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Genetic variation of foot-and-mouth disease virus during persistent infection in cattle.

Genetic variation of foot-and-mouth disease virus O1 Campos has been analyzed in consecutive isolates recovered over a one- or two-year period from four cattle with experimental persistent infection. Comparisons of RNase T1 two-dimensional maps and nucleotide sequences of the VP1-coding region revealed a continual, although irregular, increase in the fixation of mutations as the infection progressed. Most changes were not conserved in consecutive isolates. These results, together with the substantial rates of genomic variation observed between some pairs of strains recovered at close time periods, suggested the coexistence of heterogeneous populations in which variants evolve independently from each other, and predominate at irregular time intervals. Furthermore, non-related patterns of variation were observed in the four animals. Similarly, genetic diversity of representative strains from major serotype O outbreaks in endemic disease regions of southeastern Brazil and central eastern Argentina which occurred between 1958 and 1983, suggested that outbreak strains are also likely to represent fluctuations of heterogeneous populations which evolve independently from each other. The possible role of persistent infections in the introduction of variant populations in the field is discussed.

Amino Acid Sequence↗

Intrapartum cardiotocography -- the dilemma of interpretational variation.

OBJECTIVE: To evaluate and compare interobserver variation in interpretation of intrapartum cardiotocograms. SUBJECTS: Fifteen senior (experience >4 years) and 16 junior (experience < or =4 years) obstetricians from 10 delivery units. DESIGN: Thirty-one obstetricians interpreted intrapartum cardiotocographic (CTG) readings from 22 parturients. METHODS: Inter-observer agreement in CTG interpretation and decision-making was assessed via proportions of agreement (Pa), with 95% confidence intervals (CI). MAIN OUTCOME MEASURES: The level of inter-observer agreement was analyzed by calculating Pa values for CTG baseline, variability, early, variable and late decelerations, uterine tonus, power of contractions, hypertonus and clinical decision. RESULTS: In assessments of normal cases the Pa were acceptable or good (0.63-0.82) as regards all CTG interpretation elements except for the power of contractions (0.24), but in assessments of abnormal cases the Pa values were lower (0.18-0.60). As regards clinical decisions, a higher Pa was found in cases without recommendation for intervention (0.63, 95% CI 0.62-0.64) than in cases with such recommendation (0.55, 95% CI 0.54-0.56). The Pa in the abnormal cases was better among senior than among junior obstetricians. CONCLUSIONS: Inter-observer variation in interpretation of abnormal CTG readings and recommendations for intervention is relatively wide. To improve reliability, uniform classification and standardized training in CTG interpretation are needed, as well as increased use of computerized CTG.

Cardiotocography↗

Dynamic ultrasonography of rotator cuff muscles.

PURPOSE: To confirm the neuromuscular integrity of the rotator cuff and to investigate the effect of different contraction patterns on shoulder function, we sonographically analyzed dynamic contraction patterns of this muscle group. METHODS: Fifty supra- and 50 infraspinatus muscle contraction patterns of patients with different shoulder pathologies examined with a 7.5-MHz transducer were recorded and saved as video files. Both data sets were analyzed by 3 independent observers who then assigned a grade to each contraction pattern: normal, slightly disturbed, severely disturbed, or no contraction. Intra- and inter-observer variations were calculated. In 43 patients with isolated supraspinatus tears, the clinical relation to shoulder function as measured with the Constant score was evaluated. RESULTS: In the 100 cases tested, the intraclass correlations for the 3 observers were 0.82, 0.88, and 0.88. The inter-observer reliability was 0.74. No pair of first and second readings for either the supraspinatus or infraspinatus muscle differed by more than 1 grade. In patients with a supraspinatus tear, the contraction type of the supraspinatus correlated significantly with the Constant score (p=0.02). CONCLUSIONS: When dynamic ultrasonography is used to assess the contraction patterns of the supra- and infraspinatus muscles, good intra- and inter-observer reliability is attained. Because a better contraction type correlates significantly with better shoulder function, this new diagnostic criterion may improve decision-making in the treatment of shoulder diseases.

Humans↗

[Magnetic Resonance Imaging (MRI) of the TMJ: Influence on therapy and inter-observer agreement of two radiologists].

