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The New Coimbra Method is the most recently proposed standardized method to assess entheseal changes (EC). However, the method's developers acknowledge the inadequacy of their guidelines and state that those who will use the method need in‐person training from them. This study aims to determine the applicability of the method's guideline by testing the interobserver agreement (IOA) with observers who were not trained by the developers. The second objective of this study is to apply the New Coimbra Method to a relatively small archeological sample, in this case a Bronze Age population from Kültepe‐Kanesh, Türkiye. Four observers (the authors) scored EC in three entheses of the right upper limb of 52 adults. IOA was analyzed via Fleiss' kappa (FK) and percentage of agreement (PA) tests. FK test results indicate moderate overall agreement (0.458), while PA implies significantly high agreement (95%). The results of the FK and PA tests contradict each other due to the known limitations of the latter. However, FK values among features vary broadly; some of the features indicate substantial agreement and surpass the required benchmark, while the rest remains moderate or lower. The features that revealed substantial agreement indicate the sufficiency of the method's guidelines. However, the guidelines for the other features appear to be inadequate. Further revision of the guidelines could make the method more applicable for all researchers with no requirement of in‐person training. [ABSTRACT FROM AUTHOR]

With the increasing longevity of cystic fibrosis (CF), there is a growing need to minimise exposure to ionising radiation in patients who undergo regular imaging tests while monitoring the course of the lung disease. This study aimed to define the role of lung ultrasounds (LUS) in the evaluation of lung disease severity in children with clinically stable CF. LUS was performed on 131 patients aged 5 weeks to 18 years (study group) and in 32 healthy children of an equivalent age range (control group). Additionally, an interobserver study was performed on 38 patients from the study group. In CF patients, the following ultrasound signs were identified: I-lines; Z-lines; single, numerous and confluent B-lines; Am-lines; small and major consolidations; pleural line abnormalities and small amounts of pleural fluid. The obtained results were evaluated against an original ultrasound score. LUS results were correlated with the results of chest X-ray (CXR) [very high], pulmonary function tests (PFTs) [high] and microbiological status [significant]. The interobserver study showed very good agreement between investigators. We conclude that LUS is a useful test in the evaluation of CF lung disease severity compared to routinely used methods. With appropriate standardisation, LUS is highly reproducible. [ABSTRACT FROM AUTHOR]

Procedural fidelity is the extent to which independent variables are implemented as designed. Despite 40 years of discussion about the importance of procedural fidelity for behavioral research, reporting of fidelity data remains an uncommon practice in behavior‐analytic journals. Researchers have speculated about reasons for underreporting, but the perspectives of scholars about when reporting is warranted or necessary have not yet been explored. Thus, the purpose of this study was to evaluate possible reasons for infrequent reporting of fidelity data in behavior‐analytic studies. To address this purpose, we conducted focus groups with scholars in applied behavior analysis. Five themes emerged regarding why procedural fidelity data are not typically reported. We provide a discussion about how these themes are interrelated and offer suggestions and recommendations to assist with the collection and reporting of fidelity data. [ABSTRACT FROM AUTHOR]

Ultrasound is commonly used to assess rotator cuff repair (RCR), but no standardized criterion exists to characterize the tendon. The aims of this study were to (1) develop content validity for ultrasound specific criteria to grade the postoperative appearance of a tendon after RCR, (2) assess the reliability of the criteria, and (3) assess the feasibility to use these assessments. Following expert consultation and literature review for content validity, 2 scales were created: 1) the Fibrillar matrix, Echogenicity, Contour, Thickness, and Suture (FECTS) scale and 2) the Rotator Cuff Repair-Investigator Global Assessment (RCR-IGA). A prospective cohort study was undertaken on patients who had received a RCR and serial B-mode ultrasound images. Four raters assessed the 64-ultrasound images using the scales created in a blinded fashion using intraclass correlation coefficients. The FECTS scale was a composite score with 5 key parameters and the RCR-IGA scale was a 5-point global score. The intrarater reliability for the FECTS scale was excellent for the most experienced rater (0.92) and fair for the rater with no experience (0.72). The intrarater reliability for the RCR-IGA scale was excellent for 3 of the 4 raters (0.80-0.87) and fair when used by the least experienced rater (0.56). Inter-rater testing for all the FECTS scale parameters had excellent reliability (0.82-0.92) except for Fibrillar matrix (0.73). The average time to complete the FECTS scale per image was 23 seconds and 11 seconds for the RCR-IGA scale. The FECTS scale and the RCR-IGA scale are reliable tools to assess the ultrasonic appearance of the repaired rotator cuff tendon. The FECTS scale was more reliable for less experienced assessors. The RCR-IGA scale was easier, more time efficient and reliable for those with experience. [ABSTRACT FROM AUTHOR]

Objectives: Lung ultrasound (LUS) has sparked significant interest during COVID‐19. LUS is based on the detection and analysis of imaging patterns. Vertical artifacts and consolidations are some of the recognized patterns in COVID‐19. However, the interrater reliability (IRR) of these findings has not been yet thoroughly investigated. The goal of this study is to assess IRR in LUS COVID‐19 data and determine how many LUS videos and operators are required to obtain a reliable result. Methods: A total of 1035 LUS videos from 59 COVID‐19 patients were included. Videos were randomly selected from a dataset of 1807 videos and scored by six human operators (HOs). The videos were also analyzed by artificial intelligence (AI) algorithms. Fleiss' kappa coefficient results are presented, evaluated at both the video and prognostic levels. Results: Findings show a stable agreement when evaluating a minimum of 500 videos. The statistical analysis illustrates that, at a video level, a Fleiss' kappa coefficient of 0.464 (95% confidence interval [CI] = 0.455–0.473) and 0.404 (95% CI = 0.396–0.412) is obtained for pairs of HOs and for AI versus HOs, respectively. At prognostic level, a Fleiss' kappa coefficient of 0.505 (95% CI = 0.448–0.562) and 0.506 (95% CI = 0.458–0.555) is obtained for pairs of HOs and for AI versus HOs, respectively. Conclusions: To examine IRR and obtain a reliable evaluation, a minimum of 500 videos are recommended. Moreover, the employed AI algorithms achieve results that are comparable with HOs. This research further provides a methodology that can be useful to benchmark future LUS studies. [ABSTRACT FROM AUTHOR]

Background and aimA recently carried out randomized controlled trial showed the benefit of a novel 20-G fine-needle biopsy (FNB) over a 25-G fine-needle aspiration (FNA) needle. The current study evaluated the reproducibility of these findings among expert academic and non-academic pathologists.MethodsThis study was a side-study of the ASPRO (ASpiration versus PROcore) study. Five centers retrieved 74 (59%) consecutive FNB and 51 (41%) FNA samples from the ASPRO study according to randomization; 64 (51%) pancreatic and 61 (49%) lymph node specimens. Samples were re-reviewed by five expert academic and five non-academic pathologists and rated in terms of sample quality and diagnosis. Ratings were compared between needles, expert academic and non-academic pathologists, target lesions, and cytology versus histological specimens.ResultsBesides a higher diagnostic accuracy, FNB also provided for a better agreement on diagnosing malignancy (ĸ = 0.59 vs ĸ = 0.76, P

Classification of thyroid nodules (TNs) based on TIRADS category is important for predicting malignancy, avoiding unnecessary biopsy and aiding in the management of patients. A prospective nonintervention study was carried out in the period from February 2020 to February 2021 in King Fahad Specialist Hospital in Dammam (Saudi Arabia). The study included 222 patients with suspected TNs (TIRADS 3-5). The thyroid ultrasound scanning was performed with a high frequency linear array probe (9 MHz and 15 MHz). The thyroid gland and adjacent neck tissues were scanned. The diagnostic performance of the TIRADS classifications was evaluated against final histology. Three highly experienced sonographers independently rated the US features of each nodule. Each sonographer assigned points to each TN for the five separate categories (composition, echogenicity, shape, margin, and echogenic foci), according to the TIRADS protocols produced by ACR. Cohen’s kappa scale was used to measure the interobserver agreement in categorizing TNs, and then the performance of ACR TIRADS categories for predicting malignancy was assessed using fine needle aspiration (FNA) as reference standard. For estimation of the diagnostic performance of ACR TIRADS to predict malignancy, the category for each TN was assigned by the principal investigator (Observer 1). This study included only TIRADS 3-5 (mildly to highly suspicious nodules: TR3-TR5), according to ACR TIRADS classification. The agreement for all sonographic features of TN among three observers (principal Observer 1 and two sub-investigators [Observer 2 and Observer 3]) was perfect, being 0.91-1.00 (Cohen’s kappa). Out of 222 patients with TNs, the percentage of malignancy in 68 TIRADS-5 nodules was 91.2%, while in 154 TIRADS 3-4 nodules the percentage of malignancy was 29.9%. The study concluded that interobserver agreement in TIRADS classification and characterization of suspicious thyroid nodule was perfect.

