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Background Currently, no classification system using magnification endoscopy for the diagnosis of superficial Barrett’s esophagus (BE)-related neoplasia has been widely accepted. This nationwide multicenter study aimed to validate the diagnostic accuracy and reproducibility of the magnification endoscopy classification system, including the diagnostic flowchart developed by the Japan Esophageal Society—Barrett’s esophagus working group (JES-BE) for superficial Barrett’s esophagus-related neoplasms. Methods The JES-BE acquired high-definition magnification narrow-band imaging (HM-NBI) images of non-dysplastic and dysplastic BE from 10 domestic institutions. A total of 186 high-quality HM-NBI images were selected. Thirty images were used for the training phase and 156 for the validation (test) phase. We invited five non-experts and five expert reviewers. In the training phase, the reviewers discussed how to correctly predict the histology based on the JES-BE criteria. In the validation phase, they evaluated whether the criteria accurately predicted the histology results according to the diagnostic flowchart. The validation phase was performed immediately after the training phase and at 6 weeks thereafter. Results The sensitivity and specificity for all reviewers were 87% and 97%, respectively. Overall accuracy, positive predictive value, and negative predictive value were 91%, 98%, and 83%, respectively. The overall strength of inter-observer and intra-observer agreements for dysplastic histology prediction was κ = 0.77 and κ = 0.83, respectively. No significant difference in diagnostic accuracy and reproducibility between experts and non-experts was found. Conclusion The JES-BE classification system, including the diagnostic flowchart for predicting dysplastic BE, is acceptable and reliable, regardless of the clinician’s experience level.

This article examines the limitations of existing classification systems from the historical, cultural, political, and legal perspectives. It covers the evolution of classification systems with particular emphasis on the DSM and ICD systems. While pointing out the inherent Western bias in these systems, it highlights the potential of misuse of these systems to subserve other agendas. It raises concerns about the reliability, validity, comorbidity, and heterogeneity within diagnostic categories of contemporary classification systems. Finally, it postulates future directions in alternative methods of diagnosis and classification factoring in advances in artificial intelligence, machine learning, genetic testing, and brain imaging. In conclusion, it emphasizes the need to go beyond the limitations inherent in classifications systems to provide more relevant diagnoses and effective treatments. .Este artículo examina las limitaciones de los sistemas de clasificación existentes desde perspectivas históricas, culturales, políticas y legales. Aborda la evolución de los sistemas de clasificación con especial énfasis en los sistemas DSM y CIE. Aunque se señala el inherente sesgo occidental de estos sistemas, también se destaca el potencial del mal uso de estos sistemas para favorecer otros objetivos. Se plantean preocupaciones acerca de la confiabilidad, validez, comorbilidad y heterogeneidad dentro de las categorías diagnósticas de los sistemas de clasificación contemporáneos. Finalmente, se proponen direcciones futuras en cuanto a métodos alternativos de diagnóstico y factorización de la clasificación de acuerdo con avances en inteligencia artificial, aprendizaje automático, pruebas genéticas e imágenes cerebrales. En conclusión, se enfatiza la necesidad de ir más allá de las limitaciones inherentes a los sistemas de clasificación para proporcionar diagnósticos más relevantes y tratamientos efectivos.Les limites des systèmes actuels de classification sont analysées ici à partir de points de vue historique, culturel, politique et légal. L’article trace leur évolution en mettant l’accent sur le DSM et la CIM. Outre leur parti-pris occidental, ces systèmes peuvent être utilisés à d’autres fins abusives. Voici qui soulève des interrogations quant à la fiabilité, la validité, la comorbidité et l’hétérogénéité des catégories diagnostiques des systèmes de classification actuels. D’autres méthodes de diagnostic et de classification pourraient voir le jour en tenant compte des progrès de l’intelligence artificielle, de l’apprentissage automatique, des tests génétiques et de l’imagerie cérébrale. Les auteurs concluent sur la nécessité de dépasser les limites des systèmes de classification afin de proposer des diagnostics plus pertinents et des traitements plus efficaces.

Objective Taxonomies are classification systems used to reduce complexity and better understand a domain. The present research aims to develop a useful taxonomy for health information managers to classify and compare patient portals based on characteristics appropriate to promote patient engagement. As a result, the taxonomy should contribute to understanding the differences and similarities of the portals. Further, the taxonomy shall support health information managers to more easily define which general type and functionalities of patient portals they need and to select the most suitable solution offered on the market. Methods We followed the formal taxonomy-building method proposed by Nickerson et al. Based on a literature review, we created a preliminary taxonomy following the conceptional approach of the model. We then evaluated each taxa's appropriateness by analyzing and classifying 17 patient portals offered by software vendors and 11 patient portals offered by health care providers. After each iteration, we examined the achievement of the determined objective and subjective ending conditions. Results After two conceptional approaches to create our taxonomy, and two empirical approaches to evaluate it, the final taxonomy consists of 20 dimensions and 49 characteristics. To make the taxonomy easy to comprehend, we assigned to the dimensions seven aspects related to patient engagement. These aspects are (1) portal design, (2) management, (3) communication, (4) instruction, (5) self-management, (6) self-determination, and (7) data management. The taxonomy is considered finished and useful after all ending conditions that defined beforehand have been fulfilled. We demonstrated that the taxonomy serves to understand the differences and similarities by comparing patient portals. We call our taxonomy “Taxonomy of Patient Portals based on Characteristics of Patient Engagement (TOPCOP).” Conclusion We developed the first useful taxonomy for health information managers to classify and compare patient portals. The taxonomy is based on characteristics promoting patient engagement. With 20 dimensions and 49 characteristics, our taxonomy is particularly suitable to discriminate among patient portals and can easily be applied to compare portals. The TOPCOP taxonomy enables health information managers to better understand the differences and similarities of patient portals. Further, the taxonomy may help them to define the type and general functionalities needed. But it also supports them in searching and comparing patient portals offered on the market to select the most suitable solution.

