Kinahan, P. E.; Lartizien, C.; King, M. A.

2007-02-01

A localization ROC (LROC) study was conducted to evaluate nonprewhitening matched-filter (NPW) and channelized NPW (CNPW) versions of a multiclass model observer as predictors of human tumor-detection performance with PET images. Target localization is explicitly performed by these model observers. Tumors were placed in the liver, lungs, and background soft tissue of a mathematical phantom, and the data simulation modeled a full-3D acquisition mode. Reconstructions were performed with the FORE+AWOSEM algorithm. The LROC study measured observer performance with 2D images consisting of either coronal, sagittal, or transverse views of the same set of cases. Versions of the CNPW observer based on two previously published difference-of-Gaussian channel models demonstrated good quantitative agreement with human observers. One interpretation of these results treats the CNPW observer as a channelized Hotelling observer with implicit internal noise

EasyDIAg: A tool for easy determination of interrater agreement.

PubMed

Holle, Henning; Rein, Robert

2015-09-01

Reliable measurements are fundamental for the empirical sciences. In observational research, measurements often consist of observers categorizing behavior into nominal-scaled units. Since the categorization is the outcome of a complex judgment process, it is important to evaluate the extent to which these judgments are reproducible, by having multiple observers independently rate the same behavior. A challenge in determining interrater agreement for timed-event sequential data is to develop clear objective criteria to determine whether two raters' judgments relate to the same event (the linking problem). Furthermore, many studies presently report only raw agreement indices, without considering the degree to which agreement can occur by chance alone. Here, we present a novel, free, and open-source toolbox (EasyDIAg) designed to assist researchers with the linking problem, while also providing chance-corrected estimates of interrater agreement. Additional tools are included to facilitate the development of coding schemes and rater training.

Inter-observer agreement improves with PERCIST 1.0 as opposed to qualitative evaluation in non-small cell lung cancer patients evaluated with F-18-FDG PET/CT early in the course of chemo-radiotherapy.

PubMed

Fledelius, Joan; Khalil, Azza; Hjorthaug, Karin; Frøkiær, Jørgen

2016-12-01

The purpose of this study is to determine whether a qualitative approach or a semi-quantitative approach provides the most robust method for early response evaluation with 2'-deoxy-2'-[(18)F]fluoro-D-glucose (F-18-FDG) positron emission tomography combined with whole body computed tomography (PET/CT) in non-small cell lung cancer (NSCLC). In this study eight Nuclear Medicine consultants analyzed F-18-FDG PET/CT scans from 35 patients with locally advanced NSCLC. Scans were performed at baseline and after 2 cycles of chemotherapy. Each observer used two different methods for evaluation: (1) PET response criteria in solid tumors (PERCIST) 1.0 and (2) a qualitative approach. Both methods allocate patients into one of four response categories (complete and partial metabolic response (CMR and PMR) and stable and progressive metabolic disease (SMD and PMD)). The inter-observer agreement was evaluated using Fleiss' kappa for multiple raters, Cohens kappa for comparison of the two methods, and intraclass correlation coefficients (ICC) for comparison of lean body mass corrected standardized uptake value (SUL) peak measurements. The agreement between observers when determining the percentage change in SULpeak was "almost perfect", with ICC = 0.959. There was a strong agreement among observers allocating patients to the different response categories with a Fleiss kappa of 0.76 (0.71-0.81). In 22 of the 35 patients, complete agreement was observed with PERCIST 1.0. The agreement was lower when using the qualitative method, moderate, having a Fleiss kappa of 0.60 (0.55-0.64). Complete agreement was achieved in only 10 of the 35 patients. The difference between the two methods was statistically significant (p < 0.005) (chi-squared). Comparing the two methods for each individual observer showed Cohen's kappa values ranging from 0.64 to 0.79, translating into a strong agreement between the two methods. PERCIST 1.0 provides a higher overall agreement between observers

Suboptimal Agreement Among Cytopathologists in Diagnosis of Malignancy Based on Endoscopic Ultrasound Needle Aspirates of Solid Pancreatic Lesions: A Validation Study.

PubMed

Marshall, Carrie; Mounzer, Rawad; Hall, Matt; Simon, Violette; Centeno, Barbara; Dennis, Katie; Dhillon, Jasreman; Fan, Fang; Khazai, Laila; Klapman, Jason; Komanduri, Srinadh; Lin, Xiaoqi; Lu, David; Mehrotra, Sanjana; Muthusamy, V Raman; Nayar, Ritu; Paintal, Ajit; Rao, Jianyu; Sams, Sharon; Shah, Janak; Watson, Rabindra; Rastogi, Amit; Wani, Sachin

2018-07-01

Despite the widespread use of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) to sample pancreatic lesions and the standardization of pancreaticobiliary cytopathologic nomenclature, there are few data on inter-observer agreement among cytopathologists evaluating pancreatic cytologic specimens obtained by EUS-FNA. We developed a scoring system to assess agreement among cytopathologists in overall diagnosis and quantitative and qualitative parameters, and evaluated factors associated with agreement. We performed a prospective study to validate results from our pilot study that demonstrated moderate to substantial inter-observer agreement among cytopathologists for the final cytologic diagnosis. In the first phase, 3 cytopathologists refined criteria for assessment of quantity and quality measures. During phase 2, EUS-FNA specimens of solid pancreatic lesions from 46 patients were evaluated by 11 cytopathologists at 5 tertiary care centers using a standardized scoring tool. Individual quantitative and qualitative measures were scored and an overall cytologic diagnosis was determined. Clinical and EUS parameters were assessed as predictors of unanimous agreement. Inter-observer agreement (IOA) was calculated using multi-rater kappa (κ) statistics and a logistic regression model was created to identify factors associated with unanimous agreement. The IOA for final diagnoses, based on cytologic analysis, was moderate (κ = 0.56; 95% CI, 0.43-0.70). Kappa values did not increase when categories of suspicious for malignancy, malignant, and neoplasm were combined. IOA was slight to moderate for individual quantitative (κ = 0.007; 95% CI, -0.03 to -0.04) and qualitative parameters (κ = 0.5; 95% CI, 0.47-0.53). Jaundice was the only factor associated with agreement among all cytopathologists on multivariate analysis (odds ratio for unanimous agreement, 5.3; 95% CI, 1.1-26.89). There is a suboptimal level of agreement among cytopathologists in the diagnosis

An ERP study of agreement features in Spanish.

PubMed

Silva-Pereyra, Juan F; Carreiras, Manuel

2007-12-14

The goal of the present study was to investigate whether two morphological agreement features, Person and Number, play a different role in the agreement process. According to the Feature Hierarchy hypothesis, different nominal agreement features have different degrees of cognitive strength (e.g., Person>Number). Event-related potentials (ERPs) were collected from Spanish speakers while they read sentences in which either Person Disagreement (PD; e.g., Tú salto en el patio [You (2ndPerSing) jump (1stPerSing) in the backyard]), Number Disagreement (ND; e.g., Nosotros salto en el patio [We (1stPerPl) jump (1stPerSing) in the backyard]) or both Person and Number Disagreement (NPD; e.g., Ustedes salto en el patio [You (2ndPerPl) jump (1stPerSing) in the backyard]) relationships were manipulated. ND, PD and NPD all elicited an anterior negativity (AN) and P600 pattern. An AN effect was only found in the NPD with a different topography from the classic LAN effect as it was lateralized to right and central sites. The P600 effect elicited by the NPD condition was larger than the agreement condition and that of ND and PD in the first window 500-700, while the three disagreement conditions elicited larger P600 amplitudes than the agreement condition in the second window 700-900. There were no differences between the processing of person and number. Thus, the combination of number and person disagreement could be solved in parallel through an additive mechanism of the two features. These results do not support the Feature Hierarchy hypothesis.

Interparent Agreement on the Strengths and Difficulties Questionnaire: A Chinese Study

ERIC Educational Resources Information Center

Mellor, David; Wong, Jessica; Xu, Xiaoyan

2011-01-01

This article reports on the first study to investigate interparent agreement when the Strengths and Difficulties Questionnaire (SDQ) is used to assess school-aged children. It is also the first study conducted in China on agreement between parents reporting on their child. Both parents of 380 girls and 320 boys completed the Strengths and…

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

Patient-family agreement on values and preferences for life-sustaining treatment: results of a multicentre observational study.

PubMed

Abdul-Razzak, Amane; Heyland, Daren K; Simon, Jessica; Ghosh, Sunita; Day, Andrew G; You, John J

2017-07-22

To quantify agreement between patients and their family members on their own values and preferences for use or non-use of life-sustaining treatments for the patient. Hospitalised patients aged 55 years or older with advanced pulmonary, cardiac, liver disease or metastatic cancer or aged 80 years or older from medical wards at 16 Canadian hospitals and their family members completed a questionnaire including eight items about values related to life-sustaining treatment and a question about preferences for life-sustaining treatments. We recruited a total of 313 patient-family member dyads. Crude agreement between patients and family members about values related to life-sustaining treatment was 42% across all eight items but varied widely: 20% when asking how important it was for the patient to respect the wishes of family members regarding their care; 72% when asking how important it was for the patient to be kept comfortable and suffer as little as possible. Crude agreement on preferences for life-sustaining treatment was 91% (kappa 0.60; 95%CI 0.45 to 0.75) when looking at preferences for cardiopulmonary resuscitation (CPR) versus no CPR but fell to 56% when including all five response options with varying degrees of resuscitative, medical or comfort options (kappa 0.39; 95%CI 0.31 to 0.47). There is appreciable disagreement between seriously ill hospitalised patients and family members in their values and preferences for life-sustaining treatment. Strategies are needed to improve the quality of advance care planning, so that surrogates are better able to honour patient's wishes at the end of life. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

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

Measures of Agreement Between Many Raters for Ordinal Classifications

PubMed Central

Nelson, Kerrie P.; Edwards, Don

2015-01-01

Screening and diagnostic procedures often require a physician's subjective interpretation of a patient's test result using an ordered categorical scale to define the patient's disease severity. Due to wide variability observed between physicians’ ratings, many large-scale studies have been conducted to quantify agreement between multiple experts’ ordinal classifications in common diagnostic procedures such as mammography. However, very few statistical approaches are available to assess agreement in these large-scale settings. Existing summary measures of agreement rely on extensions of Cohen's kappa [1 - 5]. These are prone to prevalence and marginal distribution issues, become increasingly complex for more than three experts or are not easily implemented. Here we propose a model-based approach to assess agreement in large-scale studies based upon a framework of ordinal generalized linear mixed models. A summary measure of agreement is proposed for multiple experts assessing the same sample of patients’ test results according to an ordered categorical scale. This measure avoids some of the key flaws associated with Cohen's kappa and its extensions. Simulation studies are conducted to demonstrate the validity of the approach with comparison to commonly used agreement measures. The proposed methods are easily implemented using the software package R and are applied to two large-scale cancer agreement studies. PMID:26095449

Inter-observer variability in diagnosing radiological features of aneurysmal subarachnoid hemorrhage; a preliminary single centre study comparing observers from different specialties and levels of training.

PubMed

Siddiqui, Usman T; Khan, Anjum F; Shamim, Muhammad Shahzad; Hamid, Rana Shoaib; Alam, Muhammad Mehboob; Emaduddin, Muhammad

2014-01-01

A noncontrast computed tomography (CT) scan remains the initial radiological investigation of choice for a patient with suspected aneurysmal subarachnoid hemorrhage (aSAH). This initial scan may be used to derive key information about the underlying aneurysm which may aid in further management. The interpretation, however, is subject to the skill and experience of the interpreting individual. The authors here evaluate the interpretation of such CT scans by different individuals at different levels of training, and in two different specialties (Radiology and Neurosurgery). Initial nonontrast CT scan of 35 patients with aSAH was evaluated independently by four different observers. The observers selected for the study included two from Radiology and two from Neurosurgery at different levels of training; a resident currently in mid training and a resident who had recently graduated from training of each specialty. Measured variables included interpreter's suspicion of presence of subarachnoid blood, side of the subarachnoid hemorrhage, location of the aneurysm, the aneurysm's proximity to vessel bifurcation, number of aneurysm(s), contour of aneurysm(s), presence of intraventricular hemorrhage (IVH), intracerebral hemorrhage (ICH), infarction, hydrocephalus and midline shift. To determine the inter-observer variability (IOV), weighted kappa values were calculated. There was moderate agreement on most of the CT scan findings among all observers. Substantial agreement was found amongst all observers for hydrocephalus, IVH, and ICH. Lowest agreement rates were seen in the location of aneurysm being supra or infra tentorial. There were, however, some noteworthy exceptions. There was substantial to almost perfect agreement between the radiology graduate and radiology resident on most CT findings. The lowest agreement was found between the neurosurgery graduate and the radiology graduate. Our study suggests that although agreements were seen in the interpretation of some of

The definition of polytrauma: variable interrater versus intrarater agreement--a prospective international study among trauma surgeons.

PubMed

Butcher, Nerida E; Enninghorst, Natalie; Sisak, Krisztian; Balogh, Zsolt J

2013-03-01

The international trauma community has recognized the lack of a validated consensus definition of "polytrauma." We hypothesized that using a subjective definition, trauma surgeons will not have substantial agreement; thus, an objective definition is needed. A prospective observational study was conducted between December 2010 and June 2011 (John Hunter Hospital, Level I trauma center). Inclusion criteria were all trauma call patients with subsequent intensive care unit admission. The study was composed of four stages as follows: (1) four trauma surgeons assessed patients until 24 hours, then coded as either "yes" or "no" for polytrauma, and results compared for agreement; (2) eight trauma surgeons representing the United States, Germany, and the Netherlands graded the same prospectively assessed patients and coded as either "yes" or "no" for polytrauma; (3) 12 months later, the original four trauma surgeons repeated assessment via data sheets to test intrarater variability; and (4) individual subjective definitions were compared with three anatomic scores, namely, (a) Injury Severity Score (ISS) of greater than 15, (b) ISS of greater 17, and (c) Abbreviated Injury Scale (AIS) score of greater than 2 in at least two ISS body regions. A total of 52 trauma patients were included. Results for each stage were as follows: (1) κ score of 0.50, moderate agreement; (2) κ score of 0.41, moderate agreement; (3) Rater 1 had moderate intrarater agreement (κ score, 0.59), while Raters 2, 3, 4 had substantial intrarater agreement (κ scores, 0.75, 0.66, and 0.71, respectively); and (4) none had most agreement with ISS of greater than 15 (κ score, 0.16), while both definitions ISS greater than 17 and Abbreviated Injury Scale (AIS) score of greater than 2 in at least two ISS body regions had on average fair agreement (κ scores, 0.27 and 0.39, respectively). Based on subjective assessments, trauma surgeons do not agree on the definition of polytrauma, with the subjective

Cross-Cultural Agreement in Facial Attractiveness Preferences: The Role of Ethnicity and Gender

PubMed Central

Coetzee, Vinet; Greeff, Jaco M.; Stephen, Ian D.; Perrett, David I.

2014-01-01

Previous work showed high agreement in facial attractiveness preferences within and across cultures. The aims of the current study were twofold. First, we tested cross-cultural agreement in the attractiveness judgements of White Scottish and Black South African students for own- and other-ethnicity faces. Results showed significant agreement between White Scottish and Black South African observers' attractiveness judgements, providing further evidence of strong cross-cultural agreement in facial attractiveness preferences. Second, we tested whether cross-cultural agreement is influenced by the ethnicity and/or the gender of the target group. White Scottish and Black South African observers showed significantly higher agreement for Scottish than for African faces, presumably because both groups are familiar with White European facial features, but the Scottish group are less familiar with Black African facial features. Further work investigating this discordance in cross-cultural attractiveness preferences for African faces show that Black South African observers rely more heavily on colour cues when judging African female faces for attractiveness, while White Scottish observers rely more heavily on shape cues. Results also show higher cross-cultural agreement for female, compared to male faces, albeit not significantly higher. The findings shed new light on the factors that influence cross-cultural agreement in attractiveness preferences. PMID:24988325

Cross-cultural agreement in facial attractiveness preferences: the role of ethnicity and gender.

PubMed

Coetzee, Vinet; Greeff, Jaco M; Stephen, Ian D; Perrett, David I

2014-01-01

Previous work showed high agreement in facial attractiveness preferences within and across cultures. The aims of the current study were twofold. First, we tested cross-cultural agreement in the attractiveness judgements of White Scottish and Black South African students for own- and other-ethnicity faces. Results showed significant agreement between White Scottish and Black South African observers' attractiveness judgements, providing further evidence of strong cross-cultural agreement in facial attractiveness preferences. Second, we tested whether cross-cultural agreement is influenced by the ethnicity and/or the gender of the target group. White Scottish and Black South African observers showed significantly higher agreement for Scottish than for African faces, presumably because both groups are familiar with White European facial features, but the Scottish group are less familiar with Black African facial features. Further work investigating this discordance in cross-cultural attractiveness preferences for African faces show that Black South African observers rely more heavily on colour cues when judging African female faces for attractiveness, while White Scottish observers rely more heavily on shape cues. Results also show higher cross-cultural agreement for female, compared to male faces, albeit not significantly higher. The findings shed new light on the factors that influence cross-cultural agreement in attractiveness preferences.

Specific agreement on dichotomous outcomes can be calculated for more than two raters.

PubMed

de Vet, Henrica C W; Dikmans, Rieky E; Eekhout, Iris

2017-03-01

For assessing interrater agreement, the concepts of observed agreement and specific agreement have been proposed. The situation of two raters and dichotomous outcomes has been described, whereas often, multiple raters are involved. We aim to extend it for more than two raters and examine how to calculate agreement estimates and 95% confidence intervals (CIs). As an illustration, we used a reliability study that includes the scores of four plastic surgeons classifying photographs of breasts of 50 women after breast reconstruction into "satisfied" or "not satisfied." In a simulation study, we checked the hypothesized sample size for calculation of 95% CIs. For m raters, all pairwise tables [ie, m (m - 1)/2] were summed. Then, the discordant cells were averaged before observed and specific agreements were calculated. The total number (N) in the summed table is m (m - 1)/2 times larger than the number of subjects (n), in the example, N = 300 compared to n = 50 subjects times m = 4 raters. A correction of n√(m - 1) was appropriate to find 95% CIs comparable to bootstrapped CIs. The concept of observed agreement and specific agreement can be extended to more than two raters with a valid estimation of the 95% CIs. Copyright © 2017 Elsevier Inc. All rights reserved.

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.

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.

A prospective study assessing agreement and reliability of a geriatric evaluation.

PubMed

Locatelli, Isabella; Monod, Stéfanie; Cornuz, Jacques; Büla, Christophe J; Senn, Nicolas

2017-07-19

The present study takes place within a geriatric program, aiming at improving the diagnosis and management of geriatric syndromes in primary care. Within this program it was of prime importance to be able to rely on a robust and reproducible geriatric consultation to use as a gold standard for evaluating a primary care brief assessment tool. The specific objective of the present study was thus assessing the agreement and reliability of a comprehensive geriatric consultation. The study was conducted at the outpatient clinic of the Service of Geriatric Medicine, University of Lausanne, Switzerland. All community-dwelling older persons aged 70 years and above were eligible. Patients were excluded if they hadn't a primary care physician, they were unable to speak French, or they were already assessed by a geriatrician within the last 12 months. A set of 9 geriatricians evaluated 20 patients. Each patient was assessed twice within a 2-month delay. Geriatric consultations were based on a structured evaluation process, leading to rating the following geriatric conditions: functional, cognitive, visual, and hearing impairment, mood disorders, risk of fall, osteoporosis, malnutrition, and urinary incontinence. Reliability and agreement estimates on each of these items were obtained using a three-way Intraclass Correlation and a three-way Observed Disagreement index. The latter allowed a decomposition of overall disagreement into disagreements due to each source of error variability (visit, rater and random). Agreement ranged between 0.62 and 0.85. For most domains, geriatrician-related error variability explained an important proportion of disagreement. Reliability ranged between 0 and 0.8. It was poor/moderate for visual impairment, malnutrition and risk of fall, and good/excellent for functional/cognitive/hearing impairment, osteoporosis, incontinence and mood disorders. Six out of nine items of the geriatric consultation described in this study (functional

A Local Agreement Pattern Measure Based on Hazard Functions for Survival Outcomes

PubMed Central

Dai, Tian; Guo, Ying; Peng, Limin; Manatunga, Amita K.

2017-01-01

Summary Assessing agreement is often of interest in biomedical and clinical research when measurements are obtained on the same subjects by different raters or methods. Most classical agreement methods have been focused on global summary statistics, which cannot be used to describe various local agreement patterns. The objective of this work is to study the local agreement pattern between two continuous measurements subject to censoring. In this paper, we propose a new agreement measure based on bivariate hazard functions to characterize the local agreement pattern between two correlated survival outcomes. The proposed measure naturally accommodates censored observations, fully captures the dependence structure between bivariate survival times and provides detailed information on how the strength of agreement evolves over time. We develop a nonparametric estimation method for the proposed local agreement pattern measure and study theoretical properties including strong consistency and asymptotical normality. We then evaluate the performance of the estimator through simulation studies and illustrate the method using a prostate cancer data example. PMID:28724196

Interobserver Agreement on Endoscopic Classification of Oesophageal Varices in Children.

PubMed

D'Antiga, Lorenzo; Betalli, Pietro; De Angelis, Paola; Davenport, Mark; Di Giorgio, Angelo; McKiernan, Patrick J; McLin, Valerie; Ravelli, Paolo; Durmaz, Ozlem; Talbotec, Cecile; Sturm, Ekkehard; Woynarowski, Marek; Burroughs, Andrew K

2015-08-01

Data regarding agreement on endoscopic features of oesophageal varices in children with portal hypertension (PH) are scant. The aim of this study was to evaluate endoscopic visualisation and classification of oesophageal varices in children by several European clinicians, to build a rational basis for future multicentre trials. Endoscopic pictures of the distal oesophagus of 100 children with a clinical diagnosis of PH were distributed to 10 endoscopists. Observers were requested to classify variceal size according to a 3-degree scale (small, medium, and large, class A), a 2-degree scale (small and large, class B), and to recognise red wales (presence or absence, class Red). Overall agreement was considered fair if Fleiss and Cohen κ test was ≥0.30, good if ≥0.40, excellent if ≥0.60, and perfect if ≥0.80. Agreement between observers was fair with class A (κ = 0.34) and class B (κ = 0.38), and good with class Red (κ = 0.49). The agreement was good on presence versus absence of varices (class A = 0.53, class B = 0.48). The agreement among the observers was good in class A when endoscopic features of severe PH (medium and large sizes, red marks) were grouped and compared with mild features (absent and small varices) (κ = 0.58). Experts working in different centres show a fairly good agreement on endoscopic features of PH in children, although a better training of paediatric endoscopists may improve the agreement in grading severity of varices in this setting.

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.

Spine Instability Neoplastic Score: agreement across different medical and surgical specialties.

PubMed

Arana, Estanislao; Kovacs, Francisco M; Royuela, Ana; Asenjo, Beatriz; Pérez-Ramírez, Úrsula; Zamora, Javier

2016-05-01

Spinal instability is an acknowledged complication of spinal metastases; in spite of recent suggested criteria, it is not clearly defined in the literature. This study aimed to assess intra and interobserver agreement when using the Spine Instability Neoplastic Score (SINS) by all physicians involved in its management. Independent multicenter reliability study for the recently created SINS, undertaken with a panel of medical oncologists, neurosurgeons, radiologists, orthopedic surgeons, and radiation oncologists, was carried out. Ninety patients with biopsy-proven spinal metastases and magnetic resonance imaging, reviewed at the multidisciplinary tumor board of our institution, were included. Intraclass correlation coefficient (ICC) was used for SINS score agreement. Fleiss kappa statistic was used to assess agreement on the location of the most affected vertebral level; agreement on the SINS category ("stable," "potentially stable," or "unstable"); and overall agreement with the classification established by tumor board. Clinical data and imaging were provided to 83 specialists in 44 hospitals across 14 Spanish regions. No assessment criteria were pre-established. Each clinician assessed the SINS score twice, with a minimum 6-week interval. Clinicians were blinded to assessments made by other specialists and to their own previous assessment. Subgroup analyses were performed by clinicians' specialty, experience (≤7, 8-13, ≥14 years), and hospital category (four levels according to size and complexity). This study was supported by Kovacs Foundation. Intra and interobserver agreement on the location of the most affected levels was "almost perfect" (κ>0.94). Intra-observer agreement on the SINS score was "excellent" (ICC=0.77), whereas interobserver agreement was "moderate" (ICC=0.55). Intra-observer agreement in SINS category was "substantial" (k=0.61), whereas interobserver agreement was "moderate" (k=0.42). Overall agreement with the tumor board classification

No cataclysmic variables missing: higher merger rate brings into agreement observed and predicted space densities

NASA Astrophysics Data System (ADS)

Belloni, Diogo; Schreiber, Matthias R.; Zorotovic, Mónica; Iłkiewicz, Krystian; Hurley, Jarrod R.; Giersz, Mirek; Lagos, Felipe

2018-06-01

The predicted and observed space density of cataclysmic variables (CVs) have been for a long time discrepant by at least an order of magnitude. The standard model of CV evolution predicts that the vast majority of CVs should be period bouncers, whose space density has been recently measured to be ρ ≲ 2 × 10-5 pc-3. We performed population synthesis of CVs using an updated version of the Binary Stellar Evolution (BSE) code for single and binary star evolution. We find that the recently suggested empirical prescription of consequential angular momentum loss (CAML) brings into agreement predicted and observed space densities of CVs and period bouncers. To progress with our understanding of CV evolution it is crucial to understand the physical mechanism behind empirical CAML. Our changes to the BSE code are also provided in details, which will allow the community to accurately model mass transfer in interacting binaries in which degenerate objects accrete from low-mass main-sequence donor stars.

The inter-observer agreement in the assessment of carotid plaque neovascularization by contrast-enhanced ultrasonography: The impact of plaque thickness.

PubMed

Chen, Jian; Zhang, Yan-Ming; Song, Ze-Zhou; Fu, Yan-Fei; Geng, Yu

2018-04-10

The interobserver agreement in the assessment of the grade of carotid plaque neovascularization by contrast-enhanced ultrasonography is poorly established. We examined 140 carotid plaques in 66 patients (all patients had bilateral plaques, and 8 patients had 2 plaques on one side). We performed conventional and contrast-enhanced ultrasonography to analyze the presence of carotid plaque neovascularization, which was graded by two independent observers whose interobserver agreement (κ) was evaluated according to the thickness of carotid plaque. For all carotid plaques, the mean κ was 0.689 (95% confidence interval 0.604-0.774). It was 0.689 (0.569-0.808), 0.637 (0.487-0.787), and 0.740 (0.585-0.896), respectively for carotid plaques with maximal thickness <2 mm, from 2 mm to 3 mm, and >3 mm. The interobserver agreement for assessing carotid plaque neovascularization by using contrast-enhanced ultrasonography is substantial and acceptable for research purposes, regardless of the maximal thickness of the plaque. © 2018 Wiley Periodicals, Inc.

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.

Application Agreement and Integration Services

NASA Technical Reports Server (NTRS)

Driscoll, Kevin R.; Hall, Brendan; Schweiker, Kevin

2013-01-01

Application agreement and integration services are required by distributed, fault-tolerant, safety critical systems to assure required performance. An analysis of distributed and hierarchical agreement strategies are developed against the backdrop of observed agreement failures in fielded systems. The documented work was performed under NASA Task Order NNL10AB32T, Validation And Verification of Safety-Critical Integrated Distributed Systems Area 2. This document is intended to satisfy the requirements for deliverable 5.2.11 under Task 4.2.2.3. This report discusses the challenges of maintaining application agreement and integration services. A literature search is presented that documents previous work in the area of replica determinism. Sources of non-deterministic behavior are identified and examples are presented where system level agreement failed to be achieved. We then explore how TTEthernet services can be extended to supply some interesting application agreement frameworks. This document assumes that the reader is familiar with the TTEthernet protocol. The reader is advised to read the TTEthernet protocol standard [1] before reading this document. This document does not re-iterate the content of the standard.

A Population-Based Assessment of the Agreement Between Grading of Goniophotographic Images and Gonioscopy in the Chinese-American Eye Study (CHES)

PubMed Central

Murakami, Yohko; Wang, Dandan; Burkemper, Bruce; Lin, Shan C.; Varma, Rohit

2016-01-01

Purpose To compare grading of goniophotographic images and gonioscopy in assessing the iridocorneal angle. Methods In a population-based, cross-sectional study, participants underwent gonioscopy and goniophotographic imaging during the same visit. The iridocorneal angle was classified as closed if the posterior trabecular meshwork could not be seen. A single masked observer graded the goniophotographic images, and each eye was classified as having angle closure based on the number of closed quadrants. Agreement between the methods was analyzed by calculating kappa (κ) and first-order agreement coefficient (AC1) statistics and comparison of area under receiver operating characteristic curves (AUC). Results A total of 4149 Chinese Americans (3994 eyes) were included in this study. The agreement for angle closure diagnosis between gonioscopy and EyeCam was moderate to excellent (κ = 0.60, AC1 0.90, AUC 0.76–0.80). Conclusions Detection of iridocorneal angle closure based on goniophotographic imaging shows moderate to very good agreement with angle closure assessment using gonioscopy. PMID:27571018

A Population-Based Assessment of the Agreement Between Grading of Goniophotographic Images and Gonioscopy in the Chinese-American Eye Study (CHES).

PubMed

Murakami, Yohko; Wang, Dandan; Burkemper, Bruce; Lin, Shan C; Varma, Rohit

2016-08-01

To compare grading of goniophotographic images and gonioscopy in assessing the iridocorneal angle. In a population-based, cross-sectional study, participants underwent gonioscopy and goniophotographic imaging during the same visit. The iridocorneal angle was classified as closed if the posterior trabecular meshwork could not be seen. A single masked observer graded the goniophotographic images, and each eye was classified as having angle closure based on the number of closed quadrants. Agreement between the methods was analyzed by calculating kappa (κ) and first-order agreement coefficient (AC1) statistics and comparison of area under receiver operating characteristic curves (AUC). A total of 4149 Chinese Americans (3994 eyes) were included in this study. The agreement for angle closure diagnosis between gonioscopy and EyeCam was moderate to excellent (κ = 0.60, AC1 0.90, AUC 0.76-0.80). Detection of iridocorneal angle closure based on goniophotographic imaging shows moderate to very good agreement with angle closure assessment using gonioscopy.

Agreement between self-reported and general practitioner-reported chronic conditions among multimorbid patients in primary care - results of the MultiCare Cohort Study

PubMed Central

2014-01-01

Background Multimorbidity is a common phenomenon in primary care. Until now, no clinical guidelines for multimorbidity exist. For the development of these guidelines, it is necessary to know whether or not patients are aware of their diseases and to what extent they agree with their doctor. The objectives of this paper are to analyze the agreement of self-reported and general practitioner-reported chronic conditions among multimorbid patients in primary care, and to discover which patient characteristics are associated with positive agreement. Methods The MultiCare Cohort Study is a multicenter, prospective, observational cohort study of 3,189 multimorbid patients, ages 65 to 85. Data was collected in personal interviews with patients and GPs. The prevalence proportions for 32 diagnosis groups, kappa coefficients and proportions of specific agreement were calculated in order to examine the agreement of patient self-reported and general practitioner-reported chronic conditions. Logistic regression models were calculated to analyze which patient characteristics can be associated with positive agreement. Results We identified four chronic conditions with good agreement (e.g. diabetes mellitus κ = 0.80;PA = 0,87), seven with moderate agreement (e.g. cerebral ischemia/chronic stroke κ = 0.55;PA = 0.60), seventeen with fair agreement (e.g. cardiac insufficiency κ = 0.24;PA = 0.36) and four with poor agreement (e.g. gynecological problems κ = 0.05;PA = 0.10). Factors associated with positive agreement concerning different chronic diseases were sex, age, education, income, disease count, depression, EQ VAS score and nursing care dependency. For example: Women had higher odds ratios for positive agreement with their GP regarding osteoporosis (OR = 7.16). The odds ratios for positive agreement increase with increasing multimorbidity in almost all of the observed chronic conditions (OR = 1.22-2.41). Conclusions For multimorbidity research, the

Quantitative blood flow measurements in gliomas using arterial spin-labeling at 3T: intermodality agreement and inter- and intraobserver reproducibility study.

PubMed

Hirai, T; Kitajima, M; Nakamura, H; Okuda, T; Sasao, A; Shigematsu, Y; Utsunomiya, D; Oda, S; Uetani, H; Morioka, M; Yamashita, Y

2011-12-01

QUASAR is a particular application of the ASL method and facilitates the user-independent quantification of brain perfusion. The purpose of this study was to assess the intermodality agreement of TBF measurements obtained with ASL and DSC MR imaging and the inter- and intraobserver reproducibility of glioma TBF measurements acquired by ASL at 3T. Two observers independently measured TBF in 24 patients with histologically proved glioma. ASL MR imaging with QUASAR and DSC MR imaging were performed on 3T scanners. The observers placed 5 regions of interest in the solid tumor on rCBF maps derived from ASL and DSC MR images and 1 region of interest in the contralateral brain and recorded the measured values. Maximum and average sTBF values were calculated. Intermodality and intra- and interobsever agreement were determined by using 95% Bland-Altman limits of agreement and ICCs. The intermodality agreement for maximum sTBF was good to excellent on DSC and ASL images; ICCs ranged from 0.718 to 0.884. The 95% limits of agreement ranged from 59.2% to 65.4% of the mean. ICCs for intra- and interobserver agreement for maximum sTBF ranged from 0.843 to 0.850 and from 0.626 to 0.665, respectively. The reproducibility of maximum sTBF measurements obtained by methods was similar. In the evaluation of sTBF in gliomas, ASL with QUASAR at 3T yielded measurements and reproducibility similar to those of DSC perfusion MR imaging.