AIM: To evaluate the influence of MRI of the temporomandibular joint on the therapeutic strategy in patients with craniomandibular disorders (internal derangement) and, furthermore, to analyze interobserver agreement for defined MRI criteria. MATERIALS AND METHODS: Fifty-one unilateral and bilateral MRI examinations of 32 patients were enrolled. Therapeutic strategies before and after performance of the MRI were compared. Retrospectively, two radiologists independently analyzed the MR images for position of the disk, position of the condyle, signal intensity of the disk and bilaminar zone, osseous changes and several additional findings, using a check list. Agreement was tested by kappa statistics. RESULTS: In 56% of the cases, changes of the therapeutic regimen were registered after MRI. Statistically significant agreement of the two observers was found for anterior position of the disk (kappa = 0.44), transverse position of the disk (kappa = 0.46) and position of the condyle (kappa = 0.45). No significant agreement was found for signal intensity of the disk (kappa = 0.14) or bilaminar zone (kappa = 0.24), osseous changes (kappa = 0.13) and the additional findings (kappa = 0.29). DISCUSSION: MRI has a measurable impact on the therapeutic approach to the internal derangement of the TMJ. The position of the disk and condyle can be reproducibly judged, while the signal intensity of the disk and bilaminar zone and the osseous changes are subject to wide observer variations.

Adolescent↗

[Systemic-psychodynamic model for family evaluation].

In this paper a family evaluation instrument called systemic-psychodynamic family evaluation model is described. Also, the second stage of the validation study of this instrument is presented (which deals with the inter-observers variation). Twenty families were studied. They were assessed always by the same interviewers designated as experts. They are all family therapy specialists and their assessment was used as the evaluation reference standard or "gold standard". The observers were psychiatrists without previous training in family therapy. For the purpose of the interview, both experts and observers were blind to the medical diagnosis of the patients. During the first stage of the validation study the observers did not have a reference guide which resulted in a low concordance rating. For the second stage, a 177 item guide was used and a considerable increase in the concordance rating was observed. Validation studies like the one used here are of considerable value to increase the reliability and further utilisation of evaluation instruments of this type.

Evaluation Studies as Topic↗

[The limited detection of lung cancer on chest X-rays].

In a study of everyday clinical practice, the diagnosis 'lung cancer' was not made on the chest X-ray initially in one-fifth of the cases, even though in retrospect the lesions had been visible on the chest X-ray. In nearly half of these cases, the diagnosis had been missed at least twice on succeeding X-rays of the patient in question. Most often, superimposed structures are responsible for having missed lesions on the chest X-ray; this was the case in 71% of the patients in whom a lesion was missed. The intra- and inter-observer variation in the detection of small tumours on the chest X-ray are quite large (kappa: 0.38 and 0.48, respectively). Providing clinical information or previous chest X-rays for purposes of comparison does not improve the observer performance. Separate evaluation by two assessors ('double reading') also does not improve the results significantly. Simultaneous evaluation ('dual reading') improves the sensitivity slightly (from 28 to 37%), but has hardly any effect on the specificity (from 93 to 92%), thus improving the results somewhat. The results with computed tomography are much better (high sensitivity but low specificity). A CT-scan of the chest seems indicated in case of a suspicion of lung cancer and/or when there is a (slight) suspicion of lung cancer on the basis of the chest X-ray.

Humans↗

Is the penile brachial index a reproducible and useful measurement?

The intra- and inter-observer variation in the measurement of the penile brachial index (PBI) was prospectively assessed in 30 patients. An appreciable error was discovered that cast doubt on the reliability of the measurements. Up to 20% of patients deemed normal by one observer would be deemed abnormal by a second. The PBI appears to be an inaccurate and poorly reproducible test of penile blood flow which can lead to a false diagnosis and subsequent management of impotent patients. There would appear no justification for the continued use of the penile brachial index in the assessment of erectile dysfunction.

Adult↗

Diagnostic problems of early leprosy in field studies.

