Krippendorff's Alpha Coefficient Research Articles

Real-Time Ultrasonography and the Evaluation of Static Images Yield Different Results in the Assessment of EU-TIRADS Categories.

The studies on the effectiveness of various TIRADS in the diagnostics of thyroid nodules differ in the method of ultrasound image assessment: real time (rtUS) vs. static ultrasonography (stUS). The aim of the study was to evaluate the impact of those two methods on the categorization of nodules in EU-TIRADS. Three experienced raters assessed 842 nodules in routine rtUS and reassessed with the use of sUS. Reproducibility of the assessment of malignancy risk features and categorization of nodules with EU-TIRADS was estimated with Krippendorff's alpha coefficient (Kα). The reproducibility of EU-TIRADS categories on sUS in relation to rtUS was in range 70.9-76.5% for all raters (Kα: 0.60-0.68) with the highest reproducibility for category 3 (80.0-86.5%) and the lowest for category 5 (48.7-77.8%). There was a total disagreement of the identification of microcalcifications on sUS in relation to rtUS, a strongly variable reproducibility of marked hypoechogenicity (12.5-84.6%, Kα: 0.14-0.48) and a tendency toward more frequent identification of the non-oval shape on sUS. The percentage of agreement for each pair of raters in assigning the EU-TIRADS category on sUS was in the range 71.6-72.3% (Kα: 0.60-0.62). The method of sonographic image evaluation influences the nodule's feature assessment and, eventually, the categorization within EU-TIRADS.

The utility of standing knee radiographs for detection of lipohemarthrosis: comparison with supine horizontal beam radiographs.

Lipohemarthrosis is a key finding in acute trauma patients and indicates an intra-articular fracture. The horizontal beam lateral radiography with supine position is known to be the best technique to demonstrate knee lipohemarthrosis. Our main purpose was to compare the sensitivity of supine and standing lateral knee radiographs to detect lipohemarthrosis. In our retrospective study, consecutive patients with lipohemarthrosis on computed tomography of the knee between October 2019 and September 2021 were included. Fractured bone, the presence of lipohemarthrosis, and image quality in both standing and supine anteroposterior and lateral knee radiographs were evaluated. Interobserver reliability of the three observers was calculated. Fisher exact chi-square and z-proportion tests were used to compare lateral and anteroposterior knee radiographs. Krippendorff's Alpha and Kappa coefficients were used for inter-observer agreement. A total of 61 patients (38 men [62.3%], 23 women [37.7%]; mean age, 43years ± 17 [standard deviation]) were included. The most common type of fracture was isolated tibial fractures (n = 32; 52.5%). The sensitivity of showing lipohemarthrosis of standing lateral knee radiographs (95.5%) was higher than supine lateral radiographs (38.5%) (p < 0.001). While non-optimal image quality did not affect lipohemarthrosis detection on lateral radiographs (p > 0.99), it caused a significant decrease in the diagnosis of lipohemarthrosis on anteroposterior radiographs (p = 0.036). We found a good-excellent interobserver agreement in lipohemarthrosis detection. Standing lateral radiographs have higher sensitivity than supine lateral radiographs in detecting lipohemarthrosis and are beneficial for detecting lipohemarthrosis which indicates the presence of occult-evident intraarticular fracture in patients with knee trauma. Standing lateral knee radiographs offer a useful method for reducing the misdiagnosis of the occult intra-articular fractures by showing the fat-fluid leveling more clearly. Its advantages may be more prominent when the advanced imaging modalities are limited. • Fat-fluid level (lipohemarthrosis) is an important radiographic sign to assess patients with acute trauma. It almost always indicates an intra-articular fracture. • Our retrospective study results support that lipohemarthrosis sign could be observed more frequently in standing lateral knee radiographs than in supine lateral radiographs. • Knee trauma patients, when available, should be evaluated with standing lateral radiographs for the diagnosis of lipohemarthrosis.