Background: The Mayo-Fundación Jiménez Díaz (FJD) classification for proximal humerus fractures aims to identify specific fracture patterns and apply displacement criteria to each pattern. The classification includes 7 common fracture patterns: isolated fractures of the greater or lesser tuberosity, fractures of the surgical neck, impacted fractures involving head rotation in a varus and posteromedial direction or in valgus, and fractures where the humeral head is dislocated (head dislocation), split (head splitting), or depressed (head impaction). The purpose of this study was to evaluate the intraobserver and interobserver agreement of the Mayo-FJD classification system using plain radiographs (xR) and computed tomography (CT). Methods: Three fellowship-trained shoulder surgeons blindly and independently evaluated the xR and CT of 103 consecutive proximal humerus fractures treated at a Level I trauma center. Each surgeon classified all fractures according to the Mayo-FJD classification system on 4 separate sessions at least 6 weeks apart. K values were calculated for intraobserver and interobserver reliability. Results: The average intraobserver agreement was 0.9 (almost perfect) for xR and 0.9 (almost perfect) for CT scans. The average interobserver agreement was 0.69 (substantial) for xR and 0.81 (almost perfect) for CT scans at the first round, and 0.66 (substantial) for xR and 0.75 (substantial) for CT scans at the second round. Conclusion: The pattern-based Mayo-FJD classification scheme for proximal humerus fractures was associated with adequate intraobserver and interobserver agreement using both xR and CT scan. Interobserver agreement was best when fractures were classified using CT scans.

The goal of a medico‐legal autopsy is primarily to determine the cause and manner of death. To this end, the pathologist often uses auxiliary analyses, including histology. However, the utility of routine histology in all medico‐legal autopsies is unknown. Earlier studies on the utility of routine histology have shown inconsistent effects, with some studies recommending it and others rejecting it. To study the degree to which histology informs on the underlying cause of death, we sent autopsy reports from suspension‐, immersion‐, fire‐, and traffic‐related deaths to senior board‐certified forensic pathologists and had them assess the cause of death, first without knowledge of the histological findings and then with knowledge thereof. Fifty cases were identified in each of four subgroups: fire‐, immersion‐, suspension‐, and traffic‐related deaths. The autopsy reports were anonymized, and the histological findings and conclusions were removed. Two board‐certified forensic pathologists independently reviewed the reports in each subgroup and assessed the manner and underlying cause of death (including their certainty of this assessment on a five‐level scale) with and without access to histological findings. The probability of changing the underlying cause of death posthistology was low in all study groups. There was a slight increase in the degree of certainty posthistology in cases where the underlying cause of death was not changed, but only when the antehistology certainty was low. Our results suggest that histology does not meaningfully inform on the underlying cause of death in suspension‐, immersion‐, fire‐, and traffic‐related deaths except when antehistology certainty is low. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the reproducibility of lower uterine segment (LUS) thickness measurement before induction of labor (IOL), and to assess the relationship between LUS thickness and IOL outcomes. Methods: This was a prospective cohort study of pregnant women undergoing IOL at term, conducted in a single tertiary hospital between July 2014 and February 2017. Women with a singleton pregnancy at ≥ 37 weeks' gestation, with a live fetus in cephalic presentation and a Bishop score of ≤ 6, were eligible for inclusion. Both nulliparous and parous women, and those with a previous Cesarean section (CS), were eligible. All women underwent transvaginal ultrasound assessment before IOL admission, and cervical length and LUS thickness were measured offline after delivery. Maternal and obstetric characteristics and Bishop score were recorded. The main outcome was the overall rate of CS after IOL, and secondary outcomes were CS for either failure to progress in the active phase of labor or failed IOL, and CS for failed IOL only. Interobserver agreement for measurement of LUS thickness between two operators was assessed using the intraclass correlation coefficient (ICC) and Bland–Altman analysis with the ANOVA test to evaluate systematic bias. Univariable and multivariable analysis were employed to evaluate the relationship between clinical and sonographic characteristics and IOL outcomes. Results: Of 265 women included in the analysis, 195 (73.6%) had a vaginal delivery and 70 (26.4%) required a CS after IOL. Reproducibility analysis showed excellent interobserver agreement for the measurement of LUS thickness (ICC, 0.96 (95% CI, 0.93–0.98)). On Bland–Altman analysis, the mean difference in LUS thickness between the two operators was 0.15 mm (95% limits of agreement, –1.84 to 2.14 mm), and there was no evidence of systematic bias (ANOVA test, P = 0.46). Univariable analysis showed that LUS thickness was associated significantly with overall CS (P = 0.002), CS for failure to progress in the active phase of labor or failed IOL (P = 0.03) and CS for failed IOL (P = 0.037). On multivariable logistic regression analysis, LUS thickness was an independent predictive factor for overall CS (odds ratio (OR), 1.149 (95% CI, 1.031–1.281)) and CS for failure to progress in the active phase of labor or failed IOL (OR, 1.226 (95% CI, 1.039–1.445)). Conclusions: In women undergoing IOL at term, measurement of LUS thickness is feasible and reproducible, and is associated significantly with IOL outcome. © 2022 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Radiographers can accurately report musculoskeletal and chest radiographs, but there is paucity of research comparing the performance of reporting radiographers (RRs) with consultant radiologists when interpreting and reporting abdominal radiographs. This study assessed interobserver agreement in the clinical setting between reporting radiographers and a consultant radiologist compared to an expert gastrointestinal radiologist in a District General Hospital. Major discordant reports affecting patient management were also examined. 126 abdominal radiographs reported by 3 RRs in clinical practice were randomly selected and reported by a consultant radiologist and index gastrointestinal radiologist. The reports of the RRs and consultant radiologist were compared against the reports made by the index radiologist for agreement by a colorectal consultant surgeon. All 126 reports were scored as being in either complete agreement, minor disagreement or major disagreement which would have resulted in a change to patient management. There was no significant difference in overall agreement between the consultant radiologist (CR) and RRs when compared to the index radiologist (CR: n = 90/126, 71.4% and RRs: n = 94/126, 74.6%. p = 0.57). Major disagreements were found, but there was no significant difference between both groups (CR: n = 23/126, 18.3% and RRs: n = 17/126, 13.5%. p = 0.30). RRs can report abdominal radiographs to a comparable level of agreement as a consultant radiologist in the clinical setting. There was no significant difference in reports deemed to affect patient management. This study addresses the gap in assessing the performance of RRs reporting abdominal radiographs. This small scale study indicates that radiographers could provide additional support in the reporting of abdominal radiographs. This would help to reduce radiologist workload and enhance the role of the reporting radiographer. Agreement between reporting radiographers and radiologists interpreting and reporting abdominal radiographs. [ABSTRACT FROM AUTHOR]

Simple Summary: Hip laxity is one of the most frequent orthopedic disorders in dogs, and it is one of the main underlying reasons for canine hip dysplasia. Canine hip dysplasia is a progressive disease influenced by inheritance. Veterinarians can take timely preventive/therapeutic measures when hip laxity is diagnosed early, and prevent the participation of dysplastic dogs in breeding programs to reduce the prevalence of the disease. Effective treatment strategies can increase the welfare of dogs by reducing the severity of the disease at older ages. In this study, we aimed to assess the reproducibility of the protocols reported for the radiographic assessment of canine hip dysplasia in 8- and 12-month-old Rottweilers. Five observers investigated eight radiographic parameters at each examination time. According to the results, there were high interobserver agreements at both ages for the measurable parameters, such as the center edge angle (CEA), dorsal acetabular rim slope (DARS), distraction index (DI), and Norberg angle (NA), whereas the observers recorded poor to moderate agreements for the subjective values, such as the grading of the dorsal acetabular rim (GDAR), grading of the degenerative joint disease (GDJD), location of the center of the femoral head (LCFH), and sclerosis of the cranial acetabular rim (SCAR). Hip laxity is one of the predisposing factors of canine hip dysplasia. The early diagnosis of hip laxity allows veterinarians to prevent the participation of dysplastic dogs in breeding programs, which could lower the disease's prevalence due to its genetic background. Furthermore, it allows them to plan preventive/therapeutic procedures for mild/near-normal hips to reduce the symptoms of the disease at older ages. A reliable screening program must be repeatable and reproducible, and intra- and inter-observer studies can help us to determine the best methods. In this study, we aimed to evaluate the radiographic parameters used for the early diagnosis of hip dysplasia in Rottweilers at 8 and 12 months of age with five observers to assess the interobserver agreements. According to our findings, there were high interobserver agreements at both ages for the quantitative values, such as the center edge angle (CEA), dorsal acetabular rim slope (DARS), distraction index (DI), and Norberg angle (NA), whereas we recorded from poor to moderate agreements for the qualitative values, such as the grading of the dorsal acetabular rim (GDAR), grading of the degenerative joint disease (GDJD), location of the center of the femoral head (LCFH), and sclerosis of the cranial acetabular rim (SCAR). [ABSTRACT FROM AUTHOR]

We examined articles with experiments published in the Journal of Applied Behavior Analysis and in Behavior Analysis in Practice from 2017 through 2021 to determine how frequently procedural fidelity was assessed. When procedural fidelity was assessed, we determined how often a measure of interobserver agreement for those fidelity data was provided. We also determined how often a measure of interobserver agreement for participants' behavior was provided. Across both journals and all years, 54.7% of relevant articles provided a measure of procedural fidelity. Of them, 17.7% provided a measure of interobserver agreement for procedural fidelity. In marked contrast, 96.4% provided interobserver agreement data for participants' behavior. It is unfortunate that applied behavior analysts frequently fail to provide procedural fidelity data and, when they do, often fail to provide interobserver agreement data for the fidelity data. Reviewers for, and editors of, behavior‐analytic journals are encouraged to strongly consider the relative value of procedural fidelity and agreement on procedural fidelity measures when rendering recommendations on the suitability of a given submission. [ABSTRACT FROM AUTHOR]

Abstract Background Shoulder impingement syndrome is the painful entrapment of the soft tissues between the acromion and the humeral head. The severity of shoulder impingement could be graded according to the limitation of shoulder joint moment. The reliability of sonographic findings in the grading of shoulder impingement severity grading is required to be evaluated by the consistency of findings between the observers. Purpose To assess the interobserver agreement in the sonographic severity grading of shoulder impingement syndrome with the help of a ratio between acromion-to-greater tuberosity distance in the abduction and neutral arm position. Material and methods Patients were examined by two independent observers in the coronal approach with neutral arm position. Acromion-to-greater tuberosity distance was measured in abduction and neutral shoulder position. The ratios of the distances in the abduction and neutral position were calculated to grade the severity of shoulder impingement syndrome. Results A total of 78 shoulders were included in this study. A strong agreement was found for the grading of shoulder impingement severity grading between the two independent observers with Kappa value of 0.94. And correlation between the results of the two observers for the severity grading of shoulder impingement syndrome was significant at 0.01 level. Conclusion Severity grading of the shoulder impingement syndrome was performed based on the ratio of acromion-to-greater tuberosity distance in abduction and neutral arm position. However, the sonographic findings were consistent and a strong interobserver agreement was seen in this sonographic severity grading.