A local agreement pattern measure based on hazard functions for survival outcomes.

PubMed

Dai, Tian; Guo, Ying; Peng, Limin; Manatunga, Amita K

2018-03-01

Assessing agreement is often of interest in biomedical and clinical research when measurements are obtained on the same subjects by different raters or methods. Most classical agreement methods have been focused on global summary statistics, which cannot be used to describe various local agreement patterns. The objective of this work is to study the local agreement pattern between two continuous measurements subject to censoring. In this article, we propose a new agreement measure based on bivariate hazard functions to characterize the local agreement pattern between two correlated survival outcomes. The proposed measure naturally accommodates censored observations, fully captures the dependence structure between bivariate survival times and provides detailed information on how the strength of agreement evolves over time. We develop a nonparametric estimation method for the proposed local agreement pattern measure and study theoretical properties including strong consistency and asymptotical normality. We then evaluate the performance of the estimator through simulation studies and illustrate the method using a prostate cancer data example. © 2017, The International Biometric Society.

Indices of agreement between neurosurgeons and a radiologist in interpreting tomography scans in an emergency department.

PubMed

Dourado, Jules Carlos; Pereira, Júlio Leonardo Barbosa; Albuquerque, Lucas Alverne Freitas de; Carvalho, Gervásio Teles Cardos de; Dias, Patrícia; Dias, Laura; Bicalho, Marcos; Magalhães, Pollyana; Dellaretti, Marcos

2015-08-01

The power of interpretation in the analysis of cranial computed tomography (CCT) among neurosurgeons and radiologists has rarely been studied. This study aimed to assess the rate of agreement in the interpretation of CCTs between neurosurgeons and a radiologist in an emergency department. 227 CCT were independently analyzed by two neurosurgeons (NS1 and NS2) and a radiologist (RAD). The level of agreement in interpreting the examination was studied. The Kappa values obtained between NS1 and NS2 and RAD were considered nearly perfect and substantial agreement. The highest levels of agreement when evaluating abnormalities were observed in the identification of tumors, hydrocephalus and intracranial hematomas. The worst levels of agreement were observed for leukoaraiosis and reduced brain volume. For diseases in which the emergency room procedure must be determined, agreement in the interpretation of CCTs between the radiologist and neurosurgeons was satisfactory.

Agreement of three interpretation systems of intrapartum foetal heart rate monitoring by different levels of physicians.

PubMed

Pruksanusak, Ninlapa; Thongphanang, Putthaporn; Chainarong, Natthicha; Suntharasaj, Thitima; Kor-Anantakul, Ounjai; Suwanrath, Chitkasaem; Petpichetchian, Chusana

2017-11-01

A prospective study was conducted in centre in Southern Thailand, to evaluate agreement in EFM interpretation among various physicians in order to find out the most practical system for daily use. We found strong agreement of very normal FHR tracings among the FIGO, NICHD 3-tier and 5-tier systems. The NICHD 3-tier was more compatible with the FIGO system than 5-tier system. Overall inter-observer agreement was moderate for the NICHD 3-tier system while inter-observer agreement of 5-tier system was fair also the intra-observer agreement was higher in the NICHD 3-tier system. So the 3-tier systems are more suitable than the 5-tier system in general obstetric practice. Impact statement What is already known on this subject: The 3-tier and 5-tier systems were widely used in general obstetrics practice. What the results of this study add: The inter- and intra-observer agreement of NICHD 3-tier system was higher than the 5-tier system. What the implications are of these findings for clinical practice and/or further research: The 3-tier systems were more suitable than the 5-tier systems in general obstetrics practice.

Observer agreement in the reporting of knee and lumbar spine magnetic resonance (MR) imaging examinations: selectively trained MR radiographers and consultant radiologists compared with an index radiologist.

PubMed

Brealey, S; Piper, K; King, D; Bland, M; Caddick, J; Campbell, P; Gibbon, A; Highland, A; Jenkins, N; Petty, D; Warren, D

2013-10-01

To assess agreement between trained radiographers and consultant radiologists compared with an index radiologist when reporting on magnetic resonance imaging (MRI) examinations of the knee and lumbar spine and to examine the subsequent effect of discordant reports on patient management and outcome. At York Hospital two MR radiographers, two consultant radiologists and an index radiologist reported on a prospective, random sample of 326 MRI examinations. The radiographers reported in clinical practice conditions and the radiologists during clinical practice. An independent consultant radiologist compared these reports with the index radiologist report for agreement. Orthopaedic surgeons then assessed whether the discordance between reports was clinically important. Overall observer agreement with the index radiologist was comparable between observers and ranged from 54% to 58%; for the knee it was 46-57% and for the lumbar spine was 56-66%. There was a very small observed difference of 0.6% (95% CI -11.9 to 13.0) in mean agreement between the radiographers and radiologists (P=0.860). For the knee, lumbar spine and overall, radiographers' discordant reports, when compared with the index radiologist, were less likely to have a clinically important effect on patient outcome than the radiologists' discordant reports. Less than 10% of observer's reports were sufficiently discordant with the index radiologist's reports to be clinically important. Carefully selected MR radiographers with postgraduate education and training reported in clinical practice conditions on specific MRI examinations of the knee and lumbar spine to a level of agreement comparable with non-musculoskeletal consultant radiologists. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Inter-observer agreement, diagnostic sensitivity and specificity of animal-based indicators of young lamb welfare.

PubMed

Phythian, C J; Toft, N; Cripps, P J; Michalopoulou, E; Winter, A C; Jones, P H; Grove-White, D; Duncan, J S

2013-07-01

A scientific literature review and consensus of expert opinion used the welfare definitions provided by the Farm Animal Welfare Council (FAWC) Five Freedoms as the framework for selecting a set of animal-based indicators that were sensitive to the current on-farm welfare issues of young lambs (aged ≤ 6 weeks). Ten animal-based indicators assessed by observation - demeanour, response to stimulation, shivering, standing ability, posture, abdominal fill, body condition, lameness, eye condition and salivation were tested as part of the objective of developing valid, reliable and feasible animal-based measures of lamb welfare The indicators were independently tested on 966 young lambs from 17 sheep flocks across Northwest England and Wales during December 2008 to April 2009 by four trained observers. Inter-observer reliability was assessed using Fleiss's kappa (κ), and the pair-wise agreement with an experienced, observer designated as the 'test standard observer' (TSO) was examined using Cohen's κ. Latent class analysis (LCA) estimated the sensitivity (Se) and specificity (Sp) of each observer without assuming a gold standard and predicted the Se and Sp of randomly selected observers who may apply the indicators in the future. Overall, good levels of inter-observer reliability, and high levels of Sp were identified for demeanour (κ = 0.54, Se ≥ 0.70, Sp ≥ 0.98), stimulation (κ = 0.57, Se = 0.30 to 0.77, Sp ≥ 0.98), shivering (κ = 0.55, Se = 0.37 to 0.85, Sp ≥ 0.99), standing ability (0.54, Se ≥ 0.80, Sp ≥ 0.99), posture (κ = 0.45, Se ≥ 0.56, Sp = 0.99), abdominal fill (κ = 0.44, Se = 0.39 to 0.98, Sp = 0.99), body condition (κ = 0.72, Se ⩾ 0.38 to 0.90, Sp = 0.99), lameness (κ = 0.68, Se > 0.73, Sp = 1.00), and eye condition (κ = 0.72, Se ≥ 0.86, Sp = 0.99). LCA predicted that randomly selected observers had Se > 0.77 (acceptable), and Sp ≥ 0.98 (high) for assessments of demeanour, lameness, abdominal fill posture, body condition and eye

Surrogate Agreement in Tzotzil.

ERIC Educational Resources Information Center

Aissen, Judith L.

This study investigates whether other relationships in sentence structure besides the "brother-in-law" relation sanction surrogate agreement in Zinacanteco Tzotzil (Mayan). Surrogate agreement refers to cases in which an element that lies outside the class of regular agreement controllers in a language (the surrogate) controls…

3-D microphysical model studies of Arctic denitrification: comparison with observations

NASA Astrophysics Data System (ADS)

Davies, S.; Mann, G. W.; Carslaw, K. S.; Chipperfield, M. P.; Kettleborough, J. A.; Santee, M. L.; Oelhaf, H.; Wetzel, G.; Sasano, Y.; Sugita, T.

2005-11-01

fit to MLS observations. Both adjustments would be required to bring the model into agreement with the MIPAS-B observations. The agreement between the model and observations suggests that a NAT-only denitrification scheme (without ice), which was discounted by previous studies, must now be considered as one mechanism for the observed Arctic denitrification. The timing of onset and the rate of denitrification remain poorly constrained by the available observations.

3-D microphysical model studies of Arctic denitrification: comparison with observations

NASA Astrophysics Data System (ADS)

Davies, S.; Mann, G. W.; Carslaw, K. S.; Chipperfield, M. P.; Kettleborough, J. A.; Santee, M. L.; Oelhaf, H.; Wetzel, G.; Sasano, Y.; Sugita, T.

2005-01-01

. Both adjustments would be required to bring the model into agreement with the MIPAS-B observations. The agreement between the model and observations suggests that a NAT-only denitrification scheme (without ice), which was discounted by previous studies, must now be considered as one mechanism for the observed Arctic denitrification. The timing of onset and the rate of denitrification remain poorly constrained by the available observations.

Global Water Cycle Agreement in the Climate Models Assessed in the IPCC AR4

NASA Technical Reports Server (NTRS)

Waliser, D.; Seo, K. -W.; Schubert, S.; Njoku, E.

2007-01-01

This study examines the fidelity of the global water cycle in the climate model simulations assessed in the IPCC Fourth Assessment Report. The results demonstrate good model agreement in quantities that have had a robust global observational basis and that are physically unambiguous. The worst agreement occurs for quantities that have both poor observational constraints and whose model representations can be physically ambiguous. In addition, components involving water vapor (frozen water) typically exhibit the best (worst) agreement, and fluxes typically exhibit better agreement than reservoirs. These results are discussed in relation to the importance of obtaining accurate model representation of the water cycle and its role in climate change. Recommendations are also given for facilitating the needed model improvements.

68Ga-DOTATATE PET/CT interobserver agreement for neuroendocrine tumor assessments: results from a prospective study on 50 patients

PubMed Central

Fendler, Wolfgang Peter; Barrio, Martin; Spick, Claudio; Allen-Auerbach, Martin; Ambrosini, Valentina; Benz, Matthias; Bluemel, Christina; Grewal, Ravinder Kaur; Lapa, Constantin; Miederer, Matthias; Nicolas, Guillaume; Schuster, Tibor; Czernin, Johannes; Herrmann, Ken

2016-01-01

We evaluated the observer agreement for 68Ga-DOTATATE PET/CT study interpretations in patients with neuroendocrine tumors (NET). Methods 68Ga-DOTATATE PET/CT was performed in 50 patients with known or suspected NET of the small bowel (n = 19), pancreas (n = 14), lung (n = 4) or other location (n = 13). Images were reviewed by seven observers who used a standardized approach for image interpretation. Observers were classified as having low (<500 scans or <5 years experience with 68Ga-DOTATATE PET/CT; n = 4) or high level of experience (≥500 scans and ≥5 years experience with 68Ga-DOTATATE PET/CT; n = 3). Interpretation by the primary nuclear medicine physician un-blinded to all clinical and imaging data served as reference standard. Interobserver agreement was determined by Cohen's κ and intraclass correlation coefficient (ICC) with corresponding 95% confidence interval (CI). Results Interobserver agreement was substantial and the median number of false findings (FF) was low for the overall scan result; i.e. positive versus negative study (κ = 0.80, 95%CI 0.74–0.86; FF = 3), organ involvement (κ = 0.70, 95%CI 0.64–0.76; FF = 5), and lymph node involvement (κ = 0.71, 95%CI 0.65–0.78; FF = 6). The interobserver agreement was substantial to almost-perfect and the average absolute difference (Δ) to the reference reader was low for number of organ and lymph node metastases (ICC = 0.84, 95%CI 0.77–0.89, Δ = 0.45 and ICC = 0.77, 95%CI 0.69–0.84, Δ = 0.45), tumor SUVmax (ICC = 0.99, 95%CI 0.97–0.99; Δ = 0.44) and reference SUV (SUVmean spleen: ICC = 0.81, Δ = 1.10; SUVmax liver ICC = 0.79, Δ = 0.62). Interpretations of the appropriateness for peptide-receptor radionuclide therapy (PRRT) varied more significantly among observers (κ = 0.64, 95%CI 0.57–0.70) and a higher frequency of false positive recommendations for PRRT occurred in observers with low versus high levels of experience (range, 7–12 versus 4–8). Conclusion The interpretation of

Agreement among undergraduate and graduate veterinary students and veterinary anesthesiologists on pain assessment in cats and dogs: A preliminary study

PubMed Central

Doodnaught, Graeme M.; Benito, Javier; Monteiro, Beatriz P.; Beauchamp, Guy; Grasso, Stefania C.; Steagall, Paulo V.

2017-01-01

This study investigated agreement among undergraduate and graduate veterinary students and veterinary anesthesiologists on video pain assessment at the University of Montreal. Pain assessment in dogs and cats appeared to be affected by gender, previous experience, and degree of training despite a small population of observers. PMID:28761184

Assessing agreement with relative area under the coverage probability curve.

PubMed

Barnhart, Huiman X

2016-08-15

There has been substantial statistical literature in the last several decades on assessing agreement, and coverage probability approach was selected as a preferred index for assessing and improving measurement agreement in a core laboratory setting. With this approach, a satisfactory agreement is based on pre-specified high satisfactory coverage probability (e.g., 95%), given one pre-specified acceptable difference. In practice, we may want to have quality control on more than one pre-specified differences, or we may simply want to summarize the agreement based on differences up to a maximum acceptable difference. We propose to assess agreement via the coverage probability curve that provides a full spectrum of measurement error at various differences/disagreement. Relative area under the coverage probability curve is proposed for the summary of overall agreement, and this new summary index can be used for comparison of different intra-methods or inter-methods/labs/observers' agreement. Simulation studies and a blood pressure example are used for illustration of the methodology. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Agreement in cardiovascular risk rating based on anthropometric parameters

PubMed Central

Dantas, Endilly Maria da Silva; Pinto, Cristiane Jordânia; Freitas, Rodrigo Pegado de Abreu; de Medeiros, Anna Cecília Queiroz

2015-01-01

Objective To investigate the agreement in evaluation of risk of developing cardiovascular diseases based on anthropometric parameters in young adults. Methods The study included 406 students, measuring weight, height, and waist and neck circumferences. Waist-to-height ratio and the conicity index. The kappa coefficient was used to assess agreement in risk classification for cardiovascular diseases. The positive and negative specific agreement values were calculated as well. The Pearson chi-square (χ2) test was used to assess associations between categorical variables (p<0.05). Results The majority of the parameters assessed (44%) showed slight (k=0.21 to 0.40) and/or poor agreement (k<0.20), with low values of negative specific agreement. The best agreement was observed between waist circumference and waist-to-height ratio both for the general population (k=0.88) and between sexes (k=0.93 to 0.86). There was a significant association (p<0.001) between the risk of cardiovascular diseases and females when using waist circumference and conicity index, and with males when using neck circumference. This resulted in a wide variation in the prevalence of cardiovascular disease risk (5.5%-36.5%), depending on the parameter and the sex that was assessed. Conclusion The results indicate variability in agreement in assessing risk for cardiovascular diseases, based on anthropometric parameters, and which also seems to be influenced by sex. Further studies in the Brazilian population are required to better understand this issue. PMID:26466060

A Pilot Study Comparing Observational and Questionnaire Surrogate Measures of Pesticide Exposure Among Residents Impacted by the Ecuadorian Flower Industry.

PubMed

Handal, Alexis J; McGough-Maduena, Alison; Páez, Maritza; Skipper, Betty; Rowland, Andrew S; Fenske, Richard A; Harlow, Siobán D

2015-01-01

Self-reported measures of residential pesticide exposure are commonly used in epidemiological studies, especially when financial and logistical resources are limited. However, self-reporting is prone to misclassification bias. This pilot study assesses the agreement between self-report of residential pesticide exposure with direct observation measures, in an agricultural region of Ecuador, as a cross-validation method in 26 participants (16 rose workers and 10 controls), with percent agreement and kappa statistics calculated. Proximity of homes to nearby flower farms was found to have only fair agreement (kappa =.35). The use of discarded plastics (kappa =.06) and wood (kappa =.13) were found to have little agreement. Results indicate that direct observation or measurement may provide more accurate appraisals of residential exposures, such as proximity to industrial farmland and the use of discarded materials obtained from the flower farms.

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.

34 CFR 675.35 - Agreement.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 34 Education 3 2013-07-01 2013-07-01 false Agreement. 675.35 Section 675.35 Education Regulations..., DEPARTMENT OF EDUCATION FEDERAL WORK-STUDY PROGRAMS Job Location and Development Program § 675.35 Agreement... agreement with the Secretary. (b) The agreement must provide— (1) That the institution will administer the...

34 CFR 675.35 - Agreement.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 34 Education 3 2014-07-01 2014-07-01 false Agreement. 675.35 Section 675.35 Education Regulations..., DEPARTMENT OF EDUCATION FEDERAL WORK-STUDY PROGRAMS Job Location and Development Program § 675.35 Agreement... agreement with the Secretary. (b) The agreement must provide— (1) That the institution will administer the...

34 CFR 675.35 - Agreement.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 34 Education 3 2012-07-01 2012-07-01 false Agreement. 675.35 Section 675.35 Education Regulations..., DEPARTMENT OF EDUCATION FEDERAL WORK-STUDY PROGRAMS Job Location and Development Program § 675.35 Agreement... agreement with the Secretary. (b) The agreement must provide— (1) That the institution will administer the...

34 CFR 675.35 - Agreement.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 34 Education 3 2011-07-01 2011-07-01 false Agreement. 675.35 Section 675.35 Education Regulations..., DEPARTMENT OF EDUCATION FEDERAL WORK-STUDY PROGRAMS Job Location and Development Program § 675.35 Agreement... agreement with the Secretary. (b) The agreement must provide— (1) That the institution will administer the...

34 CFR 675.35 - Agreement.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 34 Education 3 2010-07-01 2010-07-01 false Agreement. 675.35 Section 675.35 Education Regulations..., DEPARTMENT OF EDUCATION FEDERAL WORK-STUDY PROGRAMS Job Location and Development Program § 675.35 Agreement... agreement with the Secretary. (b) The agreement must provide— (1) That the institution will administer the...

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.

High Agreement and High Prevalence: The Paradox of Cohen's Kappa.

PubMed

Zec, Slavica; Soriani, Nicola; Comoretto, Rosanna; Baldi, Ileana

2017-01-01

Cohen's Kappa is the most used agreement statistic in literature. However, under certain conditions, it is affected by a paradox which returns biased estimates of the statistic itself. The aim of the study is to provide sufficient information which allows the reader to make an informed choice of the correct agreement measure, by underlining some optimal properties of Gwet's AC1 in comparison to Cohen's Kappa, using a real data example. During the process of literature review, we have asked a panel of three evaluators to come up with a judgment on the quality of 57 randomized controlled trials assigning a score to each trial using the Jadad scale. The quality was evaluated according to the following dimensions: adopted design, randomization unit, type of primary endpoint. With respect to each of the above described features, the agreement between the three evaluators has been calculated using Cohen's Kappa statistic and Gwet's AC1 statistic and, finally, the values have been compared with the observed agreement. The values of the Cohen's Kappa statistic would lead to believe that the agreement levels for the variables Unit, Design and Primary Endpoints are totally unsatisfactory. The AC1 statistic, on the contrary, shows plausible values which are in line with the respective values of the observed concordance. We conclude that it would always be appropriate to adopt the AC1 statistic, thus bypassing any risk of incurring the paradox and drawing wrong conclusions about the results of agreement analysis.

Many participants in inpatient rehabilitation can quantify their exercise dosage accurately: an observational study.

PubMed

Scrivener, Katharine; Sherrington, Catherine; Schurr, Karl; Treacy, Daniel

2011-01-01

Are inpatients undergoing rehabilitation who appear able to count exercises able to quantify accurately the amount of exercise they undertake? Observational study. Inpatients in an aged care rehabilitation unit and a neurological rehabilitation unit, who appeared able to count their exercises during a 1-2 min observation by their treating physiotherapist. Participants were observed for 30 min by an external observer while they exercised in the physiotherapy gymnasium. Both the participants and the observer counted exercise repetitions with a hand-held tally counter and the two tallies were compared. Of the 60 people admitted for aged care rehabilitation during the study period, 49 (82%) were judged by their treating therapist to be able to count their own exercise repetitions accurately. Of the 30 people admitted for neurological rehabilitation during the study period, 20 (67%) were judged by their treating therapist to be able to count their repetitions accurately. Of the 69 people judged to be accurate, 40 underwent observation while exercising. There was excellent agreement between these participants' counts of their exercise repetitions and the observers' counts, ICC (3,1) of 0.99 (95% CI 0.98 to 0.99). Eleven participants (28%) were in complete agreement with the observer. A further 19 participants (48%) varied from the observer by less than 10%. Therapists were able to identify a group of rehabilitation participants who were accurate in counting their exercise repetitions. Counting of exercise repetitions by therapist-selected patients is a valid means of quantifying exercise dosage during inpatient rehabilitation. Copyright © 2011 Australian Physiotherapy Association. Published by .. All rights reserved.

Processing temporal agreement in a tenseless language: an ERP study of Mandarin Chinese.

PubMed

Qiu, Yinchen; Zhou, Xiaolin

2012-03-29

Human languages are equipped with an impressive repertoire of time-encoding devices which vary significantly across different cultures. Previous research on temporal processing has focused on morphosyntactic processes in Indo-European languages. This study investigated the neural correlates of temporal processing in Mandarin Chinese, a language that is not morphologically marked for tense. In a sentence acceptability judgment task, we manipulated the agreement between semantically enriched temporal adverbs or a highly grammaticalized aspectual particle (-guo) and temporal noun phrases. Disagreement of both the temporal adverbs and the aspectual particle elicited a centro-parietal P600 effect in event-related potentials (ERPs) whereas only disagreeing temporal adverbs evoked an additional broadly distributed N400 effect. Moreover, a sustained negativity effect was observed on both the words following the critical ones and the last words in sentences with temporal disagreement. These results reveal both commonalities and differences between Chinese and Indo-European languages in temporal agreement processing. In particular, we demonstrate that temporal reference in Chinese relies on both lexical semantics and morphosyntactic processes and that the level of grammaticalization of linguistic devices representing similar temporal information is reflected in differential ERP responses. Copyright © 2012 Elsevier B.V. All rights reserved.

Improving agreement in assessment of synovitis in rheumatoid arthritis.

PubMed

Cheung, Peter P; Dougados, Maxime; Andre, Vincent; Balandraud, Nathalie; Chales, Gérard; Chary-Valckenaere, Isabelle; Chatelus, Emmanuel; Dernis, Emmanuelle; Gill, Ghislaine; Gilson, Mélanie; Guis, Sandrine; Mouterde, Gael; Pavy, Stephan; Pouyol, François; Marhadour, Thierry; Richette, Pascal; Ruyssen-Witrand, Adeline; Soubrier, Martin; Gossec, Laure

2013-03-01

Synovitis assessment through evaluation of swollen joints is integral in steering treatment decisions in rheumatoid arthritis (RA). However, there is high inter-observer variation. The objective was to assess if a short collegiate consensus would improve swollen joint agreement between rheumatologists and whether this was affected by experience. Eighteen rheumatologists from French university rheumatology units participated in three 30 minutes rounds over a half day meeting evaluating joint counts of RA patients in small groups, followed by short consensus discussions. Agreement was evaluated at the end of each round as follows: (i) global agreement of swollen joints (ii) swollen joint agreement according to level of experience of the rheumatologist (iii) swollen joint count and (iv) agreement of disease activity state according to the Disease Activity Score (DAS28). Agreement was calculated using percentage agreement and kappa. Global agreement of swollen joints failed to improve (kappa 0.50 to 0.52) at the joint level. Agreement between seniors did not improve but agreement between newly qualified rheumatologists and their senior peer, which was initially poor (kappa 0.28), improved significantly (to 0.54) at the end of the consensus exercises. Concordance of DAS28 activity states improved from 71% to 87%. Consensus exercises for swollen joint assessment is worthwhile and may potentially improve agreement between clinicians in clinical synovitis and disease activity state, benefit was mostly observed in newly qualified rheumatologists. Copyright © 2012 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.

Grammatical number agreement processing using the visual half-field paradigm: an event-related brain potential study.

PubMed

Kemmer, Laura; Coulson, Seana; Kutas, Marta

2014-02-01

Despite indications in the split-brain and lesion literatures that the right hemisphere is capable of some syntactic analysis, few studies have investigated right hemisphere contributions to syntactic processing in people with intact brains. Here we used the visual half-field paradigm in healthy adults to examine each hemisphere's processing of correct and incorrect grammatical number agreement marked either lexically, e.g., antecedent/reflexive pronoun ("The grateful niece asked herself/*themselves…") or morphologically, e.g., subject/verb ("Industrial scientists develop/*develops…"). For reflexives, response times and accuracy of grammaticality decisions suggested similar processing regardless of visual field of presentation. In the subject/verb condition, we observed similar response times and accuracies for central and right visual field (RVF) presentations. For left visual field (LVF) presentation, response times were longer and accuracy rates were reduced relative to RVF presentation. An event-related brain potential (ERP) study using the same materials revealed similar ERP responses to the reflexive pronouns in the two visual fields, but very different ERP effects to the subject/verb violations. For lexically marked violations on reflexives, P600 was elicited by stimuli in both the LVF and RVF; for morphologically marked violations on verbs, P600 was elicited only by RVF stimuli. These data suggest that both hemispheres can process lexically marked pronoun agreement violations, and do so in a similar fashion. Morphologically marked subject/verb agreement errors, however, showed a distinct LH advantage. Copyright © 2013 Elsevier B.V. All rights reserved.

Grammatical number agreement processing using the visual half-field paradigm: An event-related brain potential study

PubMed Central

Kemmer, Laura; Coulson, Seana; Kutas, Marta

2014-01-01

Despite indications in the split-brain and lesion literatures that the right hemisphere is capable of some syntactic analysis, few studies have investigated right hemisphere contributions to syntactic processing in people with intact brains. Here we used the visual half-field paradigm in healthy adults to examine each hemisphere’s processing of correct and incorrect grammatical number agreement marked either lexically, e.g., antecedent/reflexive pronoun (“The grateful niece asked herself/*themselves…”) or morphologically, e.g., subject/verb (“Industrial scientists develop/*develops…”). For reflexives, response times and accuracy of grammaticality decisions suggested similar processing regardless of visual field of presentation. In the subject/verb condition, we observed similar response times and accuracies for central and right visual field (RVF) presentations. For left visual field (LVF) presentation, response times were longer and accuracy rates were reduced relative to RVF presentation. An event-related brain potential (ERP) study using the same materials revealed similar ERP responses to the reflexive pronouns in the two visual fields, but very different ERP effects to the subject/verb violations. For lexically marked violations on reflexives, P600 was elicited by stimuli in both the LVF and RVF; for morphologically marked violations on verbs, P600 was elicited only by RVF stimuli. These data suggest that both hemispheres can process lexically marked pronoun agreement violations, and do so in a similar fashion. Morphologically marked subject/verb agreement errors, however, showed a distinct LH advantage. PMID:24326084

Assessing agreement between malaria slide density readings.

PubMed

Alexander, Neal; Schellenberg, David; Ngasala, Billy; Petzold, Max; Drakeley, Chris; Sutherland, Colin

2010-01-04

Several criteria have been used to assess agreement between replicate slide readings of malaria parasite density. Such criteria may be based on percent difference, or absolute difference, or a combination. Neither the rationale for choosing between these types of criteria, nor that for choosing the magnitude of difference which defines acceptable agreement, are clear. The current paper seeks a procedure which avoids the disadvantages of these current options and whose parameter values are more clearly justified. Variation of parasite density within a slide is expected, even when it has been prepared from a homogeneous sample. This places lower limits on sensitivity and observer agreement, quantified by the Poisson distribution. This means that, if a criterion of fixed percent difference criterion is used for satisfactory agreement, the number of discrepant readings is over-estimated at low parasite densities. With a criterion of fixed absolute difference, the same happens at high parasite densities. For an ideal slide, following the Poisson distribution, a criterion based on a constant difference in square root counts would apply for all densities. This can be back-transformed to a difference in absolute counts, which, as expected, gives a wider range of acceptable agreement at higher average densities. In an example dataset from Tanzania, observed differences in square root counts correspond to a 95% limits of agreement of -2,800 and +2,500 parasites/microl at average density of 2,000 parasites/microl, and -6,200 and +5,700 parasites/microl at 10,000 parasites/microl. However, there were more outliers beyond those ranges at higher densities, meaning that actual coverage of these ranges was not a constant 95%, but decreased with density. In a second study, a trial of microscopist training, the corresponding ranges of agreement are wider and asymmetrical: -8,600 to +5,200/microl, and -19,200 to +11,700/microl, respectively. By comparison, the optimal limits of

Tooth shade measurements under standard and nonstandard illumination and their agreement with skin color.

PubMed

Al-Dwairi, Ziad; Shaweesh, Ashraf; Kamkarfar, Sohrab; Kamkarfar, Shahrzad; Borzabadi-Farahani, Ali; Lynch, Edward

2014-01-01

The purpose of this study was to examine the relationship between skin color (shade) and tooth shade under standard and nonstandard illumination sources. Four hundred Jordanian participants (200 males, 200 females, 20 to 50 years of age) were studied. Skin colors were assessed and categorized using the L'Oreal and Revlon foundation shade guides (light, medium, dark). The Vita Pan Classical Shade Guide (VPCSG; Vident) and digital Vita EasyShade Intraoral Dental Spectrophotometer (VESIDS; Vident) were used to select shades in the middle thirds of maxillary central incisors; tooth shades were classified into four categories (highest, high, medium, low). Significant gender differences were observed for skin colors (P = .000) and tooth shade guide systems (P = .001 and .050 for VPCSG and VESIDS, respectively). The observed agreement was 100% and 93% for skin and tooth shade guides, respectively. The corresponding kappa statistic values were 1.00 and 0.79, respectively (substantial agreement, P < .001). The observed agreement between skin color and tooth shades (VPCSG and VESIDS) was approximately 50%. The digital tooth shade guide system can be a satisfactory substitute for classical tooth shade guides and clinical shade matching. There was only moderate agreement between skin color and tooth shade.

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.

Agreement in the assessment of metastatic spine disease using scoring systems.

PubMed

Arana, Estanislao; Kovacs, Francisco M; Royuela, Ana; Asenjo, Beatriz; Pérez-Ramírez, Ursula; Zamora, Javier

2015-04-01

To assess variability in the use of Tomita and modified Bauer scores in spine metastases. Clinical data and imaging from 90 patients with biopsy-proven spinal metastases, were provided to 83 specialists from 44 hospitals. Spinal levels involved and the Tomita and modified Bauer scores for each case were determined twice by each clinician, with a minimum of 6-week interval. Clinicians were blinded to every evaluation. Kappa statistic was used to assess intra and inter-observer agreement. Subgroup analyses were performed according to clinicians' specialty (medical oncology, neurosurgery, radiology, orthopedic surgery and radiation oncology), years of experience (⩽7, 8-13, ⩾14), and type of hospital (four levels). For metastases identification, intra-observer agreement was "substantial" (0.600.80) at the other levels. Inter-observer agreement was "almost perfect" at lumbar spine, and "substantial" at the other levels. Intra-observer agreement for the Tomita and Bauer scores was almost perfect. Inter-observer agreement was almost perfect for the Tomita score and substantial for the Bauer one. Results were similar across specialties, years of experience and type of hospital. Agreement in the assessment of metastatic spine disease is high. These scoring systems can improve communication among clinicians involved in oncology care. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Stress-only myocardial perfusion scintigraphy: a prospective study on the accuracy and observer agreement with quantitative coronary angiography as the gold standard.