Decoding Communicative Intent: Rhetoric Moves and Metadiscourse in DepEd Funded Research Papers

This study sought to decode the communicative intent of the analyzed rhetoric moves and metadiscourse markers of basic and action research funded under the Department of Education’s Basic Education Research Fund (BERF). Genre Analysis was used to analyze the corpora of the 30 BERF papers completed from 2016-2022. With the aid of coding sheets, the following structures were used: a combination of Hardjanto’s (1997; 2017) and Kosasih’s (2018) Abstract; Swales and Feak’s (2012) Introduction, Mc Combes’ (2019; 2021) Research Questions; Kwan’s (2006) Literature Review; DepEd’s Innovation, Intervention, and Strategy; a combination of Lim (2006), Peacock (2011), Kanoksilapatham (2012) and Huang’s (2014) Methodology; Swales and Feak’s (2012) Results and Discussion, and Yang &amp; Allison’s (2003) Conclusion and Recommendation moves and steps framework. Using the Krippendorff alpha coefficient, the inter-rater reliability of the coders was set at almost perfect agreement (0. 838 or 84%). Generally, 26 obligatory, 31 optional, and 25 non-obligatory moves and steps were identified per the research section. Metadiscourse markers were determined utilizing AntConc 4.0.10 and were ranked as follows: (1) Evidentials, (2) Transition, (2) Self-mentions, (4) Code glosses, (5) Frame Markers, (6) Attitude Markers, (7) Hedges, (8) Engagement Markers, (9) Boosters, and (10) Endophoric Markers. Integrating the rhetoric moves, steps, and markers, the researcher came up with the six communicative intents (Inform, Outline, Convince, Explain, Present, Integrate) in writing research. A structure for writing BERF research proposal and completed papers were crafted in response to the findings. This study shall promote the culture of research, contribute to the growing literature, address gaps, and open opportunities for follow-up studies. Keywords: Communicative intent, genre analysis, metadiscourse, rhetoric moves, research papers

Mental Action Way of Understanding (WoU) and Way of Thinking (WoT) Students in Statistics Learning in Higher Education

This study aims to examine in depth the Mental Action Way of Understanding (WoU) and Way of Thinking (WoT) of students in learning Statistics in Higher Education and the relationship between WoU and WoT. This research is qualitative research using the Grounded Theory approach. The participants involved were 36 people in the city of Bandung, West Java, Indonesia. Validity and reliability using the Krippendorff content analysis method with the Inter-coder Agreement (ICA) test using Krippendorff alpha coefficients. The results showed that there was a significant relationship between students' mental action statistics and students' WoU and WoT in Statistical Understanding and Thinking. The relationship between WoU and WoT: (1) Students’ WoU will build such a statistical framework. (2) Students’ WoT affects how statistical modeling from their statistical knowledge. This relationship fits the philosophy of statistics and inductive inference. The statistical mental action of WoU students was to make models, analyze, calculate and generalize. The mental actions of Statistics students from WoT were interpreting, analyzing, predicting, reasoning, and inferring. The WoU and WoT mental action models developed the PPDC Cycle model and the Gal’s statistical literacy model. the PPDAC Cycle model by Wild and Pfankuch, consists of five dimensions, and one of the dimensions was the PPDAC Cycle. The statistical literacy model by Gal consists of two dimensions, namely the dimensions of statistical knowledge and disposition. The novelty of this research was developing the PPDAC Cycle statistical thinking model by Wild and Pfankuch, and the statistical literacy model on the statistical knowledge dimension by Gal. This study's results can be considered in designing statistical learning in universities and measuring students' understanding and statistical thinking skills.

Assessment of Mathematical Reasoning Competence in Accordance with PISA 2021 Mathematics Framework

The aim of this study is to develop a rubric to evaluate mathematical reasoning proficiency. Within the scope of this purpose, each of the actions expected from the reasoning process in the PISA 2021 Mathematics Framework was taken as criteria by the researchers and a rubric was created. Data were collected from 30 primary school mathematics teachers with the data collection tool containing reasoning questions prepared by the researchers and these data were analyzed using the finalized rubric. In reliability analysis; The "percentage of agreement" among researchers was used to determine the criteria included in the rubric and to be followed with the data collection tool, "Cohen's kappa coefficient" and "Krippendorff's alpha coefficient" methods were used for the agreement between the raters after the analysis of the collected data. The findings show that the Reasoning Competence Rubric (RCR), which consists of 12 criteria, is valid and reliable at a sufficient level.

