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Background: The purpose of this study was to evaluate the repeatability and agreement of multispectral refraction topography (MRT) in measuring retinal refraction before and after cycloplegia in children. The results of this study will provide valuable insights into the accuracy and reliability of MRT as a tool for assessing retinal refraction in pediatric patients. Methods: Children aged 7 to 18 years old were recruited for this prospective research. The central and peripheral retinal refraction was measured three times using multispectral refraction topography (MRT) before and after cycloplegia. The retinal deviation value (RDV) was used to describe the average peripheral refractive error of the retina. In addition, objective refraction (OR) and subjective refraction (SR) measurements were also performed. Results: A total of 60 children with a mean age of 10.50 ± 1.81 years were enrolled. Before cycloplegia, all the central and peripheral retinal refraction parameters showed good repeatability with the lowest intraclass correlation coefficient (ICC) being 0.78 in the retinal deviation value from 45° eccentricity to 53° of the retina (RDV 45–53). After cycloplegia, the repeatability of MRT was significantly enhanced (lowest ICC = 0.91 in RDV-I). The 95% limits of agreement (LoA) of the central refraction and OR ranged from − 2.1 to 1.8 D before cycloplegia, and from − 1.69 to 0.27 D after cycloplegia. The 95% LoA of the central refraction and SR ranged from − 1.57 to 0.36 D after cycloplegia. All the 95% LoA demonstrated high agreement. Conclusions: The MRT shows high agreement with autorefractometry and experienced optometrist in measuring central refraction. Additionally, the MRT provides good repeatable measurements of retinal peripheral refraction before and after cycloplegia in schoolchildren. [ABSTRACT FROM AUTHOR]

Summary Obstructive sleep apnea diagnosis is based on the manual scoring of respiratory events. The agreement in the manual scoring of the respiratory events lacks an in‐depth investigation as most of the previous studies reported only the apnea–hypopnea index or overall agreement, and not temporal, second‐by‐second or event subtype agreement. We hypothesized the temporal and subtype agreement to be low because the event duration or subtypes are not generally considered in current clinical practice. The data comprised 50 polysomnography recordings scored by 10 experts. The respiratory event agreement between the scorers was calculated using kappa statistics in a second‐by‐second manner. Obstructive sleep apnea severity categories (no obstructive sleep apnea/mild/moderate/severe) were compared between scorers. The Fleiss' kappa value for binary (event/no event) respiratory event scorings was 0.32. When calculated separately within N1, N2, N3 and R, the Fleiss' kappa values were 0.12, 0.23, 0.22 and 0.23, respectively. Binary analysis conducted separately for the event subtypes showed the highest Fleiss' kappa for hypopneas to be 0.26. In 34% of the participants, the obstructive sleep apnea severity category was the same regardless of the scorer, whereas in the rest of the participants the category changed depending on the scorer. Our findings indicate that the agreement of manual scoring of respiratory events depends on the event type and sleep stage. The manual scoring has discrepancies, and these differences affect the obstructive sleep apnea diagnosis. This is an alarming finding, as ultimately these differences in the scorings affect treatment decisions. [ABSTRACT FROM AUTHOR]

This study investigates whether forms associated with verbal inflection can be acquired in relation to two UG-based L2 acquisition hypotheses: the Full Transfer Full Access (FTFA) Hypothesis (Schwartz, Bonnie & Rex Sprouse. 1994. Word order and nominative case in nonnative language acquisition: A longitudinal study of (L1 Turkish) German interlanguage. In Teun Hoekstra & Bonnie D. Schwartz (eds.), Language acquisition Studies in generative grammar, 317–368. Amsterdam: John Benjamins, Schwartz, Bonnie & Rex Sprouse. 1996. L2 cognitive states and the 'full transfer/full access' model. Second Language Research 12. 40–72) and the Interpretability Hypothesis (Tsimpli, Ianthi-maria & Maria Dimitrakopoulou. 2007. The Interpretability hypothesis: Evidence from wh-interrogatives in second language acquisition. Second Language Research 23. 215–242). The former captures the insight that convergence on grammars like those of native speakers is possible, whereas the latter argues that a native/non-native divergence results from the inaccessibility of some uninterpretable syntactic features. Ninety adult L1 speakers of Chinese of different English proficiency levels were asked to interpret and produce tense and agreement in various contexts in three tasks. Results suggest that the underlying grammatical representations in the end-state grammar may not be the same as native speakers'. We speculate that the inaccessibility of the uninterpretable [uInfl:] feature of v and the uninterpretable [uInfl:*] feature of be are the potential source of difficulty in acquiring verbal inflection in L2 English. [ABSTRACT FROM AUTHOR]

Background and Purpose: Carotid artery stenosis is a major risk factor for ischemic stroke. Despite carotid artery stenting, in‐stent restenosis (ISR) remains challenging. Pigs serve as an ideal ISR model. This study aims to establish a novel porcine model of carotid ISR using open‐loop and closed‐loop stents and to assess ISR with optical coherence tomography (OCT) and histopathology, comparing incidence and vascular response between stent types. Methods: Twelve adult male Bama miniature pigs underwent carotid stenting with either open‐loop or closed‐loop stents. The animals received antiplatelet therapy pre‐ and postimplantation. Postimplantation evaluations at 90 days included carotid digital subtraction angiography (DSA), OCT, histopathological examination, and electron microscopy. Results: Both stent types showed ISR as detected by OCT and DSA. OCT revealed comparable neointimal proliferation within stent struts for both types, with no significant differences in stent, lumen, and neointimal dimensions. Histopathological analysis and electron microscopy provided insights into tissue responses and healing processes following stent implantation. No significant difference in ISR incidence was found between the stent types based on a χ2 test (p =.110). OCT and hematoxylin‐eosin staining exhibit the highest consistency in evaluating neointimal area. Conclusions: The novel porcine ISR model demonstrated similar ISR outcomes for open‐loop and closed‐loop stents. OCT proved to be a highly consistent and valuable tool for evaluating stent and arterial conditions, comparable to histopathological findings. However, due to a small sample size, the validity of these preliminary findings requires further investigation to be confirmed. [ABSTRACT FROM AUTHOR]

Objective: The study aimed to evaluate the interobserver agreement among glaucoma subspecialists in diagnosing glaucoma and to explore the causes of diagnostic discrepancies. Methods: Three experienced glaucoma subspecialists independently assessed frequency domain optical coherence tomography, fundus color photographs, and static perimetry results from 464 eyes of 275 participants, adhering to unified glaucoma diagnostic criteria. All data were collected from the Wenzhou Glaucoma Progression Study between August 2014 and June 2021. Results: The overall interobserver agreement among the three experts was poor, with a Fleiss' kappa value of 0.149. The kappa values interobserver agreement between pairs of experts ranged from 0.133 to 0.282. In 50 cases, or approximately 10.8%, the three experts reached completely different diagnoses. Agreement was more likely in cases involving larger average cup-to-disc ratios, greater vertical cup-to-disc ratios, more severe visual field defects, and thicker retinal nerve fiber layer measurements, particularly in the temporal and inferior quadrants. High myopia also negatively impacted interobserver agreement. Conclusions: Despite using unified diagnostic criteria for glaucoma, significant differences in interobserver consistency persist among glaucoma subspecialists. To improve interobserver agreement, it is recommended to provide additional training on standardized diagnostic criteria. Furthermore, for cases with inconsistent diagnoses, long-term follow-up is essential to confirm the diagnosis of glaucoma. [ABSTRACT FROM AUTHOR]

Objective: To evaluate concordance of asthma severity classification via physician chart notation compared with guideline-based criteria in adolescents with diagnosed asthma. Methods: Of 284 urban primary care and subspecialty clinic patients aged 13–18 years approached through convenience sampling, 203 surveys were completed (RR = 71.5%). We assessed concordance with sensitivity, specificity, and positive predictive values; overall agreement was evaluated with weighted kappa coefficients and McNemar's test. Results: When considering prescribed treatment according to NAEPP guidelines as a gold standard, the sensitivity for chart notation was very good for intermittent (95%) and less for non-intermittent severity ratings (51%, 58%, and 67% for moderate, severe, and mild persistent asthma, respectively). Overall agreement between chart notation and guideline-based asthma criteria ranged from fair-to-good for mild- (k = 0.36), moderate- (k = 0.44), and severe-persistent severity (k = 0.66). Although the agreement for intermittent severity was highest (k = 0.88), it did not significantly differ by between the two classifications (p ≥ 0.05). Conclusions: Concordance for all non-intermittent asthma severity classifications varied between physician and medication-driven 2007 NAEPP guideline classifications in an ethnically diverse urban adolescent patient sample. Physicians should remain aware of the potential for this discordance and refer to the guidelines to classify and treat adolescents with asthma. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Medication data are a valuable resource in epidemiological studies. As the most common data collection method of medication data is self‐report, it is important to understand the accuracy of this in comparison with other methods such as dispensing records. The aim of this study was to compare the agreement between two different sources of medication data of older adults with intellectual disability (ID).Self‐report medication data were gathered from the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing and linked to national pharmacy dispensing records. The kappa statistic was used to measure agreement between the two data sources for psychotropic medication.The lowest agreement level was ‘moderate’ for the number of anxiolytics reported (kappa 0.56). The highest level of agreement was ‘almost perfect’ for the binary variable of antipsychotics (kappa 0.91). Other agreement results were ‘substantial’ or ‘almost perfect’.Good agreement was found between the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing medication dataset and national dispensing records. Self‐report medication data appear to be a valid method of data collection in psychotropic medication use in adults with ID. [ABSTRACT FROM AUTHOR]

