Experienced Graders Research Articles

Multimodal imaging characterization of peripheral drusen.

To provide an integrate multimodal imaging characterization of peripheral drusen in the eyes with and without macular signs of age-related macular degeneration (AMD) and to analyze their association with macular findings. In this retrospective, cross-sectional study, subjects with peripheral drusen were imaged with the Optos (Optos PLC, Dunfermline, Scotland, UK) and Spectralis devices to obtain referenced spectral domain optical coherence tomography (SD-OCT) images. Two experienced graders independently graded the ultra-widefield (UWF) pseudocolor and fundus autofluorescence (FAF) images for the presence of peripheral drusen and analyzed peripheral druse features using OCT. Main outcome measures included quantitative and qualitative assessment of peripheral drusen. Fifty-seven eyes (30 subjects) were included in the analysis. Mean ± SD age was 77.6 ± 9.2years (range 54-97years). On pseudocolor images, graders identified the presence of drusen in all the enrolled eyes (Cohen's kappa was 1.0). On FAF images, Cohen's kappa was 0.71. In the topographical assessment, peripheral drusen were detected in 23 cases in the temporal region, in 40 cases in the nasal region, in 40 cases in the inferior region, and in 42 cases in the superior region. On SD-OCT images, peripheral drusen had a high reflective core in 97.1% of cases, while remaining drusen were characterized by a low reflective core. The macula was affected by early/intermediate AMD in 23 eyes (43.5%) and late AMD in 6 eyes (10.5%). We provided an integrate multimodal imaging assessment of peripheral drusen in the eyes with and without AMD. Peripheral drusen were characterized by distinguished features that may suggest that these lesions constitute a distinct disease, rather than representing an expansion of AMD.

A Proposed Method to Quantify Vitreous Hemorrhage by Ultrasound.

PurposeTo propose a method for quantification of vitreous hemorrhages (VH) termed minimum image gain (MIG). Therefore, to obtain MIG measurements in patients with VH and to compare them to normal controls; to compare results between graders; and to obtain and compare MIG from two different ultrasound systems.MethodsRetrospective and cross-sectional, observational, and comparative study performed in two parts: Part 1) Retrospective comparison of MIG in VH vs controls by two experienced graders, with intra/inter-observer variability: MIG technique is described. MIG is performed retrospectively in two groups, VH patients and normal controls. Groups are compared with independent samples t-test. Intra- and interobserver variability between graders was obtained. Part 2) Cross-sectional analysis of variability from nonexperienced graders and with different ultrasound systems: MIG is performed in cross-sectional measurements of VH patients, by two unexperienced graders, and with two ultrasound systems. Interobserver variability and Bland–Altman plot with levels of agreement (LoA) were obtained.ResultsPart 1: 50 patients with VH resulted in mean MIG: 52.8 dB; 34 controls resulted in mean MIG: 77.97 dB. Independent samples t-test resulted in a statistical significant difference. Intra- and inter-observer variability resulted in an almost perfect agreement between experienced graders. Part 2: 63 patients with VH, mean MIG: 56.19 dB. Inter-observer variability resulted in a very high agreement between unexperienced observers. LoA resulted in a statistical difference between the two ultrasound systems.ConclusionMIG may provide an objective and reproducible way to quantify vitreous hemorrhage density and potentially any vitreous humor opacity. Agreement is high even with unexperienced graders. However, the two ultrasound systems analyzed may not be interchangeable.