Objective Different classification systems for surgical tumor resections in the proximal humerus and scapula have been described, but none are specific or have been recently revised. The purpose of this article is to report modified surgical techniques and a new classification system for resections in the humerus and scapula. Methods Thirty-two patients with shoulder girdle bone tumors were operated upon. Two separate new classifications were assigned to resections in the humerus (types I–IV) and scapula (types I–III). An annotation is added to signify deltoid preservation (A) or sacrifice (B). Modified surgical techniques were devised. Results For extra-articular resections of the proximal humerus, we show that sacrificing the acromion and coracoid process is not required. Preservation of these structures can improve cosmetic shoulder outcome. For tumors with no large medial component, we show that there is no need to detach the muscle attachment from the coracoid process allowing earlier elbow extension postoperatively. After a mean follow-up period of 46 months, only two patients developed local recurrence. Postoperative infection was seen in two and stem loosening in one patient. The average MSTS functional score for all patients was 83%. Conclusion Our modified surgical techniques saved structures which were unnecessarily resected with no advantage in surgical series. We reserved the integrity of more muscular tissues and attachments leading to less restriction during the rehabilitation process. This new classification system is realistic, easy to implement, and applicable to all patients.

Background Many tools exist to document drug-related problems (DRP), such as the Pharmaceutical Care Network Europe (PCNE) classification. However, none have been adapted and published for French-speaking Belgian community pharmacies. Settings French-speaking Belgian Community pharmacies. Objective The objective was to translate and adapt the PCNE V6.2 classification to the Belgian pharmacy practice and legal setting and to assess the content validity, daily use and inter-rater reliability of this classification. Main Outcome Measure Validation of the French-language adapted PCNE v6.2 classification in Belgium. Method The first step translated and adapted the PCNE V6.2 classification to the Belgian setting. Thereafter academic and community pharmacists evaluated the content validity, which involved six criteria and concerned the instruction manual (clarity, helpfulness) and the registration form (representativeness, logical design, completeness and uniqueness). The next step was the DRP collection, using the PCNE tool daily. Compliance with the instructions and the time needed to solve a DRP were evaluated. Finally, the inter-rater reliability was evaluated by comparing DRP codings done by pharmacist volunteers. Results The classification was translated into French and adapted by adding 16 items. The classification showed a high content validity for the academics and the community pharmacists. A total of 109 DRP forms were coded, with an average resolution time of 5 min. Regarding the inter-rater reliability, 74 tool items out of the set of 83 showed high consistency in coding. Conclusion This study showed that the tool adaptation to a French-speaking Belgian context was reliable and has adequate validity for daily use., SCOPUS: ar.j, info:eu-repo/semantics/published

STUDY DESIGN Global cross-sectional survey. OBJECTIVE To validate the AO Spine Subaxial Cervical Spine Injury Classification by examining the perceived injury severity by surgeon across AO geographical regions and practice experience. SUMMARY OF BACKGROUND DATA Previous subaxial cervical spine injury classifications have been limited by subpar interobserver reliability and clinical applicability. In an attempt to create a universally validated scheme with prognostic value, AO Spine established a subaxial cervical spine injury classification involving four elements: (1) injury morphology, (2) facet injury involvement, (3) neurologic status, and (4) case-specific modifiers. METHODS A survey was sent to 272 AO Spine members across all geographic regions and with a variety of practice experience. Respondents graded the severity of each variable of the classification system on a scale from zero (low severity) to 100 (high severity). Primary outcome was to assess differences in perceived injury severity for each injury type over geographic regions and level of practice experience. RESULTS A total of 189 responses were received. Overall, the classification system exhibited a hierarchical progression in subtype injury severity scores. Only three subtypes showed a significant difference in injury severity score among geographic regions: F3 (floating lateral mass fracture, p:0.04), N3 (incomplete spinal cord injury, p:0.03), and M2 (critical disk herniation, p:0.04). When stratified by surgeon experience, pairwise comparison showed only 2 morphological subtypes, B1 (bony posterior tension band injury, p:0.02) and F2 (unstable facet fracture, p:0.03), and one neurologic subtype (N3, p:0.02) exhibited a significant difference in injury severity score. CONCLUSIONS The AO Spine Subaxial Cervical Spine Injury Classification System has shown to be reliable and suitable for proper patient management. The study shows this classification is substantially generalizable by geographic region and surgeon experience; and provides a consistent method of communication among physicians while covering the majority of subaxial cervical spine traumatic injuries.Level of Evidence: 4.

(1) Objective: To evaluate long-term functional outcome in patients who underwent primary or salvage total laryngectomy (TL), TL with partial (TLPP), or total pharyngectomy (TLTP), and to establish a new scoring system to predict complication rate and long-term functional outcome, (2) Material and Methods: Between 1993 and 2019, 258 patients underwent TL (n = 85), TLPP (n = 101), or TLTP (n = 72). Based on the extent of tumor resection, all patients were stratified to (i) localization I: TL, II: TLPP, III: TLTP and (ii) surgical treatment (A: primary resection, B: salvage surgery). Type and rate of complication and functional outcome, including oral nutrition, G-tube dependence, pharyngeal stenosis, and voice rehabilitation were evaluated in 163 patients with a follow-up ≥ 12 months and absence of recurrent disease, (3) Results: We found 61 IA, 24 IB, 63 IIA, 38 IIB, 37 IIIA, and 35 IIIA patients. Complications and subsequently revision surgeries occurred most frequently in IIIB cases but rarely in IA patients (57.1% vs. 18%, p = 0.001 and 51.4% vs. 14.8%, p = 0.002), respectively. Pharyngocutaneous fistula (PCF) was the most common complication (33%), although it did not significantly differ among cohorts (p = 0.345). Pharyngeal stenosis was found in 27% of cases, with the highest incidence in IIIA (45.5%) and IIIB (72.7%) patients (p &lt, 0.001). Most (91.1%) IA patients achieved complete oral nutrition compared to only 41.7% in class IIIB patients (p &lt, 0.001). Absence of PCF (odds ratio (OR) 3.29, p = 0.003), presence of complications (OR 3.47, p = 0.004), and no need for pharyngeal reconstruction (OR 4.44, p = 0.042) represented independent favorable factors for oral nutrition. Verbal communication was achieved in 69.3% of patients and was accomplished by the insertion of voice prosthesis in 37.4%. Acquisition of esophageal speech was reached in 31.9% of cases. Based on these data, we stratified patients regarding the extent of surgery and previous treatment into subgroups reflecting risk profiles and expectable functional outcome, (4) Conclusions: The extent of resection accompanied by the need for reconstruction and salvage surgery both carry a higher risk of complications and subsequently worse functional outcome. Both factors are reflected in our classification system that can be helpful to better predict patients’ functional outcome.