Images are capable of conveying emotions, but emotional experience is highly subjective. Advances in artificial intelligence have enabled the generation of images based on emotional descriptions. However, the level of agreement between the generative images and human emotional responses has not yet been evaluated. In order to address this, 20 artistic landscapes were generated using StyleGAN2-ADA. Four variants evoking positive emotions (contentment and amusement) and negative emotions (fear and sadness) were created for each image, resulting in 80 pictures. An online questionnaire was designed using this material, in which 61 observers classified the generated images. Statistical analyses were performed on the collected data to determine the level of agreement among participants between the observers' responses and the generated emotions by AI. A generally good level of agreement was found, with better results for negative emotions. However, the study confirms the subjectivity inherent in emotional evaluation. [ABSTRACT FROM AUTHOR]

The Furtado-Gallagher Children Observational Movement Pattern Assessment System (FG-COMPASS) is an observational tool using sequential decisions to assess fundamental movement skill proficiency. The current version of the test has three locomotor and five manipulative skills. Adding two more locomotor skills to the assessment tool enriches its scope, enabling a more comprehensive and nuanced evaluation of individual movement skills. We assessed expert-non-expert rater agreement and inter/intra non-expert rater reliability of two new scales for the locomotor subscale. We divided this study into two parts. In Part I, we filmed 60 children aged 5–10 years old who performed gallop and vertical jump skills. A motor behavior expert then classified the videotapes using our newly created rating scales. Next, we selected eight videos for training purposes and 24 videos for testing purposes. In Part II, 30 undergraduate students underwent rater training. Rating data were analyzed using weighted kappa (Kw) and the intra-class correlation coefficient (ICC), and these indices showed 'very good' agreement between the expert and the non-expert raters for vertical jump (Kw =.96) and gallop (Kw =.89). The ICC expert to non-expert rater values for vertical jump and gallop were.98 and.94, respectively; and mean kappa values for inter-rater reliability between non-experts were considered 'very good' for vertical jump (MKw =.92) and 'good' for gallop (MKw =.78). The ICC inter-rater values were.98 and.95 (considered 'excellent') for vertical jump and gallop, respectively; and the kappa intra-rater values were.96 and.85, respectively, with intra-rater ICC values.98 and.92. Thus, the proposed rating scales were reliable for assessing vertical jump and gallop. Future studies should focus on criterion-related validity and reliability evidence from live performances. [ABSTRACT FROM AUTHOR]

Objectives: The prevalence of low birth weight (LBW) is an important indicator of child health and wellbeing. However, in many countries, decisions regarding care and treatment are often based on mothers' perceptions of their children's birth size due to a lack of objective birth weight data. Additionally, birth weight data that is self-reported or recorded often encounters the issue of heaping. This study assesses the concordance between the perceived birth size and the reported or recorded birth weight. We also investigate how the presence of heaped birth weight data affects this concordance, as well as the relationship between concordance and various sociodemographic factors. Methods: We examined 4,641 birth records reported in the 2019 Bangladesh Multiple Indicator Cluster Survey. The sensitivity-specificity analysis was performed to assess perceived birth size's ability to predict LBW, while Cohen's Kappa statistic assessed reliability. We used the kernel smoothing technique to correct heaping of birth weight data, as well as a multivariable multinomial logistic model to assess factors associated with concordance. Results: Maternally-perceived birth size exhibited a low sensitivity (63.5%) and positive predictive value (52.6%) for predicting LBW, but a high specificity (90.1%) and negative predictive value (93.4%). There was 86.1% agreement between birth size and birth weight-based classifications (Kappa = 0.49, indicating moderate agreement). Smoothed birth weight data did not improve agreement (83.4%, Kappa = 0.45). Of the sociodemographic factors, early marriage was positively associated with discordance (i.e., overestimation). Conclusions: An important consideration when calculating the LBW prevalence is that maternally perceived birth size is not an optimal proxy for birth weight. Focus should be placed on encouraging institutional births and educating community health workers and young mothers about the significance of measuring and recording birth weight. Significance: Maternally-perceived birth size has been used to determine the LBW prevalence in many countries, including Bangladesh, where many or most births occur at home and birth weight data are not routinely collected. Research in Bangladesh has not investigated the value of perceived birth size in predicting birth weight, and earlier research in different countries has yielded inconsistent results. This study demonstrates that maternal perception of birth size has limited LBW prediction accuracy in Bangladesh. Consequently, it is imperative to exercise caution when estimating the prevalence of LBW based on data on perceived birth size, as LBW is a critical indicator of health outcomes and informs policy and interventions at both individual and national levels. [ABSTRACT FROM AUTHOR]

It is common to explain agreement and disagreement in terms of relations among mental states. The main purpose of the present discussion is to present an alternative way of thinking about the relationship between mental states and agreement and disagreement. The idea is to connect agreement and disagreement with the individuation of mental states. More specifically, for at least some mental states, standing in the same relations of agreement and disagreement is both necessary and sufficient for identity. This provides us with a framework for discussing issues related to agreement and disagreement. It is for instance well-known that de se beliefs raise questions about agreement and disagreement. The present framework allows us to discuss such beliefs while relying on assumptions that are interestingly different from the standard assumptions in the literature. While most of the discussion focuses on beliefs, there are other mental states, such as desires, that can seemingly also stand in relations of agreement and disagreement. This raises questions about how far the framework can be extended. [ABSTRACT FROM AUTHOR]

This systematic review aimed to summarise and analyse the evidence on the reliability and validity of linear tranducers (LTs) in exercises of different nature and different modes of execution. This systematic review was carried out under PRISMA guidelines, and was carried out using three databases (PubMed, Web of Sciences, and Scopus). Of the 351 initially found, 21 were included in the qualitative synthesis. The results reflected that linear position transducers (LPTs) were valid and reliable in monitoring movement velocity in non-plyometric exercises. However, precision and reliability were lower in execution protocols without isometric phase and in the execution of exercises in multiple planes of movement, with greater measurement errors at higher sampling frequencies. On the other hand, linear velocity transducers (LVTs) proved to be valid and reliable in measuring velocity during plyometric and non-plyometric exercises performed on the Smith machine, with less variation in measurement in the latter. Finally, the use of peak values is recommended, since they are less dependent on the technological errors of LTs. Therefore, the performance of non-plyometric exercises, carried out in the Smith machine and with an isometric phase in the execution of the movement, will help to minimise the technological error of the LTs. [ABSTRACT FROM AUTHOR]

Pragma-Dialectics (PD) is an approach to argumentation that can be described as disagreement-centric. On PD, disagreement is the condition which defines argument, it is the practical problem to be solved by it, and disagreement's management is the ultimate source of argument's normativity. On PD, arguing in the context of agreement is taken to be "incorrect" and arguments where agreement already reigns are "pointless." Even the PD account of fallacies is disagreement-centered: a fallacy is something that impedes resolution of a dispute. We argue here that the disagreement-focus of PD yields procedural errors of application in cases of arguments given explicitly for agreement-management, that there are explanations of fallacies better understood as agreement-focused (straw man and ad hominem in particular), and that there are unique meta-argumentative errors emergent in instances of agreement. [ABSTRACT FROM AUTHOR]