Role of immunohistochemistry for interobserver agreement of Peritoneal Regression Grading Score in peritoneal metastasis

Pressurized intraperitoneal aerosol chemotherapy (PIPAC)-directed therapy is a new treatment option for peritoneal metastasis (PM). The 4-tiered Peritoneal Regression Grading Score (PRGS) has been proposed for assessment of histological treatment response. We aimed to evaluate the effect of immunohistochemistry (IHC) on interobserver agreement of the PRGS. Hematoxylin and eosin (H&E)-stained and IHC-stained slides (n=662) from 331 peritoneal quadrant biopsies (QBs) taken prior to 99 PIPAC procedures performed on 33 patients were digitalized and uploaded to a web library. Eight raters (five consultants and three residents) assessed the PRGS, and Krippendorff's alpha coefficients (α) were calculated. Results (IHC-PRGS) were compared with data published in 2019, using H&E-stained slides only (H&E-PRGS). Overall, agreement for IHC-PRGS was substantial to almost perfect. Agreement (all raters) regarding single QBs after treatment was substantial for IHC-PRGS (α=0.69, 95% confidence interval [CI] = 0.66-0.72) and moderate for H&E-PRGS (α=0.60, 95% CI = 0.56-0.64). Agreement (all raters) regarding the mean PRGS per QB set after treatment was higher for IHC-PRGS (α=0.78, 95% CI = 0.73-0.83) than for H&E-PRGS (α=0.71, 95% CI = 0.64-0.78). Among residents, agreement was almost perfect for IHC-PRGS and substantial for H&E-PRGS. Agreement (all raters) regarding maximum PRGS per QB set after treatment was substantial for IHC-PRGS (α=0.61, 95% CI = 0.54-0.68) and moderate for H&E-PRGS (α=0.60, 95% CI = 0.53-0.66). Among residents, agreement was substantial for IHC-PRGS (α=0.66, 95% CI = 0.57-0.75) and moderate for H&E-PRGS (α=0.55, 95% CI = 0.45-0.64). Additional IHC seems to improve the interobserver agreement of PRGS, particularly between less experienced raters.

Taphonomic study on drowned victims in a non-sequestered aquatic environment in the Mediterranean Sea

Human decomposition in sea water poses several challenges to forensic practitioners tasked with the analysis of drowned bodies. Postmortem changes in the marine environment have not been extensively investigated and the current literature is mainly based on bodies retrieved from shallow waters or on limited samples. On 18 April 2015, a fishing boat carrying allegedly 1,000 migrants sank in the Mediterranean Sea. In a fifteen-month time span, humanitarian missions were carried out to recover the bodies from the sea. The present study investigates postmortem changes on the drowned victims in a non-sequestered environment in the Mediterranean Sea. A retrospective study was performed by two observers on the autopsy photographic records in the series of bodies recovered from the open sea. For 184 bodies, the postmortem changes were evaluated according to facial, body, limb, and total aquatic decomposition score (FADS, BADS, LADS, TADS, respectively). Furthermore, a modification to the current scoring system that divides upper and lower limbs was suggested. The interobserver agreement was assessed using Krippendorff's alpha coefficient. Possible relations between the decomposition scores and PMSI were investigated with Pearson correlation analysis. According to the sequence of the recovery missions, increasing FADS, BADS, LADS, and TADS were observed. The modified scoring system showed a strong agreement between observers, allowing a more accurate description of the actual extent of decomposition. The scores showed a significant relation with the PMSI (p < 0.01). Prolonged submersion in the open marine environment was confirmed to show increasing decomposition rates, from moderate decay to full disarticulation. This study provides a descriptive unicum of the postmortem changes in the open sea, which may contribute to strengthen the discipline and aid description of bodies recovered in similar circumstances, especially if a body needs to be associated to a disaster or period with respect to another, thus facilitating families or authorities in the search for specific victims.

