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Objective To present and validate a new simulation model for endoscopic phonomicrosurgery training as an improved teaching method. Methods A low-cost artificial model was assembled using 3D printing, silicone, and gelatin. The study was designed to test the model's ability to carry out training and teaching of endoscopic phonomicrosurgery. The synthetic model was built to simulate normal and pathological vocal folds such as polyps, intracordal cysts and keratoses, made of silicone and gelatin and embedded in a larynx framework made by 3D printing. Simulations of endoscopic surgical procedures were performed and documented through photographs and videos and the images were submitted to the evaluation of a group of 17 otorhinolaryngologists who used a Likert scale questionnaire. The responses were submitted to an agreement analysis using the sum of the scores obtained for the responses as an appropriate level of validation. Cronbach's alpha index was calculated to measure the degree of the questionnaire internal consistency. Result The evaluations indicated maximum approval for the model adequacy for use in practical classes and for the teaching of the procedures, as well as in the overall satisfaction with the model in the use of surgical training. Conclusion The present proposal for training laryngeal endoscopic surgery in a 3D synthetic model is a viable option according to the validation methodology used in the present study.

Introduction: Prakriti assessment is of fundamental importance for research and standardization of clinical practice. The available tools for prakriti assessment are not intended to be used in a clinical setting, which demands a short and clinically flexible one. Methods: 3 selected tools were compared with a newly developed questionnaire. These were administered first in 100 healthy volunteers. Agreement analysis between these tools were done. The validation process was completed by running the new tool together with TNMC questionnaire in 150 more individuals who have some doshavriddhi. The results were discussed in an FGD involving clinicians and faculties. Results: The new tool has shown fair agreement with Ayusoft (kappa 0.434 and Spearman correlation 0.506) and TNMC (kappa 0.429 and Spearman correlation 0.454) questionnaires. And it showed week agreement with self-assessment tool (kappa 0.214 and Spearman correlation 0.407). Meanwhile self-assessment tool has poor agreement with both Ayusoft (kappa 0.172 and Spearman correlation 0.279) and TNMC (kappa 0.175 and Spearman correlation 0.244). Reliability was tested in a total of 250 individuals and a Cronbach’s alpha of 0.524 was obtained. Factor analysis was also done. In this total dataset, the new tool showed better agreement with TNMC questionnaire (kappa 0.581 and Spearman correlation 0.442). Conclusion: These results show that the new tool has potency to be run in large scale to study more variability among patients. This will add to the standardization of Ayurvedic diagnostic, prognostic and therapeutic fields.

PRCIS Automated gonioscopy is a recent method of recording angle pictures. Our study shows that agreement between observers is moderate in most categories used in clinical practice, underlying its clinical usefulness but also room for improvement. INTRODUCTION Iridocorneal angle (ICA) imaging methods have been recently developed to record gonioscopic images. The purpose of this study was to perform an interrater agreement analysis of ICA photographs. METHODS Multicentric cross-sectional observational study. Consecutive patients in 2 ophthalmology departments underwent automated gonioscopy. One picture per quadrant from each eye was selected for randomization. Pictures were graded and analyzed by 4 masked glaucoma specialists regarding angle opening, width, Shaffer and Spaeth gradings and other findings. Fleiss' κ statistics was performed to assess interrater agreement. RESULTS A total of 50 patients were recruited, with the sample containing a variety of diagnosis including pseudoexfoliation (22%), angle-closure suspect (12%), and pigmentary glaucoma (4%). The sample included phakic (68%) and pseudophakic patients, as well as cases with gonio-implanted surgical devices (10%). There was moderate agreement on angle opening, angle width, presence of angle vessels, and peripheral anterior synechiae (κ=0.435, 0.511, 0.558, 0.488, respectively; P

Maximal lactate steady state (MLSS) is defined as the highest intensity of exercise where the balance between the production and removal of lactate in the blood occurs. The MLSS deermination is based on several tests carried out on different days using invasive procedures (i.e. blood sampling), making its use limited in practical situations. Therefore, since the 1980s, several other methods/protocols non-invasive and/or less time-consuming have been used to estimate the MLSS. In addition, much debate in the literature has been done about the validity of estimating MLSS by these methods/tests. Because of the large number of studies and methods/tests and the great variability among them, several meta-analyses will be carried out separately for each type of predictor, as follow: 1- Maximal lactate steady state versus lactate thresholds methods; 2- Maximal lactate steady state versus non-invasive thresholds methods from incremental exercise testing; 3- Maximal lactate steady state versus lactate minimum testing; and 4- Maximal lactate steady state versus performance measures, including time-trials and critical power calculations.

Clash of interest seems to be unavoidable in real estate matters. This could be due to the market’s complexity and the heterogeneous participants involved. The study examined the causes of dispute and its implication on real estate transactions in Akure (a traditional urban city), Nigeria. Data were collected through questionnaires administered to the target respondents, which comprise disputant residents and Estate Surveyors, and Valuers. The results were analyzed with mean item score and agreement analysis. Findings are that multiple allocations of land and boundary conflicts are the significant factors causing disputes within the study area. It was also discovered that development delay and market interruptions are the substantial implication in the disputes arising from real estate transactions. The study recommends that the concerned authority on land matters should ensure proper land record-keeping. This will help put to check the problem of multiple land allocations. Also, the appropriate land boundary mapping should be done to mitigate issues arising from boundary conflicts.

Background Laboratory diagnosis of Lyme disease (LD) relies on a two-tier protocol. We have observed disproportionate equivocal serologies in children requiring reflex western blot (WB) using manufacturer-provided ranges based on adult studies. We aimed to determine appropriate ranges for our pediatric population. Methods We performed a one-year retrospective institutional review of all 2755 children with LD testing with the Vidas® Lyme IgM II/IgG II immunoassays with reflex to WB for equivocal/positive serologies. Results were assessed by frequency distributions, optimization via percent agreement analysis, and clinical adjudication. Results The proposed ranges for IgM (negative ≤0.20, equivocal ≥0.21 to 0.50) allowed for a decrease in the IgM equivocal rate (7% to 2%) and IgG positive rate (15% to 13%). There was a decrease in the positive percent agreement between tiers (95% to 83% and 98% to 95%) with increase in the negative (32% to 63% and 70% to 81%) and overall (65% to 73% and 85% to 88%) percent agreements for IgM and IgG, respectively. Of 15 IgM serologies reclassified as negative with a positive WB and not positive for IgG, 8 were clinically negative, 5 were clinically positive, and two had insufficient history. Of the 10 IgG serologies reclassified as negative with a positive WB 3 were clinically positive, 6 were clinically negative and one had insufficient history. Conclusions Our modified ranges are more suitable for our pediatric population while reducing overdiagnosis, unnecessary treatment, diagnostic uncertainty, and turnaround time.

