High Rate Of Agreement Research Articles

‘Validation of ultrasound examinations performed by general practitioners’

Objective: The aim of this study was to evaluate the diagnostic agreement when a general practitioner and subsequently a specialist (radiologist/gynecologist) performed point-of-care ultrasound examinations for certain abdominal and gynecological conditions of low to moderate complexity.Design: A prospective study of inter-rater reliability and agreement.Setting: Patients were recruited and initially scanned in general practice. The validation examinations were conducted in a hospital setting.Subjects: A convenient sample of 114 patients presenting with abdominal pain or discomfort, possible pregnancy or known risk factors toward abdominal aortic aneurism were included.Main outcome measures: Inter-rater agreement (Kappa statistic and percentage agreement) between ultrasound examinations by general practitioner and specialist for the following conditions: gallstones, ascites, abdominal aorta >5 cm, intrauterine pregnancy and gestational age.Results: An overall Kappa value of 0.93 (95% confidence interval (CI): 0.87–0.98) was obtained. Ascites, abdominal aortic diameter >5cm, and intrauterine pregnancy showed Kappa values of 1.Conclusion: Our study showed that general practitioners performing point-of-care ultrasound examinations with low-to-moderate complexity had a very high rate of inter-rater agreement compared with specialists.

Determinants of teachers’ collaborative use of information and communications technology for teaching and learning: A European perspective

Collaboration between teachers constitutes an important predictor for the successful implementation of digital media in schools and teaching. The present contribution examines the supporting conditions of ICT (information and communications technology)-related teacher collaboration as a feature of school quality in six selected European educational systems on the basis of the instruments and data administered by the International Association for the Evaluation of Educational Achievement’s study of ICILS 2013 (International Computer and Information Literacy Study 2013). Along the ICILS 2013 theoretical framework, predictors on the level of the school and classroom, antecedents regarding teachers’ attitudes and competencies, variables concerning processes at school and in class, as well as teachers’ background variables, are analysed. The regression analysis shows no consistent differences regarding the coefficients of different predictors with respect to ICT-related collaboration in the countries where teachers have expressed a high, medium or low rate of agreement with ICT-related collaboration.

AR2, a novel automatic muscle artifact reduction software method for ictal EEG interpretation: Validation and comparison of performance with commercially available software.

Objective: To develop a novel software method (AR2) for reducing muscle contamination of ictal scalp electroencephalogram (EEG), and validate this method on the basis of its performance in comparison to a commercially available software method (AR1) to accurately depict seizure-onset location. Methods: A blinded investigation used 23 EEG recordings of seizures from 8 patients. Each recording was uninterpretable with digital filtering because of muscle artifact and processed using AR1 and AR2 and reviewed by 26 EEG specialists. EEG readers assessed seizure-onset time, lateralization, and region, and specified confidence for each determination. The two methods were validated on the basis of the number of readers able to render assignments, confidence, the intra-class correlation (ICC), and agreement with other clinical findings. Results: Among the 23 seizures, two-thirds of the readers were able to delineate seizure-onset time in 10 of 23 using AR1, and 15 of 23 using AR2 (p<0.01). Fewer readers could lateralize seizure-onset (p<0.05). The confidence measures of the assignments were low (probable-unlikely), but increased using AR2 (p<0.05). The ICC for identifying the time of seizure-onset was 0.15 (95% confidence interval (CI), 0.11-0.18) using AR1 and 0.26 (95% CI 0.21-0.30) using AR2. The EEG interpretations were often consistent with behavioral, neurophysiological, and neuro-radiological findings, with left sided assignments correct in 95.9% (CI 85.7-98.9%, n=4) of cases using AR2, and 91.9% (77.0-97.5%) (n=4) of cases using AR1. Conclusions: EEG artifact reduction methods for localizing seizure-onset does not result in high rates of interpretability, reader confidence, and inter-reader agreement. However, the assignments by groups of readers are often congruent with other clinical data. Utilization of the AR2 software method may improve the validity of ictal EEG artifact reduction.