Objective:Histopathological examination of the liver is the gold standard in the follow-up and treatment of chronic hepatit B vius (HBV) disease. Ishak’s Modified histological activity index (HAI) and fibrosis staging system are usually used in Turkey. Although a common scoring system is used, the same sample can be interpreted differently between different pathologists due to various variables. In this study, the evaluation of liver histopathologies of chronic HBV patients by pathologists in different hospitals and the correlation of the results with each other and the effect on the treatment decision were investigated.Methods:Pathology slides of liver biopsy materials of 10 patients were evaluated by pathologists in 5 different tertiary care hospitals. Using non-parametric statistical methods, the coefficient of agreement between pathologists was determined. Also, descriptive statistics were used to determine the percentage of receiving treatment.Results:Agreement between pathologists was calculated the most in total HAI and Fibrosis score (k=0.8186, k=0.8217). The Kuder-Richardson reliability coefficient among centres was found to be high in the treatment decision (k=0.8207). Although all patients were indicated for treatment according to The European Association for the Study of the Liver 2017 guideline, it was calculated that an average of 58% of the patients could receive treatment according to liver histopathology.Conclusion:Differences in the pathological diagnosis between pathologists in centres may cause delays in chronic hepatitis B patients' access to treatment.

Background: The Neer classification is among the most widely used systems to describe proximal humerus fractures (PHF) despite the poor interobserver agreement. The purpose of this study was to verify whether or not blinded shoulder surgeons and trainees agree with the authors of articles published in the highest impact-factor orthopedic journals. Methods: All articles regarding PHF published between 2017 and 2019 in the top 10 orthopedic journals as rated by impact factor were searched. Articles were included if the authors used the Neer classification to describe at least 1 PHF in the figures. Figures were extracted without the legend, and X-rays ± computed tomography scan images were included when available. An international survey was conducted among 138 shoulder surgeons who were asked to record the Neer classification for each de-identified radiograph in the publications. The type of fracture mentioned in the legend of the published figure was considered as the gold standard. Results: Survey participants agreed with the published article authors in 55% of cases overall (range 6%-96%, n = 35). The most common response disagreed with the article authors in 13 cases (37%), underestimating the number of parts in 11 of 13 cases. The interobserver agreement between the 138 responders was fair (k = 0.296). There was an association between the percentage of concordant answers and greater experience (number of years of shoulder surgery practice) of the responders (P = .0023). The number of parts, the number or type of available imaging modalities, and the geographic origin of participants did not influence the agreement between responders and authors. Discussion: In more than one-third of cases, specialized shoulder surgeons disagree with article authors when interpreting the Neer classification of de-identified images of PHF in published manuscripts. Morphologic classification of PHF as the sole basis for treatment algorithms and surgical success should be scrutinized.

We aimed to compare the performance and interobserver agreement of radiologists manually segmenting images or those assisted by automatic segmentation. We further aimed to reduce interobserver variability and improve the consistency of radiomics features. This retrospective study included 327 patients diagnosed with prostate cancer from September 2016 to June 2018; images from 228 patients were used for automatic segmentation construction, and images from the remaining 99 were used for testing. First, four radiologists with varying experience levels retrospectively segmented 99 axial prostate images manually using T2-weighted fat-suppressed magnetic resonance imaging. Automatic segmentation was performed after 2 weeks. The Pyradiomics software package v3.1.0 was used to extract the texture features. The Dice coefficient and intraclass correlation coefficient (ICC) were used to evaluate segmentation performance and the interobserver consistency of prostate radiomics. The Wilcoxon rank sum test was used to compare the paired samples, with the significance level set at p < 0.05. The Dice coefficient was used to accurately measure the spatial overlap of manually delineated images. In all the 99 prostate segmentation result columns, the manual and automatic segmentation results of the senior group were significantly better than those of the junior group (p < 0.05). Automatic segmentation was more consistent than manual segmentation (p < 0.05), and the average ICC reached >0.85. The automatic segmentation annotation performance of junior radiologists was similar to that of senior radiologists performing manual segmentation. The ICC of radiomics features increased to excellent consistency (0.925 [0.888~0.950]). Automatic segmentation annotation provided better results than manual segmentation by radiologists. Our findings indicate that automatic segmentation annotation helps reduce variability in the perception and interpretation between radiologists with different experience levels and ensures the stability of radiomics features.

Abstract Background Magnetic Resonance Imaging (MRI) is an important tool in preoperative evaluation of patients with lumbar spinal stenosis (LSS). Reported reliability of various MRI findings in LSS varies from fair to excellent. There are inconsistencies in the evaluated parameters and the methodology of the studies. The purpose of this study was to evaluate the reliability of the preoperative MRI findings in patients with LSS between musculoskeletal radiologists and orthopaedic spine surgeons, using established evaluation methods and imaging data from a prospective trial. Methods Consecutive lumbar MRI examinations of candidates for surgical treatment of LSS from the Norwegian Spinal Stenosis and Degenerative Spondylolisthesis (NORDSTEN) study were independently evaluated by two musculoskeletal radiologists and two orthopaedic spine surgeons. The observers had a range of experience between six and 13 years and rated five categorical parameters (foraminal and central canal stenosis, facet joint osteoarthritis, redundant nerve roots and intraspinal synovial cysts) and one continuous parameter (dural sac cross-sectional area). All parameters were re-rated after 6 weeks by all the observers. Inter- and intraobserver agreement was assessed by Gwet’s agreement coefficient (AC1) for categorical parameters and Intraclass Correlation Coefficient (ICC) for the dural sac cross-sectional area. Results MRI examinations of 102 patients (mean age 66 ± 8 years, 53 men) were evaluated. The overall interobserver agreement was substantial or almost perfect for all categorical parameters (AC1 range 0.67 to 0.98), except for facet joint osteoarthritis, where the agreement was moderate (AC1 0.39). For the dural sac cross-sectional area, the overall interobserver agreement was good or excellent (ICC range 0.86 to 0.96). The intraobserver agreement was substantial or almost perfect/ excellent for all parameters (AC1 range 0.63 to 1.0 and ICC range 0.93 to 1.0). Conclusions There is high inter- and intraobserver agreement between radiologists and spine surgeons for preoperative MRI findings of LSS. However, the interobserver agreement is not optimal for evaluation of facet joint osteoarthritis. Trial registration www.ClinicalTrials.gov identifier: NCT02007083 , registered December 2013.

Context: The Indian Academy of Cytologists published Guidelines and categories for Reporting Serous Effusions (IACGRSE) in 2020 to improve consistency and reproducibility of fluid cytology reporting and to guide patient management. Aims: To evaluate category-wise agreement while using IACGRSE 2020 categories. To analyze interobserver agreement among participants with different level of training and years of experience. Settings and Design: A retrospective interobserver variability study. Methods and Material: Study was done with four participants: an expert cytopathologist and three cytopathology fellows with varying experience. Fluid smears from 60 cases with clinical and/or radiological evidence of malignancy were categorized into one of the five IACGRSE 2020 categories. The interpretations of expert cytopathologist were taken as standard. Statistical Analysis Used: Interobserver agreement was analyzed using Kappa statistics. Results: Previous cases without definitive category got classified into “Atypical cells NOS” (3.33%) and “Atypical cells, Suspicious of Malignancy” (15%). Agreement analysis for IACGRSE 2020 categories showed better concordance for inadequate (I), malignant (V), and benign (II) categories. The range of Kappa for interobserver agreement of fellows was fair to substantial (range 0.1692–0.7249). The participant with substantial diagnostic agreement with expert (κ = 0.729, 88.3%) had the most experience. Causes of major discordance were pertaining to paucity and distribution of cells, and to misinterpretation of reactive mesothelial cells. Conclusions: IACGRSE 2020 categories and participants' experience were important determinants in classifying the effusion fluid cytology smears and interobserver agreement; emphasizing the need to use IACGRSE2020, and sufficient time and training required for accurate diagnosis of fluid specimens.