A Series of exercises were undertaken in order to develop methodology for consistency and reliability of clinical diagnosis of leprosy under field conditions in longitudinal studies. It was observed in initial studies that the field investigators could miss about 35% of cases of leprosy, mostly those with early manifestations. After training and experience, the proportion of missed cases came down to about 20%. In about 14% of females with patches suggestive of leprosy the patches were present in the covered areas of the body and so are likely to be missed during examination in field situations. One hundred forty two individuals with suspicious and definite leprosy lesions detected by paramedical workers were examined by a senior medical officer experienced in leprosy on two different occasions at an interval of three months for leprosy diagnosis. The concordance rates for diagnosis and classification of leprosy were about 80% and 70% respectively; and corresponding values for kappa were 0.59 and 0.62 similar to earlier experiences in inter-observer variation studies.

Adolescent↗

Long-term reliability and observer comparisons in the radiographic diagnosis of periapical disease.

AIM: The aim of this study was to evaluate and compare the long-term diagnostic consistency of two examiners, an endodontist and a radiologist, and to make comparisons with findings recorded by an observer with more recent scientific and clinical experience in endodontics. METHODOLOGY: Three groups, each consisting of 20 full mouth series of intraoral radiographs, with 79, 93 and 85 endodontically-treated roots, respectively, were successively evaluated for periapical disease. Evaluations were at first performed separately by the three observers. Disagreement and difficult, borderline cases were subjected to joint evaluation. Intra- and interexaminer comparisons were made. For two of the observers the observations were compared with findings recorded several years before for the same cases in the same radiographs. RESULTS: The intra- and interobserver long-term reliability of the two original examiners resulted in 83% overall agreement, the kappa values were 0.54, 0.57 and 0.53. Comparisons between all three observers disclosed 82%, 85% and 86% agreement and kappa values 0.55, 0.58 and 0.60. The joint evaluations and decisions did not indicate a dominating influence from any of the observers. CONCLUSIONS: The long-term reliability of the two original observers was judged as being satisfactory. All three observers judged the overall disease status of the material in the same way. The joint discussions of selected cases might reduce observer variation to an acceptable level, avoid a number of false recordings and increase the reliability and validity of the findings.

Humans↗

[Interobserver variation of the sonographic diagnosis of orbital floor fractures and fractures of the infraorbital margin].

PURPOSE: The aim of the study was to evaluate the interobserver variation of the ultrasound diagnosis of orbital floor fractures and fractures of the infraorbital rim. MATERIAL AND METHODS: A total of 25 patients with a clinical diagnosis of an orbital trauma were investigated prospectively by computed tomography (CT) and ultrasonography (US). Inter-observer variation was calculated using the lambda coefficient (lambda). The US images were reassessed by two inexperienced investigators. RESULTS: The lambda value for the US investigation of the orbital floor showed poor reliability comparing the US findings with the results of the re-investigators. The comparison between the two re-investigators showed a good reliability for the US evaluation of the orbital floor. The lambda for the US investigation of the infraorbital margin showed a good reliability comparing the US findings with the results of the both re-investigators. The comparison of the two re-investigators showed a good reliability as well. CONCLUSION: Ultrasound is not yet an alternative method for the evaluation of orbital floor fractures and fractures of the infraorbital margin. To replace CT which is accepted as the current gold standard, further studies have to be done to reach a better diagnostic quality of the method and to achieve a better calibration of the investigations.

Adolescent↗

Interobserver variation in postimplant computed tomography contouring affects quality assessment of prostate brachytherapy.

