Verifying a novel bile cytology scoring system.

BACKGROUND: The scoring system for bile cytology (SSBC) aims to improve bile cytology diagnostic accuracy. Here, the practicality of SSBC was verified by multiple cytotechnologists. METHODS: Bile cytological specimens were evaluated by 24 cytotechnologists using SSBC. The samples were assessed before using the SSBC (first-time assessment) according to three categories: benign, indeterminate, and malignant. A first scoring evaluation (FSE) was then performed using SSBC; each item in the scoring system was classified as present or absent. After distributing an instruction sheet with diagnostic criteria, a second scoring evaluation (SSE) was performed using SSBC. Each method was evaluated using diagnostic accuracy and interobserver and intraobserver agreement. RESULTS: Several samples were assessed as indeterminate in the first-time assessment. Although the specificity of the SSE improved, the sensitivity and accuracy decreased compared with those of the FSE. The overall interobserver agreement was fair for all parameters, including abnormal chromatin, irregular internuclear distances, irregularly overlapped nuclei, irregular cluster margins, and final evaluation in the FSE and SSE. The final evaluation by histological type exhibited slight agreement for well-differentiated tubular adenocarcinoma and almost perfect agreement for poorly differentiated tubular adenocarcinoma in the FSE and SSE. For moderately differentiated tubular adenocarcinoma, agreement was moderate in the FSE and fair in the SSE. For cholangitis, a slight agreement was observed in the FSE, which improved to fair in the SSE. CONCLUSIONS: Although the SSBC is expected to improve specificity, there exists ambiguity regarding SSBC criteria and interindividual assessment differences. Therefore, the objective assessment method should be revised.

Categorical Analysis of Database Consistency in Reporting Drug-Drug Interactions for Cardiovascular Diseases.

Drug-drug interactions (DDIs) can either enhance or diminish the positive or negative effects of the associated drugs. Multiple drug combinations create difficulties in identifying clinically relevant drug interactions; this is why electronic drug interaction checkers frequently report DDI results inconsistently. Our paper aims to analyze drug interactions in cardiovascular diseases by selecting drugs from pharmacotherapeutic subcategories of interest according to Level 2 of the Anatomical Therapeutic Chemical (ATC) classification system. We checked DDIs between 9316 pairs of cardiovascular drugs and 25,893 pairs of cardiovascular and other drugs. We then evaluated the overall agreement on DDI severity results between two electronic drug interaction checkers. Thus, we obtained a fair agreement for the DDIs between drugs in the cardiovascular category, as well as for the DDIs between drugs in the cardiovascular and other (i.e., non-cardiovascular) categories, as reflected by the Fleiss' kappa coefficients of κ=0.3363 and κ=0.3572, respectively. The categorical analysis of agreement between ATC-defined subcategories reveals Fleiss' kappa coefficients that indicate levels of agreement varying from poor agreement (κ<0) to perfect agreement (κ=1). The main drawback of the overall agreement assessment is that it includes DDIs between drugs in the same subcategory, a situation of therapeutic duplication seldom encountered in clinical practice. Our main conclusion is that the categorical analysis of the agreement on DDI is more insightful than the overall approach, as it allows a more thorough investigation of the disparities between DDI databases and better exposes the factors that influence the different responses of electronic drug interaction checkers. Using categorical analysis avoids potential inaccuracies caused by particularizing the results of an overall statistical analysis in a heterogeneous dataset.

Accuracy of the Lacrimal Syringing Test in Relation to Dacryocystography and Dacryoendoscopy.

Purpose: This study aimed to evaluate the accuracy of the lacrimal syringing test (syringing) in relation to dacryocystography (DCG) and dacryoendoscopy (DE) in lacrimal pathway (LP) obstruction. Methods: We retrospectively reviewed 101 patients (188 LPs) who underwent syringing, cone-beam computed tomography (CBCT)-DCG, and DE to diagnose the degree and site of LP obstruction. The degree of obstruction was classified into patent, partial obstruction, and complete obstruction. The degree of LP obstruction was determined by combining the findings of DE and CBCT-DCG and was designated as DCG+DE. When differentiating complete or partial obstruction on DE was uncertain, complete or partial obstruction was assigned if the DCG showed evidence of contrast media obstruction or passage, respectively. The consistency between syringing and DCG+DE was evaluated by calculating the weighted kappa coefficient. Results: The sensitivity and specificity of syringing were 94% and 89%, respectively. The weighted Cohen's kappa value of agreement between syringing and DCG+DE was κ = 0.73 (SE = 0.04, 95% confidence interval [CI]: 0.66-0.80, p < 0.01). When divided into presaccal and postsaccal obstruction categories, the kappa values were κ = 0.40 (SE = 0.11, 95% CI: 0.19-0.62, p < 0.01) and 0.55 (SE = 0.09, 95% CI: 0.37-0.73, p < 0.01), respectively. Furthermore, when limited to common canaliculus obstruction (stenoses), which accounted for 78% (46 LPs) of the total presaccal obstructions, the kappa value was κ = 0.29 (SE = 0.12, 95% CI: 0.05-0.54, p = 0.021), which demonstrated the lowest consistency between syringing and DCG+DE. Conclusion: Syringing was "substantially" in agreement with DCG+DE in detecting the degree of LP obstruction. Moreover, syringing was a sufficiently sensitive and specific test when performed by an experienced clinician. However, distinguishing between complete and partial obstructions by syringing was sometimes difficult, particularly in the common canaliculus obstruction (stenosis).