National Retail Benchmarking for Pork 2018

ObjectivesThe objective of this study was to quantify pork quality attributes in the retail meat case nationwide. Similar evaluations were conducted in 2012 and 2015. The comparisons of the benchmarking projects show trends in pork products in nationwide retail stores.Materials and MethodsEighty-five stores representing 26 retailers in 15 cities were visited. Subjective color score (1–6) and subjective marbling score (1–10) on center-cut loin chops was assessed by an experienced grader under lighting of the self-serve meat case. Four individual loin chops with at least 50% lean exposed were randomly selected for evaluation from ten retail packages for each brand and enhancement type. Preference was given to boneless, 2.5 cm-thick center-cut loin chops where available. Ten additional packages of chops for each brand and enhancement type were evaluated in-store and purchased. Each of the purchased packages were labeled and each chop within a package was identified for later evaluation. The purchased packages were subsequently placed inside a cooler and transported to a temporary lab station where chops were again subjectively evaluated for color and marbling under controlled lighting and evaluated in the center of the loin muscle for instrumental color (CIE L*, a*, and b* color space values) using a calibrated Minolta Colorimeter and a Hunter Colorimeter. Chops were then vacuum sealed and immediately placed in the freezer. The samples were later packed in a cooler with dry ice and shipped to the University of Florida on dry ice. After arrival, they were placed in frozen storage until thawed for cooking and shearing. Chops were weighed prior to and after cooking on open hearth, adjustable heat grills until reaching 65°C then evaluated for slice shear.Data was analyzed using the mixed procedure in SAS (v. 9.4, SAS Institute, Cary, NC). The model included enhancement type (EN or NON), and the interaction between enhancement type as fixed effects. Package nested within store, brand, and purchased (yes or no) was fit as a random effect.ResultsThe USDA AMS defined “Tender” as having a minimum threshold values for slice shear as 20.0 kg and “Very Tender” at 15.3 kg, respectively. Sixteen percent of the instore evaluated and purchased retail packages were enhanced (247 and 119 retail packages, respectively). Means for instore enhanced (EN) and non-enhanced (NON) chops were 2.52 and 2.70 for subjective color and 2.25 and 2.65 for subjective marbling, respectively. Means for chops purchased for EN and NON chops under controlled lighting were: subjective color (2.07 and 2.25), subjective marbling (1.89 and 2.21), Minolta L* (56.35 and 56.86), Minolta a* (15.48 and 15.61), Hunter L (56.99 and 58.69), Hunter a (13.98 and 15.08), cook loss (13.02 and 15.64%), and slice shear (12.68 and 15.63 kg).ConclusionResults indicate extensive variation for color, marbling, cooking loss and tenderness exists in the pork meat case. Enhancement continues to improve tenderness though less enhanced pork is found in the marketplace. However, regardless of enhancement, the average value for slice shear of center loin chops were quite tender.Table 5.

Qualitative evaluation of neuroretinal rim and retinal nerve fibre layer on optical coherence tomography to detect glaucomatous damage

PurposeTo understand the added value of Bruch’s membrane opening-minimum rim width (BMO-MRW) measurements to conventional circumpapillary retinal nerve fibre layer (cpRNFL) thickness measurements on optical coherence tomography (OCT) imaging for...

Highly Variable Disease Courses in Siblings with Stargardt Disease

To investigate intersibling phenotypic concordance in Stargardt disease (STGD1). Retrospective cohort study. Siblings with genetically confirmed STGD1 and at least 1 available fundus autofluorescence (FAF) image of both eyes. We compared age at onset within families. Disease duration was matched to investigate differences in best-corrected visual acuity (BCVA) and compared the survival time for reaching severe visual impairment (<20/200 Snellen or >1.0 logarithm of the minimum angle of resolution [logMAR]). Central retinal atrophy area was quantified independently by 2 experienced graders using semiautomated software and compared between siblings. Both graders performed qualitative assessment of FAF and spectral-domain (SD) OCT images to identify phenotypic differences. Differences in age at onset, disease duration-matched BCVA, time to severe visual impairment development, FAF atrophy area, FAF patterns, and genotypes. Substantial differences in age at onset were present in 5 of 17 families, ranging from 13 to 39 years. Median BCVA at baseline was 0.60 logMAR (range, -0.20 to 2.30 logMAR; Snellen equivalent, 20/80 [range, 20/12-hand movements]) in the right eye and 0.50 logMAR (range, -0.20 to 2.30 logMAR; Snellen equivalent, 20/63 [range, 20/12-hand movements]) in the left eye. Disease duration-matched BCVA was investigated in 12 of 17 families, and the median difference was 0.41 logMAR (range, 0.00-1.10 logMAR) for the right eye and 0.41 logMAR (range, 0.00-1.08 logMAR) for the left eye. We observed notable differences in time to severe visual impairment development in 7 families, ranging from 1 to 29 years. Median central retinal atrophy area was 11.38 mm2 in the right eye (range, 1.98-44.78 mm2) and 10.59 mm2 in the left eye (range, 1.61-40.59 mm2) and highly comparable between siblings. Similarly, qualitative FAF and SD OCT phenotypes were highly comparable between siblings. Phenotypic discordance between siblings with STGD1 carrying the same ABCA4 variants is a prevalent phenomenon. Although the FAF phenotypes are highly comparable between siblings, functional outcomes differ substantially. This complicates both sibling-based prognosis and genotype-phenotype correlations and has important implications for patient care and management.

