Major Disagreements Research Articles

Evolution of radiology staff perspectives during artificial intelligence (AI) implementation for expedited lung cancer triage

Evolution of radiology staff perspectives during artificial intelligence (AI) implementation for expedited lung cancer triage

Practical Implications of Sum Scores Being Psychometrics' Greatest Accomplishment.

This paper reflects on some practical implications of the excellent treatment of sum scoring and classical test theory (CTT) by Sijtsma et al. (Psychometrika 89(1):84-117, 2024). I have no major disagreements about the content they present and found it to be an informative clarification of the properties and possible extensions of CTT. In this paper, I focus on whether sum scores-despite their mathematical justification-are positioned to improve psychometric practice in empirical studies in psychology, education, and adjacent areas. First, I summarize recent reviews of psychometric practice in empirical studies, subsequent calls for greater psychometric transparency and validity, and how sum scores may or may not be positioned to adhere to such calls. Second, I consider limitations of sum scores for prediction, especially in the presence of common features like ordinal or Likert response scales, multidimensional constructs, and moderated or heterogeneous associations. Third, I review previous research outlining potential limitations of using sum scores as outcomes in subsequent analyses where rank ordering is not always sufficient to successfully characterize group differences or change over time. Fourth, I cover potential challenges for providing validity evidence for whether sum scores represent a single construct, particularly if one wishes to maintain minimal CTT assumptions. I conclude with thoughts about whether sum scores-even if mathematically justified-are positioned to improve psychometric practice in empirical studies.

"Thoughts & Prayers" or " ❤️ & 🙏 ": How the Release of New Reactions on CaringBridge Reshapes Supportive Communication in Health Crises

Following Facebook's introduction of the "Like" in 2009, CaringBridge (a nonprofit health journaling platform) implemented a "Heart" symbol as a single-click reaction affordance in 2012. In 2016, Facebook expanded its Like into a set of emotion-based reactions. In 2021, CaringBridge likewise added three new reactions: "Prayer", "Happy", and "Sad." Through user surveys (N=808) and interviews (N=13), we evaluated this product launch. Unlike Likes on mainstream social media, CaringBridge's single-click Heart was consistently interpreted as a simple, meaningful expression of acknowledgement and support. Although most users accepted the new reactions, the product launch transformed user perceptions of the feature and ignited major disagreement regarding the meanings and functions of reactions in the high stakes context of health crises. Some users found the new reactions to be useful, convenient, and reducing of caregiver burden; others felt they cause emotional harms by stripping communication of meaningful expression and authentic care. Overall, these results surface tensions for small social media platforms that need to survive amidst giants, as well as highlighting crucial trade-offs between the cognitive effort, meaningfulness, and efficiency of different forms of Computer-Mediated Communication (CMC). Our work provides three contributions to support researchers and designers in navigating these tensions: (1) empirical knowledge of how users perceived the reactions launch on CaringBridge; (2) design implications for improving health-focused CMC; and (3) concrete questions to guide future research into reactions and health-focused CMC.

Intraoperative assessment of axillary sentinel lymph nodes by telepathology.

Although axillary dissection is no longer indicated for many breast cancer patients with 1-2 positive axillary sentinel lymph nodes (ASLN), intraoperative ASLN assessment is still performed in many institutions for patients undergoing mastectomy or neoadjuvant therapy. With recent advancements in digital pathology, pathologists increasingly evaluate ASLN via remote telepathology. We aimed to compare the performance characteristics of remote telepathology and conventional on-site intraoperative ASLN assessment. Data from ASLN evaluation for breast cancer patients performed at two sites between April 2021 and October 2022 was collated. Remote telepathology consultation was conducted via the Aperio eSlideManager system. A total of 385 patients were identified during the study period (83 telepathology, 302 on-site evaluations). Although not statistically significant (P = 0.20), the overall discrepancy rate between intraoperative and final diagnoses was slightly higher at 9.6% (8/83) for telepathology compared with 5.3% (16/302) for on-site assessment. Further comparison of performance characteristics of ASLN assessment between telepathology and conventional on-site evaluation revealed no statistically significant differences between deferral rates, discrepancy rates, interpretive or sampling errors, major or minor disagreements, false negative or false positive results as well as clinical impact and turn-around time (P ≥ 0.12). ASLN assessment via telepathology is not significantly different from conventional on-site evaluation, although it shows a slightly higher overall discrepancy rate between intraoperative and final diagnoses (9.6% vs. 5.3%). Further studies are warranted to ensure accuracy of ASLN assessment via telepathology.