To assess the reliability of a tear film (TF) viscosity video grading system. Thirty-four dynamic TF viscosity videos were obtained by a clinically available TF analyzer and objectively sorted according to the movement speed of three arbitrary reflective light particles. A 4-grade system was constructed on a specially designed window for simultaneous comparison with the three standard videos. Two masked graders were invited to grade these videos under a randomized procedure. Observer reliabilities were determined by Spearman’s correlation analysis and Bland-Altman agreement analysis. For this four-grade system, the intra-observer correlation was very strong in the two graders (ρ = 0.96 and 0.82; both P < 0.0001). However, the inter-observer correlation showed moderate strength in normal playback speed (ρ = 0.53, P = 0.002 and ρ = 0.52, P = 0.003 for 1st and 2nd gradings, respectively). In slower playback videos, the inter-observer correlation of the two graders was higher (ρ = 0.70 and P < 0.0001) when reduced to 0.8-times playback speed. Moreover, the 0.8-times mode was also significantly better than normal playback mode (P = 0.0204) in terms of inter-observer agreement. The dynamic 4-grade system has an excellent intra-observer reliability and a good inter-observer reliability under 0.8-times playback speed. The grading system established in this study provides a promising solution for rapidly determining the level of TF viscosity.

PURPOSE To analyze the agreement of corrected intraocular pressure (IOP) values between Corvis ST (ΔIOP1) and Pentacam (ΔIOP2) in patients with keratoconus (KC), subclinical KC (sub-KC), and normal cornea. METHODS In total, 235 eyes were divided into KC, sub-KC, and control groups. Differences in ΔIOP1 (biomechanically corrected IOP minus uncorrected IOP) and ΔIOP2 (central corneal thickness-corrected amounts of IOP) were analyzed within and among groups. Topographical and biomechanical differences were compared among the 3 groups. Factors affecting differences between ΔIOP1 and ΔIOP2 were analyzed. Agreement analysis of ΔIOP2 and ΔIOP1 was performed by Bland-Altman plots for all 3 groups. RESULTS Mean ΔIOP1 was highest in the KC group (1.23 ± 0.84 mm Hg), followed by sub-KC and control groups (all P < 0.05). Deformation amplitude ratio at 2 mm (DA-2 mm), integrated radius, stiffness parameter at first applanation, and Corvis biomechanical index values significantly differed between sub-KC and control groups. The differences between ΔIOP1 and ΔIOP2 were affected by stiffness parameter at first applanation, after adjusting for central corneal thickness and age, in all 3 groups. The lowest agreement between ΔIOP2 and ΔIOP1 was observed in the KC group (mean difference: 1.90 mm Hg; 95% limit of agreement ranged from -0.2 to 3.9 mm Hg). CONCLUSIONS Among the 3 groups in this study, the KC group exhibited the worst consistency between ΔIOP2 and ΔIOP1. For the sub-KC and control groups, corrected IOP values derived by Pentacam were similar to Corvis ST. Ophthalmologists should carefully consider the mechanical properties of eyes with KC during IOP management.

Purpose Active anterior rhinomanometry (AAR) and computed tomography (CT) are standardized methods for the evaluation of nasal obstruction. Recent attempts to correlate AAR with CT-based computational fluid dynamics (CFD) have been controversial. We aimed to investigate this correlation and agreement based on an in-house developed procedure. Methods In a pilot study, we retrospectively examined five subjects scheduled for septoplasty, along with preoperative digital volume tomography and AAR. The simulation was performed with Sailfish CFD, a lattice Boltzmann code. We examined the correlation and agreement of pressure derived from AAR (RhinoPress) and simulation (SimPress) and these of resistance during inspiration by 150 Pa pressure drop derived from AAR (RhinoRes150) and simulation (SimRes150). For investigation of correlation between pressures and between resistances, a univariate analysis of variance and a Pearson’s correlation were performed, respectively. For investigation of agreement, the Bland–Altman method was used. Results The correlation coefficient between RhinoPress and SimPress was r = 0.93 (p r = 0.65; p = 0.041). Conclusion The simulation of rhinomanometry pressure by CT-based CFD seems more feasible with the lattice Boltzmann code in the less obstructed nasal side. In the more obstructed nasal side, error rates of up to 100% were encountered. Our results imply that the pressure and resistance derived from CT-based CFD and AAR were similar, yet not same.

Background/purpose: Among patients suspected of pectus excavatum, visual examination is a key aspect of diagnosis and, moreover, guides work-up and treatment strategy. This study evaluated the inter observer and intra-observer agreement of visual examination and diagnosis of pectus excavatum among experts. Methods: Three-dimensional surface images of consecutive patients suspected of pectus excavatum were reviewed in a multi-center setting. Interactive three-dimensional images were evaluated for the presence of pectus excavatum, asymmetry, flaring, depth of deformity, cranial onset, overall severity and morphological subtype through a questionnaire. Observers were blinded to all clinical patient information, completing the questionnaire twice per subject. Agreement was analyzed by kappa statistics. Results: Fifty-eight subjects with a median age of 15.5 years (interquartile range: 14.1-18.2) were evaluated by 5 (cardio)thoracic surgeons. Pectus excavatum was visually diagnosed in 55% to 95% of cases by different surgeons, revealing considerable inter-observer differences (kappa: 0.50; 95%-confidence interval [CI]: 0.41-0.58). All other items demonstrated inter-observer kappa's of 0.25-0.37. Intra-observer analyses evaluating the presence of pectus excavatum demonstrated a kappa of 0.81 (95%-CI: 0.72-0.91), while all other items showed intra-observer kappa's of 0.36-0.68. Conclusions: Visual examination and diagnosis of pectus excavatum yields considerable inter-observer and intra-observer disagreements. As this variation in judgement could impact work-up and treatment strategy, objective standardization is urged. Levels of evidence: III. (c) 2021 Elsevier Inc. All rights reserved.

BACKGROUND: Minimum cardiorespiratory fitness (CRF) has been recommended for firefighters due to job requirements. Thus, it is important to identify accurate and readily available methods to assess CRF in this population. Non-exercise CRF estimates (NEx-CRF) have been proposed but this approach requires validation in this population. OBJECTIVE: To evaluate the accuracy of a NEx-CRF, as compared to a field maximum exercise test, among career military firefighters of both genders using a comprehensive agreement analysis. METHODS: We evaluated the accuracy of a NEx-CRF estimate compared to the Cooper 12 min running test among 702 males and 106 female firefighters. RESULTS: Cooper and NEx-CRF tests yielded similar CRF in both genders (differences

Magnetic resonance imaging (MRI) is routinely used for preoperative tumor staging and to assess response to therapy in rectal cancer patients. The aim of our study was to evaluate the accuracy of MRI based restaging after neoadjuvant chemoradiotherapy (CRT) in predicting pathologic response. This multicenter cohort study included adult patients with histologically confirmed locally advanced rectal adenocarcinoma treated with neoadjuvant CRT followed by curative intent elective surgery between January 2014 and December 2019 at four academic high-volume institutions. Magnetic resonance tumor regression grade (mrTRG) and pathologic tumor regression grade (pTRG) were reviewed and compared for all the patients. The agreement between radiologist and pathologist was assessed with the weighted k test. Risk factors for poor agreement were investigated using logistic regression. A total of 309 patients were included. Modest agreement was found between mrTRG and pTRG when regression was classified according to standard five-tier systems (k = 0.386). When only two categories were considered for each regression system, (pTRG 0-3 vs pTRG 4; mrTRG 2-5 vs mrTRG 1) an accuracy of 78% (95% confidence interval [CI] 0.73-0.83) was found between radiologic and pathologic assessment with a k value of 0.185. The logistic regression model revealed that "T3 greater than 5 mm extent" was the only variable significantly impacting on disagreement (OR 0.33, 95% CI 0.15-0.68, P = .0034). Modest agreement exists between mrTRG and pTRG. The chances of appropriate assessment of the regression grade after neoadjuvant CRT appear to be higher in case of a T3 tumor with at least 5 mm extension in the mesorectal fat at the pretreatment MRI.