National Retail Benchmarking for Pork 2018

ObjectivesThe objective of this study was to quantify pork quality attributes in the retail meat case nationwide. Similar evaluations were conducted in 2012 and 2015. The comparisons of the benchmarking projects show trends in pork products in nationwide retail stores.Materials and MethodsEighty-five stores representing 26 retailers in 15 cities were visited. Subjective color score (1–6) and subjective marbling score (1–10) on center-cut loin chops was assessed by an experienced grader under lighting of the self-serve meat case. Four individual loin chops with at least 50% lean exposed were randomly selected for evaluation from ten retail packages for each brand and enhancement type. Preference was given to boneless, 2.5 cm-thick center-cut loin chops where available. Ten additional packages of chops for each brand and enhancement type were evaluated in-store and purchased. Each of the purchased packages were labeled and each chop within a package was identified for later evaluation. The purchased packages were subsequently placed inside a cooler and transported to a temporary lab station where chops were again subjectively evaluated for color and marbling under controlled lighting and evaluated in the center of the loin muscle for instrumental color (CIE L*, a*, and b* color space values) using a calibrated Minolta Colorimeter and a Hunter Colorimeter. Chops were then vacuum sealed and immediately placed in the freezer. The samples were later packed in a cooler with dry ice and shipped to the University of Florida on dry ice. After arrival, they were placed in frozen storage until thawed for cooking and shearing. Chops were weighed prior to and after cooking on open hearth, adjustable heat grills until reaching 65°C then evaluated for slice shear.Data was analyzed using the mixed procedure in SAS (v. 9.4, SAS Institute, Cary, NC). The model included enhancement type (EN or NON), and the interaction between enhancement type as fixed effects. Package nested within store, brand, and purchased (yes or no) was fit as a random effect.ResultsThe USDA AMS defined “Tender” as having a minimum threshold values for slice shear as 20.0 kg and “Very Tender” at 15.3 kg, respectively. Sixteen percent of the instore evaluated and purchased retail packages were enhanced (247 and 119 retail packages, respectively). Means for instore enhanced (EN) and non-enhanced (NON) chops were 2.52 and 2.70 for subjective color and 2.25 and 2.65 for subjective marbling, respectively. Means for chops purchased for EN and NON chops under controlled lighting were: subjective color (2.07 and 2.25), subjective marbling (1.89 and 2.21), Minolta L* (56.35 and 56.86), Minolta a* (15.48 and 15.61), Hunter L (56.99 and 58.69), Hunter a (13.98 and 15.08), cook loss (13.02 and 15.64%), and slice shear (12.68 and 15.63 kg).ConclusionResults indicate extensive variation for color, marbling, cooking loss and tenderness exists in the pork meat case. Enhancement continues to improve tenderness though less enhanced pork is found in the marketplace. However, regardless of enhancement, the average value for slice shear of center loin chops were quite tender.Table 5.

Assessment of muscle Longissimus thoracis et lumborum marbling by image analysis and relationships between meat quality parameters.