PubMed

Ejlersen, June A; May, Ole; Mortensen, Jesper; Nielsen, Gitte L; Lauridsen, Jeppe F; Allan, Johansen

2017-11-01

Patients with normal stress perfusion have an excellent prognosis. Prospective studies on the diagnostic accuracy of stress-only scans with contemporary, independent examinations as gold standards are lacking. A total of 109 patients with typical angina and no previous coronary artery disease underwent a 2-day stress (exercise)/rest, gated, and attenuation-corrected (AC), 99m-technetium-sestamibi perfusion study, followed by invasive coronary angiography. The stress datasets were evaluated twice by four physicians with two different training levels (expert and novice): familiar and unfamiliar with AC. The two experts also made a consensus reading of the integrated stress-rest datasets. The consensus reading and quantitative data from the invasive coronary angiography were applied as reference methods. The sensitivity/specificity were 0.92-1.00/0.73-0.90 (reference: expert consensus reading), 0.93-0.96/0.63-0.82 (reference: ≥1 stenosis>70%), and 0.75-0.88/0.70-0.88 (reference: ≥1 stenosis>50%). The four readers showed a high and fairly equal sensitivity independent of their familiarity with AC. The expert familiar with AC had the highest specificity independent of the reference method. The intraobserver and interobserver agreements on the stress-only readings were good (readers without AC experience) to excellent (readers with AC experience). AC stress-only images yielded a high sensitivity independent of the training level and experience with AC of the nuclear physician, whereas the specificity correlated positively with both. Interobserver and intraobserver agreements tended to be the best for physicians with AC experience.

12 CFR 133.5 - Related agreements considered a single agreement.

Code of Federal Regulations, 2012 CFR

2012-01-01

... agreement. 133.5 Section 133.5 Banks and Banking COMPTROLLER OF THE CURRENCY, DEPARTMENT OF THE TREASURY DISCLOSURE AND REPORTING OF CRA-RELATED AGREEMENTS § 133.5 Related agreements considered a single agreement... § 133.2 of this part. (a) Agreements entered into by same parties. All written agreements to which an...

Interobserver Agreement and Disagreement in Continuous Recording Exemplified by Measurement of Behavior State.

ERIC Educational Resources Information Center

Mudford, Oliver C.; Hogg, James; Roberts, Jessica

1997-01-01

Continuous observational recording over 57 hours evaluated behavior states of three adults with profound and multiple disabilities. Two independent observers also recorded for 22 hours. Although overall percentage agreement was satisfactory (above 80%), agreement on occurrence was unsatisfactory (mean of 65%). Agreement data were superimposed on…

Development of an observational measure of healthcare worker hand-hygiene behaviour: the hand-hygiene observation tool (HHOT).

PubMed

McAteer, J; Stone, S; Fuller, C; Charlett, A; Cookson, B; Slade, R; Michie, S

2008-03-01

Previous observational measures of healthcare worker (HCW) hand-hygiene behaviour (HHB) fail to provide adequate standard operating procedures (SOPs), accounts of inter-rater agreement testing or evidence of sensitivity to change. This study reports the development of an observational tool in a way that addresses these deficiencies. Observational categories were developed systematically, guided by a clinical guideline, previous measures and pilot hand-hygiene behaviour observations (HHOs). The measure, a simpler version of the Geneva tool, consists of HHOs (before and after low-risk, high-risk or unobserved contact), HHBs (soap, alcohol hand rub, no action, unknown), and type of HCW. Inter-observer agreement for each category was assessed by observation of 298 HHOs and HHBs by two independent observers on acute elderly and intensive care units. Raw agreement (%) and Kappa were 77% and 0.68 for HHB; 83% and 0.77 for HHO; and 90% and 0.77 for HCW. Inter-observer agreement for overall compliance of a group of HCWs was assessed by observation of 1191 HHOs and HHBs by two pairs of independent observers. Overall agreement was good (intraclass correlation coefficient = 0.79). Sensitivity to change was examined by autoregressive time-series modelling of longitudinal observations for 8 months on the intensive therapy unit during an Acinetobacter baumannii outbreak and subsequent strengthening of infection control measures. Sensitivity to change was demonstrated by a rise in compliance from 80 to 98% with an odds ratio of increased compliance of 7.00 (95% confidence interval: 4.02-12.2) P < 0.001.

Methods to systematically review and meta-analyse observational studies: a systematic scoping review of recommendations.

PubMed

Mueller, Monika; D'Addario, Maddalena; Egger, Matthias; Cevallos, Myriam; Dekkers, Olaf; Mugglin, Catrina; Scott, Pippa

2018-05-21

Systematic reviews and meta-analyses of observational studies are frequently performed, but no widely accepted guidance is available at present. We performed a systematic scoping review of published methodological recommendations on how to systematically review and meta-analyse observational studies. We searched online databases and websites and contacted experts in the field to locate potentially eligible articles. We included articles that provided any type of recommendation on how to conduct systematic reviews and meta-analyses of observational studies. We extracted and summarised recommendations on pre-defined key items: protocol development, research question, search strategy, study eligibility, data extraction, dealing with different study designs, risk of bias assessment, publication bias, heterogeneity, statistical analysis. We summarised recommendations by key item, identifying areas of agreement and disagreement as well as areas where recommendations were missing or scarce. The searches identified 2461 articles of which 93 were eligible. Many recommendations for reviews and meta-analyses of observational studies were transferred from guidance developed for reviews and meta-analyses of RCTs. Although there was substantial agreement in some methodological areas there was also considerable disagreement on how evidence synthesis of observational studies should be conducted. Conflicting recommendations were seen on topics such as the inclusion of different study designs in systematic reviews and meta-analyses, the use of quality scales to assess the risk of bias, and the choice of model (e.g. fixed vs. random effects) for meta-analysis. There is a need for sound methodological guidance on how to conduct systematic reviews and meta-analyses of observational studies, which critically considers areas in which there are conflicting recommendations.

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.

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.

34 CFR 675.48 - Agreement.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 34 Education 3 2014-07-01 2014-07-01 false Agreement. 675.48 Section 675.48 Education Regulations..., DEPARTMENT OF EDUCATION FEDERAL WORK-STUDY PROGRAMS Work-Colleges Program § 675.48 Agreement. To participate in the Work-Colleges program, an institution shall enter into an agreement with the Secretary. The...

34 CFR 675.48 - Agreement.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 34 Education 3 2013-07-01 2013-07-01 false Agreement. 675.48 Section 675.48 Education Regulations..., DEPARTMENT OF EDUCATION FEDERAL WORK-STUDY PROGRAMS Work-Colleges Program § 675.48 Agreement. To participate in the Work-Colleges program, an institution shall enter into an agreement with the Secretary. The...

34 CFR 675.48 - Agreement.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 34 Education 3 2011-07-01 2011-07-01 false Agreement. 675.48 Section 675.48 Education Regulations..., DEPARTMENT OF EDUCATION FEDERAL WORK-STUDY PROGRAMS Work-Colleges Program § 675.48 Agreement. To participate in the Work-Colleges program, an institution shall enter into an agreement with the Secretary. The...

34 CFR 675.48 - Agreement.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 34 Education 3 2012-07-01 2012-07-01 false Agreement. 675.48 Section 675.48 Education Regulations..., DEPARTMENT OF EDUCATION FEDERAL WORK-STUDY PROGRAMS Work-Colleges Program § 675.48 Agreement. To participate in the Work-Colleges program, an institution shall enter into an agreement with the Secretary. The...

34 CFR 675.48 - Agreement.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 34 Education 3 2010-07-01 2010-07-01 false Agreement. 675.48 Section 675.48 Education Regulations..., DEPARTMENT OF EDUCATION FEDERAL WORK-STUDY PROGRAMS Work-Colleges Program § 675.48 Agreement. To participate in the Work-Colleges program, an institution shall enter into an agreement with the Secretary. The...

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.

Inter-observer agreement for Crohn's disease sub-phenotypes using the Montreal Classification: How good are we? A multi-centre Australasian study.

PubMed

Krishnaprasad, Krupa; Andrews, Jane M; Lawrance, Ian C; Florin, Timothy; Gearry, Richard B; Leong, Rupert W L; Mahy, Gillian; Bampton, Peter; Prosser, Ruth; Leach, Peta; Chitti, Laurie; Cock, Charles; Grafton, Rachel; Croft, Anthony R; Cooke, Sharon; Doecke, James D; Radford-Smith, Graham L

2012-04-01

Crohn's disease (CD) exhibits significant clinical heterogeneity. Classification systems attempt to describe this; however, their utility and reliability depends on inter-observer agreement (IOA). We therefore sought to evaluate IOA using the Montreal Classification (MC). De-identified clinical records of 35 CD patients from 6 Australian IBD centres were presented to 13 expert practitioners from 8 Australia and New Zealand Inflammatory Bowel Disease Consortium (ANZIBDC) centres. Practitioners classified the cases using MC and forwarded data for central blinded analysis. IOA on smoking and medications was also tested. Kappa statistics, with pre-specified outcomes of κ>0.8 excellent; 0.61-0.8 good; 0.41-0.6 moderate and ≤0.4 poor, were used. 97% of study cases had colonoscopy reports, however, only 31% had undergone a complete set of diagnostic investigations (colonoscopy, histology, SB imaging). At diagnosis, IOA was excellent for age, κ=0.84; good for disease location, κ=0.73; only moderate for upper GI disease (κ=0.57) and disease behaviour, κ=0.54; and good for the presence of perianal disease, κ=0.6. At last follow-up, IOA was good for location, κ=0.68; only moderate for upper GI disease (κ=0.43) and disease behaviour, κ=0.46; but excellent for the presence/absence of perianal disease, κ=0.88. IOA for immunosuppressant use ever and presence of stricture were both good (κ=0.79 and 0.64 respectively). IOA using MC is generally good; however some areas are less consistent than others. Omissions and inaccuracies reduce the value of clinical data when comparing cohorts across different centres, and may impair the ability to translate genetic discoveries into clinical practice. Crown Copyright © 2011. Published by Elsevier B.V. All rights reserved.

Seeing Eye to Eye: Predicting Teacher-Student Agreement on Classroom Social Networks

PubMed Central

Neal, Jennifer Watling; Cappella, Elise; Wagner, Caroline; Atkins, Marc S.

2010-01-01

This study examines the association between classroom characteristics and teacher-student agreement in perceptions of students’ classroom peer networks. Social network, peer nomination, and observational data were collected from a sample of second through fourth grade teachers (N=33) and students (N=669) in 33 classrooms across five high poverty urban schools. Results demonstrate that variation in teacher-student agreement on the structure of students’ peer networks can be explained, in part, by developmental factors and classroom characteristics. Developmental increases in network density partially mediated the positive relationship between grade level and teacher-student agreement. Larger class sizes and higher levels of normative aggressive behavior resulted in lower levels of teacher-student agreement. Teachers’ levels of classroom organization had mixed influences, with behavior management negatively predicting agreement, and productivity positively predicting agreement. These results underscore the importance of the classroom context in shaping teacher and student perceptions of peer networks. PMID:21666768

The "ugly duckling" sign: agreement between observers.

PubMed

Scope, Alon; Dusza, Stephen W; Halpern, Allan C; Rabinovitz, Harold; Braun, Ralph P; Zalaudek, Iris; Argenziano, Giuseppe; Marghoob, Ashfaq A

2008-01-01

To assess whether multiple observers can identify the same pigmented lesion(s) as being different from a patient's other moles ("ugly duckling" [UD] sign) and to explore whether the UD sign is sensitive for melanoma detection. Baseline back images of 12 patients were obtained from a database of standardized patient images. All patients had at least 8 atypical moles on the back, and in 5 patients, one of the lesions was a histologically confirmed melanoma. The overview back images were supplemented with close-up clinical images of lesions. Participants were asked to evaluate whether the images showed any lesions on the back that differed from other nevi. Dermatology clinic specializing in pigmented lesions. Images were evaluated by 34 participants, including 8 pigmented lesion experts, 13 general dermatologists, 5 dermatology nurses, and 8 nonclinical medical staff. A lesion was considered a generally apparent UD if it was perceived as different by at least two-thirds of the participants. Sensitivity was defined as the fraction of melanomas identified as different. All 5 melanomas (100%) and only 3 of 140 benign lesions (2.1%) were generally apparent as different. The sensitivity of the UD sign for melanoma detection was 0.9 for the whole group, 1.0 for experts, 0.89 for general dermatologists, 0.88 for nurses, and 0.85 for nonclinicians. A limitation of the study is that assessment was done in virtual settings. In the present study, melanomas were generally apparent as UDs. The potential of the UD sign for melanoma screening should be further assessed.

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.

Scales of degree of facial paralysis: analysis of agreement.

PubMed

Fonseca, Kércia Melo de Oliveira; Mourão, Aline Mansueto; Motta, Andréa Rodrigues; Vicente, Laelia Cristina Caseiro

2015-01-01

It has become common to use scales to measure the degree of involvement of facial paralysis in phonoaudiological clinics. To analyze the inter- and intra-rater agreement of the scales of degree of facial paralysis and to elicit point of view of the appraisers regarding their use. Cross-sectional observational clinical study of the Chevalier and House & Brackmann scales performed by five speech therapists with clinical experience, who analyzed the facial expression of 30 adult subjects with impaired facial movements two times, with a one week interval between evaluations. The kappa analysis was employed. There was excellent inter-rater agreement for both scales (kappa>0.80), and on the Chevalier scale a substantial intra-rater agreement in the first assessment (kappa=0.792) and an excellent agreement in the second assessment (kappa=0.928). The House & Brackmann scale showed excellent agreement at both assessments (kappa=0.850 and 0.857). As for the appraisers' point of view, one appraiser thought prior training is necessary for the Chevalier scale and, four appraisers felt that training is important for the House & Brackmann scale. Both scales have good inter- and intra-rater agreement and most of the appraisers agree on the ease and relevance of the application of these scales. Copyright © 2014 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

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

Interobserver agreement in CTG interpretation using the 2015 FIGO guidelines for intrapartum fetal monitoring.

PubMed

Rei, Mariana; Tavares, Sara; Pinto, Pedro; Machado, Ana P; Monteiro, Sofia; Costa, Antónia; Costa-Santos, Cristina; Bernardes, João; Ayres-De-Campos, Diogo

2016-10-01

Visual analysis of cardiotocographic (CTG) tracings has been shown to be prone to poor intra- and interobserver agreement when several interpretation guidelines are used, and this may have an important impact on the technology's performance. The aim of this study was to evaluate agreement in CTG interpretation using the new 2015 FIGO guidelines on intrapartum fetal monitoring. A pre-existing database of intrapartum CTG tracings was used to sequentially select 151 cases acquired with a fetal electrode, with duration exceeding 60minutes, and signal loss less than 15%. These tracings were presented to six clinicians, three with more than 5 years' experience in the labor ward, and three with 5 or less years' experience. Observers were asked to evaluate tracings independently, to assess basic CTG features: baseline, variability, accelerations, decelerations, sinusoidal pattern, tachysystole, and to classify each tracing as normal, suspicious or pathologic, according to the 2015 FIGO guidelines on intrapartum fetal monitoring. Agreement between observers was evaluated using the proportions of agreement (Pa), with 95% confidence intervals (95%CI). A good interobserver agreement was found in the evaluation of most CTG features, but not bradycardia, reduced variability, saltatory pattern, absence of accelerations and absence of decelerations. For baseline classification Pa was 0.85 [0.82-0.90], for variability 0.82 [0.78-0.85], for accelerations 0.72 [0.68-0.75], for tachysystole 0.77 [0.74-0.81], for decelerations 0.92 [0.90-0.95], for variable decelerations 0.62 [0.58-0.65], for late decelerations 0.63 [0.59-0.66], for repetitive decelerations 0.73 [0.69-0.78], and for prolonged decelerations 0.81 [0.77-0.85]. For overall CTG classification, Pa were 0.60 [0.56-0.64], for classification as normal 0.67 [0.61-0.72], for suspicious 0.54 [0.48-0.60] and for pathologic 0.59 [0.51-0.66]. No differences in agreement according to the level of expertise were observed, except in the

Cervical Cancer Screening in Cameroon: Interobserver Agreement on the Interpretation of Digital Cervicography Results.

PubMed

Manga, Simon; Parham, Groesbeck; Benjamin, Nkoum; Nulah, Kathleen; Sheldon, Lisa Kennedy; Welty, Edith; Ogembo, Javier Gordon; Bradford, Leslie; Sando, Zacharie; Shields, Ray; Welty, Thomas

2015-10-01

The World Health Organization recommends visual inspection with acetic acid (VIA) for cervical cancer screening in resource-limited settings. In Cameroon, we use digital cervicography (DC) to capture images of the cervix after VIA. This study evaluated interobserver agreement of DC results, compared DC with histopathologic results, and examined interobserver agreement among screening methods. Three observers, blinded to each other's interpretations, evaluated 540 DC photographs as follows: (1) negative/positive for acetowhite lesions or cancer and (2) assigned a presumptive diagnosis of histopathologic lesion grade in the 91 cases that had a histopathologic diagnosis. Observer A was the actual screening nurse; B, a reproductive health nurse; C, a gynecologic oncologist; and D, the histopathologic diagnosis. We compared inter-rater agreement of DC impressions among observers A, B, and C, and with D, with Cohen kappas. For interpretations of DC, (negative/positive) strengths of agreement of paired observers were the following: A/B, moderate [K, 0.54; 95% confidence interval (CI), 0.47-0.61], A/C, fair (K, 0.37; 95% CI, 0.29-0.44), and B/C, moderate (K, 0.45; 95% CI, 0.37-0.53). For presumptive pathologic grading, strengths of agreement for weighted Ks were as follows: A/B, moderate (K, 0.42; 95% CI, 0.28-0.56); A/C, fair (K, 0.33; 95% CI, 0.20-0.46); B/C, fair (K, 0.54; 95% CI, 0.40-0.67); A/D, moderate (K, 0.59; 95% CI, 0.45-0.74); B/D, moderate (K, 0.58; 95% CI, 0.46-0.70); and C/D, moderate (K, 0.50; 95% CI, 0.37-0.63). Interobserver agreement of DC interpretations was mostly moderate among the 3 observers, between them and histopathology, and comparable to that of other visual-based screening methods, i.e., VIA, cytology, or colposcopy.

Intramodality and intermodality agreement in radiography and computed tomography of equine distal limb fractures.

PubMed

Crijns, C P; Martens, A; Bergman, H-J; van der Veen, H; Duchateau, L; van Bree, H J J; Gielen, I M V L

2014-01-01

Computed tomography (CT) is increasingly accessible in equine referral hospitals. To document the level of agreement within and between radiography and CT in characterising equine distal limb fractures. Retrospective descriptive study. Images from horses that underwent radiographic and CT evaluation for suspected distal limb fractures were reviewed, including 27 horses and 3 negative controls. Using Cohen's kappa and weighted kappa analysis, the level of agreement among 4 observers for a predefined set of diagnostic characteristics for radiography and CT separately and for the level of agreement between the 2 imaging modalities were documented. Both CT and radiography had very good intramodality agreement in identifying fractures, but intermodality agreement was lower. There was good intermodality and intramodality agreement for anatomical localisation and the identification of fracture displacement. Agreement for articular involvement, fracture comminution and fracture fragment number was towards the lower limit of good agreement. There was poor to fair intermodality agreement regarding fracture orientation, fracture width and coalescing cracks; intramodality agreement was higher for CT than for radiography for these features. Further studies, including comparisons with surgical and/or post mortem findings, are required to determine the sensitivity and specificity of CT and radiography in the diagnosis and characterisation of equine distal limb fractures. © 2013 EVJ Ltd.

Assessing the validity and intra-observer agreement of the MIDAM-LTC; an instrument measuring factors that influence personal dignity in long-term care facilities

PubMed Central

2014-01-01

Background Patients who are cared for in long-term care facilities are vulnerable to lose personal dignity. An instrument measuring factors that influence dignity can be used to better target dignity-conserving care to an individual patient, but no such instrument is yet available for the long-term care setting. The aim of this study was to create the Measurement Instrument for Dignity AMsterdam - for Long-Term Care facilities (MIDAM-LTC) and to assess its validity and intra-observer agreement. Methods Thirteen items specific for the LTC setting were added to the earlier developed, more general MIDAM. The MIDAM-LTC consisted of 39 symptoms or experiences for which presence as well as influence on dignity were asked, and a single item score for overall personal dignity. Questionnaires containing the MIDAM-LTC were administered face-to-face at two moments (with a 1-week interval) to 95 nursing home residents residing on general medical wards of six nursing homes in the Netherlands. Constructs related to dignity (WHO Well-Being Five Index, quality of life and physical health status) were also measured. Ten residents answered the questions while thinking aloud. Content validity, construct validity and intra-observer agreement were examined. Results Nine of the 39 items barely exerted influence on dignity. Eight of them could be omitted from the MIDAM-LTC, because the thinking aloud method revealed sensible explanations for their small influence on dignity. Residents reported that they missed no important items. Hypotheses to support construct validity, about the strength of correlations between on the one hand personal dignity and on the other hand well-being, quality of life or physical health status, were confirmed. On average, 83% of the scores given for each item’s influence on dignity were practically consistent over 1 week, and more than 80% of the residents gave consistent scores for the single item score for overall dignity. Conclusion The MIDAM-LTC has good

A Statistical Analysis of Reviewer Agreement and Bias in Evaluating Medical Abstracts 1

PubMed Central

Cicchetti, Domenic V.; Conn, Harold O.

1976-01-01

Observer variability affects virtually all aspects of clinical medicine and investigation. One important aspect, not previously examined, is the selection of abstracts for presentation at national medical meetings. In the present study, 109 abstracts, submitted to the American Association for the Study of Liver Disease, were evaluated by three “blind” reviewers for originality, design-execution, importance, and overall scientific merit. Of the 77 abstracts rated for all parameters by all observers, interobserver agreement ranged between 81 and 88%. However, corresponding intraclass correlations varied between 0.16 (approaching statistical significance) and 0.37 (p < 0.01). Specific tests of systematic differences in scoring revealed statistically significant levels of observer bias on most of the abstract components. Moreover, the mean differences in interobserver ratings were quite small compared to the standard deviations of these differences. These results emphasize the importance of evaluating the simple percentage of rater agreement within the broader context of observer variability and systematic bias. PMID:997596

Gastritis staging: interobserver agreement by applying OLGA and OLGIM systems.

PubMed

Isajevs, Sergejs; Liepniece-Karele, Inta; Janciauskas, Dainius; Moisejevs, Georgijs; Putnins, Viesturs; Funka, Konrads; Kikuste, Ilze; Vanags, Aigars; Tolmanis, Ivars; Leja, Marcis

2014-04-01

Atrophic gastritis remains a difficult histopathological diagnosis with low interobserver agreement. The aim of our study was to compare gastritis staging and interobserver agreement between general and expert gastrointestinal (GI) pathologists using Operative Link for Gastritis Assessment (OLGA) and Operative Link on Gastric Intestinal Metaplasia (OLGIM). We enrolled 835 patients undergoing upper endoscopy in the study. Two general and two expert gastrointestinal pathologists graded biopsy specimens according to the Sydney classification, and the stage of gastritis was assessed by OLGA and OLGIM system. Using OLGA, 280 (33.4 %) patients had gastritis (stage I-IV), whereas with OLGIM this was 167 (19.9 %). OLGA stage III- IV gastritis was observed in 25 patients, whereas by OLGIM stage III-IV was found in 23 patients. Interobserver agreement between expert GI pathologists for atrophy in the antrum, incisura angularis, and corpus was moderate (kappa = 0.53, 0.57 and 0.41, respectively, p < 0.0001), but almost perfect for intestinal metaplasia (kappa = 0.82, 0.80 and 0.81, respectively, p < 0.0001). However, interobserver agreement between general pathologists was poor for atrophy, but moderate for intestinal metaplasia. OLGIM staging provided the highest interobserver agreement, but a substantial proportion of potentially high-risk individuals would be missed if only OLGIM staging is applied. Therefore, we recommend to use a combination of OLGA and OLGIM for staging of chronic gastritis.

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

The Proposed Anti-Counterfeiting Trade Agreement: Background and Key Issues

DTIC Science & Technology

2010-03-12

or is negotiating regional and bilateral FTAs with several of the ACTA participants. Some observers have questioned why countries designated in...Notably, China, India , and Brazil currently are not participants to this agreement. Negotiations on the agreement are ongoing; participants have expressed...bilateral free trade agreements ( FTAs ). In negotiating recent FTAs , the USTR frequently has sought levels of protection that exceed the minimum standards

Reliability and agreement in student ratings of the class environment.

PubMed

Nelson, Peter M; Christ, Theodore J

2016-09-01

The current study estimated the reliability and agreement of student ratings of the classroom environment obtained using the Responsive Environmental Assessment for Classroom Teaching (REACT; Christ, Nelson, & Demers, 2012; Nelson, Demers, & Christ, 2014). Coefficient alpha, class-level reliability, and class agreement indices were evaluated as each index provides important information for different interpretations and uses of student rating scale data. Data for 84 classes across 29 teachers in a suburban middle school were sampled to derive reliability and agreement indices for the REACT subscales across 4 class sizes: 25, 20, 15, and 10. All participating teachers were White and a larger number of 6th-grade classes were included (42%) relative to 7th- (33%) or 8th- (23%) grade classes. Teachers were responsible for a variety of content areas, including language arts (26%), science (26%), math (20%), social studies (19%), communications (6%), and Spanish (3%). Coefficient alpha estimates were generally high across all subscales and class sizes (α = .70-.95); class-mean estimates were greatly impacted by the number of students sampled from each class, with class-level reliability values generally falling below .70 when class size was reduced from 25 to 20. Further, within-class student agreement varied widely across the REACT subscales (mean agreement = .41-.80). Although coefficient alpha and test-retest reliability are commonly reported in research with student rating scales, class-level reliability and agreement are not. The observed differences across coefficient alpha, class-level reliability, and agreement indices provide evidence for evaluating students' ratings of the class environment according to their intended use (e.g., differentiating between classes, class-level instructional decisions). (PsycINFO Database Record (c) 2016 APA, all rights reserved).

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

Agreement between histopathological results in clinically diagnosed cases of indeterminate leprosy in São Paulo, Brazil.

PubMed

Lombardi, C; Cohen, S; Leiker, D L; Souza, J M; Cunha, P R; Martelli, C M; Andrade, A L; Zicker, F

1994-01-01

Histopathological slides from skin biopsies of fifty-seven self-reporting patients diagnosed as indeterminate leprosy by the Leprosy Control Programme in São Paulo, were sent to three independent histopathologists. Agreement between the reports were based on the following diagnosis: "indeterminate leprosy", "suggestive leprosy" or "no leprosy". A great variation was observed in the interpretation of the histopathological examination. The three pathologists reported "indeterminate leprosy" respectively in 7.0%, 54.4% and 84.2%, of the cases studied. A kappa index of agreement between any two pathologists ranged from 0.08 to 0.32, showing poor agreement between observers. Agreement improved by pooling together the reports "suggestive leprosy" and "indeterminate leprosy". The three pathologists agreed in the results of 24 biopsies of the 27 classified as leprosy by any one of the three observers. Eight cases were considered as "no leprosy" by all pathologists. Higher agreement indices were obtained for positive and negative proportionate concordance between any two examiners. The implications of the variation in the diagnosis of indeterminate leprosy and early leprosy are discussed in the context of public health and case-management.

New definitions of 6 clinical signs of perceptual disorder in children with cerebral palsy: an observational study through reliability measures.

PubMed

Ferrari, A; Sghedoni, A; Alboresi, S; Pedroni, E; Lombardi, F

2014-12-01

Recently authors have begun to emphasize the non-motor aspects of Cerebral Palsy and their influence on motor control and recovery prognosis. Much has been written about single clinical signs (i.e., startle reaction) but so far no definitions of the six perceptual signs presented in this study have appeared in literature. This study defines 6 signs (startle reaction, upper limbs in startle position, frequent eye blinking, posture freezing, averted eye gaze, grimacing) suggestive of perceptual disorders in children with cerebral palsy and measures agreement on sign recognition among independent observers and consistency of opinions over time. Observational study with both cross-sectional and prospective components. Fifty-six videos presented to observers in random order. Videos were taken from 19 children with a bilateral form of cerebral palsy referred to the Children Rehabilitation Unit in Reggio Emilia. Thirty-five rehabilitation professionals from all over Italy: 9 doctors and 26 physiotherapists. Measure of agreement among 35 independent observers was compiled from a sample of 56 videos. Interobserver reliability was determined using the K index of Fleiss and reliability intra-observer was calculated by the Spearman correlation index between ranks (rho - ρ). Percentage of agreement between observers and Gold Standard was used as criterion validity. Interobserver reliability was moderate for startle reaction, upper limb in startle position, adverted eye gaze and eye-blinking and fair for posture freezing and grimacing. Intraobserver reliability remained consistent over time. Criterion validity revealed very high agreement between independent observer evaluation and gold standard. Semiotics of perceptual disorders can be used as a specific and sensitive instrument in order to identify a new class of patients within existing heterogeneous clinical types of bilateral cerebral palsy forms and could help clinicians in identifying functional prognosis. To provide

Assessment of Interobserver Reliability in Nutrition Studies that Use Direct Observation of School Meals

PubMed Central

BAGLIO, MICHELLE L.; BAXTER, SUZANNE DOMEL; GUINN, CAROLINE H.; THOMPSON, WILLIAM O.; SHAFFER, NICOLE M.; FRYE, FRANCESCA H. A.

2005-01-01

This article (a) provides a general review of interobserver reliability (IOR) and (b) describes our method for assessing IOR for items and amounts consumed during school meals for a series of studies regarding the accuracy of fourth-grade children's dietary recalls validated with direct observation of school meals. A widely used validation method for dietary assessment is direct observation of meals. Although many studies utilize several people to conduct direct observations, few published studies indicate whether IOR was assessed. Assessment of IOR is necessary to determine that the information collected does not depend on who conducted the observation. Two strengths of our method for assessing IOR are that IOR was assessed regularly throughout the data collection period and that IOR was assessed for foods at the item and amount level instead of at the nutrient level. Adequate agreement among observers is essential to the reasoning behind using observation as a validation tool. Readers are encouraged to question the results of studies that fail to mention and/or to include the results for assessment of IOR when multiple people have conducted observations. PMID:15354155

Inter-observer variability in fetal biometric measurements.

PubMed

Kilani, Rami; Aleyadeh, Wesam; Atieleh, Luay Abu; Al Suleimat, Abdul Mane; Khadra, Maysa; Hawamdeh, Hassan M

2018-02-01

To evaluate inter-observer variability and reproducibility of ultrasound measurements for fetal biometric parameters. A prospective cohort study was implemented in two tertiary care hospitals in Amman, Jordan; Prince Hamza Hospital and Albashir Hospital. 192 women with a singleton pregnancy at a gestational age of 18-36 weeks were the participants in the study. Transabdominal scans for fetal biometric parameter measurement were performed on study participants from the period of November 2014 to March 2015. Women who agreed to participate in the study were administered two ultrasound scans for head circumference, abdominal circumference and femur length. The correlation coefficient was calculated. Bland-Altman plots were used to analyze the degree of measurement agreement between observers. Limits of agreement ± 2 SD for the differences in fetal biometry measurements in proportions of the mean of the measurements were derived. Main outcome measures examine the reproducibility of fetal biometric measurements by different observers. High inter-observer inter-class correlation coefficient (ICC) was found for femur length (0.990) and abdominal circumference (0.996) where Bland-Altman plots showed high degrees of agreement. The highest degrees of agreement were noted in the measurement of abdominal circumference followed by head circumference. The lowest degree of agreement was found for femur length measurement. We used a paired-sample t-test and found that the mean difference between duplicate measurements was not significant (P > 0.05). Biometric fetal parameter measurements may be reproducible by different operators in the clinical setting with similar results. Fetal head circumference, abdominal circumference and femur length were highly reproducible. Large organized studies are needed to ensure accurate fetal measurements due to the important clinical implications of inaccurate measurements. Copyright © 2018. Published by Elsevier B.V.

New agreement measures based on survival processes

PubMed Central

Guo, Ying; Li, Ruosha; Peng, Limin; Manatunga, Amita K.

2013-01-01

Summary The need to assess agreement arises in many scenarios in biomedical sciences when measurements were taken by different methods on the same subjects. When the endpoints are survival outcomes, the study of agreement becomes more challenging given the special characteristics of time-to-event data. In this paper, we propose a new framework for assessing agreement based on survival processes that can be viewed as a natural representation of time-to-event outcomes. Our new agreement measure is formulated as the chance-corrected concordance between survival processes. It provides a new perspective for studying the relationship between correlated survival outcomes and offers an appealing interpretation as the agreement between survival times on the absolute distance scale. We provide a multivariate extension of the proposed agreement measure for multiple methods. Furthermore, the new framework enables a natural extension to evaluate time-dependent agreement structure. We develop nonparametric estimation of the proposed new agreement measures. Our estimators are shown to be strongly consistent and asymptotically normal. We evaluate the performance of the proposed estimators through simulation studies and then illustrate the methods using a prostate cancer data example. PMID:23844617

Measuring agreement of multivariate discrete survival times using a modified weighted kappa coefficient.

PubMed

Guo, Ying; Manatunga, Amita K

2009-03-01

Assessing agreement is often of interest in clinical studies to evaluate the similarity of measurements produced by different raters or methods on the same subjects. We present a modified weighted kappa coefficient to measure agreement between bivariate discrete survival times. The proposed kappa coefficient accommodates censoring by redistributing the mass of censored observations within the grid where the unobserved events may potentially happen. A generalized modified weighted kappa is proposed for multivariate discrete survival times. We estimate the modified kappa coefficients nonparametrically through a multivariate survival function estimator. The asymptotic properties of the kappa estimators are established and the performance of the estimators are examined through simulation studies of bivariate and trivariate survival times. We illustrate the application of the modified kappa coefficient in the presence of censored observations with data from a prostate cancer study.