Background While the use of herbal and traditional medicine (H&TM) has been extensive worldwide, the current status of H&TM management in pharmacovigilance remains to be investigated. To date, there is little information regarding the use of the classification/coding system (CCS) to detect signals for certain drugs within databases built on the basis of the spontaneous reporting system (SRS). The purpose of this study is to investigate the status of the SRS and CCS for H&TM in the pharmacovigilance systems of various countries around the world. Methods An e-mail survey was performed from late December 2018 to early January 2019 with 54 experts in pharmacovigilance. The results based on the information provided by the respondents were summarized. Results Fourteen experts from 13 countries responded to the survey. Eleven countries/regions were found to already include H&TM in their SRSs, managing only limited range of H&TM. Of the 9 countries/regions that provided the information on the status of CCS for H&TM in their domestic pharmacovigilance systems, only China had a separate CCS for H&TM. Conclusion Revising the current pharmacovigilance systems to include or expand the range of H&TM, and developing an internationally harmonized system to classify and code H&TM suitable to the unique characteristics of H&TM are critical and overall beneficial.

Aim (1) To determine the interobserver reliability of magnetic resonance classifications and lesion instability criteria for capitellar osteochondritis dissecans lesions and (2) to assess differences in reliability between subgroups. Methods Magnetic resonance images of 20 patients with capitellar osteochondritis dissecans were reviewed by 33 observers, 18 orthopaedic surgeons and 15 musculoskeletal radiologists. Observers were asked to classify the osteochondritis dissecans according to classifications developed by Hepple, Dipaola/Nelson, Itsubo, as well as to apply the lesion instability criteria of DeSmet/Kijowski and Satake. Interobserver agreement was calculated using the multirater kappa (k) coefficient. Results Interobserver agreement ranged from slight to fair: Hepple (k = 0.23); Dipaola/Nelson (k = 0.19); Itsubo (k = 0.18); DeSmet/Kijowksi (k = 0.16); Satake (k = 0.12). When classifications/instability criteria were dichotomized into either a stable or unstable osteochondritis dissecans, there was more agreement for Hepple (k = 0.52; p = .002), Dipaola/Nelson (k = 0.38; p = .015), DeSmet/Kijowski (k = 0.42; p = .001) and Satake (k = 0.41; p .05). Conclusion One should be cautious when assigning grades using magnetic resonance classifications for capitellar osteochondritis dissecans. When making treatment decisions, one should rather use relatively simple distinctions (e.g. stable versus unstable osteochondritis dissecans; lateral wall intact versus not intact), as these are more reliable.

Objective We conducted this study to evaluate the reproducibility of a new classification system for Blount's disease and assess its correlation with established radiological measures used to evaluate the severity of this disorder. Materials and Methods This is a retrospective review of children with Blount’s disease that were younger than 10 years of age. Recurrence was defined as the need for a second corrective surgery. Radiographs immediately pre-surgery and at final follow-up were used to measure mechanical axis (MA), tibial metaphyseal-diaphyseal angle (TMDA), epiphyseal-metaphyseal angle (EMA), lateral distal femoral angle (LDFA), and medial proximal tibial angle (MPTA). Patients were stratified according to the new classification (Type A, B, or C). Results Sixty-five limbs from 16 males and 24 females met our inclusion criteria. The average follow-up was 4.2 years. Twelve patients (with 22 Type-A extremities) underwent bracing with a success rate of 54%. Thirty-four patients (53 extremities) underwent surgical correction. The recurrence rate was 35.8%. Group C had a recurrence rate of 62%, higher than that of Group B (33%), and Group A (23%) (P = 0.026). In addition, irrespective of reoperation, patients in Group C had the least change in the MA (62%, P = 0.046) and the most severe values of MPTA and TMDA initially and after the operation (P < 0.05). Conclusion The new classification system for Blount’s disease holds validity for predicting recurrence. The severity of the grades is correlated with the TMDA, MPTA, and varus reversibility. This can aid physicians and families in making an informed decision and setting treatment goals.

We aimed to clarify the impact of the serum zinc (Zn) level grading system proposed by the Japanese society of clinical nutrition (JSCN: 80 &mu, g/dL &lt, serum Zn level &lt, 130 &mu, g/dL (type A), 60 &mu, 80 &mu, g/dL (type B), and serum Zn level &lt, 60 &mu, g/dL (type C)) in patients with hepatitis C virus (HCV)-related liver cirrhosis (LC) on the incidence of composite hepatic events (Com-HEs) compared with Child&ndash, Pugh (C&ndash, P) classification or albumin-bilirubin (ALBI) grade. (n = 275, median age = 67 years). The Akaike information criterion (AIC) was compared among three prognostic models. Factors associated with the incidence of Com-HEs were also studied. The first incidence of any HE was confirmed in 112 patients (40.7%). The AIC value for Com-HEs by the Zn level grading system was the lowest among the three prognostic models (AIC: 301.788 in Zn level grading system, 303.372 in ALBI grade, and 333.953 in C&ndash, P classification). In the multivariate analysis, male (p = 0.0031), ALBI grade 3 (p = 0.0041), type B (p = 0.0238), type C (p = 0.0004), and persistent viremia (p &lt, 0.0001) were significant factors associated with the incidence of Com-HEs. In conclusion, the serum Zn level grading system proposed by JSCN can be helpful for estimating the incidence of Com-HEs in HCV-related LC patients.