Wildlife habitat mapping using Sentinel-2 imagery of Mehao Wildlife Sanctuary, Arunachal Pradesh, India.

Mehao Wildlife Sanctuary, situated in the state of Arunachal Pradesh, is part of an important biodiversity hotspot in the north-eastern part of India in the Himalayas. The current study deals with the identification of important wildlife habitats in the sanctuary. We used a supervised classification technique to delineate these habitats in the sanctuary, which are used by several mammals and bird species encountered during camera trap and sign surveys conducted between November 2017 and May 2020. Satellite images from Sentinel - 2A were used to classify the land use land cover (LULC) of the sanctuary. The LULC information was generated by using a maximum likelihood classifier. We classified a total of thirteen LULC classes, i.e., water, built-up, agriculture, orchard, grassland, bamboo forest, bamboo-mixed forest, riverbed, barren land, snow, wild banana, riverine forest and mixed forest. LULC classification reveals a high percentage of mixed forest, about 69.9%, followed by wild bananas at 7.2%. The commission and omission error rates, however, are high for riverbed and agriculture (0.5) and bamboo forest (0.5), respectively. The accuracy assessment showed an overall classification accuracy of 88.5% with a Kappa coefficient of 0.87. The abundance of mammals was high in the mixed forest, but Ivlev's electivity index shows that species generally avoided this habitat and preferred specialized forest habitats, such as bamboo forest, bamboo-mixed forest, grassland, riverbed and riverine forest. Our LULC map will provide a baseline for potential planning and monitoring changes of wildlife habitats in Mehao WLS.

Assessment of the Accuracy, Usability and Acceptability of a Rapid Test for the Simultaneous Diagnosis of Syphilis and HIV Infection in a Real-Life Scenario in the Amazon Region, Brazil.

We field-assessed the accuracy, acceptability, and feasibility of the SD BIOLINE HIV/Syphilis Duo rapid diagnostic test in three groups: pregnant women, female sex workers (FSW), and men who have sex with men (MSM). Venous blood samples collected in the field were compared with the respective gold standard methods: SD BIOLINE HIV/Syphilis Duo Treponemal Test versus FTA-abs (Wama brand) treponemal laboratory test for syphilis, and SD BIOLINE HIV/Syphilis Duo Test versus the fourth generation Genscreen Ultra HIV Ag-Ag (Bio-Rad brand) laboratory test for HIV. From a total of 529 participants, 397 (75.1%) were pregnant women, 76 (14.3%) FSW and 56 (10.6%) MSM. Sensitivity and specificity parameters of HIV were 100.0% (95% CI: 82.35-100.0%) and 100.0% (95% CI: 99.28-100.0%), respectively. Sensitivity and specificity parameters found for TP antibody detection were 95.00% (95% CI: 87.69-98.62%) and 100.0% (95% CI: 98.18-100.0%), respectively. The SD BIOLINE HIV/Syphilis Duo Test showed high acceptability among participants (85.87%) and health professionals (85.51%), as well as easy usability by professionals (91.06%). The usability of the SD BIOLINE HIV/Syphilis Duo Test kit would not be a barrier to accessing rapid testing, if the product were incorporated into the list of health service supplies.

Cohen's Kappa Coefficient as a Measure to Assess Classification Improvement following the Addition of a New Marker to a Regression Model.

The need to search for new measures describing the classification of a logistic regression model stems from the difficulty in searching for previously unknown factors that predict the occurrence of a disease. A classification quality assessment can be performed by testing the change in the area under the receiver operating characteristic curve (AUC). Another approach is to use the Net Reclassification Improvement (NRI), which is based on a comparison between the predicted risk, determined on the basis of the basic model, and the predicted risk that comes from the model enriched with an additional factor. In this paper, we draw attention to Cohen's Kappa coefficient, which examines the actual agreement in the correction of a random agreement. We proposed to extend this coefficient so that it may be used to detect the quality of a logistic regression model reclassification. The results provided by Kappa's reclassification were compared with the results obtained using NRI. The random variables' distribution attached to the model on the classification change, measured by NRI, Kappa, and AUC, was presented. A simulation study was conducted on the basis of a cohort containing 3971 Poles obtained during the implementation of a lower limb atherosclerosis prevention program.

Test-retest reliability of the Cost for Patients Questionnaire.

