Relevant Disagreement Research Articles

Márta Font. Jason Vincz (trans). The Kings of the House of Árpád and the Rurikid Princes: Cooperation and Conflict in Medieval Hungary and Kievan Rus’

Márta Font. Jason Vincz (trans). <i>The Kings of the House of Árpád and the Rurikid Princes: Cooperation and Conflict in Medieval Hungary and Kievan Rus’</i>

Evaluation of a novel probe based on laser Doppler flowmetry and comparison with photo plethysmography for assessment of the skin perfusion pressure

This study aims to compare skin perfusion pressure measurements (SPP) at midfoot and below knee level performed with a novel laser Doppler flowmetry (LD) probe with a reference method based on photo plethysmography (PP). It includes 40 patients referred with known or suspected peripheral arterial disease. The SPP was performed with both devices. Blinded re-interpretation of the SPP measurements was carried out by three observers and a consensus quality score was provided for each measurement. SPP >40 mmHg was considered a clinically relevant cut-off. This study evaluates a total of 48 paired measurements of the midfoot and 54 below knee. The two methods agreed in overall diagnostic classification in 80 of 102 measurements (78%) with both methods showing SPP ≥40 mmHg in 21 cases, and both methods showing SPP <40 mmHg in 59 cases. Of the 22 participants with disagreement (22%) in overall classification, 15 had measurements within the range of 30-50 mmHg, and 7 with a clinically relevant disagreement with one device showing SPP <30 mmHg and the other ≥40 mmHg. Analysis of inter observer variation for the LD readings showed an intraclass correlation coefficient of 0.880 (95% CI: 0.807 to 0.929, p- value <0.05) at midfoot, and 0.933 (95% CI: 0.894 to 0.959, p-value <0.05) at below knee level. The novel probe based on LD showed good correlation with PP in absolute pressures, sufficient agreement in overall disease classification as well as good to excellent reliability in terms of inter observer variation.

Integrationism, practice-dependence and global justice

An increasingly popular approach to global justice claims we should be ‘integrationist,’ where integrationism represents an attempt to unify our theorising between different domains of global politics. These political theorists have argued that we cannot identify plausible principles in one domain, such as climate justice, which are not sensitive to general moral concerns. This paper argues we ought to reject the concept of integrationism. It shows that integrationism is either trivial, or it obscures relevant disagreement by ignoring the distinctive methodological and substantive commitments held by its opponents. The paper then argues that the relevant disagreement is actually about the role of practices for political philosophy and, as such, should be framed in terms of the distinction between practice-dependent and practice-independent theory. Finally, I provide my own account of that distinction, identifying a practice-dependent claim that those concerned about the narrowness of prominent accounts of global justice should target.

Pre-Exercise Screening Questionnaire: tradução do instrumento de triagem relacionado à COVID-19

A pandemia causada pela doença do coronavírus 2019 (COVID-19) e as medidas de distanciamento social provocaram reduções nos níveis de atividade física das pessoas. A atividade física está associada a uma melhor saúde física e mental, e manter a população ativa durante a pandemia é essencial. No entanto, ainda não se sabe se exercícios podem, em pessoas infectadas, causar uma potencial exacerbação de sintomas da COVID-19. O presente estudo objetivou traduzir o Pre-exercise screening questionnaire (PESQ) para o Português Brasileiro e de Portugal, para facilitar a sua utilização por profissionais ligados ao exercício físico não fluentes na língua inglesa. O PESQ contém sete perguntas diretas sobre os sintomas mais comuns de COVID-19 mais comumente encontrado em adultos e idosos, para orientação segura para prática de exercício físico. A tradução foi feita em 5 etapas: Tradução inicial, tradução cega, revisão da tradução, adequação da língua Portuguesa e ajustes e finalização. As etapas foram realizadas por pesquisadores experientes, com fluência em língua inglesa e nativos em português Brasileiro e de Portugal. No processo de tradução não houve divergências importantes entre os tradutores. A adaptação transcultural foi importante, pois, o português de Portugal difere-se do brasileiro. O instrumento foi devidamente traduzido e pode ser utilizado como ferramenta de screening para os sintomas da COVID-19 por profissionais do exercício durante a pandemia. No momento, o PESQ é a principal ferramenta disponível para prevenir danos relacionados à COVID-19 e a prática de exercícios.