Community behavioral health care linkages for youth

Introduction and objectivebehavioral health (BH) agencies have care linkages for youth including juvenile justice (JJ). However, there are few studies on youth care linkages. This study focuses on six sites with the objective of examining BH and JJ staff perceptions about information exchange on screening, assessment and treatment.MethodsWe developed an index to quantify BH and JJ staff perceptions of information exchange on youth screening, assessment and treatment. After Informed Consent, staff rated past year interactions from agree to disagree on a 7-point Likert scale. Chi-squares and T-tests were used.ResultsAll 64 staff consented 17 (26.5%) BH staff and 47 (73.5%) JJ staff. Significant differences included BH staff were more likely to be licensed (P &lt; .001) and had a masters degree or higher (P = &lt; .01). Professional experience ranged from 9.8 to 15.8 years. However, there were no statistically significant differences. BH staff was somewhat higher from 5.7 for “shared assessment results” to 6.8 for “been easy to talk to” while JJ staff were from 5.1 for “shared screening results” to 6.1 for “treated youth with respect”.ConclusionsThis pilot study found high rates of staffs agreement including ease of talking and listening, sharing screenings and assessments information, and helping begin, continue, and complete treatment. This high agreement was not expected with confidentiality restrictions and traditions. Future studies should target care linkages including letters of agreement, case conferences, and guidelines.The study is supported by the National Institutes of Health.Disclosure of interestThe authors have not supplied their declaration of competing interest.

AR2, a novel automatic muscle artifact reduction software method for ictal EEG interpretation: Validation and comparison of performance with commercially available software

Objective: To develop a novel software method (AR2) for reducing muscle contamination of ictal scalp electroencephalogram (EEG), and validate this method on the basis of its performance in comparison to a commercially available software method (AR1) to accurately depict seizure-onset location. Methods: A blinded investigation used 23 EEG recordings of seizures from 8 patients. Each recording was uninterpretable with digital filtering because of muscle artifact and processed using AR1 and AR2 and reviewed by 26 EEG specialists. EEG readers assessed seizure-onset time, lateralization, and region, and specified confidence for each determination. The two methods were validated on the basis of the number of readers able to render assignments, confidence, the intra-class correlation (ICC), and agreement with other clinical findings. Results: Among the 23 seizures, two-thirds of the readers were able to delineate seizure-onset time in 10 of 23 using AR1, and 15 of 23 using AR2 (p<0.01). Fewer readers could lateralize seizure-onset (p<0.05). The confidence measures of the assignments were low (probable-unlikely), but increased using AR2 (p<0.05). The ICC for identifying the time of seizure-onset was 0.15 (95% confidence interval (CI), 0.11-0.18) using AR1 and 0.26 (95% CI 0.21-0.30) using AR2. The EEG interpretations were often consistent with behavioral, neurophysiological, and neuro-radiological findings, with left sided assignments correct in 95.9% (CI 85.7-98.9%, n=4) of cases using AR2, and 91.9% (77.0-97.5%) (n=4) of cases using AR1. Conclusions: EEG artifact reduction methods for localizing seizure-onset does not result in high rates of interpretability, reader confidence, and inter-reader agreement. However, the assignments by groups of readers are often congruent with other clinical data. Utilization of the AR2 software method may improve the validity of ictal EEG artifact reduction.

AR2, a novel automatic artifact reduction software method for ictal EEG interpretation: Validation and comparison of performance with commercially available software.