PURPOSE: Permanent seed implants are accepted treatment of early stage prostate cancer. Implant quality is assessed by post implant CT-based dosimetry but prostate contours on CT images are obscured by metallic seed artefact and edema. Outcome depends on implant quality, but perceived implant quality depends on accurate prostate contouring. This study documents inter observer variation in prostate contouring on post implant CT scans. METHODS AND MATERIALS: Ten patients had implant dosimetry calculated on 4 copies of the post implant CT scan. Prostate contours from MRI-CT fusion were the gold standard for prostate edge identification. CTs were contoured by an experienced prostate brachytherapist matching CT images to the pre implant TRUS, and by 2 GU radiation oncologists experienced in conformal radiotherapy planning. Dosimetry was compared to that obtained using MRI-CT fusion in terms of D90 and V100. RESULTS: Contours and dosimetry were not reproducible among the 3 observers. The V100's of the experienced brachytherapist differed from that of MRI-CT fusion by a mean of 2.4% compared to 9.1% and 4.4% for observers 1 and 2, and the D90 by a mean of 9.3 Gy compared to 30.3 and 14.4 Gy for observers 1 and 2. CONCLUSIONS: Quality assessment of prostate brachytherapy based on 1 month post implant CT is difficult. This may obscure the dose-response relationship in brachytherapy as well as create problems for quality assurance in multicentre trials evaluating brachytherapy against standard modalities. Whenever possible, MRI-CT fusion should be employed to verify prostate contours post implant.

Brachytherapy↗

Molecular genetic diversity in 5 populations of Madhya Pradesh, India.

This paper presents data on the distribution of 3 amplified fragment length polymorphisms (D1S80, APOB, and YNZ22) in 5 populations of Central India. Using the polymerase chain reaction technique, 3 caste (Brahmin, Khatri, and Dhimer) and 2 tribal (Gond and Baiga) populations were studied for the 3 loci. The allelic variations observed in the caste populations are compatible with those of many Caucasian populations, but the caste populations showed significant overall and interpopulation variability within the region. D1S80 allele *24 varied from 32% (Dhimers) to 42% (Brahmins). Allele *18 was not observed in Baiga tribal populations, but in caste populations it varied from 11% (Dhimers) to 24% (Brahmins). Both tribal populations showed higher frequencies of allele *31 (17%-18%). For APOB, caste populations again showed bimodal distribution of alleles *35 and *37, but in tribal populations higher allele numbers (*47, *49) were also frequent. For YNZ22, extensive variation was observed for all populations studied. Allele *4 was the most common in caste populations, while alleles *2, *7, and *10 were prominent in tribal populations. The level of gene differentiation is not very high for the 3 systems studied in the 5 populations. Overall, allele frequency distribution, heterozygosity, and genetic diversity analysis show that the genetic diversity observed is socially and geographically structured.

Alleles↗

Efforts to improve interobserver agreement in histopathological grading.

The present study aimed to assess the interobserver variation in histopathological grading of 88 slides by four experienced pathologists who, before the start of the study, reached consensus about the method of grading through a joint session behind a discussion microscope. The results were compared with two previous studies, the first assessing the observer variation under normal conditions, the second doing the same after theoretical agreement about which morphological characteristics were relevant for grading. In the present study the pathologists first made a provisional diagnosis on low power view, followed by a final diagnosis on high power view, scoring various morphological characteristics as in the second study. The unweighted and weighted group kappa values for the final diagnosis were 0.41 and 0.71 respectively in the present study (after the consensus meeting), compared to 0.33 and 0.70 respectively in the second study (after only theoretical consensus), and 0.28 and 0.55 in the first study (without consensus). We conclude that a consensus meeting appears to be useful to improve the interobserver agreement.

Female↗

Repeatability of an optimised lower body model.

The optimisation technique, optimised lower-limb gait analysis (OLGA), is described together with a preliminary study of repeatability compared to an implementation of the Newington-Helen Hayes gait model. The study of repeatability used a single healthy subject, three physiotherapists as observers and provided approximately 100 gait cycles. Improvement in intra- and inter-observer repeatability of the lower limb model was found for OLGA, indicated by significantly lower standard deviations (S.D.s) in local marker co-ordinate (a measure of rigidity of the marker attachment), together with reduced S.D. in the estimated length of the bone segments. The S.D. in the inter-hip distance measured by OLGA (N = 25) was found to be only 2.4 mm. The repeatability of clinically significant output variables (joint angles, forces and moments) was also improved, with the inter-observer variations for joint angles and forces being significantly lower for OLGA. Euler angle component cross-talk effects frequently reported at the hip, knee and ankle were also successfully reduced by OLGA, this being the chief cause of the improvement in inter-observer repeatability.

Algorithms↗

Pattern of group I fibre projections from ankle flexor and extensor muscles in man.

