Assessment of the comparative agreement between chest radiographs and CT scans in intensive care units.

PURPOSE: Chest radiographs in critically ill patients can be difficult to interpret due to technical and clinical factors. We sought to determine the agreement of chest radiographs and CT scans, and the inter-observer variation of chest radiograph interpretation, in intensive care units (ICUs). METHODS: Chest radiographs and corresponding thoracic computerised tomography (CT) scans (as reference standard) were collected from 45 ICU patients. All radiographs were analysed by 20 doctors (radiology consultants, radiology trainees, ICU consultants, ICU trainees) from 4 different centres, blinded to CT results. Specificity/sensitivity were determined for pleural effusion, lobar collapse and consolidation/atelectasis. Separately, Fleiss' kappa for multiple raters was used to determine inter-observer variation for chest radiographs. RESULTS: The median sensitivity and specificity of chest radiographs for detecting abnormalities seen on CTs scans were 43.2% and 85.9% respectively. Diagnostic sensitivity for pleural effusion was significantly higher among radiology consultants but no specialty/experience distinctions were observed for specificity. Median inter-observer kappa coefficient among assessors was 0.295 ("fair"). CONCLUSIONS: Chest radiographs commonly miss important radiological features in critically ill patients. Inter-observer agreement in chest radiograph interpretation is only "fair". Consultant radiologists are least likely to miss thoracic radiological abnormalities. The consequences of misdiagnosis by chest radiographs remain to be determined.

Integrating Engineering With Nature® strategies and landscape architecture techniques into the Sabine-to-Galveston Coastal Storm Risk Management Project.

Damaging storm events frequently impact the Texas coast. In response, the US Army Corps of Engineers Galveston District (SWG) has undertaken the Sabine-to-Galveston (S2G) Coastal Storm Risk Management (CSRM) Project. This approximately $3.9B project includes numerous measures across several counties of the upper Texas coast, including levees, floodwalls, and pump stations. In June 2019, SWG leadership enlisted a team including the paper authors to integrate Engineering With Nature (EWN) strategies into this infrastructure project. EWN strategies intentionally align natural and engineering processes to efficiently and sustainably deliver economic, environmental, and social benefits through collaboration. The first step in this process was to develop potentially relevant EWN strategies. A collaborative workshop included visits to project sites and working sessions where the project team reviewed challenges associated with each site, generated an array of EWN strategies, and began to test design concepts based on those strategies through collaborative drawing sessions. Afterward, prioritized ideas were refined and evaluated in terms of property acquisition, estimated cost, logistics, stakeholder and sponsor interest, constructability, aesthetics, recreational opportunities, and ecological benefit. Design concepts considered feasible for integration into the broader S2G project included horizontal levees, inland floodwater storage areas that double as wildlife habitat, and strategic placement of sediment berms to reduce storm impacts and provide marsh substrate. All these concepts should achieve intended CSRM outcomes while enhancing environmental and social benefits. This assimilation of EWN strategies and landscape architecture techniques into a large CSRM study illustrates a method for expanding overall project value and producing infrastructure that benefits coastal communities. Integr Environ Assess Manag 2022;18:63-73. © 2021 SETAC.

Advancing nature-based solutions by leveraging Engineering With Nature® strategies and landscape architectural practices in highly collaborative settings.

The US Army Corps of Engineers (USACE)'s Engineering With Nature® (EWN® ) initiative consistently promotes the use of collaboration for identifying innovative, nature-based solutions (NBS) that lead to more resilient communities and water-based infrastructure. In recent years, EWN researchers, in partnership with landscape architects (LAs) affiliated with the Dredge Research Collaborative (DRC), have championed an innovative, collaborative strategy that offers traditional planners an opportunity to participate in visioning exercises during the initial phases of coastal storm risk management projects. This has resulted in the identification, development, and incorporation of design concepts that prioritize NBS and the placement of natural and nature-based features (NNBF). These concepts, and their development process, have been documented in reports for the use of both the participating planners and other audiences interested in innovative NNBF. Upon observing these favorable outcomes, it has become clear that the integration of disciplines-landscape architecture, applied science, and engineering-has increased our ability to process, utilize, and communicate complex information. Both groups (i.e., DRC's LAs and EWN engineers and scientists) have considerable experience related to infrastructure design and performance; they elucidate ways to achieve functional engineering criteria while also maximizing ecological value and/or promoting more recreational opportunities. However, this partnership also produces a complementary set of uniquely acquired skills and expertise, which advances the development of NBS through accelerated and more meaningful communications. This study will offer insight into the partnership, collaborative techniques, and resulting products that have fostered innovation as well as advocacy for more sustainable infrastructure. Integr Environ Assess Manag 2022;18:108-114. © 2021 SETAC. This article has been contributed to by US Government employees and their work is in the public domain in the USA.

The effect of body mass index on three methods of fetal weight estimation.

OBJECTIVE: To assess agreement between three methods of estimation of fetal weight and determine the influence of maternal obesity. DESIGN: Prospective observational study. SETTING: A tertiary referral teaching hospital. POPULATION: Unselected women attending for induction of labour. METHOD: Maternal, clinical and ultrasonic estimations of fetal weight were made prior to induction of labour in 96 consenting women. The estimations of fetal weight were performed independently by the three methods. MAIN OUTCOME MEASURE: Bland and Altman plots to show limits of agreement, and intraclass correlation coefficients. RESULTS: Variable levels of accuracy were obtained for maternal, clinical and ultrasound estimates of fetal weight. Ultrasound estimation of fetal weight performed equally best for women of high and low body mass index (BMI). For women of low BMI, the intraclass correlation coefficient (ICC) was 0.90 (95% CI 0.83-0.94) and 0.87 (95% CI 0.77-0.93) for women with high BMI. Despite this, the limits of agreement for ultrasound were in the order of -700 to +500 g. Both maternal and clinical estimation of fetal weight under-estimated true fetal weight in women with low BMI and over-estimated the true fetal weight in women with high BMI. The largest observed mean difference was obtained with clinical palpation in both low and high BMI women. CONCLUSION: The accuracy of ultrasound estimation of fetal weight was better than maternal and clinical estimation of fetal weight and was not influenced significantly by maternal BMI.