Objective: To develop a novel software method (AR2) for reducing muscle contamination of ictal scalp electroencephalogram (EEG), and validate this method on the basis of its performance in comparison to a commercially available software method (AR1) to accurately depict seizure-onset location. Methods: A blinded investigation used 23 EEG recordings of seizures from 8 patients. Each recording was uninterpretable with digital filtering because of muscle artifact and processed using AR1 and AR2 and reviewed by 26 EEG specialists. EEG readers assessed seizure-onset time, lateralization, and region, and specified confidence for each determination. The two methods were validated on the basis of the number of readers able to render assignments, confidence, the intra-class correlation (ICC), and agreement with other clinical findings. Results: Among the 23 seizures, two-thirds of the readers were able to delineate seizure-onset time in 10 of 23 using AR1, and 15 of 23 using AR2 (p<0.01). Fewer readers could lateralize seizure-onset (p<0.05). The confidence measures of the assignments were low (probable-unlikely), but increased using AR2 (p<0.05). The ICC for identifying the time of seizure-onset was 0.15 (95% confidence interval (CI), 0.11-0.18) using AR1 and 0.26 (95% CI 0.21-0.30) using AR2. The EEG interpretations were often consistent with behavioral, neurophysiological, and neuro-radiological findings, with left sided assignments correct in 95.9% (CI 85.7-98.9%, n=4) of cases using AR2. Conclusions: EEG artifact reduction methods for localizing seizure-onset does not result in high rates of interpretability, reader confidence, and inter-reader agreement. However, the assignments by groups of readers are often congruent with other clinical data. Utilization of the AR2 software method may improve the validity of ictal EEG artifact reduction.

Hysteroscopy in an outpatient setting–38 months experience

INTRODUTION: Hysteroscopy is one the main diagnostic and therapeutic tools of modern Gynecology, allowing a direct visualization of the uterine cavity for diagnosis and minimally invasive intervention with sampling or removal of any structural abnormalities. At our unit office-based diagnostic hysteroscopy is not available; as such the pre-operative imaging diagnosis is largely based on transvaginal or pelvic ultrasound, often with hysterosonography. OBJECTIVE: Evaluate de correlation between the pre-operative diagnosis, hysteroscopic findings, and histological analysis, concerning all hysteroscopies performed at our Outpatient Surgery Unit during 38 months of activity. METHODS: The authors performed a retrospective study based on the review of medical files from patients who underwent hysteroscopic procedures at our institution's Outpatient Surgery Unit from November 1st 2012 to December 31st 2015. RESULTS: During the study period 644 hysteroscopies were performed, all under sedation. The patients’ average age was 55 years (27 to 87), 60% were post-menopausal and 77% presented co-morbidities, 8% having a history of breast cancer with current or previous treatment with tamoxifen. All patients had an ultrasound evaluation, 66% at our ultrasound unit (55% with hysterosonography). The main indications for hysteroscopy were: suspected post-menopausal asymptomatic polyps (34%); suspected pre-menopausal polyps (31%); suspected post-menopausal symptomatic polyps (12%); post-menopausal endometrial thickening (12%); retained trophoblastic products (2%). The main findings were: endometrial polyp(s) (70%); endometrial thickening/irregularities (6%); polypoid/secretory endometrium (2%); submucosal leiomyoma (1,2%); suspicious vegetative formations (0,5%); no abnormalities, normal endometrium (11%). Cervical dilation was used in 14% of the procedures; in 0,8% the endometrial cavity was not accessed due to cervical stenosis. Globally, intra-operative findings were concordant with the presumptive diagnosis by ultrasound in 77% of cases, 82% when hysterosonography was previously used. Bipolar energy was used in 39% of the operative procedures; curettage was performed in 37% of the cases. There was four cases of endometrial adenocarcinoma and two of complex hyperplasia with atypia. The diagnosed complications were: uterine perforation (n = 5); bowel injury (n = 1); moderate uterine bleeding (n = 3). CONCLUSION: The indications and complications rate were similar to other centers described in literature. The previous detailed ultrasound study with hysterosonography resulted in a high rate of agreement between the presumptive diagnosis and intra-operative findings, resulting in a more accurate referral to operative hysteroscopy and obviating a previous diagnostic hysteroscopy. This strategy has been previous advocated by other authors, which reduces the number of hysteroscopies per patient, and is particularly relevant in centers without the possibility of office-based procedures.