Introduction: A wide range of descriptive terms have been used for dermoscopic findings in intraepidermal carcinoma (IEC) and the clinical diagnostic accuracy of IEC can be challenging. Furthermore, dermoscopic findings in IEC have only rarely been evaluated in fair-skinned populations. Objectives: To measure the interobserver agreement between dermatologists for dermoscopic findings in IEC. Furthermore, to describe the frequency of these findings in a predominantly fair-skinned population. Methods: One hundred dermoscopic images of histopathologically verified IECs were collected. The 11 most common dermoscopic findings described in previous studies were re-defined in a new terminology in a pre-study consensus meeting. Images were assessed by eight experienced international dermoscopists. The frequency of findings and the interobserver agreement was analyzed. Results: Scales (83%), dotted/glomerular vessels (77%), pinkish-white areas (73%) and hemorrhage (46%) were the most commonly present dermoscopic findings. Pigmented structures were found in 32% and shiny white structures (follicular or stromal) in 54% of the IEC. Vascular structures (vessels and/or hemorrhage) could be seen in 89% of the lesions. Overall, the interobserver agreement for the respective dermoscopic findings was poor to moderate, with the highest kappa values noted for scales (0.55) and hemorrhage (0.54) and the lowest for pinkish-white areas (0.015). Conclusion: Our results confirm those of previous studies on dermoscopy in IEC, including the frequency of pigmented structures despite the fair-skinned population. The interobserver agreement was relatively low. The proposed new terminology and our findings can hopefully serve as a guideline for researchers, teachers and students on how to identify IEC.

Objective Despite its routine use in intrapartum care, the technique of fetal cardiotocography has some limitations. The aim of this study is to analyze the predictive capacity and interobserver agreement in the latest versions of four international cardiotocography guidelines: Federation of Gynecology and Obstetrics (FIGO), American College of Obstetrics and Gynecology (ACOG), the National Institute for Health and Care Excellence (NICE) and Chandraharan, used to predict neonatal acidemia. Study design The last 30 min of 150 cardiotocographic records were analyzed over all the pH ranges and were blindly evaluated by three independent reviewers. The sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve (AUC) were calculated to assess the predictive capacity of each fetal cardiotocographic guideline. The degree of interobserver agreement was evaluated with the Fleiss Kappa coefficient. Results Observers found fetal cardiotocography guidelines to have a variable sensitivity and specificity. The Chandraharan classification reached the highest sensitivity (78.79%), while ACOG had the highest specificity (95.73%). On average for the three observers, Chandraharan had the highest discrimination capacity for neonatal acidemia, although this was only moderate (AUC 0.66; 95%CI, 0.55–0.77) and did not differ significantly from the remaining guidelines. The degree of agreement among the three observers, assessed according to the Fleiss Kappa coefficient, was generally acceptable or moderate for all items and classifications, being highest with the FIGO classification (ĸ = 0.35; 95%CI, 0.28–0.41) and lowest with the ACOG (ĸ = 0.23; 95%CI, 0.16–0.30). Conclusion Although all the guidelines have a moderate capacity to predict neonatal acidemia, the Chandraharan guideline has the highest capacity. This follows a different approach from the others in that it relies on interpretations of cardiotocographic traces based on fetal physiology. The degree of interobserver agreement is, in general, acceptable for the four guidelines, and is the highest for FIGO. [ABSTRACT FROM AUTHOR]

Background: High‐risk human papilloma virus (HR HPV) testing and liquid‐based cytology are used for primary cervical screening. Digital cytology, based on whole‐slide scanned samples, is a promising technique for teaching and diagnostic purposes. The aim of our study was to evaluate the interobserver and intraobserver variation in low‐grade squamous lesions, HR HPV status bias, and the use of whole‐slide scanned digital cervical cytology slides. Methods: Fifteen expert cytopathologists evaluated 71 digitalized ThinPrep slides (31 atypical squamous cells of undetermined significance [ASC‐US], 21 negative for intraepithelial lesion or malignancy, and 19 low‐grade squamous intraepithelial lesion cases). HR HPV data were accessible only in the second round. Results: In interobserver analysis, Kendall's coefficient of concordance was 0.52 in the first round and 0.58 in the second round. Fleiss' kappa values were 0.29 in the first round and 0.31 in the second round. In the ASC‐US category, Fleiss kappa increased from 0.19 to 0.22 in the second round and the increase was even higher expressed by Kendall's coefficient: from 0.42 to 0.52. In intraobserver analysis, personal scores were higher in the second round. Conclusions: The interobserver and intraobserver variability in low‐grade squamous lesions was within fair agreement values in the present study, in line with previous works. The comparison of two rounds showed that expert cytopathologists are generally unbiased by the knowledge of HR HPV data, but that being informed of the HR HPV status leads to a better agreement. Stain quality and back discomfort were highlighted as factors affecting digital cytopathology use. The interobserver and intraobserver variability in low‐grade squamous lesions was within fair agreement values and knowing high‐risk human papillomavirus status leads to better agreement. Stain quality and back discomfort were highlighted as factors affecting digital cytopathology use. [ABSTRACT FROM AUTHOR]

Background: Studies systematically documenting US findings in children with acute pancreatitis are limited. Pancreas duct dilation is described as the most reliable finding of acute pancreatitis but this has not been rigorously examined in children. Objective: To systematically document US findings in children with acute pancreatitis and to define interobserver agreement on those findings. Materials and methods: In this cross-sectional study we retrospectively reviewed images for all pediatric patients <18 years of age who had been prospectively enrolled in a registry of patients with index admissions for acute pancreatitis between March 2013 and July 2020. Two blinded observers (R1, R2) reviewed the first transabdominal US examination performed within 2 weeks of the pancreatitis attack for each patient. Results: In 141 children, US was performed at a median of 1 day (interquartile range [IQR]: 0, 1) following acute attack. Thirty-three (23%, R1) and 38 (27%, R2) children had no abnormal findings on US. Peripancreatic edema was the most frequent finding documented by both reviewers (63% R1, 54% R2). The pancreatic duct was visible in only 35% of the children and was dilated in only 12% (R1) and 14% (R2). There was substantial to almost-perfect agreement between reviewers on findings of acute pancreatitis (κ=0.62–1), including duct visibility. Conclusion: Peripancreatic edema was the most frequently identified finding in children with acute pancreatitis, present in up to 63%, with almost perfect interobserver agreement. Duct dilation, cited in the literature as a reliable finding of acute pancreatitis, was rarely identified in our sample. [ABSTRACT FROM AUTHOR]

The 3-category rating of volar plate prominence in relation to the most volar edge of the distal radius (the watershed line) on lateral radiographs was reliable among a small group of surgeons and associated with the probability of flexor tendon irritation and potential rupture. Classifications are often less reliable when tested among a large group of practicing surgeons in different environments. In this survey-based experiment, an international group of 115 fracture and upper extremity surgeons viewed 1 of 4 sets of 24 lateral radiographs (96 unique lateral radiographs) of patients with distal radius fractures who underwent volar plating in the practice of a single surgeon using 2 types of plates. Surgeons were asked to rate the following metrics: (1) the grade of plate prominence according to Soong, (2) whether the plate was more prominent than the watershed line, (3) whether the plate was separate from the bone distally, and (4) whether there is more than 5° of dorsal angulation of the distal radius articular surface. The interobserver agreement of the classification was "fair" (κ = 0.32; 95% confidence interval [CI] = 0.27–0.36), and grading was more reliable among surgeons who do not supervise trainees. Volar prominence was less reliable (κ = 0.034; 95% CI = 0.013–0.055) than plate separation from bone (κ = 0.50; 95% CI = 0.42–0.59) and more than 5° of dorsal angulation (κ = 0.42; 95% CI = 0.35–0.48). Among a large number of international practicing surgeons, the classification of volar plate prominence in 3 categories was fair. The diagnosis of plate prominence might develop toward criteria with moderate reliability, such as separation of the plate from the bone and residual angulation of the distal radius. [ABSTRACT FROM AUTHOR]

Objectives: To assess intra‐ and inter‐institutional concordance and identify methods to increase precision in radiologic extranodal extension (rENE) ascertainment in HPV+ oropharyngeal carcinoma. Methods: Six radiologists, blinded to clinical outcomes, from three centers assessed rENE in two phases: Phase‐I (20 cases) utilized each individual's a priori appreciation of the literature. Phase‐II (30 additional cases) was performed after deliberating experience and consolidating operating definitions. Intra‐ and inter‐institutional Kappa were calculated at >50% and >75% certainty levels, respectively. Results: The Phase‐I intra‐institutional kappa was 0.76, 0.32, and 0.44 at >50% certainty and improved to 0.89, 0.61, and 0.66 at >75% certainty. Inter‐institutional Fleiss' kappa also improved with higher certainty (from 0.40 to 0.57, p = 0.039). The Phase‐II inter‐rater kappa was significantly higher than Phase‐I at the same certainty level (both p < 0.001). Conclusion: A learning curve exists for rENE assessment. Strategies to augment reliability include high certainty for declaration, consolidated operating definitions, and sharing experience among radiologists. [ABSTRACT FROM AUTHOR]

