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Abstract Background In the Ugandan setting, investigation for PHNM with CT uses a protocol with both unenhanced and contrast enhanced procedures hence doubling the ionizing radiation exposure. The purpose of this study was to determine the feasibility of single CT procedures in diagnosing PHNM. Methods This was a cross-sectional study using CT images from patients, aged fifteen years and below, investigated for head and neck malignancies at the Uganda Cancer Institute. Three radiologists, observers A, B and C, with 12, 5 and 2 years of experience, respectively, participated in the study. They independently reported contrast enhanced images (protocol A), unenhanced images (protocol B), then both unenhanced and contrast enhanced images (protocol C) in 2 months intervals. Inter- and intra- observer agreement was determined using Gwen’s Agreement coefficient. Results Seventy-three CT scans of 36 boys and 37 girls, with a median age of 9 (3–13) years, were used. Intra-and inter-observer agreement on primary tumour location ranged from substantial to almost perfect with the highest intra-observer agreement observed when protocols A and C were compared. Inter-observer agreement for tumour calcifications was substantial for protocol A. Observers A and C demonstrated an almost perfect intra-observer agreement when protocols A and C were compared. There was a substantial inter-observer agreement on diagnosis for all protocols. Conclusions In our setting and examining a limited number of CT images, we demonstrated that contrast-enhanced CT scans provide sufficient information with no evidence of additional value of unenhanced images. Using contrast-enhanced images alone reduced the radiation exposure significantly.

This study aimed to evaluate the reliability of an age estimation method based on the pulp⁄tooth area ratio by assessing intra- and inter-examiner agreement across five observers at different intervals. Using the same X-ray device and technical parameters, 96 digital periapical X-ray images of upper and lower canines were obtained from 28 deceased people in Central America, whose age at death ranged from 19 to 49 years. Excellent and good agreement of results were achieved, and there were no statistically significant differences. The R2 value for upper teeth (54.0%) was higher than the R2 value for lower teeth (45.7%). The highest intraclass correlation coefficient value was 0.995 (0.993–0.997) and the lowest 0.798 (0.545–0.895). Inter-examiner agreement was high with values of 0.975 (0.965–0.983) and 0.927 (0.879–0.955). This method is adequate for assessing age in missing and unidentified people, including victims of mass disasters.

Computed tomography-based active surveillance is increasingly used to manage small renal tumors, regardless of patient age. However, there is an unmet need for decreasing radiation exposure while maintaining the necessary accuracy and reproducibility in radiographic measurements, allowing for detecting even minor changes in renal mass size. In this article, we present supplementary data from a multiobserver investigation. We explored the accuracy and reproducibility of low-dose CT (75% dose reduction) compared to normal-dose CT in assessing maximum axial renal tumor diameter. Open-access CT datasets from the 2019 Kidney and Kidney Tumor Segmentation Challenge were used. A web-based platform for assessing observer performance was used by six radiologist observers to obtain and provide data on tumor diameters and accompanying viewing settings, in addition to key images of each measurement and an interactive module for exploring diameter measurements. These data can serve as a baseline and inform future studies investigating and validating lower-dose CT protocols for active surveillance of small renal masses.

Abstract Background Under ongoing climate and land-use change, biodiversity is continuously decreasing and monitoring biodiversity is becoming increasingly important. National Forest Inventory (NFI) programmes provide valuable time-series data on biodiversity and thus contribute to assessments of the state and trends in biodiversity, as well as ecosystem functioning. Data quality in this context is of paramount relevance, particularly for ensuring a meaningful interpretation of changes. The Swiss NFI revisits about 8%–10% of its sample plots regularly in repeat surveys to supervise the quality of fieldwork. Methods We analysed the relevance of observer bias with equivalence tests, examined data quality objectives defined by the Swiss NFI instructors, and calculated the pseudo-turnover (PT) of species composition, that is, the percentage of species not observed by both teams. Three attributes of woody species richness from the latest Swiss NFI cycles (3 and 4) were analysed: occurrence of small tree and shrub species (1) on the sample plot and (2) at the forest edge, and (3) main shrub and trees species in the upper storey. Results We found equivalent results between regular and repeat surveys for all attributes. Data quality, however, was significantly below expectations in all cases, that is, as much as 20%–30% below the expected data quality limit of 70%–80% (proportion of observations that should not deviate from a predefined threshold). PT values were about 10%–20%, and the PT of two out of three attributes decreased significantly in NFI4. This type of uncertainty – typically caused by a mixture of overlooking and misidentifying species – should be considered carefully when interpreting change figures on species richness estimates from NFI data. Conclusions Our results provide important information on the data quality achieved in Swiss NFIs in terms of the reproducibility of the collected data. The three applied approaches proved to be effective for evaluating the quality of plot-level species richness and composition data in forest inventories and other biodiversity monitoring programmes. As such, they could also be recommended for assessing the quality of biodiversity indices derived from monitoring data.

