Assessment of inter-examiner agreement and variability in the manual classification of auditory brainstem response

Abstract Background: The analysis of the Auditory Brainstem Response (ABR) is of fundamental importance to the investigation of the auditory system behaviour, though its interpretation has a subjective nature because of the manual process employed in its study and the clinical experience required for its analysis. When analysing the ABR, clinicians are often interested in the identification of ABR signal components referred to as Jewett waves. In particular, the detection and study of the time when these waves occur (i.e., the wave latency) is a practical tool for the diagnosis of disorders affecting the auditory system. Significant differences in inter-examiner results may lead to completely distinct clinical interpretations of the state of the auditory system. In this context, the aim of this research was to evaluate the inter-examiner agreement and variability in the manual classification of ABR. Methods: A total of 160 ABR data samples were collected, for four different stimulus intensity (80dBHL, 60dBHL, 40dBHL and 20dBHL), from 10 normal-hearing subjects (5 men and 5 women, from 20 to 52 years). Four examiners with expertise in the manual classification of ABR components participated in the study. The Bland-Altman statistical method was employed for the assessment of inter-examiner agreement and variability. The mean, standard deviation and error for the bias, which is the difference between examiners’ annotations, were estimated for each pair of examiners. Scatter plots and histograms were employed for data visualization and analysis. Results: In most comparisons the differences between examiner’s annotations were below 0.1 ms, which is clinically acceptable. In four cases, it was found a large error and standard deviation (>0.1 ms) that indicate the presence of outliers and thus, discrepancies between examiners. Conclusions: Our results quantify the inter-examiner agreement and variability of the manual analysis of ABR data, and they also allows for the determination of different patterns of manual ABR analysis.

The ocean’s role in setting the mean position of the Inter-Tropical Convergence Zone

Through study of observations and coupled climate simulations, it is argued that the mean position of the Inter-Tropical Convergence Zone (ITCZ) north of the equator is a consequence of a northwards heat transport across the equator by ocean circulation. Observations suggest that the hemispheric net radiative forcing of climate at the top of the atmosphere is almost perfectly symmetric about the equator, and so the total (atmosphere plus ocean) heat transport across the equator is small (order 0.2 PW northwards). Due to the Atlantic ocean’s meridional overturning circulation, however, the ocean carries significantly more heat northwards across the equator (order 0.4 PW) than does the coupled system. There are two primary consequences. First, atmospheric heat transport is southwards across the equator to compensate (0.2 PW southwards), resulting in the ITCZ being displaced north of the equator. Second, the atmosphere, and indeed the ocean, is slightly warmer (by perhaps 2 °C) in the northern hemisphere than in the southern hemisphere. This leads to the northern hemisphere emitting slightly more outgoing longwave radiation than the southern hemisphere by virtue of its relative warmth, supporting the small northward heat transport by the coupled system across the equator. To conclude, the coupled nature of the problem is illustrated through study of atmosphere–ocean–ice simulations in the idealized setting of an aquaplanet, resolving the key processes at work.