The intramuscular fat (IMF), recognized by the consumer as marbling, is an important meat quality trait. The objective of this study was to validate a new method of beef marbling evaluation by image analysis. The new assessment was compared with two known marbling measurements: chemical IMF and USDA scores. Moreover, the relationship between marbling measurements and other meat quality parameters was investigated. Samples of Longissimus thoracis et lumborum (LTL) muscle were obtained from carcasses of 39 Italian crossbred heifers and 62 Angus bred heifers, that underwent two different dietary treatments. The use of various breeds and diets was chosen to obtain different intramuscular fat levels, in order to validate the use of Image J software for the analysis of different type of beef meat. The images of fresh cuts were appraised by experienced beef graders, and the samples were used to determine fat content by chemical Soxhlet extraction. Carcasses measurements according to the EUROP system, and other physical meat proprieties were also assessed. The results demonstrated that the marbling measurements obtained by computer image analysis, such as the number of marbling particles, the average particle size (mm), and the percentage of marbling particles (%), significantly (P < 0.05) correlated with USDA scores and IMF content. Moreover, the principal component analysis (PCA) showed three principal meat components, identified as 1) color, 2) fat, and 3) water release. The second principal component (PC) explained 24.94% of variance, and was positively correlated with image analysis measures, USDA score, and IMF, while negatively correlated with the Warner–Bratzler shear force (WBSF).

Impact of correct anatomical slab segmentation on foveal avascular zone measurements by optical coherence tomography angiography in healthy adults

PurposeTo evaluate the impact of correct anatomical slab segmentation on foveal avascular zone (FAZ) dimensions in the superficial capillary plexus (SCP) and deep capillary plexus (DCP) using optical coherence tomography angiography (OCTA). MethodsParticipants with healthy retinas were recruited, and 5 × 5 mm OCTA images were acquired using the Canon HS-100 Angio eXpert module. FAZ size was measured in automatically (AS, manufacturer-based) and manually (MS, anatomical-based) segmented OCTA slabs by two experienced graders. FAZ dimensions, inter-rater agreement, and correlation to demographic and retinal parameters were evaluated. ResultsA total of 38 eyes from 20 healthy adult subjects were included in this cross-sectional study. While in AS slabs, the FAZ in the SCP was smaller than in the DCP, in MS images, it was the opposite. MS had a relevant impact on inter-rater agreement of FAZ measurements in the SCP. The FAZ area in both plexus correlated inversely with the central retinal thickness (CRT), irrespective of the segmentation applied. Furthermore, an enlargement of FAZ size in the DCP with increasing age was found. Finally, the FAZ in female participants was significantly larger than in their male counterparts, regardless of the evaluated plexus and chosen segmentation. ConclusionsCorrect anatomical slab segmentation has a significant impact on FAZ size measurements. Not adjusting the segmentation boundaries represents a significant source of error for measuring FAZ area and confounds comparisons across studies as well as OCTA devices.

In Vivo Confocal Microscopy Cellular Features of Host and Organism in Bacterial, Fungal, and Acanthamoeba Keratitis

PurposeTo determine cellular features of fungal (FK), Acanthamoeba (AK), and bacterial keratitis (BK) using HRT3 in vivo confocal microscopy (IVCM).DesignProspective observational cross-sectional study.MethodsEligible participants were adults with microbiologically positive FK, AK, or BK, of size ≥ 3 mm, attending Aravind Eye Hospital from February 2012 to February 2013. Exclusion criteria were descemetocele or perforation. At presentation, IVCM imaging was performed, then corneal scrapes were obtained for culture/light microscopy. An experienced grader (masked to microbiology/clinical features) assessed IVCM images for presence/absence of normal keratocyte-like morphology, stellate interconnected cells with/without visible nuclei, dendritiform cells (DFCs), inflammatory cells in a honeycomb distribution, and organism features. Statistical significance was assessed by logistic regression, adjusted for age, sex, ulcer size, and symptom duration. Main outcome measures were presence/absence of IVCM features in FK, AK, BK.ResultsA total of 183 participants had FK, 18 AK, 17 BK. Acanthamoeba appeared as bright spots (16/18, 89%), double-walled cysts (15/18, 83%), or signet rings (3/18, 17%), and often formed clusters after topical steroid use (univariable odds ratio [OR] 9.98, 95% confidence interval [CI] 1.02-97.96, P = .048). BK was associated with bullae in anterior stroma (OR 9.99, 95% CI: 3.11-32.06, P < .001). Honeycomb distribution of anterior stromal inflammatory cells was associated with FK (univariable OR 2.74, 95% CI: 1.01-7.40, P = .047). Aspergillus ulcers were associated with stromal DFCs (OR 11.05, 95% CI: 1.49-82.13, P = .019) and Fusarium ulcers with stellate appearance of interconnected cell processes with nuclei (OR 0.24, 95% CI: 0.09-0.65, P = .005).ConclusionSpecific cellular and structural features observed using IVCM in microbial keratitis may be associated with organism.