In Germany all keepers of livestock are legally required to record animal welfare indicators as part of their on-farm self-assessment. The Association for Technology and Structures in Agriculture (Kuratorium für Technik und Bauwesen in der Landwirtschaft e.V. (KTBL)) has suggested the use of a particular set of animal welfare indicators in their publication Animal welfare indicators: Practical guide – Pigs. The aim of the present study was to evaluate the inter-observer reliability (Inter-OR) and intra-observer reliability (Intra-OR) of these indicators with respect to the welfare of fattening pigs. For the assessment of Inter-OR, three observers evaluated six KTBL animal welfare indicators. The Inter-OR of the indicators was calculated from the results using intra-class correlation coefficients (ICC). ‘Excellent’ Inter-OR results were found for the indicators tail length (ICC 0.89), skin lesions (ICC 0.77) and ear lesions (ICC 0.80). In contrast, the Inter-OR of the indicators tail lesions (ICC 0.46) and faecal soiling (ICC 0.47) were considered to be only ‘fair’ and that of the indicator lameness (ICC 0.36) as ‘poor’. For the evaluation of the Intra-OR, the same three observers assessed the welfare of 162 to 200 fattening pigs using the same welfare indicators in total eight times. Again ICCs, here per indicator and observer, were used to calculate the Intra-OR. The Intra-OR of the indicators faecal soiling (ICC 0.81) and ear lesions (ICC 0.97) lay in the ‘excellent’ range on average. While the Intra-OR of the indicators skin lesions (ICC 0.67), tail length (ICC 0.74) and lameness (ICC 0.60) could still be considered as being ‘good’, the Intra-OR of the indicator tail lesions (ICC 0.52) could only be assessed as being ‘fair’. From these results the significance of the KTBL indicators could be judged as follows: it is possible to use all the chosen indicators apart from the indicator tail lesions as an internal controlling instrument or as part of an internal weak-point analysis as long as the indicators are evaluated by the same person. A comparison of the indicators tail lesions, lameness and faecal soiling when assessed by different observers should be considered critically because the Inter-OR of these three indicators could only be considered as being ‘poor’ to ‘fair’.

Dogs suffering from Myxomatous Mitral Valve Disease (MMVD) show a potential heart enlargement, especially in the left atrium, detectable by radiography. Due to digital radiography, different radiographic measurements estimate cardiac size quite uncomplicatedly. The Vertebral Heart Size (VHS), Radiographic Left Atrial Dimension (RLAD), Left Atrial Width (LAWidth), and the Vertebral Left Atrial Size (VLAS) used anatomical landmarks for measuring cardiac size in relation to the vertebral column. This study aimed to compare VHS, RLAD, LAWidth, and VLAS measured in conventional and inverted radiographs by veterinarians with different levels of experience in healthy dogs and dogs with MMVD. The reliability and user-friendliness of these measurements were evaluated, and the staging was compared to the echocardiography staging. A total of 50 unaffected dogs and 150 dogs with MMVD in stages B1, B2, and C were assessed. Three veterinarians with different levels of experience examined 200 conventional radiographs and their corresponding inverted radiographs blinded to the echocardiographic and clinical examination results. Analyses were performed to compare the measurements’ grading and determine anatomical landmarks with measurement difficulties. Additionally, inter- and intraobserver agreement was assessed using intraclass correlation coefficient, and the agreement between radiographic and echocardiographic staging was compared using the kappa coefficient. The VHS, LAWidth, and VLAS were easier to define than the RLAD. The interobserver agreement was almost perfect for VHS (0.962) and good for the other radiographic measurements (RLAD: 0.778, LAWidth: 0.772, VLAS: 0.858). The VHS assigned the most dogs to the correct stage. However, VHS, RLAD, LAWidth, and VLAS presented an almost perfect intraobserver agreement. The dorsal left atrial margin of the RLAD was the most difficult measurement point to identify. The VHS is the most reproducible radiographic method for measuring the canine heart size and shows the highest agreement with echocardiography. An observer-related influence could be detected for RLAD, LAWidth, and VLAS.

