The reasons for discrepancies in target volume delineation: a SASRO study on head-and-neck and prostate cancer

But : comprendre les raisons des divergences observées dans le tracé des volumes cibles entre radio-oncologues. Matériel et méthodes : 18 centres suisses de radio-oncologie ont été invités à tracer les volumes pour un cas de cancer de la prostate et pour un cas de cancer de la sphère ORL. Nous avons également envoyé un questionnaire pour évaluer d'une part les différences dans la définition- des volumes (GTV [ gross tumor volume= volume tumoral macroscopique ], CTV [clinical tumor volume= volume de la tumeur clinique, macroscopique et microscopique], PTV [planning target volume= volume cible pour la planification], et d'autre part des variations dans les marges appliquées et les ganglions considérés à risque. Pour chaque centre, on a calculé la corrélation entre les marges qui ont été dessinées et celles qui ont été annoncées. Nous avons inclus dans le questionnaire une série de questions non spécifiques pour évaluer les méthodes de planification utilisées dans les différents centres. Résultats : Dans les 2 situations cliniques, on a mis en évidence de relativement grandes différences tant au niveau des volumes dessinés par les différents centres que dans leur définition des volumes. La corrélation entre les marges dessinées et définies était assez correcte dans le cas de la prostate mais médiocre dans le cas ORL. Le questionnaire a révélé d'importantes différences dans les méthodes de planification utilisées par les centres. Conclusion : Ces grandes différences peuvent être expliquées par, (1) une connaissance/interprétation variable des définitions ICRU, (2) des appréciations différentes de l'extension tumorale microscopique potentielle, (3) des difficultés dans l'identification du GTV, (4) des différences de concept, et (5) des différences entre la théorie (par ex. la description des marges) et la pratiqué (par ex. les marges dessinées).

Measuring discrepancies between knowledge, preoccupation and fear of aids in populations.

A simple tool to quantify discrepancies between knowledge, preoccupation and fear regarding hiv and aids is presented. This tool is based on standard questions available in health surveys. Some results using recent Swiss data are presented, and the method is discussed.

Discrepancies between clinical needs and helpseeking behaviors in co-occurring posttraumatic stress and alcohol use disorders.

OBJECTIVE: The aim of the study was to compare subjects dually diagnosed with posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) to those with only one or none of these conditions regarding helpseeking needs and behaviors. METHOD: Data from a large community sample (N=3694) were used to assess the associations among lifetime PTSD and AUD, other psychiatric disorders, clinical characteristics and lifetime helpseeking behaviors derived from a semi-structured interview. RESULTS: Comorbid individuals had more severe clinical profiles and were more impaired than individuals with either PTSD or AUD alone or those with no/other psychiatric conditions. However, they did not differ in overall helpseeking behavior from any other group. Those with comorbid PTSD/AUD were even less likely than the other groups to seek help for depression and anxiety disorders through specific treatment facilities or the use of prescribed psychotropic drugs. CONCLUSIONS: Despite a greater need for treatment the comorbid group did not seek more help than the others. Their lower use of prescribed drugs supports the self-medication hypothesis, suggesting that those individuals relieve their symptoms through higher alcohol use instead. Our findings underline the need for health care facilities to encourage helpseeking behavior in the aftermath of stressful life events.

Clinico-Pathological discrepancies in the Diagnosis of Causes of Maternal Death in Sub-Saharan Africa: Retrospective Analysis