Reports are the standard way of communication between the radiologist and the referring clinician. Efforts are made to improve this communication by, for instance, introducing standardization and structured reporting. Natural Language Processing (NLP) is another promising tool which can improve and enhance the radiological report by processing free text. NLP as such adds structure to the report and exposes the information, which in turn can be used for further analysis. This paper describes pre-processing and processing steps and highlights important challenges to overcome in order to successfully implement a free text mining algorithm using NLP tools and machine learning in a small language area, like Dutch. A rule-based algorithm was constructed to classify T-stage of pulmonary oncology from the original free text radiological report, based on the items tumor size, presence and involvement according to the 8th TNM classification system. PyContextNLP, spaCy and regular expressions were used as tools to extract the correct information and process the free text. Overall accuracy of the algorithm for evaluating T-stage was 0,83 in the training set and 0,87 in the validation set, which shows that the approach in this pilot study is promising. Future research with larger datasets and external validation is needed to be able to introduce more machine learning approaches and perhaps to reduce required input efforts of domain-specific knowledge. However, a hybrid NLP approach will probably achieve the best results. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s10278-020-00327-z) contains supplementary material, which is available to authorized users.

PurposeTo grade the severity of limbal stem cell deficiency (LSCD) based on the extent of clinical presentation and central corneal basal epithelial cell density (BCD).MethodsThis is a retrospective observational comparative study of 48 eyes of 35 patients with LSCD and 9 eyes of 7 normal subjects (controls). Confocal images of the central cornea were acquired. A clinical scoring system was created based on the extent of limbal and corneal surface involvement. LSCD was graded as mild, moderate, and severe stages based on the clinical scores. The degree of BCD reduction was given a score of 0 to 3.ResultsCompared with BCD in controls, BCD decreased by 23.0%, 40.4%, and 69.5% in the mild, moderate, and severe stages of LSCD classified by the clinical scoring system, respectively. The degree of BCD reduction was positively correlated with larger limbal and corneal surface involvement and when the central visual axis was affected (all P ≤ 0.0005). Mean corrected distance visual acuity logarithm of the minimum angle of resolution was 0.0 ± 0.0 in control eyes, 0.2 ± 0.5 in mild LSCD, 0.6 ± 0.4 in moderate LSCD, and 1.6 ± 1.1 in severe LSCD (P < 0.0001). There was a significant correlation between a higher clinical score and corrected distance visual acuity logarithm of the minimum angle of resolution (rho = 0.82; P < 0.0001) and a greater decrease in BCD (rho = -0.78; P < 0.0001).ConclusionsA clinical scoring system was developed to assess the extent of clinical presentation of LSCD. A classification system to grade the severity of LSCD can be established by combining the BCD score with the clinical score.

Simple Summary Ultrasound (US) is the preferred imaging modality for thyroid nodule evaluation. Accurate US assessment of thyroid lesions can help decrease unwarranted FNA procedures of benign nodules. Several thyroid nodule risk classification systems that focus on US features have been published. Some of them highlight simple US patterns, while others rely on the presence of multiple US features to categorize thyroid nodules. The current review offers an evaluation of different US system, combining them with the use of fine needle aspiration and the cytological classification systems. Abstract The increasing application of ultrasound (US) in recent years has led to a greater number of thyroid nodule diagnoses. Consequently, the number of fine needle aspirations performed to evaluate these lesions has increased. Although the majority of thyroid nodules are benign, identifying methods to define specific lesions and tailor risk of malignancy has become vital. Some of the tools employed to stratify thyroid nodule risk include clinical factors, thyroid US findings, and reporting systems for thyroid cytopathology. Establishing high concordance between US features and cytologic diagnoses might help reduce healthcare costs by diminishing unnecessary thyroid procedures and treatment. This review aims to review radiology US classification systems that influence the practice of thyroid cytology.

Background To evaluate reproducibility of a reporting system for endometrial cytology. Methods Cytologic slides from 49 patients, prepared via liquid based cytology, were blindly examined by five cytopathologists of various experience levels, applying a recently introduced reporting system as previously reported. The agreement among cytopathologists was evaluated via Kappa (κ) statistics and the Kendall's Coefficient of Variation (W); cytologic results were compared with the relevant histologic report. Results Substantial agreement among all five raters was found in the benign, ACE-L and malignant categories, fair agreement in inadequate and ACE-H categories, whereas only slight agreement in ACE-U. For the three more experienced cytopathologists, an almost perfect agreement was found in inadequate, benign, and ACE-L categories, substantial agreement in ACE-H and malignant categories and fair agreement in ACE-U category. Overall agreement for all five cytopathologists and for all categories was moderate, whereas it was very high for the three senior raters. Using the Kendall's test, both five cytopathologists (W = 0.81) and the three senior ones (W = 0.93) had very high agreement. Sensitivity: 83.33–92.59%, specificity: 83.33–94.74%, ROC area: 71.72–90.3%. Conclusion Application of appropriate statistical tests shows that integration of a new reporting cytologic system is effective with an overall accuracy around 90%. Both statistical tests applied disclosed lower agreement rates among both all five raters and the three most experienced ones in the intermediate categories constituting the gray zone, thus delineating the need for better training of cytopathologists to correctly identify diagnostic criteria for classification of a given case into these categories.