OBJECTIVES: To investigate the test-retest reliability of the Costs for Patients Questionnaire (CoPaQ). METHODS: Through an online survey, individuals were invited to participate in a two-step study to assess the test-retest reliability of the CoPaQ. Participants to the first step were invited to complete the questionnaire a second time 2 weeks after. Reliability was assessed by calculating Cohen's Kappa coefficients and intraclass correlation coefficients (ICC) for discrete and continuous data, respectively. A sensitivity analysis was carried out. RESULTS: From a total of 1,200 participants who completed the first test, 403 completed the second test. The ICC varied from -0.00 to 0.98 with poor, moderate, good, and excellent results. The Kappa coefficients varied from -0.004 to 0.65 and were poor, slight, fair, moderate, and substantial. The sensitivity analysis showed the median value of ICC and Kappa coefficients for each category before and after the outliers' exclusion. The median value of ICC changed from 0.30 (before) to 0.70 (after), and from 0.12 (before) to 0.04 (after), respectively, for each category. The median value of the Cohen's Kappa coefficient increased from 0.44 (before) to 0.46 (after) and decreased from 0.32 (before) to 0.30 (after), respectively. CONCLUSIONS: Test-retest reliability results indicated that the CoPaQ has a moderate reliability in terms of ICC and Kappa coefficients. The moderate reliability observed gives additional support for the applicability of this tool in economic evaluations of health interventions. Additional studies including on other properties and a cultural adaptation could further enhance the use of the tool.

A Systematic Review of Sleep-Wake Disorder Diagnostic Criteria Reliability Studies.

The aim of this article is to provide a systematic review of reliability studies of the sleep-wake disorder diagnostic criteria of the international classifications used in sleep medicine. Electronic databases (ubMed (1946-2021) and Web of Science (-2021)) were searched up to December 2021 for studies computing the Cohen's kappa coefficient of diagnostic criteria for the main sleep-wake disorder categories described in the principal classifications. Cohen's kappa coefficients were extracted for each main sleep-wake disorder category, for each classification subtype, and for the different types of methods used to test the degree of agreement about a diagnosis. The database search identified 383 studies. Fifteen studies were analyzed in this systematic review. Insomnia disorder (10/15) and parasomnia disorder (7/15) diagnostic criteria were the most studied. The reliability of all sleep-wake disorders presented a Cohen's kappa with substantial agreement (Cohen's kappa mean = 0.66). The two main reliability methods identified were "test-retest reliability" (11/15), principally used for International Classification of Sleep Disorders (ICSD), and "joint interrater reliability" (4/15), principally used for Diagnostic and Statistical Manual of Mental Disorders (DSM) subtype diagnostic criteria, in particularl, the DSM-5. The implications in terms of the design of the methods used to test the degree of agreement about a diagnosis in sleep medicine are discussed.

An Automated Wavelet-Based Sleep Scoring Model Using EEG, EMG, and EOG Signals with More Than 8000 Subjects.

Human life necessitates high-quality sleep. However, humans suffer from a lower quality of life because of sleep disorders. The identification of sleep stages is necessary to predict the quality of sleep. Manual sleep-stage scoring is frequently conducted through sleep experts' visually evaluations of a patient's neurophysiological data, gathered in sleep laboratories. Manually scoring sleep is a tough, time-intensive, tiresome, and highly subjective activity. Hence, the need of creating automatic sleep-stage classification has risen due to the limitations imposed by manual sleep-stage scoring methods. In this study, a novel machine learning model is developed using dual-channel unipolar electroencephalogram (EEG), chin electromyogram (EMG), and dual-channel electrooculgram (EOG) signals. Using an optimum orthogonal filter bank, sub-bands are obtained by decomposing 30 s epochs of signals. Tsallis entropies are then calculated from the coefficients of these sub-bands. Then, these features are fed an ensemble bagged tree (EBT) classifier for automated sleep classification. We developed our automated sleep classification model using the Sleep Heart Health Study (SHHS) database, which contains two parts, SHHS-1 and SHHS-2, containing more than 8455 subjects with more than 75,000 h of recordings. The proposed model separated three classes if sleep: rapid eye movement (REM), non-REM, and wake, with a classification accuracy of 90.70% and 91.80% using the SHHS-1 and SHHS-2 datasets, respectively. For the five-class problem, the model produces a classification accuracy of 84.3% and 86.3%, corresponding to the SHHS-1 and SHHS-2 databases, respectively, to classify wake, N1, N2, N3, and REM sleep stages. The model acquired Cohen's kappa (κ) coefficients as 0.838 with SHHS-1 and 0.86 with SHHS-2 for the three-class classification problem. Similarly, the model achieved Cohen's κ of 0.7746 for SHHS-1 and 0.8007 for SHHS-2 in five-class classification tasks. The model proposed in this study has achieved better performance than the best existing methods. Moreover, the model that has been proposed has been developed to classify sleep stages for both good sleepers as well as patients suffering from sleep disorders. Thus, the proposed wavelet Tsallis entropy-based model is robust and accurate and may help clinicians to comprehend and interpret sleep stages efficiently.