Objective: To study the interobserver agreement for diagnosing Helicobacter pylori gastritis using narrow band imaging (NBI) with magnification., Methods: This prospective study recruited patients who underwent gastroscopy for dyspepsia in the Department of Gastroenterology, Aster MIMS Hospital, Kannur.361 patients were included in the study. The gastroscopy was performed using high-definition white light endoscopy (WLE) and NBI with magnification. Histopathology and rapid urease test were used to detect HP infection. Endoscopy videos were analyzed by three trained endoscopists who were blinded to each other. NBI patterns were classified into four types (Types 1, 2A, 2B, and 3). Interobserver variability was examined using Kappa Statistics., Results: 164 of 361 patients had HP infection (45.42%). Of 361 people, 199 had Type 1 (55.12%), 54 Type 2a (14.95%), 65 Type 2b (18%), and 43 Type 3 cases (11.91%). There was good interobserver agreement with a kappa value of 0.730 (95% confidence interval (CI) 0.693-0.768). 87% of HP-negative patients had Type 1 NBI pattern. 79.5% of type 2A and 89.2% of Type 2b pattern were HP positive. The Type 1 pattern identified normal gastric mucosa with 84.75% sensitivity, 88.32% specificity and 87.4% negative predictive value. Type 2 and Type 3 NBI patterns had high positive predictive value and specificity for HP infection., Conclusions: This study demonstrates excellent interobserver agreement among experienced endoscopists in using NBI to identify gastric mucosal patterns associated with HP infection. While biopsies remain essential for comprehensive evaluation of gastric pathologies, our findings suggest that NBI, with appropriate training and validation, may have the potential to reduce the need for biopsies in specific cases where the primary concern is HP infection. The good level of interobserver agreement seen in our study is encouraging and suggests that NBI has the potential to be a reliable tool for diagnosing HP infection., Competing Interests: The authors declare no conflicts of interest., (© 2024 The Author(s). JGH Open published by Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.)

Introduction: Audits for monitoring the quality of antimicrobial prescribing are a main tool in antimicrobial stewardship programs; however, interobserver reliability has not been conclusively assessed. Our objective was to measure the level of agreement between pharmacists and physicians on the appropriateness of antimicrobials prescribing in hospitals., Methods: A national multicenter, cross-sectional study was conducted of patients who were receiving antimicrobials one day of April 2021. Hospital participation was voluntary, and the study population was randomly selected. Pharmacists and physicians performed a simultaneous, independent assessment of the quality of antimicrobial prescriptions. The observers used an assessment method by which all indicators of the quality of antimicrobial use were considered. Finally, an algorithm was used to rate overall antimicrobial prescribing as appropriate, suboptimal, inappropriate, or not assessable. Gwet's AC1 coefficient was used to assess interobserver agreement., Results: In total, 101 hospitals participated, and 411 hospital antimicrobial prescriptions were reviewed. The strength of agreement was moderate regarding the overall quality of prescribing (AC1=0.51; 95%CI=[0.44-0.58]). A very good level of agreement (AC1>0.80) was observed between pharmacists and physicians in all indicators of the quality, except for duration of treatment, rated as good (AC1=0.79; 95%CI=[0.75-0.83]), and registration on the medical record, rated as fair (AC1=0.34; 95%CI=[0.26-0.43]). The agreement was greater in critical care, onco-hematology, and pediatric units than in medical and surgery units., Conclusions: In this point prevalence study, a moderate level of agreement was observed between pharmacists and physicians in the evaluation of the appropriateness of antimicrobials prescribing in hospitals., (Copyright © 2023 Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. Published by Elsevier España, S.L.U. All rights reserved.)

ST analysis during labour requires the classification of CTG traces in order to help clinical decisions. The usual STAN classification is based on the FIGO 1987 classification, modified in 2007. New STAN guidelines adapted to physiology-based interpretation have been proposed in 2022. This study compares the interobserver agreement of CTG classification and clinical decisions making, and the ease of use following the 2022 and 2007 STAN guidelines., Material and Methods: Thirty CTG traces from STAN monitors were selected from a local French database and analysed (CTG classification, clinical decision making) by six observers with different levels of experience in two sessions three months apart. Observers followed the STAN2007 and the STAN2022 guidelines in the first and in the second sessions respectively. Weighted kappa (primary outcome), proportion of complete agreement within the 6 observers, and percent agreement (secondary outcomes) were estimated. At the end of the second session observers rated their satisfaction, ease of use and which guidelines they preferred., Results: The interobserver agreement for CTG classification were comparable when following STAN2007 and STAN2022 guidelines (weighted kappa 0.57 versus 0.58, P = 0.91, moderate agreement), but a higher proportion of complete agreement within the 6 observers and a higher percent agreement were obtained when following STAN2022 compared to STAN2007 guidelines (complete agreement 50 % versus 20 % respectively, P = 0.01; percentage of agreement 72 % vs 55 %, P = 0.006). Interobserver agreement for clinical decisions did not differ when following STAN2007 or STAN2022 guidelines. Satisfaction scores were higher with STAN2022 guidelines, but not significantly (P = 0.052). All 6 observers stated that they preferred to use the STAN2022 guidelines., Conclusion: Interobserver agreement is comparable between STAN2022 and STAN2007 for CTG classification in labour and clinical decision making. However, complete agreement and percent agreement are in favour of STAN 2022 for CTG classification., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to declare., (Copyright © 2024 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.)

Objectives: To evaluate the interobserver agreement and diagnostic accuracy of ovarian-adnexal reporting and data system magnetic resonance imaging (O-RADS MRI) and applicability to machine learning., Material and Methods: Dynamic contrast-enhanced pelvic MRI examinations 471 lesions were retrospectively analyzed and assessed by three radiologists according to O-RADS MRI criteria. Radiomic data were extracted from T2, and post-contrast fat-suppressed T1-weighted images. Using these data, an artificial neural network (ANN), support vector machine, random forest, and naive Bayes models were constructed., Results: Among all readers, the lowest agreement was found for the O-RADS 4 group (kappa: 0.669 (95% confidence interval [CI] 0.634-0.733)), followed by the O-RADS 5 group (kappa: 0.709 (95% CI 0.678-0.754)). O-RADS 4 predicted a malignancy with an area under the curve (AUC) value of 74.3% (95% CI 0.701-0.782), and O-RADS 5 with an AUC of 95.5% (95% CI 0.932-0.972),(p < 0.001). Among the machine learning models, ANN achieved the highest success, distinguishing O-RADS groups with an AUC of 0.948, a precision of 0.861, and a recall of 0.824., Conclusion: The interobserver agreement and diagnostic sensitivity of the O-RADS MRI in assigning O-RADS 4-5 were not perfect, indicating a need for structural improvement. Integrating artificial intelligence into MRI protocols may enhance their performance., Advances in Knowledge: Machine learning can achieve high accuracy in the correct classification of O-RADS MRI. Malignancy prediction rates were 74% for O-RADS 4 and 95% for O-RADS 5., (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Institute of Radiology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Purpose: The present computerized techniques have limits to estimate the ischemic lesion volume especially in vertebrobasilar ischemia (VBI) automatically. We investigated the ability of the RAPID AI (RAPID) software on diffusion-weighted imaging (DWI) to estimate the infarct size in VBI in comparison to supratentorial ischemia (STI). Methods: Among 123 stroke patients (39 women, 84 men, mean age 66 ± 11 years) having undergone DWI, 41 had had a VBI and 82 a STI. The infarct volume calculation by RAPID was compared to volume calculations by 2 neurologists using the ABC/2 method. For inter-reader and between-method analysis intraclass correlation coefficient (ICC), area under the curve (AUC) estimations, and Bland–Altman plots were used. Results: ICC between the two neurologists and each neurologist and RAPID were >0.946 (largest 95% CI boundaries 0.917–0.988) in the STI group, and > 0.757 (95% CI boundaries between 0.544 and 0.982) in the VBI group. In the STI group, AUC values ranged between 0.982 and 0.999 (95% CI 0.971–1) between the 2 neurologists and between 0.875 and 1 (95% CI 0.787–1) between the neurologists and RAPID; in the VBI group, they ranged between 0.925 and 0.965 (95% CI 0.801–1) between the neurologists, and between 0.788 and 0.931 (95% CI 0.663–1) between RAPID and the neurologists. Compared to the visual DWI interpretation by the neurologists, RAPID did not recognize a substantial number of infarct volumes of ≤ 2 ml. Conclusion: The ability of the RAPID software to depict strokes in the vertebrobasilar artery system seems close to its ability in the supratentorial brain tissue. However, small lesion volumes ≤ 2 ml remain still undetected in both brain areas. [ABSTRACT FROM AUTHOR]

Context: The Indian Academy of Cytologists published Guidelines and categories for Reporting Serous Effusions (IACGRSE) in 2020 to improve consistency and reproducibility of fluid cytology reporting and to guide patient management. Aims: To evaluate category-wise agreement while using IACGRSE 2020 categories. To analyze interobserver agreement among participants with different level of training and years of experience. Settings and Design: A retrospective interobserver variability study. Methods and Material: Study was done with four participants: an expert cytopathologist and three cytopathology fellows with varying experience. Fluid smears from 60 cases with clinical and/or radiological evidence of malignancy were categorized into one of the five IACGRSE 2020 categories. The interpretations of expert cytopathologist were taken as standard. Statistical Analysis Used: Interobserver agreement was analyzed using Kappa statistics. Results: Previous cases without definitive category got classified into "Atypical cells NOS" (3.33%) and "Atypical cells, Suspicious of Malignancy" (15%). Agreement analysis for IACGRSE 2020 categories showed better concordance for inadequate (I), malignant (V), and benign (II) categories. The range of Kappa for interobserver agreement of fellows was fair to substantial (range 0.1692--0.7249). The participant with substantial diagnostic agreement with expert ( = 0.729, 88.3%) had the most experience. Causes of major discordance were pertaining to paucity and distribution of cells, and to misinterpretation of reactive mesothelial cells. Conclusions: IACGRSE 2020 categories and participants' experience were important determinants in classifying the effusion fluid cytology smears and interobserver agreement; emphasizing the need to use IACGRSE2020, and sufficient time and training required for accurate diagnosis of fluid specimens. [ABSTRACT FROM AUTHOR]