Background: Many methods under the umbrella of inter-rater agreement (IRA) have been proposed to evaluate how well two or more medical experts agree on a set of outcomes. The objective of this work was to assess key IRA statistics in the context of multiple raters with binary outcomes. Methods: We simulated the responses of several raters (2–5) with 20, 50, 300, and 500 observations. For each combination of raters and observations, we estimated the expected value and variance of four commonly used inter-rater agreement statistics (Fleiss’ Kappa, Light’s Kappa, Conger’s Kappa, and Gwet’s AC1). Results: In the case of equal outcome prevalence (symmetric), the estimated expected values of all four statistics were equal. In the asymmetric case, only the estimated expected values of the three Kappa statistics were equal. In the symmetric case, Fleiss’ Kappa yielded a higher estimated variance than the other three statistics. In the asymmetric case, Gwet’s AC1 yielded a lower estimated variance than the three Kappa statistics for each scenario. Conclusion: Since the population-level prevalence of a set of outcomes may not be known a priori, Gwet’s AC1 statistic should be favored over the three Kappa statistics. For meaningful direct comparisons between IRA measures, transformations between statistics should be conducted.

Abstract Background Overviews of reviews (overviews) compile information from multiple systematic reviews (SRs) to provide a single synthesis of relevant evidence for decision-making. It is recommended that authors assess and report the methodological quality of SRs in overviews—for example, using A MeaSurement Tool to Assess systematic Reviews (AMSTAR). Currently, there is variation in whether and how overview authors assess and report SR quality, and limited guidance is available. Our objectives were to: examine methodological considerations involved in using AMSTAR to assess the quality of Cochrane and non-Cochrane SRs in overviews of healthcare interventions; identify challenges (and develop potential decision rules) when using AMSTAR in overviews; and examine the potential impact of considering methodological quality when making inclusion decisions in overviews. Methods We selected seven overviews of healthcare interventions and included all SRs meeting each overview’s inclusion criteria. For each SR, two reviewers independently conducted AMSTAR assessments with consensus and discussed challenges encountered. We also examined the correlation between AMSTAR assessments and SR results/conclusions. Results Ninety-five SRs were included (30 Cochrane, 65 non-Cochrane). Mean AMSTAR assessments (9.6/11 vs. 5.5/11; p

Introduction The objective of this study was to compare two radiographic methods - digital intraoral and digital panoramic radiography in assessing marginal bone level around dental implants. The study also evaluated inter-observer and intra-observer reliability during repeated assessments. Material and Methods Marginal bone around 29 implants in 17 patients was assessed using standardized digital intraoral and digital panoramic radiographs. Two observers evaluated bone level by noting the thread at which marginal bone seemed to be attached at distal and mesial surfaces of the implants. The assessments were repeated after one week. Kappa statistics was used to evaluate agreement between assessments, observers, and radiographical methods. Results The agreement rate between digital intraoral and digital panoramic radiography was fair. Intra-observer agreement was very good, while inter-observer agreement was moderate. Conclusion Digital panoramic radiographs can be used to evaluate marginal bone level in patients with multiple implants and also to supplement intraoral radiographs. However, observer variability should be considered when comparing values from follow up studies for implant maintenance.

Sixteen animal-based indicators of sheep welfare, previously selected by a stakeholder panel, and based on the Farm Animal Welfare Council (FAWC) Five Freedoms, were assessed in terms of the level of inter-observer agreement achieved during on-farm testing. Eight observers independently tested the 16 indicators on 1158 sheep from 38 farms in England and Wales. Overall inter-observer agreement was evaluated by Fleiss’s kappa (κ), and the pair-wise agreement of each observer was compared to a ‘test standard’ observer (TSO). Inter-observer assessments of the welfare indicators; dental abnormality, cleanliness score (ventral abdomen), mastitis, tail length, skin lesions, body condition scoring and lameness produced ‘fair to good’ levels of agreement (0.40 < κ < 0.75) and joint swellings had ‘excellent’ levels of agreement (κ ≥ 0.75). The very low apparent prevalence (