Classification of Hoi-An and Sin-Chew Agarwood by Components Analysis of VOCs Released in Heat-Treated Agarwood using TD-GCMS and Chemometric Methods

Agarwood can be divided into resinous heartwood from the Hoi-An zone and Sin-Chew zone. Traditionally, an experienced human grader classifies agarwood by odor. However, sensory errors can follow from subjectivity, poor reproducibility, and time consumption during manual work. In this study, agarwood samples were heat-treated to release volatile organic compounds (VOCs), which were analyzed using the thermal desorption - gas chromatograph mass spectrograph (TD-GCMS) method and chemometrics analysis. The classification of agarwood was then identified. Sesquiterpenes and other aromatic compounds were the main compounds of heat-treated VOCs. Twenty-six characteristic compounds were screened via stepwise regression. Fisher discriminant analysis and Bayes discriminant analysis were conducted, based on the 26 compounds, to classify the agarwood samples. Discriminant functions of the two analysis methods were obtained.The results showed that it is feasible to use the TD-GCMS method combined with chemometrics analysis to analyze VOCs from heat-treated agarwood instead of experienced graders to classify the agarwood samples as being from either the Hoi-An zone and Sin-Chew zone. This study also provides a way to classify unknown samples by odor through 26 characteristic compound’srelative peak area and the discriminant equations, offering the possibility of testing an unknown sample’s cultivation region.

Numerical versus narrative: A comparison between methods to measure medical student performance during clinical clerkships

Background: Medical school evaluations typically rely on both language-based narrative descriptions and psychometrically converted numeric scores to convey performance to the grading committee. We evaluated inter-rater reliability and correlation of numeric versus narrative evaluations for students on their Neurology Clerkship.Design/Methods: 50 Neurology Clerkship in-training evaluation reports completed by their residents and faculty members at the University of Rochester School of Medicine were dissected into narrative and numeric components. 5 Clerkship grading committee members retrospectively gave new narrative scores (NNS) while blinded to original numeric scores (ONS). We calculated intra-class correlation coefficients (ICC) and their associated confidence intervals for the ONS and the NNS. In addition, we calculated the correlation between ONS and NNS.Results: The ICC was greater for the NNS (ICC = .88 (95% CI = .70–.94)) than the ONS (ICC = .62 (95% CI = .40–.77)) Pearson correlation coefficient showed that the ONS and NNS were highly correlated (r = .81).Conclusions: Narrative evaluations converted by a small group of experienced graders are at least as reliable as numeric scoring by individual evaluators. We could allow evaluators to focus their efforts on creating richer narrative of greater value to trainees.

Agreement between OCT Leakage and Fluorescein Angiography to Identify Sites of Alteration of the Blood–Retinal Barrier in Diabetes

To compare the location of the sites of lower reflectivity, as determined by OCT leakage using spectral domain (SD)-OCT, with sites of fluorescein leakage identified by fluorescein angiography (FA) in eyes with diabetic retinopathy. Prospective consecutive case series. Fifty-two eyes from 28 patients with type 2 diabetes and presence of nonproliferative diabetic retinopathy. All patients were imaged with FA and SD-OCT (Angioplex, Carl Zeiss Meditec, Inc). All FA images were analyzed by 2 experienced graders, and the area surrounding well-defined sites of leakage was outlined by the graders. The SD-OCT scans were processed using OCT leakage proprietary software and semiautomated segmentation. Both procedures were performed without access to the clinical data. Agreement of OCT leakage with FA findings. In eyes that were classified as having well-defined sites of leakage on FA, OCT leakage showed a sensitivity of 95.9% and a specificity of 75.4% regarding agreement between these sites of alteration of the blood-retinal barrier. The areas of abnormal extracellular fluid increase were larger than the areas of fluorescein leakage and included the well-defined leakage sites identified by FA. On OCT leakage, localized increases in extracellular space were identified, mainly in the inner nuclear, outer plexiform, or outer nuclear layers, even in eyes without leakage on FA. Using SD-OCT, OCT leakage was found to better identify abnormal retinal fluid than did FA and showed good sensitivity and specificity in comparison with FA for identification of sites of alterations of the blood-retinal barrier.