Transcutaneous bilirubinometry during and after phototherapy in preterm infants: a prospective observational study

ObjectiveTo examine the accuracy of transcutaneous bilirubinometry (TCB) measurements during and after phototherapy (PT) in preterm infants.DesignProspective observational cohort study.SettingLevel III neonatal centre.PatientsPreterm infants (from 23+0 to 36+6 weeks of...

Discrepancies in Electrolyte Measurements by Direct and Indirect Ion Selective Electrodes due to Interferences by Proteins and Lipids.

Objectives We aim to report the simultaneous effect of different protein and lipid concentrations on sodium (Na + ) and potassium (K + ) measurement by direct and indirect ion selective electrodes (dISE and iISE) in patient samples. Materials and Methods Na + and K + were measured in 195 serum samples received in the laboratory using iISE by Roche Modular P800 autoanalyzer and using dISE by XI-921 ver. 6.0 Caretium electrolyte analyzer. Serum total protein (TP), cholesterol (Chol), and triglycerides (TG) were measured using conventional photometric methods on Roche Modular P800 autoanalyzer. Differences for each pair of results for Na + (Diff_Na + = [Na + dISE– Na + iISE ]) and K + (Diff_K + = [K + dISE– K + iISE ]) were calculated. Patient subgroups with high, normal, or low TP (< 5, 5–7.9, or ≥ 8 g/dL), Chol (< 150, 150–299, or ≥300 mg/dL), or TG (< 150, 150–299, or ≥300 mg/dL) were compared using analysis of variance. Note that 95% confidence interval of Diff_Na + and Diff_K + were calculated to see the number of samples showing clinically significant differences. Results Diff_Na + ( p = 0.007) and Diff_K + ( p = 0.002) were found significant between samples with normal and high TP. However, effect of TG was not significant. Chol concentration affected Diff_Na + significantly between low versus normal ( p = 0.002), and high versus normal ( p = 0.031) Chol groups. Diff_K + was significant ( p = 0.009) between low versus normal Chol. Clinically relevant disagreement of ≥|5| mmol/L for Na + was observed in high percentage of samples including all subcategories; however, for K + only 3.6% of the total samples showed disagreement of ≥ |0.5| mmol/L. A multivariate regression equation based on fit regression model was also derived. Conclusion Summarily, interchangeable use of electrolyte results from dISE and iISE is not advisable, especially in a setting of hyperproteinemia (≥8 g/dL) or hypercholesterolemia (≥300 mg/dL); more so for Na + .

Normative disagreement: a functional account for inferentialists

There was a time when meta-ethical expressivism seemed to be the only game in town for meta-ethical non-representationalists. In recent years, though, meta-ethical inferentialism has emerged as a promising non-representationalist alternative. So far, however, inferentialists lack something that would really allow them to draw level with expressivists. This is an explanation for the distinctive difference between normative and descriptive vocabulary when it comes to disagreement—something expressivists can explain in terms of the difference between representational and desire-like states and which constitutes one of the primary motivations for expressivism. This paper develops a novel and distinctive account for this difference on behalf of inferentialists, based on the different functions of these two vocabularies. Not only does this account help inferentialists, it also shows how non-representionalist accounts can capture the relevant disagreement phenomena without appealing to the sorts of desire-like states expressivists tend to appeal to.

Evolution and Moral Disagreement

Several philosophers have recently argued that evolutionary considerations undermine the justification of all objectivist moral beliefs by implying a hypothetical disagreement: had our evolutionary history been different, our moral beliefs would conflict with the moral beliefs of our counterfactual selves. This paper aims at showing that evolutionary considerations do not imply epistemically relevant moral disagreement. In nearby scenarios, evolutionary considerations imply tremendous moral agreement. In remote scenarios, evolutionary considerations do not entail relevant disagreement with our epistemic peers, neither on a narrow nor on a broad conception of peerhood. In conclusion, evolutionary considerations do not reveal epistemically troubling kinds of disagreement. Anti-objectivists need to look elsewhere to fuel their sceptical argument.