// Bo Li 1 , Zhi-Yu Gu 1 , Kai-Xiao Yan 1, 2 , Zhi-Ning Wen 3 , Zhi-He Zhao 1 , Long-Jiang Li 1, 2 and Yi Li 1, 2 1 State Key Laboratory of Oral Disease, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China 2 Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China 3 College of Chemistry, Sichuan University, Chengdu 610064, China Correspondence to: Long-Jiang Li, email: muzili63@163.com Yi Li, email: liyi1012@163.com Keywords: oral epithelial dysplasia, near-infrared Raman spectroscopy, support vector machine, classification system Received: November 10, 2016 Accepted: June 27, 2017 Published: July 18, 2017 ABSTRACT Until now, the classification system of oral epithelial dysplasia is still based on the architectural and cytological changes, which relies on the observation of pathologists and is relatively subjective. The purpose of present research was to discriminate the oral dysplasia by the near-infrared Raman spectroscope, in order to evaluate the classification system. We collected Raman spectra of normal mucosa, oral squamous cell carcinoma (OSCC) and dysplasia by near-infrared Raman spectroscope. The biochemical variations between different stages were analyzed by the characteristic peaks in the subtracted mean spectra. Gaussian radial basis function support vector machines (SVM) were used to establish the diagnostic models. At the same time, principal component analysis (PCA) and linear discriminant analysis (LDA) were used to verify the results of SVM. Raman spectral differences were observed in the range between 730~1913 cm -1 . Compared with normal mucosa, high contents of protein and DNA in oral dysplasia and OSCC were observed. There were no significant or gradual variation of Raman peaks among different dysplastic grades. The accuracies of comparison between mild, moderate, severe dysplasia with OSCC were 100%, 44.44%, 71.15%, which elucidated the low modeling ability of support vector machines, especially for the moderate dysplasia. The analysis by PCA-LDA could not discriminate the stages, either. Combined with support vector machines, near-infrared Raman spectroscopy could detect the biochemical variations in oral normal, OSCC and dysplastic tissues, but could not establish diagnostic model accurately. The classification system needs further improvements.

The zebrafish model system offers significant utility for in vivo imaging of adipose tissue (AT) dynamics and for screening to identify chemical and genetic modifiers of adiposity. In particular, AT can be quantified accurately in live zebrafish using fluorescent lipophilic dyes. Although this methodology offers considerable promise, the comprehensive identification and classification of zebrafish ATs has not been performed. Here, we use fluorescent lipophilic dyes and in vivo imaging systematically to identify, classify and quantify the zebrafish AT pool. We identify 34 regionally distinct zebrafish ATs, including five visceral ATs and 22 subcutaneous ATs. For each of these ATs, we describe detailed morphological characteristics to aid their identification in future studies. Furthermore, we quantify the areas for each AT and construct regression models to allow prediction of expected AT size and variation across a range of developmental stages. Finally, we demonstrate the utility of this resource for identifying effects of strain variation and high-fat diet on AT growth. Altogether, this resource provides foundational information on the identity, dynamics and expected quantities of zebrafish ATs for use as a reference for future studies., Summary: A standardized nomenclature and classification system for zebrafish adipose tissues and regression models to predict expected adipose size during the course of zebrafish development.

Currently, the Japanese society of clinical nutrition (JSCN) defines serum zinc (Zn) level &lt, 60 &mu, g/dL as Zn deficiency and 60 &mu, g/dL &le, serum Zn level &lt, 80 &mu, g/dL as subclinical Zn deficiency, and 80 &mu, 130 &mu, g/dL as normal Zn range. We aimed to elucidate the prognostic impact of this Zn classification system in patients with liver cirrhosis (LC) compared to the Child&ndash, Pugh classification and the albumin&ndash, bilirubin (ALBI) grading system (n = 441, median age = 66 years). The Akaike information criterion (AIC) with each evaluation method was tested in order to compare the overall survival (OS). The median serum Zn level was 65 &mu, g/dL. There were 56 patients with normal Zn level, 227 with subclinical Zn deficiency and 158 with Zn deficiency. OS was well stratified among three groups of serum Zn level (p &lt, 0.0001). The AIC value for survival by the Zn classification system was the lowest among three prognostic models (AIC: 518.99 in the Child&ndash, Pugh classification, 502.411 in ALBI grade and 482.762 in the Zn classification system). Multivariate analyses of factors associated with OS revealed that serum Zn classification by JSCN was an independent factor. In conclusion, the serum Zn classification proposed by JSCN appears to be helpful for estimating prognosis in LC patients.