Assessing the symptoms of proximal weakness caused by neurological deficits requires the knowledge and experience of neurologists. Recent advances in machine learning and the Internet of Things have resulted in the development of automated systems that emulate physicians’ assessments. The application of those systems requires not only accuracy in the classification but also reliability regardless of users’ proficiency in the real environment for the clinical point-of-care and the personalized health management. This study provides an agreement and reliability analysis of using a machine learning-based scaling of Medical Research Council (MRC) proximal scores to evaluate proximal weakness by experts and non-experts. The system trains an ensemble learning model using the signals from sensors attached to the limbs of patients in a neurological intensive care unit. For the agreement analysis, we investigated the percent agreement of MRC proximal scores and Bland-Altman plots of kinematic features between the expert- and non-expert scaling. We also analyzed the intra-class correlation coefficients (ICCs) of kinematic features and Krippendorff’s alpha of the observers’ scaling for the reliability analysis. The mean percent agreement between the expert- and the non-expert scaling was 0.542 for manual scaling and 0.708 for autonomous scaling. The ICCs of kinematic features measured using sensors ranged from 0.742 to 0.850, whereas the Krippendorff’s alpha of manual scaling for the three observers was 0.275. The autonomous assessment system can be utilized by the caregivers, paramedics, or other observers during an emergency to evaluate acute stroke patients.

OBJECTIVE: The purpose of this study was to determine if there was agreement between a new point‐of‐care (POC) lactate analyzer and a handheld laboratory analyzer when measuring blood lactate concentration in cats. DESIGN: Prospective observational study. SETTING: University veterinary teaching hospital. ANIMALS: Fifty‐four cats that presented to an emergency service. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Lactate concentrations as measured by the handheld laboratory analyzer ranged from 0.3 to 15.4 mmol/L. Agreement analysis of the handheld laboratory analyzer and the POC lactate meter demonstrated a bias, −0.06 and limits of agreement ranging from −0.87 to 0.99 mmol/L. Regression analysis demonstrated a coefficient of determination (R²) of 0.98. CONCLUSION: Results of the present study indicate that the POC lactate meter provided results that are in agreement with a handheld laboratory analyzer when measuring lactate in clinically ill patients.

Geomagnetism, similar to other areas of geophysics, is an observation-based science. Data agreement between comparative geomagnetic vector observations is one of the most important evaluation criteria for high-quality geomagnetic data. The main influencing factors affecting the agreement between comparative observational data are the attitude angle, scale factor, long-term time drift, and temperature. In this paper, we propose a method based on a genetic algorithm and linear regression to correct for these effects and use the distribution pattern of points in Bland–Altman plots with a 95% confidence interval length to qualitatively and quantitatively evaluate the agreement between the comparative observational data. In Bland–Altman plots with better agreement, that is, with the corrected data, more than 95% of the points are distributed within the 95% confidence interval and there is no obvious pattern in the distribution of the points. Meanwhile, the length of 95% confidence interval decreased significantly after the correction. The method presented here has positive effects on the vector instrumentation detection and would enhance the robustness of geomagnetic observatory by bringing the data quality of the backup variometer data in line with the primary variometer. Graphical Abstract

Bland-Altman analysis is a very commonly used method in the biomedical research. This method is used to study the agreement between two measurements that are in continuous scale. Although this method is commonly used in medical research, the statistical software packages do not have the menu-driven operation for the Bland-Altman analysis. Hence this paper intends to provide an R function (BA.plot) for Bland-Altman analysis.

Purpose: To test whether some biometry measurements provided by the Lenstar LS900 compared well with the AL-Scan, Pentacam rotating Scheimpflug camera, Ultrasound Biomicroscopy (UBM) and Tomey EM-3000. Methods: 201 patients having routine cataract surgery had standard preoperative assessment. In this clinical study, the axis length (AL) and lens thickness (LT) were taken by Lenstar LS900 and AL-Scan; anterior chamber depth (ACD) were taken by Lenstar LS900, A-scan, Pentacam and UBM; central corneal thickness (CCT) were taken by Lenstar LS900, Pentacam and Tomey EM-3000. The results were compared using a Wilcoxon-Mann-Whitney U test and Pearson correlation calculations. Agreement was assessed through intraclass correlation coefficients and Bland-Altman plots.Results: The highest correlation was found between Lenstar and AL-Scan for AL (r = 0.975; P r = 0.699; P r=0.948, 0.704, respectively; both P r=0.453, P r=0.817, 0.882, respectively; both P

Clinical agreement between two quantitative measurements on a group of subjects is generally assessed with the help of the Bland-Altman (B-A) limits. The interpretation regarding agreement is based on whether B-A limits are within the pre-specified clinical tolerance. Thus, clinical tolerance limits are necessary for this method. We argue in this communication that such limits of clinical tolerance can be directly used for assessing agreement and plead that this nonparametric approach is simple and robust to the distribution pattern and outliers. Such direct use of clinical tolerance limits has more flexibility, and it is more effective in assessing the extent of agreement.

Wheat blast is a threat to global wheat production, and limited blast-resistant cultivars are available. The current estimations of wheat spike blast severity rely on human assessments, but this technique could have limitations. Reliable visual disease estimations paired with Red Green Blue (RGB) images of wheat spike blast can be used to train deep convolutional neural networks (CNN) for disease severity (DS) classification. Inter-rater agreement analysis was used to measure the reliability of who collected and classified data obtained under controlled conditions. We then trained CNN models to classify wheat spike blast severity. Inter-rater agreement analysis showed high accuracy and low bias before model training. Results showed that the CNN models trained provide a promising approach to classify images in the three wheat blast severity categories. However, the models trained on non-matured and matured spikes images showing the highest precision, recall, and F1 score when classifying the images. The high classification accuracy could serve as a basis to facilitate wheat spike blast phenotyping in the future.

Purpose The assessment of symptoms of dry eye disease using a questionnaire is an effective and simple method of quantifying symptoms. The aim of this study was to translate the SPEED questionnaire and adapt it for the Italian language and verify the main psychometric performance of the translated version, including repeatability and agreement. Methods The SPEED questionnaire was translated into Italian following a standard methodology. The resulting questionnaire was administered to 206 adult participants in order to perform a validation analysis. A subgroup of 82 participants was retested after one week to give a repeatability and agreement assessment. Results Internal consistency showed an alpha of 0.852 (95% CI 0.818–0.881) and no unnecessary items. The factor analysis showed a saturation for three main factors related to (i) Dryness and Soreness, (ii) Fatigue, and (iii) Burning. Repeatability was high, with a CCC of 0.896 (95% CI 0.844–0.931). Agreement analysis showed no significant bias between sessions and an interval of agreement of 5 points for SPEED score. Conclusion The translation and adaptation of the SPEED questionnaire for the Italian language have demonstrated good psychometric properties for the translated questionnaire, confirming and expanding the original psychometric characteristics. Consequently, the SPEED questionnaire could be used to measure the presence of symptoms of dry eye quantitatively.