Mitosis Counting in Breast Cancer: Object-Level Interobserver Agreement and Comparison to an Automatic Method

PubMed Central

Veta, Mitko; van Diest, Paul J.; Jiwa, Mehdi; Al-Janabi, Shaimaa; Pluim, Josien P. W.

2016-01-01

Background Tumor proliferation speed, most commonly assessed by counting of mitotic figures in histological slide preparations, is an important biomarker for breast cancer. Although mitosis counting is routinely performed by pathologists, it is a tedious and subjective task with poor reproducibility, particularly among non-experts. Inter- and intraobserver reproducibility of mitosis counting can be improved when a strict protocol is defined and followed. Previous studies have examined only the agreement in terms of the mitotic count or the mitotic activity score. Studies of the observer agreement at the level of individual objects, which can provide more insight into the procedure, have not been performed thus far. Methods The development of automatic mitosis detection methods has received large interest in recent years. Automatic image analysis is viewed as a solution for the problem of subjectivity of mitosis counting by pathologists. In this paper we describe the results from an interobserver agreement study between three human observers and an automatic method, and make two unique contributions. For the first time, we present an analysis of the object-level interobserver agreement on mitosis counting. Furthermore, we train an automatic mitosis detection method that is robust with respect to staining appearance variability and compare it with the performance of expert observers on an “external” dataset, i.e. on histopathology images that originate from pathology labs other than the pathology lab that provided the training data for the automatic method. Results The object-level interobserver study revealed that pathologists often do not agree on individual objects, even if this is not reflected in the mitotic count. The disagreement is larger for objects from smaller size, which suggests that adding a size constraint in the mitosis counting protocol can improve reproducibility. The automatic mitosis detection method can perform mitosis counting in an unbiased

Mitosis Counting in Breast Cancer: Object-Level Interobserver Agreement and Comparison to an Automatic Method.

PubMed

Veta, Mitko; van Diest, Paul J; Jiwa, Mehdi; Al-Janabi, Shaimaa; Pluim, Josien P W

2016-01-01

Tumor proliferation speed, most commonly assessed by counting of mitotic figures in histological slide preparations, is an important biomarker for breast cancer. Although mitosis counting is routinely performed by pathologists, it is a tedious and subjective task with poor reproducibility, particularly among non-experts. Inter- and intraobserver reproducibility of mitosis counting can be improved when a strict protocol is defined and followed. Previous studies have examined only the agreement in terms of the mitotic count or the mitotic activity score. Studies of the observer agreement at the level of individual objects, which can provide more insight into the procedure, have not been performed thus far. The development of automatic mitosis detection methods has received large interest in recent years. Automatic image analysis is viewed as a solution for the problem of subjectivity of mitosis counting by pathologists. In this paper we describe the results from an interobserver agreement study between three human observers and an automatic method, and make two unique contributions. For the first time, we present an analysis of the object-level interobserver agreement on mitosis counting. Furthermore, we train an automatic mitosis detection method that is robust with respect to staining appearance variability and compare it with the performance of expert observers on an "external" dataset, i.e. on histopathology images that originate from pathology labs other than the pathology lab that provided the training data for the automatic method. The object-level interobserver study revealed that pathologists often do not agree on individual objects, even if this is not reflected in the mitotic count. The disagreement is larger for objects from smaller size, which suggests that adding a size constraint in the mitosis counting protocol can improve reproducibility. The automatic mitosis detection method can perform mitosis counting in an unbiased way, with substantial

Agreement Analysis: What He Said, She Said Versus You Said.

PubMed

Vetter, Thomas R; Schober, Patrick

2018-06-01

Correlation and agreement are 2 concepts that are widely applied in the medical literature and clinical practice to assess for the presence and strength of an association. However, because correlation and agreement are conceptually distinct, they require the use of different statistics. Agreement is a concept that is closely related to but fundamentally different from and often confused with correlation. The idea of agreement refers to the notion of reproducibility of clinical evaluations or biomedical measurements. The intraclass correlation coefficient is a commonly applied measure of agreement for continuous data. The intraclass correlation coefficient can be validly applied specifically to assess intrarater reliability and interrater reliability. As its name implies, the Lin concordance correlation coefficient is another measure of agreement or concordance. In undertaking a comparison of a new measurement technique with an established one, it is necessary to determine whether they agree sufficiently for the new to replace the old. Bland and Altman demonstrated that using a correlation coefficient is not appropriate for assessing the interchangeability of 2 such measurement methods. They in turn described an alternative approach, the since widely applied graphical Bland-Altman Plot, which is based on a simple estimation of the mean and standard deviation of differences between measurements by the 2 methods. In reading a medical journal article that includes the interpretation of diagnostic tests and application of diagnostic criteria, attention is conventionally focused on aspects like sensitivity, specificity, predictive values, and likelihood ratios. However, if the clinicians who interpret the test cannot agree on its interpretation and resulting typically dichotomous or binary diagnosis, the test results will be of little practical use. Such agreement between observers (interobserver agreement) about a dichotomous or binary variable is often reported as the

Standards and guidelines for observational studies: quality is in the eye of the beholder.

PubMed

Morton, Sally C; Costlow, Monica R; Graff, Jennifer S; Dubois, Robert W

2016-03-01

Patient care decisions demand high-quality research. To assist those decisions, numerous observational studies are being performed. Are the standards and guidelines to assess observational studies consistent and actionable? What policy considerations should be considered to ensure decision makers can determine if an observational study is of high-quality and valid to inform treatment decisions? Based on a literature review and input from six experts, we compared and contrasted nine standards/guidelines using 23 methodological elements involved in observational studies (e.g., study protocol, data analysis, and so forth). Fourteen elements (61%) were addressed by at least seven standards/guidelines; 12 of these elements disagreed in the approach. Nine elements (39%) were addressed by six or fewer standards/guidelines. Ten elements (43%) were not actionable in at least one standard/guideline that addressed the element. The lack of observational study standard/guideline agreement may contribute to variation in study conduct; disparities in what is considered credible research; and ultimately, what evidence is adopted. A common set of agreed on standards/guidelines for conducting observational studies will benefit funders, researchers, journal editors, and decision makers. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Successful associateship agreements.

PubMed

Crafton, B C

1997-08-01

When evaluating potential associateship agreements, dentists need to recognize and understand how status, noncompete clauses, scheduling and compensation affect the strength of an associateship agreement. Dentists should not enter an associateship agreement without fully understanding the agreement and its obligations or without the help of an accountant and an attorney.

Patient-clinician agreement on signs and symptoms of 'strep throat': a MetroNet study.

PubMed

Xu, Jinping; Schwartz, Kendra; Monsur, Joseph; Northrup, Justin; Neale, Anne Victoria

2004-12-01

Despite substantial use of the telephone in health care, only a few studies have formally evaluated the appropriateness of telephone-based management for acute medical problems. The accuracy of patients' report of signs and symptoms remains unknown. We compared the agreement between patient self-assessment and clinician assessment on the typical signs and symptoms of group A beta-haemolytic Streptococcus (GABHS) to investigate the potential difficulties of using patient self-report to triage sore throat patients. In this cross-sectional study, each of 200 adult pharyngitis patients was instructed to examine him/herself and to record the symptoms and physical findings. Two clinicians independently interviewed and examined each patient and recorded their findings. Each patient then had a rapid GABHS antigen test, the results of which were blinded to both clinicians and patients. Each patient self-assessment was compared with the findings of each clinician, and the agreement and disagreement between them computed. We found varying levels of agreement (kappa=-0.05 to 0.71) between patients and clinicians on sore throat history and physical assessments. Importantly, there was fair to substantial agreement (kappa=0.20-0.71) on the key signs and symptoms used in GABHS clinical prediction rules. As expected, history items had the highest agreement (kappa=0.52-0.71). Patients were more likely than clinicians to report rather than deny a specific physical sign. Adult sore throat patients may reliably report their symptoms, but may not be able to assess and report accurately on relevant physical signs of pharyngitis. Patients have a tendency to over-report physical signs. This study indicates the potential difficulties associated with telephone triage of sore throat patients, or other illnesses that require assessment of physical signs.

Interrater agreement of an observational tool to code knockouts and technical knockouts in mixed martial arts.

PubMed

Lawrence, David W; Hutchison, Michael G; Cusimano, Michael D; Singh, Tanveer; Li, Luke

2014-09-01

Interrater agreement evaluation of a tool to document and code the situational factors and mechanisms of knockouts (KOs) and technical knockouts (TKOs) in mixed martial arts (MMA). Retrospective case series. Professional MMA matches from the Ultimate Fighting Championship-2006-2012. Two nonmedically trained independent raters. The MMA Knockout Tool (MMA-KT) consists of 20 factors and captures and codes information on match characteristics, situational context preceding KOs and TKOs, as well as describing competitor states during these outcomes. The MMA-KT also evaluates the mechanism of action and subsequent events surrounding a KO. The 2 raters coded 125 unique events for a total of 250 events. The 8 factors of Part A had an average κ of 0.87 (SD = 0.10; range = 0.65-0.98); 7 were considered "substantial" agreement and 1 "moderate." Part B consists of 12 factors with an average κ of 0.84 (SD = 0.16; range = 0.59-1.0); 7 classified as "substantial" agreement, 4 "moderate," and 1 "fair." The majority of the factors in the MMA-KT demonstrated substantial interrater agreement, with an average κ of 0.86 (SD = 0.13; range = 0.59-1.0). The MMA-KT is a reliable tool to extract and code relevant information to investigate the situational factors and mechanism of KOs and TKOs in MMA competitions.

Assessing the influence of rater and subject characteristics on measures of agreement for ordinal ratings.

PubMed

Nelson, Kerrie P; Mitani, Aya A; Edwards, Don

2017-09-10

Widespread inconsistencies are commonly observed between physicians' ordinal classifications in screening tests results such as mammography. These discrepancies have motivated large-scale agreement studies where many raters contribute ratings. The primary goal of these studies is to identify factors related to physicians and patients' test results, which may lead to stronger consistency between raters' classifications. While ordered categorical scales are frequently used to classify screening test results, very few statistical approaches exist to model agreement between multiple raters. Here we develop a flexible and comprehensive approach to assess the influence of rater and subject characteristics on agreement between multiple raters' ordinal classifications in large-scale agreement studies. Our approach is based upon the class of generalized linear mixed models. Novel summary model-based measures are proposed to assess agreement between all, or a subgroup of raters, such as experienced physicians. Hypothesis tests are described to formally identify factors such as physicians' level of experience that play an important role in improving consistency of ratings between raters. We demonstrate how unique characteristics of individual raters can be assessed via conditional modes generated during the modeling process. Simulation studies are presented to demonstrate the performance of the proposed methods and summary measure of agreement. The methods are applied to a large-scale mammography agreement study to investigate the effects of rater and patient characteristics on the strength of agreement between radiologists. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

Inter-method agreement in retinal blood vessels diameter analysis between Dynamic Vessel Analyzer and optical coherence tomography.

PubMed

Benatti, Lucia; Corvi, Federico; Tomasso, Livia; Mercuri, Stefano; Querques, Lea; Ricceri, Fulvio; Bandello, Francesco; Querques, Giuseppe

2017-06-01

To analyze the inter-methods agreement in arteriovenous ratio (AVR) evaluation between spectral-domain optical coherence tomography (SD-OCT) and Dynamic Vessel Analyzer (DVA). Healthy volunteers underwent DVA and SD-OCT examination. AVR was measured by SD-OCT using the four external lines of the optic nerve head-centered 7-line cube and by DVA using an automated AVR estimation. The mean AVR was calculated, twice, separately by two independent readers for each tool. Twenty-two eyes of 11 healthy subjects (five women and six men, mean age 35) were included. AVR analysis by DVA showed high inter-observer agreement between reader 1 and 2, and high intra-observer agreement for both reader 1 and reader 2. With regard to AVR analysis on SD-OCT, we found high inter-observer agreement between reader 1 and 2, and low intra-observer agreement for reader 2 but high intra-observer agreement for reader 1. Overall, the mean AVR measured on SD-OCT turned out to be significantly higher than mean AVR measured through DVA (reader 1, 0.9023 ± 0.06 vs 0.8036 ± 0.08; p < 0.001, and reader 2, 0.9067 ± 0.06 vs 0.8083 ± 0.05; p= 0.003). No inter-method agreement in AVR could be detected in the present study due to bias in measurements (shift between DVA and SD-OCT). We found significant difference in the two noninvasive methods for AVR measurement, with a tendency for SD-OCT to overestimate retinal vascular caliber in comparison to DVA. This may be useful for achieving greater accuracy in the evaluation of retinal vessel in ocular as well as systemic diseases.

Lenke and King classification systems for adolescent idiopathic scoliosis: interobserver agreement and postoperative results

PubMed Central

Hosseinpour-Feizi, Hojjat; Soleimanpour, Jafar; Sales, Jafar Ganjpour; Arzroumchilar, Ali

2011-01-01

Purpose The aim of this study was to investigate the interobserver agreement of the Lenke and King classifications for adolescent idiopathic scoliosis, and to compare the results of surgery performed based on classification of the scoliosis according to each of these classification systems. Methods The study was conducted in Shohada Hospital in Tabriz, Iran, between 2009 and 2010. First, a reliability assessment was undertaken to assess interobserver agreement of the Lenke and King classifications for adolescent idiopathic scoliosis. Second, postoperative efficacy and safety of surgery performed based on the Lenke and King classifications were compared. Kappa coefficients of agreement were calculated to assess the agreement. Outcomes were compared using bivariate tests and repeated measures analysis of variance. Results A low to moderate interobserver agreement was observed for the King classification; the Lenke classification yielded mostly high agreement coefficients. The outcome of surgery was not found to be substantially different between the two systems. Conclusion Based on the results, the Lenke classification method seems advantageous. This takes into consideration the Lenke classification’s priority in providing details of curvatures in different anatomical surfaces to explain precise intensity of scoliosis, that it has higher interobserver agreement scores, and also that it leads to noninferior postoperative results compared with the King classification method. PMID:22267934

Lenke and King classification systems for adolescent idiopathic scoliosis: interobserver agreement and postoperative results.

PubMed

Hosseinpour-Feizi, Hojjat; Soleimanpour, Jafar; Sales, Jafar Ganjpour; Arzroumchilar, Ali

2011-01-01

The aim of this study was to investigate the interobserver agreement of the Lenke and King classifications for adolescent idiopathic scoliosis, and to compare the results of surgery performed based on classification of the scoliosis according to each of these classification systems. The study was conducted in Shohada Hospital in Tabriz, Iran, between 2009 and 2010. First, a reliability assessment was undertaken to assess interobserver agreement of the Lenke and King classifications for adolescent idiopathic scoliosis. Second, postoperative efficacy and safety of surgery performed based on the Lenke and King classifications were compared. Kappa coefficients of agreement were calculated to assess the agreement. Outcomes were compared using bivariate tests and repeated measures analysis of variance. A low to moderate interobserver agreement was observed for the King classification; the Lenke classification yielded mostly high agreement coefficients. The outcome of surgery was not found to be substantially different between the two systems. Based on the results, the Lenke classification method seems advantageous. This takes into consideration the Lenke classification's priority in providing details of curvatures in different anatomical surfaces to explain precise intensity of scoliosis, that it has higher interobserver agreement scores, and also that it leads to noninferior postoperative results compared with the King classification method.

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

PubMed

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

1996-03-01

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.

Rater agreement of visual lameness assessment in horses during lungeing

PubMed Central

Hammarberg, M.; Egenvall, A.; Pfau, T.

2015-01-01

Summary Reasons for performing study Lungeing is an important part of lameness examinations as the circular path may accentuate low‐grade lameness. Movement asymmetries related to the circular path, to compensatory movements and to pain make the lameness evaluation complex. Scientific studies have shown high inter‐rater variation when assessing lameness during straight line movement. Objectives The aim was to estimate inter‐ and intra‐rater agreement of equine veterinarians evaluating lameness from videos of sound and lame horses during lungeing and to investigate the influence of veterinarians’ experience and the objective degree of movement asymmetry on rater agreement. Study design Cross‐sectional observational study. Methods Video recordings and quantitative gait analysis with inertial sensors were performed in 23 riding horses of various breeds. The horses were examined at trot on a straight line and during lungeing on soft or hard surfaces in both directions. One video sequence was recorded per condition and the horses were classified as forelimb lame, hindlimb lame or sound from objective straight line symmetry measurements. Equine veterinarians (n = 86), including 43 with >5 years of orthopaedic experience, participated in a web‐based survey and were asked to identify the lamest limb on 60 videos, including 10 repeats. The agreements between (inter‐rater) and within (intra‐rater) veterinarians were analysed with κ statistics (Fleiss, Cohen). Results Inter‐rater agreement κ was 0.31 (0.38/0.25 for experienced/less experienced) and higher for forelimb (0.33) than for hindlimb lameness (0.11) or soundness (0.08) evaluation. Median intra‐rater agreement κ was 0.57. Conclusions Inter‐rater agreement was poor for less experienced raters, and for all raters when evaluating hindlimb lameness. Since identification of the lame limb/limbs is a prerequisite for successful diagnosis, treatment and recovery, the high inter‐rater variation

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.

The Treatment of Brain Arteriovenous Malformation Study (TOBAS): A preliminary inter- and intra-rater agreement study on patient management.

PubMed

Fahed, Robert; Batista, André L; Darsaut, Tim E; Gentric, Jean-Christophe; Ducroux, Célina; Chaalala, Chiraz; Roberge, David; Bojanowski, Michel W; Weill, Alain; Roy, Daniel; Magro, Elsa; Raymond, Jean

2017-07-01

The best management of brain arteriovenous malformation (bAVM) patients remains unknown. Randomized allocation may be more readily accepted when there is uncertainty and disagreement regarding the management of potential participants. In planning for a trial, we aimed to assess variability and agreement among physicians managing bAVM patients. A portfolio composed of 35 patients was sent to 47 clinicians of various specialties managing bAVM patients. For each patient, physicians were asked their best management decision (surgery/embolization/radiosurgery/conservative), their confidence level, and whether they would include the patient in a randomized trial comparing conservative and curative management. Seven physicians, who had access to all images of each patient, independently responded twice, to assess inter and intra-rater agreement using kappa statistics. The inter-rater agreement (30 raters, including 16 neuroradiologists) for best management decision was only "fair" (κ [95%CI]=0.210[0.157; 0.295]). Agreement remained below 'substantial' (κ<.6) between physicians of the same specialty, and when no distinctions were made between various treatments (when responses were dichotomized as conservative versus curative). With access to all images the inter-rater agreement remained fair. The intra-rater agreement reached "substantial" only for the dichotomized decisions. Responding clinicians were willing to include 54.4% of patients (mainly unruptured bAVMs) in a randomized trial. There is a lack of agreement among clinicians involved in the management of bAVM patients. In this study a substantial proportion of clinicians were willing to offer randomized allocation of management options to a substantial number of patients. Copyright © 2017 Elsevier Masson SAS. 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

Inter-rater agreement on PIVC-associated phlebitis signs, symptoms and scales.

PubMed

Marsh, Nicole; Mihala, Gabor; Ray-Barruel, Gillian; Webster, Joan; Wallis, Marianne C; Rickard, Claire M

2015-10-01

Many peripheral intravenous catheter (PIVC) infusion phlebitis scales and definitions are used internationally, although no existing scale has demonstrated comprehensive reliability and validity. We examined inter-rater agreement between registered nurses on signs, symptoms and scales commonly used in phlebitis assessment. Seven PIVC-associated phlebitis signs/symptoms (pain, tenderness, swelling, erythema, palpable venous cord, purulent discharge and warmth) were observed daily by two raters (a research nurse and registered nurse). These data were modelled into phlebitis scores using 10 different tools. Proportions of agreement (e.g. positive, negative), observed and expected agreements, Cohen's kappa, the maximum achievable kappa, prevalence- and bias-adjusted kappa were calculated. Two hundred ten patients were recruited across three hospitals, with 247 sets of paired observations undertaken. The second rater was blinded to the first's findings. The Catney and Rittenberg scales were the most sensitive (phlebitis in >20% of observations), whereas the Curran, Lanbeck and Rickard scales were the most restrictive (≤2% phlebitis). Only tenderness and the Catney (one of pain, tenderness, erythema or palpable cord) and Rittenberg scales (one of erythema, swelling, tenderness or pain) had acceptable (more than two-thirds, 66.7%) levels of inter-rater agreement. Inter-rater agreement for phlebitis assessment signs/symptoms and scales is low. This likely contributes to the high degree of variability in phlebitis rates in literature. We recommend further research into assessment of infrequent signs/symptoms and the Catney or Rittenberg scales. New approaches to evaluating vein irritation that are valid, reliable and based on their ability to predict complications need exploration. © 2015 John Wiley & Sons, Ltd.

Bullying at school: Agreement between caregivers' and children's perception.

PubMed

Durán, Lucas G; Scherñuk Schroh, Jordán C; Panizoni, Estefanía P; Jouglard, Ezequiel F; Serralunga, M Gabriela; Esandi, M Eugenia

2017-02-01

Bullying at school is usually kept secret from adults, making them unaware of the situation. To describe caregivers' and children's perception and assess their agreement in terms of bullying situations. Cross-sectional study in children aged 8-12 years old attending public schools and their caregivers. The questionnaire on preconceptions of intimidation and bullying among peers (PRECONCIMEI) (child/caregiver version) was used. Studied outcome measures: Scale of bullying, causes of bullying, child involvement in bullying, communication in bullying situations. Univariate and bivariate analyses were done and agreement was estimated using the Kappa index. A total of 529 child/caregiver dyads participated. Among caregivers, 35% stated that bullying occurred in their children's schools. Among children, 133 (25%) admitted to being involved: 70 (13%) were victims of bullying, 40 (8%) were bullies, and 23 (4%) were bullied and perpetrated bullying. Among the 63 caregivers of children who admitted to be bullies, 78% did not consider their children capable of perpetrating bullying. Among children who were bullied or who both suffered bullying and bullied others, 69.9% (65/93) indicated that "if they were the victims of bullying, they would tell their family." However, 89.2% (83/93) of caregivers considered that their children would tell them if they were ever involved in these situations. Agreement was observed in terms of a positive communication (Kappa = -0.04) between 62.6% (57/91) of the child/caregiver dyads school bullying. Disagreement was observed between children and their caregivers in relation to the frequency and communication of bullying situations. Few caregivers whose children admitted to being involved in these situations believed it was a possibility. Sociedad Argentina de Pediatría

Prospective assessment of interobserver agreement for defecography in fecal incontinence.

PubMed

Dobben, Annette C; Wiersma, Tjeerd G; Janssen, Lucas W M; de Vos, Rien; Terra, Maaike P; Baeten, Cor G; Stoker, Jaap

2005-11-01

The primary aim of our study was to determine the interobserver agreement of defecography in diagnosing enterocele, anterior rectocele, intussusception, and anismus in fecal-incontinent patients. The subsidiary aim was to evaluate the influence of level of experience on interpreting defecography. Defecography was performed in 105 consecutive fecal-incontinent patients. Observers were classified by level of experience and their findings were compared with the findings of an expert radiologist. The quality of the expert radiologist's findings was evaluated by an intraobserver agreement procedure. Intraobserver agreement was good to very good except for anismus: incomplete evacuation after 30 sec (kappa, 0.55) and puborectalis impression (kappa, 0.54). Interobserver agreement for enterocele and rectocele was good (kappa, 0.66 for both) and for intussusception, fair (kappa, 0.29). Interobserver agreement for anismus: incomplete evacuation after 30 sec was moderate (kappa, 0.47), and for anismus: puborectalis impression was fair (kappa, 0.24). Agreement in grading of enterocele and rectocele was good (kappa, 0.64 and 0.72, respectively) and for intussusception, fair (kappa, 0.39). Agreement separated by experience level was very good for rectocele (kappa, 0.83) and grading of rectoceles (kappa, 0.83) and moderate for intussusception (kappa, 0.44) at the most experienced level. For enterocele and grading, experience level did not influence the reproducibility. Reproducibility for enterocele, anterior rectocele, and severity grading is good, but for intussusception is fair to moderate. For anismus, the diagnosis of incomplete evacuation after 30 sec is more reproducible than puborectalis impression. The level of experience seems to play a role in diagnosing anterior rectocele and its grading and in diagnosing intussusception.

Describing Peripancreatic Collections According to the Revised Atlanta Classification of Acute Pancreatitis: An International Interobserver Agreement Study.

PubMed

Bouwense, Stefan A; van Brunschot, Sandra; van Santvoort, Hjalmar C; Besselink, Marc G; Bollen, Thomas L; Bakker, Olaf J; Banks, Peter A; Boermeester, Marja A; Cappendijk, Vincent C; Carter, Ross; Charnley, Richard; van Eijck, Casper H; Freeny, Patrick C; Hermans, John J; Hough, David M; Johnson, Colin D; Laméris, Johan S; Lerch, Markus M; Mayerle, Julia; Mortele, Koenraad J; Sarr, Michael G; Stedman, Brian; Vege, Santhi Swaroop; Werner, Jens; Dijkgraaf, Marcel G; Gooszen, Hein G; Horvath, Karen D

2017-08-01

Severe acute pancreatitis is associated with peripancreatic morphologic changes as seen on imaging. Uniform communication regarding these morphologic findings is crucial for accurate diagnosis and treatment. For the original 1992 Atlanta classification, interobserver agreement is poor. We hypothesized that for the revised Atlanta classification, interobserver agreement will be better. An international, interobserver agreement study was performed among expert and nonexpert radiologists (n = 14), surgeons (n = 15), and gastroenterologists (n = 8). Representative computed tomographies of all stages of acute pancreatitis were selected from 55 patients and were assessed according to the revised Atlanta classification. The interobserver agreement was calculated among all reviewers and subgroups, that is, expert and nonexpert reviewers; interobserver agreement was defined as poor (≤0.20), fair (0.21-0.40), moderate (0.41-0.60), good (0.61-0.80), or very good (0.81-1.00). Interobserver agreement among all reviewers was good (0.75 [standard deviation, 0.21]) for describing the type of acute pancreatitis and good (0.62 [standard deviation, 0.19]) for the type of peripancreatic collection. Expert radiologists showed the best and nonexpert clinicians the lowest interobserver agreement. Interobserver agreement was good for the revised Atlanta classification, supporting the importance for widespread adaption of this revised classification for clinical and research communications.

Seeing Eye to Eye: Predicting Teacher-Student Agreement on Classroom Social Networks

ERIC Educational Resources Information Center

Neal, Jennifer Watling; Cappella, Elise; Wagner, Caroline; Atkins, Marc S.

2011-01-01

This study examines the association between classroom characteristics and teacher-student agreement in perceptions of students' classroom peer networks. Social network, peer nomination, and observational data were collected from a sample of second through fourth grade teachers (N = 33) and students (N = 669) in 33 classrooms across five…

Evaluation of interobserver agreement for postoperative pain and sedation assessment in cats.

PubMed

Benito, Javier; Monteiro, Beatriz P; Beauchamp, Guy; Lascelles, B Duncan X; Steagall, Paulo V

2017-09-01

OBJECTIVE To evaluate agreement between observers with different training and experience for assessment of postoperative pain and sedation in cats by use of a dynamic and interactive visual analog scale (DIVAS) and for assessment of postoperative pain in the same cats with a multidimensional composite pain scale (MCPS). DESIGN Randomized, controlled, blinded study. ANIMALS 45 adult cats undergoing ovariohysterectomy. PROCEDURES Cats received 1 of 3 preoperative treatments: bupivacaine, IP; meloxicam, SC with saline (0.9% NaCl) solution, IP, (positive control); or saline solution only, IP (negative control). All cats received premedication with buprenorphine prior to general anesthesia. An experienced observer (observer 1; male; native language, Spanish) used scales in English, and an inexperienced observer (observer 2; female; native language, French) used scales in French to assess signs of sedation and pain. Rescue analgesia was administered according to MCPS scoring by observer 1. Mean pain and sedation scores per treatment and time point, proportions of cats in each group with MCPS scores necessitating rescue analgesia, and mean MCPS scores assigned at the time of rescue analgesia were compared between observers. Agreement was assessed by intraclass correlation coefficient determination. Percentage disagreement between observers on the need for rescue analgesia was calculated. RESULTS Interobserver agreements for pain scores were good, and that for sedation scores was fair. On the basis of observer 1's MCPS scores, a greater proportion of cats in the negative control group received rescue analgesia than in the bupivacaine or positive control groups. Scores from observer 2 indicated a greater proportion of cats in the negative control group than in the positive control group required rescue analgesia but identified no significant difference between the negative control and bupivacaine groups for this variable. Overall, disagreement regarding need for rescue

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.

46 CFR 298.38 - Partnership agreements and limited liability company agreements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 8 2010-10-01 2010-10-01 false Partnership agreements and limited liability company... liability company agreements. Partnership and limited liability company agreements must be in form and...) Duration of the entity; (b) Adequate partnership or limited liability company funding requirements and...

Intra- and interobserver agreement for fetal cerebral measurements in 3D-ultrasonography.

PubMed

Albers, Maria E W A; Buisman, Erato T I A; Kahn, René S; Franx, Arie; Onland-Moret, N Charlotte; de Heus, Roel

2018-04-10

The aim of this study is to evaluate intra- and interobserver agreement for measurement of intracranial, cerebellar, and thalamic volume with the Virtual Organ Computer-aided AnaLysis (VOCAL) technique in three-dimensional ultrasound images, in comparison to two-dimensional measurements of these brain structures. Three-dimensional ultrasound images of the brains of 80 fetuses at 20-24 weeks' gestational age were obtained from YOUth, a Dutch prospective cohort study. Two observers performed offline measurement of the occipitofrontal diameter, intracranial volume, transcerebellar diameter, cerebellar volume, and thalamic width, area, and volume, independently. VOCAL was used for calculation of the volumes. The two-way random, single measures intraclass correlation coefficient (ICC) was used for analysis of agreement and Bland-Altman plots were configured. Intra- and interobserver agreement was almost perfect for occipitofrontal diameter (intra ICC 0.88, 95% CI 0.82-0.92; inter ICC 0.91, 95% CI 0.85-0.94), intracranial volume (intra ICC 0.96, 95% CI 0.91-0.98; inter ICC 0.97, 95% CI 0.96-0.98) and transcerebellar diameter (intra ICC 0.91, 95% CI 0.86-0.94; inter ICC 0.86, 95% CI 0.78-0.910). For cerebellar volume, the intraobserver agreement was almost perfect (0.85, 95% CI 0.76-0.90), whereas the interobserver agreement was substantial (0.75, 95% CI 0.44-0.88). Agreement was only moderate for thalamic measurements. Bland-Altman plots for the volume measurements are normally distributed with acceptable mean differences and 95% limits of agreement. The intra- and interobserver agreement of the measurement of intracranial and cerebellar volume with VOCAL was almost perfect. These measurements are therefore reliable, and can be used to investigate fetal brain development. Thalamic measurements are not reliable enough. © 2018 Wiley Periodicals, Inc.

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

Agreement processing and attraction errors in aging: evidence from subject-verb agreement in German.

PubMed

Reifegerste, Jana; Hauer, Franziska; Felser, Claudia

2017-11-01

Effects of aging on lexical processing are well attested, but the picture is less clear for grammatical processing. Where age differences emerge, these are usually ascribed to working-memory (WM) decline. Previous studies on the influence of WM on agreement computation have yielded inconclusive results, and work on aging and subject-verb agreement processing is lacking. In two experiments (Experiment 1: timed grammaticality judgment, Experiment 2: self-paced reading + WM test), we investigated older (OA) and younger (YA) adults' susceptibility to agreement attraction errors. We found longer reading latencies and judgment reaction times (RTs) for OAs. Further, OAs, particularly those with low WM scores, were more accepting of sentences with attraction errors than YAs. OAs showed longer reading latencies for ungrammatical sentences, again modulated by WM, than YAs. Our results indicate that OAs have greater difficulty blocking intervening nouns from interfering with the computation of agreement dependencies. WM can modulate this effect.

Intra- and inter-rater agreement between an ophthalmologist and mid-level ophthalmic personnel to diagnose retinal diseases based on fundus photographs at a primary eye center in Nepal: the Bhaktapur Retina Study.