Context In the management of urothelial carcinoma, determination of the pathological grade aims at stratifying tumours into different prognostic groups to allow evaluation of treatment results, and optimise patient management. This article reviews the principles behind different grading systems for urothelial bladder carcinoma discussing their reproducibility and prognostic value. Objective This paper aims to show the evolution of the World Health Organisation (WHO) grading system, discussing their reproducibility and prognostic value, and evaluating which classification system best predicts disease recurrence and progression. The most optimal classification system is robust, reproducible, and transparent with comprehensive data on interobserver and intraobserver variability. The WHO published an updated tumour classification in 2016, which presents a step forward, but its performance will need validation in clinical studies. Evidence acquisition Medline and EMBASE were searched using the key terms WHO 1973, WHO/International Society of Urological Pathology 1998, WHO 2004, WHO 2016, histology, reproducibility, and prognostic value, in the time frame 1973 to May 2016. The references list of relevant papers was also consulted, resulting in the selection of 48 papers. Evidence synthesis There are still inherent limitations in all available tumour classification systems. The WHO 1973 presents considerable ambiguity for classification of the G2 tumour group and grading of the G1/2 and G2/3 groups. The 2004 WHO classification introduced the concept of low-grade and high-grade tumours, as well as the papillary urothelial neoplasm of low malignant potential category which is retained in the 2016 classification. Furthermore, while molecular markers are available that have been shown to contribute to a more accurate histological grading of urothelial carcinomas, thereby improving selection of treatment for a given patient, these are not (yet) part of standard clinical practice. Conclusions The prognosis of patients diagnosed with urothelial carcinoma greatly depends on correct histological grading of the tumour. There is still limited data regarding intraobserver and interobserver variability differences between the WHO 1973 and 2004 classification systems. Additionally, reproducibility remains a concern: histological differences between the various types of tumour may be subtle and there is still no consensus amongst pathologists. The recent WHO 2016 classification presents a further improvement on the 2004 classification, but until further data becomes available, the European Association of Urology currently recommends the use of both WHO 1973 and WHO 2004/2016 classifications. Patient summary Bladder cancer, when treated in time, has a good prognosis. However, selection of the most optimal treatment is largely dependent on the information your doctor will receive from the pathologist following evaluation of the tissue resected from the bladder. It is therefore important that the classification system that the pathologist uses to grade the tissue is transparent and clear for both urologists and pathologists. A reliable classification system will ensure that aggressive tumours are not misinterpreted, and less aggressive cancer is not overtreated.

The Joint Commission in the United States disseminated a Sentinel Event Alert because of the number of adverse outcomes from problems with health information technology (HIT). The HITs were trading off safety and quality against throughput or efficiency. The Alert urged healthcare providers to improve process measurement and provide leadership in mitigating the risks. In order to understand what problems compromise safety and efficiency, this study has accessed, deconstructed, categorized and analyzed Australian patient safety incident reports of the things that go wrong in medical imaging, and their impact on both patients and the medical imaging acquisition and processing systems. Data Sources comprised two sets of voluntary incident reports and convenience samples of interviews with radiology staff. A special targeted search was undertaken for identifying HIT related incidents so that they could be deconstructed with the health information technology classification system. This resulted in 436 HIT related incidents. Within these incidents, 623 HIT related issues were found. These included use or human factor related issues (40%), software and hardware related issues (30%) and machine related issues (30%). Although many technical problems and deficiencies were detected in the reports identified, we did not anticipate that more than half of the incidents would have involved failures of human performance. Identifying and characterizing the things that are going wrong, related to HIT through the lens of medical imaging incident reports can provide a basis for preventing issues and improving clinical practice Refereed/Peer-reviewed

The ability to predict tableting properties of a powder mixture from individual components is of both fundamental and practical importance to the efficient formulation development of tablet products. A common tableting classification system (TCS) of binary powder mixtures facilitates the systematic development of new knowledge in this direction. Based on the dependence of tablet tensile strength on weight fraction in a binary mixture, three main types of tableting behavior are identified. Each type is further divided to arrive at a total of 15 sub-classes. The proposed classification system lays a framework for a better understanding of powder interactions during compaction. Potential applications and limitations of this classification system are discussed.

Background: This study aims to evaluate the inter-rater reliability and perceived usability of a newly developed drug-related problem (DRP) classification system for use by pharmacists in the intermediate and long-term care (ILTC) setting in Singapore. Methods: This was a cross-sectional survey study involving the use of a self-administered questionnaire. All 55 pharmacists affiliated to the Pharmaceutical Society of Singapore (PSS) ILTC Pharmacists Workgroup who were above 21 years old and not authors of the classification system were invited to participate. The inter-rater reliability of participants&rsquo, classification of 46 mock DRP cases using the new DRP classification system was determined using Fleiss&rsquo, s kappa (&kappa, ). Participants&rsquo, perceived usability of the classification system was evaluated using six items with five-point Likert scales (1&mdash, &ldquo, strongly disagree&rdquo, 5&mdash, strongly agree&rdquo, ). Results: Thirty-three pharmacists responded to the survey. Overall inter-rater reliability was found to be substantial (&kappa, = 0.614, 95% CI: 0.611&ndash, 0.617). All usability items received positive ratings (&ldquo, or &ldquo, agree&rdquo, ) from at least 69% of participants. Conclusion: The new DRP classification system has substantial external validity and appears to be suitable for use by pharmacists to document and report DRPs in the ILTC setting in Singapore and facilitate evaluation of the impact of pharmaceutical care in the ILTC setting.

Several classification systems for female genital tract anomalies exist but are of limited use in clinical practice. We, therefore, assessed the applicability and ease of use of the new ESHRE/ESGE classification, using only patient records. This retrospective, single-center, proof-of-principle study systematically analyzed the surgical reports and other hospital records of 920 inpatients and outpatients treated for confirmed female genital tract congenital malformations at a major German university hospital during 2003–2013. Using only this information, a non-expert (medical student) assigned patients to an ESHRE/ESGE class, rating ease of classification based on the time and the number of additional medical records required. Results were verified by an expert gynecologist, who also classified any malformations previously left unclassified. Data analysis used descriptive statistics. The non-expert successfully classified 859/920 patients (93.4%), rating classification as “easy” for 836/859 (90.9%) and “moderately difficult” for 23/859 (2.5%) patients. The expert gynecologist successfully classified 60 (60/920, 6.5%) of the remaining 61 patients rated as “difficult” by the non-expert, but was unable to accurately subclassify 1 patient (1/920, 0.1%) because the operative report lacked the relevant details. 251/920 (27.3%) patients had associated non-Mullerian anomalies, most frequently renal (20.9%) and skeletal (9.1%) malformations. The ESHRE/ESGE classification provides a generally applicable, comprehensive, and adequately specific classification of female genital tract congenital malformations. It offers an efficient basis for communication between non-experts and experts in the field and is, therefore, useful in clinical management and treatment planning.