Evaluation of the Initial Thematic Output from a Continuous Change-Detection Algorithm for Use in Automated Operational Land-Change Mapping by the U.S. Geological Survey

The U.S. Geological Survey (USGS) has begun the development of operational, 30-m resolution annual thematic land cover data to meet the needs of a variety of land cover data users. The Continuous Change Detection and Classification (CCDC) algorithm is being evaluated as the likely methodology following early trials. Data for training and testing of CCDC thematic maps have been provided by the USGS Land Cover Trends (LC Trends) project, which offers sample-based, manually classified thematic land cover data at 2755 probabilistically located sample blocks across the conterminous United States. These samples represent a high quality, well distributed source of data to train the Random Forest classifier invoked by CCDC. We evaluated the suitability of LC Trends data to train the classifier by assessing the agreement of annual land cover maps output from CCDC with output from the LC Trends project within 14 Landsat path/row locations across the conterminous United States. We used a small subset of circa 2000 data from the LC Trends project to train the classifier, reserving the remaining Trends data from 2000, and incorporating LC Trends data from 1992, to evaluate measures of agreement across time, space, and thematic classes, and to characterize disagreement. Overall agreement ranged from 75% to 98% across the path/rows, and results were largely consistent across time. Land cover types that were well represented in the training data tended to have higher rates of agreement between LC Trends and CCDC outputs. Characteristics of disagreement are being used to improve the use of LC Trends data as a continued source of training information for operational production of annual land cover maps.

An Examination of the Coherence of Fourth Amendment Jurisprudence

For decades, scholars have routinely attacked the Supreme Court’s Fourth Amendment jurisprudence as an incoherent mess, impossible for lower courts to follow. These scholars have based their claims almost entirely on qualitative analysis of the Court’s opinions. This article presents the first systematic evaluation of the consensus view of Fourth Amendment law as incoherent. The primary method I use to evaluate the coherence of the body of law is an assessment of lower court performance on Fourth Amendment issues the Supreme Court would later resolve. Because the Supreme Court’s agreement with lower courts likely reflects, at least in part, the clarity of the Supreme Court’s previous pronouncements, a high rate of agreement between lower courts and the Supreme Court would tend to suggest the coherence of the field. I examine lower court decisions dealing with issues the Supreme Court subsequently addressed over the course of twenty Supreme Court terms. Because Supreme Court cases tend to deal with the most difficult, divisive issues, I also compare the frequency with which the Court has felt compelled to review Fourth Amendment questions to the rate at which the Court has dealt with other important constitutional issues.In addition to tracking the performance of lower courts, I track variables that might impact the likelihood of lower courts reaching “right” answers to Fourth Amendment questions. Because the process the Court uses to resolve a case gives clues about the kind of guidance the Court has previously provided on an issue, I account for whether the Supreme Court used open-ended balancing or a more constrained form of analogical reasoning from precedent to resolve each case in the data set. I also assess whether the directive the Court issued for each case took the form of a bright-line rule or an open-ended standard. Finally, because several scholars have recommended reference to positive law as a means of clarifying Fourth Amendment law, I evaluate the Court’s reliance on positive law to resolve Fourth Amendment questions during the twenty-year period.Ultimately, the results show that lower courts have reached the “right” answers to Fourth Amendment questions about as often as lower courts have reached the “right” answers to all questions the Supreme Court later reviews. Furthermore, the Court has not felt compelled to resolve Fourth Amendment questions at a rate that seems disproportionate to other important constitutional matters. These data point toward the plausible conclusion that Fourth Amendment law is not particularly incoherent, as compared with other areas of law. Examination of the Court’s use of positive law reveals that the Court has, for the most part, not relied on positive law in ways likely to enhance significantly the coherence of Fourth Amendment law. Thus, a more principled approach to using positive law to resolve Fourth Amendment questions might increase the coherence of the field. Finally, analysis of the data suggests the Court should issue directives in the form of bright-line rules instead of open-ended standards if it hopes further to enhance the clarity of Fourth Amendment law.