Objectives: To determine the applicability of Jones, Hansen, and Wasserman predictive equations for maximal oxygen consumption (VO 2max ) in Saudi females. Methods: This cross-sectional study was conducted at Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia, between March and May 2017. Maximal oxygen consumption was measured directly through the COSMED system for cardiopulmonary exercise testing in 102 girls with normal body mass index (19-25 years old). Maximal oxygen consumption was indirectly predicted by Jones, Hansen, and Wasserman equations. Paired t-test, Pearson correlation, and Bland-Altman plot were used for comparison, correlation, and agreement analysis. Results: The difference between the mean and standard deviation (±SD) VO 2max values of the direct measurement (27.39±4.06 ml/kg −1 /min −1 ), and the Jones (35.19±2.12 ml/kg −1 /min −1 ), Hansen (33.64±0.24 ml/kg −1 /min −1 ), and Wasserman (35.20±0.17 ml/kg −1 /min −1 ) equations, was statistically significant ( p less than 0.001). Bland-Altman plot analysis suggested a lack of agreement between direct and predicted VO 2max . Pearson correlation failed to reveal any correlation between direct VO 2max and VO 2max calculated with any of the 3 equations. Conclusion: Jones, Hansen, and Wasserman equations for prediction of VO 2max cannot be justified in the studied population. For the better prediction of VO 2max , either these equations should be modified, or a new equation should be developed for the Saudi population.

BackgroundThe study objective was to compare the ISS manually assigned by hospital personnel and those generated by the ICDPIC software for value agreement and predictive power of length of stay (LOS) and mortality.MethodsWe used data from the 2010–2016 trauma registry of a paediatric trauma centre (PTC) and 2014 National Trauma Data Bank (NTDB) hospitals that reported manually coded ISS. Agreement analysis was performed between manually and computer assigned ISS with severity groupings of 1–8, 9–15, 16–25 and 25–75. The prediction of LOS was compared using coefficients of determination (R2) from linear regression models. Mortality predictive power was compared using receiver operating characteristic (ROC) curves from logistic regression models.ResultsThe proportion of agreement between manually and computer assigned ISS in PTC data was 0.84 and for NTDB was 0.75. Analysing predictive power for LOS in the PTC sample, the R2=0.19 for manually assigned scores, and the R2=0.15 for computer assigned scores (p=0.0009). The areas under the ROC curve indicated a mortality predictive power of 0.95 for manually assigned scores and 0.86 for computer assigned scores in the PTC data (p=0.0011).ConclusionsManually and computer assigned ISS had strong comparative agreement for minor injuries but did not correlate well for critical injuries (ISS=25–75). The LOS and mortality predictive power were significantly higher for manually assigned ISS when compared with computer assigned ISS in both PTC and NTDB data sets. Thus, hospitals should be cautious about transitioning to computer assigned ISS, specifically for patients who are critically injured.

Background and purposeThe ideal stroke classification system needs to have validity, high reliability and applicability among different stroke research settings. The Chinese Ischemic Stroke Subclassification (CISS) and the Subtypes of Ischemic Stroke Classification System (SPARKLE) have emerged recently but have not been tested using agreement analysis. As a result, the objective of this study is to investigate the level of agreement among stroke subtype classifications using CISS, SPARKLE and Trial of Org 10172 in Acute Stroke Treatment (TOAST). We also analyse the inter-rater reliability of CISS.MethodsThe data include 623 inpatients who have had an ischaemic stroke, accrued from Beijing Tiantan Hospital between 1 October 2015 and 19 April 2016. According to the diagnostic standards of the three subtype classification systems, 299 inpatients who satisfied the requirements of our study were independently classified with etiological subtypes, and we compared the three subclassifications.ResultsThere was substantial overall agreement among the three classification systems: CISS versus SPARKLE (kappa value=0.684, pConclusionThere were generally substantial agreements among three ischaemic stroke etiological classification systems. CISS is a valid and reliable classification system, with which different stroke research centres can apply and compare data.

Background In critically ill patients, who require multiple blood gas assessments, agreement between arterial and venous blood gas values for pH and partial pressure of carbon dioxide, is not clear. Good agreement would mean that venous values could be used to assess ventilation and metabolic status of patients in intensive care unit. Methods All adult patients admitted to Alfred intensive care unit, Melbourne, from February 2013 to January 2014, who were likely to have arterial and central venous lines for three days, were enrolled. Patients on extra-corporeal life support and pregnant women were excluded. After enrolment, near simultaneous arterial and central venous sampling and analysis were performed at least once per nursing shift till the lines were removed or the patient died. Bland-Altman analysis for repeated measures was performed to assess the agreement between arterio-venous pH and partial pressure of carbon dioxide. Results A total of 394 paired blood gas analyses were performed from 59 participants. The median (IQR) number of samples per patient was 6 (5–9) with the median (IQR) sampling interval 9.4 (5.2–18.5) h. The mean bias for pH was + 0.036 with 95% limits of agreement ranging from − 0.005 to + 0.078. For partial pressure of carbon dioxide, the values were −2.58 and −10.43 to + 5.27 mmHg, respectively. Conclusions The arterio-venous agreement for pH in intensive care unit patients appears to be acceptable. However, the agreement for partial pressure of carbon dioxide was poor.

Essentials In 2016 the SSC proposed definitions for effective hemostasis in management of major bleeding. To validate these definitions, we studied the use in three large anticoagulant-reversal studies. Method agreement analysis and interobserver reliability showed at least acceptable agreement. Recommendations were made, advising use of the definition in hemostatic effectiveness studies. SUMMARY: Introduction In 2016 the Scientific and Standardization Subcommittee (SSC) on Control of Anticoagulation of the International Society on Thrombosis and Haemostasis (ISTH) proposed criteria to evaluate the effectiveness of anticoagulant reversal in major bleeding management. Testing and validation of these criteria are required. Objective To investigate the method agreement, interobserver reliability and applicability of the ISTH proposed definitions for hemostatic effectiveness. Methods Patient data from three anticoagulant-antidote studies were used for hemostatic effectiveness assessment using the ISTH-proposed definitions and clinical opinion. For every patient a case document was produced. For each cohort, four adjudicators were asked to assess the hemostatic effectiveness independently on a case-by-case basis. Agreement between the two methods of hemostatic effectiveness assessment was calculated using Cohen's kappa (κ), with a calculated sample size of at least 73 cases. Results The full dataset consisted of 116 cases, resulting in 464 assessments. Method agreement in outcome was observed in 364 of 464 assessments (78.5%), resulting in κ of 0.634 (95% CI: 0.575-0.694), or "substantial agreement." Interobserver reliability analysis of the proposed definitions computed an overall agreement of 54.2% with κ of 0.312 ("fair agreement"). Discussion Method agreement analysis shows that the conclusions drawn using the ISTH definitions have "substantial agreement" with clinical opinion. Interobserver reliability analysis demonstrated acceptable agreement. In-depth analysis provided minor opportunities for further improvement and correct application of the definition. The definition is recommended to be used in all future studies evaluating hemostatic effectiveness, taking the suggested recommendations into account.