Assessment of spatiotemporal dynamics of land and vegetation cover change detection in Maze National Park, Southwest Ethiopia.

Biodiversity conservation areas include National Parks which are integral parts of protected areas. In parks, the dynamics of land and vegetation covers are significantly affected by anthropogenic activities and natural factors. These resources are exposed to challenges due to unwise practices. Assessing and monitoring the status of park's natural resources enables us to understand the extent of land and vegetation resources. Few studies have been conducted in Maze National Park (MzNP) but none of them quantified the land and vegetation cover dynamics. The purpose of this study is, therefore, to quantify the extents spatiotemporal dynamics of land and vegetation cover of MzNP using GIS and RS technology considering three decades Landsat images acquired from USGS. GPS and GCPs were collected for the analysis of land cover classification and accuracy assessment, respectively. The trend analysis result revealed that scattered tree and grass land cover area have increased from 19.8% in 1987 to 51.6% in 2019. The area of sparse vegetation cover increased from 19.7% in 2000 to 78.4% in 2019. Highly dense and dense vegetation cover decreased remarkably. Accuracy assessment was 98% and computed Kappa coefficient was 0.97. The results suggested that the extent of MzNP's vegetation cover change was basically due to anthropogenic pressure. This study could be used to alarm responsible bodies to restructure and implement better environmental protection strategies for restoration of the rapidly deteriorating vegetation resource of MzNP.

Reliability and Validation of the Persian Version of JUICE Study Questionnaire.

BACKGROUND: This study is part of a prospective international cohort study on the composition of microbiota living in the upper gastrointestinal (GI) tract and its correlations to the patients' symptoms, and their psychological and physical health status in three different populations (JUICE Study). Our study evaluates the reliability and validity of the Persian version of a three-part questionnaire which will be used in this study. METHODS: The original English version of the questionnaire was translated to Farsi and then back translated to English by an expert Iranian English teacher. The back-translation was edited by a native English speaker and then retranslated to Farsi. The questionnaire consists of three parts; the first part includes demographic data, the second part is the EQ-5D questionnaire which is an instrument developed by the EuroQol group to measure five dimensions of quality of life and health status, and the third part is the Hospital Anxiety and Depression Scale questionnaire (HADS). By convenience sampling, 22 participants were enrolled. To check reliability, they were asked to complete the questionnaire and repeat this two weeks later. For validity, one of the researchers completed the questionnaire for each of the participants after interviewing them and this was compared with the questionnaire completed by the participant. Each participant was also asked to comment on the content and structure of the questionnaire and these points were considered for improvement of the questionnaire. RESULTS: The first six questions were demographic, and completely the same in the test and retest phases. All of the other questions in the first part of the questionnaire had Kappa values above 0.6 for both reliability and validity. Four questions in this section were assessed with percentage agreement. Percentage agreements were 0.86, 0.54, 0.66 and 0.9 for reliability and 1, 0.81, 0.81 and 1 for validity for the 8th, 12th, 13th and 14th questions, respectively. In the second part, i.e. the EQ5D questionnaire, percentage agreements of the first and second items for reliability equaled 1. Percentage agreements of the three last items were 0.90, 0.63 and 0.72, respectively. Validity of the EQ5D questionnaire was 100% for the first three items and 95% for the last one. For the HADS questionnaire, percentage agreement averaged 0.63 in the reliability phase and 0.78 in the validation phase. CONCLUSION: According to our data, this three-part questionnaire has acceptable reliability and validity to be used as an instrument in Farsi-speaking populations for the JUICE study.

Validation of central serous chorioretinopathy multimodal imaging-based classification system.

PURPOSE: Validation of a recently described central serous chorioretinopathy (CSCR) classification system and assessment of levels of agreement among 10 retina physicians. METHODS: This was a cross-sectional (inter-reader agreement) study. Ten retina physicians (assigned a role of masked grader) were provided with a comprehensive dataset of 61 eyes of 34 patients of presumed CSCR. Relevant clinical details and multimodal imaging (fundus autofluorescence, fluorescein and indocyanine green angiography, optical coherence tomography) of both involved and fellow eye were electronically shared. Later, only the fellow eye images were resent to understand the influence of affected eye on the grading of the fellow eye. Multiple inter-grader agreement using Fleiss Kappa was performed to determine the level of agreement among the 10 graders. p value of ≤ 0.05 was considered statistically significant. RESULTS: Sixty-one eyes of 34 patients were evaluated. There was moderate agreement for major criteria with Fleiss Kappa value of 0.50 (p < 0.0001) with a single outlier observer. After excluding that observer, the Fleiss Kappa value increased to 0.57 (p < 0.0001) with statistically significant p values among all categories, i.e., simple CSC ([Formula: see text] = 0.575), complex CSC ([Formula: see text] = 0.621), and no CSC ([Formula: see text] = 0.452). Overall, moderate to substantial agreement was noted among the subtypes (primary, recurrent, and resolved). The influence of the affected eye on fellow eye grading was studied. The global Fleiss Kappa coefficient ([Formula: see text] = 0.642, p < 0.0001) showed substantial agreement when observers were aware of the affected eye grading. However, without prior available information on the affected eye, the inter-grader agreement was significantly lower (global [Formula: see text] = 0.255, p < 0.0001). CONCLUSION: A fair-moderate inter-grader agreement among the masked graders suggests a need for further refinement of this novel classification system. Disease grading should include both eyes as lack of information on affected eye has a bearing on fellow eye grading and inter-grader agreement as shown by a significant difference in global [Formula: see text] values.