Objective: Histopathological examination of the liver is the gold standard in the follow-up and treatment of chronic hepatit B vius (HBV) disease. Ishak's Modified histological activity index (HAI) and fibrosis staging system are usually used in Turkey. Although a common scoring system is used, the same sample can be interpreted differently between different pathologists due to various variables. In this study, the evaluation of liver histopathologies of chronic HBV patients by pathologists in different hospitals and the correlation of the results with each other and the effect on the treatment decision were investigated. Methods: Pathology slides of liver biopsy materials of 10 patients were evaluated by pathologists in 5 different tertiary care hospitals. Using non-parametric statistical methods, the coefficient of agreement between pathologists was determined. Also, descriptive statistics were used to determine the percentage of receiving treatment. Results: Agreement between pathologists was calculated the most in total HAI and Fibrosis score (k=0.8186, k=0.8217). The Kuder-Richardson reliability coefficient among centres was found to be high in the treatment decision (k=0.8207). Although all patients were indicated for treatment according to The European Association for the Study of the Liver 2017 guideline, it was calculated that an average of 58% of the patients could receive treatment according to liver histopathology. Conclusion: Differences in the pathological diagnosis between pathologists in centres may cause delays in chronic hepatitis B patients' access to treatment. [ABSTRACT FROM AUTHOR]

To validate a vascular severity score as an appropriate output for artificial intelligence (AI) Software as a Medical Device (SaMD) for retinopathy of prematurity (ROP) through comparison with ordinal disease severity labels for stage and plus disease assigned by the International Classification of Retinopathy of Prematurity, Third Edition (ICROP3), committee. Validation study of an AI-based ROP vascular severity score. A total of 34 ROP experts from the ICROP3 committee. Two separate datasets of 30 fundus photographs each for stage (0–5) and plus disease (plus, preplus, neither) were labeled by members of the ICROP3 committee using an open-source platform. Averaging these results produced a continuous label for plus (1–9) and stage (1–3) for each image. Experts were also asked to compare each image to each other in terms of relative severity for plus disease. Each image was also labeled with a vascular severity score from the Imaging and Informatics in ROP deep learning system, which was compared with each grader's diagnostic labels for correlation, as well as the ophthalmoscopic diagnosis of stage. Weighted kappa and Pearson correlation coefficients (CCs) were calculated between each pair of grader classification labels for stage and plus disease. The Elo algorithm was also used to convert pairwise comparisons for each expert into an ordered set of images from least to most severe. The mean weighted kappa and CC for all interobserver pairs for plus disease image comparison were 0.67 and 0.88, respectively. The vascular severity score was found to be highly correlated with both the average plus disease classification (CC = 0.90, P < 0.001) and the ophthalmoscopic diagnosis of stage (P < 0.001 by analysis of variance) among all experts. The ROP vascular severity score correlates well with the International Classification of Retinopathy of Prematurity committee member's labels for plus disease and stage, which had significant intergrader variability. Generation of a consensus for a validated scoring system for ROP SaMD can facilitate global innovation and regulatory authorization of these technologies. [ABSTRACT FROM AUTHOR]

Research on host response to infectious disease often involves pharmacological induction of immunosuppression, frequently through administration of dexamethasone. Reports on the effect of dexamethasone in birds are largely restricted to poultry and pigeons. This study describes changes in white blood cell (WBC) differentials, hemoparasite counts, splenic histology, and splenic CD3 immunoreactivity in House Finches (Haemorhous mexicanus). Experimental group birds (n=9) were treated with a daily intramuscular injection of 25 µg of dexamethasone for 8 d; a control group (n=9) received daily saline solution. Smears were made with blood collected immediately before the first dose (day 0) and on d 4, 8, and 9, and stained with modified Wright. The WBC differential counts were performed by three blinded observers, parasite counts by two blinded observers, and histology by one blinded observer. Dexamethasone-treated birds experienced relative heterophilia and lymphopenia on d 4 (P=0.008); heterophilia was also present at d 8 (P=0.018). Hemosporidian counts were significantly increased in dexamethasone-treated birds on d 4 and 8 (P=0.048 and P=0.031, respectively). In contrast with control birds, all dexamethasone-treated birds lacked histologically apparent splenic lymphoid follicles (P<0.001). No significant difference was observed in splenic CD3 immunoreactivity between groups. Our results indicate that dexamethasone has an effect on the hematologic profile of House Finches and suggest that it may be a useful method to induce immunosuppression in this species. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of the study was to determine interobserver and intraobserver agreement, repeatability, and intrasubject variation of the detection of Demodex infestation in eyelids of blepharitis patients using in vivo confocal microscopy (IVCM). Methods: Eighty-three eyes of 42 blepharitis patients were included in the study. All eyelids were evaluated from temporal to nasal with IVCM using section mode and 10 lashes with their follicles were imagined, and every image with suspicion of Demodex infestation was recorded. Two experienced and two inexperienced ophthalmologists were masked for the diagnosis and interpreted the IVCM images regarding the presence of Demodex infestation with a 3-week interval. Inter- observer and intraobserver agreements were calculated with Cohen's kappa and its variant statistics between and within experienced observers and between inexperienced observers. Results: While average sensitivity for the diagnosis of demodicosis in IVCM images was 83.35% for experienced and 51.35% for inexperienced observers, the average positive predictive value was 88.6% for experienced observers and 91.05% for inexperienced ones. Interobserver agreement between experienced observers was moderate (K = 0.529) and intraobserver agreements within experienced observers were perfect (K = 0.918 for observer-1; K = 0.958 for observer-2). Interobserver agreement between inexperienced observers was poor (K = 0.162) and intraobserver agreements within inexperienced observers were fair (K = 0.427 for observer-3; K = 0.475 for observer-4). Conclusion: The sensitivity, interobserver and intraobserver agreements in IVCM image analysis for the detection of Demodex infestation were highly associated with the clinical experience on IVCM imaging. In the hands of an experienced clinician, IVCM could be reliable for the diagnosis of ocular demodicosis. [ABSTRACT FROM AUTHOR]

ObjectiveThe purpose of this study is to explore the diagnostic performance of two investigational quantitative ultrasound (QUS) parameters, attenuation coefficient and backscatter coefficient, in comparison with conventional ultrasound (CUS) and MRI-estimated proton density fat fraction (PDFF) for predicting histology-confirmed steatosis grade in adults with nonalcoholic fatty liver disease (NAFLD).Subjects and methodsIn this prospectively designed pilot study, 61 adults with histology-confirmed NAFLD were enrolled from September 2012 to February 2014. Subjects underwent QUS, CUS, and MRI examinations within 100 days of clinical-care liver biopsy. QUS parameters (attenuation coefficient and backscatter coefficient) were estimated using a reference phantom technique by two analysts independently. Three-point ordinal CUS scores intended to predict steatosis grade (1, 2, or 3) were generated independently by two radiologists on the basis of QUS features. PDFF was estimated using an advanced chemical shift-based MRI technique. Using histologic examination as the reference standard, ROC analysis was performed. Optimal attenuation coefficient, backscatter coefficient, and PDFF cutoff thresholds were identified, and the accuracy of attenuation coefficient, backscatter coefficient, PDFF, and CUS to predict steatosis grade was determined. Interobserver agreement for attenuation coefficient, backscatter coefficient, and CUS was analyzed.ResultsCUS had 51.7% grading accuracy. The raw and cross-validated steatosis grading accuracies were 61.7% and 55.0%, respectively, for attenuation coefficient, 68.3% and 68.3% for backscatter coefficient, and 76.7% and 71.3% for MRI-estimated PDFF. Interobserver agreements were 53.3% for CUS (κ = 0.61), 90.0% for attenuation coefficient (κ = 0.87), and 71.7% for backscatter coefficient (κ = 0.82) (p < 0.0001 for all).ConclusionPreliminary observations suggest that QUS parameters may be more accurate and provide higher interobserver agreement than CUS for predicting hepatic steatosis grade in patients with NAFLD.