Hypertension is a silent killer and one-third of its sufferers are unaware of its presence. Tonometric devices, like SphygmoCor, Compilor etc., represent the gold standard in pulse wave velocity (PWV) and augmentation index (AIx) measurements which are limited by their high cost and operational accuracy. Here, we present an alternative technology that is low cost and may be suitable for the `wearable' setting. We undertook the comparisons of arterial waveforms obtained by photoplethysmogram (PPG) and finger ballistocardiogram (BPP) sensors which were then validated against a SphygmoCor tonometric device. Specifically, the agreement analysis of the augmentation, stiffness, reflection, elasticity, ejection elasticity and dicrotic reflection indexes showed that arterial distension waveform sensing using BPP sensor, has precision and accuracy similar to that of a SphygmoCor tonometric device whilst outperforming the volumetric arterial flow sensing using a PPG sensor, in every index. BPP indexes showed the r2 fit of up to 0.95 and Spearman's rank correlation up to 0.91 when validated against the SphygmoCor tonometer. The estimated individual transfer functions for the BPP sensor, with reference to SphygmoCor, have accuracies of above 85% and 98% for 2 and 4-element windkessel (WK) models, respectively. The findings reported in this work may also be useful for the development of systems that are beneficial in the early and/or routine detection of hypertension.

Objective To analyze the agreement, in relation to the 90th percentile, of ultrasound measurements of abdominal circumference (AC) and estimated fetal weight (EFW), between the World Health Organization (WHO) and the International Fetal and Newborn Growth Consortium for the 21st Century (intergrowth-21st) tables, as well as regarding birth weight in fetuses/newborns of diabetic mothers. Methods Retrospective study with data from medical records of 171 diabetic pregnant women, single pregnancies, followed between January 2017 and June 2018. Abdominal circumference and EFW data at admission (from 22 weeks) and predelivery (up to 3 weeks) were analyzed. These measures were classified in relation to the 90th percentile. The Kappa coefficient was used to analyze the agreement of these ultrasound variables between the WHO and intergrowth-21st tables, as well as, by reference table, these measurements and birth weight. Results The WHO study reported 21.6% large-for-gestational-age (LGA) newborns while the intergrowth-21st reported 32.2%. Both tables had strong concordances in the assessment of initial AC, final AC, and initial EFW (Kappa = 0.66, 0.72 and 0.63, respectively) and almost perfect concordance in relation to final EFW (Kappa = 0.91). Regarding birth weight, the best concordances were found for initial AC (WHO: Kappa = 0.35; intergrowth-21st: Kappa= 0.42) and with the final EFW (WHO: Kappa = 0.33; intergrowth- 21st: Kappa = 0.35). Conclusion The initial AC and final EFW were the parameters of best agreement regarding birth weight classification. The WHO and intergrowth-21st tables showed high agreement in the classification of ultrasound measurements in relation to the 90th Resumo Objetivo Analisar a concordância, em relação ao percentil 90, das medidas ultrassonográficas da circunferência abdominal (CA) e peso fetal estimado (PFE), entre as tabelas da Organização Mundial de Saúde (OMS) e do International Fetal and Newborn Growth Consortium for the 21st Century integrowth-21st, bem como em relação ao peso ao nascer em fetos/recém-nascidos de mães diabéticas. Métodos Estudo retrospectivo com dados de prontuários de 171 gestantes diabéticas, com gestações únicas, seguidas entre Janeiro de 2017 e Junho de 2018. Foram analisados dados da CA e do PFE na admissão (a partir de 22 semanas) e no pré-parto (até 3 semanas). Essas medidas foram classificadas em relação ao percentil 90. O coeficiente Kappa foi utilizado para analisar a concordância entre as tabelas da OMS e Intergrowth-21st, assim como, por tabela de referência, entre as medidas e o peso ao nascer. Resultados O estudo da OMS relatou 21,6% dos recém nascidos grandes para a idade gestacional (GIG) enquanto que o estudo do intergrowth-21st relatou 32,2%. Ambas as tabelas tiveram fortes concordâncias na avaliação da CA inicial e final e PFE inicial (Kappa= 0,66, 0,72 e 0,63, respectivamente) e concordância quase perfeita em relação ao PFE final (Kappa= 0,91).Emrelação ao peso ao nascer, asmelhores concordâncias foram encontradas para aCAinicial (OMS: Kappa= 0,35; intergrowth-21st: Kappa= 0,42) e como PFE final (OMS: Kappa = 0,33; intergrowth-21st: Kappa= 0,35). Conclusão A CA inicial e o PFE final foram os parâmetros de melhor concordância em relação à classificação do peso ao nascer. As tabelas da OMS e intergrowth-21st mostraram alta concordância na classificação das medidas ultrassonográficas em relação ao percentil 90. Estudos são necessários para confirmar se alguma dessas tabelas é superior na previsão de resultados negativos a curto e longo prazo no grupo GIG.

This study examines agreement between the devices Anterion® and Pentacam HR® used for corneal and pupil measurements in healthy eyes. The parameters compared between the two devices were: anterior Km (D), anterior K2 (D), anterior K1 (D), anterior K1 axis (°), anterior astigmatism (D), anterior K max (D), posterior Km (D), posterior K2 (D), posterior K1 (D), posterior K1 axis (°), posterior astigmatism (D), CCT (µm), thinnest point thickness (µm), thinnest point X-coordinate (mm), thinnest point Y-coordinate (mm), pupil diameter (mm), pupil center-corneal vertex distance (mm) (angle kappa), pupil centroid angle (°), pupil centroid X-coordinate (mm), and pupil centroid Y-coordinate (mm). The Student’s t test for independent samples identified significant differences (p < 0.005) between devices for the measurements anterior and posterior flat K axis, posterior flat K, steep K, and mean K. For these last three measurements, although significant, none of the differences were clinically relevant. Corneal power and thickness measurements except Kf axis showed excellent agreement between Anterion and Pentacam. In a clinical setting we would not recommend the interchangeable use of Pentacam and Anterion for measurement of pupil parameters.

Aim Although it is not yet used in clinical practice, metabolic tumor volume (MTV) assessed on the baseline FDG-PET has shown consistent prognostic value in various lymphoma types. The aim of our study was to compare interobserver agreement and reproducibility across platforms of MTV calculation using different SUV thresholding methods in a large series of patients with newly diagnosed Hodgkin lymphoma. Materials and methods We retrospectively studied 121 patients. MTV at baseline FDG-PET was independently computed by three readers with three programs of semi-automatic segmentation, Fiji, LifeX, and Accurate. MTV measurement was performed with different thresholds: SUV >2.5, SUV >4, and SUV >41% of SUV max. Results At inter-observer agreement analysis all Intraclass Correlation Coefficients (ICCs) were excellent (ICC >0.9), except for Accurate SUV >41% of SUV max (ICC = 0.8). The highest correlations were obtained at the SUV >4 threshold. The second best was SUV >2.5 threshold. Regarding reproducibility across software, we found statistically significant differences between Fiji versus LifeX and Accurate at fixed thresholds and between LifeX and Accurate at SUV >41% of SUV max, while no significant differences emerged between LifeX and Accurate using fixed thresholds. Conclusion The three SUV thresholds studied are all suitable for MTV calculation in terms of reproducibility. The best reproducibility is achieved using fixed thresholds, both SUV >4 and SUV >2.5. If more than one software has to be used in a study, we suggest the use of fixed thresholds and the platforms LifeX and Accurate.

