Agreement between self-report and medical records on signs and symptoms of respiratory illness

Background: Information on patient symptoms can be obtained by patient self-report or medical records review. Both methods have limitations. Aims: To assess the agreement between self-report and documentation in the medical records of signs/symptoms of respiratory illness (fever, cough, runny nose, sore throat, headache, sinus problems, muscle aches, fatigue, earache, and chills). Methods: Respondents were 176 research participants in the Hutterite Influenza Prevention Study during the 2008-2009 influenza season with information about the presence or absence of signs/symptoms from both self-report and primary care medical records. Results: Compared with medical records, lower proportions of self-reported fever, sore throat, earache, cough, and sinus problems were found. Total agreements between self-report and medical report of symptoms ranged from 61% (for sore throat) to 88% (for muscle aches and earache), with kappa estimates varying from 0.05 (for chills) to 0.41 (for cough) and 0.51 (for earache). Negative agreement was considerably higher (from 68% for sore throat to 93% for muscle aches and earache) than positive agreement (from 13% for chills to 58% for earache) for each symptom except cough where positive agreement (77%) was higher than negative agreement (64%). Agreements varied by age group. We found better agreement for earache (kappa=0.62) and lower agreements for headache, sinus problems, muscle aches, fatigue, and chills in older children (aged =5 years) and adults. Conclusions: Agreements were variable depending on the specific symptom. Contrary to research in other patient populations which suggests that clinicians report fewer symptoms than patients, we found that the medical record captured more symptoms than selfreport. Symptom agreement and disagreement may be affected by the perspectives of the person experiencing them, the observer, the symptoms themselves, measurement error, the setting in which the symptoms were observed and recorded, and the broader community and cultural context of patients. © 2012 Primary Care Respiratory Society UK. All rights reserved.

Inter-observer agreement in evaluating the anterior chamber angle by ultrasound biomicroscopy

Purpose. To determine the agreement between observers in estimating the configuration of the human anterior chamber angle (ACA) using ultrasound biomicroscopy (UBM). Methods. Two masked clinicians used UBM images to estimate, in 41 eyes, the configuration of the ACA, especially (1) the position of contact between the peripheral iris and the inside of the eye wall, (2) the angularity of the approach to the ACA, and (3) the curvature of the peripheral iris. Agreement between observers was evaluated by the kappa statistic. Results. Inter-observer agreement in assessing the iris insertion (kappa = 0.79), angular width (Kappa = 0.95), and the peripheral iris curvature (kappa = 0.84) was high. Conclusions. The agreement between observers in evaluating the anterior chamber angle configuration by UBM was excellent.

Clinical agreement among glaucoma experts in the detection of glaucomatous changes of the optic disk using simultaneous stereoscopic photographs

PURPOSE: To evaluate the clinical agreement in the detection of optic disk changes in patients with glaucoma using simultaneous stereophotographs. DESIGN: Masked-observer variability study. METHODS: Ten glaucoma specialists examined pairs of simultaneous stereophotographs of glaucomatous and control optic disks to determine whether there were changes compatible with progression of glaucomatous damage. RESULTS: Intraobserver agreement had a kappa value ranging from 0.55 to 0.78. Interobserver agreement among the glaucoma specialists had a kappa value ranging from 0.34 to 0.68. CONCLUSION: Clinical examination of stereophotographs to detect optic disk changes in glaucoma patients has limitations associated with suboptimal reproducibility. © 2003 by Elsevier Inc. All rights reserved.

Agreement between clinical and ultrasound biomicroscopy findings in different types of glaucoma

Purpose. To evaluate agreement between clinical examination (slit lamp examination and gonioscopy) and ultrasound biomicroscopy (UBM) in characterizing various features of the anterior chamber angle and adjacent structures. Methods. Twenty-eight patients (51 eyes) with open angle glaucoma (14), closed angle glaucoma (4), narrow angle and/or plateau iris (10), who had undergone UBM between March 94 and September 95 were studied. Evaluated parameters included angle width, iris configuration and presence of angle closure. The UBMs were reviewed in a masked fashion. Results. In 87.8% of cases there was agreement (within 10 degrees) between gonioscopic and UBM estimates of angle width. In all cases with greater than 10 degrees difference (12.2%) the angle size estimated by UBM was less than that estimated clinically. Iris configuration was graded identically in 51% of cases; the majority of disagreements (76.1%) occurred in cases graded as "regular" by gonioscopy and as "steep" by UBM. Angle closure was judged to be present more frequently by UBM. Conclusions. UBM and gonioscopy do not necessarily yield identical values for angle width, iris configuration, and presence of angle closure.

Systematic review of the agreement of tonometers with Goldmann applanation tonometry

OBJECTIVE: To assess the agreement of tonometers available for clinical practice with the Goldmann applanation tonometer (GAT), the most commonly accepted reference device.

DESIGN: A systematic review and meta-analysis of directly comparative studies assessing the agreement of 1 or more tonometers with the reference tonometer (GAT).

PARTICIPANTS: A total of 11 582 participants (15 525 eyes) were included.

METHODS: Summary 95% limits of agreement (LoA) were produced for each comparison.

MAIN OUTCOME MEASURES: Agreement, recordability, and reliability.