Comparison of GeneFinder human papillomavirus (HPV) Liquid Beads Microarray PCR Kit and Hybrid Capture 2 Assay for Detection of HPV Infection

Along with advances in methodological technologies, various assays for detecting high-risk human papillomavirus (HR HPV) have been introduced. The GeneFinder HPV liquid beads microarray PCR kit is one of the recently developed. Our aim was to compare the performance of GeneFinder to Hybrid Capture 2 for detection of HR HPV. A total of 900 cervical swab specimens were obtained. All specimens were submitted for HR HPV detection with Hybrid Capture 2 (HC2) and GeneFinder and then additionally analyzed the discordant or both positive results using restriction fragment mass polymorphism (RFMP) genotyping analysis. Hybrid Capture 2 detected 12.8% cases and GeneFinder detected 15.8% cases with 13 HR HPV types. Also, GeneFinder detected 27.4% cases for 32 detectable HPV types. The overall agreement rate was 93.2% with 0.724 kappa coefficient. Discordant results between these two assays were observed in 56 cases. HC2 showed sensitivity of 83.5% and specificity of 95.9%, while GeneFinder showed sensitivity of 85.4% and specificity of 91.9%. For HPV 16 or HPV 18 detection, GeneFinder showed 95.0% or 66.7% of sensitivity and 99.2% or 100%, respectively. Overall coinfection rate was 15.4% (38/247) in GeneFinder analysis. Considering the high agreement rate with HC2, high sensitivity and the ability to differentiate 32 HPV genotypes including HPV 16/18, GeneFinder could be used as a laboratory testing method for the screening of HPV infections. The use of GeneFinder may also contribute to future research associated with the significance of various HPV types and multiple coinfections.

Test-Retest Reliability of Brief KS-15 - Korean Sasang Constitutional Diagnostic Questionnaire -

The purpose of this study was to evaluate the reliabilities of questions and diagnostic value of the Korean Sasang Constitutional Diagnostic Questionnaire(KS-15). The young adults aged 20’s participated in this study. The first survey was conducted in march, 2016, and the second one was conducted two weeks later. Three hundred and three questionnaires and the informed consent were obtained from all participants. The test-retest kappa analysis was used to identify the reliabilities of the questions and diagnostic value, and the significance level was .05. The number of subjects was 303 [87(28.7%)males and 216(71.3%)females]. The Cronbach’s α were .630 in 6 characteristic questions. The test-retest reliabilities of questions were ranged from .469 to 734. The agreement rate of KS-15 between the first and second constitutional diagnostic value was 87.13%(Kappa=0.794). The higher Sasang constitutional probability score in first survey resulted in the higher agreement rate between first and second diagnostic value. KS-15 seems to be a reliable implement. Further studies for the reliability of the people of different ages and suitable cut off point in Sasang constitutional probability score are needed for the practical use of KS-15.

Incidence of elbow injuries in adolescent baseball players: screening by a low field magnetic resonance imaging system specialized for small joints.

The aim of this preliminary study was to examine the capability of screening for elbow injuries induced by baseball using a low field small joint MRI system. Sixty-two players in the 4th-6th elementary school grades, with ages ranging from 9 to 12 years, participated in this study. Screening for elbow injuries was performed using a low-magnetic-field (0.2-T) magnetic resonance imaging (MRI) system designed for examinations of small joints of the extremities. Gradient-echo coronal, sagittal, and short-tau inversion recovery (STIR) coronal images of the dominant arm used for pitching were obtained to identify medial collateral ligament (MCL) injuries with or without avulsion fracture and osteochondritis dissecans. All 62 examinations were performed successfully, with 26 players (41.9 %) showing positive findings, all being confined to the MCL. No child showed bone damage. All criteria in the MRI evaluation of injuries showed high agreement rates and kappa values between two radiologists. Screening for early detection of elbow injuries in junior Japanese baseball players can be successfully performed using a low-field MRI system specialized for small joints. The percentage of MCL injury without avulsion fracture was unexpectedly high (41.9 %).