In the third of a series of studies and reports, the authors expand on the frequency occurrence proportions of various handwritten features. The first study culminated in the publication of "Measuring the Frequency Occurrence of Handwriting and Handprinting Characteristics." That study was followed by "Measuring the Frequency Occurrence of Handwritten Numeral Characteristics." The premise of this current and future follow-up studies is to expand on the initial lists of information incrementally by expanding the number of features and the number of writers. This study expands on the list of numeral features. A total of 34 numeral features was selected by the authors as candidates for this study and tested through an attribute agreement analysis. Based on the results of the testing, 17 new features have been added to the list of proportions. The original 1410 handwritten numeral specimen forms were utilized and pared to 1024 to obtain a proper population sampling for the United States. Interdependency testing was conducted on 783 pairs of inter-character numerals. A coefficient of correlation between -0.2 and +0.2 was found in 534 (68.20%) of these pairs. As of this report, there are now a total of 42 numerals with measured frequencies of occurrence. This material has already borne fruit as the combined frequency of occurrence studies were explained during an unsuccessful exclusion hearing in court with an explanation as to how these studies support the reliability of forensic document examination.

Background Given the high prevalence of neck pain, the neck disability index (NDI) has been used to evaluate patient status and treatment outcomes. Modified versions were proposed as solutions to measurement deficits in the NDI. However, the original 10-item NDI was scored out of 50 and is still the most frequently administered version. Examining the extent of agreement between traditional and Rasch-based versions using Bland-Altman (B&A) plots will inform our understanding of score differences that might rise from using different versions. Therefore, the objective of current study was to describe the extent of agreement between different versions of NDI. Methods The current study was a secondary data analysis. The study data was compiled from two prospectively collected data sources. We performed a comprehensive literature search to identify Rasch approved NDI within four databases including Embase, Medline, PubMed, and Google Scholar. Alternate forms and scorings were compared to each other and to the standard NDI. We graphed B&A plots and calculated the mean difference and the 95% limits of agreement (LoA; ±1.96 times the standard deviation). Results Two Rasch approved alternative versions (8 vs 5 items) were identified from 303 screened publications. We analyzed data from 201 (43 males and 158 females) patients attending community clinics for neck pain. We found that the mean difference was approximately 10% of the total score between the 10-item and 5-item (− 4.6 points), whereas the 10-item versus 8-item and 8-item versus 5-item had smaller mean differences (− 2.3 points). The B&A plots displayed wider 95% LoA for the agreement between 10-item and 8-item (LoA: − 12.0, 7.4) and 5-item (LoA: − 14.9, 5.8) compared with the LoA for the 8-item and 5-item (LoA: − 7.8, 3.3). Conclusion Two Rasch-based NDI solutions (8 vs 5 items) which differ in number of items and conceptual construction are available to provide interval level scoring. They both provide scores that are substantially different from the ordinal NDI, which does not provide interval level scoring. Smaller differences between the two Rasch solutions exist and may relate to the items included. Due to the size and unpredictable nature of the bias between measures, they should not be used interchangeably.

Made available in DSpace on 2021-06-25T11:14:12Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-01-01 Considering the necessity of interdisciplinary approaches for planning and managing the expansion of urban landscapes worldwide, this study aimed to (1) assess landscape permeability for birds and people inhabiting a Neotropical city and (2) propose priority streets and areas for the implementation of a green infrastructure project that could benefit both. To reach these goals, we generated resistance surfaces using expert knowledge to simulate multiple least-cost corridors (MLCC) between parks and green spaces within an urban landscape for people and seven bird species. We compared the solutions using a corridors’ spatial agreement analysis, which allow us to identify the overlap between modeled corridors for all organisms or functional groups of interest. We also identified the streets most selected by the simulated MLCC and then identified a green space which is a convergence point of corridors modeled for both people and bird species. Finally, we suggested priority streets for planting trees and proposed interventions to turn the green space into a multifunctional park, conciliating social and ecological perspectives. Spatial Ecology and Conservation lab (LEEC) Department of Biodiversity São Paulo State University - UNESP, Avenue: 24A, 1515 Red de Ambiente y Sustentabilidad Instituto de Ecología A.C., carretera el Haya Spatial Ecology and Conservation lab (LEEC) Department of Biodiversity São Paulo State University - UNESP, Avenue: 24A, 1515

JCI established a standard for common medical errors in hospitals known as IPSG. This study focused on the emergency departments of government hospitals A to C and a private hospital D. The objective for this study is to know and determine which among the factors must be considered in constructing an emergency department (ED), which lessens medical errors, and to be able to create a mathematical model among the factors. This research used a combination of quantitative correlational research and quasi-experimental research. The data were tested for reliability using the Attribute Agreement Analysis (3A) method in MINITAB v.17 then it proceeded to factor analysis using SPSS, which yields the result of interdependence of the factors to each presence. SEM can be performed to see the partial correlation and multi collinearity of the variables. All of the measurements used were incorporated to create a mathematical model, which aims to analyze the factors. Among the three major factors that were cited, environmental-related (ER) factors ranked the highest correlativity to medical errors or International Patient Safety Goals (IPSGs) with a value of 0.82 versus the other factors of 0.59 and 0.68. Noise and illumination were the two highest contributors of medical errors from ER factors with a value of 0.93 and 0.82, respectively.

ObjectiveTo evaluate agreement of the body adiposity index (BAI) and paediatric body adiposity index (BAIp) in estimating body fat compared with dual-energy X-ray absorptiometry (DXA) and to propose cut-off points for these indices to classify excess adiposity in Brazilian children and adolescents.DesignCross-sectional study. Measures of weight, height, hip circumference, BMI and body fat percentage (%BF) assessed by DXA were taken, and BAI and BAIp were calculated. The Bland–Altman plot was used to estimate agreement between the methods, and the receiver-operating characteristic curve to determine the cut-off points for BAI and BAIp per age and sex in comparison with DXA.SettingViçosa, Minas Gerais, Brazil.SubjectsChildren and adolescents aged 8–19 years (n 1049).ResultsOf the children and adolescents, 52·4 % were girls. BAI and BAIp had satisfactory performance by the receiver-operating characteristic curve, except for the 18–19 years age group, whose BAIp had better predictive capacity than BAI. The agreement analysis showed that BAI overestimated %BF by 2·64 %, on average, using DXA; while BAIp underestimated %BF by 3·37 %.ConclusionsBAI and BAIp showed low agreement with the body fat obtained by DXA, requiring caution when interpreting body composition data in children and adolescents.