For over 60 years, International Environmental Law has produced hundreds of texts aimed at protecting the environment at global to regional scales. Most of these texts do not gather the support of all the states concerned. The reasons for this are analysed here. This retrospective look provides a striking panorama of the current situation. The international and domestic motivations that lead a state to the sovereign decision to ratify or not a treaty, are first recalled and put into perspective in their interdependencies. The analysis of thousands of ratifications of 51 major treaties draws lines of divergence between leading states, follower states, and states reluctant to enter into environmental commitments. On a global scale the latter form a large majority, including most African and Asian states. The states of Northern and Western Europe are among the first to ratify these treaties, followed by other European states. G7 member states occupy vey contrasting normative positions. Overall, three major moves emerge from this global panorama. First, historical and persistent inequalities in the development of countries have cast an indelible shadow on environmental international multilateral treaties which do not bring the expected fruits of development. Second, in environmental matters, over the past 15 years the trend consists in establishing agreements of more restricted range (regional, bilateral), with commitments from states on fairly flexible objectives, adaptable to their social and economic context. Third, these agreements are set within the broadly negotiated and thematically inclusive principles of sustainable development. [ABSTRACT FROM AUTHOR]

The agreement between a wearable inertial sensor (GYKO, G) and the force platform (P) was assessed by evaluating test-retest and inter-rater reliability. Thirty-eight subjects were enrolled; the selected indices of balance were investigated over foot positions and (un)stable conditions. Intraclass correlation coefficient (ICC), standard error of measurement (SEM%) and minimal detectable change (MDC95%) were computed. For G, ICC bounds range from poor to excellent (0.040 ÷ 0.921), mean of 0.687 (= moderate reliability). Regarding P, ICC ranges from poor to excellent (0.070 ÷ 0.920), mean of 0.683 (= moderate reliability). For G, SEM% ranges from 11% to 47%; MDC95% from 30% to 132%. Concerning P, SEM% ranges from 7% to 41%; MDC95% from 21% to 114%. Finally, the inter-rater reliability ICC by comparing devices ranges from poor to excellent (−0.162 ÷ 0.911), mean of 0.338 (= poor reliability). GYKO appears to be a convenient tool with high consistency among multiple measurements but for specific clinic/research purposes. [ABSTRACT FROM AUTHOR]

Background: Dizziness and vertigo are common referrals to Ear Nose Throat (ENT) outpatient services however these services have long waitlists for assessment. Primary contact physiotherapy-led vestibular clinics are recognized as improving access to care. This pilot study investigated agreement between physiotherapists and an ENT medical practitioner for diagnostic and management decisions in patients attending a primary contact physiotherapy-led vestibular clinic. Methods: Prospective blinded inter-rater agreement study undertaken in an ENT primary contact physiotherapy-led vestibular clinic. Participants were adults referred to ENT from general practitioners, triaged (Category 2 or 3) to the primary contact physiotherapy-led vestibular clinic with clinical symptoms consistent with vestibular disorder. Primary outcome measures included agreement of diagnoses and management decisions made by an ENT medical practitioner and Physiotherapist based on a vestibular physiotherapy assessment. Adverse events were reviewed 11 months post data collection. Gwet's first order agreement co-efficient (AC1) calculated inter-rater reliability between physiotherapy and ENT. Results: Fifty-one participants were recruited consecutively from the primary contact physiotherapy-led vestibular clinic. Physiotherapy and ENT had a substantial agreement (AC1 0.613) on diagnosis. AC1 between physiotherapy and ENT for recommending Magnetic resonance imaging (0.810) and computerized tomography (0.935) both indicated near perfect agreement. There was moderate to near-perfect agreement regarding management recommendations between physiotherapy and ENT. Substantial agreement (AC1 0.720) was found for recommendations for ENT input, near perfect agreement (AC1 0.933) for neurology input and moderate agreement (AC1 0.574) for physiotherapy input. There were no adverse events from physiotherapist's management decision, based on final recommendations undertaken 11-months post data collection. Conclusions: Physiotherapists and ENT medical practitioner made comparable diagnostic and management decisions, based on physiotherapy and audiology hearing assessment, for adults with signs of vestibular dysfunction, within an ENT primary contact physiotherapy-led vestibular clinic. This study provides support for this type of Physiotherapy-led service in managing patients referred to an ENT service with vestibular dysfunction. Key points: 1. This is the first study investigating interprofessional agreement between physiotherapists and an ENT medical practitioner in the diagnosis and management of patients within an ENT primary contact physiotherapy-led vestibular clinic (recommendations were based on a vestibular physiotherapy assessment as participants were not directly assessed by ENT). 2. Physiotherapists and ENT agreement on diagnosis was substantial. 3. Agreement between physiotherapy and ENT on requesting MRI brain and CT head were near perfect; and agreement between physiotherapy and ENT for onward management to ENT, neurology or physiotherapy was moderate to near perfect. 4. There were no adverse events from physiotherapy's management decision, based on the final recommendations. 5. This paper provides support for the competency of physiotherapists in managing patients referred to ENT with vestibular dysfunction and the safety of ENT primary contact physiotherapy-led vestibular clinics, albeit the presence of bias given the recommendations were based on a vestibular physiotherapy assessment only. [ABSTRACT FROM AUTHOR]

Objectives To introduce and evaluate a simple method for assessing joint inflammation and structural damage on whole-body MRI (WBMRI) in juvenile idiopathic arthritis (JIA), which is usable in clinical practice. Methods The proposed system utilizes post-contrast Dixon WBMRI scans. Joints are assessed for synovitis (grade 0–2) and structural damage (present/absent) at 81 sites. The synovitis grading is based on features including above-normal intensity synovial enhancement, synovial hypertrophy, joint effusion, subarticular bone marrow oedema and peri-articular soft tissue oedema. This system was evaluated in a prospective study of 60 young people (47 patients with JIA and 13 controls with non-inflammatory musculoskeletal pain) who underwent a WBMRI. Three readers (blinded to diagnosis) independently reviewed all images and re-reviewed 20 individual scans. The intra- and inter-reader overall agreement (OA) and the intra- and inter-reader Gwet's agreement coefficients 2 (GAC2) were measured for the detection of a) participants with ≥1 joint with inflammation or structural damage and b) joint inflammation or structural damage for each joint. Results The inter-reader OA for detecting patients with ≥1 joint with inflammation, defined as grade 2 synovitis (G2), and ≥1 joint with structural damage were 80% and 73%, respectively. The intra-reader OA for readers 1–3 was 80–90% and 75–90%, respectively. The inter-reader OA and GAC2 for joint inflammation (G2) at each joint were both ≥85% for all joints but were lower if grade 1 synovitis was included as positive. Conclusion The intra- and inter-reader agreements of this WBMRI assessment system are adequate for assessing objective joint inflammation and damage in JIA. [ABSTRACT FROM AUTHOR]