Creatinine correction to account for fluid overload in children with acute respiratory distress syndrome treated with extracorporeal membrane oxygenation: an initial exploratory report

Creatinine is distributed between the intracellular and extracellular compartments, and as a result, the measurement of its concentration is strongly related to the fluid status of the patient. An interest has been shown in correcting measured serum creatinine levels according to the fluid balance in order to better specify the degree of acute kidney injury(AKI). We conducted a retrospective observational study of 33 children, aged 0 to 5years, admitted to the pediatric intensive care unit for acute respiratory distress syndrome treated by extracorporeal membrane oxygenation. We compared measured and corrected creatinine and assessed the degree of agreement between these values using both Cohen's kappa and Krippendorff's alpha coefficient. In our cohort, 37% of the classifications made according to measured creatinine levels were erroneous and, in the majority of cases, the degree of AKI was underestimated. Correction of the measured creatinine value according to the degree of fluid overload may result in more accurate diagnosis of AKI. Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary information.

Heterogeneous indications and the need for viability assessment: An international survey on the use of machine perfusion in liver transplantation.

Although machine perfusion (MP) is being increasingly adopted in liver transplantation, indications, timing, and modality are debated. To investigate current indications for MP a web‐based Google Forms survey was launched in January 2021 and addressed to 127 experts in the field, identified among first and corresponding Authors of MP literature in the last 10 years. The survey presented 10 real‐life cases of donor–recipient matching, asking whether the liver would be accepted (Q1), whether MP would be used in that particular setting (Q2) and, if so, by which MP modality (Q3) and at what timing during preservation (Q4). Respondents could also comment on each case. The agreement was evaluated using Krippendorff's alpha coefficient. Answers from 39 (30.1%) participants disclosed significant heterogeneity in graft acceptance, MP indications, technique, and timing. Agreement between respondents was generally poor (Q1, α = 0.11; Q2, α = 0.14; Q3, α = 0.12, Q4, α = 0.11). Overall, respondents preferred hypothermic MP and an end‐ischemic approach in 56.3% and 81.1% of cases, respectively. A total of 18 (46.2%) participants considered only one MP approach, whereas 17 (43.6%) and 3 (7.7%) considered using alternatively 2 or 3 different techniques. Of 38 comments, 17 (44.7%) were about the use of MP for graft viability assessment before implantation. This survey shows considerable variability in MP indications, emphasizing the need to identify scenarios of optimal utilization for each technique. Viability assessment emerges as a fundamental need of transplant professionals when considering the use of MP.

Evaluation and impact of fetal physiology training on fetal heart rate analysis

IntroductionEvaluation of fetal well-being during labor is based on fetal heart rate (FHR) analysis, which requires physiology expertise. The aim of the present study was to assess medical residents’ fetal physiology training in terms of theoretical knowledge, FHR interpretation, and use of second-line examinations. MethodsThis single-center, prospective study of obstetrics and gynecology residents (N = 34) at CHU de Lille Hospital (Lille, France) was conducted from November 2017 to November 2018. Evaluation and training were conducted in three stages. First, residents’ pre-training knowledge of FHR interpretation and use of fetal scalp blood sampling (FBS) was assessed using clinical cases. Second, a didactic training session on fetal physiology was delivered. Finally, post-training knowledge was evaluated using the same cases presented during pre-training. iPre-training, 3%, 11.8%, and 14.7% of residents considered their training on fetal physiology, FHR analysis, and second-line examinations, respectively, to be sufficient. Training significantly improved their theoretical knowledge, which was assessed using multiple-choice questions (median [interquartile range]: 1.5 [1.0–2.0] vs. 4.0 [3.0–4.5], p<0.001), and reduced the number of FBS requested (36.3% vs. 29.5%, p = 0.002). Krippendorff's alpha coefficient for the reproducibility of residents’ responses improved significantly, reflecting greater homogenization of clinical practice decisions (alpha [95% confidence interval]: 0.60 [0.55–0.65] vs. 0.72 [0.67–0.76]). ConclusionImproved fetal physiology knowledge promotes more accurate FHR interpretation, better indications for second-line examinations, and greater homogenization of clinical practice decisions. Future studies should evaluate the impact of fetal physiology training on clinical practice.