PubMed

Thapa, Raba; Bajimaya, Sanyam; Bouman, Renske; Paudyal, Govinda; Khanal, Shankar; Tan, Stevie; Thapa, Suman S; van Rens, Ger

2016-07-18

Early detection can reduce irreversible blindness from retinal diseases. This study aims to assess the intra- and inter-rater agreement of retinal pathologies observed on fundus photographs between an ophthalmologist and two-mid level ophthalmic personnel (MLOPs). A population-based, cross-sectional study was conducted among subjects 60 years and above in the Bhaktapur district of Nepal. Fundus photographs of 500 eyes of 500 subjects were assessed. The macula-centered 45-degree photographs were graded twice by one ophthalmologist and two MLOPs. Intra-rater and inter-rater agreements were assessed for the ophthalmologist and the MLOPs. Mean age was 70.22 years ± 6.94 (SD). Retinal pathologies were observed in 55.6 % of photographs (age-related macular degeneration: 34.2 %; diabetic retinopathy: 4.2 %; retinal vein occlusion: 3.8 %). Twelve (2.4 %) fundus pictures were non-gradable. The intra-rater agreement for overall retinal pathologies, retinal hemorrhage, and maculopathy were substantial both for the ophthalmologist as well as for the MLOPs. There was moderate inter-rater agreement between the ophthalmologist and the first MLOP on second rating for overall retinal pathologies, [kappa (k); 95 % CI = 0.59 (0.51-0.66)], retinal hemorrhage [k; 95 % CI = 0.60 (0.41-0.78)], and maculopathy [k; 95 % CI = 0.52 (0.43-0.60)]. Inter-rater agreement between the ophthalmologist and the second MLOP for second rating was moderate for overall retinal pathologies [k; 95 % CI = 0.52 (0.44-0.60)], substantial agreement for retinal hemorrhage [k; 95 % CI = 0. 68 (0.52-0.84)], moderate agreement for maculopathy [k; 95 % CI = 0.59 (0.50-0.67)]. There is moderate agreement between the MLOPs and the ophthalmologist in grading fundus photographs for retinal hemorrhages and maculopathy.

Technology Partnership Agreements | NREL

Science.gov Websites

Partnership Agreements Technology Partnership Agreements Looking for Funding? We do not fund any projects under a technology partnership agreement. The partner provides the necessary resources and, in using technology partnership agreements. See a summary of our Fiscal Year 2017 technology partnership

22 CFR 124.6 - Termination of manufacturing license agreements and technical assistance agreements.

Code of Federal Regulations, 2010 CFR

2010-04-01

... and technical assistance agreements. 124.6 Section 124.6 Foreign Relations DEPARTMENT OF STATE... Termination of manufacturing license agreements and technical assistance agreements. The U.S. party to a manufacturing license or a technical assistance agreement must inform the Directorate of Defense Trade Controls...

[A systematic social observation tool: methods and results of inter-rater reliability].

PubMed

Freitas, Eulilian Dias de; Camargos, Vitor Passos; Xavier, César Coelho; Caiaffa, Waleska Teixeira; Proietti, Fernando Augusto

2013-10-01

Systematic social observation has been used as a health research methodology for collecting information from the neighborhood physical and social environment. The objectives of this article were to describe the operationalization of direct observation of the physical and social environment in urban areas and to evaluate the instrument's reliability. The systematic social observation instrument was designed to collect information in several domains. A total of 1,306 street segments belonging to 149 different neighborhoods in Belo Horizonte, Minas Gerais, Brazil, were observed. For the reliability study, 149 segments (1 per neighborhood) were re-audited, and Fleiss kappa was used to access inter-rater agreement. Mean agreement was 0.57 (SD = 0.24); 53% had substantial or almost perfect agreement, and 20.4%, moderate agreement. The instrument appears to be appropriate for observing neighborhood characteristics that are not time-dependent, especially urban services, property characterization, pedestrian environment, and security.

Kappa statistic to measure agreement beyond chance in free-response assessments.

PubMed

Carpentier, Marc; Combescure, Christophe; Merlini, Laura; Perneger, Thomas V

2017-04-19

The usual kappa statistic requires that all observations be enumerated. However, in free-response assessments, only positive (or abnormal) findings are notified, but negative (or normal) findings are not. This situation occurs frequently in imaging or other diagnostic studies. We propose here a kappa statistic that is suitable for free-response assessments. We derived the equivalent of Cohen's kappa statistic for two raters under the assumption that the number of possible findings for any given patient is very large, as well as a formula for sampling variance that is applicable to independent observations (for clustered observations, a bootstrap procedure is proposed). The proposed statistic was applied to a real-life dataset, and compared with the common practice of collapsing observations within a finite number of regions of interest. The free-response kappa is computed from the total numbers of discordant (b and c) and concordant positive (d) observations made in all patients, as 2d/(b + c + 2d). In 84 full-body magnetic resonance imaging procedures in children that were evaluated by 2 independent raters, the free-response kappa statistic was 0.820. Aggregation of results within regions of interest resulted in overestimation of agreement beyond chance. The free-response kappa provides an estimate of agreement beyond chance in situations where only positive findings are reported by raters.

The effect of meteorological and chemical factors on the agreement between observations and predictions of fine aerosol composition in southwestern Ontario during BAQS-Met

NASA Astrophysics Data System (ADS)

Markovic, M. Z.; Hayden, K. L.; Murphy, J. G.; Makar, P. A.; Ellis, R. A.; Chang, R. Y.-W.; Slowik, J. G.; Mihele, C.; Brook, J.

2011-04-01

The Border Air Quality and Meteorology Study (BAQS-Met) was an intensive, collaborative field campaign during the summer of 2007 that investigated the effects of transboundary pollution, local pollution, and local meteorology on air quality in southwestern Ontario. This analysis focuses on the measurements of the inorganic constituents of particulate matter with diameter of less than 1 μm (PM1), with a specific emphasis on nitrate. We evaluate the ability of AURAMS, Environment Canada's chemical transport model, to represent regional air pollution in SW Ontario by comparing modelled aerosol inorganic chemical composition with measurements from Aerosol Mass Spectrometers (AMS) onboard the National Research Council (NRC) of Canada Twin Otter aircraft and at a ground site in Harrow, ON. The agreement between modelled and measured pNO3- at the ground site (observed mean (Mobs) = 0.50 μg m-3; modelled mean (Mmod) = 0.58 μg m-3; root mean square error (RSME) = 1.27 μg m-3) was better than aloft (Mobs = 0.32 μg m-3; Mmod = 0.09 μg m-3; RSME = 0.48 μg m-3). Possible reasons for discrepancies include errors in (i) emission inventories, (ii) atmospheric chemistry, (iii) predicted meteorological parameters, or (iv) gas/particle thermodynamics in the model framework. Using the inorganic thermodynamics model, ISORROPIA, in an offline mode, we find that the assumption of thermodynamic equilibrium is consistent with observations of gas and particle composition at Harrow. We develop a framework to assess the sensitivity of PM1 nitrate to meteorological and chemical parameters and find that errors in both the predictions of relative humidity and free ammonia (FA ≡ NH3(g) + pNH4+ - 2 · pSO42-) are responsible for the poor agreement between modelled and measured values.

The effect of meteorological and chemical factors on the agreement between observations and predictions of fine aerosol composition in Southwestern Ontario during BAQS-Met

NASA Astrophysics Data System (ADS)

Markovic, M. Z.; Hayden, K. L.; Murphy, J. G.; Makar, P. A.; Ellis, R. A.; Chang, R. Y.-W.; Slowik, J. G.; Mihele, C.; Brook, J.

2010-10-01

The Border Air Quality and Meteorology Study (BAQS-Met) was an intensive, collaborative field campaign during the summer of 2007 that investigated the effects of transboundary pollution, local pollution, and local meteorology on regional air quality in Southwestern Ontario. This analysis focuses on the measurements of the inorganic constituents of particulate matter with diameter of less than 1 μm (PM1), with a specific emphasis on nitrate. We evaluate the ability of AURAMS, the Environment Canada's chemical transport model, to represent regional air pollution in SW Ontario by comparing modelled aerosol inorganic chemical composition with measurements from Aerosol Mass Spectrometers (AMS) onboard the National Research Council (NRC) of Canada Twin Otter aircraft and at a ground site in Harrow, ON. The agreement between modelled and measured pNO3- at the ground site (observed mean (M_obs) = 0.50 μg m-3; modelled mean (M_mod) = 0.58 μg m-3; root mean square error (RSME) = 1.27 μg m-3) was better than aloft (M_obs = 0.32 μg m-3; M_mod = 0.09 μg m-3; RSME = 0.48 μg m-3). Possible reasons for discrepancies include errors in (i) emission inventories, (ii) atmospheric chemistry, (iii) predicted meteorological parameters, or (iv) gas/particle thermodynamics in the model framework. Using the inorganic thermodynamics model, ISORROPIA, in an offline mode, we find that the assumption of thermodynamic equilibrium is consistent with observations of gas and particle composition at Harrow. We develop a framework to assess the sensitivity of PM1 nitrate to meteorological and chemical parameters and find that errors in both the predictions of relative humidity and free ammonia (FA ≡ NH3(g) + NH4+ - SO42-) are responsible for the poor agreement between modelled and measured values.

Improved inter-observer agreement of an expert review panel in an oncology treatment trial--Insights from a structured interventional process.

PubMed

Nestle, Ursula; Rischke, Hans Christian; Eschmann, Susanne Martina; Holl, Gabriele; Tosch, Marco; Miederer, Matthias; Plotkin, Michail; Essler, Markus; Puskas, Cornelia; Schimek-Jasch, Tanja; Duncker-Rohr, Viola; Rühl, Friederike; Leifert, Anja; Mix, Michael; Grosu, Anca-Ligia; König, Jochem; Vach, Werner

2015-11-01

Oncologic imaging is a key for successful cancer treatment. While the quality assurance (QA) of image acquisition protocols has already been focussed, QA of reading and reporting offers still room for improvement. The latter was addressed in the context of a prospective multicentre trial on fluoro-deoxyglucose (FDG)-positron-emission tomography (PET)/CT-based chemoradiotherapy for locally advanced non-small cell lung cancer (NSCLC). An expert panel was prospectively installed performing blinded reviews of mediastinal NSCLC involvement in FDG-PET/CT. Due to a high initial reporting inter-observer disagreement, the independent data monitoring committee (IDMC) triggered an interventional harmonisation process, which overall involved 11 experts uttering 6855 blinded diagnostic statements. After assessing the baseline inter-observer agreement (IOA) of a blinded re-review (phase 1), a discussion process led to improved reading criteria (phase 2). Those underwent a validation study (phase 3) and were then implemented into the study routine. After 2 months (phase 4) and 1 year (phase 5), the IOA was reassessed. The initial overall IOA was moderate (kappa 0.52 CT; 0.53 PET). After improvement of reading criteria, the kappa values improved substantially (kappa 0.61 CT; 0.66 PET), which was retained until the late reassessment (kappa 0.71 CT; 0.67 PET). Subjective uncertainty was highly predictive for low IOA. The IOA of an expert panel was significantly improved by a structured interventional harmonisation process which could be a model for future clinical trials. Furthermore, the low IOA in reporting nodal involvement in NSCLC may bear consequences for individual patient care. Copyright © 2015 Elsevier Ltd. All rights reserved.

Tense and Agreement in German Agrammatism

ERIC Educational Resources Information Center

Wenzlaff, Michaela; Clahsen, Harald

2004-01-01

This study presents results from sentence-completion and grammaticality-judgment tasks with 7 German-speaking agrammatic aphasics and 7 age-matched control subjects examining tense and subject-verb agreement marking. For both experimental tasks, we found that the aphasics achieved high correctness scores for agreement, while tense marking was…

Histological features associated with diagnostic agreement in atypical ductal hyperplasia of the breast: illustrative cases from the B-Path study.

PubMed

Allison, Kimberly H; Rendi, Mara H; Peacock, Sue; Morgan, Tom; Elmore, Joann G; Weaver, Donald L

2016-12-01

This study examined the case-specific characteristics associated with interobserver diagnostic agreement in atypical ductal hyperplasia (ADH) of the breast. Seventy-two test set cases with a consensus diagnosis of ADH from the B-Path study were evaluated. Cases were scored for 17 histological features, which were then correlated with the participant agreement with the consensus ADH diagnosis. Participating pathologists' perceptions of case difficulty, borderline features or whether they would obtain a second opinion were also examined for associations with agreement. Of the 2070 participant interpretations of the 72 consensus ADH cases, 48% were scored by participants as difficult and 45% as borderline between two diagnoses; the presence of both of these features was significantly associated with increased agreement (P < 0.001). A second opinion would have been obtained in 80% of interpretations, and this was associated with increased agreement (P < 0.001). Diagnostic agreement ranged from 10% to 89% on a case-by-case basis. Cases with papillary lesions, cribriform architecture and obvious cytological monotony were associated with higher agreement. Lower agreement rates were associated with solid or micropapillary architecture, borderline cytological monotony, or cases without a diagnostic area that was obvious on low power. The results of this study suggest that pathologists frequently recognize the challenge of ADH cases, with some cases being more prone to diagnostic variability. In addition, there are specific histological features associated with diagnostic agreement on ADH cases. Multiple example images from cases in this test set are provided to serve as educational illustrations of these challenges. © 2016 John Wiley & Sons Ltd.

Interobserver agreement in the histologic diagnosis of colorectal polyps. the experience of the multicenter adenoma colorectal study (SMAC).

PubMed

Costantini, Massimo; Sciallero, Stefania; Giannini, Augusto; Gatteschi, Beatrice; Rinaldi, Paolo; Lanzanova, Giuseppe; Bonelli, Luigina; Casetti, Tino; Bertinelli, Elisabetta; Giuliani, Orietta; Castiglione, Guido; Mantellini, Paola; Naldoni, Carlo; Bruzzi, Paolo

2003-03-01

Current clinical practice guidelines for patients with colorectal polyps are mainly based on the histologic characteristics of their lesions. However, interobserver variability in the assessment of specific polyp characteristics was evaluated in very few studies. The purpose of this study was to evaluate the interobserver agreement of four pathologists in the diagnosis of histologic type of colorectal polyps and in the degree of dysplasia and of infiltrating carcinoma in adenomas. A stratified random sample of 100 polyps was obtained from the 4,889 polyps resected within the Multicentre Adenoma Colorectal Study (SMAC), and the slides were blindly reviewed by the four pathologists. Agreement was analyzed using kappa statistics. A median kappa of 0.89 (range 0.79-1.0) was estimated for the interobserver agreement for the diagnosis of hyperplastic polyp vs. adenoma. The agreement in the diagnosis of tubular, tubulovillous, and villous type, was given by median kappa values of 0.50, 0.15, and 0.36, respectively. The median kappa for the diagnosis of infiltrating carcinoma was 0.78 (range 0.73-0.84). Agreement on diagnosis of adenoma histologic subtypes, degrees of dysplasia, or infiltrating carcinoma in adenoma was moderate. A simpler classifications might help to better identify patients at different risk of colorectal cancer.

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.

A Simulation Study of Rater Agreement Measures with 2x2 Contingency Tables

ERIC Educational Resources Information Center

Ato, Manuel; Lopez, Juan Jose; Benavente, Ana

2011-01-01

A comparison between six rater agreement measures obtained using three different approaches was achieved by means of a simulation study. Rater coefficients suggested by Bennet's [sigma] (1954), Scott's [pi] (1955), Cohen's [kappa] (1960) and Gwet's [gamma] (2008) were selected to represent the classical, descriptive approach, [alpha] agreement…

Enhanced Two-Factor Authentication and Key Agreement Using Dynamic Identities in Wireless Sensor Networks.

PubMed

Chang, I-Pin; Lee, Tian-Fu; Lin, Tsung-Hung; Liu, Chuan-Ming

2015-11-30

Key agreements that use only password authentication are convenient in communication networks, but these key agreement schemes often fail to resist possible attacks, and therefore provide poor security compared with some other authentication schemes. To increase security, many authentication and key agreement schemes use smartcard authentication in addition to passwords. Thus, two-factor authentication and key agreement schemes using smartcards and passwords are widely adopted in many applications. Vaidya et al. recently presented a two-factor authentication and key agreement scheme for wireless sensor networks (WSNs). Kim et al. observed that the Vaidya et al. scheme fails to resist gateway node bypassing and user impersonation attacks, and then proposed an improved scheme for WSNs. This study analyzes the weaknesses of the two-factor authentication and key agreement scheme of Kim et al., which include vulnerability to impersonation attacks, lost smartcard attacks and man-in-the-middle attacks, violation of session key security, and failure to protect user privacy. An efficient and secure authentication and key agreement scheme for WSNs based on the scheme of Kim et al. is then proposed. The proposed scheme not only solves the weaknesses of previous approaches, but also increases security requirements while maintaining low computational cost.

Enhanced Two-Factor Authentication and Key Agreement Using Dynamic Identities in Wireless Sensor Networks

PubMed Central

Chang, I-Pin; Lee, Tian-Fu; Lin, Tsung-Hung; Liu, Chuan-Ming

2015-01-01

Key agreements that use only password authentication are convenient in communication networks, but these key agreement schemes often fail to resist possible attacks, and therefore provide poor security compared with some other authentication schemes. To increase security, many authentication and key agreement schemes use smartcard authentication in addition to passwords. Thus, two-factor authentication and key agreement schemes using smartcards and passwords are widely adopted in many applications. Vaidya et al. recently presented a two-factor authentication and key agreement scheme for wireless sensor networks (WSNs). Kim et al. observed that the Vaidya et al. scheme fails to resist gateway node bypassing and user impersonation attacks, and then proposed an improved scheme for WSNs. This study analyzes the weaknesses of the two-factor authentication and key agreement scheme of Kim et al., which include vulnerability to impersonation attacks, lost smartcard attacks and man-in-the-middle attacks, violation of session key security, and failure to protect user privacy. An efficient and secure authentication and key agreement scheme for WSNs based on the scheme of Kim et al. is then proposed. The proposed scheme not only solves the weaknesses of previous approaches, but also increases security requirements while maintaining low computational cost. PMID:26633396

Inter and intra-observer concordance for the diagnosis of portal hypertension gastropathy.

PubMed

Casas, Meritxell; Vergara, Mercedes; Brullet, Enric; Junquera, Félix; Martínez-Bauer, Eva; Miquel, Mireia; Sánchez-Delgado, Jordi; Dalmau, Blai; Campo, Rafael; Calvet, Xavier

2018-03-01

At present there is no fully accepted endoscopic classification for the assessment of the severity of portal hypertensive gastropathy (PHG). Few studies have evaluated inter and intra-observer concordance or the degree of concordance between different endoscopic classifications. To evaluate inter and intra-observer agreement for the presence of portal hypertensive gastropathy and enteropathy using different endoscopic classifications. Patients with liver cirrhosis were included into the study. Enteroscopy was performed under sedation. The location of lesions and their severity was recorded. Images were videotaped and subsequently evaluated independently by three different endoscopists, one of whom was the initial endoscopist. The agreement between observations was assessed using the kappa index. Seventy-four patients (mean age 63.2 years, 53 males and 21 females) were included. The agreement between the three endoscopists regarding the presence or absence of PHG using the Tanoue and McCormack classifications was very low (kappa scores = 0.16 and 0.27, respectively). The current classifications of portal hypertensive gastropathy have a very low degree of intra and inter-observer agreement for the diagnosis and assessment of gastropathy severity.

Rater agreement of visual lameness assessment in horses during lungeing.

PubMed

Hammarberg, M; Egenvall, A; Pfau, T; Rhodin, M

2016-01-01

Lungeing is an important part of lameness examinations as the circular path may accentuate low-grade lameness. Movement asymmetries related to the circular path, to compensatory movements and to pain make the lameness evaluation complex. Scientific studies have shown high inter-rater variation when assessing lameness during straight line movement. The aim was to estimate inter- and intra-rater agreement of equine veterinarians evaluating lameness from videos of sound and lame horses during lungeing and to investigate the influence of veterinarians' experience and the objective degree of movement asymmetry on rater agreement. Cross-sectional observational study. Video recordings and quantitative gait analysis with inertial sensors were performed in 23 riding horses of various breeds. The horses were examined at trot on a straight line and during lungeing on soft or hard surfaces in both directions. One video sequence was recorded per condition and the horses were classified as forelimb lame, hindlimb lame or sound from objective straight line symmetry measurements. Equine veterinarians (n = 86), including 43 with >5 years of orthopaedic experience, participated in a web-based survey and were asked to identify the lamest limb on 60 videos, including 10 repeats. The agreements between (inter-rater) and within (intra-rater) veterinarians were analysed with κ statistics (Fleiss, Cohen). Inter-rater agreement κ was 0.31 (0.38/0.25 for experienced/less experienced) and higher for forelimb (0.33) than for hindlimb lameness (0.11) or soundness (0.08) evaluation. Median intra-rater agreement κ was 0.57. Inter-rater agreement was poor for less experienced raters, and for all raters when evaluating hindlimb lameness. Since identification of the lame limb/limbs is a prerequisite for successful diagnosis, treatment and recovery, the high inter-rater variation when evaluating lameness on the lunge is likely to influence the accuracy and repeatability of lameness examinations

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.

Performing both propensity score and instrumental variable analyses in observational studies often leads to discrepant results: a systematic review.

PubMed

Laborde-Castérot, Hervé; Agrinier, Nelly; Thilly, Nathalie

2015-10-01

Propensity score (PS) and instrumental variable (IV) are analytical techniques used to adjust for confounding in observational research. More and more, they seem to be used simultaneously in studies evaluating health interventions. The present review aimed to analyze the agreement between PS and IV results in medical research published to date. Review of all published observational studies that evaluated a clinical intervention using simultaneously PS and IV analyses, as identified in MEDLINE and Web of Science. Thirty-seven studies, most of them published during the previous 5 years, reported 55 comparisons between results from PS and IV analyses. There was a slight/fair agreement between the methods [Cohen's kappa coefficient = 0.21 (95% confidence interval: 0.00, 0.41)]. In 23 cases (42%), results were nonsignificant for one method and significant for the other, and IV analysis results were nonsignificant in most situations (87%). Discrepancies are frequent between PS and IV analyses and can be interpreted in various ways. This suggests that researchers should carefully consider their analytical choices, and readers should be cautious when interpreting results, until further studies clarify the respective roles of the two methods in observational comparative effectiveness research. Copyright © 2015 Elsevier Inc. All rights reserved.

Collaboration Agreement | FNLCR Staging

Cancer.gov

A Collaboration Agreement is appropriate for research collaboration involving intellectual and material contributions by the Frederick National Laband external partner(s). It is useful for proof-of-concept studies. Includes brief rese

Do observational studies using propensity score methods agree with randomized trials? A systematic comparison of studies on acute coronary syndromes

PubMed Central

Dahabreh, Issa J.; Sheldrick, Radley C.; Paulus, Jessica K.; Chung, Mei; Varvarigou, Vasileia; Jafri, Haseeb; Rassen, Jeremy A.; Trikalinos, Thomas A.; Kitsios, Georgios D.

2012-01-01

Aims Randomized controlled trials (RCTs) are the gold standard for assessing the efficacy of therapeutic interventions because randomization protects from biases inherent in observational studies. Propensity score (PS) methods, proposed as a potential solution to confounding of the treatment–outcome association, are widely used in observational studies of therapeutic interventions for acute coronary syndromes (ACS). We aimed to systematically assess agreement between observational studies using PS methods and RCTs on therapeutic interventions for ACS. Methods and results We searched for observational studies of interventions for ACS that used PS methods to estimate treatment effects on short- or long-term mortality. Using a standardized algorithm, we matched observational studies to RCTs based on patients’ characteristics, interventions, and outcomes (‘topics’), and we compared estimates of treatment effect between the two designs. When multiple observational studies or RCTs were identified for the same topic, we performed a meta-analysis and used the summary relative risk for comparisons. We matched 21 observational studies investigating 17 distinct clinical topics to 63 RCTs (median = 3 RCTs per observational study) for short-term (7 topics) and long-term (10 topics) mortality. Estimates from PS analyses differed statistically significantly from randomized evidence in two instances; however, observational studies reported more extreme beneficial treatment effects compared with RCTs in 13 of 17 instances (P = 0.049). Sensitivity analyses limited to large RCTs, and using alternative meta-analysis models yielded similar results. Conclusion For the treatment of ACS, observational studies using PS methods produce treatment effect estimates that are of more extreme magnitude compared with those from RCTs, although the differences are rarely statistically significant. PMID:22711757

Development and testing of the cancer multidisciplinary team meeting observational tool (MDT-MOT)

PubMed Central

Harris, Jenny; Taylor, Cath; Sevdalis, Nick; Jalil, Rozh; Green, James S.A.

2016-01-01

Abstract Objective To develop a tool for independent observational assessment of cancer multidisciplinary team meetings (MDMs), and test criterion validity, inter-rater reliability/agreement and describe performance. Design Clinicians and experts in teamwork used a mixed-methods approach to develop and refine the tool. Study 1 observers rated pre-determined optimal/sub-optimal MDM film excerpts and Study 2 observers independently rated video-recordings of 10 MDMs. Setting Study 2 included 10 cancer MDMs in England. Participants Testing was undertaken by 13 health service staff and a clinical and non-clinical observer. Intervention None. Main Outcome Measures Tool development, validity, reliability/agreement and variability in MDT performance. Results Study 1: Observers were able to discriminate between optimal and sub-optimal MDM performance (P ≤ 0.05). Study 2: Inter-rater reliability was good for 3/10 domains. Percentage of absolute agreement was high (≥80%) for 4/10 domains and percentage agreement within 1 point was high for 9/10 domains. Four MDTs performed well (scored 3+ in at least 8/10 domains), 5 MDTs performed well in 6–7 domains and 1 MDT performed well in only 4 domains. Leadership and chairing of the meeting, the organization and administration of the meeting, and clinical decision-making processes all varied significantly between MDMs (P ≤ 0.01). Conclusions MDT-MOT demonstrated good criterion validity. Agreement between clinical and non-clinical observers (within one point on the scale) was high but this was inconsistent with reliability coefficients and warrants further investigation. If further validated MDT-MOT might provide a useful mechanism for the routine assessment of MDMs by the local workforce to drive improvements in MDT performance. PMID:27084499

Agreement between different methods of measuring height in elderly patients.

PubMed

Frid, H; Adolfsson, E Thors; Rosenblad, A; Nydahl, M

2013-10-01

The present study aimed to examine the agreement between measurements of standing height and self-reported height, height measured with a sliding caliper, and height estimated from either demispan or knee height in elderly patients. Fifty-five patients (mean age 79 years) at a Swedish hospital were included in this observational study. The participants' heights were evaluated as the standing height, self-reported height, height measured in a recumbent position with a sliding caliper, and height estimated from the demispan or knee height. The measurements made with a sliding caliper in the recumbent position agreed most closely with the standing height. Ninety-five percent of the individuals' differences from standing height were within an interval of +1.1 to -4.8 cm (limits of agreement). Self-reported height and height estimated from knee height differed relatively strongly from standing height. The limits of agreement were +5.2 to -9.8 cm and +9.4 to -6.2 cm, respectively. The widest distribution of differences was found in the height estimated from the demispan, with limits of agreements from +11.2 to -9.3 cm. When measuring the height of patients who find it difficult to stand upright, a sliding caliper should be the method of choice, and the second choice should be self-reported height or the height estimated from knee height. Estimating height from the demispan should be the method of last resort. © 2013 The Authors Journal of Human Nutrition and Dietetics © 2013 The British Dietetic Association Ltd.

22 CFR 124.8 - Clauses required both in manufacturing license agreements and technical assistance agreements.

Code of Federal Regulations, 2010 CFR

2010-04-01

... agreements and technical assistance agreements. 124.8 Section 124.8 Foreign Relations DEPARTMENT OF STATE... Clauses required both in manufacturing license agreements and technical assistance agreements. The following statements must be included both in manufacturing license agreements and in technical assistance...

Nondisclosure Agreements | NREL

Science.gov Websites

the agreement. 5. Share Information and Maintain Records Once the nondisclosure agreement has been executed, appropriately labeled information may be shared. NREL and the other party then maintain records

A pilot study of clinical agreement in cardiovascular preparticipation examinations: how good is the standard of care?

PubMed

O'Connor, Francis G; Johnson, Jeremy D; Chapin, Mark; Oriscello, Ralph G; Taylor, Dean C

2005-05-01

To evaluate the interobserver agreement between physicians regarding a abnormal cardiovascular assessment on athletic preparticipation examinations. Cross-sectional clinical survey. Outpatient Clinic, United States Military Academy, West Point, NY. We randomly selected 101 out of 539 cadet-athletes presenting for a preparticipation examination. Two primary care sports medicine fellows and a cardiologist examined the cadets. After obtaining informed consent from all participants, all 3 physicians separately evaluated all 101 cadets. The physicians recorded their clinical findings and whether they thought further cardiovascular evaluation (echocardiography) was indicated. Rate of referral for further cardiovascular evaluation, clinical agreement between sports medicine fellows, and clinical agreement between sports medicine fellows and the cardiologist. Each fellow referred 6 of the 101 evaluated cadets (5.9%). The cardiologist referred none. Although each fellow referred 6 cadets, only 1 cadet was referred by both. The kappa statistic for clinical agreement between fellows is 0.114 (95% CI, -0.182 to 0.411). There was no clinical agreement between the fellows and the cardiologist. This pilot study reveals a low level of agreement between physicians regarding which athletes with an abnormal examination deserved further testing. It challenges the standard of care and questions whether there is a need for improved technologies or improved training in cardiovascular clinical assessment.

Second Language Acquisition of Gender Agreement in Explicit and Implicit Training Conditions: An Event-Related Potential Study

PubMed Central

Morgan-Short, Kara; Sanz, Cristina; Steinhauer, Karsten; Ullman, Michael T.

2011-01-01

This study employed an artificial language learning paradigm together with a combined behavioral/event-related potential (ERP) approach to examine the neurocognition of the processing of gender agreement, an aspect of inflectional morphology that is problematic in adult second language (L2) learning. Subjects learned to speak and comprehend an artificial language under either explicit (classroomlike) or implicit (immersionlike) training conditions. In each group, both noun-article and noun-adjective gender agreement processing were examined behaviorally and with ERPs at both low and higher levels of proficiency. Results showed that the two groups learned the language to similar levels of proficiency but showed somewhat different ERP patterns. At low proficiency, both types of agreement violations (adjective, article) yielded N400s, but only for the group with implicit training. Additionally, noun-adjective agreement elicited a late N400 in the explicit group at low proficiency. At higher levels of proficiency, noun-adjective agreement violations elicited N400s for both the explicit and implicit groups, whereas noun-article agreement violations elicited P600s for both groups. The results suggest that interactions among linguistic structure, proficiency level, and type of training need to be considered when examining the development of aspects of inflectional morphology in L2 acquisition. PMID:21359123

12 CFR 1291.9 - Agreements.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 12 Banks and Banking 9 2013-01-01 2013-01-01 false Agreements. 1291.9 Section 1291.9 Banks and... HOUSING PROGRAM § 1291.9 Agreements. (a) Agreements between Banks and members. A Bank shall have in place with each member receiving an AHP subsidized advance or AHP direct subsidy an agreement or agreements...

12 CFR 1291.9 - Agreements.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 12 Banks and Banking 10 2014-01-01 2014-01-01 false Agreements. 1291.9 Section 1291.9 Banks and... HOUSING PROGRAM § 1291.9 Agreements. (a) Agreements between Banks and members. A Bank shall have in place with each member receiving an AHP subsidized advance or AHP direct subsidy an agreement or agreements...

12 CFR 1291.9 - Agreements.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 12 Banks and Banking 7 2011-01-01 2011-01-01 false Agreements. 1291.9 Section 1291.9 Banks and... HOUSING PROGRAM § 1291.9 Agreements. (a) Agreements between Banks and members. A Bank shall have in place with each member receiving an AHP subsidized advance or AHP direct subsidy an agreement or agreements...

12 CFR 1291.9 - Agreements.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Agreements. 1291.9 Section 1291.9 Banks and... HOUSING PROGRAM § 1291.9 Agreements. (a) Agreements between Banks and members. A Bank shall have in place with each member receiving an AHP subsidized advance or AHP direct subsidy an agreement or agreements...

12 CFR 1291.9 - Agreements.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 12 Banks and Banking 9 2012-01-01 2012-01-01 false Agreements. 1291.9 Section 1291.9 Banks and... HOUSING PROGRAM § 1291.9 Agreements. (a) Agreements between Banks and members. A Bank shall have in place with each member receiving an AHP subsidized advance or AHP direct subsidy an agreement or agreements...

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.

25 CFR 225.22 - Approval of minerals agreements.

Code of Federal Regulations, 2013 CFR

2013-04-01

... agreement. (1) The written findings shall include an environmental study which meets the requirements of..., studies, data or other information (other than the environmental study required by § 225.24) possessed by... interest of the Indian mineral owner; (2) The minerals agreement does not have adverse cultural, social, or...

25 CFR 225.22 - Approval of minerals agreements.

Code of Federal Regulations, 2014 CFR

2014-04-01

... agreement. (1) The written findings shall include an environmental study which meets the requirements of..., studies, data or other information (other than the environmental study required by § 225.24) possessed by... interest of the Indian mineral owner; (2) The minerals agreement does not have adverse cultural, social, or...

Observational Studies: Cohort and Case-Control Studies

PubMed Central

Song, Jae W.; Chung, Kevin C.

2010-01-01

Observational studies are an important category of study designs. To address some investigative questions in plastic surgery, randomized controlled trials are not always indicated or ethical to conduct. Instead, observational studies may be the next best method to address these types of questions. Well-designed observational studies have been shown to provide results similar to randomized controlled trials, challenging the belief that observational studies are second-rate. Cohort studies and case-control studies are two primary types of observational studies that aid in evaluating associations between diseases and exposures. In this review article, we describe these study designs, methodological issues, and provide examples from the plastic surgery literature. PMID:20697313

Results of Observational Studies: Analysis of Findings from the Nurses’ Health Study

PubMed Central

Tai, Vicky; Grey, Andrew; Bolland, Mark J.