Hypopharyngeal cancer trends in a high-incidence region: A retrospective tertiary single center study.

Hypopharyngeal cancer has the bleakest prognosis among head and neck cancers due to its extensive submucosal involvement, advanced tumor stage, and limited surgical reconstruction options. Its primary causes include alcohol consumption, tobacco use, genetic predisposition, 1` diet, and socioeconomic conditions. While squamous cell carcinoma (SCC) accounts for 95% of hypopharyngeal tumors, it remains a rare form, comprising only 3%-5% of all SCC cases in the head and neck region. Globally, Central and Eastern Europe have the highest incidence rates for males (3.9 per 100000) and the third highest for females (2.26 per 100000), underscoring the significance of this seemingly uncommon condition. In Romania, hypopharyngeal cancer ranked 24th in incidence rate, with 634 new cases in 2020. To study the incidence, treatment and survival rates of hypopharyngeal tumor cases in a major ear, nose, throat (ENT) surgical center. A retrospective epidemiological clinical study was conducted on patients diagnosed and treated for hypopharyngeal cancer at the ENT department of "Carol Davila Central University Emergency Military Hospital" in Bucharest between January 2018 and August 2022. The study included 53 patients and was authorized by the Ethics Committee of Titu Maiorescu Doctoral School (Bucharest, Romania) and the Ethics Committee of Carol Davila Central University Emergency Military Hospital (Bucharest, Romania). Inclusion criteria required a positive histopathological diagnosis of hypopharyngeal cancer, tumor localization in the hypopharyngeal region, and informed consent for data usage. Exclusion criteria involved major psychiatric pathologies and disagreement for data usage. Diagnosis was based on ENT assessment, imaging reports, and laboratory data. Treatment methods were determined based on various factors. Additional tools, such as Adult Comorbidity Evaluation-27 and Karnofski Performance Status Scale, were used for risk assessment and functional capacity evaluation. Quality of life aspects were measured using the European Organisation for Reasearch and Treatment of Cancer Quality of Life Questionnaire Head and Neck-35 questionnaire. Our retrospective study examined 53 patients with hypopharyngeal cancer between January 2018 and August 2022. The majority of patients were male (94.3%), with an average age at diagnosis of 62.5 years. Among the patients, 20.75% were employed, 66.03% were retired, and 9.43% were unemployed. Smoking was prevalent among 69.81% of patients, while alcohol consumption was frequent in 32.07% of cases. The tumors were mostly diagnosed at an advanced stage (stage IV) and were predominantly SCC. Comorbidities were present in 83.01% of patients, with cardiovascular diseases being the most common. Dysphagia and neck mass were the most common symptoms reported. Treatment methods included surgery, radiation therapy, and chemotherapy. A favorable treatment response was observed in 22.64% of cases, while relapse occurred in 6 cases. Follow-up data was unavailable for some patients. In summary, our findings align with existing literature; however, we observed a higher severity.

Investigating the porosity of Enceladus

ABSTRACT The interior of Enceladus, a medium-sized icy moon of Saturn hosts hydrothermal activity and exhibits tidal heating and related geyser-like activity. There are major disagreements in the existing literature on the porosity of the interior due to the different theoretical assumptions on which porosity related calculations are based. We present an application of experimental equations – derived for the Earth – for icy planetary objects and Enceladus in particular. We chose a set of boundary values for our initial parameters from measured porosity values of chondrite samples as references and calculated the porosity related values of Enceladus using various approaches. We present a comprehensive investigation of the effects of using these different porosity calculation methods on icy moons. With our most realistic approach, we also calculated the same values for the Earth and Mars for comparison. Our result for Enceladus is a minimum porosity of about 5 per cent at the centre of the body. For the total pore volume, we estimated 1.51 · 107 km3 for Enceladus, 2.11 · 108 km3 for the Earth and 1.62 · 108 km3 for Mars. Using the same method, we estimated the total pore surface area. From this, we derived that the pore surface under a given 1 km2 area of the surface on Enceladus is about 1.37 · 109 km2, while for the Earth this value is only 5.07 · 107 km2.