Background: Speech and language therapists (SLTs) regularly use phonetic transcription to record and analyse typical and disordered speech. Phonetic transcription is highly demanding of auditory perceptual skills so researchers are sceptical about its accuracy and reliability. The literature describes how phonetic transcription is prone to auditory illusions and biases, such as a preference to transcribe speech sounds from the transcriber's own language. Few empirical research studies have calculated agreement amongst transcribers where a range of agreement scores have been reported (51%–97%). There is a consensus that agreement rates decrease as phonetic detail increases. Vowels and consonants are characterised by different perceptual features within the International Phonetic Alphabet (IPA) so they may differ in agreement rates, and thus far there is contradictory evidence as to whether vowels or consonants are more agreed upon. Transcription agreement studies to date have most commonly recruited phoneticians rather than SLTs so further research is warranted to determine transcription agreement amongst SLTs and its impact on clinical practice. Aims: The study's primary aim was to calculate agreement scores from a group of English‐speaking SLTs who transcribed disordered speech samples in an ecologically valid setting. The study also sought to contribute to the pre‐existing contradictory evidence base regarding whether vowels or consonants may be more agreed upon by comparing their agreement scores. The researcher aimed to comment on SLTs' use of diacritics and non‐native speech symbols (symbols not included in the English phonetic inventory) in terms of their frequency and agreement of use. By analysing transcriptions, the study aimed to discuss the impact transcription variability has on speech sound error patterns and thus its impact on clinical decision‐making such as diagnosis, choice of intervention and therapy targets. Methods: Twelve paediatric SLTs were recruited via a convenience sample at two National Health Service trusts, two of whom were specialists in Speech Sound Disorders (SSDs). Participants transcribed 16 words from a video of a boy with disordered speech completing the Diagnostic Evaluation of Articulation and Phonology (DEAP, Dodd et al., 2006) from a telehealth appointment. The use of diacritics and non‐English IPA symbols were manually analysed. A classic agreement score was calculated for each target word using a Python script, and then for vowels and consonants in isolation. Datasets were manually analysed to determine whether differences in transcription resulted in the identification of different speech sound error patterns. The researcher considered the implications this had within clinical practice. Results: The average classic agreement score was 56.3%. Consonants were more agreed upon than vowels with agreement scores of 62.8% and 48.6%, respectively. Nine participants (75%) used diacritics (most commonly length marks) and eight participants (67%) transcribed non‐native IPA symbols at least once in their datasets, but generally with low frequencies and agreements amongst their use. Transcriptions captured the occurrence of typical and atypical error patterns but only three error patterns, out of the 20 identified, were present in all 12 participants' transcriptions. Conclusions: The agreement score of 56.3% questions the accuracy and reliability of transcription amongst SLTs which is an essential skill of the profession. The findings highlight SLTs should be more cautious of interpreting vowels than consonants given lower agreement rates. The frequency of use of non‐native symbols and diacritics was relatively low which could reflect a low accuracy of their use or reduced confidence in transcribing these. The study discussed how variations in transcriptions can impact phonological and phonetic analysis, which in turn can influence clinical decision‐making such as diagnosing SSDs, selecting further diagnostic assessments and choosing therapy targets and interventions. The Royal College of Speech and Language Therapists‐endorsed transcription guidelines (Child Speech Disorder Research Network, 2017) could be revised to convey realistic expectations of SLTs' transcription skills, or SLTs should be offered more training to improve transcription skills to meet current expectations. Other suggestions to improve transcription accuracy are discussed such as via instrumental methods, yet these come with their own limitations such as practicality, costs and need for specialist training. WHAT THIS PAPER ADDS: What is already known on this subject: Phonetic transcription is highly demanding of human perceptual skills, and researchers are sceptical about its reliability. There are few empirical research studies calculating agreement amongst transcribers, and a range of agreement scores have been reported (51%−97%) dependent on the research conditions. Research mostly involves experienced transcribers (e.g., phoneticians) rather than speech and language therapists (SLTs), a profession expected to regularly use phonetic transcription to record and analyse typical and disordered speech. What this study adds to existing knowledge: A range of transcription agreement scores have been reported in previous studies, mainly comparing pairs or small groups of specialist transcribers rather than SLTs. This study provides an agreement score of 56.3% when a group of 12 SLTs transcribed a disordered speech sample in an ecologically valid setting (where speech samples were taken from a real‐life speech sound assessment over a telehealth appointment using the Diagnostic Evaluation of Articulation and Phonology). The study found consonants are more agreed upon than vowels, adding to the contradictory evidence base. Unlike other studies, the researcher analysed transcriptions to identify error patterns to examine the impact that transcription variation has on clinical decision‐making. What are the potential or actual clinical implications of this work?: The researcher questions whether SLTs are meeting the expectations of 'accurate transcription' as listed by the Royal College of Speech and Language Therapists (RCSLT) endorsed transcription guidelines (Child Speech Disorder Research Network, 2017) given the relatively low agreement score of 56.3%. The study also questions the reliability of the use of diacritics and non‐English International Phonetic Alphabet (IPA) symbols and whether SLTs should be expected to use these due to perceptual limitations. Twenty phonological processes emerged from the datasets, only three of which were agreed upon across all 12 participants. The researcher therefore discusses how transcription variations could result in different diagnoses, therapy targets and interventions choices. The paper suggests more training is required to enhance transcription accuracy, and also considers the appropriateness of utilising instrumental methods whilst recognising its limitations such as feasibility, costs and specialist training needs. [ABSTRACT FROM AUTHOR]

Step counts can be estimated from wrist-worn accelerometers through the Verisense Step Count Algorithm. No study has assessed agreement between stepping metrics from ActiGraph accelerometers during free-living. Thirty-four participants (age: 22.9 ± 3.4 years) provided 24 h accelerometer data (non-dominant wrist) and waist. Agreement of two Verisense Algorithms (Verisense 1 & 2) for estimating daily steps, moderate-to-vigorous physical activity (MVPA), peak 1-min and 30-min accumulated steps, against the waist and ActiLife step-count Algorithm was assessed. Mean bias ± 95% limits of agreement (LoA) for daily steps was +1255 ± 3780 steps/day (mean absolute percent error (MAPE): 21%) (Verisense 1) and +1357 ± 3434 steps/day (MAPE: 20%) (Verisense 2). For peak 1-min accumulated steps, mean bias and 95% LoA was −17 ± 23 steps/min (MAPE: 17%) (Verisense 1) and −6 ± 5 steps/min (MAPE: 9%) with Verisense 2. For peak 30-min accumulated steps, mean bias and 95% LoA was −12 ± 45 steps/min (MAPE: 25%) (Verisense 1) and −2 ± 38 steps/min (MAPE: 13%) (Verisense 2). For MVPA steps/day, mean bias and 95% LoA was −1450 ± 3194 steps/day (MAPE: 420%) (Verisense 1) and −844 ± 2571 steps/day (MAPE: 211%) (Verisense 2). For MVPA min/day, mean bias and 95% LoA was −13 ± 27 min/day (MAPE: 368%) (Verisense 1) and −8 ± 24 min/day (MAPE: 209%) (Verisense 2). The Verisense 2 algorithm enhanced agreement for stepping intensity metrics but further refinement is needed to enhance agreement for MVPA against the waist. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to examine if the General Health Questionnaire (GHQ)‐12 and Kessler 6 (K6) assess the same underlying construct and to develop a score conversion table for the two scales. Methods: A random sample of 4303 people who completed both the GHQ‐12 and K6 in 2021 were analyzed. Exploratory bifactor analysis evaluated if both scales measured the same construct, and Rasch analysis assessed item severities. The scales were transformed using Equipercentile equivalence for comparability and score conversion. Agreement was estimated with Cohen's Kappa coefficient, along with raw positive and negative agreement. Results: We found that the two scales measure the same phenomenon to the extent that they can be made equivalent. Conversion tables between GHQ‐12 and K6 are presented. Applying the commonly used cut‐off of ≥3 on the GHQ‐12 bi‐modal scoring, we found that the best corresponding cut‐off on the K6 would be ≥8. The prevalence of psychological distress was then 22% with GHQ‐12% and 21% with K6. Conclusions: The GHQ‐12 and K6 measure the same construct and corresponding cut‐off scores on one scale were found for the other scale. This is valuable for longitudinal studies or time series where one scale has replaced the other scale. [ABSTRACT FROM AUTHOR]

Objective: Advancements in smartphone technology provide availability to evaluate movement in a more practical and feasible manner, improving clinicians' ability to diagnose and treat adults at risk for mobility loss. The purpose of this study was to evaluate the validity and reliability of a smartphone application to measure spatiotemporal outcomes during level (primary) and uphill/downhill (secondary) walking with and without an assistive device for older adults (OAs), Parkinson's Disease (PD) and cerebrovascular accident (CVA) populations. Methods: A total of 50 adults (OA = 20; PD = 15; CVA = 15) underwent gait analysis at self-selected gait speeds under 0-degree, 5-degree uphill and 5-degree downhill environments. The validity and reliability of the smartphone outcomes were compared to a motion-capture laboratory. Bland–Altman analysis was used to evaluate limits of agreement between the two systems. Intraclass correlation coefficients (ICCs) were used to determine absolute agreement, and Pearson correlation coefficients (r) were used to assess the strength of the association between the two systems. Results: For level walking, Bland–Altman analysis revealed relatively equal estimations of spatiotemporal outcomes between systems for OAs without an assistive device and slight to mild under- and overestimations of outcomes between systems for PD and CVA with and without an assistive device. Moderate to very high correlations between systems (without an assistive device: OA r-range, 0.72–0.99; PD r-range, 0.87–0.97; CVA r-range, 0.56–0.99; with an assistive device: PD r-range, 0.35–0.98; CVA r-range, 0.50–0.99) were also observed. Poor to excellent ICCs for reliability between systems (without an assistive device: OA ICC range, 0.71–0.99; PD ICC range, 0.73–0.97; CVA ICC range, 0.56–0.99; with an assistive device: PD ICC range, 0.22–0.98; CVA ICC range, 0.44–0.99) were observed across all outcomes. Conclusions: This smartphone application can be clinically useful in detecting most spatiotemporal outcomes in various walking environments for older and diseased adults at risk for mobility loss. [ABSTRACT FROM AUTHOR]