This article aims to provide an agreement analysis between the postpositional phrase head and its complement in the Tenetehára language (Tupí-Guaraní). I assume that, in Tenetehára, the postpositions complements move to a specifier position of a functional category above PP, in order to check the Oblique Case. I provisionally label this functional category as FP. Thus, at the point of the derivation in which the head Fo, which moved from Po, is in a Spec-Head relation with the FP specifier, generated as a complement to Po, relational agreement is established., Este artigo tem como objetivo oferecer uma análise acerca da concordância estabelecida entre o núcleo do sintagma posposicional e seu complemento na língua Tenetehára (Tupí-Guaraní). Assumo que, em Tenetehára, os complementos das posposições deslocam-se para uma posição de especificador de uma categoria funcional acima de PP com o intuito de checar o Caso oblíquo. Rotulo provisoriamente tal categoria funcional como FP. Assim, no ponto da derivação em que o núcleo Fo, o qual se moveu a partir de Po, encontra-se em uma relação Spec-Head com o especificador de FP, gerado com complemento de Po, é estabelecida a concordância relacional.

Guojun Chen,1,* Longyuan Jiang,1,* Liwen Wang,1 Wei Zhang,2 Carlos Castillo,3,4 Xiangshao Fang1 1Department of Emergency Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; 2Department of Respiratory Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; 3Zhang Neuroscience Research Laboratories, School of Medicine, Loma Linda University, Loma Linda, CA, USA; 4Bioengineering Department, Gordon and Jill Bourns College of Engineering, California Baptist University, Riverside, CA, USA *These authors contributed equally to this work Background and aim: It is desirable to facilitate the use of an affordable, reliable, and portable spirometer, for earlier diagnosis of COPD in China, particularly in rural areas. The aim of this study was to assess the agreement of a handheld “disposable pneumotachograph” (D-PNEU) spirometer with the gold standard spirometer and to evaluate its diagnostic accuracy of spirometric classification of airflow obstruction. Subjects and methods: A total of 241 adult Chinese subjects ranging from healthy to those with mixed levels of pulmonary disease performed spirometry in a conventional body plethysmograph, and using a D-PNEU device in randomized order. The three best spirometric tests were recorded for comparative analysis. A Bland–Altman graph was created to assess the agreement between devices. Using FEV1/FVC

Introduction/Background US imaging due to its limited cost is under intense investigation as base for dose adaptation in cervical cancer brachytherapy. This work test inter/intra-observer uncertainties between MR and TRUS imaging defining maximum tumor width before first BT application in a prospective cohort of cervical cancer patients undergoing IGABT. Methodology 110 consecutive cervical cancer patients were included. Before first BT implant underwent MR and TRUS scan with no applicator in place. Images were independently analyzed by three examiners, blinded to the other’s results. With clinical information at hand, maximum tumor width was measured on preBT TRUS and MR (figure.1). Quantitative agreement analysis was undertaken. Intra-class correlation coefficient (ICC), Passing-Bablok and Bland Altman plots were used to evaluate the intra/inter-observers agreement. Results Average difference between HRCTVMR and HRCTVTRUS was 1.3±3.2 mm (p Conclusion TRUS is equivalent to MR in assessing preBT tumor maximum width in cervical cancer FIGO stage I/II. In advanced stages TRUS is slightly inferior to MR. Disclosure Nothing to disclose.

Due to the increasingly severe situation regarding adaptation to climate change, global attention has focused on whether China can fulfill its commitment to the Paris Agreement as the largest producer of carbon dioxide (CO2) emissions. In this study, the CO2 emissions and CO2 intensities in China during 2030 were forecast using three scenarios, seven indicators, and a back-propagation neural network. Under the business as usual (BAU), strategic planning (SP), and low carbon (LC) scenarios, the predicted CO2 emissions in China during 2030 are 13,908.00, 11,837.60, and 9102.50 million tonnes, respectively, and the predicted CO2 intensities are 1.8652, 1.7405, and 1.5382 when considering carbon capture, utilization, and storage (CCUS). Furthermore, China cannot fulfill its commitment under the BAU scenario, whereas China will fulfill its commitment on schedule under the SP scenario. Under the LC scenario, China will fulfill its commitment ahead of schedule to reduce the CO2 intensity by 60% in 2025, and it will even reduce the CO2 intensity by 65% in 2030. In addition, if the amounts of CCUS are not considered for measuring the CO2 intensity, China can still fulfill its commitment under the LC scenario, whereas it cannot fulfill its commitment by 2030 under the SP scenario. This study evaluated the fulfillment of China's commitment in the Paris Agreement, demonstrated that CCUS plays an important role in reducing the CO2 intensity, and provided policy suggestions for the Chinese government regarding the reductions of the CO2 intensity.

WHAT IS KNOWN AND OBJECTIVES: Formulae estimating glomerular filtration rate (GFR) are frequently used to guide drug dosing. The objectives of this prospective single-center study were to evaluate agreement between these equations and measured creatinine clearance (CrCl) in non-critically ill surgery patients with normal kidney function and augmented renal clearance (ARC, CrCl ≥ 130 mL/min/1.73 m²), to determine predictors for disagreement, define a GFR estimator cut-off value identifying ARC and determine the ARC prevalence and duration in non-critically ill surgical patients. METHODS: Hospitalized adult non-critically ill abdominal and trauma surgery patients were eligible for inclusion. Measured CrCl based on an 8-hour urinary collection (CrCl8h ) was used as the primary method for determining kidney function. Agreement between equations and measured CrCl8h was assessed in terms of precision, defined as a bias within ±10 mL/min/1.73 m². Predictors for disagreement were identified for the most precise estimator using an ordinal logistic regression model with negative bias, agreement and positive bias as outcome variables. A receiver operating characteristic (ROC) analysis was performed to identify an estimator cut-off predicting ARC, which was subsequently applied for the daily proportion of patients displaying ARC and ARC duration. RESULTS AND DISCUSSION: During the study period (14/11/2013 - 13/05/2014), in 232 adult non-critically ill abdominal and trauma surgery patients, all estimators tend to underestimate CrCl8h (mean bias ranging from 17 to 22 mL/min/1.73 m²), especially in patients displaying ARC (mean bias ranging from 44 to 56 mL/min/1.73 m²). eGFRCKD-EPI performed the best. Younger age and low ASA score independently predicted underestimation of CrCl8h . Three different eGFRCKD-EPI cut-offs with decreasing sensitivity and increasing specificity (84, 95 and 112 mL/min/1.73 m²) identified, respectively, 65%, 44% and 14% patients displaying ARC. The median ARC duration was 4, 4 and 3 days, respectively. WHAT IS NEW AND CONCLUSION: In surgical patients, eGFR frequently underestimates measured CrCl, especially in young patients with low ASA score. eGFR cut-offs predicting ARC were identified. ispartof: JOURNAL OF CLINICAL PHARMACY AND THERAPEUTICS vol:43 issue:5 pages:695-706 ispartof: location:England status: published

Automatic Optical Inspection (AOI) machines have an important role in the monitoring and detection of errors during the manufacturing process of electronic circuit boards. These machines show images of products with potential assembly defects to an operator and let him decide whether the product has a real defect or on the contrary it was an automated false positive detection. The attribute agreement analysis methodology is part of a Six Sigma strategy to examine the repeatability and reproducibility of an evaluation system, thus giving important feedback on the suitability of each operator in classifying defects. In order to reduce the number of operator errors, a training method was developed with the support of the attribute agreement analysis method with test images presented to operators for classification. By using this methodology, it was possible to check the capability of each operator, and improve the operator's evaluation score. After the application of the tool, the improvement of results is shown.