Assessment of Mathematics and Science Teachers’ Knowledge and Practice of Feed-back System in Junior High Schools in Hohoe, Ghana

Aim: Teachers' knowledge of feedback systems encompasses their understanding of the purpose and types of feedback, as well as their knowledge of how to design and implement effective feedback processes. The practice of feedback systems refers to the extent to which they implement feedback processes in the classroom. This includes the frequency and quality of feedback provided to students, as well as the use of feedback to guide instructional decisions. Assessing teachers' knowledge and practice of feedback systems in junior high schools is important because effective feedback practices are essential for promoting student learning and academic achievement. This study aimed to assess mathematics and science teachers' Knowledge and Practice of feedback systems in junior high schools in Hohoe, Ghana.
 Methods: A survey research design was used to collect data from 104 mathematics and science teachers using a self-administered questionnaire. Descriptive statistics, Mann-Whitney U test, and Pearson's correlation coefficient were used to analyze the data.
 Results: The results showed that the mean Knowledge score of mathematics and science teachers was 3.12, indicating a majority agreement level of knowledge of feedback system. The mean practice score was 2.12, indicating a majority disagreement level of practice of feedback system in the classroom. There was no significant difference in knowledge and practice scores between male and female teachers. However, an inverse correlation was found between knowledge and practice scores, indicating that teachers with higher knowledge of feedback systems may not necessarily be effective at implementing those systems in practice.
 Conclusion: It was observed that majority of the participants do not practice feedback in their teaching.
 Recommendations: There is need for professional development programs and policies that support effective feedback practices in the classroom. Further research is needed to identify the contextual factors that influence teachers' feedback practices and their understanding of feedback purposes in Ghana.

High Resolution Forest Masking for Seasonal Monitoring with a Regionalized and Colourimetrically Assisted Chorologic Typology

Comparisons of recent global forest products at higher resolutions that are only available annually have shown major disagreements among forested areas in highly fragmented landscapes. A holistic reductionist framework and colourimetry were applied to create a chorologic typology of environmental indicators to map forest extent with an emphasis on large-scale performance, interpretability/communication, and spatial–temporal scalability. Interpretation keys were created to identify forest and non-forest features, and a set of candidate tree cover indices were developed and compared with a decision matrix of prescribed criteria. The candidate indices were intentionally limited to those applying only the visible and NIR bands to obtain the highest possible resolution and be compatible with commonly available multispectral satellites and higher resolution sensors, including aerial and potentially UAV/drone sensors. A new High-Resolution Tree Cover Index (HRTCI) in combination with the Green band was selected as the best index based on scores from the decision matrix. To further improve the performance of the indices, the chorologic typology included two insolation indices, a water index and a NIR surface saturation index, to exclude any remaining spectrally similar but unrelated land cover features such as agriculture, water, and built-up features using a process of elimination. The approach was applied to the four seasons across a wide range of ecosystems in south-eastern Australia, with and without regionalisation, to identify which season produces the most accurate results for each ecoregion and to assess the potential for mitigating the spatial–temporal scaling effects of the Modifiable Spatio-Temporal Unit Problem. Autumn was found to be the most effective season, yielding overall accuracies of 94.19% for the full extent, 95.79% for the temperate zone, and 95.71% for the arid zone. It produced the greatest spatial agreement between two recognised global products, the GEDI forest heights extent and the ESA WorldCover Tree cover class. The performance, transparency, and scalability of the approach should provide the basis for a framework for globally relatable forest monitoring.

Pluralistic sociotechnical imaginaries in Artificial Intelligence (AI) law: the case of the European Union’s AI Act

ABSTRACT This paper asks how lawmakers and other stakeholders envision the potential benefits and challenges arising from Artificial Intelligence (AI). A close reading of the European Union's draft AI Act, a bill proposed by the European Commission in April 2021, and of 302 response papers submitted by NGOs, businesses and business associations, trade unions, academics, public authorities, and citizens, shows that pluralistic sociotechnical imaginaries contest: (1) the essential characteristics of technology as they relate to society, politics, and law; (2) whether, how and how much law can enable, direct or constrain scientific & technological developments; and (3) the degree to which law does and should intervene into scientific & technological controversies. The feedback from stakeholders reveals major disagreements with the lawmakers in terms of how the relevant characteristics of AI should influence legal regulation, what the desired law should look like, and whether and how the law should intervene into expert debates in AI. What is more, different types of stakeholders diverge considerably in what they problematise and how they do so.