Sensorimotor disturbances such as disturbed cervical joint position sense (JPS) and reduced reaction time and velocity in fast cervical movements have been demonstrated in people with neck pain. While these sensorimotor functions have been assessed mainly in movement science laboratories, new sensor technology enables objective assessments in the clinic. The aim was to investigate concurrent validity of a VR-based JPS test and a new cervical reaction acuity (CRA) test. Twenty participants, thirteen asymptomatic and seven with neck pain, participated in this cross-sectional study. The JPS test, including outcome measures of absolute error (AE), constant error (CE), and variable error (VE), and the CRA test, including outcome measures of reaction time and maximum velocity, were performed using a VR headset and compared to a gold standard optical motion capture system. The mean bias (assessed with the Bland–Altman method) between VR and the gold standard system ranged from 0.0° to 2.4° for the JPS test variables. For the CRA test, reaction times demonstrated a mean bias of −19.9 milliseconds (ms), and maximum velocity a mean bias of −6.5 degrees per seconds (°/s). The intraclass correlation coefficients (ICCs) between VR and gold standard were good to excellent (ICC 0.835–0.998) for the JPS test, and excellent (ICC 0.931–0.954) for reaction time and maximum velocity for the CRA test. The results show acceptable concurrent validity for the VR technology for assessment of JPS and CRA. A slightly larger bias was observed in JPS left rotation which should be considered in future research. [ABSTRACT FROM AUTHOR]

The gait variable minimum toe clearance (MTC) has been investigated concerning trip-related fall research in older adults. However, comparing studies is difficult due to the different methods used to measure MTC and shoe conditions, which may affect agreement. Measurement methods can include using a single virtual point (SVP), multiple virtual points (MVPS), or metatarsal head markers (marker-based). The shoe types used in MTC studies include standard shoes (SS), personal shoes (PS), and barefoot (BF) conditions. What is the agreement, inter and intra-rater reliability, and repeatability for the 3 commonly used methods of measuring MTC (SVP, MVPS, marker-based) under the 3 shoe conditions for optical motion capture systems (SS, PS, BF)? Twelve healthy young adults (mean [SD] 23.8 [1.9] years,7 males) participated in this observational study. In a randomized order, participants completed 25 walking trials at self-selected normal and slow speeds in SS, PS, and BF conditions while infrared cameras recorded the maker trajectories. Each participant performed a familiarization trial for at least 1 minute before collecting data on each shoe condition. Statistical analyses included Bland-Altman 95 % limits of agreement (LOA) analyses, interclass correlation coefficient (ICC) analyses for inter- and intra-rater reliability, and the repeatability coefficient (RC). The SVP and MVPS had a tighter 95 % LOA than the marker-based method, particularly under SS and BF conditions. The inter-rater reliability was good to excellent under these shoe conditions. Intra-reliability for all methods under all shoe conditions was excellent (ICC >.90). The RC was very similar for each method, with none exceeding 1.02 cm. The study provides estimates of the agreement between MTC methods and suggests that only SVP or MVPS produced similar results in SS/BF conditions. Additionally, a "true" change in MTC requires a difference greater than 1.02 cm. • Single and multiple virtual point methods to assess MTC agreed in shoe and barefoot conditions. • The intra-rater reliability was excellent for marker and virtual point methods of assessing MTC. • "True" change in MTC requires a difference greater than 1.02 cm. [ABSTRACT FROM AUTHOR]

Introduction: Clinical remission is a relatively new concept in asthma but recent research initiatives suggest it could be an ambitious and achievable therapeutic target for patients with asthma. Methods: In this modified Delphi study (comprising two online surveys, completed either side of a virtual scientific workshop), the opinions of a panel of respiratory physicians were evaluated to summarize perspective statements on key therapeutic outcomes and criteria for on-treatment clinical remission in patients with moderate asthma. An agreement threshold was pre-defined as agreement by ≥ 75% of participants. Results: Surveys 1 and 2 were completed by 20 and 18 participants, respectively. Most participants (95%) agreed with the concept of clinical remission in moderate asthma and that this should be a desirable treatment goal (90%). Based on a composite measure of 4–6 desirable therapeutic outcomes, current understanding of clinical remission was considered as 12 months with no exacerbations, no oral corticosteroids, no daytime or night-time asthma symptoms (Asthma Control Test score ≥ 20 or Asthma Control Questionnaire score ≤ 0.75), stable lung function, and no treatment-related adverse events. No agreement was reached on the role of relievers in defining therapeutic outcomes or on the wider use of biomarkers and airway hyperresponsiveness for defining asthma remission in clinical practice. Conclusions: In line with recent consensus statements from the United States and Europe, there was a high level of agreement on the elements of clinical remission among a panel of respiratory physicians from Asia, the Middle East, and South America. Extension of the concept of clinical remission to patients with moderate asthma was considered aligned with the potential of clinical remission as a goal of therapy. [ABSTRACT FROM AUTHOR]

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Point-of-care ultrasound (POCUS) is an important tool for clinical diagnosis and decision-making in critical and non-critical scenarios. Dyspnea, chest pain, and shock are conditions susceptible to evaluation with ultrasound considering diagnostic accuracy and clinical impact already proven. There is scarce evidence in diagnosis agreement using ultrasound as an extension of physical examination. We aimed to evaluate ED patients in whom POCUS was performed, to analyze agreement between clinical initial diagnosis using ultrasound images and final diagnosis. Furthermore, we analyze failed diagnosis, inconclusive POCUS exams, and discuss details. A cross-sectional analytical study was conducted on adults who visited the emergency department with any of these three chief complaints: dyspnea, chest pain, and shock. All were evaluated with ultrasound at admission. Agreement between initial diagnosis using POCUS and final definite diagnosis was calculated. Failed diagnosis and inconclusive exams were analyzed. A total of 209 patients were analyzed. Populations: mostly males, mean age 64 years old, hypertensive. Agreement on patients with dyspnea and suspicion of acute decompensated heart failure was 0.98; agreement on chest pain suspicion of non-ST acute coronary syndrome was 0.96; agreement on type of shock was 0.90. Among the population, 12 patients had an inconclusive POCUS exam, and 16 patients had a failed diagnosis. The use of POCUS in the emergency department shows almost perfect agreement when compared with the final diagnosis in individuals experiencing acutely decompensated heart failure, acute coronary syndrome, and shock. Prospective studies are needed to evaluate the impact of this tool on mortality and prognosis when there are diagnostic errors. [ABSTRACT FROM AUTHOR]

Objectives. This study aimed to investigate the consistency between results of the American Conference for Governmental Occupational Hygienists (ACGIH) threshold limit value (TLV) for hand activity and proposed action levels of objective measurements in risk assessments of work-related musculoskeletal disorders. Methods. Wrist velocities and forearm muscular load were measured for 11 assemblers during one working day. Simultaneously, each assembler's hand activity level (HAL) during three sub-cycles was rated twice on two separate occasions by two experts, using a HAL scale. Arm/hand exertion was also rated by the assemblers themselves using a Borg scale. In total, 66 sub-cycles were assessed and assigned to three exposure categories: A) below ACGIH action limit (AL) (green); B) between AL and TLV (yellow); and C) above TLV (red). The median wrist velocity and the 90th percentile of forearm muscular load obtained from the objective measurements corresponding to the sub-cycles were calculated and assigned to two exposure categories: A) below or C) above the proposed action level. Results. The agreement between ACGIH TLV for hand activity and the proposed action level for wrist velocity was 87%. Conclusions. The proposed action level for wrist velocity is highly consistent with the TLV. Additional studies are needed to confirm the results. [ABSTRACT FROM AUTHOR]

According to a widely held view, successful communication does not require the speaker and the hearer to grasp the same proposition. The purpose of this paper is to present and discuss an argument for the thesis that an instance of communication is successful only if the speaker and the hearer grasp the same proposition. The argument is based on the idea that there is a connection between successful communication and agreement. [ABSTRACT FROM AUTHOR]

Abstract Objective Maintaining normothermia is crucial for neonatal survival, especially in preterm infants prone to temperature instability. This study evaluates the correlation and variability between axillary and rectal temperatures at Neonatal Intensive Care (NICU) admission across gestational age ranges of 23–28, 29–32, 33–36, and ≥ 37 weeks, aiming to inform improved neonatal thermal management strategies. Methods This cross-sectional study was conducted at King Abdulaziz Medical City, Riyadh, from October 2023 to April 2024, involving 160 infants. Admission temperatures were measured using digital thermometers. Data analysis included ANOVA/Kruskal-Wallis for continuous variables, Chi-square tests for categorical data, Bland-Altman method for agreement assessment, and Pearson correlation coefficients to evaluate temperature correlations. Results Mean axillary temperature increased from 36.4 °C in the 23–28 weeks gestational group, to 36.5 °C in the 29–32 weeks group, and to 36.7 °C in the 33–36 weeks and ≥ 37 weeks groups, (p = 0.033). Rectal temperature increased from 36.5 °C in the 23–28 weeks group, to 36.6 °C in the 29–32 weeks group, and reached 36.8 °C in both the 33–36 weeks and ≥ 37 weeks groups (p = 0.006). Notable differences between measurement methods were observed in the 33–36 and ≥ 37 weeks groups (p