Purpose The purpose of this study was to identify the most reliable classification system for clinical outcome studies to categorize post-traumatic—fracture—osteoarthritis. Methods A total of 118 orthopaedic surgeons and residents—gathered in the Ankle Platform Study Collaborative Science of Variation Group—evaluated 128 anteroposterior and lateral radiographs of patients after a bi- or trimalleolar ankle fracture on a Web-based platform in order to rate post-traumatic osteoarthritis according to the classification systems coined by (1) van Dijk, (2) Kellgren, and (3) Takakura. Reliability was evaluated with the use of the Siegel and Castellan’s multirater kappa measure. Differences between classification systems were compared using the two-sample Z-test. Results Interobserver agreement of surgeons who participated in the survey was fair for the van Dijk osteoarthritis scale (k = 0.24), and poor for the Takakura (k = 0.19) and the Kellgren systems (k = 0.18) according to the categorical rating of Landis and Koch. This difference in one categorical rating was found to be significant (p

Background This prospective study compared clinical characteristics and prognosis between primary (P) and secondary (S) acute gastrointestinal injury (AGI) (P-AGI)/(S-AGI) in critically ill patients. Methods This was a prospective, single-center observational study. Patients were included if they had been hospitalized for at least 72 h before the AGI diagnosis. Patients were classified according to severity of gastrointestinal dysfunction, while P-AGI or S-AGI were defined according to whether the gastrointestinal system was directly or indirectly involved. Clinical characteristics, Acute Physiology and Chronic Health Evaluation (APACHE) II score, and Sepsis-related Organ Failure Assessment (SOFA) scores after inclusion and 28-day mortality were recorded. Results Altogether, 282 patients were included: P and S groups enrolled 100 and 182 patients, respectively. The S group patients were older and showed increased morbidities and higher APACHE II and SOFA scores. Compared to the S group, the P group had a higher prevalence in abdominal distention and enteroparalysis and fewer patients at AGI grade I, while more patients at grade III or IV. The S group patients had the higher 28-day mortality. Multiple logistic regression analysis showed AGI grades, APACHE II score, and S-AGI independently predicted the odds of 28-day mortality. Conclusions Comparing to the P-AGI patients, the S group patients were older, with higher APACHE II and SOFA scores. AGI grade, APACHE II score, and S-AGI independently predicted the odds of 28-day mortality in AGI patients.

Background Each year, about 5.3 million babies die in the perinatal period. Understanding of causes of death is critical for prevention, yet there is no globally acceptable classification system. Instead, many disparate systems have been developed and used. We aimed to identify all systems used or created between 2009 and 2014, with their key features, including extent of alignment with the International Classification of Diseases (ICD) and variation in features by region, to inform the World Health Organization’s development of a new global approach to classifying perinatal deaths. Methods A systematic literature review (CINAHL, EMBASE, Medline, Global Health, and PubMed) identified published and unpublished studies and national reports describing new classification systems or modifications of existing systems for causes of perinatal death, or that used or tested such systems, between 2009 and 2014. Studies reporting ICD use only were excluded. Data were independently double-extracted (except from non-English publications). Subgroup analyses explored variation by extent and region. Results Eighty-one systems were identified as new, modifications of existing systems, or having been used between 2009 and 2014, with an average of ten systems created/modified each year. Systems had widely varying characteristics: (i) comprehensiveness (40 systems classified both stillbirths and neonatal deaths); (ii) extent of use (systems were created in 28 countries and used in 40; 17 were created for national use; 27 were widely used); (iii) accessibility (three systems available in e-format); (iv) underlying cause of death (64 systems required a single cause of death); (v) reliability (10 systems tested for reliability, with overall Kappa scores ranging from .35–.93); and (vi) ICD alignment (17 systems used ICD codes). Regional databases were not searched, so system numbers may be underestimated. Some non-differential misclassification of systems was possible. Conclusions The plethora of systems in use, and continuing system development, hamper international efforts to improve understanding of causes of death. Recognition of the features of currently used systems, combined with a better understanding of the drivers of continued system creation, may help the development of a truly effective global system. Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-1071-0) contains supplementary material, which is available to authorized users.

Background To reduce the burden of 5.3 million stillbirths and neonatal deaths annually, an understanding of causes of deaths is critical. A systematic review identified 81 systems for classification of causes of stillbirth (SB) and neonatal death (NND) between 2009 and 2014. The large number of systems hampers efforts to understand and prevent these deaths. This study aimed to assess the alignment of current classification systems with expert-identified characteristics for a globally effective classification system. Methods Eighty-one classification systems were assessed for alignment with 17 characteristics previously identified through expert consensus as necessary for an effective global system. Data were extracted independently by two authors. Systems were assessed against each characteristic and weighted and unweighted scores assigned to each. Subgroup analyses were undertaken by system use, setting, type of death included and type of characteristic. Results None of the 81 systems were aligned with more than 9 of the 17 characteristics; most (82 %) were aligned with four or fewer. On average, systems were aligned with 19 % of characteristics. The most aligned system (Frøen 2009-Codac) still had an unweighted score of only 9/17. Alignment with individual characteristics ranged from 0 to 49 %. Alignment was somewhat higher for widely used as compared to less used systems (22 % v 17 %), systems used only in high income countries as compared to only in low and middle income countries (20 % vs 16 %), and systems including both SB and NND (23 %) as compared to NND-only (15 %) and SB-only systems (13 %). Alignment was higher with characteristics assessing structure (23 %) than function (15 %). Conclusions There is an unmet need for a system exhibiting all the characteristics of a globally effective system as defined by experts in the use of systems, as none of the 81 contemporary classification systems assessed was highly aligned with these characteristics. A particular concern in terms of global effectiveness is the lack of alignment with “ease of use” among all systems, including even the most-aligned. A system which meets the needs of users would have the potential to become the first truly globally effective classification system. Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-1040-7) contains supplementary material, which is available to authorized users.