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

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

Mediators with Italian Characteristics. Styles, Conflict Attitudes and Settlement Rates

Mediation has been in recent years at the center stage of European legislation. Through the collaboration of the conciliation service of the Chamber of Arbitration of Milan, we analyzed a questionnaire sent to 200 mediators registered with the mediation providers managed by the Italian Chambers of Commerce. A major issue, also be related to the attitude to the conflict, was the style of mediators. To determine the stylistic orientation of the mediator, we tried to find out what types of behavior by respondents corresponded to his/her own style as a mediator, and the style that ideally they believed the most correct. In this way we tried to typify styles, similarly to what had already been done with the attitudes to the conflict, but without using explicit definitions, and so avoiding a labeling that would undoubtedly threaten to target the mediator in a certain direction. We sought to investigate three areas relevant to the professionalism and attitudes of the mediators: 1) the style of mediation; 2) the personal attitude towards the conflict; 3) effectiveness in leading the parties to a negotiated agreement in mediation. As for the distribution of the style of mediation compared to the characteristics of the respondents, there were no major differences by gender, age and experience of mediation. Compared to the attitudes to conflict resolution, there is a majority of collaborating styles (35%), followed by the avoidant styles (17.8%) and competitive (16:56%). The styles less represented are compromise (28.8%) and accommodation (7%). However, about 15% of the respondents reported mixed attitudes. The distribution of the styles of conflict management is homogenous even compared the experience of mediation and the number of mediation agreements. However, the avoidant style shows a significant difference with regard to the number of mediations closed.We then probed the relationship between the variables related to characteristics of respondents (age, length of service, number of mediation, mediation style and attitude to the conflict) through correlation analysis. The index r of pearson shows no correlation between age and other variables. Instead, the level of experience, measured as the number of years since the first mediation at the time of filling in this form, not only correlates, as expected, with the number of mediations conducted, but also with the style of mediation. Expert mediators, in fact, bring more transformative style. There were no significant correlations between the style of mediation and the attitude of the respondents to the conflict. This result contrasts with the prejudice that mediators with a directive approach (ie evaluative mediators, and sometimes even transformative mediators) have a higher rate of agreement. A second significant result is that individuals with economic education have a higher rate of agreements with respect to the lawyers. In this regard, it is interesting to note a potential association between success rate and post-graduate training. In fact, although not by a significant difference due to the relatively small sample, respondents with a post-graduate training in economics or accounting, report rates of agreement significantly higher than those who reported a background in law, in ADR, in psychology or who do not report a post-graduate training. Finally, the gender factor was significant compared to the rate of agreement. The anova test on the rate of mediation agreements shows a significant difference between men and women. In particular, men show a statistically higher rate of agreement of women. The conclusion of an agreement between the parties is not the only way to determine the effectiveness of the mediator. It is known that in many cases, even a mediation which is not crowned by an agreement, leads the parties through a process of mutual recognition and to manage the conflict underlying the dispute, which results in a resolution only in the medium-long term. In these cases, much of the work of mediation occurs long after the mediator has concluded the process. However, in this historic phase of mediation in Italy, we felt that the rate of agreement between the parties could be a satisfactory measure of the effectiveness of the mediator. The Italian model is definitely legalistic, but its practical results seems not so distant from the results obtained in voluntary models. Again, it seems that the style of the mediator might be of some use as a paradigm of orientation with respect to each phase of the process, but has no sufficient predictive value to be confirmed as a key to the functioning of the mediation.

Agreement between clinical and histopathologic diagnoses and completeness of oral biopsy forms