The Agreement between Feline Pancreatic Lipase Immunoreactivity and DGGR-Lipase Assay in Cats-Preliminary Results.

The colorimetric catalytic assay based on the use of 1,2-o-dilauryl-rac-glycero-3-glutaric acid-(6'-methylresorufin) (DGGR) ester as a substrate for pancreatic lipase activity is commonly used for the diagnosis of pancreatitis in dogs and cats. Even though the assay has generally been shown to yield consistent results with feline pancreatic lipase immunoreactivity (fPLI) assay, the agreement may vary between assays of different manufacturers. In this study, the chance-corrected agreement between a DGGR-lipase assay offered by one of the biggest providers of diagnostic solutions in Poland and fPLI assay was investigated. The study was carried out on 50 cats in which DGGR-lipase activity and fPLI were tested in the same blood sample. The chance-corrected agreement was determined using Gwet's AC1 coefficient separately for the fPLI assay's cut-off values of >3.5 µg/L and >5.3 µg/L. The DGGR-lipase activity significantly positively correlated with fPLI (Rs = 0.665; CI 95%: 0.451, 0.807, p < 0.001). The chance-corrected agreement between the fPLI assay and DGGR-lipase assay differed considerably depending on the cut-off values of the DGGR-lipase assay. When the cut-off value reported in the literature (>26 U/L) was used, it was poor to fair. It was moderate at the cut-off value recommended by the laboratory (>45 U/L), and good at the cut-off value recommended by the assay's manufacturer (>60 U/L). The highest agreement was obtained between the fPLI assay at the cut-off value of 3.5 µg/L and the DGGR-lipase assay at the cut-off value of 55 U/L (AC1 = 0.725; CI 95%: 0.537, 0.914) and between the fPLI assay at the cut-off value of 5.3 µg/L and the DGGR-lipase assay at the cut-off value of 70 U/L (AC1 = 0.749; CI 95%: 0.577, 0.921). The study confirms that the chance-corrected agreement between the two assays is good. Prospective studies comparing both assays to a diagnostic gold standard are needed to determine which of them is more accurate.

Validation of the Use of Dried Blood Samples for the Detection of Toxoplasma gondii Antibodies in Stray Cats (Felis s. catus).

If validated beforehand, the analysis of dried blood on blotting paper (BP samples) is very useful for monitoring free-ranging animals. We aimed to validate this method for the detection of antibodies against Toxoplasma gondii in stray cats. We used the modified agglutination test (MAT) in 199 sample pairs of sera and BP samples from 54, 39, 56, and 50 cats trapped during four periods in five dairy farms. Screening was at 1:6, 1:12, and 1:24 dilutions. The cut-off value was at MAT titre ≥ 24, but MAT titre ≥ 12 was also considered for BP samples that often have a higher dilution level. Depending on the period, sample type, and cut-off value, sensitivity of the analysis of the BP sample vs. serum varied from 87.1% to 100% and specificity ranged from 72.22% to 100%. The concordance values and Kappa coefficient showed a substantial to excellent agreement between the results of the two methods, whatever the cut-off value. These findings quantifiably validate the use of MAT on BP samples for the detection of antibodies to T. gondii in stray cats, but we recommend expressing results from BP samples with several cut-off values as the MAT titres tend to be lower than those of sera.

[Detection of porcine reproductive and respiratory syndrome virus (PRRS) genome fragments and anti-- bodies in chewing ropes allow -monitoring of PRRS in pig farms]. / Der Nachweis von Genomfragmenten des Porcinen Reproduktiven und ­Respiratorischen Syndrom Virus (PRRSV) und -spezifischen Antikörpern in Kaustricken ermöglicht die Überwachung PRRSV-unverdächtiger schweine­haltender Betriebe.