Quantitation of cancer treatment response by 2-[18F]FDG PET/CT: multi-center assessment of measurement variability using AUTO-PERCIST\u2122

BackgroundThe aim of this study was to assess the reader variability in quantitatively assessing pre- and post-treatment 2-deoxy-2-[18F]fluoro-d-glucose positron emission tomography/computed tomography ([18F]FDG PET/CT) scans in a defined set of images of cancer patients using the same semi-automated analytical software (Auto-PERCIST™), which identifies tumor peak standard uptake value corrected for lean body mass (SULpeak) to determine [18F]FDG PET quantitative parameters.MethodsPaired pre- and post-treatment [18F]FDG PET/CT images from 30 oncologic patients and Auto-PERCIST™ semi-automated software were distributed to 13 readers across US and international sites. One reader was aware of the relevant medical history of the patients (readreference), whereas the 12 other readers were blinded to history but had access to the correlative images. Auto-PERCIST™ was set up to first automatically identify the liver and compute the threshold for tumor measurability (1.5 × liver mean) + (2 × liver standard deviation [SD]) and then detect all sites with SULpeak greater than the threshold. Next, the readers selected sites they believed to represent tumor lesions. The main performance metric assessed was the percent change in the SULpeak (%ΔSULpeak) of the hottest tumor identified on the baseline and follow-up images.ResultsThe intra-class correlation coefficient (ICC) for the %ΔSULpeak of the hottest tumor was 0.87 (95%CI: [0.78, 0.92]) when all reads were included (n = 297). Including only the measurements that selected the same target tumor as the readreference (n = 224), the ICC for %ΔSULpeak was 1.00 (95%CI: [1.00, 1.00]). The Krippendorff alpha coefficient for response (complete or partial metabolic response, versus stable or progressive metabolic disease on PET Response Criteria in Solid Tumors 1.0) was 0.91 for all reads (n = 380) and 1.00 including for reads with the same target tumor selection (n = 270).ConclusionQuantitative tumor [18F]FDG SULpeak changes measured across multiple global sites and readers utilizing Auto-PERCIST™ show very high correlation. Harmonization of methods to single software, Auto-PERCIST™, resulted in virtually identical extraction of quantitative tumor response data from [18F]FDG PET images when the readers select the same target tumor.

MRI LI-RADS Version 2018: Impact of and Reduction in Ancillary Features.

OBJECTIVE. The purpose of this study is to determine the impact of LI-RADS ancillary features on MRI and to ascertain whether the number of ancillary features can be reduced without compromising LI-RADS accuracy. MATERIALS AND METHODS. A total of 222 liver observations in 81 consecutive patients were identified on MRI between August 2013 and December 2018. The presence or absence of major and ancillary features was used to determine the LI-RADS category for LR-1 to LR-5 observations. Final diagnosis was established on the basis of pathologic findings or one of several composite clinical reference standards. Diagnostic accuracy was compared with and without ancillary features by use of the z test of proportions. Decision tree analysis and machine learning-based feature pruning were used to identify noncontributory ancillary features for LI-RADS categorization. Interobserver agreement with and without ancillary features was measured using the Krippendorff alpha coefficient, and comparisons were made using bootstrapping. A p < .05 was considered statistically significant. RESULTS. Application of ancillary features resulted in a change in the LI-RADS category of seven hepatocellular carcinomas (HCCs), with the category of six of seven (86%) HCCs upgraded; 51 benign observations also had a change in LI-RADS category, with the category of 33 (65%) of these observations downgraded. When ancillary features were applied, the percentage of HCCs in each LI-RADS category did not differ significantly compared with major features alone (p = .06-.49). Decision tree analysis and the machine learning model identified five ancillary features as noncontributory: corona enhancement, nodule-in-nodule, mosaic architecture, blood products in mass, and fat in a mass, more than in adjacent liver. Interobserver agreement was high with and without application of ancillary features; however, it was significantly higher without ancillary features (p < .001). CONCLUSION. Although ancillary features are an important component of LI-RADS, their impact may be small. Several ancillary features likely can be removed from LI-RADS without compromising diagnostic performance.