Comparison of clinical and sonographic scores in hidradenitis suppurativa and proposal of a novel ultrasound scoring system.

Hidradenitis suppurativa (HS) is a chronic, inflammatory disease that presents with nodules, abscesses and fistulae affecting the apocrine gland-bearing skin. Since few years, ultrasonography is used to better characterize HS skin lesions but comparison between clinical and sonographic scores has been made only in small series of patients. To assess concordance between clinical and sonographic scores in a larger cohort of HS patients. We conducted a retrospective observational study on 140 HS patients comparing two clinical score systems, Hurley and HS-Physical Global Assessment (PGA), with two ultrasonographic scores, sonographic score of hidradenitis suppurativa (SOS-HS) and ultrasonographic HS-PGA, a novel ultrasound scoring system set up by our group. We used the weighted Cohen's Kappa statistic (k) to evaluate the agreement. Agreement between Hurley staging and SOS-HS was found in 61.4% of patients (weighted kappa 0.477), while agreement between clinical and ultrasonography HS-PGA scores was found in 35% of patients (weighted kappa 0.278), both findings suggesting a substantial disagreement. Our study demonstrated a relevant disagreement between clinical and ultrasonography scores. Ultrasonography discovered non-clinically evident HS lesions, notably fistulae. Taken together, the above findings may support the view, previously suggested in expert panel reports, on the higher sensitivity of ultrasonography compared to clinics in HS.

Third factor explanations and disagreement in metaethics

Several moral objectivists try to explain the reliability of moral beliefs by appealing to a third factor, a substantive moral claim that explains, first, why we have the moral beliefs that we have and, second, why these beliefs are true. Folke Tersman has recently suggested that moral disagreement constrains the epistemic legitimacy of third-factor explanations. Apart from constraining third-factor explanations, Tersman’s challenge could support the view that the epistemic significance of debunking explanations depends on the epistemic significance of disagreement. This paper aims to show that disagreement does not constrain the epistemic legitimacy of third-factor explanations in metaethics, and it suggests a way forward in addressing the view that debunking depends on disagreement. First, Tersman’s constraints are impossible to violate, given the assumption that the justification relation exhibits monotonicity. Second, some disagreements are irrelevant, given that they cannot be about beliefs whose reliability the objectivist seeks to defend. Third, actual disagreement about moral beliefs is implausible, given recent ethnographic findings. In light of this discussion, the paper shows that the prospects of the disagreement view depend on which moral beliefs objectivists need to defend and the criteria we use to assess epistemically relevant moral disagreement.

Validation Task for Solution of Optimal Slotted Flap Position Using Fluent Software

CFD solvers are commonly used in optimization problems in aerodynamics. Typical task is the search for optimal position of slotted flap. On the example is shown that the optimum predicted by CFD software can differ significantly from that found in the wind tunnel. Then the focus is on the optimal position of slotted flaps. It was examined with ANSYS Fluent CFD code with both 2D and 3D structured meshes and three different models of turbulence. Results from CFD and those of wind tunnel were compared with relevant disagreement found. Possible sources of the error are discussed and topics for further investigation in this field are suggested in conclusion.

Ultra high performance liquid chromatography tandem mass spectrometric detection of glucuronides resistant to enzymatic hydrolysis: Implications to doping control analysis