Abstract Background The purpose of this study was to evaluate the repeatability and agreement of multispectral refraction topography (MRT) in measuring retinal refraction before and after cycloplegia in children. The results of this study will provide valuable insights into the accuracy and reliability of MRT as a tool for assessing retinal refraction in pediatric patients. Methods Children aged 7 to 18 years old were recruited for this prospective research. The central and peripheral retinal refraction was measured three times using multispectral refraction topography (MRT) before and after cycloplegia. The retinal deviation value (RDV) was used to describe the average peripheral refractive error of the retina. In addition, objective refraction (OR) and subjective refraction (SR) measurements were also performed. Results A total of 60 children with a mean age of 10.50 ± 1.81 years were enrolled. Before cycloplegia, all the central and peripheral retinal refraction parameters showed good repeatability with the lowest intraclass correlation coefficient (ICC) being 0.78 in the retinal deviation value from 45° eccentricity to 53° of the retina (RDV 45–53). After cycloplegia, the repeatability of MRT was significantly enhanced (lowest ICC = 0.91 in RDV-I). The 95% limits of agreement (LoA) of the central refraction and OR ranged from − 2.1 to 1.8 D before cycloplegia, and from − 1.69 to 0.27 D after cycloplegia. The 95% LoA of the central refraction and SR ranged from − 1.57 to 0.36 D after cycloplegia. All the 95% LoA demonstrated high agreement. Conclusions The MRT shows high agreement with autorefractometry and experienced optometrist in measuring central refraction. Additionally, the MRT provides good repeatable measurements of retinal peripheral refraction before and after cycloplegia in schoolchildren.

Abstract This prospective cohort study included 80 healthy candidates for Implantable Collamer Lens (ICL) implantation who underwent biometric assessments with Scheimpflug imaging (the Pentacam-AXL) and swept-source optical coherence tomography (SS-OCT; the IOLMaster-700), both before and 3 months after surgery. The main outcome measures were mean keratometry, anterior chamber depth, axial length, and various intraocular lens (IOL) calculation formulas (Haigis, SRK/T, Hoffer Q, Holladay 1, Barrett Universal 2, and Olsen). The interchangeability of the devices was assessed by generating 95% limits of agreement (95% LoA) and associated Bland-Altman plots. The average age of the participants was 31.5 ± 5.4 years (22–43), with 58 (72.5%) being female. Among the cases analyzed, 11 (13.4%) had incorrect anterior lens surface segmentation using the IOLMaster-700, and 1 case (1.2%) had inappropriate segmentation using the Pentacam-AXL. Postoperative IOL power calculation resulted in readings that were, on average, 0.15 to 0.30 D higher compared to preoperative measurements. The 95% LoAs could differ by up to 0.85 D higher after surgery, indicating weak agreement between pre- and postoperative measurements. There was poor agreement between the IOLMaster-700 and Pentacam-AXL in IOL power calculation for eyes with post-ICL implantation, with a difference of more than 1 D in the 95% LoAs. In conclusion, Scheimpflug imaging was found to be less susceptible than the SS-OCT technique to segmentation errors of the anterior lens surface after ICL implantation. Neither device showed interchangeable results for pre- versus postoperative IOL power calculation. The determination of IOL power by the IOLMaster-700 versus Pentacam-AXL was not interchangeable in eyes with ICL implantation.

The importance of this research lies in clarifying the reasons behind and the disagreements over the definition of major sins (kaba'ir), as well as understanding the emergence of the issue regarding the perpetrator of major sins and the points of agreement and disagreement on this matter between the Kharijites and the Mu'tazilites. The research employs an inductive methodology that includes analysis, relying on what is found in the Qur'an and the interpretations provided by scholars.

Background: The cardiovascular disease (CVD) risk prediction charts, updated by the World Health Organization for 21 regions in 2019. These charts—lab and non-lab versions—estimate a person’s overall CVD risk; the non-lab version is intended for low-resource environments. Objectives: Using the “non-lab” and “lab” versions of the WHO CVD risk prediction charts, we sought to estimate the burden of ten-year risk of a fatal or non-fatal CVD event in a tertiary care hospital of Puducherry and to assess the agreement between them. Materials and Methods: We included 255 doctors working in a tertiary care hospital in Puducherry. Age, gender, systolic blood pressure, and smoking status are all factors used in both charts. Moreover, a lab chart requires a person’s total cholesterol and diabetes mellitus status, whereas a non-lab chart requires a person’s body mass index. Proportions (95% confidence intervals) were used to portray the population at various CVD risk levels. Using Cohen’s Kappa, the degree of agreement between the lab and non-lab charts was assessed (k). Results: The majority of the study participants had 20% in both the charts, which shows the better health-seeking behaviour of doctors. A good level of agreement was shown by the 95.2% (95%CI = 91.7 – 97.4 ) concordance in the risk categorization between the two charts (k = 0.934). Conclusion: When data are available and there is strong agreement between non-lab and lab-based charts, it is practical to apply WHO-updated CVD risk prediction charts.

Abstract The repeatability of two biometers (Lenstar-LS900 and Eyestar-900) to measure ocular parameters and intraocular lens (IOL) power calculation, and their agreement were evaluated. 134 eyes of 134 participants were measured thrice with each biometer. Axial length (AL), anterior chamber depth (ACD), lens thickness (LT) and keratometry (K) were evaluated. The IOL power was calculated using different formulas. The repeatability limit (RLimit), the mean differences (MD) and the limits of agreement (LoA) were calculated. The RLimits for all parameters were higher with Lenstar compared to Eyestar. RLimits were lower than 0.50 D except for Barrett Universal II (0.54 D) and Haigis (0.51 D) formulas with the Lenstar. Mean differences were lower than 0.01 mm for AL, ACD and LT, and lower than 0.03 D for K. MD ranged from 0 to 0.02 D for all formulas except for Barrett and Hill. When dividing the sample into subgroups (short, normal and long eyes), the MDs were similar for the IOL power and were lower than 0.03 D, except for the Barrett and Hill formulas. Both biometers provide repeatable biometry and IOL power calculations. The LoA interval for the IOL power calculation was between 0.75 and 1.50D, which was similar among the subgroups.

Ultrasound is a valuable, non-invasive technique. It allows for detailed examination, precise measurement, and effective monitoring of teats in dairy cows. This study aimed to evaluate the reliability of ultrasound measurements of teats in dairy cows, specifically focusing on intra- and inter-rater agreement between operators with different levels of experience. The study included 51 healthy Holstein cows, with two operators (experienced and inexperienced) performing measurements on ultrasound images obtained before and after milking. The parameters analyzed were teat-canal length (TCL), teat-end width (TEW), teat-wall thickness (TWT), and teat-cistern width (TCW). Differences in teat measurements before and after milking, as well as between operators, were assessed using the Wilcoxon Signed Rank test and the Mann-Whitney U test, respectively. Intra- and inter-rater agreement was calculated using the intra-class correlation coefficient (ICC). Statistical significance was set at p < 0.05. A total of 402 ultrasound images were analyzed. Significant differences were found in TCL, TWT, and TCW before and after milking, while TEW remained unaffected. Statistically significant differences in TWT and TCW were observed between the two operators, while TCL and TEW did not show significant differences. Intra-rater agreement for the experienced operator was excellent, and for the inexperienced operator, it was good. Inter-rater agreement ranged from good to excellent for most parameters, except for TWT, where it was poor. The study confirms that both milking and operator experience influence teat measurements. However, with proper training, ultrasonography can be a reliable tool for assessing udder health in dairy cows, supporting its use in field conditions. [ABSTRACT FROM AUTHOR]

Negotiating a first contract can be a stressful experience for soon-to-be early-career physicians. Most trainees do not have extensive experience with the contract negotiation process, and this unfamiliarity often breeds a lack of confidence and anxiety. However, understanding some key points and the general mechanics of a contract will help bridge any areas of uncertainty. The following review article is designed to help explain these important points so that early-career physicians can feel prepared during the contract negotiation process. Additionally, seeking the help of a contract lawyer can further prepare a physician for successful contract negotiations. [ABSTRACT FROM AUTHOR]