2014-01-01

Background The role of observational studies in informing clinical practice is debated, and high profile examples of discrepancies between the results of observational studies and randomised controlled trials (RCTs) have intensified that debate. We systematically reviewed findings from the Nurses’ Health Study (NHS), one of the longest and largest observational studies, to assess the number and strength of the associations reported and to determine if they have been confirmed in RCTs. Methods We reviewed NHS publication abstracts from 1978–2012, extracted information on associations tested, and graded the strength of the reported effect sizes. We searched PubMed for RCTs or systematic reviews for 3 health outcomes commonly reported in NHS publications: breast cancer, ischaemic heart disease (IHD) and osteoporosis. NHS results were compared with RCT results and deemed concordant when the difference in effect sizes between studies was ≤0.15. Findings 2007 associations between health outcomes and independent variables were reported in 1053 abstracts. 58.0% (1165/2007) were statistically significant, and 22.2% (445/2007) were neutral (no association). Among the statistically significant results that reported a numeric odds ratio (OR) or relative risk (RR), 70.5% (706/1002) reported a weak association (OR/RR 0.5–2.0), 24.5% (246/1002) a moderate association (OR/RR 0.25–0.5 or 2.0–4.0) and 5.0% (50/1002) a strong association (OR/RR ≤0.25 or ≥4.0). 19 associations reported in NHS publications for breast cancer, IHD and osteoporosis have been tested in RCTs, and the concordance between NHS and RCT results was low (≤25%). Conclusions NHS publications contain a large number of analyses, the majority of which reported statistically significant but weak associations. Few of these associations have been tested in RCTs, and where they have, the agreement between NHS results and RCTs is poor. PMID:25330007

Reliability and agreement on embryo assessment: 5 years of an external quality control programme.

PubMed

Martínez-Granados, Luis; Serrano, María; González-Utor, Antonio; Ortiz, Nereyda; Badajoz, Vicente; López-Regalado, María Luisa; Boada, Montserrat; Castilla, Jose A

2018-03-01

An external quality-control programme for morphology-based embryo quality assessment, incorporating a standardized embryo grading scheme, was evaluated over a period of 5 years to determine levels of inter-observer reliability and agreement between practising clinical embryologists at IVF centres and the opinions of a panel of experts. Following Guidelines for Reporting Reliability and Agreement Studies, the Gwet index and proportion of positive (Ppos) and negative agreement were calculated. For embryo morphology assessment, a substantial degree of reliability was measured between the centres and the panel of experts (Gwet index: 0.76; 95% CI 0.70 to 0.84). The agreement was higher for good- versus poor-quality embryos. When multinucleation or vacuoles were observed, low levels of reliability were obtained (Ppos: 0.56 and 0.43, respectively). In blastocysts, the characteristic that presented the largest discrepancy was that related to the inner cell mass. In decisions about the final disposition of the embryo, reliability between centre and the panel of experts was moderate (Gwet index: 0.51; 95% CI 0.41 to 0.60). In conclusion, the ability of clinical embryologists to evaluate the presence of multinucleation and vacuoles in the early cleavage embryo, and to determine the category of the inner cell mass in blastocysts, needs to be improved. Copyright © 2017 Reproductive Healthcare Ltd. All rights reserved.

Characteristics and allowed behaviors of gay male couples’ sexual agreements

PubMed Central

Mitchell, Jason W.

2015-01-01

Research has shown that gay male couples’ sexual agreements may affect their risk for HIV. Few U.S. studies have collected dyadic data nationally from gay male couples to assess what sexual behaviors they allow to occur by agreement type and the sequence of when certain behaviors occur within their relationships. In our cross-sectional study, dyadic data from a convenience sample of 361 male couples were collected electronically throughout the U.S. by using paid Facebook ads. Findings from our study revealed that couples discussed their HIV status before having UAI, but established their agreement some time after having UAI. About half of the couples (N = 207) concurred about having an agreement. Among these couples, 58% concurred about explicitly discussing their agreement, 84% concurred about having the same type of agreement, and 54% had both men adhering to it. A variety of sexual behaviors were endorsed and varied by agreement type. Concordance about aspects of couples’ agreements varied, suggesting the need to engage couples to be more explicit and detailed when establishing and communicating about their agreements. The allowed behaviors and primary reasons for establishing and breaking sexual agreements further highlight the need to bolster HIV prevention for gay male couples. PMID:23514544

Histologic Features associated with Diagnostic Agreement in Atypical Ductal Hyperplasia of the Breast: Illustrative Cases from the B-Path Study

PubMed Central

Allison, Kimberly H.; Rendi, Mara H.; Peacock, Sue; Morgan, Tom; Elmore, Joann G.; Weaver, Donald L.

2016-01-01

Background Case specific characteristics associated with interobserver diagnostic agreement in atypical ductal hyperplasia (ADH) of the breast are poorly understood. Methods Seventy-two test set cases with a consensus diagnosis of ADH from the B-Path study were evaluated. Cases were scored for 17 histologic features which were then correlated with the participant agreement with the consensus ADH diagnosis. Participating pathologists’ perceptions of case difficulty, borderline features, or if they would obtain a second opinion were also examined for associations with agreement. Results Of the 2,070 participant interpretations on the 72 consensus ADH cases, 48% were scored by participants as difficult and 45% as borderline between two diagnoses; the presence of both of these features was significantly associated with increased agreement (p < 0.001). A second opinion would have been obtained in 80% of interpretations, and this was associated with increased agreement (p < 0.001). Diagnostic agreement ranged from 10–89% on a case-by-case basis. Cases with papillary lesions, cribriform architecture and obvious cytologic monotony were associated with higher agreement. Lower agreement rates were associated with solid or micro-papillary architecture, borderline cytologic monotony or cases without a diagnostic area that was obvious on low power. Conclusions The results of this study suggest that pathologists frequently recognize the challenge of ADH cases with some cases more prone to diagnostic variability. In addition, there are specific histologic features associated with diagnostic agreement on ADH cases. Multiple example images from cases in this test set are provided to serve as educational illustrations of these challenges. PMID:27398812

Effect of patient age awareness on diagnostic agreement of chronic or aggressive periodontitis between clinicians; a pilot study.

PubMed

Oshman, Sarah; El Chaar, Edgard; Lee, Yoonjung Nicole; Engebretson, Steven

2016-07-25

The aim of this pilot study was to test whether diagnostic agreement of aggressive and chronic periodontitis amongst Board Certified Periodontists, is influenced by knowledge of a patient's age. In 1999 at the International World Workshop age was removed as a diagnostic criteria for aggressive periodontitis. The impact of this change on the diagnostic reliability amongst clinicians has not yet been assessed. Nine periodontal case reports were twice presented to sixteen board certified periodontists, once with age withheld and again with patient age provided. Participants were instructed to choose a diagnosis of Chronic Periodontitis or Aggressive Periodontitis. Diagnostic agreement was calculated using the Fleiss Kappa test. Including the patients' age in case report information increased diagnostic agreement (the kappa statistic) from 0.49 (moderate agreement) to 0.61 (substantial agreement). These results suggest that knowledge of a patients' age influenced clinical diagnosis, when distinguishing between aggressive periodontitis and chronic periodontitis, which may in turn impact treatment decision-making.

Sandia National Laboratories: Agreements

Science.gov Websites

Technology Partnerships Business, Industry, & Non-Profits Government Universities Center for Development Agreement (CRADA) Strategic Partnership Projects, Non-Federal Entity (SPP/NFE) Agreements New Projects, Non-Federal Entity (SPP/NFE) Agreements Sandia performs work on a reimbursable basis for a non

Development and testing of the cancer multidisciplinary team meeting observational tool (MDT-MOT).

PubMed

Harris, Jenny; Taylor, Cath; Sevdalis, Nick; Jalil, Rozh; Green, James S A

2016-06-01

To develop a tool for independent observational assessment of cancer multidisciplinary team meetings (MDMs), and test criterion validity, inter-rater reliability/agreement and describe performance. Clinicians and experts in teamwork used a mixed-methods approach to develop and refine the tool. Study 1 observers rated pre-determined optimal/sub-optimal MDM film excerpts and Study 2 observers independently rated video-recordings of 10 MDMs. Study 2 included 10 cancer MDMs in England. Testing was undertaken by 13 health service staff and a clinical and non-clinical observer. None. Tool development, validity, reliability/agreement and variability in MDT performance. Study 1: Observers were able to discriminate between optimal and sub-optimal MDM performance (P ≤ 0.05). Study 2: Inter-rater reliability was good for 3/10 domains. Percentage of absolute agreement was high (≥80%) for 4/10 domains and percentage agreement within 1 point was high for 9/10 domains. Four MDTs performed well (scored 3+ in at least 8/10 domains), 5 MDTs performed well in 6-7 domains and 1 MDT performed well in only 4 domains. Leadership and chairing of the meeting, the organization and administration of the meeting, and clinical decision-making processes all varied significantly between MDMs (P ≤ 0.01). MDT-MOT demonstrated good criterion validity. Agreement between clinical and non-clinical observers (within one point on the scale) was high but this was inconsistent with reliability coefficients and warrants further investigation. If further validated MDT-MOT might provide a useful mechanism for the routine assessment of MDMs by the local workforce to drive improvements in MDT performance. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

Measuring agreement between cervical vertebrae and hand-wrist maturation in determining skeletal age: reassessing the theory in patients with short stature.

PubMed

Danaei, Shahla Momeni; Karamifar, Amirali; Sardarian, Ahmadreza; Shahidi, Shoaleh; Karamifar, Hamdollah; Alipour, Abbas; Ghodsi Boushehri, Sahar

2014-09-01

The objective of this study was to determine the degree of agreement between hand-wrist radiography and cervical vertebral maturation analysis in patients diagnosed with short stature. A cross-sectional study was designed; 178 patients (90 girls, 88 boys) diagnosed with short stature and seeking treatment were selected. The patients were divided into 2 groups (76 with familial short stature, 102 with nonfamilial short stature). Hand-wrist and lateral cephalometric radiographs were obtained from the patients. The hand-wrist radiographs were analyzed using the Fishman method, and the lateral cephalometric views were categorized according to the method of Hassel and Farman. The degree of agreement between the 2 methods of predicting skeletal maturation was measured by calculating the contingency coefficient and the weighted kappa statistic. A high degree of agreement was observed between the 2 methods of analyzing skeletal maturation. It was also observed that agreement was higher in girls in the familial short-stature group, whereas boys had higher agreement in the nonfamilial short-stature group. Cervical vertebral maturation can be a valuable substitute for hand-wrist radiography in patients with short stature. Copyright © 2014 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

Brief report: Agreement between parent and adolescent autonomy expectations and its relationship to adolescent adjustment.

PubMed

Pérez, J Carola; Cumsille, Patricio; Martínez, M Loreto

2016-12-01

While disagreement in autonomy expectations between parents and their adolescent children is normative, it may also compromise adolescent adjustment. This study examines the association between parents' and adolescents' agreement on autonomy expectations by cognitive social domains and adolescent adjustment. A sample of 211 Chilean dyads of adolescents (57% female, M age  = 15.29 years) and one of their parents (82% mothers, M age  = 44.36 years) reported their expectations for the age at which adolescents should decide on their own regarding different issues in their life. Indexes of parent-adolescent agreement on autonomy expectations were estimated for issues of personal and prudential domains. Greater agreement in the prudential than in the personal domain was observed. For boys and girls, higher agreement in adolescent-parent autonomy expectations in the personal domain was associated with lower substance use. A negative association between level of agreement in adolescent-parent autonomy expectations in the prudential domain and externalizing behaviors and substance use was found. Copyright © 2016 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

Studies in support of an SNM cutoff agreement: The PUREX exercise

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

Stanbro, W.D.; Libby, R.; Segal, J.

1995-07-01

On September 23, 1993, President Clinton, in a speech before the United Nations General Assembly, called for an international agreement banning the production of plutonium and highly enriched uranium for nuclear explosive purposes. A major element of any verification regime for such an agreement would probably involve inspections of reprocessing plants in Nuclear Nonproliferation Treaty weapons states. Many of these are large facilities built in the 1950s with no thought that they would be subject to international inspection. To learn about some of the problems that might be involved in the inspection of such large, old facilities, the Department ofmore » Energy, Office of Arms Control and Nonproliferation, sponsored a mock inspection exercise at the PUREX plant on the Hanford Site. This exercise examined a series of alternatives for inspections of the PUREX as a model for this type of facility at other locations. A series of conclusions were developed that can be used to guide the development of verification regimes for a cutoff agreement at reprocessing facilities.« less

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.

The 27-28 October 1986 FIRE IFO Cirrus case study: Comparison of radiative transfer theory with observations by satellite and aircraft

NASA Technical Reports Server (NTRS)

Wielicki, Bruce A.; Suttles, J. T.; Heymsfield, Andrew J.; Welch, Ronald M.; Spinhirne, James D.; Wu, Man-Li C.; Starr, David OC.; Parker, Lindsay; Arduini, Robert F.

1989-01-01

Observations of cirrus and altocumulus clouds during the First International Satellite Cloud Climatology Project Regional Experiment (FIRE) are compared to theoretical models of cloud radiative properties. Three tests are performed. First, LANDSAT radiances are used to compare the relationship between nadir reflectance ot 0.83 micron and beam emittance at 11.5 microns with that predicted for model calculations using spherical and nonspherical phase functions. Good agreement is found between observations and theory when water droplets dominate. Poor agreement is found when ice particles dominate, especially using scattering phase functions for spherical particles. Even when compared to a laboratory measured ice particle phase function, the observations show increased side scattered radiation relative to the theoretical calculations. Second, the anisotropy of conservatively scattered radiation is examined using simultaneous multiple angle views of the cirrus from LANDSAT and ER-2 aircraft radiometers. Observed anisotropy gives good agreement with theoretical calculations using the laboratory measured ice particle phase function and poor agreement with a spherical particle phase function. Third, Landsat radiances at 0.83, 1.65, and 2.21 microns are used to infer particle phase and particle size. For water droplets, good agreement is found with King Air FSSP particle probe measurements in the cloud. For ice particles, the LANDSAT radiance observations predict an effective radius of 60 microns versus aircraft observations of about 200 microns. It is suggested that this descrepancy may be explained by uncertainty in the imaginary index of ice and by inadequate measurements of small ice particles by microphysical probes.

49 CFR 212.105 - Agreements.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 4 2011-10-01 2011-10-01 false Agreements. 212.105 Section 212.105 Transportation... TRANSPORTATION STATE SAFETY PARTICIPATION REGULATIONS State/Federal Roles § 212.105 Agreements. (a) Scope. The... agreement with FRA. An agreement may delegate investigative and surveillance authority with respect to all...

7 CFR 247.4 - Agreements.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 4 2011-01-01 2011-01-01 false Agreements. 247.4 Section 247.4 Agriculture... CHILD NUTRITION PROGRAMS COMMODITY SUPPLEMENTAL FOOD PROGRAM § 247.4 Agreements. (a) What agreements are necessary for agencies to administer CSFP? The following agreements are necessary for agencies to administer...

49 CFR 212.105 - Agreements.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 49 Transportation 4 2013-10-01 2013-10-01 false Agreements. 212.105 Section 212.105 Transportation... TRANSPORTATION STATE SAFETY PARTICIPATION REGULATIONS State/Federal Roles § 212.105 Agreements. (a) Scope. The... agreement with FRA. An agreement may delegate investigative and surveillance authority with respect to all...

7 CFR 247.4 - Agreements.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 4 2014-01-01 2014-01-01 false Agreements. 247.4 Section 247.4 Agriculture... CHILD NUTRITION PROGRAMS COMMODITY SUPPLEMENTAL FOOD PROGRAM § 247.4 Agreements. (a) What agreements are necessary for agencies to administer CSFP? The following agreements are necessary for agencies to administer...

7 CFR 247.4 - Agreements.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 4 2010-01-01 2010-01-01 false Agreements. 247.4 Section 247.4 Agriculture... CHILD NUTRITION PROGRAMS COMMODITY SUPPLEMENTAL FOOD PROGRAM § 247.4 Agreements. (a) What agreements are necessary for agencies to administer CSFP? The following agreements are necessary for agencies to administer...

49 CFR 212.105 - Agreements.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 49 Transportation 4 2014-10-01 2014-10-01 false Agreements. 212.105 Section 212.105 Transportation... TRANSPORTATION STATE SAFETY PARTICIPATION REGULATIONS State/Federal Roles § 212.105 Agreements. (a) Scope. The... agreement with FRA. An agreement may delegate investigative and surveillance authority with respect to all...

49 CFR 212.105 - Agreements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 4 2010-10-01 2010-10-01 false Agreements. 212.105 Section 212.105 Transportation... TRANSPORTATION STATE SAFETY PARTICIPATION REGULATIONS State/Federal Roles § 212.105 Agreements. (a) Scope. The... agreement with FRA. An agreement may delegate investigative and surveillance authority with respect to all...

7 CFR 247.4 - Agreements.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 4 2012-01-01 2012-01-01 false Agreements. 247.4 Section 247.4 Agriculture... CHILD NUTRITION PROGRAMS COMMODITY SUPPLEMENTAL FOOD PROGRAM § 247.4 Agreements. (a) What agreements are necessary for agencies to administer CSFP? The following agreements are necessary for agencies to administer...

7 CFR 247.4 - Agreements.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 4 2013-01-01 2013-01-01 false Agreements. 247.4 Section 247.4 Agriculture... CHILD NUTRITION PROGRAMS COMMODITY SUPPLEMENTAL FOOD PROGRAM § 247.4 Agreements. (a) What agreements are necessary for agencies to administer CSFP? The following agreements are necessary for agencies to administer...

49 CFR 212.105 - Agreements.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 49 Transportation 4 2012-10-01 2012-10-01 false Agreements. 212.105 Section 212.105 Transportation... TRANSPORTATION STATE SAFETY PARTICIPATION REGULATIONS State/Federal Roles § 212.105 Agreements. (a) Scope. The... agreement with FRA. An agreement may delegate investigative and surveillance authority with respect to all...

Correlation and agreement of self-assessed and objective skin disease severity in a cross-sectional study of patients with acne, psoriasis, and atopic eczema.

PubMed

Magin, Parker J; Pond, C Dimity; Smith, Wayne T; Watson, Alan B; Goode, Susan M

2011-12-01

Previous studies have shown variable correlation of patients' self-assessed skin severity measures and clinician-assessed objective measures of severity. But, generally, correlation has not been as good as might be expected for conditions in which the objective physical extent of skin disease is apparent to the sufferer to an extent that is not applicable in many other diseases. This paper reports agreement and correlation of self-assessed and objective severity measures in a study of 108 subjects with acne, psoriasis, or atopic eczema. The study was a cross-sectional study examining psychological associations of these skin diseases. Objective severity was assessed with the Leeds technique (acne), the Psoriasis Area and Severity Index, and Six Area Six Sign Atopic Dermatitis instruments. Agreement is a more appropriate measure than correlation in this situation and was measured with weighted kappa, while correlation was measured with Spearman's rank correlation. There was a modest correlation of ρ = 0.46 and similarly very modest agreement of 0.35 (weighted kappa) of self-assessed and clinician-assessed disease severity. Furthermore, self-assessed (but not clinician-assessed) severity was statistically associated with psychological morbidity in this study; i.e. - depression, anxiety, and overall psychological morbidity. Clinicians should consider psychological sequelae of skin disease, not only in those with objectively more severe disease but in patients across the severity spectrum. Both observational and interventional studies of skin disease should include both clinician-assessed and self-assessed measures of severity among assessed variables. © 2011 The International Society of Dermatology.

7 CFR 1499.5 - Agreements.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 10 2013-01-01 2013-01-01 false Agreements. 1499.5 Section 1499.5 Agriculture... AGRICULTURE EXPORT PROGRAMS FOOD FOR PROGRESS PROGRAM § 1499.5 Agreements. (a) After FAS approves an applicant's proposal, FAS will develop an agreement in consultation with the applicant. The agreement will set...

7 CFR 1499.5 - Agreements.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 10 2012-01-01 2012-01-01 false Agreements. 1499.5 Section 1499.5 Agriculture... AGRICULTURE EXPORT PROGRAMS FOOD FOR PROGRESS PROGRAM § 1499.5 Agreements. (a) After FAS approves an applicant's proposal, FAS will develop an agreement in consultation with the applicant. The agreement will set...

7 CFR 1499.5 - Agreements.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 10 2014-01-01 2014-01-01 false Agreements. 1499.5 Section 1499.5 Agriculture... AGRICULTURE EXPORT PROGRAMS FOOD FOR PROGRESS PROGRAM § 1499.5 Agreements. (a) After FAS approves an applicant's proposal, FAS will develop an agreement in consultation with the applicant. The agreement will set...

2 CFR 3001.661 - Reimbursable Agreement.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 2 Grants and Agreements 1 2013-01-01 2013-01-01 false Reimbursable Agreement. 3001.661 Section 3001.661 Grants and Agreements Federal Agency Regulations for Grants and Agreements DEPARTMENT OF... Reimbursable Agreement. Reimbursable Agreement means an award in which the recipient is reimbursed for...

Reliability of psychiatric diagnosis in hospitalized adolescents. Interrater agreement using DSM-III.

PubMed

Strober, M; Green, J; Carlson, G

1981-02-01

To determine the reliability of psychiatric diagnosis in hospitalized adolescents, 95 consecutively admitted patients were diagnosed independently by two experienced clinicians using DSM-III criteria. Diagnostic judgments were based on joint interview of the patient via a structured mental-status examination, nursing observations, and referral materials. Concordance was analyzed by the kappa coefficient. A total of 13 DSM-III categories were used to classify this cohort, with the majority of categories representing traditional syndromes of functional psychopathology. There was complete agreement between the raters for more than three fourths of the patients. Levels of agreement for the categories of schizophrenia and major affective disorder were similar to values obtained in recent studies of adult patients. The results are discussed in relation to historical conceptions of adolescent psychopathology.

16 CFR 2.32 - Agreement.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 16 Commercial Practices 1 2013-01-01 2013-01-01 false Agreement. 2.32 Section 2.32 Commercial... Consent Order Procedure § 2.32 Agreement. Every agreement in settlement of a Commission complaint shall... of findings of fact and conclusions of law. Every agreement also shall waive further procedural steps...

16 CFR 2.32 - Agreement.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 16 Commercial Practices 1 2010-01-01 2010-01-01 false Agreement. 2.32 Section 2.32 Commercial... Consent Order Procedure § 2.32 Agreement. Every agreement in settlement of a Commission complaint shall... of findings of fact and conclusions of law. Every agreement also shall waive further procedural steps...

16 CFR 2.32 - Agreement.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 16 Commercial Practices 1 2012-01-01 2012-01-01 false Agreement. 2.32 Section 2.32 Commercial... Consent Order Procedure § 2.32 Agreement. Every agreement in settlement of a Commission complaint shall... of findings of fact and conclusions of law. Every agreement also shall waive further procedural steps...

16 CFR 2.32 - Agreement.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 16 Commercial Practices 1 2011-01-01 2011-01-01 false Agreement. 2.32 Section 2.32 Commercial... Consent Order Procedure § 2.32 Agreement. Every agreement in settlement of a Commission complaint shall... of findings of fact and conclusions of law. Every agreement also shall waive further procedural steps...

16 CFR 2.32 - Agreement.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 16 Commercial Practices 1 2014-01-01 2014-01-01 false Agreement. 2.32 Section 2.32 Commercial... Consent Order Procedure § 2.32 Agreement. Every agreement in settlement of a Commission complaint shall... of findings of fact and conclusions of law. Every agreement also shall waive further procedural steps...

Interrater agreement in the interpretation of neonatal electroencephalography in hypoxic-ischemic encephalopathy.

PubMed

Wusthoff, Courtney J; Sullivan, Joseph; Glass, Hannah C; Shellhaas, Renée A; Abend, Nicholas S; Chang, Taeun; Tsuchida, Tammy N

2017-03-01

Research using neonatal electroencephalography (EEG) has been limited by a lack of a standardized classification system and interpretation terminology. In 2013, the American Clinical Neurophysiology Society (ACNS) published a guideline for standardized terminology and categorization in the description of continuous EEG in neonates. We sought to assess interrater agreement for this neonatal EEG categorization system as applied by a group of pediatric neurophysiologists. A total of 60 neonatal EEG studies were collected from three institutions. All EEG segments were from term neonates with hypoxic-ischemic encephalopathy. Three pediatric neurophysiologists independently reviewed each record using the ACNS standardized scoring system. Unweighted kappa values were calculated for interrater agreement of categorical data across multiple observers. Interrater agreement was very good for identification of seizures (κ = 0.93, p < 0.001), with perfect agreement in 95% of records (57 of 60). Interrater agreement was moderate for classifying records as normal or having any abnormality (κ = 0.49, p < 0.001), with perfect agreement in 78% of records (47 of 60). Interrater agreement was good in classifying EEG backgrounds on a 5-category scale (normal, excessively discontinuous, burst suppression, status epilepticus, or electrocerebral inactivity) (κ = 0.70, p < 0.001), with perfect agreement in 72% of records (43 of 60). Other specific background features had lower agreement, including voltage (κ = 0.41, p < 0.001), variability (κ = 0.35, p < 0.001), symmetry (κ = 0.18, p = 0.01), presence of abnormal sharp waves (κ < 0.20, p < 0.05), and presence of brief rhythmic discharges (κ < 0.20, p < 0.05). We found good or very good interrater agreement applying the ACNS system for identification of seizures and classification of EEG background. Other specific EEG features showed limited interrater agreement. Of importance to both clinicians and

2 CFR 1401.220 - Cooperative agreement.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 2 Grants and Agreements 1 2013-01-01 2013-01-01 false Cooperative agreement. 1401.220 Section 1401.220 Grants and Agreements Federal Agency Regulations for Grants and Agreements DEPARTMENT OF THE... agreement. Cooperative agreement means an award of financial assistance that, consistent with 31 U.S.C. 6305...

49 CFR 605.14 - Agreement.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 49 Transportation 7 2012-10-01 2012-10-01 false Agreement. 605.14 Section 605.14 Transportation... TRANSPORTATION SCHOOL BUS OPERATIONS School Bus Agreements § 605.14 Agreement. Except as provided in § 605.11 no... entered into a written agreement that the applicant will not engage in school bus operations exclusively...

49 CFR 605.14 - Agreement.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 49 Transportation 7 2014-10-01 2014-10-01 false Agreement. 605.14 Section 605.14 Transportation... TRANSPORTATION SCHOOL BUS OPERATIONS School Bus Agreements § 605.14 Agreement. Except as provided in § 605.11 no... entered into a written agreement that the applicant will not engage in school bus operations exclusively...

23 CFR 660.111 - Agreements.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 23 Highways 1 2014-04-01 2014-04-01 false Agreements. 660.111 Section 660.111 Highways FEDERAL... (DIRECT FEDERAL) Forest Highways § 660.111 Agreements. (a) A statewide FH agreement shall be executed among the FHWA, the FS, and each SHA. This agreement shall set forth the responsibilities of each party...

23 CFR 660.111 - Agreements.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 23 Highways 1 2011-04-01 2011-04-01 false Agreements. 660.111 Section 660.111 Highways FEDERAL... (DIRECT FEDERAL) Forest Highways § 660.111 Agreements. (a) A statewide FH agreement shall be executed among the FHWA, the FS, and each SHA. This agreement shall set forth the responsibilities of each party...

23 CFR 660.111 - Agreements.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 23 Highways 1 2012-04-01 2012-04-01 false Agreements. 660.111 Section 660.111 Highways FEDERAL... (DIRECT FEDERAL) Forest Highways § 660.111 Agreements. (a) A statewide FH agreement shall be executed among the FHWA, the FS, and each SHA. This agreement shall set forth the responsibilities of each party...

49 CFR 605.14 - Agreement.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 49 Transportation 7 2013-10-01 2013-10-01 false Agreement. 605.14 Section 605.14 Transportation... TRANSPORTATION SCHOOL BUS OPERATIONS School Bus Agreements § 605.14 Agreement. Except as provided in § 605.11 no... entered into a written agreement that the applicant will not engage in school bus operations exclusively...

49 CFR 605.14 - Agreement.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 7 2011-10-01 2011-10-01 false Agreement. 605.14 Section 605.14 Transportation... TRANSPORTATION SCHOOL BUS OPERATIONS School Bus Agreements § 605.14 Agreement. Except as provided in § 605.11 no... entered into a written agreement that the applicant will not engage in school bus operations exclusively...

23 CFR 660.111 - Agreements.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 23 Highways 1 2013-04-01 2013-04-01 false Agreements. 660.111 Section 660.111 Highways FEDERAL... (DIRECT FEDERAL) Forest Highways § 660.111 Agreements. (a) A statewide FH agreement shall be executed among the FHWA, the FS, and each SHA. This agreement shall set forth the responsibilities of each party...

49 CFR 605.14 - Agreement.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 7 2010-10-01 2010-10-01 false Agreement. 605.14 Section 605.14 Transportation... TRANSPORTATION SCHOOL BUS OPERATIONS School Bus Agreements § 605.14 Agreement. Except as provided in § 605.11 no... entered into a written agreement that the applicant will not engage in school bus operations exclusively...

23 CFR 660.111 - Agreements.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 23 Highways 1 2010-04-01 2010-04-01 false Agreements. 660.111 Section 660.111 Highways FEDERAL... (DIRECT FEDERAL) Forest Highways § 660.111 Agreements. (a) A statewide FH agreement shall be executed among the FHWA, the FS, and each SHA. This agreement shall set forth the responsibilities of each party...

Molecular Carbon in the Galaxy: Laboratory and Observational Studies

NASA Technical Reports Server (NTRS)

Saykally, Richard James

2003-01-01

In a collaboration with the Mats Larsson group from Stockholm, we carried out a new measurement of the rate of dissociative recombination of H(sup *, sub j), using a new pulsed supersonic beam source of rotationally cold H(sup *, sub j). This source was first designed and characterized in our lab by IR cavity ringdown spectroscopy, determining a rotationaYtranslationa1 temperature of 20-60K, depending on conditions. This new source was then taken to Stockholm for the recombination rate studies at the CRYRING storage ring. The recombination rate constant measured against temperature yields values consistent with the most recent calculations, whereas previous experimental measurements varied over a range of 10(exp 4) and were poor agreement with theory. This is a crucial achievement for understanding the ion chemistry of diffuse clouds. Moreover, this result in combination with recent observations implies a greatly enhanced (factor of 40) cosmic ray ionization rate in a diffuse cloud (zeta Persei) relative to previous studies. The implications of this are discussed in our recent Nature paper. An enhanced cosmic-ray flux towards zeta Persei inferred from a laboratory study of the H(sup *, sub j)-e(sup -) recombination rate.

On the Agreement between Manual and Automated Methods for Single-Trial Detection and Estimation of Features from Event-Related Potentials

PubMed Central

Biurrun Manresa, José A.; Arguissain, Federico G.; Medina Redondo, David E.; Mørch, Carsten D.; Andersen, Ole K.

2015-01-01

The agreement between humans and algorithms on whether an event-related potential (ERP) is present or not and the level of variation in the estimated values of its relevant features are largely unknown. Thus, the aim of this study was to determine the categorical and quantitative agreement between manual and automated methods for single-trial detection and estimation of ERP features. To this end, ERPs were elicited in sixteen healthy volunteers using electrical stimulation at graded intensities below and above the nociceptive withdrawal reflex threshold. Presence/absence of an ERP peak (categorical outcome) and its amplitude and latency (quantitative outcome) in each single-trial were evaluated independently by two human observers and two automated algorithms taken from existing literature. Categorical agreement was assessed using percentage positive and negative agreement and Cohen’s κ, whereas quantitative agreement was evaluated using Bland-Altman analysis and the coefficient of variation. Typical values for the categorical agreement between manual and automated methods were derived, as well as reference values for the average and maximum differences that can be expected if one method is used instead of the others. Results showed that the human observers presented the highest categorical and quantitative agreement, and there were significantly large differences between detection and estimation of quantitative features among methods. In conclusion, substantial care should be taken in the selection of the detection/estimation approach, since factors like stimulation intensity and expected number of trials with/without response can play a significant role in the outcome of a study. PMID:26258532

49 CFR 22.23 - Agreements.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 49 Transportation 1 2013-10-01 2013-10-01 false Agreements. 22.23 Section 22.23 Transportation... Agreements. (a) DOT OSDBU may enter into a cooperative agreement with a lender that meets the criteria defined in § 22.21 in order for the lender to become a Participating Lender in the STLP. Such an agreement...

49 CFR 22.23 - Agreements.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 49 Transportation 1 2014-10-01 2014-10-01 false Agreements. 22.23 Section 22.23 Transportation... Agreements. (a) DOT OSDBU may enter into a cooperative agreement with a lender that meets the criteria defined in § 22.21 in order for the lender to become a Participating Lender in the STLP. Such an agreement...

49 CFR 22.23 - Agreements.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 49 Transportation 1 2012-10-01 2012-10-01 false Agreements. 22.23 Section 22.23 Transportation... Agreements. (a) DOT OSDBU may enter into a cooperative agreement with a lender that meets the criteria defined in § 22.21 in order for the lender to become a Participating Lender in the STLP. Such an agreement...