Controversial results have been reported in the literature regarding the behavior of two testosterone (T) metabolites (3α-glucuronide-6β-hydroxyandrosterone and 3α-glucuronide-6β-hydroxyetiocholanolone) excreted after T administration. Due to their potential as biomarkers of T misuse, a UHPLC–MS/MS method for the direct quantification of these glucuronides was developed and validated. In addition, the main phase II metabolites of T that compose the steroid profile used for doping control purposes (glucuronides of T, epitestosterone, androsterone and etiocholanolone) were included. The method was found to be linear and with suitable LODs and LOQs for all metabolites. The average accuracies were between 86% and 120%, the RSDs for the intra- and inter-day precision were below 15% and 25% respectively. The method showed low matrix effect. Samples obtained before and after the administration of T were analyzed by both the developed UHPLC–MS/MS method and the GC–MS/MS method currently used by anti-doping laboratories. Relevant disagreements between the results obtained for 3α-glucuronide-6β-hydroxyandrosterone and 3α-glucuronide-6β-hydroxyetiocholanolone quantitation were observed. These markers seemed to be more suitable for the screening of T misuse when detected by UHPLC–MS/MS. These discrepancies were further investigated in 50 urine samples from healthy volunteers. The two methods gave highly correlated results for all metabolites that are currently included in the athlete's steroid profile confirming the reliability of the UHPLC–MS/MS method. However, the quantification of 3α-glucuronide-6β-hydroxyandrosterone and 3α-glucuronide-6β-hydroxyetiocholanolone, was only possible by using the UHPLC–MS/MS method since three interfering compounds were observed when performing the GC–MS/MS analysis with the most intense ion transitions. These results confirm the potential of the resistant glucuronides as biomarkers of T misuse. Additionally, they suggest that previously reported reference ranges for these metabolites should be reevaluated.

Factors influencing the agreement on histopathological assessments of breast biopsies among pathologists

It has been recommended that the histopathology results of core biopsies of the breast are categorized according to the B-categorization scheme. We measured the interobserver variability of the B-categorization of core biopsies of the breast. Core biopsies were taken among 765 women at the University of Halle between 2006 and 2008. All histological slides were reviewed in a blinded fashion by two experienced breast pathologists. We calculated observed and chance-corrected agreements (kappa) and 95% confidence intervals (CI). The prevalence of B3-B5 biopsies was 41.6%. The observed and weighted kappa agreement of the five-level B-categorization scheme was 0.87 (95% CI: 0.84 -0.89) and 0.89 (95% CI: 0.89-0.91), respectively. The most frequent disagreement was between B2 and B3 (47 of 103 disagreements, 45.6%). Overall, 49.5% of all disagreements were clinically relevant disagreements that would imply different therapeutic strategies. Agreement was modified by referral group, Breast Imaging Reporting and Data System (BIRADS) level, radiological breast density, imaging guidance and application of immunohistological staining. Interobserver agreement of the B-categorization scheme was high and was modified by referral status, level of radiological suspicion of breast cancer, breast density, imaging guidance of core biopsies and requirement of additional immunohistological staining.

Store-and-forward teledermatology versus in-person visits: A comparison in pediatric teledermatology clinic

The role of teledermatology in the diagnosis of pediatric skin conditions has not been studied exclusively. To determine the ability of a pediatric dermatologist to correctly diagnose rashes by history and digital images. Consecutive, new referrals to the pediatric dermatology clinic with a rash were enrolled in the study. A history, demographic data, and digital photographs were obtained from each patient. The data were reviewed by a pediatric dermatologist who made a preliminary diagnosis. The child was then seen in person and a final diagnosis was made. Concordance and kappa values were calculated. Cases of diagnostic disagreement were analyzed for their effect on management. One hundred thirty-five patients were enrolled. Diagnostic concordance was 82% (95% confidence interval [CI], 73%-88%), and the kappa value was 0.80. Clinically relevant disagreement occurred in 12% of cases. The study was performed at a single site, theoretically limiting generalizability. Teledermatology appears to have a useful role in the care of children with rashes.