Eyelash Epilation in the Absence of Trichiasis: Results of a Population-Based Prevalence Survey in the Western Division of Fiji.

BackgroundThe WHO definition of trachomatous trichiasis (TT) is “at least one eyelash touching the globe, or evidence of recent epilation of in-turned eyelashes”, reflecting the fact that epilation is used as a self-management tool for TT. In Fiji’s Western Division, a high TT prevalence (8.7% in those aged ≥15 years) was reported in a 2012 survey, yet a 2013 survey found no TT and Fijian ophthalmologists rarely see TT cases. Local anecdote suggests that eyelash epilation is a common behaviour, even in the absence of trichiasis. Epilators may have been identified as TT cases in previous surveys.MethodsWe used a preliminary focus group to design an interview questionnaire, and subsequently conducted a population-based prevalence survey to estimate the prevalence of epilation in the absence of trichiasis, and factors associated with this behaviour, in the Western Division of Fiji.ResultsWe sampled 695 individuals aged ≥15 years from a total of 457 households in 23 villages. 125 participants (18%) reported epilating their eyelashes at least once within the past year. Photographs were obtained of the eyes of 121/125 (97%) individuals who epilated, and subsequent analysis by an experienced trachoma grader found no cases of trachomatous conjunctival scarring or trichiasis. The age- and sex- adjusted prevalence of epilation in those aged ≥15 years was 8.6% (95% CI 5.7–11.3%). iTaukei ethnicity, female gender, and a higher frequency of drinking kava root were independently associated with epilation.ConclusionEpilation occurs in this population in the absence of trichiasis, with sufficient frequency to have markedly inflated previous estimates of local TT prevalence. Individuals with epilated eyelashes should be confirmed as having epilated in-turned eyelashes in an eye with scarring of the conjunctiva before being counted as cases of TT.

Sensitivity and specificity of multispectral imaging in detecting central serous chorioretinopathy

Central serous chorioretinopathy (CSCR) is a common and idiopathic retinal disorder that affects young to middle aged adults. The aim of this study was to describe the characteristics of eyes with CSCR using a light-emitting diode (LED)-based multispectral imaging (MSI) system and to evaluate the diagnostic reliability of MSI compared to fluorescein angiography (FA) in detecting CSCR. A total of 56 eyes among 52 patients with 1 or more retinal pigment epithelium (RPE) abnormality were retrospectively enrolled in the study. The patients underwent complete examination, including optical coherence tomography, FA, indocyanine-green angiography, and MSI. MSI images were retrospectively reviewed by experienced masked graders. Diagnoses that were made based on MSI alone were compared with those that were made using FA. Sensitivity and specificity were calculated, and the morphological features on MSI were summarized. Among 56 eyes in 52 patients, MSI detected 22 of 26 true-positive CSCR cases but missed 4 FA-confirmed lesions. Further, it correctly excluded 30 of 30 non-CSCR lesions. The sensitivity and specificity of MSI were 84.6 and 100%, respectively, for identifying CSCR. Using MSI, RPE leakage was observed in 25 (96.2%) of 26 eyes with CSCR, which was comparable to the performance of FA. Dome-shaped areas of signal, which corresponded to fluid accumulation associated with neurosensory retinal detachment or RPE detachment were observed in 23 (88.5%) of 26 eyes. As a non-invasive technique, MSI permitted the visualization of RPE leakage and neurosensory detachment and allowed good detection of CSCR in this selected clinical population. Lasers Surg. Med. 49:498-505, 2017. © 2016 Wiley Periodicals, Inc.

Automatic identification of the temporal retinal nerve fiber raphe from macular cube data.