Background Maternal mortality is a major public-health problem in developing countries. Extreme differences in maternal mortality rates between developed and developing countries indicate that most of these deaths are preventable. Most information on the causes of maternal death in these areas is based on clinical records and verbal autopsies. Clinical diagnostic errors may play a significant role in this problem and might also have major implications for the evaluation of current estimations of causes of maternal death. Methods and Findings A retrospective analysis of clinico-pathologic correlation was carried out, using necropsy as the gold standard for diagnosis. All maternal autopsies (n ¼ 139) during the period from October 2002 to December 2004 at the Maputo Central Hospital, Mozambique were included and major diagnostic discrepancies were analyzed (i.e., those involving the cause of death). Major diagnostic errors were detected in 56 (40.3%) maternal deaths. A high rate of false negative diagnoses was observed for infectious diseases, which showed sensitivities under 50%: HIV/AIDS-related conditions (33.3%), pyogenic bronchopneumonia (35.3%), pyogenic meningitis (40.0%), and puerperal septicemia (50.0%). Eclampsia, was the main source of false positive diagnoses, showing a low predictive positive value (42.9%). Conclusions Clinico-pathological discrepancies may have a significant impact on maternal mortality in sub-Saharan Africa and question the validity of reports based on clinical data or verbal autopsies. Increasing clinical awareness of the impact of obstetric and nonobstetric infections with their inclusion in the differential diagnosis, together with a thorough evaluation of cases clinically thought to be eclampsia, could have a significant impact on the reduction of maternal mortality.

Clinico-Pathological discrepancies in the Diagnosis of Causes of Maternal Death in Sub-Saharan Africa: Retrospective Analysis

Background Maternal mortality is a major public-health problem in developing countries. Extreme differences in maternal mortality rates between developed and developing countries indicate that most of these deaths are preventable. Most information on the causes of maternal death in these areas is based on clinical records and verbal autopsies. Clinical diagnostic errors may play a significant role in this problem and might also have major implications for the evaluation of current estimations of causes of maternal death. Methods and Findings A retrospective analysis of clinico-pathologic correlation was carried out, using necropsy as the gold standard for diagnosis. All maternal autopsies (n ¼ 139) during the period from October 2002 to December 2004 at the Maputo Central Hospital, Mozambique were included and major diagnostic discrepancies were analyzed (i.e., those involving the cause of death). Major diagnostic errors were detected in 56 (40.3%) maternal deaths. A high rate of false negative diagnoses was observed for infectious diseases, which showed sensitivities under 50%: HIV/AIDS-related conditions (33.3%), pyogenic bronchopneumonia (35.3%), pyogenic meningitis (40.0%), and puerperal septicemia (50.0%). Eclampsia, was the main source of false positive diagnoses, showing a low predictive positive value (42.9%). Conclusions Clinico-pathological discrepancies may have a significant impact on maternal mortality in sub-Saharan Africa and question the validity of reports based on clinical data or verbal autopsies. Increasing clinical awareness of the impact of obstetric and nonobstetric infections with their inclusion in the differential diagnosis, together with a thorough evaluation of cases clinically thought to be eclampsia, could have a significant impact on the reduction of maternal mortality.

Discrepancies over the onset of surfactant monomer aggregation interpreted by fluorescence, conductivity and surface tension methods

Molecular probe techniques have made important contributions to the determination of microstructure of surfactant assemblies such as size, stability, micropolarity and conformation. Conductivity and surface tension were used to determine the critical aggregation concentration (cac) of polymer-surfactant complexes and the critical micellar concentration (cmc) of aqueous micellar aggregates. The results are compared with those of fluorescent techniques. Several surfactant systems were examined, 1-butanol-sodium dodecylsulfate (SDS) mixtures, solutions containing poly(ethylene oxide)-SDS, poly(vinylpyrrolidone)-SDS and poly(acrylic acid)-alkyltrimethylammonium bromide complexes. We found differences between the cac and cmc values obtained by conductivity or surface tension and those obtained by techniques which use hydrophobic probe.

Discrepancies between clinical diagnoses and autopsy findings

Autopsy examination is considered to be an essential element for medical auditing and teaching. Despite the significant progress in diagnostic procedures, autopsy has not always confirmed the clinical diagnosis. In the present study, we compared the diagnosis recorded on medical charts with reports of 96 autopsies performed at the University Teaching Hospital of the Faculdade de Medicina de Botucatu, Botucatu, SP, Brazil, between 1975 and 1982, and of 156 autopsies performed at the same institution between 1992 and 1996. The clinical diagnosis of the basic cause of death was confirmed at autopsy in 77% of cases. The percent confirmation fell to 60% when the immediate terminal cause of death was considered, and in 25% of cases, the terminal cause was only diagnosed at autopsy. The discrepancies between clinical and autopsy diagnosis were even larger for secondary diagnoses: 50% of them were not suspected upon clinical diagnosis. Among them, we emphasize the diagnosis of venous thromboses (83%), pulmonary embolisms (80%), bronchopneumonias (46%) and neoplasias (38%). Iatrogenic injuries were very frequent, and approximately 90% of them were not described in clinical reports. Our results suggest that highly sensitive and specific diagnostic tests are necessary but cannot substitute the clinical practice for the elaboration of correct diagnoses.