Reducing the Risks of Wound Consultation

The purpose of this study was to examine the impact of digital images on the assessment and recommendations of a WOC nurse who was providing remote nurse-to-nurse consultations on home care patients with wounds. In a descriptive comparative study, data were collected by home care nurses from a sample of 43 adult patients with a total of 89 wounds with various etiologies. To determine whether or not the addition of a digital photograph influenced the WOC nurse's assessment and recommendations, the WOC nurse first completed a wound assessment and recommendation form based on a verbal report from the home care nurse. The WOC nurse then accessed digital images of the wounds and made any indicated modifications to the original assessment and management plan, providing a rationale for any changes. Comparisons were made between the assessment completed by the home care nurse and the WOC nurse's assessment and between the WOC nurse's assessment and recommendations based only on a verbal report and his or her assessment and recommendations based on the combination of a verbal report and a digital photograph. Although there was a high percentage of agreement between the wound assessments completed by the home care nurse and those completed by the WOC nurse, areas of disagreement often impacted on the overall assessment. The agreement rates between the WOC nurse's assessment and recommendations based only on a verbal report versus those based on a combination of verbal report and digital photographs were as follows: total agreement (26/89 = 29.2%), trivial disagreement (11/89 = 12.4%), and clinically relevant disagreement (52/89 = 58.4%). WOC nurses who provide remote nurse-to-nurse consultations without directly visualizing the patients' wounds through digital images are at risk for under-or overtreating patients' wounds. Digital images also provide an opportunity for the WOC nurse to mentor home care nurses in wound assessment and care.

A randomized trial comparing INR monitoring devices in patients with anticoagulation self-management: evaluation of a novel error-grid approach

In addition to the metrological quality of international normalized ratio (INR) monitoring devices used in patients' self-management of long-term anticoagulation, the effectiveness of self-monitoring with such devices has to be evaluated under real-life conditions with a focus on clinical implications. An approach to evaluate the clinical significance of inaccuracies is the error-grid analysis as already established in self-monitoring of blood glucose. Two anticoagulation monitors were compared in a real-life setting and a novel error-grid instrument for oral anticoagulation has been evaluated. In a randomized crossover study 16 patients performed self-management of anticoagulation using the INRatio and the CoaguChek S system. Main outcome measures were clinically relevant INR differences according to established criteria and to the error-grid approach. A lower rate of clinically relevant disagreements according to Anderson's criteria was found with CoaguChek S than with INRatio without statistical significance (10.77% vs. 12.90%; P = 0.787). Using the error-grid we found principally consistent results: More measurement pairs with discrepancies of no or low clinical relevance were found with CoaguChek S, whereas with INRatio we found more differences with a moderate clinical relevance. A high rate of patients' satisfaction with both of the point of care devices was found with only marginal differences. A principal appropriateness of the investigated point-of-care devices to adequately monitor the INR is shown. The error-grid is useful for comparing monitoring methods with a focus on clinical relevance under real-life conditions beyond assessing the pure metrological quality, but we emphasize that additional trials using this instrument with larger patient populations are needed to detect differences in clinically relevant disagreements.

Trace element intake and status of Italian subjects living in the Gubbio area

Daily intakes of certain trace elements (Pb, Cd, Ni, Hg, and Cr) were assessed using dietary history and weighed record methods and concurrent chemical analysis (CA) of duplicate portions, along with blood levels, in a group (21 M, 23 F) of inhabitants of the Gubbio area (Belvedere, Biscina, Scritto). The evaluation of only intake of trace elements was accomplished in 40 subjects (20 M, 20 F) 1 year later. In both surveys, trace element intakes were generally lower than the potential tolerable weekly intake. However, daily intakes of Pb, Cd, Ni, Hg, and Cr were higher in men compared to women in both surveys (P<0.05). In fact, intakes at the 50th percentile were greater in men by approximately 75% for Pb, 91% for Cd, 20% for Ni, 45% for Hg, and 29% for Cr in the first survey. In the second survey, percentage differences for Pb, Cd, Ni, and Cr were about 12%, 28%, 26%, and 26%, respectively. Blood trace element levels were slightly higher in men in the first survey. Interestingly, no correlation was observed between the intake of trace elements and corresponding blood values. Food basket and total diet, which were computed from the weighed record method for 2 days, showed relevant disagreements with CA of duplicate portion. Moreover, the comparison in content of Pb, Cd, Ni, and Cr obtained by CA of cooked dishes or by calculation using values of raw foods showed significant differences (P<0.05). It was concluded that trace element intake should be assessed by CA of duplicate portion.