RESULTS: A total of 102 studies, including 130 paired comparisons, were included, representing 8 tonometers: dynamic contour tonometer, noncontact tonometer (NCT), ocular response analyzer, Ocuton S, handheld applanation tonometer (HAT), rebound tonometer, transpalpebral tonometer, and Tono-Pen. The agreement (95% limits) seemed to vary across tonometers: 0.2 mmHg (-3.8 to 4.3 mmHg) for the NCT to 2.7 mmHg (-4.1 to 9.6 mmHg) for the Ocuton S. The estimated proportion within 2 mmHg of the GAT ranged from 33% (Ocuton S) to 66% and 59% (NCT and HAT, respectively). Substantial inter- and intraobserver variability were observed for all tonometers.

CONCLUSIONS: The NCT and HAT seem to achieve a measurement closest to the GAT. However, there was substantial variability in measurements both within and between studies.

Intraobserver and interobserver agreement in evaluating the anterior chamber angle configuration by ultrasound biomicroscopy

Purpose: To determine the intra- and interobserver agreement in assessing the configuration of the human anterior chamber angle using ultrasound biomicroscopy (UBM). Methods: Two masked clinicians used ubm images to estimate, in 41 eyes, (a) the position of contact between the peripheral iris and the inside of the eye wall, (b) the angular size of the anterior chamber angle (ACA), and (c) the curvature of the peripheral iris. Both observers, masked to the previous results, examined the same images in a second session. Agreement was evaluated using the unweighted ? statistic. Results: Intraobserver agreement in assessing the iris insertion, angular width, and the iris curvature was high (range of ? values, 0.83-0.92). Interobserver agreement in evaluating the level of iris insertion (? = 0.79), the angular width (? = 0.95), and the iris curvature (? = 0.84) was also high. Conclusion: The agreement within the same observer and between observers in evaluating the ACA configuration by UBM was excellent.

The Irish High Court Issues its First Order on a Commitment Agreement between the NCA and an Undertaking (Fitflop)

The Irish Competition (Amendment) Act 2012 introduced court-endorsed commitment agreements to Irish competition law. The new section 14B of the principal Competition Act 2002 provides for making commitment agreements between the Irish Competition and undertakings an order of the Irish High Court. This piece, first, investigates the prior Irish practice regarding commitment or settlement agreements and its legal basis. It looks then into the newly introduced rules on court-endorsed commitment agreements. Finally, before concluding, it points to the first instance of their application — to an order issued by the High Court in the FitFlop case in December 2012, which came into effect in February 2013.

A Probe-Goal Approach to Agreement and Incorporation Restrictions in Southern Tiwa

Southern Tiwa (Tanoan) exhibits agreement with up to three arguments (ergative, absolutive, dative). This agreement is subject to certain restrictions resembling the Person-Case Constraint paradigm (Bonet 1991). Moreover, there is a correlation between agreement restrictions and conditions on (the obviation of) noun-incorporation in Southern Tiwa, as explicitly and elegantly captured by Rosen (1990) in terms of a heterogeneous feature hierarchy and rules of association. We attempt to recast Rosen’s central insights in terms of Anagnostopoulou’s probe-sharing model of Person-Case Constraint effects (Anagnostopoulou 2003, 2006), to show that the full range of Southern Tiwa agreement and (non-)incorporation restrictions can be given a single, unified analysis within the probe-goal-Agree framework of Chomsky (2001). In particular, we argue that Southern Tiwa’s triple-agreement system is characterized by (a) an independent class probe located on the heads T and v, and (b) a rule that allows this class probe to be deleted in the context of local-person T-agreement. The various restrictions on agreement and non-incorporation then reduce to a single source: failure of class-valuation with DP (as opposed to NP) arguments.

Load Balanced Scalable Byzantine Agreement through Quorum Building, with Full Information

We address the problem of designing distributed algorithms for large scale networks that are robust to Byzantine faults. We consider a message passing, full information model: the adversary is malicious, controls a constant fraction of processors, and can view all messages in a round before sending out its own messages for that round. Furthermore, each bad processor may send an unlimited number of messages. The only constraint on the adversary is that it must choose its corrupt processors at the start, without knowledge of the processors’ private random bits.

A good quorum is a set of O(logn) processors, which contains a majority of good processors. In this paper, we give a synchronous algorithm which uses polylogarithmic time and Õ(vn) bits of communication per processor to bring all processors to agreement on a collection of n good quorums, solving Byzantine agreement as well. The collection is balanced in that no processor is in more than O(logn) quorums. This yields the first solution to Byzantine agreement which is both scalable and load-balanced in the full information model.

The technique which involves going from situation where slightly more than 1/2 fraction of processors are good and and agree on a short string with a constant fraction of random bits to a situation where all good processors agree on n good quorums can be done in a fully asynchronous model as well, providing an approach for extending the Byzantine agreement result to this model.

'Whatever You Say, Say Nothing' : Researching Memory & Identity in Mid-Ulster, 1945-1969

The influence of collective memory on political identity in Ireland has been well documented. It has particular force in Northern Ireland where there is fundamental disagreement about how and why the conflict erupted and how it should be resolved. This article outlines some of the issues encountered by an ‘insider’ when attempting to record and analyse the conflicting memories of a range of Protestants and Catholics who grew up in Mid-Ulster in the decades preceding the Troubles. In particular, it considers the challenges and opportunities presented by a two-pronged approach to oral history: using testimony as evidence about historical experience in the past and as evidence about historical memory – both collective and individual – in the present.