The value of a specialized second-opinion pathological diagnosis for oral and maxillofacial lesions

ObjectivesAn error in the diagnosis of an oral or maxillofacial lesion could potentially be detrimental to a patient’s prognosis and management. Major discrepancies between the initial and subsequent diagnoses of head and neck pathologies range from 7 to 53%. This study determined the rate of discrepancies found in the diagnoses of oral and maxillofacial lesions after a second opinion in Saudi Arabia.MethodsA retrospective single-center study was conducted by oral and maxillofacial pathology consultants to review all cases referred for a second opinion to the oral and maxillofacial pathology laboratory between January 2015 and December 2020. If the second-opinion diagnosis matched the original diagnosis, this was described as “agreement.” If the second-opinion diagnosis did not match the original diagnosis but would not change the management or prognosis of a patient, this was classified as a “minor disagreement.” If the second-opinion diagnosis resulted in the changing of a patient’s management or prognosis, this was categorized as a “major disagreement.” Chi-square test and Fisher’s exact test were used to compare data between original and second-opinion diagnoses. A p-value of less than 0.05 was considered significant.ResultsOf 138 cases, 59 (43%) had an initial diagnosis and a second-opinion diagnosis that were in major disagreement. The most common tumor for which there was a major disagreement was squamous cell carcinoma. No single factor influenced the occurrence of major disagreements.ConclusionsOur evaluation reiterates the importance of obtaining a second opinion from a specialist in oral and maxillofacial pathology to improve the diagnostic accuracy for lesions. A formal system for this step, in addition to the obtaining of adequate clinical and radiographic information about a patient, is mandatory for the review of difficult cases.

Association of accelerated approval (AA) status with National Comprehensive Cancer Network (NCCN) guideline recommendation for cancer drug indications: A cross-sectional study.

1599 Background: Many oncology drugs are approved via FDA’s accelerated approval pathway based on trials showing changes to surrogate measures only ‘reasonably likely’ to predict clinical benefit. Despite this preliminary evidence, accelerated approval drugs are incorporated into clinical practice and included in guidelines. We assessed NCCN evidence and preference ratings for drugs with accelerated vs traditional approval. Methods: Accelerated approval oncology drugs were identified using an FDA list as of June 30 2022. Drug labelling revealed other oncology indications of these drugs. Accelerated approvals were stratified if they had been converted to traditional approval after confirmatory studies or withdrawn. Indications with no NCCN guidelines or tumor-agnostic approvals were excluded. Relevant NCCN guidelines were reviewed as of Oct 19 2022. Each indication was assessed for ratings of level of evidence and treatment preference. Levels of evidence included category 1 (consensus, high-level evidence), 2A (consensus, lower-level evidence), 2B (lower-level evidence without consensus), or 3 (major disagreement). Treatment preference rankings included preferred, alternative preferred, other recommended, or useful in certain circumstances. Results: Among 315 indications for 100 drugs, 156 (50%) had traditional approval and 159 (50%) had current or previous accelerated approval. Among accelerated approval indications, 78 (49%) had been converted to traditional approval and 21 (13%) withdrawn. Among all indications, 105 (33%) were rated as category 1 evidence, 185 (59%) as 2A, 6 (2%) as 2B, and 2 (0.6%) as 3. The treatment preference for 153 (49%) was preferred, for 55 (17%) was recommended, for 5 (2%) was alternative preferred, and for 38 (12%) was useful in certain circumstances. Compared to traditional approval, accelerated approval indications less often had category 1 evidence (3% v 47%), and were less often listed as preferred (40% v 58%). Converted accelerated approval indications had mid-range ratings for evidence (38% category 1) and treatment preference (47% preferred). 11 withdrawn accelerated approval indications remained in NCCN guidelines. Conclusions: In most cases, NCCN guidelines identified accelerated approval indications as having lower evidence than traditionally approved cancer drugs. Many traditional approvals and conversions from accelerated approvals had only category 2A evidence, suggesting better evidence is needed for traditional approval of oncology drugs. But in about half of accelerated approval indications withdrawn by the drug’s manufacturer, NCCN continued recommending the drug. Professional organizations like NCCN should ensure their guidelines reflect that accelerated approval drugs are being marketed based on preliminary evidence.