Background Accurately distinguishing non-traumatic intracerebral hemorrhage (ICH) subtypes is important since they may have different risk factors, causal pathways, management, and prognosis. We systematically assessed the inter- and intra-rater reliability of ICH classification systems. Methods We sought all available reliability assessments of anatomical and mechanistic ICH classification systems from electronic databases and personal contacts until October 2014. We assessed included studies’ characteristics, reporting quality and potential for bias; summarized reliability with kappa value forest plots; and performed meta-analyses of the proportion of cases classified into each subtype. Summary of review We included 8 of 2152 studies identified. Inter- and intra-rater reliabilities were substantial to perfect for anatomical and mechanistic systems (inter-rater kappa values: anatomical 0.78–0.97 [six studies, 518 cases], mechanistic 0.89–0.93 [three studies, 510 cases]; intra-rater kappas: anatomical 0.80–1 [three studies, 137 cases], mechanistic 0.92–0.93 [two studies, 368 cases]). Reporting quality varied but no study fulfilled all criteria and none was free from potential bias. All reliability studies were performed with experienced raters in specialist centers. Proportions of ICH subtypes were largely consistent with previous reports suggesting that included studies are appropriately representative. Conclusions Reliability of existing classification systems appears excellent but is unknown outside specialist centers with experienced raters. Future reliability comparisons should be facilitated by studies following recently published reporting guidelines.

Objective: The aim of this study was to develop a new calcaneal fracture classification system which will consider sustentacular fragment configuration and relation of posterior calcaneal facet to calcaneal body. Methods: The new classification system used sustentacular fragment configuration and relation of posterior calcaneal facet fracture with fracture components of calcaneal body as key aspects of main types and subtypes. Between 2000 and 2014, 126 intraarticular calcaneal fractures were classified according to the new classification system by using computed tomography images. The new classification system was studied in term of reliability, correlation to choices of treatment, implant fixation and quality of fracture reduction. Results: Types of sustentacular fragment comprised type A, B and C. Type A sustentacular fragment included sustentacular tali containing middle calcaneal facet. In Type B and C fractures sustentacular fragment included medial aspect and entire posterior calcaneal facet as a single unit, respectively. The fractures with type A, B and C sustentacular fragments were classified as main type A, B and C intra-articular calcaneal fractures. The main type A and B comprised 4 subtypes. Subtypes A1, A3, B1, and B3 associated with avulsion and bending fragments of calcaneal body. Subtype A2, B2, and B4 associated with burst calcaneal body. Subtype B4 was not found in the study. Main type C had no subtype and associated with burst calcaneal body. The data showed good reliability. Conclusion: The study showed that our new intra-articular calcaneal fracture classification system correlates to choices of treatment, implant fixation and quality of fracture reduction.Level of Evidence: Level IV, Study of Diagnostic Test Keywords: Intra-articular calcaneal fracture, Classification system, Sustentacular fragment, Posterior calcaneal facet fracture, Choices of treatment, Quality of fracture reduction

The use of sEMG signals for the movement classification plays an important role in various applications from robotics to effective prosthetic limbs control. The performance of the classification scheme is severely influenced by the efficiency of the used feature set to create discriminant subspaces for each movement. In the recent literature, various feature sets have been proposed, that usually create rather complicated feature spaces. The aim of this research is to propose a versatile scheme based on simple and uniform characteristics capable to significantly improve the performance of the movement classification by using the sEMG signals. The set is comprised of features like energies and a few other features from the well-know and widely used Hudgins set, all estimated on the wavelet domain of the sEMG signal. The application of the proposed scheme on standard database of sEMG signals, the NINAPRO a database that is built for benchmarking and algorithmic evaluation, proved that the classification performance of movements exceeds 96% with a significant improvement when compared with the performance of other schemes proposed. © Springer International Publishing Switzerland 2016. 57 33 36 Sponsors: Conference code: 172989 Cited By :1

Background: In 2000, the Institute of Medicine reported disturbing numbers on the scope it covers and the impact of medical error in the process of health delivery. Nevertheless, a solution to this problem may lie on the adoption of adverse event reporting and learning systems that can help to identify hazards and risks. It is crucial to apply models to identify the adverse events root causes, enhance the sharing of knowledge and experience. The efficiency of the efforts to improve patient safety has been frustratingly slow. Some of this insufficiency of progress may be assigned to the lack of systems that take into account the characteristic of the information about the real world. In our daily lives, we formulate most of our decisions normally based on incomplete, uncertain and even forbidden or contradictory information. One’s knowledge is less based on exact facts and more on hypothesis, perceptions or indications. Purpose: From the data collected on our adverse event treatment and learning system on medical imaging, and through the use of Extended Logic Programming to knowledge representation and reasoning, and the exploitation of new methodologies for problem solving, namely those based on the perception of what is an agent and/or multi-agent systems, we intend to generate reports that identify the most relevant causes of error and define improvement strategies, concluding about the impact, place of occurrence, form or type of event recorded in the healthcare institutions. Results and conclusions: The Eindhoven Classification Model was extended and adapted to the medical imaging field and used to classify adverse events root causes. Extended Logic Programming was used for knowledge representation with defective information, allowing for the modelling of the universe of discourse in terms of data and knowledge default. A systematization of the evolution of the body of knowledge about Quality of Information embedded in the Root Cause Analysis was accomplished. An adverse event reporting and learning system was developed based on the presented approach to medical errors in imaging. This system was deployed in two Portuguese healthcare institutions, with an appealing outcome. The system enabled to verify that the majority of occurrences were concentrated in a few events that could be avoided. The developed system allowed automatic knowledge extraction, enabling report generation with strategies for the improvement of quality-of-care.