The time and costs associated with HVAC system installation are significant percentages of the total time and cost of construction projects. Furthermore, these systems affect many of the other construction activities. They are complicated, and their installations face many risks, which may lead to time and cost overruns for the project. Therefore, more attention should be paid to how these systems are installed in construction projects. The main objective of this study was to identify the main activities associated with HVAC system installation in construction projects, as well as the risk factors that affect them. Other objectives included conducting an analysis and assessment of the effects of these risk factors on time and cost objectives. Multi-stage field surveys were used in this study. The major risk sources were qualified in terms of their severity, probability of occurrences, and impacts on time and cost objectives. Three activities associated with HVAC system installation were identified: (a) air distribution duct work, (b) chilled water distribution pipe work, and (c) HVAC equipment installation. Fifty-five risk factors that affect each specific activity and that are common to all activities were also identified and categorized into four groups. Two agreement analysis tests and a full statistical analysis were conducted. A high degree of agreement between all partners was obtained. The time and cost percentages of the three activities were determined. A detailed discussion and analysis indicated that approximately 50% of the key risks belonged to common risks that affected all activities, while the most important risky activity was chilled water distribution pipe work. Furthermore, the analysis emphasized that the number of risk factors increased as the expected duration of the activity increased; however, this relationship did not exist in the case of cost. Ultimately, the obtained results indicate that the expected time and cost overruns caused by the effects of risk factors on HVAC system delivery are approximately 10–20% and 5–10%, respectively.

While concrete recycling is crucial to protecting the environment, its implementation in practice is low in many countries. This study aims to highlight challenges to concrete recycling. To achieve that aim, the study objectives are (1) to identify the main challenges to concrete recycling in construction projects, (2) to compare the main challenges between small–medium enterprises (SMEs) and large enterprises (LEs), and (3) to determine the underlying groups among the main challenges. Potential challenges were identified through a systematic literature review of journal articles and semi-structured interviews with fifteen industry practitioners. Then, the identified challenges were inserted into a questionnaire survey and distributed to industry practitioners. Eighty-nine valid responses were collected and analyzed using the mean score ranking, normalization, agreement analysis, and factor analysis techniques. The analyses show thirteen main challenges to concrete recycling. The main challenges include increased project duration, lack of national programs, lack of comprehensive rules and regulations, increased project cost, low demand for recycled concrete, low cost-effectiveness of concrete recycling, and increased transportation cost. However, there is no consensus on the criticality between SMEs and LEs. For example, increased project cost is the main challenge for SMEs but is only middlingly ranked for LEs. Finally, the main challenges can be categorized into three interrelated groups: people and technical, legal and environmental, and economic challenges. This study contributes to the literature by analyzing challenges that hinder concrete recycling in practice. The findings allow researchers and practitioners to develop strategies to reduce concrete recycling rejection.

Objective. To evaluate interrater reliability of a universal evaluator rubric used to assess student pharmacist communication skills during patient education sessions. Methods. Six schools/colleges of pharmacy each submitted ten student videos of a simulated community pharmacy patient education session and recruited two raters in each of the five rater groups (faculty, standardized patients, postgraduate year one residents, student pharmacists, and pharmacy preceptors). Raters used a rubric containing 20 items and a global assessment to evaluate student communication of 12 videos. Agreement was computed for individual items and overall rubric score within each rater group, and for each item across all rater groups. Average overall rubric agreement scores were compared between rater groups. Agreement coefficient scores were categorized as no to minimal, weak, moderate, strong, or almost perfect agreement. Results. Fifty-five raters representing five rater groups and six schools/colleges of pharmacy evaluated student communication. Item agreement analysis for all raters revealed five items with no to minimal or weak agreement, 10 items with moderate agreement, one item with strong agreement, and five items with almost perfect agreement. Overall average agreement across all rater groups was 0.73 (95% CI 0.66-0.81). The preceptor rater group exhibited the lowest agreement score of 0.68 (95% CI 0.58-0.78), which significantly deviated from the overall average. Conclusion. While strong or almost perfect agreement scores were not observed for all rubric items, overall average interrater reliability results support the use of this rubric in a variety of raters to assess student pharmacist communication skills during patient education sessions.

Aging horses through dental evaluation has many applications. Typically, users view the occlusal surface of the incisors to evaluate the appearance and disappearance of cups and rings. When the structure of the cup becomes smaller than half the surface of the tooth and the dental star appears, the cups are considered worn. The cups start wearing on the middle incisor teeth first and then laterally until all cups are worn on incisors. A similar pattern then repeats the process with rings. The ring is a characteristic found at the very bottom of the cup. It disappears on the central incisors and then proceeds laterally until all rings disappear. Recently, a Computerized Horse Aging Program (CHAP) app was developed for use on a mobile platform. The app uses the camera on a mobile device to capture the occlusal surface of the incisor teeth. The app will provide a 2-year age range based upon the cup system analysis. The cups are detected by computer vision, then analyzed through artificial intelligence, and compared with a database of horses with known age. The objective of this study was to determine whether CHAP could accurately predict horse ages. One hundred and 2 registered horses were used for this study. Images of both the upper and lower incisor teeth were captured and uploaded to CHAP. Estimated ages were compared with actual ages using Bland Altman agreement analysis and the MIXED procedure of SAS (SAS v 9.4), to determine whether the difference between predicted and actual (residual) age was different from 0. CHAP could accurately predict age using upper incisors in horses between 8 and 13, while lower incisors were accurate between 8 and 10 years (Table 1). Age prediction in horses greater than 14 years and less than 8 years was not accurate. Older horses have consumed a variety of feeds throughout their lifetimes which can influence age prediction. Further, our data set included fewer horses of these ages. CHAP is recommended for use on younger horses and users should take upper and lower teeth into consideration.

The Language ENvironment Analysis system (LENA™) automatically analyzes the natural sound environments of children. Among other things, it estimates the amounts of adult words (AWC), child vocalizations (CV), conversational turns (CT), and electronic media (TV) that a child is exposed to. To assess LENA's reliability, we compared it to manual transcription. Specifically, we calculated the correlation and agreement between the LENA estimates and manual counts for 48 five-min audio samples. These samples were selected from eight day-long recordings of six Dutch-speaking children (ages 2-5). The correlations were strong for AWC, r = . 87, and CV, r = . 77, and comparatively low for CT, r = . 52, and TV, r = . 50. However, the agreement analysis revealed a constant bias in AWC counts, and proportional biases for CV and CT (i.e., the bias varied with the values for CV and CT). Agreement for detecting electronic media was poor. Moreover, the limits of agreement were wide for all four metrics. That is, the differences between LENA and the manual transcriptions for individual audio samples varied widely around the mean difference. This variation could indicate that LENA was affected by differences between the samples that did not equally affect the human transcribers. The disagreements and biases cast doubt on the comparability of LENA measurements across families and time, which is crucial for using LENA in research. Our sample is too small to conclude within which limits LENA's measurements are comparable, but it seems advisable to be cautious of factors that could systematically bias LENA's performance and thereby create confounds. ispartof: BEHAVIOR RESEARCH METHODS vol:50 issue:5 pages:1921-1932 ispartof: location:United States status: published