We evaluated several approaches for automatic location of the temporal nerve fiber raphe from standard macular cubes acquired on a Heidelberg Spectralis OCT. Macular cubes with B-scan separation of 96-122 µm were acquired from 15 healthy participants, and "high density" cubes with scan separation of 11 µm were acquired from the same eyes. These latter scans were assigned to experienced graders for subjective location of the raphe, providing the ground truth by which to compare methods operating on the lower density data. A variety of OCT scan parameters and image processing strategies were trialed. Vertically oriented scans, purposeful misalignment of the pupil to avoid reflective artifacts, and the use of intensity as opposed to thickness of the nerve fiber layer were all critical to minimize error. The best performing approach "cFan" involved projection of a fan of lines from each of several locations across the foveal pit; in each fan the line of least average intensity was identified. The centroid of the crossing points of these lines provided the raphe orientation with an average error of 1.5° (max = 4.1°) relative to the human graders. The disc-fovea-raphe angle was 172.4 ± 2.3° (range = 168.5-176.2°), which agrees well with other published estimates.

Relationships between marbling measures across principal muscles

As marbling is a principal input into many grading systems it is important to have an accurate and reliable measurement procedure. This paper compares three approaches to measuring marbling: trained personnel, near infrared spectroscopy (NIR) and image analysis. One 25mm slice of meat was utilised from up to 12 cuts from 48 carcasses processed in Poland and France. Each slice was frozen to enable a consistent post-slaughter period then thawed for image analysis. The images were appraised by experienced beef graders and the sample used to determine fat content by NIR. We find that image analysis based marbling measures are capturing something different to trained personnel and that there is a strong relationship between near infrared spectroscopy and trained personnel. Finally, we demonstrate that marbling measures taken on one muscle can be predictive of marbling in other muscles in the same carcase. This is particularly important for cut based models such as the Meat Standards Australia system.

Prospective Study of the Diagnostic Accuracy of the In Vivo Laser Scanning Confocal Microscope for Severe Microbial Keratitis

PurposeTo determine the diagnostic accuracy of in vivo confocal microscopy (IVCM) for moderate to severe microbial keratitis (MK).DesignDouble-masked prospective cohort study.ParticipantsConsecutive patients presenting to Aravind Eye Hospital, Madurai, India, between February 2012 and February 2013 with MK (diameter ≥3 mm, excluding descemetocele, perforation, or herpetic keratitis).MethodsFollowing examination, the corneal ulcer was scanned by IVCM (HRT3/RCM, Heidelberg Engineering, Heidelberg, Germany). Images were graded for the presence or absence of fungal hyphae or Acanthamoeba cysts by the confocal microscopist who performed the scan (masked to microbial diagnosis) and 4 other experienced confocal graders (masked to clinical features and microbiology). The regrading of the shuffled image set was performed by 3 graders, 3 weeks later. Corneal-scrape samples were collected for microscopy and culture.Main Outcome MeasuresThe main outcome measures were sensitivity, specificity, and positive and negative predictive values of IVCM compared with those of a reference standard of positive culture or light microscopy. Sensitivities and specificities for multiple graders were pooled and 95% confidence intervals calculated using a bivariate random-effects regression model.ResultsThe study enrolled 239 patients with MK. Fungal infection was detected in 176 (74%) and Acanthamoeba in 17 (7%) by microbiological methods. IVCM had an overall pooled (5 graders) sensitivity of 85.7% (95% confidence interval [CI]: 82.2%–88.6%) and pooled specificity of 81.4% (95% CI: 76.0%–85.9%) for fungal filament detection. For Acanthamoeba, the pooled sensitivity was 88.2% (95% CI: 76.2%–94.6%) and pooled specificity was 98.2% (95% CI: 94.9%–99.3%). Intergrader agreement was good: κ was 0.88 for definite fungus; κ was 0.72 for definite Acanthamoeba. Intragrader repeatability was high for both definite fungus (κ: 0.88–0.95) and definite Acanthamoeba classification (κ: 0.63–0.90). IVCM images from 11 patients were considered by all 5 graders to have a specific organism present (10 fungus, 1 Acanthamoeba) but had negative results via culture and light microscopy.ConclusionsLaser scanning IVCM performed with experienced confocal graders has high sensitivity, specificity, and test reproducibility for detecting fungal filaments and Acanthamoeba cysts in moderate to large corneal ulcers in India. This imaging modality was particularly useful for detecting organisms in deep ulcers in which culture and light microscopy results were negative.