49 CFR 22.23 - Agreements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 1 2010-10-01 2010-10-01 false Agreements. 22.23 Section 22.23 Transportation... Agreements. (a) DOT OSDBU may enter into a cooperative agreement with a lender that meets the criteria defined in § 22.21 in order for the lender to become a Participating Lender in the STLP. Such an agreement...

49 CFR 22.23 - Agreements.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 1 2011-10-01 2011-10-01 false Agreements. 22.23 Section 22.23 Transportation... Agreements. (a) DOT OSDBU may enter into a cooperative agreement with a lender that meets the criteria defined in § 22.21 in order for the lender to become a Participating Lender in the STLP. Such an agreement...

Magnetic resonance features of the feline hippocampus in epileptic and non-epileptic cats: a blinded, retrospective, multi-observer study.

PubMed

Claßen, Anne Christine; Kneissl, Sibylle; Lang, Johann; Tichy, Alexander; Pakozdy, Akos

2016-08-11

Hippocampal necrosis in cats has been reported to be associated with epileptic seizures. Magnetic resonance imaging (MRI) features of temporal lobe (TL) abnormalities in epileptic cats have been described but MR images from epileptic and non-epileptic individuals have not yet been systematically compared. TL abnormalities are highly variable in shape, size and signal, and therefore may lead to varying evaluations by different specialists. The aim of this study was to investigate whether there were differences in the appearance of the TL between epileptic and non-epileptic cats, and whether there were any relationships between TL abnormalities and seizure semiologies or other clinical findings. We also investigated interobserver agreement among three specialists. The MR images of 46 cats were reviewed independently by three observers, who were blinded to patient data, examination findings and the review of the other observers. Images were evaluated using a multiparametric scoring system developed for this study. Mann-Whitney U-tests and chi-square were used to analyse the differences between observers' evaluations. The kappa coefficient (k) and Fleiss' kappa coefficient were used to quantify interobserver agreement. The overall interobserver agreement was moderate to good (k =0.405 to 0.615). The MR scores between epileptic and non-epileptic cats did not differ significantly. However, there was a significant difference between the MR scores of epileptic cats with and without orofacial involvement according to all three observers. Likewise, MR scores of cats with cluster seizures were higher than those of cats without clusters. Cats presenting with recurrent epileptic seizures with orofacial involvement are more likely to have hippocampal pathologies, which suggests that TL abnormalities are not merely unspecific epileptic findings, but are associated with a certain type of epilepsy. TL signal alterations are more likely to be detected on FLAIR sequences. In contrast

Statistical methods for conducting agreement (comparison of clinical tests) and precision (repeatability or reproducibility) studies in optometry and ophthalmology.

PubMed

McAlinden, Colm; Khadka, Jyoti; Pesudovs, Konrad

2011-07-01

The ever-expanding choice of ocular metrology and imaging equipment has driven research into the validity of their measurements. Consequently, studies of the agreement between two instruments or clinical tests have proliferated in the ophthalmic literature. It is important that researchers apply the appropriate statistical tests in agreement studies. Correlation coefficients are hazardous and should be avoided. The 'limits of agreement' method originally proposed by Altman and Bland in 1983 is the statistical procedure of choice. Its step-by-step use and practical considerations in relation to optometry and ophthalmology are detailed in addition to sample size considerations and statistical approaches to precision (repeatability or reproducibility) estimates. Ophthalmic & Physiological Optics © 2011 The College of Optometrists.

Studies of the Antarctic Sea Ice Edges and Ice Extents from Satellite and Ship Observations

NASA Technical Reports Server (NTRS)

Worby, Anthony P.; Comiso, Josefino C.

2003-01-01

Passive-microwave derived ice edge locations in Antarctica are assessed against other satellite data as well as in situ observations of ice edge location made between 1989 and 2000. The passive microwave data generally agree with satellite and ship data but the ice concentration at the observed ice edge varies greatly with averages of 14% for the TEAM algorithm and 19% for the Bootstrap algorithm. The comparisons of passive microwave with the field data show that in the ice growth season (March - October) the agreement is extremely good, with r(sup 2) values of 0.9967 and 0.9797 for the Bootstrap and TEAM algorithms respectively. In the melt season however (November - February) the passive microwave ice edge is typically 1-2 degrees south of the observations due to the low concentration and saturated nature of the ice. Sensitivity studies show that these results can have significant impact on trend and mass balance studies of the sea ice cover in the Southern Ocean.

10 CFR 611.105 - Agreement.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 4 2014-01-01 2014-01-01 false Agreement. 611.105 Section 611.105 Energy DEPARTMENT OF... Direct Loan Program § 611.105 Agreement. (a) Only an Agreement executed by a duly authorized DOE... paid to DOE relating to the section 136 loan program. (d) Prior to the execution by DOE of an Agreement...

10 CFR 611.105 - Agreement.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 4 2012-01-01 2012-01-01 false Agreement. 611.105 Section 611.105 Energy DEPARTMENT OF... Direct Loan Program § 611.105 Agreement. (a) Only an Agreement executed by a duly authorized DOE... paid to DOE relating to the section 136 loan program. (d) Prior to the execution by DOE of an Agreement...

10 CFR 611.105 - Agreement.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false Agreement. 611.105 Section 611.105 Energy DEPARTMENT OF... Direct Loan Program § 611.105 Agreement. (a) Only an Agreement executed by a duly authorized DOE... paid to DOE relating to the section 136 loan program. (d) Prior to the execution by DOE of an Agreement...

10 CFR 611.105 - Agreement.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 4 2011-01-01 2011-01-01 false Agreement. 611.105 Section 611.105 Energy DEPARTMENT OF... Direct Loan Program § 611.105 Agreement. (a) Only an Agreement executed by a duly authorized DOE... paid to DOE relating to the section 136 loan program. (d) Prior to the execution by DOE of an Agreement...

ACHP | Fort Monroe Agreement Signed

Science.gov Websites

Search skip specific nav links Home arrow News arrow Fort Monroe Agreement Signed Fort Monroe Agreement Signed A historic agreement has been reached on a richly historic property, Fort Monroe, Virginia. Fort Programmatic Agreement (PA) that capped a lengthy and complex Section 106 consultation process led by the

10 CFR 611.105 - Agreement.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 4 2013-01-01 2013-01-01 false Agreement. 611.105 Section 611.105 Energy DEPARTMENT OF... Direct Loan Program § 611.105 Agreement. (a) Only an Agreement executed by a duly authorized DOE... paid to DOE relating to the section 136 loan program. (d) Prior to the execution by DOE of an Agreement...

Object attraction effects during subject-verb agreement in Persian.

PubMed

Feiz, Aazam; Cowles, Wind

2018-04-01

Subject-verb agreement provides insight into how grammatical and semantic features interact during sentence production, and prior studies have found attraction errors when an intervening local noun is grammatically part of the subject. Two major types of theories have emerged from these studies: control based and competition-based. The current study used an subject-object-verb language with optional subject-verb agreement, Persian, to test the competition-based hypothesis that intervening object nouns may also cause attraction effects, even though objects are not part of the syntactic relationship between the subject and verb. Our results, which did not require speakers to make grammatical errors, show that objects can be attractors for agreement, but this effect appears to be dependent on the type of plural marker on the object. These results support competition-based theories of agreement production, in which agreement may be influenced by attractors that are outside the scope of the subject-verb relationship.

On Deviations between Observed and Theoretically Estimated Values on Additivity-Law Failures

NASA Astrophysics Data System (ADS)

Nayatani, Yoshinobu; Sobagaki, Hiroaki

The authors have reported in the previous studies that the average observed results are about a half of the corresponding predictions on the experiments with large additivity-law failures. One of the reasons of the deviations is studied and clarified by using the original observed data on additivity-law failures in the Nakano experiment. The conclusion from the observations and their analyses clarified that it was essentially difficult to have a good agreement between the average observed results and the corresponding theoretical predictions in the experiments with large additivity-law failures. This is caused by a kind of unavoidable psychological pressure existing in subjects participated in the experiments. We should be satisfied with the agreement in trend between them.

Agreement on urgency assessment between secretaries and general practitioners: an observational study in out-of-hours general practice service in Belgium.

PubMed

Philips, H; Van Bergen, J; Huibers, L; Colliers, A; Bartholomeeusen, S; Coenen, S; Remmen, R

2015-10-01

In some European countries telephone triage (TT) during out-of-hours primary care showed to be safe and effective. Other countries, such as Belgium, may not have trained auxiliary personnel while their national health services want to establish TT. To compare urgency levels assessed by secretaries and general practitioners in one general practice cooperative in Belgium. Percentage of correct-, under-, and over-triage were calculated in total and per reason for encounter. Inter-rater agreement was investigated. The secretaries correctly triaged (same urgency level) 77% of the telephone calls, under-triaged 10% and over-triaged 13%.'Shortness of breath', 'skin cuts', 'chest pain', 'feeling unwell' and 'syncope' were often under-triaged. Before introducing TT, auxiliary staff should be trained and protocols should be used.

Misinterpretations in agreement and agreement attraction.

PubMed

Patson, Nikole D; Husband, E Matthew

2016-01-01

It has been well established that subject-verb number agreement can be disrupted by local noun phrases that differ in number from the subject head noun phrase. In sentence production, mismatches in the grammatical number of the head and local noun phrases lead to agreement errors on the verb as in: the key to the cabinets are. Similarly, although ungrammaticality typically causes disruption in measures of sentence comprehension, the disruption is reduced when the local noun phrase has a plural feature. Using a forced-choice comprehension question method, we report two experiments that provide evidence that comprehenders were likely to misinterpret the number information on the head noun phrase when morphosyntactic number markings on the local noun phrase and verb did not match the head. These results are consistent with a growing body of research that suggests that comprehenders often arrive at a final interpretation of a sentence that is not faithful to the linguistic input.

Characteristics and allowed behaviors of gay male couples' sexual agreements.

PubMed

Mitchell, Jason W

2014-01-01

Research has shown that gay male couples' sexual agreements may affect their risk for HIV. Few U.S. studies have collected dyadic data nationally from gay male couples to assess what sexual behaviors they allow to occur by agreement type and the sequence of when certain behaviors occur within their relationships. In our cross-sectional study, dyadic data from a convenience sample of 361 male couples were collected electronically throughout the United States by using paid Facebook ads. Findings revealed that couples discussed their HIV status before having unprotected anal intercourse (UAI) but established their agreement some time after having UAI. About half of the couples (N = 207) concurred about having an agreement. Among these couples, 58% concurred about explicitly discussing their agreement, 84% concurred about having the same type of agreement, and 54% had both men adhering to it. A variety of sexual behaviors were endorsed and varied by agreement type. Concordance about aspects of couples' agreements varied, suggesting the need to engage couples to be more explicit and detailed when establishing and communicating about their agreements. The allowed behaviors and primary reasons for establishing and breaking sexual agreements further highlight the need to bolster HIV prevention for gay male couples.

48 CFR 225.403 - World Trade Organization Government Procurement Agreement and Free Trade Agreements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false World Trade Organization Government Procurement Agreement and Free Trade Agreements. 225.403 Section 225.403 Federal Acquisition Regulations System DEFENSE ACQUISITION REGULATIONS SYSTEM, DEPARTMENT OF DEFENSE SOCIOECONOMIC PROGRAMS FOREIGN ACQUISITION Trade Agreements...

48 CFR 225.403 - World Trade Organization Government Procurement Agreement and Free Trade Agreements.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 3 2014-10-01 2014-10-01 false World Trade Organization Government Procurement Agreement and Free Trade Agreements. 225.403 Section 225.403 Federal Acquisition Regulations System DEFENSE ACQUISITION REGULATIONS SYSTEM, DEPARTMENT OF DEFENSE SOCIOECONOMIC PROGRAMS FOREIGN ACQUISITION Trade Agreements...

48 CFR 225.403 - World Trade Organization Government Procurement Agreement and Free Trade Agreements.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 3 2012-10-01 2012-10-01 false World Trade Organization Government Procurement Agreement and Free Trade Agreements. 225.403 Section 225.403 Federal Acquisition Regulations System DEFENSE ACQUISITION REGULATIONS SYSTEM, DEPARTMENT OF DEFENSE SOCIOECONOMIC PROGRAMS FOREIGN ACQUISITION Trade Agreements...

48 CFR 225.403 - World Trade Organization Government Procurement Agreement and Free Trade Agreements.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 3 2011-10-01 2011-10-01 false World Trade Organization Government Procurement Agreement and Free Trade Agreements. 225.403 Section 225.403 Federal Acquisition Regulations System DEFENSE ACQUISITION REGULATIONS SYSTEM, DEPARTMENT OF DEFENSE SOCIOECONOMIC PROGRAMS FOREIGN ACQUISITION Trade Agreements...

48 CFR 225.403 - World Trade Organization Government Procurement Agreement and Free Trade Agreements.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 3 2013-10-01 2013-10-01 false World Trade Organization Government Procurement Agreement and Free Trade Agreements. 225.403 Section 225.403 Federal Acquisition Regulations System DEFENSE ACQUISITION REGULATIONS SYSTEM, DEPARTMENT OF DEFENSE SOCIOECONOMIC PROGRAMS FOREIGN ACQUISITION Trade Agreements...

Ice-free Arctic projections under the Paris Agreement

NASA Astrophysics Data System (ADS)

Sigmond, Michael; Fyfe, John C.; Swart, Neil C.

2018-05-01

Under the Paris Agreement, emissions scenarios are pursued that would stabilize the global mean temperature at 1.5-2.0 °C above pre-industrial levels, but current emission reduction policies are expected to limit warming by 2100 to approximately 3.0 °C. Whether such emissions scenarios would prevent a summer sea-ice-free Arctic is unknown. Here we employ stabilized warming simulations with an Earth System Model to obtain sea-ice projections under stabilized global warming, and correct biases in mean sea-ice coverage by constraining with observations. Although there is some sensitivity to details in the constraining method, the observationally constrained projections suggest that the benefits of going from 2.0 °C to 1.5 °C stabilized warming are substantial; an eightfold decrease in the frequency of ice-free conditions is expected, from once in every five to once in every forty years. Under 3.0 °C global mean warming, however, permanent summer ice-free conditions are likely, which emphasizes the need for nations to increase their commitments to the Paris Agreement.

Patient-physician agreement on tobacco and alcohol consumption: a multilevel analysis of GPs' characteristics.

PubMed

Thebault, Jean-Laurent; Falcoff, Hector; Favre, Madeleine; Noël, Frédérique; Rigal, Laurent

2015-03-18

Data about tobacco and alcohol consumption are essential in many types of studies. These data can be obtained by directly questioning patients or by using the information collected from physicians. Agreement between these two sources varies according to the characteristics of patients but probably also those of physicians. The purpose of this study was to analyze the characteristics of general practitioners (GPs) associated with agreement between them and their patients about the patients' consumption of alcohol and tobacco. Data came from an observational survey among GPs who were internship supervisors in the Paris metropolitan area. Fifty-two volunteer GPs completed a self-administered questionnaire about the organization of their practice and their training. For each GP, a random sample of 70 patients, aged 40 to 74 years, answered questions about their personal tobacco and alcohol consumption. GPs simultaneously answered similar questions about each patient. We used a mixed logistic model to assess the association between physicians' characteristics and agreement for patients' smoking status and alcohol consumption. Data were collected from both patient and physician for 2599 patients. The agreement between patients and their physicians was 60.4% for smoking status and 48.7% for alcohol consumption. Physicians with continuing medical education in management of smokers and those reporting specific skill in managing hypertension had the best agreement for smoking. Physicians who taught courses at the university medical school and those reporting specific skill in managing alcoholism had the best agreement for alcohol consumption. Agreement increases with physicians' training and skills in management of patients with tobacco and alcohol problems. It supports the importance of professional training for improving the quality of epidemiologic data in general practice. Researchers who use GPs as a source of information about patients' tobacco and alcohol consumption

48 CFR 25.403 - World Trade Organization Government Procurement Agreement and Free Trade Agreements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false World Trade Organization Government Procurement Agreement and Free Trade Agreements. 25.403 Section 25.403 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION SOCIOECONOMIC PROGRAMS FOREIGN ACQUISITION Trade Agreements 25.403 World Trade Organization...

48 CFR 25.403 - World Trade Organization Government Procurement Agreement and Free Trade Agreements.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 1 2012-10-01 2012-10-01 false World Trade Organization Government Procurement Agreement and Free Trade Agreements. 25.403 Section 25.403 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION SOCIOECONOMIC PROGRAMS FOREIGN ACQUISITION Trade Agreements 25.403 World Trade Organization...

48 CFR 25.403 - World Trade Organization Government Procurement Agreement and Free Trade Agreements.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 1 2011-10-01 2011-10-01 false World Trade Organization Government Procurement Agreement and Free Trade Agreements. 25.403 Section 25.403 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION SOCIOECONOMIC PROGRAMS FOREIGN ACQUISITION Trade Agreements 25.403 World Trade Organization...

48 CFR 25.403 - World Trade Organization Government Procurement Agreement and Free Trade Agreements.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 1 2014-10-01 2014-10-01 false World Trade Organization Government Procurement Agreement and Free Trade Agreements. 25.403 Section 25.403 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION SOCIOECONOMIC PROGRAMS FOREIGN ACQUISITION Trade Agreements 25.403 World Trade Organization...

48 CFR 25.403 - World Trade Organization Government Procurement Agreement and Free Trade Agreements.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 1 2013-10-01 2013-10-01 false World Trade Organization Government Procurement Agreement and Free Trade Agreements. 25.403 Section 25.403 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION SOCIOECONOMIC PROGRAMS FOREIGN ACQUISITION Trade Agreements 25.403 World Trade Organization...

Self-other agreement in personality traits and profiles across cultures: A multirater, multiscale study in Blacks and Whites in South Africa.

PubMed

Fetvadjiev, Velichko H; Meiring, Deon; van de Vijver, Fons J R; Nel, J Alewyn; De Kock, François

2017-12-15

Despite the importance of self-other agreement for the validity of trait models, few studies have assessed cultural differences systematically. We examined self-other agreement in traits and profiles in the more collectivistic Black group and the more individualistic White group in South Africa. Participants were 172 Black and 198 White students, and one relative and one friend of each student. Participants completed a behavior-based and a trait-adjective-based inventory. Aggregated across traits and raters, there were no cultural differences in trait agreement. However, agreement was stronger for social-relational concepts in Blacks and for personal growth concepts in Whites, providing moderate support for the hypothesis of stronger agreement on culturally more salient traits. Trait agreement was stronger in Blacks' relatives and Whites' friends, but there was no such interaction in profile agreement. The differences in profile agreement (higher in Whites than in Blacks) involved normative agreement and were mediated by dialecticism (higher in Blacks) and social desirability (higher in Whites). Results with the two inventories were similar. In the framework of trait consistency research, cultural differences in self-other agreement may be limited compared to differences in perceived trait consistency, although sizable compared to differences in actual behavior consistency. © 2017 Wiley Periodicals, Inc.

Good Agreement Between Transabdominal and Endoscopic Ultrasound of the Pancreas in Chronic Pancreatitis.

PubMed

Engjom, Trond; Pham, Khahn Do-Chong; Erchinger, Friedemann; Haldorsen, Ingfrid Salvesen; Gilja, Odd Helge; Dimcevski, Georg; Havre, Roald Flesland

2018-03-26

 We aimed to evaluate the agreement of single criteria and dedicated scores from transabdominal ultrasound of the pancreas (US) compared to standards by endoscopic ultrasound (EUS) and computed tomography (CT).  In this observational cohort study performed in a tertiary care center, US and EUS were performed in 110 patients referred for suspected CP. Based on the Mayo score, 52 patients were diagnosed with CP. The sonographic findings obtained by both methods were registered. The number of criteria was counted and scored according to the Rosemont score.  Agreement between the number of detected US and EUS criteria was substantial (ICC = 0.74 [0.61 - 0.83]. Adding Rosemont weighting improved the agreement (ICC = 0.88 [0.81 - 0.92]). Regarding individual criteria, the agreement was substantial for the detection of calcifications (κ = 0.86) and moderate for cysts and irregular or dilated pancreatic duct (κ = 0.42 - 0.58). Agreement for the other criteria was poorer (κ≤ 0.40). The diagnostic performance indices [95 % CI] of US for diagnosing CP (using Mayo score as reference standard) were for the unweighted score: Sensitivity: 0.65 [0.51 - 0.78], specificity: 0.97 [0.87 - 1.00]; and for Rosemont score: Sensitivity: 0.75 [0.61 - 0.86], specificity: 0.95 [0.83 - 0.99].  The agreement between US and EUS for the unweighted and weighted scores was substantial. For the features calcifications, cysts and main pancreatic duct (MPD) changes, agreement was moderate to substantial. For the other detected US criteria, the agreement with EUS was too poor to be clinically relevant. © Georg Thieme Verlag KG Stuttgart · New York.

2 CFR 182.620 - Cooperative agreement.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 2 Grants and Agreements 1 2013-01-01 2013-01-01 false Cooperative agreement. 182.620 Section 182.620 Grants and Agreements Office of Management and Budget Guidance for Grants and Agreements OFFICE OF MANAGEMENT AND BUDGET GOVERNMENTWIDE GUIDANCE FOR GRANTS AND AGREEMENTS NATIONAL POLICY REQUIREMENTS...

24 CFR 582.315 - Occupancy agreements.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 24 Housing and Urban Development 3 2014-04-01 2013-04-01 true Occupancy agreements. 582.315... agreements. (a) Initial occupancy agreement. Participants must enter into an occupancy agreement for a term of at least one month. The occupancy agreement must be automatically renewable upon expiration...

Statistical methods used to test for agreement of medical instruments measuring continuous variables in method comparison studies: a systematic review.

PubMed

Zaki, Rafdzah; Bulgiba, Awang; Ismail, Roshidi; Ismail, Noor Azina

2012-01-01

Accurate values are a must in medicine. An important parameter in determining the quality of a medical instrument is agreement with a gold standard. Various statistical methods have been used to test for agreement. Some of these methods have been shown to be inappropriate. This can result in misleading conclusions about the validity of an instrument. The Bland-Altman method is the most popular method judging by the many citations of the article proposing this method. However, the number of citations does not necessarily mean that this method has been applied in agreement research. No previous study has been conducted to look into this. This is the first systematic review to identify statistical methods used to test for agreement of medical instruments. The proportion of various statistical methods found in this review will also reflect the proportion of medical instruments that have been validated using those particular methods in current clinical practice. Five electronic databases were searched between 2007 and 2009 to look for agreement studies. A total of 3,260 titles were initially identified. Only 412 titles were potentially related, and finally 210 fitted the inclusion criteria. The Bland-Altman method is the most popular method with 178 (85%) studies having used this method, followed by the correlation coefficient (27%) and means comparison (18%). Some of the inappropriate methods highlighted by Altman and Bland since the 1980s are still in use. This study finds that the Bland-Altman method is the most popular method used in agreement research. There are still inappropriate applications of statistical methods in some studies. It is important for a clinician or medical researcher to be aware of this issue because misleading conclusions from inappropriate analyses will jeopardize the quality of the evidence, which in turn will influence quality of care given to patients in the future.

Statistical Methods Used to Test for Agreement of Medical Instruments Measuring Continuous Variables in Method Comparison Studies: A Systematic Review

PubMed Central

Zaki, Rafdzah; Bulgiba, Awang; Ismail, Roshidi; Ismail, Noor Azina

2012-01-01

Background Accurate values are a must in medicine. An important parameter in determining the quality of a medical instrument is agreement with a gold standard. Various statistical methods have been used to test for agreement. Some of these methods have been shown to be inappropriate. This can result in misleading conclusions about the validity of an instrument. The Bland-Altman method is the most popular method judging by the many citations of the article proposing this method. However, the number of citations does not necessarily mean that this method has been applied in agreement research. No previous study has been conducted to look into this. This is the first systematic review to identify statistical methods used to test for agreement of medical instruments. The proportion of various statistical methods found in this review will also reflect the proportion of medical instruments that have been validated using those particular methods in current clinical practice. Methodology/Findings Five electronic databases were searched between 2007 and 2009 to look for agreement studies. A total of 3,260 titles were initially identified. Only 412 titles were potentially related, and finally 210 fitted the inclusion criteria. The Bland-Altman method is the most popular method with 178 (85%) studies having used this method, followed by the correlation coefficient (27%) and means comparison (18%). Some of the inappropriate methods highlighted by Altman and Bland since the 1980s are still in use. Conclusions This study finds that the Bland-Altman method is the most popular method used in agreement research. There are still inappropriate applications of statistical methods in some studies. It is important for a clinician or medical researcher to be aware of this issue because misleading conclusions from inappropriate analyses will jeopardize the quality of the evidence, which in turn will influence quality of care given to patients in the future. PMID:22662248

Parent-teacher agreement on children's problems in 21 societies.

PubMed

Rescorla, Leslie A; Bochicchio, Lauren; Achenbach, Thomas M; Ivanova, Masha Y; Almqvist, Fredrik; Begovac, Ivan; Bilenberg, Niels; Bird, Hector; Dobrean, Anca; Erol, Nese; Fombonne, Eric; Fonseca, Antonio; Frigerio, Alessandra; Fung, Daniel S S; Lambert, Michael C; Leung, Patrick W L; Liu, Xianchen; Marković, Ivica; Markovic, Jasminka; Minaei, Asghar; Ooi, Yoon Phaik; Roussos, Alexandra; Rudan, Vlasta; Simsek, Zeynep; van der Ende, Jan; Weintraub, Sheila; Wolanczyk, Tomasz; Woo, Bernardine; Weiss, Bahr; Weisz, John; Zukauskiene, Rita; Verhulst, Frank C

2014-01-01

Parent-teacher cross-informant agreement, although usually modest, may provide important clinical information. Using data for 27,962 children from 21 societies, we asked the following: (a) Do parents report more problems than teachers, and does this vary by society, age, gender, or type of problem? (b) Does parent-teacher agreement vary across different problem scales or across societies? (c) How well do parents and teachers in different societies agree on problem item ratings? (d) How much do parent-teacher dyads in different societies vary in within-dyad agreement on problem items? (e) How well do parents and teachers in 21 societies agree on whether the child's problem level exceeds a deviance threshold? We used five methods to test agreement for Child Behavior Checklist (CBCL) and Teacher's Report Form (TRF) ratings. CBCL scores were higher than TRF scores on most scales, but the informant differences varied in magnitude across the societies studied. Cross-informant correlations for problem scale scores varied moderately across societies studied and were significantly higher for Externalizing than Internalizing problems. Parents and teachers tended to rate the same items as low, medium, or high, but within-dyad item agreement varied widely in every society studied. In all societies studied, both parental noncorroboration of teacher-reported deviance and teacher noncorroboration of parent-reported deviance were common. Our findings underscore the importance of obtaining information from parents and teachers when evaluating and treating children, highlight the need to use multiple methods of quantifying cross-informant agreement, and provide comprehensive baselines for patterns of parent-teacher agreement across 21 societies.

[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.

31 CFR 540.305 - HEU Agreements.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 31 Money and Finance:Treasury 3 2013-07-01 2013-07-01 false HEU Agreements. 540.305 Section 540... FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY HIGHLY ENRICHED URANIUM (HEU) AGREEMENT ASSETS CONTROL REGULATIONS General Definitions § 540.305 HEU Agreements. The term HEU Agreements means the Agreement Between...

31 CFR 540.305 - HEU Agreements.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false HEU Agreements. 540.305 Section 540... FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY HIGHLY ENRICHED URANIUM (HEU) AGREEMENT ASSETS CONTROL REGULATIONS General Definitions § 540.305 HEU Agreements. The term HEU Agreements means the Agreement Between...

Assessing Two-Year-Olds' Knowledge of Number Agreement Morphology

ERIC Educational Resources Information Center

Blossom, Megan

2013-01-01

Previous research in the area of children's knowledge of number agreement morphology has yielded mixed results. Some researchers have found evidence for sensitivity to agreement morphology at as early as 16 months, while others report that children do not comprehend number agreement morphology until as late as five or six years old. Studies of…

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

46 CFR 535.404 - Agreement provisions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 9 2013-10-01 2013-10-01 false Agreement provisions. 535.404 Section 535.404 Shipping... AND MARINE TERMINAL OPERATOR AGREEMENTS SUBJECT TO THE SHIPPING ACT OF 1984 Filing of Agreements § 535.404 Agreement provisions. Generally, each agreement should: (a) Indicate the full legal name of each...

48 CFR 1642.7001 - Management agreement.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 6 2013-10-01 2013-10-01 false Management agreement. 1642... Agreement (in Lieu of Novation Agreement) 1642.7001 Management agreement. When it is in the best interest of... operations and has entered into a Purchase and Sale Agreement (or other descriptive term), but before a...

46 CFR 535.201 - Subject agreements.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 9 2013-10-01 2013-10-01 false Subject agreements. 535.201 Section 535.201 Shipping... AND MARINE TERMINAL OPERATOR AGREEMENTS SUBJECT TO THE SHIPPING ACT OF 1984 Scope § 535.201 Subject agreements. (a) Ocean common carrier agreements. This part applies to agreements by or among ocean common...

8 CFR 217.6 - Carrier agreements.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 8 Aliens and Nationality 1 2013-01-01 2013-01-01 false Carrier agreements. 217.6 Section 217.6....6 Carrier agreements. (a) General. The carrier agreements referred to in section 217(e) of the Act... Waiver Pilot Program Agreement. (b) Termination of agreements. The Commissioner, on behalf of the...

8 CFR 217.6 - Carrier agreements.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 8 Aliens and Nationality 1 2012-01-01 2012-01-01 false Carrier agreements. 217.6 Section 217.6....6 Carrier agreements. (a) General. The carrier agreements referred to in section 217(e) of the Act... Waiver Pilot Program Agreement. (b) Termination of agreements. The Commissioner, on behalf of the...

Breast lesion shape and margin evaluation: BI-RADS based metrics understate radiologists' actual levels of agreement.

PubMed

Rawashdeh, Mohammad; Lewis, Sarah; Zaitoun, Maha; Brennan, Patrick

2018-05-01

While there is much literature describing the radiologic detection of breast cancer, there are limited data available on the agreement between experts when delineating and classifying breast lesions. The aim of this work is to measure the level of agreement between expert radiologists when delineating and classifying breast lesions as demonstrated through Breast Imaging Reporting and Data System (BI-RADS) and quantitative shape metrics. Forty mammographic images, each containing a single lesion, were presented to nine expert breast radiologists using a high specification interactive digital drawing tablet with stylus. Each reader was asked to manually delineate the breast masses using the tablet and stylus and then visually classify the lesion according to the American College of Radiology (ACR) BI-RADS lexicon. The delineated lesion compactness and elongation were computed using Matlab software. Intraclass Correlation Coefficient (ICC) and Cohen's kappa were used to assess inter-observer agreement for delineation and classification outcomes, respectively. Inter-observer agreement was fair for BI-RADS shape (kappa = 0.37) and moderate for margin (kappa = 0.58) assessments. Agreement for quantitative shape metrics was good for lesion elongation (ICC = 0.82) and excellent for compactness (ICC = 0.93). Fair to moderate levels of agreement was shown by radiologists for shape and margin classifications of cancers using the BI-RADS lexicon. When quantitative shape metrics were used to evaluate radiologists' delineation of lesions, good to excellent inter-observer agreement was found. The results suggest that qualitative descriptors such as BI-RADS lesion shape and margin understate the actual level of expert radiologist agreement. Copyright © 2018 Elsevier Ltd. All rights reserved.

49 CFR 1325.2 - Credit agreements.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 49 Transportation 9 2012-10-01 2012-10-01 false Credit agreements. 1325.2 Section 1325.2... FEDERAL OFFICE OR THEIR REPRESENTATIVES § 1325.2 Credit agreements. (a) All agreements to extend credit to... parties to the agreement. A copy of each such agreement must be filed with this Board's Bureau of...

22 CFR 33.5 - Guaranty agreements.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 22 Foreign Relations 1 2013-04-01 2013-04-01 false Guaranty agreements. 33.5 Section 33.5 Foreign... UNDER SECTION 7 § 33.5 Guaranty agreements. (a) Period in effect. Agreements are effective for a Fiscal... September 30. (b) Guaranty agreement transfer. A guaranty agreement may, with the Secretary's prior consent...

49 CFR 1325.2 - Credit agreements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 9 2010-10-01 2010-10-01 false Credit agreements. 1325.2 Section 1325.2... FEDERAL OFFICE OR THEIR REPRESENTATIVES § 1325.2 Credit agreements. (a) All agreements to extend credit to... parties to the agreement. A copy of each such agreement must be filed with this Board's Bureau of...

22 CFR 33.5 - Guaranty agreements.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 22 Foreign Relations 1 2014-04-01 2014-04-01 false Guaranty agreements. 33.5 Section 33.5 Foreign... UNDER SECTION 7 § 33.5 Guaranty agreements. (a) Period in effect. Agreements are effective for a Fiscal... September 30. (b) Guaranty agreement transfer. A guaranty agreement may, with the Secretary's prior consent...

29 CFR 1908.10 - Cooperative Agreements.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 29 Labor 5 2012-07-01 2012-07-01 false Cooperative Agreements. 1908.10 Section 1908.10 Labor... CONSULTATION AGREEMENTS § 1908.10 Cooperative Agreements. (a) Who may make Agreements. The Assistant Secretary may make a Cooperative Agreement under this part with the Governor of a State or with any State agency...