INTRODUCTION: Saliva samples from chewing ropes are a reliable diagnostic of porcine reproductive and respiratory syndrome virus (PRRSV) infections. The aim of this study was to test whether saliva samples taken with saliva swabs (cotton swabs and GenoTube Livestock) or with chewing ropes are suitable for monitoring PRRSV in unsuspicious farms, this means to detect a prevalence of 20% infected animals with a 95% probability. Saliva samples were collected from 12-16 pens in five pig farms by using a chewing rope for collective samples and by individual saliva swaps from five randomly selected animals per pen. A total of 291 animals from 58 pens in four study farms and 60 animals from 12 pens in one control farm were collected. The samples were taken from all age categories. According to the current monitoring system the analysis of five individual serum samples from the same pens served as the reference method for the relative sensitivity of the saliva samples. Serum and chewing rope samples were tested by ELISA for antibodies. Two different systems were used for the serum samples. Chewing ropes, saliva swabs (GenoTube Livestock) and serum samples were examined for virus genomes using a nested reverse-transcriptase PCR and a commercial real-time reverse-transcriptase PCR kit. Cohen's Kappa was used as a measure of agreement. PRRSV antibodies were detected in the chewing ropes of 44 pens and in the serum samples of only 34 pens. Viral RNA was found in 13 (chewing ropes), respectively 16 pens (serum samples). Saliva swabs (GenoTube Livestock) showed a lower relative sensitivity of 20.00% compared to serum samples. The agreement of the two serum analysis was very good for the ELISAs (κ = 0,911), and moderate for the PCR (κ = 0,706). The comparison of the chewing rope method with the analysis of the serum samples advocates this method as a suitable supplementary monitoring tool in PRRSV unsuspicious pig farms. Easy handling and lower examination costs of the chewing rope method allow higher testing frequency and would therefore improve the monitoring system. However, they are not an alternative to serum samples. Sampling with saliva swabs is unsuitable.

INTRODUCTION: Les échantillons de salive prélevés avec des cordes à mâcher ont fait leurs preuves dans la pratique pour diagnostiquer les infections à PRRSV. Le but de cette étude était de tester si des échantillons de salive prélevés avec des écouvillons salivaires (coton-tiges et GenoTube Livestock) ou avec des cordes à mâcher sont également adaptés au suivi des élevages non suspectés de PRRSV, c'est-à-dire de découvrir des animaux infectés avec une probabilité de 95% et une prévalence de 20%. Dans cinq exploitations, des échantillons de salive collectifs ont été prélevés dans 12 à 16 boxes à l'aide de cordes à mâcher et des échantillons de salive individuels provenant d'un échantillon aléatoire de cinq animaux par boxe ont été examinés. Un total de 291 animaux de 58 lots dans quatre exploitations d'étude et 60 animaux de 12 lots dans une ferme témoin ont été échantillonnés. Les échantillons ont été prélevés dans toutes les catégories d'âge. L'examen de cinq échantillons de sérum individuels provenant des mêmes lots sur la base d'un système de surveillance existant a servi de méthode de référence pour la sensibilité relative des échantillons de salive. Les échantillons de mastication et de sérum ont été testés pour les anticorps par ELISA en utilisant deux systèmes différents pour les échantillons de sérum. Les échantillons provenant des cordes à mâcher, les écouvillonnages de salive GenoTube Livestock et les échantillons de sérum ont été examinés à la recherche de génomes viraux à l'aide d'une PCR à transcriptase inverse emboîtée et d'un kit commercial de PCR à transcriptase inverse en temps réel. Le Kappa de Cohen a été utilisé comme mesure de concordance. À l'aide des cordes à mâcher, des anticorps PRRSV ont été détectés dans 44 enclos et à l'aide de sérum sanguin uniquement dans 34 enclos. L'ARN viral a été trouvé dans 13 (cordes à mâcher) et 16 (sérum) lots. Les écouvillons de salive GenoTube Livestock ont montré une sensibilité relative inférieure de 20,00% par rapport aux échantillons de sérum. La concordance des résultats de l'examen du sérum à l'aide de deux systèmes était très bonne pour les ELISA (κ = 0,911), pour les systèmes PCR modérée (κ = 0,706). La comparaison des échantillons issus de cordes à mâcher avec des échantillons de sérum montre qu'ils sont adaptés à une surveillance supplémentaire des élevages non suspectés d'être atteints du SDRPV. En raison de leur manipulation plus simple et de leurs coûts d'examen réduits, ils peuvent être utilisés pour augmenter la fréquence des examens et ainsi améliorer le système de surveillance, mais ils ne constituent pas une alternative aux échantillons de sérum.

The impact of grey zones on the accuracy of agreement measures for ordinal tables.

BACKGROUND: In an inter-rater agreement study, if two raters tend to rate considering different aspects of the subject of interest or have different experience levels, a grey zone occurs among the levels of a square contingency table showing the inter-rater agreement. These grey zones distort the degree of agreement between raters and negatively impact the decisions based on the inter-rater agreement tables. In this sense, it is important to know how the existence of a grey zone impacts the inter-rater agreement coefficients to choose the most reliable agreement coefficient against the grey zones to reach out with more reliable decisions. METHODS: In this article, we propose two approaches to create grey zones in simulations setting and conduct an extensive Monte Carlo simulation study to figure out the impact of having grey zones on the weighted inter-rater agreement measures for ordinal tables over a comprehensive simulation space. RESULTS: The weighted inter-rater agreement coefficients are not reliable against the existence of grey zones. Increasing sample size and the number of categories in the agreement table decreases the accuracy of weighted inter-rater agreement measures when there is a grey zone. When the degree of agreement between the raters is high, the agreement measures are not significantly impacted by the existence of grey zones. However, if there is a medium to low degree of inter-rater agreement, all the weighted coefficients are more or less impacted. CONCLUSIONS: It is observed in this study that the existence of grey zones has a significant negative impact on the accuracy of agreement measures especially for a low degree of true agreement and high sample and tables sizes. In general, Gwet's AC2 and Brennan-Prediger's κ with quadratic or ordinal weights are reliable against the grey zones.