Reliability of a Manual Procedure for Marking the EZ Endpoint Location in Patients with Retinitis Pigmentosa.

PurposeWe developed and evaluated a training procedure for marking the endpoints of the ellipsoid zone (EZ), also known as the inner segment/outer segment (IS/OS) border, on frequency domain optical coherence tomography (fdOCT) scans from patients with retinitis pigmentosa (RP).MethodsA manual for marking EZ endpoints was developed and used to train 2 inexperienced graders. After training, an experienced grader and the 2 trained graders marked the endpoints on fdOCT horizontal line scans through the macula from 45 patients with RP. They marked the endpoints on these same scans again 1 month later.ResultsIntragrader agreement was excellent. The intraclass correlation coefficient (ICC) was 0.99, the average difference of endpoint locations (19.6 μm) was close to 0 μm, and the 95% limits were between −284 and 323 μm, approximately ±1.1°. Intergrader agreement also was excellent. The ICC values were 0.98 (time 1) and 0.97 (time 2), the average difference among graders was close to zero, and the 95% limits of these differences was less than 350 μm, approximately 1.2°, for both test times.ConclusionsWhile automated algorithms are becoming increasingly accurate, EZ endpoints still have to be verified manually and corrected when necessary. With training, the inter- and intragrader agreement of manually marked endpoints is excellent.Translational RelevanceFor clinical studies, the EZ endpoints can be marked by hand if a training procedure, including a manual, is used. The endpoint confidence intervals, well under ±2.0°, are considerably smaller than the 6° spacing for the typically used static visual field.

Agreement between novice and experienced trachoma graders improves after a single day of didactic training

Background/aimsPrevalence estimates and treatment decisions for trachoma are based entirely on ocular clinical examination. The aim of the current study is to demonstrate that ophthalmic assistants can be trained and...

A light-emitting diode (LED)-based multispectral imaging system in evaluating retinal vein occlusion.

Retinal vein occlusion (RVO), the second most common retinal vascular disorder worldwide, is considered to be a critical cause of visual loss. The aim of this study was to describe the characteristics of eyes with RVO using a light-emitting diode (LED)-based multispectral imaging (MSI) system and to compare its performance in terms of reliability and diagnostic power with those of fundus fluorescein angiography (FFA), optical coherence tomography (OCT), and fundus photography (FP). Fifty-six eyes of 28 patients with RVO disease were evaluated by MSI, FP, FFA, and spectral domain OCT. All images were analyzed by an experienced reading center grader. Nonperfusion area, occlusion area, and intraretinal edema from occlusions and FP abnormalities (presence of cotton-wool spots, epiretinal membrane, hard exudates, and retinal hemorrhage) were documented. The diagnostic power of MSI was evaluated by the area under receiver operating characteristic (ROC) curve (AUC). Of the 56 eyes, 15 had branch RVO (BRVO), 13 had central RVO (CRVO), and 28 were normal. The ROC curve analysis showed that MSI was a better discriminator of RVO than FP (AUC = 0.911 vs. 0.768, P = 0.0318). The sensitivity (and 95% confidence intervals) of MSI for nonperfusion area was 42.3% (18.8-70.4), 80.0% (51.4-94.7) for retinal hemorrhage, 90.0% (54.1-99.5) for cotton-wool spots, 90.9% (57.1-99.5) for hard exudates, and 21.1% (7.0-46.1) for intraretinal edema. MSI was capable of finding abnormalities such as nonperfusion area, retinal hemorrhage, cotton-wool spots, hard exudates, and epiretinal membrane. MSI oxy-deoxy maps showed low oxygen levels in the affected vein, especially in CRVOs, and could be used in detecting the nonperfusion area. MSI reveals highly defined vascular abnormalities in shortwave images and oxy-deoxy maps, which is compatible with FP, FFA, and OCT findings and indicates, preliminarily, the advantages of the noninvasiveness, simplicity, and effectiveness of MSI in evaluating RVO diseases. Lasers Surg. Med. 47:549-558, 2015. © 2015 Wiley Periodicals, Inc.