Variations in the H-reflex of soleus, tibialis anterior, quadriceps and short head of biceps femoris muscles were studied in normal man, preceded by a conditioning stimulus applied to either gastrocnemius medialis, the inferior branch of soleus or the common peroneal nerve. The observed variations were evoked by low threshold afferents, had a very short latency suggesting oligosynaptic linkage and disappeared during a selective ischaemic blockade of group I fibres; they were therefore regarded as due to group I fibre stimulation. Biphasic variations were observed in almost all cases: evidence is presented that the early low threshold effects, facilitatory for synergistic and inhibitory for antagonistic motoneurone pools, are due to stimulation of Ia fibres, while the subsequent opposite effects which had a slightly higher threshold are Ib in origin. Even though the pattern of projections of group I fibres from ankle flexors and extensors is qualitatively the same in normal man as in the spinal cat, large quantitative differences are observed; in normal man the effects of group I fibres from ankle flexors and extensors upon close synergistic and direct antagonistic motoneurone pools are weak, and often negligible, whereas they are extremely potent upon quadriceps motoneurones.

Adult↗

The anorectal angle is not a reliable parameter on defaecating proctography.

Proctography is a standard method of investigating anorectal disorders. The parameters derived from this X-ray include the anorectal angle. The reproducibility of this measurement was assessed in 43 defaecating proctograms viewed by four observers on two separate occasions. Measurements were made at rest and during defaecation straining. Significant intra- and inter-observer variation was found. The anorectal angle is an inaccurate measurement, and should be interpreted with caution.

Anal Canal↗

Larval habitats and species composition of mosquitoes in Darjeeling Himalayas, India.

BACKGROUND & OBJECTIVES: A preliminary survey of larval mosquito habitats and temporal variation in mosquito diversity in the hill town of Darjeeling, India was made during 2003, for a qualitative and quantitative assessment of mosquito distribution. METHODS: The possible larval habitats of mosquitoes were surveyed and the species diversity in the sites positive for mosquito larvae was noted. Bi-weekly sampling from a particular habitat was carried out to reveal the temporal variation in mosquito species. RESULTS: A good number of lentic aquatic habitats were found to be hosting mosquito immatures, though difference in the physical and biological features of these habitats was prominent. Altogether, immatures of six mosquito species, belonging to four genera--Aedes, Armigeres, Culex and Toxorhynchites were noted with significant difference in temporal variation in their relative and absolute numbers. A positive correlation (r = + 0.707) was found between population of the prey mosquito immatures and the population of immatures of Tx. splendens. The species diversity index (H') for the mosquitoes remained between 0.87 and 1.53. The evenness components ranged between 54.03 and 95.03% and differed significantly. INTERPRETATION & CONCLUSION: In the present study, the aquatic bodies could be categorised into six types depending on the size and structural complexity that may account for the observed variation in the species composition of the larval habitats. In addition to this, other factors like temperature, rainfall and other related climatic attributes may be responsible for the observed species variation, which needs to be confirmed through further studies.

Animals↗

Visual interpretation of the effect of maternal betamethasone administration on the fetal heart rate pattern.

This study was performed to interpret visually the effect of maternal betamethasone administration on the fetal heart patterns in women at risk for preterm delivery. These effects had previously only been described using computer analysis. It was a retrospective study of 54 women who had received two doses of betamethasone 12 hours apart and had fetal heart tracings before, and on the first and second days after steroid administration. The primary outcome measure was change in short-term variability and secondary outcome measures were change in long-term variability, baseline fetal heart rate, accelerations and decelerations. Inter-observer variation of fetal heart rate variability was also measured. Betamethasone caused a significant reduction in short-term variability 1 and 2 days after administration. There was no effect on baseline fetal heart rate or on variable decelerations. A transient decrease in fetal heart rate accelerations was observed on the first day after steroid administration but not on the second day. Inter-observer variability was good between the two observers (GJH and BVI). In most clinical settings, surveillance of fetal wellbeing is achieved most commonly by visual inspection of the fetal heart tracings and not by computer analysis. Clinicians should be aware of the effects of betamethasone on these tracings when considering interventions and/or other tests of fetal wellbeing.

Adolescent↗