Investigation of discrepancies in satellite rainfall estimates over Ethiopia

Tropical Applications of Meteorology Using Satellite and Ground-Based Observations (TAMSAT) rainfall estimates are used extensively across Africa for operational rainfall monitoring and food security applications; thus, regional evaluations of TAMSAT are essential to ensure its reliability. This study assesses the performance of TAMSAT rainfall estimates, along with the African Rainfall Climatology (ARC), version 2; the Tropical Rainfall Measuring Mission (TRMM) 3B42 product; and the Climate Prediction Center morphing technique (CMORPH), against a dense rain gauge network over a mountainous region of Ethiopia. Overall, TAMSAT exhibits good skill in detecting rainy events but underestimates rainfall amount, while ARC underestimates both rainfall amount and rainy event frequency. Meanwhile, TRMM consistently performs best in detecting rainy events and capturing the mean rainfall and seasonal variability, while CMORPH tends to overdetect rainy events. Moreover, the mean difference in daily rainfall between the products and rain gauges shows increasing underestimation with increasing elevation. However, the distribution in satellite–gauge differences demon- strates that although 75% of retrievals underestimate rainfall, up to 25% overestimate rainfall over all eleva- tions. Case studies using high-resolution simulations suggest underestimation in the satellite algorithms is likely due to shallow convection with warm cloud-top temperatures in addition to beam-filling effects in microwave- based retrievals from localized convective cells. The overestimation by IR-based algorithms is attributed to nonraining cirrus with cold cloud-top temperatures. These results stress the importance of understanding re- gional precipitation systems causing uncertainties in satellite rainfall estimates with a view toward using this knowledge to improve rainfall algorithms.

Aerosol inorganic composition at a tropical site: Discrepancies between filter-based sampling and a semi-continuous method

The concentrations of the water-soluble inorganic aerosol species, ammonium (NH4+), nitrate (NO3-), chloride (Cl-), and sulfate (SO42-), were measured from September to November 2002 at a pasture site in the Amazon Basin (Rondnia, Brazil) (LBA-SMOCC). Measurements were conducted using a semi-continuous technique (Wet-annular denuder/Steam-Jet Aerosol Collector: WAD/SJAC) and three integrating filter-based methods, namely (1) a denuder-filter pack (DFP: Teflon and impregnated Whatman filters), (2) a stacked-filter unit (SFU: polycarbonate filters), and (3) a High Volume dichotomous sampler (HiVol: quartz fiber filters). Measurements covered the late dry season (biomass burning), a transition period, and the onset of the wet season (clean conditions). Analyses of the particles collected on filters were performed using ion chromatography (IC) and Particle-Induced X-ray Emission spectrometry (PIXE). Season-dependent discrepancies were observed between the WAD/SJAC system and the filter-based samplers. During the dry season, when PM2.5 (D-p <= 2.5 mu m) concentrations were similar to 100 mu g m(-3), aerosol NH4+ and SO42- measured by the filter-based samplers were on average two times higher than those determined by the WAD/SJAC. Concentrations of aerosol NO3- and Cl- measured with the HiVol during daytime, and with the DFP during day- and nighttime also exceeded those of the WAD/SJAC by a factor of two. In contrast, aerosol NO3- and Cl- measured with the SFU during the dry season were nearly two times lower than those measured by the WAD/SJAC. These differences declined markedly during the transition period and towards the cleaner conditions during the onset of the wet season (PM2.5 similar to 5 mu g m(-3)); when filter-based samplers measured on average 40-90% less than the WAD/SJAC. The differences were not due to consistent systematic biases of the analytical techniques, but were apparently a result of prevailing environmental conditions and different sampling procedures. For the transition period and wet season, the significance of our results is reduced by a low number of data points. We argue that the observed differences are mainly attributable to (a) positive and negative filter sampling artifacts, (b) presence of organic compounds and organosulfates on filter substrates, and (c) a SJAC sampling efficiency of less than 100%.