When measuring maximum strength, a high accuracy and precision is required to monitor the training adaptations. Based on available reliability parameters, the literature suggests the replacement of the one repetition maximum (1RM) by isometric testing to save testing time. However, from a statistical point of view, correlation coefficients do not provide the required information when aiming to replace one test by another. Therefore, the literature suggests the inclusion of the mean absolute error (MAE), the mean absolute percentage error (MAPE) for agreement analysis. Consequently, to check the replaceability of 1RM testing methods, the current study examined the agreement of isometric and dynamic testing methods in the squat and the isometric mid-thigh pull. While in accordance with the literature, correlations were classified high r = 0.638–0.828 and ICC = 0.630–0.828, the agreement analysis provided MAEs of 175.75–444.17 N and MAPEs of 16.16–57.71% indicating an intolerable high measurement error between isometric and dynamic testing conditions in the squat and isometric mid-thigh pull. In contrast to previous studies, using MAE, MAPE supplemented by CCC and BA analysis highlights the poor agreement between the included strength tests. The recommendation to replace 1RM testing with isometric testing routines in the squat does not provide suitable concordance and is not recommended. [ABSTRACT FROM AUTHOR]

Background: We aimed to examine the inter‐reliability and agreement among midwives when assessing the fetal heart rate (FHR) using the handheld Doppler. The primary aim was to measure the reliability and agreement of FHR baseline (baseline) as beats per minute (bpm). The secondary aims were to measure fluctuations from the baseline, defined as increases and decreases, and classifications (normal or abnormal) of FHR soundtracks. This is the first interrater reliability and agreement study on intermittent auscultation (IA) to our knowledge. Methods: The participant population consisted of 154 women in labor, from a mixed‐risk population and admitted to hospital for intrapartum care. The rater population were 16 midwives from various maternity care settings in Norway. A total of 154 soundtracks were recorded with a handheld Doppler device, and the 16 raters assessed 1‐min soundtracks once, through an online survey (Nettskjema). They assessed the baseline, FHR increase or decrease, and the FHR classification. The primary outcome, baseline, was measured with intraclass correlation coefficient (ICC). The secondary outcomes were measured with kappa and proportion of agreement. Results: The interrater reliability for the baseline (bpm) was ICC(A,1) 0.74 (95% CI 0.69–0.78). On average, an absolute difference of 7.9 bpm (95% CI 7.3–8.5 bpm) was observed between pairs of raters. Conclusion: Our results demonstrate an acceptable level of reliability and agreement in assessing the baseline using a handheld Doppler. [ABSTRACT FROM AUTHOR]

Dowry is considered one of the social traditions rooted in religious principles in Iranian society. The diverse functions of dowry have led this tradition to persist over the years. In recent decades, the prevalence of exorbitant and unreasonable dowries and its social harmful consequences have prompted a reexamination of the legal and jurisprudential nature of such dowries. One of the undesirable consequences is the inheritance of the right to claim them, leading to the prolonged existence of the cases related to it for many years. In this article, the mentioned problem has been examined with a descriptive- analytic method. It appears that solutions based on invalidating unreasonable dowries or relying on evidence indicating the non-inheritance of such rights are not adequate. Hence, as an alternative way, proposing agreements contract like dowry including its positive function but devoid of undesirable consequences is suggested. Such contracts will not addressed to this subject and solve the interpretation of the parties’ intentions, clarify the conditions of mutual consent, and other complex issues around the topic of unreasonable dowries.

One of the forms of ownership of land rights for foreigners in Indonesia in addition to being given the Right to Rent is the Right to Use which is very attractive, because the granting of a very long period of time can be up to 80 years, and can provide opportunities for economic value on the status of land in the form of financial value. The Government of Indonesia formed a regulation granting the status of Land Use Rights for Foreign Citizens is for private residences, but in reality Foreign Citizens secretly use the status of Land Use Rights for business activities such as: villas, elite boarding houses, cafes and restaurants because of the absence of strict regulations and supervision and sanctions from the Government of Indonesia to Foreign Citizens as applicants and users of the status of Land Use Rights imposed on land owned by Indonesian Citizens.

Abstract Background Assessing refractive errors under cycloplegia is recommended for paediatric patients; however, this may not always be feasible. In these situations, refraction has to rely on measurements made under active accommodation which may increase measurements variability and error. Therefore, evaluating the accuracy and precision of non-cycloplegic refraction and biometric measurements is clinically relevant. The Myopia Master, a novel instrument combining autorefraction and biometry, is designed for monitoring refractive error and ocular biometry in myopia management. This study assessed its repeatability and agreement for autorefraction and biometric measurements pre- and post-cycloplegia. Methods A prospective cross-sectional study evaluated a cohort of 96 paediatric patients that underwent ophthalmologic examination. An optometrist performed two repeated measurements of autorefraction and biometry pre- and post-cycloplegia. Test-retest repeatability (TRT) was assessed as differences between consecutive measurements and agreement as differences between post- and pre-cycloplegia measurements, for spherical equivalent (SE), refractive and keratometric J0/J45 astigmatic components, mean keratometry (Km) and axial length (AL). Results Cycloplegia significantly improved the SE repeatability (TRT, pre-cyclo: 0.65 D, post-cyclo: 0.31 D). SE measurements were more repeatable in myopes and emmetropes compared to hyperopes. Keratometry (Km) repeatability did not change with cycloplegia (TRT, pre-cyclo: 0.25 D, post-cyclo:0.27 D) and AL repeatability improved marginally (TRT, pre-cyclo: 0.14 mm, post-cyclo: 0.09 mm). Regarding pre- and post-cycloplegia agreement, SE became more positive by + 0.79 D, varying with refractive error. Myopic eyes showed a mean difference of + 0.31 D, while hyperopes differed by + 1.57 D. Mean keratometry, refractive and keratometric J0/J45 and AL showed no clinically significant differences. Conclusions Refractive error measurements, using the Myopia Master were 2.5x less precise pre-cycloplegia than post-cycloplegia. Accuracy of pre-cycloplegic refractive error measurements was often larger than the clinically significant threshold (0.25 D) and was refractive error dependent. The higher precision compared to autorefraction measurements, pre- and post-cycloplegia agreement and refractive error independence of AL measurements emphasize the superiority of AL in refractive error monitoring.

Background: The current definition of obesity implies a rise in total body fat, which may only be evaluated through an examination of body composition. Body Mass Index (BMI) cannot detect percent body fat (BF%) effectively, prompting the need for novel, simple, affordable, and resource-constrained methods of body fat assessment and measurement. Objective: To determine the correlation of BMI and BF% estimated by BIA in children of Karachi Methods: This cross-sectional study was performed in a school located in Karachi. The study was conducted from January to April 2023. The permission to conduct this study was taken from the National Institute of Child Health and School Administration. Healthy children of age 6-15 years of either gender were enrolled in this study. Results: Total 132 children were studied with a mean age of 10.8 ± 2.5 years. The age range was 6-15 years. There was almost equal representation of both gender with 50.8% males and 49.2% females. Median weight, height, BMI, and BF% of study subjects were 30.5 (IQR=23.4-42.4) Kg, 139.5 (IQR=128-153) cm, 15.4 (IQR=13.8-17.6) Kg/m2 and 10.2 (IQR=6.1-16.7) % respectively. A significant strong positive correlation was seen for overall data (rs=0.645, p

Introduction: Detection and prompt management of hypoglycaemia among at-risk and symptomatic neonates is crucial to prevent neurodevelopmental morbidity. Laboratory-based Formal Random Blood Sugar (FRBS) is the gold standard for estimating Blood Glucose (BG) levels. Point-of-care Glucose Monitoring Devices (POCGMD)/glucometers that provide immediate results are used as surrogates. Glucometers provide widely variable and overestimated values of BG. Therefore, when using glucometers, a higher cut-off value for glucose may have to be considered as the operational threshold for hypoglycaemia. Aim: To evaluate the adequacy of POCGMD for detecting the threshold levels for treating neonatal hypoglycaemia by assessing the agreement with FRBS values. Materials and Methods: This cross-sectional study was conducted in the Neonatal Intensive Care Unit (NICU), Malankara Orthodox Syrian Church Medical College, Kerala, India, from July 2022 to October 2022. A total of 258 infants at risk for and with hypoglycaemia were selected through convenience sampling. BG was estimated simultaneously in the laboratory and with a POCGMD. Three different types of POCGMDs were consecutively used in the unit during the study period. FRBS and POCGMD values were evaluated using Spearman’s rank correlation coefficient. The agreement between the gold standard FRBS and POCGMD values was ascertained through Bland-Altman plots. Receiver Operating Characteristic (ROC) curves identified the higher cut-off levels for each of the brands of POCGMDs at which intervention for hypoglycaemia should be initiated. Results: The present study showed a strong positive correlation between the standard laboratory FRBS and POCGMD measurements. However, there was no agreement between FRBS and POCGMD values according to Bland-Altman graphs. The mean bias values for BG were higher for glucometers. The ROC curves identified 62 mg/dL for Accu-Check, 59 mg/dL for Contour, and 53 mg/dL for AccuSure as the optimum cut-off corresponding to the operational threshold of FRBS of 45 mg/dL. Conclusion: Glucometers overestimate BG values and miss the biochemical thresholds for treating neonatal hypoglycaemia. When POCGMDs are used, a higher cut-off value may have to be considered as the operational threshold for initiating treatment for hypoglycaemia.