Russia-India cooperation on Post-American Afghanistan

Russian foreign policy has long championed multipolarity in international relations. As relations between Russia and the West have deteriorated, Russia has sought to establish a Eurasian project involving non-Western great powers. India has been identified by Russia as one of the major pillars of this global realignment. However, India’s global reach and power have been undermined by its entanglement in regional disputes and volatile relations with some of its partners. While some minor differences exist on the regional level in Eurasia between Russia and India, a major disagreement has been the role of the Shanghai Cooperation Organization, which Russia views as a global organization, and India sees it as regional. Our analysis suggests that the US military presence in Afghanistan, along with its plans for geoeconomic and geopolitical dominance in Eurasia, has been a major distracting factor in Russia-India relations. The US withdrawal from Afghanistan and the decline of its influence may provide new opportunities for regional cooperation between Russia and India. Our research indicates that Afghanistan may be one such country where the interests of Russia and India can converge. Both countries are interested in a stable and secure Afghanistan, and both may be willing to accept Taliban rule, subject to certain conditions, if it helps achieve that goal. In Central Asia, Russia and India have previously pursued divergent agendas, with Russia being somewhat protective of its natural sphere of interests. However, we conclude that with the elimination of external disturbances in the form of US military occupation of Afghanistan, the interests of both countries could be reconciled in relation to Central Asia. By working in synergy, Russia and India could collaborate more effectively in this region.

Moist Thermodynamics of Convectively Coupled Waves over the Western Hemisphere

Abstract Convectively coupled waves (CCWs) over the Western Hemisphere are classified based on their governing thermodynamics. It is found that only the tropical depressions (TDs; TD waves) satisfy the criteria necessary to be considered a moisture mode, as in the Rossby-like wave found in an earlier study. In this wave, water vapor fluctuations play a much greater role in the thermodynamics than temperature fluctuations. Only in the eastward-propagating inertio-gravity (EIG) wave does temperature govern the thermodynamics. Temperature and moisture play comparable roles in all the other waves, including the Madden–Julian oscillation over the Western Hemisphere (MJO-W). The moist static energy (MSE) budget of CCWs is investigated by analyzing ERA5 data and data from the 2014/15 observations and modeling of the Green Ocean Amazon (GoAmazon 2014/15) field campaign. Results reveal that vertical advection of MSE acts as a primary driver of the propagation of column MSE in westward inertio-gravity (WIG) wave, Kelvin wave, and MJO-W, while horizontal advection plays a central role in the mixed Rossby gravity (MRG) and TD wave. Results also suggest that cloud radiative heating and the horizontal MSE advection govern the maintenance of most of the CCWs. Major disagreements are found between ERA5 and GoAmazon. In GoAmazon, convection is more tightly coupled to variations in column MSE, and vertical MSE advection plays a more prominent role in the MSE tendency. These results along with substantial budget residuals found in ERA5 data suggest that CCWs over the tropical Western Hemisphere are not represented adequately in the reanalysis. Significance Statement In comparison to other regions of the globe, the weather systems that affect precipitation in the tropical Western Hemisphere have received little attention. In this study, we investigate the structure, propagation, and thermodynamics of convectively coupled waves that impact precipitation in this region. We found that slowly evolving tropical systems are “moisture modes,” i.e., moving regions of high humidity and precipitation that are maintained by interactions between clouds and radiation. The faster waves are systems that exhibit relatively larger fluctuations in temperature. Vertical motions are more important for the movement of rainfall in these waves. Last, we found that reanalysis and observations disagree over the importance of different processes in the waves that occurred over the Amazon region, hinting at potential deficiencies on how the reanalysis represents clouds in this region.

Replacement of the Double Meropenem Disc Test with a Lateral Flow Assay for the Detection of Carbapenemase-Producing Enterobacterales and Pseudomonas aeruginosa in Clinical Laboratory Practice.