The present study aimed to assess the rate of agreement between clinical and histopathological diagnoses and to report the frequency of completed forms for specimens that were subjected to histopathological examination and retrospectively examined. Data from 8,168 specimens submitted to histopathological examination were retrieved from the records. A total of 5,368 cases were included. Agreement was defined based on the definition of lesion nature according to its diagnostic category. Sensitivity, specificity, and positive and negative predictive values were calculated for each diagnostic category. The highest rate of agreement was observed for periapical lesions (92.6%), followed by potentially malignant disorders (90.1%) and non-neoplastic proliferative disorders (89.3%). Low rates of histopathological confirmation of the clinical impression were observed for mesenchymal tumors (25.0%) and cysts (44.2%). Sensitivity values were > 0.70 for all lesions, except for cysts (0.51). Specificity was relatively high, ranging from 0.97 to 1.00. The frequency of incomplete biopsy forms ranged from 16.8% (malignant tumors of oral mucosal epithelium) to 51.0% (nonspecific inflammatory reaction). The most frequently completed biopsy forms corresponded to epithelial malignant tumors (83.2%) and glandular inflammation (72.3%). In conclusion, there was an acceptable level of agreement. The low level of completeness of biopsy forms indicates little awareness about the relevance of gathering detailed information during clinical examination.

The Role Descriptions of Triage Nurse in Emergency Department: A Delphi Study.

Background. Triage nurses play a pivotal role in the emergency department. However some researchers have attempted to expand triage nurse's role; remarkable discrepancies exist among scholarly communities. The aim was to develop a role description of triage nurse relying on the experts. Methods. A modified Delphi study consisting of 3 rounds was performed from March to October 2014. In the first round, an extensive review of the literature was conducted. Expert selection was conducted through a purposeful sample of 38 emergency medicine experts. Results. Response rates for the second and third rounds were 37% and 58%. Average age of panelists was (38.42 ± 5.94) years. Thirty-nine out of 54 items reached to the final round. Prioritizing had the higher agreement rate and least agreement on triage related interventions. Conclusion. Triage nursing as a relatively new role for nurses needs significant development to be practiced. Comprehensive educational programs and developmental research are required to support diagnostic and therapeutic interventions in triage practice by nurses.

Immunohistochemical Performance of Estrogen and Progesterone Receptor Antibodies on the Dako Omnis Staining Platform: Evaluation in Multicenter Studies.

The analysis of estrogen receptor (ER) and progesterone receptor (PR) expression levels by immunohistochemistry is an important part of the initial evaluation of breast cancer and critically important in treatment planning. Anti-ERα (clone EP1) and anti-PR (clone PgR 1294) antibodies are in development for the Dako Omnis automated staining platform. These antibodies are not yet commercially available and are in performance evaluation, including the 4 international, multicenter studies reported here. For each antibody, a reproducibility study and a method comparison study was done in a randomized manner in order to test the antibodies under conditions closest to real-world user conditions. The reproducibility studies included 5 staining runs on the Dako Omnis with 20 formalin-fixed and paraffin-embedded human breast carcinoma specimens in 3 independent laboratories, and the method comparison studies included several hundred specimens stained on the Dako Omnis and on the Autostainer Link 48 platforms. Stained slides were evaluated for nuclear ER or PR expression according to American Society of Clinical Oncology/College of American Pathologists guidelines (≥1% cut-off for positive) by pathologists who were blinded from the staining method and specimen ID. For both anti-ERα (clone EP1) and anti-PR (clone PgR 1294) on the Dako Omnis, high reproducibility agreement rates were obtained on the interrun, interlaboratory, and interobserver endpoints. High concordance rates were observed between the specimens stained on the Dako Omnis platform and the Autostainer Link 48 platform. Staining quality was excellent for both anti-ERα (clone EP1) and anti-PR (clone PgR 1294) on the Dako Omnis. These results suggest that these antibodies are reliable and reproducible tools for immunohistochemistry analysis of ER and PR expression levels in formalin-fixed and paraffin-embedded breast carcinoma tissues on the Dako Omnis platform.

Phone and Video-Based Modalities of Central Blinded Adjudication of Modified Rankin Scores in an Endovascular Stroke Trial.