22 CFR 33.5 - Guaranty agreements.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Guaranty agreements. 33.5 Section 33.5 Foreign... UNDER SECTION 7 § 33.5 Guaranty agreements. (a) Period in effect. Agreements are effective for a Fiscal... September 30. (b) Guaranty agreement transfer. A guaranty agreement may, with the Secretary's prior consent...

29 CFR 1908.10 - Cooperative Agreements.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 5 2010-07-01 2010-07-01 false Cooperative Agreements. 1908.10 Section 1908.10 Labor... CONSULTATION AGREEMENTS § 1908.10 Cooperative Agreements. (a) Who may make Agreements. The Assistant Secretary may make a Cooperative Agreement under this part with the Governor of a State or with any State agency...

29 CFR 1908.10 - Cooperative Agreements.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 29 Labor 5 2014-07-01 2014-07-01 false Cooperative Agreements. 1908.10 Section 1908.10 Labor... CONSULTATION AGREEMENTS § 1908.10 Cooperative Agreements. (a) Who may make Agreements. The Assistant Secretary may make a Cooperative Agreement under this part with the Governor of a State or with any State agency...

Assessing Agreement between Multiple Raters with Missing Rating Information, Applied to Breast Cancer Tumour Grading

PubMed Central

Ellis, Ian O.; Green, Andrew R.; Hanka, Rudolf

2008-01-01

Background We consider the problem of assessing inter-rater agreement when there are missing data and a large number of raters. Previous studies have shown only ‘moderate’ agreement between pathologists in grading breast cancer tumour specimens. We analyse a large but incomplete data-set consisting of 24177 grades, on a discrete 1–3 scale, provided by 732 pathologists for 52 samples. Methodology/Principal Findings We review existing methods for analysing inter-rater agreement for multiple raters and demonstrate two further methods. Firstly, we examine a simple non-chance-corrected agreement score based on the observed proportion of agreements with the consensus for each sample, which makes no allowance for missing data. Secondly, treating grades as lying on a continuous scale representing tumour severity, we use a Bayesian latent trait method to model cumulative probabilities of assigning grade values as functions of the severity and clarity of the tumour and of rater-specific parameters representing boundaries between grades 1–2 and 2–3. We simulate from the fitted model to estimate, for each rater, the probability of agreement with the majority. Both methods suggest that there are differences between raters in terms of rating behaviour, most often caused by consistent over- or under-estimation of the grade boundaries, and also considerable variability in the distribution of grades assigned to many individual samples. The Bayesian model addresses the tendency of the agreement score to be biased upwards for raters who, by chance, see a relatively ‘easy’ set of samples. Conclusions/Significance Latent trait models can be adapted to provide novel information about the nature of inter-rater agreement when the number of raters is large and there are missing data. In this large study there is substantial variability between pathologists and uncertainty in the identity of the ‘true’ grade of many of the breast cancer tumours, a fact often ignored in

48 CFR 242.1204 - Agreement to recognize a successor in interest (novation agreement).

Code of Federal Regulations, 2011 CFR

2011-10-01

... DEFENSE ACQUISITION REGULATIONS SYSTEM, DEPARTMENT OF DEFENSE CONTRACT MANAGEMENT CONTRACT ADMINISTRATION AND AUDIT SERVICES Novation and Change-of-Name Agreements 242.1204 Agreement to recognize a successor...

Self-Other Agreement as an Alternative Perspective of School Leadership Analysis: An Exploratory Study

ERIC Educational Resources Information Center

Devos, Geert; Hulpia, Hester; Tuytens, Melissa; Sinnaeve, Ilse

2013-01-01

This study explores the relationship between self-awareness of school leaders and variables related to school culture and change. We used the self-other rating agreement model of Atwater and Yammarino (1997) as an indication of school leader self-awareness. Based on the difference between their own leadership rating and the teachers' rating,…

'Ease of interpretation' of cytological smears stained with modified ultrafast papanicolaou stain: Interobserver agreement and reproducibility.

PubMed

Uthamalingam, Preithy; Sathish Kumar, Thabasum; Venus, Albina; Sekar, Preethi; Muthusamy, Rajeshwari K; Mehta, Sangita

2018-04-01

Since its inception in 1995, the Ultrafast Papanicoloau (UFPAP) cytological stain has undergone a number of modifications to suit the local availability of reagents and cost in different set ups. However, the reported results have been uniformly encouraging. We designed a study to investigate the inter-observer agreement in 'perceived ease of interpretation' of cytological smears stained with Modified Ultrafast Papanicoloau stain (MUFPAP). After a small pilot study, we prospectively stained air-dried fine needle aspirate smears (FNACs) and Body Fluid smears with the standardized MUFPAP stain. The MUFPAP stained slides were evaluated in tandem with other routine cytological stains as well as independently by two pathologists. Two rater kappa was used to determine the agreement. The study included 93 fluids and 34 FNACs. A vast majority of the cases stained with MUFPAP were rated 'better' than the routine stains in terms of 'overall ease of interpretation' with considerable agreement. The agreement tended to be better for FNACs than fluid specimens. Cases with malignant pathology demonstrated a perfect agreement (kappa = 1) between the raters in terms of 'overall ease of interpretation' (91.7% cases were rated 'very good' by each pathologist) when compared to cases with benign pathology (kappa = 0.52). Nuclear characteristics were appreciated with a better agreement than other parameters. Modified UFPAP stain appears to be quick, reliable, cost-effective alternative in cytology, especially for detecting malignant cells in smears with low cellularity. Its specific advantage is robust nuclear staining against a clear background. © 2018 Wiley Periodicals, Inc.

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.

Observational study of contracts processing at 29 CTSA sites.

PubMed

Kiriakis, James; Gaich, Nicholas; Johnston, S Claiborne; Kitterman, Darlene; Rosenblum, Daniel; Salberg, Libby; Rifkind, Adam

2013-08-01

We measured contracts final negotiation (FN) and full execution (FE) times using shared definitions in a prospective observational study of management of contracts for clinical trials at 29 CTSA institutions. Median FN and FE times were reached in 39 and 91 days, respectively; mean times for FN and FE were 55 and 103 days, respectively. Individual site medians ranged from 3 to 116 days for FN and 34 to 197 days for FE. The use of master agreements (MAs) and previously negotiated terms (PNTs) was associated with significant reduction of FN times by a mean of 33 days (p < 0) and 22 days (p < 0.001), respectively. PNTs, but not MAs, were associated with significantly reduced FE time (22 days, p < 0.007). Gap analysis revealed a gap of 22 days between contracts negotiation and Institutional Review Board (IRB) review and intervals of 33 days (contracts) and 48 days (IRB review) during which the process steps were being conducted alone, suggesting a potential benefit with parallel processing. These baseline data support a plan to investigate root causes of prolonged study start-up time by examining causes of variation and outliers. © 2013 Wiley Periodicals, Inc.

Observational Study of Contracts Processing at 29 CTSA Sites

PubMed Central

Kiriakis, James; Gaich, Nicholas; Johnston, S. Claiborne; Kitterman, Darlene; Salberg, Libby; Rifkind, Adam

2013-01-01

Abstract We measured contracts final negotiation (FN) and full execution (FE) times using shared definitions in a prospective observational study of management of contracts for clinical trials at 29 CTSA institutions. Median FN and FE times were reached in 39 and 91 days, respectively; mean times for FN and FE were 55 and 103 days, respectively. Individual site medians ranged from 3 to 116 days for FN and 34 to 197 days for FE. The use of master agreements (MAs) and previously negotiated terms (PNTs) was associated with significant reduction of FN times by a mean of 33 days (p < 0) and 22 days (p < 0.001), respectively. PNTs, but not MAs, were associated with significantly reduced FE time (22 days, p < 0.007). Gap analysis revealed a gap of 22 days between contracts negotiation and Institutional Review Board (IRB) review and intervals of 33 days (contracts) and 48 days (IRB review) during which the process steps were being conducted alone, suggesting a potential benefit with parallel processing. These baseline data support a plan to investigate root causes of prolonged study start‐up time by examining causes of variation and outliers. PMID:23919362

ARSH 4: Parental understanding of adolescent issues: parent-adolescent dyad agreement.

PubMed

Nair, M K C; Thankachi, Yamini; Leena, M L; George, Babu; Russell, Paul Swamidhas Sudhakar

2013-11-01

To elicit areas of discordance between the parent-adolescent dyad with regard to reproductive sexual health issues using the same questions to both and to elicit the gender sensitivity of the parents. This study was conducted using similar questions for both adolescents and young adults and their parents in three districts of Kerala. Data analysis was done comparing unmarried adolescents and young adults' response to reproductive and sexual health issues and the parental agreement status with their ward's responses. There were a total of 3,625 parent-unmarried young adults dyads. Parental attitudinal difference towards their sons and daughters on selected parenting issues was observed. With regard to the following reproductive and sexual health problems, (i) knew about menstruation before menarche (64.1%), (ii) got information on hygiene practices from home (80.8%), (iii) have menstrual problems (66.4%), agreement with adolescent response was high, whereas with regard to (i) anxious about adolescent physical and mental changes (29.2%), (ii) received information on reproductive sexual health (RSH) from mother (26.7%), (iii) do not have any abnormal vaginal discharge (46.7%), (iv) parents taken precautions to prevent sexual abuse (17.5%), (v) have been sexually abused (15.6%), agreement with unmarried young adults' response was low and all these differences were statistically significant. The results of 3,625 parent-unmarried adolescents and young adults dyad data showed poor agreement on vital issues like sexual abuse apart from gender inequality favouring sons.

7 CFR 250.12 - Agreements.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 4 2014-01-01 2014-01-01 false Agreements. 250.12 Section 250.12 Agriculture... TERRITORIES AND POSSESSIONS AND AREAS UNDER ITS JURISDICTION General Operating Provisions § 250.12 Agreements. (a) Agreements with Department. Prior to the beginning of a distribution program, distributing...

7 CFR 250.12 - Agreements.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 4 2010-01-01 2010-01-01 false Agreements. 250.12 Section 250.12 Agriculture... TERRITORIES AND POSSESSIONS AND AREAS UNDER ITS JURISDICTION General Operating Provisions § 250.12 Agreements. (a) Agreements with Department. Prior to the beginning of a distribution program, distributing...

7 CFR 250.12 - Agreements.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 4 2012-01-01 2012-01-01 false Agreements. 250.12 Section 250.12 Agriculture... TERRITORIES AND POSSESSIONS AND AREAS UNDER ITS JURISDICTION General Operating Provisions § 250.12 Agreements. (a) Agreements with Department. Prior to the beginning of a distribution program, distributing...

7 CFR 250.12 - Agreements.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 4 2011-01-01 2011-01-01 false Agreements. 250.12 Section 250.12 Agriculture... TERRITORIES AND POSSESSIONS AND AREAS UNDER ITS JURISDICTION General Operating Provisions § 250.12 Agreements. (a) Agreements with Department. Prior to the beginning of a distribution program, distributing...

7 CFR 250.12 - Agreements.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 4 2013-01-01 2013-01-01 false Agreements. 250.12 Section 250.12 Agriculture... TERRITORIES AND POSSESSIONS AND AREAS UNDER ITS JURISDICTION General Operating Provisions § 250.12 Agreements. (a) Agreements with Department. Prior to the beginning of a distribution program, distributing...

Agreement with Subjects in Lubukusu

ERIC Educational Resources Information Center

Diercks, Michael J. K.

2010-01-01

This dissertation examines three topics in the morphosyntax of Lubukusu (Bantu, Kenya), all of which are concerned with agreement with subjects: locative inversion, complementizer agreement, and alternative agreement effects in subject extraction. Each topic reports novel Lubukusu data which are both typologically interesting and theoretically…

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

Against Structural Constraints in Subject-Verb Agreement Production

ERIC Educational Resources Information Center

Gillespie, Maureen; Pearlmutter, Neal J.

2013-01-01

Syntactic structure has been considered an integral component of agreement computation in language production. In agreement error studies, clause-boundedness (Bock & Cutting, 1992) and hierarchical feature-passing (Franck, Vigliocco, & Nicol, 2002) predict that local nouns within clausal modifiers should produce fewer errors than do those within…

Behavior States Are Real and Observable.

ERIC Educational Resources Information Center

Guess, Doug; Roberts, Sally; Rues, Jane

2000-01-01

This article critiques the research methodology used by Mudford, Hogg, and Roberts (1999) that resulted in a failure to achieve inter-observer agreement on adults with mental retardation when using an experimental, 13-category behavior state code. Arguments are provided on why their videotape study does not meet requirements of acceptable…

Mining Agreements with Indian Tribes

ERIC Educational Resources Information Center

Luebben, Tom

1976-01-01

The article discusses aspects of negotiating agreements for exploration, development, and mining of hard minerals on Indian Reservations. The agreements discussed are typical of copper agreements, but the general points under discussion are applicable to most hard minerals except for uranium, coal, and oil which are substantially different.…

7 CFR 1721.107 - Agreement.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 11 2012-01-01 2012-01-01 false Agreement. 1721.107 Section 1721.107 Agriculture... Interest § 1721.107 Agreement. After approval of the Borrower's request for a deferment of principal and interest, an extension agreement, containing the terms of the extension, together with associated materials...

7 CFR 1599.5 - Agreements.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 10 2010-01-01 2010-01-01 false Agreements. 1599.5 Section 1599.5 Agriculture... AGRICULTURE McGOVERN-DOLE INTERNATIONAL FOOD FOR EDUCATION AND CHILD NUTRITION PROGRAM § 1599.5 Agreements. (a) After FAS approves an applicant's proposal, FAS will develop an agreement in consultation with the...

7 CFR 1599.5 - Agreements.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 10 2012-01-01 2012-01-01 false Agreements. 1599.5 Section 1599.5 Agriculture... AGRICULTURE McGOVERN-DOLE INTERNATIONAL FOOD FOR EDUCATION AND CHILD NUTRITION PROGRAM § 1599.5 Agreements. (a) After FAS approves an applicant's proposal, FAS will develop an agreement in consultation with the...

7 CFR 1499.5 - Agreements.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 10 2011-01-01 2011-01-01 false Agreements. 1499.5 Section 1499.5 Agriculture... AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS FOOD FOR PROGRESS PROGRAM § 1499.5 Agreements. (a) After FAS approves an applicant's proposal, FAS will develop an agreement in consultation with the applicant...

14 CFR 437.35 - Agreements.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 14 Aeronautics and Space 4 2013-01-01 2013-01-01 false Agreements. 437.35 Section 437.35 Aeronautics and Space COMMERCIAL SPACE TRANSPORTATION, FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF... Documentation § 437.35 Agreements. An applicant must enter into the agreements required by § 437.63, and provide...

7 CFR 1599.5 - Agreements.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 10 2014-01-01 2014-01-01 false Agreements. 1599.5 Section 1599.5 Agriculture... AGRICULTURE McGOVERN-DOLE INTERNATIONAL FOOD FOR EDUCATION AND CHILD NUTRITION PROGRAM § 1599.5 Agreements. (a) After FAS approves an applicant's proposal, FAS will develop an agreement in consultation with the...

7 CFR 1599.5 - Agreements.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 10 2011-01-01 2011-01-01 false Agreements. 1599.5 Section 1599.5 Agriculture... AGRICULTURE McGOVERN-DOLE INTERNATIONAL FOOD FOR EDUCATION AND CHILD NUTRITION PROGRAM § 1599.5 Agreements. (a) After FAS approves an applicant's proposal, FAS will develop an agreement in consultation with the...

7 CFR 1721.107 - Agreement.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 11 2011-01-01 2011-01-01 false Agreement. 1721.107 Section 1721.107 Agriculture... Interest § 1721.107 Agreement. After approval of the Borrower's request for a deferment of principal and interest, an extension agreement, containing the terms of the extension, together with associated materials...

7 CFR 1721.107 - Agreement.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 11 2014-01-01 2014-01-01 false Agreement. 1721.107 Section 1721.107 Agriculture... Interest § 1721.107 Agreement. After approval of the Borrower's request for a deferment of principal and interest, an extension agreement, containing the terms of the extension, together with associated materials...

7 CFR 1721.107 - Agreement.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 11 2013-01-01 2013-01-01 false Agreement. 1721.107 Section 1721.107 Agriculture... Interest § 1721.107 Agreement. After approval of the Borrower's request for a deferment of principal and interest, an extension agreement, containing the terms of the extension, together with associated materials...

7 CFR 1599.5 - Agreements.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 10 2013-01-01 2013-01-01 false Agreements. 1599.5 Section 1599.5 Agriculture... AGRICULTURE McGOVERN-DOLE INTERNATIONAL FOOD FOR EDUCATION AND CHILD NUTRITION PROGRAM § 1599.5 Agreements. (a) After FAS approves an applicant's proposal, FAS will develop an agreement in consultation with the...

14 CFR 437.35 - Agreements.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 4 2011-01-01 2011-01-01 false Agreements. 437.35 Section 437.35 Aeronautics and Space COMMERCIAL SPACE TRANSPORTATION, FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF... Documentation § 437.35 Agreements. An applicant must enter into the agreements required by § 437.63, and provide...

14 CFR 437.35 - Agreements.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 14 Aeronautics and Space 4 2012-01-01 2012-01-01 false Agreements. 437.35 Section 437.35 Aeronautics and Space COMMERCIAL SPACE TRANSPORTATION, FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF... Documentation § 437.35 Agreements. An applicant must enter into the agreements required by § 437.63, and provide...

14 CFR 437.35 - Agreements.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 4 2014-01-01 2014-01-01 false Agreements. 437.35 Section 437.35 Aeronautics and Space COMMERCIAL SPACE TRANSPORTATION, FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF... Documentation § 437.35 Agreements. An applicant must enter into the agreements required by § 437.63, and provide...

14 CFR 437.35 - Agreements.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 4 2010-01-01 2010-01-01 false Agreements. 437.35 Section 437.35 Aeronautics and Space COMMERCIAL SPACE TRANSPORTATION, FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF... Documentation § 437.35 Agreements. An applicant must enter into the agreements required by § 437.63, and provide...

7 CFR 1499.5 - Agreements.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 10 2010-01-01 2010-01-01 false Agreements. 1499.5 Section 1499.5 Agriculture... AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS FOOD FOR PROGRESS PROGRAM § 1499.5 Agreements. (a) After FAS approves an applicant's proposal, FAS will develop an agreement in consultation with the applicant...

7 CFR 1721.107 - Agreement.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 11 2010-01-01 2010-01-01 false Agreement. 1721.107 Section 1721.107 Agriculture... Interest § 1721.107 Agreement. After approval of the Borrower's request for a deferment of principal and interest, an extension agreement, containing the terms of the extension, together with associated materials...

If parents establish a no-smoking agreement with their offspring, does this prevent adolescents from smoking? Findings from three Dutch studies.

PubMed

den Exter Blokland, Endy A W; Engels, Rutger C; Harakeh, Zeena; Hale, William W; Meeus, Wim

2009-08-01

Data from three studies were used to investigate whether the establishment of a no-smoking agreement is related to lower odds of adolescent smoking. The prevalence of a no-smoking agreement was first explored by using a national sample involving 4,501 Dutch adolescents. Second, data from a longitudinal study among 595 early adolescents and their parents were used to test whether establishing a no-smoking agreement prevents adolescents from smoking. Third, the authors tested among 856 early- and mid-adolescents and their parents, whether in addition to the establishment of a no-smoking agreement, the frequency and quality of communication on smoking issues had an effect on adolescent smoking. The findings do not support that establishing a no-smoking agreement is an effective deterrent with regard to adolescent smoking. Parents who want to prevent smoking might consider focusing their efforts on establishing a good quality of communication on smoking issues whereas parents who just talk a lot about smoking issues without considering the quality of their communication might do more harm than good.

2 CFR 182.620 - Cooperative agreement.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 2 Grants and Agreements 1 2010-01-01 2010-01-01 false Cooperative agreement. 182.620 Section 182.620 Grants and Agreements OFFICE OF MANAGEMENT AND BUDGET GOVERNMENTWIDE GUIDANCE FOR GRANTS AND AGREEMENTS Reserved GOVERNMENTWIDE REQUIREMENTS FOR DRUG-FREE WORKPLACE (FINANCIAL ASSISTANCE) Definitions...

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.

7 CFR 900.109 - Mediation agreement.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 8 2012-01-01 2012-01-01 false Mediation agreement. 900.109 Section 900.109... Agreements and Orders; Fruits, Vegetables, Nuts), DEPARTMENT OF AGRICULTURE GENERAL REGULATIONS Procedure... Mediation agreement. An agreement arrived at by mediation shall not become effective until approved by the...

48 CFR 41.206 - Interagency agreements.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 1 2011-10-01 2011-10-01 false Interagency agreements. 41... agreements. Agencies shall use interagency agreements (e.g., consolidated purchase, joint use, or cross-service agreements) when acquiring utility service or facilities from other Government agencies and shall...

40 CFR 36.620 - Cooperative agreement.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 1 2010-07-01 2010-07-01 false Cooperative agreement. 36.620 Section... agreement. Cooperative agreement means an award of financial assistance that, consistent with 31 U.S.C. 6305... development agreements as defined in 15 U.S.C. 3710a. ...

24 CFR 21.620 - Cooperative agreement.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 24 Housing and Urban Development 1 2011-04-01 2011-04-01 false Cooperative agreement. 21.620... agreement. Cooperative agreement means an award of financial assistance that, consistent with 31 U.S.C. 6305... development agreements as defined in 15 U.S.C. 3710a. ...

48 CFR 41.206 - Interagency agreements.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 1 2014-10-01 2014-10-01 false Interagency agreements. 41... agreements. Agencies shall use interagency agreements (e.g., consolidated purchase, joint use, or cross-service agreements) when acquiring utility service or facilities from other Government agencies and shall...

38 CFR 48.620 - Cooperative agreement.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false Cooperative agreement. 48... agreement. Cooperative agreement means an award of financial assistance that, consistent with 31 U.S.C. 6305... development agreements as defined in 15 U.S.C. 3710a. ...

48 CFR 41.206 - Interagency agreements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Interagency agreements. 41... agreements. Agencies shall use interagency agreements (e.g., consolidated purchase, joint use, or cross-service agreements) when acquiring utility service or facilities from other Government agencies and shall...

7 CFR 900.109 - Mediation agreement.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 8 2010-01-01 2010-01-01 false Mediation agreement. 900.109 Section 900.109... Agreements and Orders; Fruits, Vegetables, Nuts), DEPARTMENT OF AGRICULTURE GENERAL REGULATIONS Procedure... Mediation agreement. An agreement arrived at by mediation shall not become effective until approved by the...

48 CFR 842.1203 - Processing agreements.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 5 2013-10-01 2013-10-01 false Processing agreements. 842... MANAGEMENT CONTRACT ADMINISTRATION AND AUDIT SERVICES Novation and Change-of-Name Agreements 842.1203 Processing agreements. Before execution of novation and change-of-name agreements, contracting officers must...

48 CFR 842.1203 - Processing agreements.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 5 2014-10-01 2014-10-01 false Processing agreements. 842... MANAGEMENT CONTRACT ADMINISTRATION AND AUDIT SERVICES Novation and Change-of-Name Agreements 842.1203 Processing agreements. Before execution of novation and change-of-name agreements, contracting officers must...

7 CFR 947.111 - Marketing agreement.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 8 2013-01-01 2013-01-01 false Marketing agreement. 947.111 Section 947.111 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (MARKETING... Definitions § 947.111 Marketing agreement. Marketing agreement means Marketing Agreement No. 114, as amended. ...

7 CFR 947.111 - Marketing agreement.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 8 2010-01-01 2010-01-01 false Marketing agreement. 947.111 Section 947.111 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing... Definitions § 947.111 Marketing agreement. Marketing agreement means Marketing Agreement No. 114, as amended. ...

7 CFR 947.111 - Marketing agreement.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 8 2011-01-01 2011-01-01 false Marketing agreement. 947.111 Section 947.111 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing... Definitions § 947.111 Marketing agreement. Marketing agreement means Marketing Agreement No. 114, as amended. ...

7 CFR 947.111 - Marketing agreement.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 8 2014-01-01 2014-01-01 false Marketing agreement. 947.111 Section 947.111 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (MARKETING... Definitions § 947.111 Marketing agreement. Marketing agreement means Marketing Agreement No. 114, as amended. ...

7 CFR 947.111 - Marketing agreement.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 8 2012-01-01 2012-01-01 false Marketing agreement. 947.111 Section 947.111 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing... Definitions § 947.111 Marketing agreement. Marketing agreement means Marketing Agreement No. 114, as amended. ...

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...

14 CFR 431.75 - Agreements.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 14 Aeronautics and Space 4 2013-01-01 2013-01-01 false Agreements. 431.75 Section 431.75...-Reusable Launch Vehicle Mission License Terms and Conditions § 431.75 Agreements. (a) Launch and reentry site use agreements. Before conducting a licensed RLV mission using property and services of a Federal...

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...

14 CFR 431.75 - Agreements.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 4 2014-01-01 2014-01-01 false Agreements. 431.75 Section 431.75...-Reusable Launch Vehicle Mission License Terms and Conditions § 431.75 Agreements. (a) Launch and reentry site use agreements. Before conducting a licensed RLV mission using property and services of a Federal...

14 CFR 431.75 - Agreements.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 4 2011-01-01 2011-01-01 false Agreements. 431.75 Section 431.75...-Reusable Launch Vehicle Mission License Terms and Conditions § 431.75 Agreements. (a) Launch and reentry site use agreements. Before conducting a licensed RLV mission using property and services of a Federal...

14 CFR 431.75 - Agreements.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 14 Aeronautics and Space 4 2012-01-01 2012-01-01 false Agreements. 431.75 Section 431.75...-Reusable Launch Vehicle Mission License Terms and Conditions § 431.75 Agreements. (a) Launch and reentry site use agreements. Before conducting a licensed RLV mission using property and services of a Federal...

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...

14 CFR 431.75 - Agreements.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 4 2010-01-01 2010-01-01 false Agreements. 431.75 Section 431.75...-Reusable Launch Vehicle Mission License Terms and Conditions § 431.75 Agreements. (a) Launch and reentry site use agreements. Before conducting a licensed RLV mission using property and services of a Federal...

If Parents Establish a No-Smoking Agreement with Their Offspring, Does This Prevent Adolescents from Smoking? Findings from Three Dutch Studies

ERIC Educational Resources Information Center

den Exter Blokland, Endy A. W.; Engels, Rutger C.; Harakeh, Zeena; Hale, William W., III.; Meeus, Wim

2009-01-01

Data from three studies were used to investigate whether the establishment of a no-smoking agreement is related to lower odds of adolescent smoking. The prevalence of a no-smoking agreement was first explored by using a national sample involving 4,501 Dutch adolescents. Second, data from a longitudinal study among 595 early adolescents and their…

Competition for Assistance Agreements

EPA Pesticide Factsheets

It is EPA policy to promote competition in the award of assistance agreements to the maximum extent practicable.When assistance agreements are awarded competitively, it is EPA policy that the competitive process be fair and open & that no applicant receive

36 CFR 1212.620 - Cooperative agreement.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 36 Parks, Forests, and Public Property 3 2010-07-01 2010-07-01 false Cooperative agreement. 1212... § 1212.620 Cooperative agreement. Cooperative agreement means an award of financial assistance that... include cooperative research and development agreements as defined in 15 U.S.C. 3710a. ...

5 CFR 2421.20 - Election agreement.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 3 2011-01-01 2011-01-01 false Election agreement. 2421.20 Section 2421.20 Administrative Personnel FEDERAL LABOR RELATIONS AUTHORITY, GENERAL COUNSEL OF THE FEDERAL LABOR... Election agreement. Election agreement means an agreement under part 2422 of this subchapter signed by all...

21 CFR 1405.620 - Cooperative agreement.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 9 2012-04-01 2012-04-01 false Cooperative agreement. 1405.620 Section 1405.620... WORKPLACE (FINANCIAL ASSISTANCE) Definitions § 1405.620 Cooperative agreement. Cooperative agreement means... contemplated by the award. The term does not include cooperative research and development agreements as defined...

45 CFR 630.620 - Cooperative agreement.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 45 Public Welfare 3 2013-10-01 2013-10-01 false Cooperative agreement. 630.620 Section 630.620... agreement. Cooperative agreement means an award of financial assistance that, consistent with 31 U.S.C. 6305... development agreements as defined in 15 U.S.C. 3710a. ...

36 CFR 1212.620 - Cooperative agreement.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 36 Parks, Forests, and Public Property 3 2012-07-01 2012-07-01 false Cooperative agreement. 1212... § 1212.620 Cooperative agreement. Cooperative agreement means an award of financial assistance that... include cooperative research and development agreements as defined in 15 U.S.C. 3710a. ...

28 CFR 83.620 - Cooperative agreement.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Cooperative agreement. 83.620 Section 83...-FREE WORKPLACE (GRANTS) Definitions § 83.620 Cooperative agreement. Cooperative agreement means an... by the award. The term does not include cooperative research and development agreements as defined in...

7 CFR 1415.17 - Cooperative agreements.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 10 2011-01-01 2011-01-01 false Cooperative agreements. 1415.17 Section 1415.17... Cooperative agreements. (a) NRCS may enter into cooperative agreements which establish terms and conditions... cooperative agreement with those eligible entities selected for funding. Once a proposal is selected by the...

45 CFR 630.620 - Cooperative agreement.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 3 2010-10-01 2010-10-01 false Cooperative agreement. 630.620 Section 630.620... agreement. Cooperative agreement means an award of financial assistance that, consistent with 31 U.S.C. 6305... development agreements as defined in 15 U.S.C. 3710a. ...

7 CFR 1415.11 - Restoration agreements.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 10 2012-01-01 2012-01-01 false Restoration agreements. 1415.11 Section 1415.11... Restoration agreements. (a) Restoration agreements are only authorized to be used in conjunction with... a restoration agreement is needed. Such a determination is also subject to the availability of...

48 CFR 16.702 - Basic agreements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Basic agreements. 16.702... AND CONTRACT TYPES TYPES OF CONTRACTS Agreements 16.702 Basic agreements. (a) Description. A basic agreement is a written instrument of understanding, negotiated between an agency or contracting activity and...

48 CFR 242.1203 - Processing agreements.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 3 2012-10-01 2012-10-01 false Processing agreements. 242...-Name Agreements 242.1203 Processing agreements. The responsible contracting officer shall process and execute novation and change-of-name agreements in accordance with the procedures at PGI 242.1203. [70 FR...

48 CFR 3416.702 - Basic agreements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 7 2010-10-01 2010-10-01 false Basic agreements. 3416.702... CONTRACTING METHODS AND CONTRACT TYPES TYPES OF CONTRACTS Agreements 3416.702 Basic agreements. (a)-(d) [Reserved] (e) Negotiated overhead rates. Basic agreements may include negotiated overhead rates for cost...

5 CFR 2421.20 - Election agreement.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 5 Administrative Personnel 3 2013-01-01 2013-01-01 false Election agreement. 2421.20 Section 2421.20 Administrative Personnel FEDERAL LABOR RELATIONS AUTHORITY, GENERAL COUNSEL OF THE FEDERAL LABOR... Election agreement. Election agreement means an agreement under part 2422 of this subchapter signed by all...

21 CFR 1405.620 - Cooperative agreement.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 9 2011-04-01 2011-04-01 false Cooperative agreement. 1405.620 Section 1405.620... WORKPLACE (FINANCIAL ASSISTANCE) Definitions § 1405.620 Cooperative agreement. Cooperative agreement means... contemplated by the award. The term does not include cooperative research and development agreements as defined...

45 CFR 630.620 - Cooperative agreement.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 45 Public Welfare 3 2011-10-01 2011-10-01 false Cooperative agreement. 630.620 Section 630.620... agreement. Cooperative agreement means an award of financial assistance that, consistent with 31 U.S.C. 6305... development agreements as defined in 15 U.S.C. 3710a. ...

7 CFR 1415.17 - Cooperative agreements.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 10 2012-01-01 2012-01-01 false Cooperative agreements. 1415.17 Section 1415.17... Cooperative agreements. (a) NRCS may enter into cooperative agreements which establish terms and conditions... cooperative agreement with those eligible entities selected for funding. Once a proposal is selected by the...

7 CFR 3021.620 - Cooperative agreement.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 15 2011-01-01 2011-01-01 false Cooperative agreement. 3021.620 Section 3021.620...) Definitions § 3021.620 Cooperative agreement. Cooperative agreement means an award of financial assistance... not include cooperative research and development agreements as defined in 15 U.S.C. 3710a. ...

7 CFR 1415.11 - Restoration agreements.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 10 2011-01-01 2011-01-01 false Restoration agreements. 1415.11 Section 1415.11... Restoration agreements. (a) Restoration agreements are only authorized to be used in conjunction with... a restoration agreement is needed. Such a determination is also subject to the availability of...

48 CFR 16.702 - Basic agreements.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 1 2011-10-01 2011-10-01 false Basic agreements. 16.702... AND CONTRACT TYPES TYPES OF CONTRACTS Agreements 16.702 Basic agreements. (a) Description. A basic agreement is a written instrument of understanding, negotiated between an agency or contracting activity and...

22 CFR 312.620 - Cooperative agreement.