Assessment of the accuracy of low-cost store-and-forward teledermatology consultation

Background: Telemedicine has the potential to revolutionize the delivery of dermatologic care to underserved areas. Objective: Our purpose was to compare diagnoses from two types of dermatology consultations: telemedicine using store-and-forward (SAF) technology, and traditional face-to-face (FTF) office visits. Methods: Skin conditions were imaged with a consumer-grade digital camera. A standardized template was used to collect historical data. Information was stored in a secured database for access by 2 or 3 board-certified dermatologists. Results from the FTF visit were used to assess the accuracy of the SAF diagnoses. Results: A total of 106 dermatologic conditions in 92 patients were included. Concordance between FTF and SAF diagnoses was high, ranging from 81% to 89% for all 3 dermatologists. Clinically relevant disagreement occurred in only 4% to 8% of cases. Remaining disagreements did not affect patient care. Diagnostic confidence and image quality affected agreement. When cases of high confidence were analyzed separately, agreement increased to 88% to 100%. This increase was substantiated by means of a chi-square test between the high confidence and low confidence groups, which demonstrated statistical significance (P < .005) for all dermatologists. Similarly, when cases of above average image quality were considered, agreement increased to 84% to 98%. Again this difference was substantiated by means of a chi-square test between adequate and poor images, with statistical significance for two dermatologists (P < .001). Accuracy was comparable between disease types with the exception of benign neoplasms, which demonstrated agreement of 22% to 46%. Conclusion: These data support the use of existing digital technology to construct an accurate SAF teledermatology system. The inexpensive camera and widely available computer equipment make this an extremely affordable system. Furthermore, participating dermatologists appear well aware of system limitations, as reflected in the increased agreement for high confidence cases. Additional investigation of the accuracy of teledermatology for benign neoplasms is warranted. (J Am Acad Dermatol 2000;42:776-83.)

Identification of the source fault of the 1908 Messina earthquake through tsunami modelling. Is it a possible task?

The 1908 Messina Straits tsunami is the last catastrophic event that hit the Italian coast. The parent earthquake may be considered one of the strongest shocks reported in Italian seismic catalogues. Several source models have been; proposed in the literature that are quite different with regard to almost all the fault parameters. The aim of this work is to evaluate whether tsunami data can add reliable inforiration for the identification of the fault mechanism of this earthquake. Tsunamis generated by two of the faults proposed in the literature were simulated via finite-element modelling in a former work (see Piatanesi et al., 1998): the results were in good agreement with the observations as regards the polarity of the first wave, whereas a relevant disagreement was found as far as run-up data were concerned. In this paper, that may be considered the continuation of the previous work, we focus on a particular fault, the one proposed by Capuano et al. (1988), and simulate the consequent tsunami adding two new features to possibly improve the agreement with run-up observations: i) an algorithm allowing for the effect of the sea bottom bathymetry on the tsunami initial condition, and ii) a heterogeneous slip distribution on the fault.

Is image selection a useful strategy to decrease the transmission time in teleradiology? A study using 100 emergency cranial CTs.

This study examines the suitability of working with a selection of images in a teleradiology consulting system in neurological or neurosurgical emergency situations. The teleradiology system was based on IBM-compatible personal computers, video digitization for data acquisition, and data transmission by Integrated System Digital Network. Forty normal and 60 abnormal emergency cranial computed tomograms were shown to a radiologist on call who presented all cases he regarded as pathologic to a neuroradiologic expert by teleradiology. To reduce transmission time, only a selection of images from the CT study was presented (up to four images per case). For each case the on-call radiologist's diagnosis (D(on-call)), the expert's diagnosis on the teleradiology screen (D(monitor)), and the expert's diagnosis on the original film (D(original)) was documented, together with an estimation of the agreement between those diagnoses. There was clinically relevant disagreement between the on-call radiologist's diagnosis and the neuroradiologist's diagnosis based on the image selection on the teleradiology monitor in 23% of cases. A clinically important discrepancy between the neuroradiologist's diagnosis based on the image selection and his diagnosis using the original films was found in 30% of cases. This was due to the presence of clinically relevant information on images not transferred by the on-call radiologist. Image quality of the transferred images was sufficient in all cases. Drastic selection of images from a complete CT study leads to a high rate of incorrect diagnoses and is not appropriate to reduce transmission time in teleradiology.