The standard outcome measure in stroke research is modified Rankin scale (mRS) evaluated by local blinded investigators. We aimed to assess feasibility and reliability of 2 central adjudication methods of mRS in the setting of a randomized endovascular stroke trial. This is a secondary analysis derived from the Randomized Trial of Revascularization With Solitaire FR Device Versus Best Medical Therapy in the Treatment of Acute Stroke Due to Anterior Circulation Large Vessel Occlusion Presenting Within Eight Hours of Symptom Onset (REVASCAT) trial cohort. Primary outcome was distribution of mRS at 90 days. Local evaluation was done by certified investigators masked to treatment assignment using structured face-to-face interviews. In addition, central assessment was performed by 2 independent raters via structured phone interview (n=120) and via video recordings of the face-to-face interviews with local investigators (n=106). Interrater agreement was evaluated using kappa and discordance statistics. Sensitivity analyses for the primary end point using different adjudication approaches were performed. Correlation between mRS obtained with each modality and 24-hour follow-up infarct volumes was studied. Using local evaluation as the reference, higher agreement rates were noted with central video than with central phone evaluations (kw 0.92 [0.88-0.96] versus 0.77 [0.72-0.83]). Discrepancies in mRS scoring between local and central raters (phone- and video-based) were similar in both treatment allocation arms. Sensitivity analyses showed benefit of endovascular treatment irrespective of adjudication method, but higher odds ratios were observed with local evaluations. Final infarct volume was similarly correlated with mRS across all 3 evaluation modalities. Central adjudication of mRS is feasible, reducing interrater variability and avoiding potential problems related to lack of blinding. Our findings may have implications in the planning of future randomized acute stroke trials, especially in those including nonpharmacological interventions. URL: http://www.clinicaltrials.gov. Unique identifier: NCT01692379.

Evaluation of a Self-Test Device Used in Allergic Contact Dermatitis

Considering the scarcity of dermatologic resources in many parts of the world, self-testing by patients is not only of interest for internal medicine but also for dermatology. In this open, nonrandomized, multicenter diagnostic trial involving subjects with suspected contact sensitization to nickel and/or a fragrance mix, we assessed the agreement of self-testing by subjects with readings made by dermatologists. The self-test product (Nixema^TM) is based on Thin-Layer Rapid Use Epicutaneous Test (TRUE Test®) technology. One hundred and sixty-five subjects self-tested the ready-made patch-test product. The test was applied for 48 h and then read after 3 or 4 days. It was also evaluated independently by experienced dermatologists after 3 or 4 days. In the 162 evaluable subjects, the proportion of agreement for both allergens together was 89.5% [95% confidence interval (CI) 83.7-93.8], the sensitivity was 97.5 % (95% CI 86.8-99.9) and the specificity was 86.9% (95% CI 79.6-92.3). Cohen's kappa was also high at 0.749 (95% CI 0.637-0.862). Discrepancies between the subjects' readings and the dermatologists' readings were mainly due to the subjects interpreting reactions of ‘irritant' or ‘doubtful' as ‘positive'. Apart from itching and burning sensations and tape irritation, no side effects were observed. In conclusion, this study showed a high rate of agreement between the self-reading of the upper arm and the readings made by the dermatologists. The upper arm proved to be an appropriate area for self-testing. Self-testing may improve the screening for contact sensitization for patients, particularly where dermatologic health resources are scarce.

Effectiveness of three electronic apex locators to determine root canal working length.

The aim of this study was to evaluate in vivo the accuracy of three electronic apex locators (EALs) in determining working length (WL) using hand files and a wear technique. Thirty two premolars that were completely formed apically and that were scheduled for extraction for orthodontic reasons from patients between ages of 15 and 20 years old were included. Electronic measurement of WL was performed using the EAL according to the manufacturer’s instructions. The following three EAL were used: A. Root ZX II; B. Raypex 5, and C. Propex II. There were significant difference (p = 0,0002) when comparing median differences among the three EAL. Statistical analysis revealed significant differences between Root ZX II vs. Raypex 5 and Root ZX II vs. Propex II (p = 0,0044; p = 0,0002), while between Raypex 5 and Propex II, there were no statistically significant differences with respect to the accuracy of the EAL in determining WL (p = 0,1087). The present findings suggest that Root ZX II presented the highest agreement rate for determining the final WL.