A scientific literature review and consensus of expert opinion used the welfare definitions provided by the Farm Animal Welfare Council (FAWC) Five Freedoms as the framework for selecting a set of animal-based indicators that were sensitive to the current on-farm welfare issues of young lambs (aged ⩽6 weeks). Ten animal-based indicators assessed by observation – demeanour, response to stimulation, shivering, standing ability, posture, abdominal fill, body condition, lameness, eye condition and salivation were tested as part of the objective of developing valid, reliable and feasible animal-based measures of lamb welfare The indicators were independently tested on 966 young lambs from 17 sheep flocks across Northwest England and Wales during December 2008 to April 2009 by four trained observers. Inter-observer reliability was assessed using Fleiss's kappa (κ), and the pair-wise agreement with an experienced, observer designated as the ‘test standard observer’ (TSO) was examined using Cohen's κ. Latent class analysis (LCA) estimated the sensitivity (Se) and specificity (Sp) of each observer without assuming a gold standard and predicted the Se and Sp of randomly selected observers who may apply the indicators in the future. Overall, good levels of inter-observer reliability, and high levels of Sp were identified for demeanour (κ = 0.54, Se ⩾ 0.70, Sp ⩾ 0.98), stimulation (κ = 0.57, Se = 0.30 to 0.77, Sp ⩾ 0.98), shivering (κ = 0.55, Se = 0.37 to 0.85, Sp ⩾ 0.99), standing ability (0.54, Se ⩾ 0.80, Sp ⩾ 0.99), posture (κ = 0.45, Se ⩾ 0.56, Sp = 0.99), abdominal fill (κ = 0.44, Se = 0.39 to 0.98, Sp = 0.99), body condition (κ = 0.72, Se ⩾ 0.38 to 0.90, Sp = 0.99), lameness (κ = 0.68, Se > 0.73, Sp = 1.00), and eye condition (κ = 0.72, Se ⩾ 0.86, Sp = 0.99). LCA predicted that randomly selected observers had Se > 0.77 (acceptable), and Sp ⩾ 0.98 (high) for assessments of demeanour, lameness, abdominal fill posture, body condition and eye condition. The diagnostic performance of some indicators was influenced by the composition of the study population, and it would be useful to test the indicators on lambs with a greater level of outcomes associated with poor welfare. The findings presented in this paper could be applied in the selection of valid, reliable and feasible indicators used for the purposes of on-farm assessments of lamb welfare.

Amaç: Bu çalışmanın amacı, özellikle serbestdişhekimliği uygulamalarında kron-köprürestorasyonları olan dişlerde sekonder çürüğündeğerlendirilmesinde sık başvurulan bir yöntemolan panoramik radyografinin, bitewing radyografinin ve klinik muayene verilerinin sekonderçürük teşhisindeki etkinliğinin araştırılması vegözlemciler arası uyumun değerlendirilmesidir. Çalışma grubunu kron-köprü restorasyonunasahip 93 hasta oluşturmaktadır. Çalışmada 114adet tek kron ve 258 adet köprü ayağı olmak üzere372 posterior dişe ait 744 ara yüz sekonder çürükaçısından iki gözlemci tarafından klinik ve radyolojik olarak değerlendirilmiştir. Hastaların DMFT veDMFS indeksleri, kron ve/veya köprü restorasyonları; restorasyonun tipi, cinsi ve ağızda kalmasürelerine göre kaydedilmiştir. Çürük lezyonlarınınsınıflandırılmasında başlangıç, erken ve derinçürük lezyonlarını tanımlayan morfolojik karakteristiklere dayalı Zoellner ve arkadaşlarının modifiye ettiği sekonder çürük kriterleri kullanılmıştır.İstatistiksel farklılıklar Pearson ki kare testi P

Amaç: Bu çalışmanın amacı, özellikle serbestdişhekimliği uygulamalarında kron-köprürestorasyonları olan dişlerde sekonder çürüğündeğerlendirilmesinde sık başvurulan bir yöntemolan panoramik radyografinin, bitewing radyografinin ve klinik muayene verilerinin sekonderçürük teşhisindeki etkinliğinin araştırılması vegözlemciler arası uyumun değerlendirilmesidir. Çalışma grubunu kron-köprü restorasyonunasahip 93 hasta oluşturmaktadır. Çalışmada 114adet tek kron ve 258 adet köprü ayağı olmak üzere372 posterior dişe ait 744 ara yüz sekonder çürükaçısından iki gözlemci tarafından klinik ve radyolojik olarak değerlendirilmiştir. Hastaların DMFT veDMFS indeksleri, kron ve/veya köprü restorasyonları; restorasyonun tipi, cinsi ve ağızda kalmasürelerine göre kaydedilmiştir. Çürük lezyonlarınınsınıflandırılmasında başlangıç, erken ve derinçürük lezyonlarını tanımlayan morfolojik karakteristiklere dayalı Zoellner ve arkadaşlarının modifiye ettiği sekonder çürük kriterleri kullanılmıştır.İstatistiksel farklılıklar Pearson ki kare testi P

The reliability and feasibility of 10 animal-based measures of ewe welfare were examined for use in extensive sheep production systems. Measures were: Body condition score (BCS), rumen fill, fleece cleanliness, fleece condition, skin lesions, tail length, dag score, foot-wall integrity, hoof overgrowth and lameness, and all were examined on 100 Merino ewes (aged 2–4 years) during mid-pregnancy, mid-lactation and weaning by a pool of nine trained observers. The measures of BCS, fleece condition, skin lesions, tail length, dag score and lameness were deemed to be reliable and feasible. All had good observer agreement, as determined by the percentage of agreement, Kendall’s coefficient of concordance (W) and Kappa (k) values. When combined, these nutritional and health measures provide a snapshot of the current welfare status of ewes, as well as evidencing previous or potential welfare issues.