Deep learning-based algorithm for assessment of knee osteoarthritis severity in radiographs matches performance of radiologists.

A fully-automated deep learning algorithm matched performance of radiologists in assessment of knee osteoarthritis severity in radiographs using the Kellgren-Lawrence grading system. PURPOSE: To develop an automated deep learning-based algorithm that jointly uses Posterior-Anterior (PA) and Lateral (LAT) views of knee radiographs to assess knee osteoarthritis severity according to the Kellgren-Lawrence grading system. MATERIALS AND METHODS: We used a dataset of 9739 exams from 2802 patients from Multicenter Osteoarthritis Study (MOST). The dataset was divided into a training set of 2040 patients, a validation set of 259 patients and a test set of 503 patients. A novel deep learning-based method was utilized for assessment of knee OA in two steps: (1) localization of knee joints in the images, (2) classification according to the KL grading system. Our method used both PA and LAT views as the input to the model. The scores generated by the algorithm were compared to the grades provided in the MOST dataset for the entire test set as well as grades provided by 5 radiologists at our institution for a subset of the test set. RESULTS: The model obtained a multi-class accuracy of 71.90% on the entire test set when compared to the ratings provided in the MOST dataset. The quadratic weighted Kappa coefficient for this set was 0.9066. The average quadratic weighted Kappa between all pairs of radiologists from our institution who took part in the study was 0.748. The average quadratic-weighted Kappa between the algorithm and the radiologists at our institution was 0.769. CONCLUSION: The proposed model performed demonstrated equivalency of KL classification to MSK radiologists, but clearly superior reproducibility. Our model also agreed with radiologists at our institution to the same extent as the radiologists with each other. The algorithm could be used to provide reproducible assessment of knee osteoarthritis severity.

High inter-rater reliability of Japanese bedriddenness ranks and cognitive function scores: a hospital-based prospective observational study.

BACKGROUND: The statistical validities of the official Japanese classifications of activities of daily living (ADLs), including bedriddenness ranks (BR) and cognitive function scores (CFS), have yet to be assessed. To this aim, we evaluated the ability of BR and CFS to assess ADLs using inter-rater reliability and criterion-related validity. METHODS: New inpatients aged ≥75 years were enrolled in this hospital-based prospective observational study. BR and CFS were assessed once by an attending nurse, and then by a social worker/medical clerk. We evaluated inter-rater reliability between different professions by calculating the concordance rate, kappa coefficient, Cronbach's α, and intraclass correlation coefficient. We also estimated the relationship of the Barthel Index and Katz Index with the BR and CFS using Spearman's correlation coefficients. RESULTS: For the 271 patients enrolled, BR at the first assessment revealed 66 normal, 10 of J1, 15 of J2, 18 of A1, 31 of A2, 37 of B1, 35 of B2, 22 of C1, and 32 of C2. The concordance rate between the two BR assessments was 68.6%, with a kappa coefficient of 0.61, Cronbach's α of 0.91, and an intraclass correlation coefficient of 0.83, thus showing good inter-rater reliability. BR was negatively correlated with the Barthel Index (r = - 0.848, p < 0.001) and Katz Index (r = - 0.820, p < 0.001), showing justifiable criterion-related validity. Meanwhile, CFS at the first assessment revealed 92 normal, 47 of 1, 19 of 2a, 30 of 2b, 60 of 3a, 8 of 3b, 8 of 4, and 0 of M. The concordance rate between the two CFS assessments was 70.1%, with a kappa coefficient of 0.62, Cronbach's α of 0.87, and an intraclass correlation coefficient 0.78, thus also showing good inter-rater reliability. CFS was negatively correlated with the Barthel Index (r = - 0.667, p < 0.001) and Katz Index (r = - 0.661, p < 0.001), showing justifiable criterion-related validity. CONCLUSIONS: BR and CFS could be reliable and easy-to-use grading scales of ADLs in acute clinical practice or large-scale screening, with high inter-rater reliabilities among different professions and significant correlations with well-established, though complicated to use, instruments to assess ADLs. TRIAL REGISTRATION: UMIN000041051 (2020/7/10).

Change-of-Direction Deficit vs. Deceleration Deficit: A Comparison of Limb Dominance and Inter-limb Asymmetry between Forwards and Backs in Elite Male Rugby Union Players.