PurposeThe present computerized techniques have limits to estimate the ischemic lesion volume especially in vertebrobasilar ischemia (VBI) automatically. We investigated the ability of the RAPID AI (RAPID) software on diffusion-weighted imaging (DWI) to estimate the infarct size in VBI in comparison to supratentorial ischemia (STI).MethodsAmong 123 stroke patients (39 women, 84 men, mean age 66 ± 11 years) having undergone DWI, 41 had had a VBI and 82 a STI. The infarct volume calculation by RAPID was compared to volume calculations by 2 neurologists using the ABC/2 method. For inter-reader and between-method analysis intraclass correlation coefficient (ICC), area under the curve (AUC) estimations, and Bland–Altman plots were used.ResultsICC between the two neurologists and each neurologist and RAPID were >0.946 (largest 95% CI boundaries 0.917–0.988) in the STI group, and > 0.757 (95% CI boundaries between 0.544 and 0.982) in the VBI group. In the STI group, AUC values ranged between 0.982 and 0.999 (95% CI 0.971–1) between the 2 neurologists and between 0.875 and 1 (95% CI 0.787–1) between the neurologists and RAPID; in the VBI group, they ranged between 0.925 and 0.965 (95% CI 0.801–1) between the neurologists, and between 0.788 and 0.931 (95% CI 0.663–1) between RAPID and the neurologists. Compared to the visual DWI interpretation by the neurologists, RAPID did not recognize a substantial number of infarct volumes of ≤ 2 ml.ConclusionThe ability of the RAPID software to depict strokes in the vertebrobasilar artery system seems close to its ability in the supratentorial brain tissue. However, small lesion volumes ≤ 2 ml remain still undetected in both brain areas.

Iliya P Amaza,1 Amy MJ O’Shea,2,3 Spyridon Fortis,1,3 Alejandro P Comellas1 1University of Iowa, Roy J. and Lucille A. Carver College of Medicine, Department of Internal Medicine, Division of Pulmonary, Critical Care, and Occupational Medicine, Iowa City, IA, USA; 2University of Iowa, Roy J. and Lucille A. Carver College of Medicine, Department of Internal Medicine, Division of General Internal Medicine, Iowa City, IA, USA; 3Iowa City VA Health Care System, Center for Access & Delivery Research and Evaluation, Iowa City, IA, USACorrespondence: Alejandro P ComellasRoy J. and Lucille A. Carver College of Medicine, Department of Internal Medicine, Division of Pulmonary, Critical Care, and Occupational Medicine, 200 Hawkins Dr, W219B GH, Iowa City, Iowa City, 52242, USATel +1 319 384 6484Fax +1 319 353 6406Email alejandro-comellas@uiowa.eduPurpose: Visual assessment of computed tomography (CT) of the lung is routinely employed in the diagnosis of emphysema. Quantitative CT (QCT) can complement visual CT but must be well validated. QCT emphysema is defined as ≥ 5% of lung volume occupied by low attenuation areas ≤− 950 Hounsfield units (LAA-950). Discordant visual and QCT assessments are not uncommon. We examined the association between visual and quantitative chest CT evaluation within a large cohort of subjects to identify variables that may explain discordant visual and QCT findings.Materials and Methods: Volumetric inspiratory CT scans of 1221 subjects enrolled in phase 1 of the COPDGene study conducted at the University of Iowa were reviewed. Participants included never smokers, smokers with normal spirometry, preserved ratio impaired spirometry, and Global Initiative for Obstructive Lung Disease (GOLD) stages I–IV. CT scans were quantitatively scored and visually interpreted by both the COPDGene Imaging Center and the University of Iowa radiologists. Individual-level visual assessments were compared with QCT measurements. Agreement between the two sets of radiologists was calculated using kappa statistic. We assessed variables associated with discordant results using regression methods.Results: There was a fair agreement for the presence or absence of emphysema between our center’s radiologists and QCT (61% concordance, kappa 0.22 [0.17– 0.28]). Similar comparisons showed a slight agreement between the COPDGene Imaging Center and QCT (56% concordance, kappa 0.16 [0.11– 0.21]), and a moderate agreement between both sets of visual assessments (80% concordance, kappa 0.60 [0.54– 0.65]). Current smoking and female gender were significantly associated with QCT-negative but visually detectable emphysema.Conclusion: The slight-to-fair agreement between visual and quantitative CT assessment of emphysema highlights the need to utilize both modalities for a comprehensive radiologic evaluation. Discordant results may be attributable to one or more factors that warrant further exploration in larger studies.Clinical Trial Registration: ClinicalTrials.gov Identifier NCT000608764.Keywords: chest imaging, chronic obstructive pulmonary disease, interobserver agreement, Akaike information criterion

The role of endoscopic evaluation in ulcerative colitis (UC) is well recognized, but a universally accepted gold standard for endoscopic activity evaluation is still lacking, and many scores have been proposed to this purpose. Among these, the Mayo Endoscopic Score (MES) and the Ulcerative Colitis Endoscopic Index (UCEIS) are currently the most used in trials and clinical practice. The aim of the study is to evaluate feasibility and performance of MES and UCEIS among expert endoscopists with no specific expertise in inflammatory bowel diseases (IBD), in a single hospital center. Two minutes video recordings, from colonoscopy of 12 UC patients, were observed and scored, according to MES and UCEIS, by seven hospital gastroenterologists with experience in digestive endoscopy and no particular expertise in IBD. Knowledge and utilization of the two scores were investigated. Inter-observer agreement and agreement with an IBD-expert gastroenterologist of the same center (central reader), and correlation between the two scores, was calculated. Among the endoscopists, MES was much more known and currently used than UCEIS. Both the scores displayed a similar good performance. Agreement with central reader was moderate for MES and UCEIS, and interobserver agreement was good, for both MES and UCEIS. Correlation between the two scores was very good both for central reader and for the hospital endoscopists. This single center study confirmed potential feasibility and usefulness of MES and UCEIS for assessment of endoscopic activity in UC patients in a real-life setting.

The extent of gastric intestinal metaplasia (GIM) can be used to determine the risk of gastric cancer. Eleven international gastrointestinal expert pathologists estimated the extent of GIM on haematoxylin and eosin (H&E)- and Alcian blue-Periodic acid Schiff (AB-PAS)-stained slides of 46 antrum biopsies in 5% increments. Interobserver agreement was tested with the intraclass correlation coefficient (ICC). Correlation between standard deviation and extent of GIM was evaluated with the Spearman correlation. The interobserver agreement was very good (ICC = 0.983, 95% confidence interval (CI) 0.975–0.990). The use of AB-PAS did not increase the agreement (ICC = 0.975, 95% CI 0.961–0.985). Cases with a higher amount of metaplastic epithelium demonstrated a higher standard deviation (rs = 0.644; p < 0.01), suggesting lower diagnostic accuracy in cases with extensive GIM. In conclusion, estimating the extent of GIM on H&E-stained slides in patients with chronic atrophic gastritis can be achieved satisfactorily with high interobserver agreement, at least among international expert gastrointestinal pathologists. [ABSTRACT FROM AUTHOR]

Background: Shoulder impingement syndrome is the painful entrapment of the soft tissues between the acromion and the humeral head. The severity of shoulder impingement could be graded according to the limitation of shoulder joint moment. The reliability of sonographic findings in the grading of shoulder impingement severity grading is required to be evaluated by the consistency of findings between the observers. Purpose: To assess the interobserver agreement in the sonographic severity grading of shoulder impingement syndrome with the help of a ratio between acromion-to-greater tuberosity distance in the abduction and neutral arm position. Material and methods: Patients were examined by two independent observers in the coronal approach with neutral arm position. Acromion-to-greater tuberosity distance was measured in abduction and neutral shoulder position. The ratios of the distances in the abduction and neutral position were calculated to grade the severity of shoulder impingement syndrome. Results: A total of 78 shoulders were included in this study. A strong agreement was found for the grading of shoulder impingement severity grading between the two independent observers with Kappa value of 0.94. And correlation between the results of the two observers for the severity grading of shoulder impingement syndrome was significant at 0.01 level. Conclusion: Severity grading of the shoulder impingement syndrome was performed based on the ratio of acromion-to-greater tuberosity distance in abduction and neutral arm position. However, the sonographic findings were consistent and a strong interobserver agreement was seen in this sonographic severity grading. [ABSTRACT FROM AUTHOR]

Purpose: Meniscal allograft transplantation (MAT) has shown good promise in restoring normal knee joint biomechanics in a meniscal deficient patient. However, MRI appearance of the meniscal allograft is often questioned and raises concerns of its viability and function. This paper aims to introduce and validate a new scoring system for MAT MRI appearance at 12 months [MRI appearance in Meniscal Transplant Score (MIMS)], using key changes such as extrusion, meniscal signal change, loss of shape, synovitis and bone marrow oedema. Methods: A retrospective analysis of 10 patients from a single surgeon series was conducted. All MAT were performed with soft tissue fixation technique. MRI was performed at 12 months post-transplant with two independent consultant musculoskeletal radiologists and one experienced meniscal transplant surgeon scoring the images obtained. Interobserver agreement and intraclass correlation were measured. Results: Interobserver agreement between examiners on individual features of the MIMS was superior for tibial bone oedema, substantial for meniscal extrusion and femoral bone oedema, moderate for meniscal shape and synovitis, and fair for meniscal signal changes. Absolute agreement between raters found good reliability (ICC = 0.774; 95% 0.359, 0.960) for single measures and excellent reliability (ICC = 0.911; 95% 0.627, 0.986) for average measures. Conclusion: MIMS is a reliable method of evaluating the meniscal allograft transplant 12 months post-transplant. Further research with larger MAT cohort groups and patient reported outcome measures may be helpful to correlate its clinical significance and guide further management. Level of evidence: Level III. [ABSTRACT FROM AUTHOR]