The prompt detection of carbapenemases among Gram-negative bacteria isolated from patients' clinical infection samples and surveillance cultures is important for the implementation of infection control measures. In this context, we evaluated the effectiveness of replacing phenotypic tests for the detection of carbapenemase producers with the immunochromatographic Carbapenem-Resistant K.N.I.V.O. Detection K-Set lateral flow assay (LFA). In total, 178 carbapenem-resistant Enterobacterales and 32 carbapenem-resistant Pseudomonas aeruginosa isolated in our hospital were tested with both our established phenotypic and molecular testing procedures and the LFA. The Kappa coefficient of agreement for Enterobacterales was 0.85 (p < 0.001) and 0.6 (p < 0.001) for P. aeruginosa. No major disagreements were observed and notably, in many cases, the LFA detected more carbapenemases than the double meropenem disc test, especially regarding OXA-48 in Enterobacterales and VIM in P. aeruginosa. Overall, the Carbapenem-Resistant K.N.I.V.O. Detection K-Set was very effective and at least equivalent to the standard procedures used in our lab. However, it was much faster as it provided results in 15 min compared to a minimum of 18-24 h for the phenotypic tests.

Diagnosis of Small Unruptured Intracranial Aneurysms

PurposeDifferentiating normal anatomical variants such as an infundibulum or a vascular loop from true intracranial aneurysms is crucial for patient management. We hypothesize that high-resolution 7 T magnetic resonance imaging (MRI) improves the detection and characterization of normal anatomical variants that may otherwise be misdiagnosed as small unruptured aneurysms.MethodsThis is a retrospective, single-center study. All patients were scanned on a clinically approved 7 T MRI scanner and on a 3 T scanner. Image analysis was performed independently by three neuroradiologists blinded to clinical information. The presence of an unruptured intracranial aneurysm (UIA) and level of diagnostic certainty were assessed and the interrater agreement was calculated. If an aneurysm was present, the anatomic location and shape were recorded and compared.ResultsIn total, 53 patients with equivocal cerebrovascular findings on 1.5 T or 3 T MRI referred for a 7T MRI examination were included. Aneurysms were suspected in 42 patients examined at 3 T and in 23 patients at 7 T (rate difference 36%, 95% confidence interval, CI, 19–53%, p-value < 0.001). Major disagreement between the field strengths was observed in the A1 segment of anterior cerebral artery/anterior communicating artery (A1/ACOM) complex. The interrater agreement among the readers on the presence of an aneurysm on 7 T MRI was higher than that for 3 T MRI (0.925, 95% CI 0.866–0.983 vs. 0.786, 95% CI 0.700–0.873).ConclusionOur analysis demonstrates a significantly higher interrater agreement and improved diagnostic certainty when small intracranial aneurysms are visualized on 7 T MRI compared to 3 T. In a selected patient cohort, clinical implementation of 7 T MRI may help to establish the definitive diagnosis and thus have a beneficial impact on patient management.

Medication Use Questionnaire for Older Adults in Malaysia: Translation, Cultural Adaptation, and Reliability

ObjectivesThis study aimed to translate the Medication Use Questionnaire into a Malay version, adapt it to Malaysia’s culture, and verify its reliability among Malaysia’s older adults. MethodsMethodological approaches were used to translate, validate, and modify the questionnaire. The subjects were older adults aged ≥ 60 years in primary care settings in Penang, Malaysia. Two forward translations (English to Malay) were developed, reviewed, and back translated to English. The reconciliation phase was conducted to compare the translated and original questionnaires. Five older adults were then interviewed for the cognitive debriefing of the reconciled questionnaire to assess the linguistic and cultural equivalence. Two experts assessed content validity, and the translated questionnaire was proofread and finalized. After that, pilot test was done to examine the internal consistency among 20 older adults. ResultsTranslation of the questionnaire was done with no major disagreements. The main issues identified in cognitive debriefing and content validity were terms, number of questions, and phrases used in the questionnaire. Most participants reported that the questionnaires were not difficult to complete during the cognitive debriefing phase. The issues were then judged and revised accordingly. Further pilot testing on 20 older adults demonstrated good internal consistency reliability, Cronbach α (0.902). ConclusionsThis study findings suggest promising data supporting the use of translated version of the Medication Use Questionnaire that can be used to identify medication use problems among older adults in Malaysia.