The concept of syntactic connection is fundamental for presenting the syntactic structure of any language. Linguists have described in detail the dichotomy of coordination and subordination, both from the point of view of the semantic relationships between the components of syntactic units and of the use of linguistic means to connect these components. Nevertheless, some syntactic structures have not yet received a comprehensive grammatical description. The article is devoted to the analysis of constructions with nouns being in appositive relations, as their combinations are interpreted inconsistently in modern scientific and educational literature. It has been established that the units in appositive constructions are connected on the basis of logical subordination, which appears in two variants: if the equal case ending agreement for both nouns is required in the entire paradigm, the linkage is characterized as agreement (without distributing it into complete and incomplete), if the case ending in entire paradigm is absent, it is viewed as a case (nominal) adjunction. The dependent component in parallel-case combinations of common nouns is considered to be the one that represents another name or an additional, including evaluative, attribute to the same referent that is named by the word being defined. In appositive combinations of a proper name and a common noun, the dependent component is noted to be the one expressed by a proper name of any type. The syntactic function of the dependent components in appositive phrases is suggested to be characterized without employing the concept of apposition, thus treating them as coordinated or uncoordinated attributes.

Introduction: In the era of Society 5.0, the use of IT in implementing agreements in Indonesia is inevitable. The development of e-contracts, becoming increasingly necessary in society, is demanding the business world's attention. Particularly in Indonesia's Treaty Law, the concept of consensual e-contracting emerged, suggesting that even in the absence of direct meetings, parties could still realize an agreement through the e-contract. Purposes of the Research: This study aims to analyze and describe the existence of e-contract consensus in contract law in Indonesia from the point of view of contract theory. Methods of the Research: This specific type of investigation is doctrinal law research, which endeavors to uncover the truth by employing legal principles, foundational doctrines, and doctrinal law as supporting material. This work utilizes an inductive methodology, first presenting specific assertions and then drawing a general conclusion from them. Results of the Research: One of the legal prerequisites for an agreement is consensus. The study's findings indicate that legislative regulations in Indonesia have incorporated e-contract consensus into contract law. We apply Uitings theory, Verzending theory, and Ontvangs theory as agreement theories to determine the existence of e-contract consensus. The legislation contains provisions that specifically address the maintenance of electronic transactions. In general, it establishes that an electronic transaction has taken place when the parties to an electronic contract (e-contract) issue a statement of acceptance of an offer.

Objective: by reviewing the legal aspects of public-private partnership agreements, to synthesize their main provisions into a common matrix, which, when digitized, can be used to standardize and simplify the formulation of agreement parameters.Methods: the author relied on comparative-legal analysis of scientific literature, legislation and Internet sources on public-private partnership, supplemented by a review of public-private partnership agreements in various socio-political spheres, which made it possible to create a science-based and practice-oriented matrix that can serve as a tool for drafting publicprivate partnership agreements.Results: national aspects in the legal regulation of the said relations in different countries were highlighted; a number of peculiarities encountered in public-private partnership agreements were described.Scientific novelty: taking into account the most important legal peculiarities characteristic of different countries, a matrix for drafting public-private partnership agreements is presented, including eight main parameters: 1 – value received, scope, benefits and risks, 2 – route to market, 3 – restraint of competition, 4 – conflict of interest and procurement issues, 5 – powers, approvals, legal assessment, 6 – liabilities, dispute resolution, 7 – ownership structure, governance and level of autonomy, 8 – exit strategies. Depending on the priorities identified, the matrix can be modified, taking into account that priorities define and shape the specific parameters of each individual partnership.Practical significance: the matrix obtained can become a planning tool used to analyze and understand the relationships between the eight legal parameters necessary for the formation of relations in the sphere of publicprivate partnership. It may serve as a legal reference point for the formulation of public-private partnership agreements around the world, and will contribute not only to the revitalization of public-private partnerships, but also to a proper understanding of obligations, responsibilities and limitations. The recommendations provided in the study show direction for the evaluation of public-private partnerships, allowing clear conclusions to be drawn about the partnership. Digital accessibility provided, the proposed matrix will be of interest to many organizations that use public-private partnerships in their professional activities.

Abstract Background Parathyroid scan is an important imaging modality for localizing hyperfunctioning parathyroid tissue in patients with hyperparathyroidism. Unfortunately, whether early or delayed timing is the optimal protocol for [99mTc]Tc-MIBI SPECT/CT parathyroid remains under debate. This study aimed to evaluate the agreement and compare the confidence levels of physicians when interpreting early and delayed [99mTc]Tc-MIBI SPECT/CT parathyroid scans. Additionally, it sought to identify clinical factors that related to positive scan result. We conducted a prospective study where the early and delayed [99mTc]Tc-MIBI SPECT/CT was separately interpreted as either positive or negative. Furthermore, these interpretations were categorized based on whether they fell within more or less confidence levels of the readers and were correlated with clinical information. Results We enrolled 39 patients with hyperparathyroidism with 158 possible locations of parathyroid glands. The per-location agreement between the early and delayed scans was moderate (concordant rate: 80.3%, Kappa = 0.558), and the per-patient agreement was slight (concordant rate: 71.8%, Kappa = 0.093). The confidence of interpretation was significantly higher for the delayed scans. Calcium supplementation, low serum parathyroid hormone levels, and low serum phosphate levels were associated with positive early scans. High calcium level and high parathyroid hormone levels were associated with positive delayed scans. Conclusions Our study highlights the impact of the timing of SPECT/CT in [99mTc]Tc-MIBI parathyroid scans. The different confidence levels between early and delayed scans, along with clinical factors, imply that various factors affect parathyroid scan interpretation, and individualized scanning protocols adjusted for specific settings may be needed to optimize the successful localization of hyperfunctioning parathyroid tissue.

Abstract Introduction Frailty is an age-related condition with increased risk for adverse health outcomes. Assessing frailty according to the Clinical Frailty Scale (CFS) based on data from medical records is useful for previously unassessed patients, but the validity of such scores in exclusively geriatric populations and in patients with dementia is relatively unknown. Methods Patients admitted for the first time to one of two geriatric wards at Örebro University hospital between January 1st – December 31st, 2021, were included in this study if they had been appointed a CFS-score by anamnestic interview (CFSI) at admission. CFS scores based on medical records (CFSR) were appointed by a single medical student, who was blinded to the CFSI score. Score-agreement was evaluated with quadratic weighted Cohen’s kappa (κ). Results In total, 145 patients between the age of 55–101 were included in the study. The CFSR and CFSI scores agreed perfectly in 102 cases (0.7, 95% CI 0.65–0.77). There was no significant difference regarding age, sex, comorbidity, or number of patients diagnosed with dementia between the patients with complete agreement and the patients whose scores did not agree. Agreement between the scores was substantial, κ = 0.66, 95% CI 0.53–0.80. Conclusions CFS scores based on information from medical records can be generated with substantial agreement to CFS scores based on in-person anamnestic interviews. A dementia diagnosis does not influence the agreement between the scores. Therefore, these scores are a useful tool for assessing frailty in geriatric patients who previously lack a frailty assessment, both in clinical practice and future research. The results support previous findings, but larger studies are warranted.

Background: The evaluation of tonsil size, Friedman Tongue Position (FTP), and Friedman staging in pediatric obstructive sleep apnea (OSA) holds significant clinical importance, offering manifold advantages in diagnosis and surgical management. Aims and Objectives: This study aimed to assess the reliability of pediatric OSA evaluation by determining inter-examiner agreement among pediatric dental specialists. Materials and Methods: Conducted at the Department of Pediatric Dentistry, PMS College of Dental Science and Research Hospital (2023-2024), this observational study utilized conventional consulting rooms, headlights, and examination chairs. Thirteen medical practitioners reviewed video recordings of the oropharyngeal regions of twelve pediatric patients exhibiting mouth breathing. Friedman staging was determined based on tonsil size and tongue position gradings.Inter-examiner agreement was evaluated using Fleiss kappa analysis. Results: Observers, including residents and practitioners in pediatric dentistry, demonstrated poor agreement regarding FTP and tonsil grading. Conclusion: Understanding the nuances of tonsil size and FTP in pediatric OSA evaluation, along with identifying avenues for refinement, can enhance medical decision-making among healthcare providers, including pediatric dentists.