Krippendorffsalpha: An R Package for Measuring Agreement Using Krippendorff's Alpha Coefficient

R package krippendorffsalpha provides tools for measuring agreement using Krippendorff's Alpha coefficient, a well-known nonparametric measure of agreement (also called inter-rater reliability and various other names). This article first develops Krippendorff's Alpha in a natural way, and situates Alpha among statistical procedures. Then the usage of package krippendorffsalpha is illustrated via analyses of two datasets, the latter of which was collected during an imaging study of hip cartilage. The package permits users to apply the Alpha methodology using built-in distance functions for the nominal, ordinal, interval, or ratio levels of measurement. User-defined distance functions are also supported. The fitting function can accommodate any number of units, any number of coders, and missingness. Bootstrap inference is supported, and the bootstrap computation can be carried out in parallel.

Evaluation of a deformable image registration quality assurance tool for head and neck cancer patients.

IntroductionA challenge in implementing deformable image registration (DIR) in radiation therapy planning is effectively communicating registration accuracy to the radiation oncologist. This study aimed to evaluate the MIM® quality assurance (QA) tool for rating DIR accuracy.MethodsRetrospective DIR was performed on CT images for 35 head and neck cancer patients. The QA tool was used to rate DIR accuracy as good, fair or bad. Thirty registered patient images were assessed independently by three RTs and a further five patients assessed by five RTs. Ratings were evaluated by comparison of Hausdorff Distance (HD), Mean Distance to Agreement (MDA), Dice Similarity Coefficients (DSC) and Jacobian determinants for parotid and mandible subregions on the two CTs post‐DIR. Inter‐operator reliability was assessed using Krippendorff's alpha coefficient (KALPA). Rating time and volume measures for each rating were also calculated.ResultsQuantitative metrics calculated for most anatomical subregions reflected the expected trend by registration accuracy, with good obtaining the most ideal values on average (HD = 7.50 ± 3.18, MDA = 0.64 ± 0.47, DSC = 0.90 ± 0.07, Jacobian = 0.95 ± 0.06). Highest inter‐operator reliability was observed for good ratings and within the parotids (KALPA 0.66–0.93), whilst ratings varied the most in regions of dental artefact. Overall, average rating time was 33 minutes and the least commonly applied rating by volume was fair.ConclusionResults from qualitative and quantitative data, operator rating differences and rating time suggest highlighting only bad regions of DIR accuracy and implementing clinical guidelines and RT training for consistent and efficient use of the QA tool.

Interobserver Variability in Assessment of Renal Mass Biopsies.

The main goal of this study was to assess the histopathological efficacy of renal mass biopsy and to check the concordance between pathological results and biopsy of the final specimen, as well as interobserver variability in the assessment of biopsy cores. A hundred sets of core biopsies of postoperative specimens (renal masses) have been performed. Three core biopsies of the intact specimen had been performed once the kidney with the tumor, or the tumor alone were resected. The urologist aimed to obtain two cores from the peripheral sides of the tumor and one core from its center. The surgical specimen was evaluated by a single pathologist, whereas biopsy samples were referred to three independent pathologists who were blinded to the final results of the renal mass biopsy. Nondiagnostic biopsy rates ranged from 13% to 22%. Sensitivity and specificity ranged 83-97% and 97-99% by excluding nondiagnostic results. The concordance between assessment of surgical specimen and biopsy in the Fuhrman grading system ranged 36.5-77.0%, respectively. Interobserver agreement between the three pathologists was substantial or moderate, depending on the tumor subtype. The Krippendorff's alpha coefficient, calculated by excluding the nondiagnostic results, was 0.28 (moderate agreement) for the Fuhrman grading system. The agreementregarding grading of biopsies between threepathologists ranged from moderate to substantial.Therefore, a team ofdedicated uropathologists should be engaged in final diagnosis of renal mass biopsy rather than single one before implementing the proper treatment.