Concordance between a gastrointestinal consultant radiologist, a consultant radiologist and qualified reporting radiographers interpreting abdominal radiographs

IntroductionRadiographers can accurately report musculoskeletal and chest radiographs, but there is paucity of research comparing the performance of reporting radiographers (RRs) with consultant radiologists when interpreting and reporting abdominal radiographs. This study assessed interobserver agreement in the clinical setting between reporting radiographers and a consultant radiologist compared to an expert gastrointestinal radiologist in a District General Hospital. Major discordant reports affecting patient management were also examined. Methods126 abdominal radiographs reported by 3 RRs in clinical practice were randomly selected and reported by a consultant radiologist and index gastrointestinal radiologist. The reports of the RRs and consultant radiologist were compared against the reports made by the index radiologist for agreement by a colorectal consultant surgeon. All 126 reports were scored as being in either complete agreement, minor disagreement or major disagreement which would have resulted in a change to patient management. ResultsThere was no significant difference in overall agreement between the consultant radiologist (CR) and RRs when compared to the index radiologist (CR: n = 90/126, 71.4% and RRs: n = 94/126, 74.6%. p = 0.57). Major disagreements were found, but there was no significant difference between both groups (CR: n = 23/126, 18.3% and RRs: n = 17/126, 13.5%. p = 0.30). ConclusionRRs can report abdominal radiographs to a comparable level of agreement as a consultant radiologist in the clinical setting. There was no significant difference in reports deemed to affect patient management. Implications for practiceThis study addresses the gap in assessing the performance of RRs reporting abdominal radiographs. This small scale study indicates that radiographers could provide additional support in the reporting of abdominal radiographs. This would help to reduce radiologist workload and enhance the role of the reporting radiographer. ClassificationAgreement between reporting radiographers and radiologists interpreting and reporting abdominal radiographs.

Complicated Relationships between Anterior and Condylar Guidance and Their Clinical Implications-Comparison by Cone Beam Computed Tomography and Electronic Axiography-An Observational Cohort Cross-Sectional Study.

A complex prosthodontic treatment is believed to be more successful when the condylar path is replicated using the articulator. However, there is an ongoing major disagreement between the researchers as the exact relationship between the posterior and anterior determinants has not been clear. The purpose of this study was to investigate whether the protrusive movement of the mandible does correlate with the temporomandibular joint (TMJ) anatomy or with incised features. Subjects (15 males and 15 females) were qualified for this study based on an initial interview including the following criteria: age 21-23 (+/-1), no history of trauma, orthodontic treatment, or temporomandibular disorders (TMD). For each patient, the angle of the condylar path, incisal guidance angle (IGA), interincisal angle, as well as overbite and overjet were measured on cone beam computed tomography (CBCT). This was followed by the examination with the Modjaw® electronic axiograph recording and calculating the functional sagittal condylar guidance angle (SCGA) for the right and left TMJ during the protrusion. The results show that the mean functional axiographic measurement of SCGA in protrusion significantly correlates with the TMJ anatomy presented on CBCT. Moreover, a significant correlation was found between the values of SCGA in the functional and anatomical measurements in all its variants. It turned out that, statistically, the AB measurement was the most accurate. Finally, results showed that incisal relationships of permanent teeth such as overbite, overjet, incisal guidance angle and interincisal angle do not correlate with TMJ anatomy, and therefore, regarding an analyzed study group, do not affect the TMJ formation in young adults.

Proofs for Eternity, Creation and the Existence of God in Medieval Islamic and Jewish Philosophy By Herbert A. Davidson

This is a most welcome reissue of Davidson’s highly praised book, first published in 1987. The combination in a single book of arguments for the existence of God with arguments for or against the eternity of the universe is neither arbitrary nor a matter of convenience. As Davidson lucidly explains in his introduction, there was no ‘public atheism’ in the medieval period. All Jewish and Islamic thinkers accepted the existence of a deity. However, their conceptions of the deity differed, most critically with regard to the question, does the deity—in addition to other qualities—possess will? The answer hinges, as affirmed by Moses Maimonides—one of Davidson’s chief sources—on the question of the creation or eternity. A created universe is the product of a willful God. In kalām proofs for the existence of God, ‘the indispensable premise is creation’, a method that has been labeled Platonic (p. 2). Though distinguished from each other by a host of major disagreements, philosophy and kalām are coloured to some extent one by the other. From the perspective of both, an argument for creation is an argument for a willful deity.

Prepacks as a mechanism for resolving financial distress: The evidence

Prepacks as a mechanism for resolving financial distress: The evidence