Interobserver agreement (IOA) is important for research and practice, and supports the consistency of behavioral data (Kahng et al., 2011). Although general parameters for how much IOA is needed have been suggested (Bailey & Burch, 2018), it is unknown if the total number of sessions with IOA might impact the IOA coefficient. In this study, IOA was reanalyzed using functional analysis data at various cutoffs. Obtained IOA from these analyses was then compared to the original IOA. Overall, results suggested that, at least when using highly trained observers in a structured clinical setting, there were no significant differences in IOA across cutoffs. However, IOA was sensitive to overall rate of responding in the functional analysis. These data are encouraging, particularly for practitioners, because they provide preliminary support that the amount of sessions with IOA may not be as important as the consistency of the data. [ABSTRACT FROM AUTHOR]

Differentiation between penile squamous cell carcinoma patients who can benefit from limited organ-sparing surgery and those at significant risk of lymph node metastasis is based on histopathological prognostic factors including histological grade and tumor histological subtype. We examined levels of interobserver and intraobserver agreement in assessment of histological subtype and grade in 207 patients with penile squamous cell carcinoma. The cases were assessed by seven pathologists from three hospitals located in Sweden and Italy. There was poor to moderate concordance in assessing both histological subtype and grade, with Fleiss kappas of 0.25 (range: 0.02–0.48) and 0.23 (range: 0.07–0.55), respectively. When choosing HPV-associated and non-HPV-associated subtypes, interobserver concordance ranged from poor to good, with a Fleiss kappa value of 0.36 (range: 0.02–0.79). A re-review of the slides by two of the pathologists showed very good intraobserver concordance in assessing histological grade and subtype, with Cohen's kappa values of 0.94 and 0.91 for grade and 0.95 and 0.84 for subtype. Low interobserver concordance could lead to undertreatment and overtreatment of many patients with penile cancer, and brings into question the utility of tumor histological subtype and tumor grade in determining patient treatment in pT1 tumors. [ABSTRACT FROM AUTHOR]

Hypothesis: This study aimed to examine whether three-dimensionally printed models (3D models) could improve interobserver and intraobserver agreement when classifying proximal humeral fractures (PHFs) using the Neer system. We hypothesized that 3D models would improve interobserver and intraobserver agreement compared with x-ray, two-dimensional (2D) and three-dimensional (3D) computed tomography (CT) and that agreement using 3D models would be higher for registrars than for consultants. Methods: Thirty consecutive PHF images were selected from a state-wide database and classified by fourteen observers. Each imaging modality (x-ray, 2D CT, 3D CT, 3D models) was grouped and presented in a randomly allocated sequence on two separate occasions. Interobserver and intraobserver agreements were quantified with kappa values (κ), percentage agreement, and 95% confidence intervals (CIs). Results: Seven orthopedic registrars and seven orthopedic consultants classified 30 fractures on one occasion (interobserver). Four registrars and three consultants additionally completed classification on a second occasion (intraobserver). Interobserver agreement was greater with 3D models than with x-ray (κ = 0.47, CI: 0.44-0.50, 66.5%, CI: 64.6-68.4% and κ = 0.29, CI: 0.26-0.31, 57.2%, CI: 55.1-59.3%, respectively), 2D CT (κ = 0.30, CI: 0.27-0.33, 57.8%, CI: 55.5-60.2%), and 3D CT (κ = 0.35, CI: 0.33-0.38, 58.8%, CI: 56.7-60.9%). Intraobserver agreement appeared higher for 3D models than for other modalities; however, results were not significant. There were no differences in interobserver or intraobserver agreement between registrars and consultants. Conclusion: Three-dimensionally printed models improved interobserver agreement in the classification of PHFs using the Neer system. This has potential implications for using 3D models for surgical planning and teaching.

Objective: Many recent studies are pointing out the heterogeneity between pathologists in the classification of malignant pleural mesotheliomas. Besides, they reported the prognostic impact of classifying epithelioid mesotheliomas according to the predominant architectural features and the nuclear grade. The authors assessed the interobserver and the intraobserver agreement of subtyping mesotheliomas between 2 pathologists used to thoracic pathology. Material and Method: The observers reviewed all the slides of the malignant pleural mesotheliomas diagnosed during the period ranging from 2004 to 2017. The Cohen Kappa was performed in order to evaluate the agreement between both observers into classifying mesotheliomas, subtyping and grading epithelioid mesotheliomas. Two rounds of examination were planned with a delay period of one month. After the first round, the reviewers discussed the different difficulties and challenges they faced. All the statistic tests were performed using the SPSS software version 12.0. Results: After the first round, a fair agreement between both observers was reported. After the second round, an improvement of the concordance rate with a good agreement in subtyping epithelioid mesotheliomas was noticed. Concerning the grading of mesotheliomas, the interobserver agreement was poor even after the second round examination. The intraobserver reproducibility of epithelioid mesothelioma subtyping was fair or moderate for both reviewers. The intraobserver agreement was poor concerning the grading of epithelioid mesothelioma. Conclusion: Integrating subtyping and grading of epithelioid mesotheliomas into a new classification necessitates an important training of the pathologists. The architectural features' definitions have to be clarified in order to avoid using own subjective opinions and habits by pathologists.

There are several available endoscopic scoring systems that are designed to assess disease activity in inflammatory bowel disease. The most widely known is the Mayo endoscopic subscore for ulcerative colitis. These schemas are not routinely used in clinical practice, largely due to their complexity or lack of granularity, although they are standard for outcomes measurement in large clinical trials. While some schemas have been validated using independent cohorts, there is high inherent interobserver variation. Furthermore, derivation of these scoring systems has been subject to selection bias and limited challenge bias., Competing Interests: Disclosure Dr C. N. Bernstein has consulted to and served on advisory boards for Abbvie, Canada; Amgen, Canada; Bristol Myers Squibb, Canada; Eli Lilly, Canada; JAMP Pharmaceuticals; Janssen, Canada; Pendopharm, Canada; Pfizer Canada; Sandoz, Canada; and Takeda and has received unrestricted educational grants from AbbVie, Canada; Boston Scientific; Bristol-Myers Squibb, Canada; Janssen, Canada; Organon, Canada; Pfizer, Canada; and Takeda, Canada. He has been on the speaker’s bureau of Abbvie Canada, Janssen, Canada, Pfizer, Canada, and Takeda, Canada. He has received research grants from Abbvie, Canada, Amgen, Canada, Pfizer Canada, and Sandoz, Canada and contract grants from Janssen., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Aims: Management of anal dysplasia relies upon the accurate diagnosis of anal biopsy specimens. As institutions move towards subspecialty signout (SSSO), decisions must be made regarding whether to assign anal biopsies to the gastrointestinal (GI) or gynaecological (GYN) pathology service. Materials and results: We identified 200 archival tissue biopsies of anal mucosa and circulated them among three GI pathologists and three GYN pathologists. Each pathologist separately scored each biopsy as normal, atypical, low‐grade squamous intra‐epithelial lesion (LSIL) or high‐grade squamous intra‐epithelial lesion (HSIL). Every case that was called HSIL by at least one pathologist was stained with p16 immunostain and a 'gold standard' interpretation of whether or not a case represented HSIL was made. The GI pathologists agreed on 97 (49%) cases prior to consensus; the GYN pathologists agreed on 33 (17%). The sensitivities of the three GI pathologists in detecting HSIL against the 'gold standard' were 47, 100 and 21% and for the GYN pathologists the sensitivities were 74, 89 and 84%; the sensitivities of the GI and GYN consensus diagnoses were 74% each. The specificities of the three GI pathologists in detecting HSIL were 99, 90 and 100% and for the GYN pathologists the specificities were 99, 92 and 91%; the specificities of both the GI and GYN consensus diagnoses were 100%. Conclusions: A mild to moderate degree of interobserver variability exists in the diagnosis of anal dysplasia among pathologists. Our study indicates the utility of some form of consensus conference, as overall agreement among GI pathologists and among GYN pathologists improved following in‐person consensus. [ABSTRACT FROM AUTHOR]

To evaluate recurrence rates and risk factors of relapse in stage IA vulvar squamous cell carcinoma (VSCC) patients. Population-based prospectively collected data on stage IA VSCC was retrieved through the Danish Gynecological Cancer Database (DGCD) during 2011–2017. A central pathology review was performed on tumors from women with recurrent disease. 62 women diagnosed and treated for stage IA VSCC were identified. Nine (14.5%) of the included cases relapsed within the observation period. The recurrences were in the vulva, groins or both in 5 (8.1%), 3 (4.8%) and 1 (1.6%) of the women, respectively. At central pathology review, including all recurrent cases (n = 9), 5 out of 21 reviewed patients were upstaged to stage IB due to depth of invasion >1 mm and two were downstaged to Carcinoma in situ. Two of the upstaged women developed an isolated groin recurrence and one an isolated vulvar relapse. After exclusion of the seven cases the overall recurrence rate decreased to 10.9% (n = 6). Among these cases (n = 55) resection margin <8 mm and tumor size were associated with cancer recurrence. Pathological assessment of stage IA VSCC (depth of invasion ≤1 mm) may be difficult. This may result in under-staging, which impact the choice of treatment and possibly the prognosis. This suggests a need for further clarification of the FIGO measurement and may require a more radical approach when it comes to treatment and groin exploration in stage IA VSCC. Resection margins <8 mm and tumor size were associated with relapse of the disease. • Measurement of depth of invasion ≤1 mm in vulvar cancer is a challenge and understaging may occur. • The rate of recurrence went from 14.5% to 10.9% after a central pathology review was performed. • Resection margins <8 mm and tumor size were associated with recurrence. [ABSTRACT FROM AUTHOR]