Low inter-rater consistency in semantic profiles of tinnitus-like sounds rated by tinnitus patients.

Characterizations of the tinnitus sound percept are always based on a subjective description by the person affected. Since the experimenter cannot have access to the tinnitus percept, it is not possible to verify whether individuals use the adjectives describing the sound in the expected way, i.e., whether a label given to the tinnitus percept corresponds to the label that the experimenter or another individual would give to the same sound percept. However, if it is assumed that tinnitus patients can reliably describe their own tinnitus, then they should also be able to reliably describe tinnitus-like sounds, presented acoustically. In this study, 26 tinnitus patients used a tablet computer to rate 18 pre-defined adjectives on their level of descriptiveness for their own tinnitus percept as well as 17 tinnitus-like sounds presented via headphones. The main interest of the current study was to calculate intraclass correlation (ICC) and Krippendorff's alpha coefficients for the rating profiles of the acoustically-presented sounds, in order to quantify how well the individuals agreed on the ratings of known sounds, i.e., whether the adjectives would receive similar ratings from all participants for a specific tinnitus-like sound. The results show that the level of agreement was low for all adjectives and sounds, meaning that the different individuals did not use the adjectives in a consistent manner. The conclusion is that subjective tinnitus descriptions should be interpreted with great caution, and that the inherent variability involved in the characterization of sounds by naïve listeners can contribute to the observed heterogeneity in tinnitus symptoms and treatment outcomes.

Öğretmenlerin Okuduğunu Anlama Düzeyleri: Temel Eğitim Okullarında Çalışan Öğretmenler Üzerine Bir Araştırma

Bu calismanin amaci, temel egitim okullarinda (ilk ve ortaokul) gorev yapan ogretmenlerinin okudugunu anlama duzeylerinin belirlenmesidir. Arastirma betimsel tarama modeli ile kurgulanmistir. Ankara’da calismakta olan 1415 ogretmen arastirmanin orneklem grubunu olusturmaktadir. Calismada arastirmaci tarafindan gelistirilen ‘Okudugunu Anlamayi Degerlendirme Olcegi’ kullanilmistir. Olcme aracina ait puanlama anahtarinin guvenilirligi Krippendorff'un alfa (α) katsayisi, Cohen'in kappa (κ) katsayisi, Pearson moment carpim katsayisi kullanilmistir. Veriler, betimsel istatistik teknikleri kullanilarak cozumlenmistir. Arastirma sonuclarina gore, ogretmenler oykuleyici metinleri ‘iyi’, bilgilendirici metinleri ‘zayif’ duzeyde anlamaktadir. Genel olarak ogretmenler, okuduklarini ‘orta’ duzeyde anlamaktadirlar. Bunun yaninda ogretmenlerin demografik ozellikleriyle (cinsiyet, mesleki kidem, brans ve ogrenim durumlari) okudugunu anlama duzeyi arasinda anlamli farklilik bulunmaktadir. Erkek, lisansustu mezunu ve mesleki kidemi fazla olan ogretmenler, okuduklarini daha fazla anlamaktadirlar. Ayrica, genel okudugunu anlama duzeyi, Turkce ogretmenlerinde iyi; beden egitimi, gorsel sanatlar, muzik ile teknoloji ve tasarim dallarindaki ogretmenlerinde zayif; bilisim teknolojileri, din kulturu ve ahlak bilgisi, fen ve teknoloji, matematik, okul oncesi, rehberlik, sinif, sosyal bilgiler ve yabanci dil ogretmenlerinde orta duzeyde oldugu belirlenmistir. Bu arastirmada ogretmenlerin okudugunu anlama duzeylerindeki yetersizlik gorunur kilinmistir. Alanyazindaki onemli bir bosluga isaret eden bu calisma, okudugunu anlama calismalarinin hizmet oncesi ve hizmetici donemi kapsayacak sekilde genisletilmesi acisindan onem tasimaktadir.