The aims of the present study were to: 1) determine whether limb dominance and inter-limb asymmetry were the same across both change of direction (COD) and deceleration (DEC) deficits and, 2) determine the association between the COD and DEC-deficits and other physical performance tests in elite male rugby union players. Twenty five players performed a series of bilateral jumps, linear and COD speed tests at the end of the pre-season period. COD and DEC-deficits were calculated for both left and right sides, and inter-limb asymmetry thereafter. Kappa coefficients revealed moderate levels of agreement in limb dominance between COD and DEC-deficits (Kappa = 0.41 on left; 0.48 on right). For the direction of asymmetry, perfect levels of agreement (Kappa = 1) were evident between 505 time and COD-deficit, but only moderate levels of agreement (Kappa = 0.41) between other asymmetry measures. Pearson's r correlations showed moderate to large relationships between jumps and linear (r = -0.42 to -0.68) and COD speed (r = -0.41 to -0.58), but not with the COD-deficit (r = 0.15 to -0.31), DEC-deficit (r = 0.01 to -0.32) or asymmetry (r = 0.16 to -0.29). When analysing by playing position, backs were significantly faster than forwards over 15-m (ES = -0.86) and across all jump tests (ES = 0.86-0.94), with the exception of the squat jump. This study is the first to provide a direct comparison of the COD and DEC-deficits and highlights that limb dominance and asymmetry cannot be guaranteed between tasks.

Comparación de ELISAs comerciales para la detección de anticuerpos en la investigación diagnóstica del aborto asociado a Neospora caninum en rodeos lecheros de Uruguay Comparación de ELISAs comerciales para detección de anticuerpos contra N. caninum / A comparative study of commercial ELISAs for antibody detection in the diagnostic investigation of Neospora caninum-associated abortion in dairy cattle herds in Uruguay

Resumen A pesar de su importancia, el diagnóstico etiológico del aborto en bovinos representa un desafío técnico para los veterinarios clínicos y laboratoristas, en parte debido a la dificultad de recuperar los fetos abortados en condiciones extensivas de campo. Dicha dificultad limita la posibilidad de detectar tempranamente los vientres abortados y de efectuar la investigación patológica y microbiológica de los abortos. Neospora caninum es un protozoario cosmopolita identificado como uno de los principales agentes abortigénicos en bovinos. En este estudio proponemos una aproximación seroepidemiológica para diagnosticar abortos por N. caninum en bovinos lecheros usando kits de ELISA comerciales. Se procesaron muestras de entre 12 y 93 vacas y/o vaquillonas con (casos) y sin (controles) historia reciente de aborto en 4 tambos comerciales de Uruguay. La proporción controles:casos analizados varió entre 1:1 y 4,6:1. Las muestras (n=230) fueron analizadas mediante 3 kits comerciales para la detección de anticuerpos IgG anti-N. caninum. En los 4 tambos la proporción de vacas y/o vaquillonas seropositivas por cualquier kit fue significativamente mayor en los casos respecto de los controles (odds ratio=5,13 a 36; p=0,0002 a 0,0485). La concordancia entre los kits varió de débil a fuerte (coeficiente Kappa de Cohen=0,58 a 0,83). Concluimos que, a pesar de la imperfecta concordancia entre estos kits, el empleo de todos ellos permitió arribar a conclusiones similares respecto de la asociación estadísticamente significativa entre seropositividad a N. caninum y aborto, lo que demuestra la utilidad de estos kits para la aproximación diagnóstica del aborto a nivel poblacional en condiciones de campo.

Abstract Bovine abortion causes considerable economic losses to the livestock industry worldwide and is of concern for public health and food safety, given that many abortigenic infectious agents of cattle are zoonotic. Despite its importance, the etiological diagnosis of abortion in cattle is challenging both for veterinary practitioners and laboratory technicians, partly due to the difficulty in recovering aborted fetuses under extensive field conditions for pathological and microbiological diagnostic investigation, and in the early identification of aborted dams. Neospora caninum is a cosmopolitan protozoon identified as one of the main abortigenic agents in cattle worldwide. In this study we propose a comparative seroepidemiological approach for the diagnosis of abortion by N. caninum in dairy cattle. Samples from 12 to 93 cows/heifers with and without recent history of abortion (cases and controls) in four commercial dairy farms were tested. The ratio of controls to cases tested varied from 1:1 to 4.6:1. All samples (n=230) were analyzed by three commercial ELISA kits for the detection of anti-N. caninum antibodies. In all four dairy farms, the proportion of seropositive cows and/or heifers per kit was significantly higher in the cases than in the controls (Odds Ratios=5.13 to 36, p=0.0002 to 0.0485). The agreement among the three kits varied from weak to strong (Cohen´s kappa coefficients=0.58 to 0.83). We conclude that, despite the imperfect agreement between these kits, all of them allowed to arrive at similar conclusions regarding the statistical association between N. caninum seropositivity and abortion, thus representing a useful tool for the diagnostic approach at the population level under field conditions.