High-performance judo: identification of the organisational factors influencing international sporting success

ABSTRACT Research question: As sports are different by nature, can their respective specificities influence their systems? This research offer insight into sport policies and systems at a sport-specific level. Research methods: To identify the organisational factors, we interviewed 33 Olympic judo experts. The study employed content analysis with a deductive-inductive approach and used the Krippendorff's alpha coefficient to verify the reliability. Results and Findings: Despite the historical and cultural characteristics in each sport, and different contexts in different countries, a total of 44 subcategories emerged (organisational factors). They were subsequently clustered into 11 categories that represent a possible systemic model. Implications: In terms of its theoretical contribution, this research enhances the understanding of sport systems at a sport-specific level. In terms of practical implications, the results offer a framework for empirically assessing the development and management of sport systems in the context of judo and in other combat sports.

Multi-institutional re-evaluation of prognostic factors in chromophobe renal cell carcinoma: proposal of a novel two-tiered grading scheme.

A histological grading system of chromophobe renal cell carcinoma (chRCC) is highly desirable to identify approximately 5-10% of tumors at risk for progression. Validation studies failed to demonstrate a correlation between the four-tiered WHO/ISUP grade and outcome. Previous proposals with three-tiered chromophobe grading systems could not be validated. In this study, the presence of sarcomatoid differentiation, necrosis, and mitosis was analyzed in a Swiss cohort (n = 42), an Italian cohort (n = 103), a German cohort (n = 54), a Japanese cohort (n = 119), and The Cancer Genome Atlas cohort (n = 64). All 3 histological parameters were significantly associated with shorter time to tumor progression and overall survival in univariate analysis. Interobserver variability for identification of these parameters was measured by Krippendorff's alpha coefficient and showed high concordance for the identification of sarcomatoid differentiation and tumor necrosis, but only low to medium concordance for the identification of mitosis. Therefore, we tested a two-tiered tumor grading system (low versus high grade) based only on the presence of sarcomatoid differentiation and/or necrosis finding in the combined cohorts (n = 382). pT stage, patient's age (> 65 vs ≤ 65), lymph node and/or distant metastasis, and the two-tiered grading system (low versus high grade) were significantly associated with overall survival and were independent prognostic parameters in multivariate analysis (Cox proportional hazard). This multi-institutional evaluation of prognostic parameters suggests tumor necrosis and sarcomatoid differentiation as reproducible components of a two-tiered chromophobe tumor grading system.

Global Health Education in UK Medical Schools (GHEMS) study protocol

# Background Global health is the study, research, and practice of medicine focused on improving health and achieving health equity for all persons worldwide. Such focuses are core tenets of modern medical practice. The General Medical Council (GMC) have published several documents that outline specific global health learning outcomes and competencies that are essential, non-elective components of UK medical school curricula. However, there is a paucity of evidence demonstrating that medical schools have integrated these mandatory global health learning outcomes within their curricula. This multicentre study aims to delineate the breadth of global health teaching during undergraduate and graduate entry medical training across UK medical schools. # Methods This national, multi-centre study will involve obtaining timetables containing details of all medical teaching provided at undergraduate and/or graduate entry level at UK medical schools for the academic year 2018/2019. Collaborators at each centre will independently code all timetabled global health learning events (compulsory, optional, or pre-elective), conforming to a pre-devised standard framework that will enable description of teaching events in terms of course year, duration, teaching format, and teaching content. The quantitative and qualitative data will be analysed using descriptive statistics and thematic analysis, respectively. Krippendorff's alpha coefficient will also be utilised to measure the level of agreement between datasets collected independently by different collaborators at the same centre. # Results This study will define, for the first time, the nature and characteristics of global health education within UK medical school curricula. It will capture any differences in the amount of teaching provided on various global health learning outcomes between medical schools. # Conclusions If this study depicts national discrepancies in teaching, it will place the onus on medical schools and the GMC to provide standardised and adequate global health education within the undergraduate and graduate entry medical curriculum. To aid medical schools in achieving this, the study will also identify currently scheduled teaching events at each medical school that could incorporate material related to the mandatory global health learning outcomes.