Discrepancies in solar irradiation data for Stockholm and Athens

The aim of this study is to evaluate the variation of solar radiation data between different data sources that will be free and available at the Solar Energy Research Center (SERC). The comparison between data sources will be carried out for two locations: Stockholm, Sweden and Athens, Greece. For the desired locations, data is gathered for different tilt angles: 0°, 30°, 45°, 60° facing south. The full dataset is available in two excel files: “Stockholm annual irradiation” and “Athens annual irradiation”. The World Radiation Data Center (WRDC) is defined as a reference for the comparison with other dtaasets, because it has the highest time span recorded for Stockholm (1964–2010) and Athens (1964–1986), in form of average monthly irradiation, expressed in kWh/m2. The indicator defined for the data comparison is the estimated standard deviation. The mean biased error (MBE) and the root mean square error (RMSE) were also used as statistical indicators for the horizontal solar irradiation data. The variation in solar irradiation data is categorized in two categories: natural or inter-annual variability, due to different data sources and lastly due to different calculation models. The inter-annual variation for Stockholm is 140.4kWh/m2 or 14.4% and 124.3kWh/m2 or 8.0% for Athens. The estimated deviation for horizontal solar irradiation is 3.7% for Stockholm and 4.4% Athens. This estimated deviation is respectively equal to 4.5% and 3.6% for Stockholm and Athens at 30° tilt, 5.2% and 4.5% at 45° tilt, 5.9% and 7.0% at 60°. NASA’s SSE, SAM and RETScreen (respectively Satel-light) exhibited the highest deviation from WRDC’s data for Stockholm (respectively Athens). The essential source for variation is notably the difference in horizontal solar irradiation. The variation increases by 1-2% per degree of tilt, using different calculation models, as used in PVSYST and Meteonorm. The location and altitude of the data source did not directly influence the variation with the WRDC data. Further examination is suggested in order to improve the methodology of selecting the location; Examining the functional dependence of ground reflected radiation with ambient temperature; variation of ambient temperature and its impact on different solar energy systems; Im pact of variation in solar irradiation and ambient temperature on system output.

Discrepancies between clinical diagnoses and autopsy findings

Autopsy examination is considered to be an essential element for medical auditing and teaching. Despite the significant progress in diagnostic procedures, autopsy has not always confirmed the clinical diagnosis. In the present study, we compared the diagnosis recorded on medical charts with reports of 96 autopsies performed at the University Teaching Hospital of the Faculdade de Medicina de Botucatu, Botucatu, SP, Brazil, between 1975 and 1982, and of 156 autopsies performed at the same institution between 1992 and 1996. The clinical diagnosis of the basic cause of death was confirmed at autopsy in 77% of cases. The percent confirmation fell to 60% when the immediate terminal cause of death was considered, and in 25% of cases, the terminal cause was only diagnosed at autopsy. The discrepancies between clinical and autopsy diagnosis were even larger for secondary diagnoses: 50% of them were not suspected upon clinical diagnosis. Among them, we emphasize the diagnosis of venous thromboses (83%), pulmonary embolisms (80%), bronchopneumonias (46%) and neoplasias (38%). Iatrogenic injuries were very frequent, and approximately 90% of them were not described in clinical reports. Our results suggest that highly sensitive and specific diagnostic tests are necessary but cannot substitute the clinical practice for the elaboration of correct diagnoses.

Marginal and Internal Discrepancies Related to Margin Design of Ceramic Crowns Fabricated by a CAD/CAM System

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Potentially malignant epithelial oral lesions: Discrepancies between clinical and histological diagnosis

OBJECTIVE: To evaluate the discrepancy index between the clinical and histological diagnosis and the prevalence of epithelial dysplasia and carcinoma in 45 patients with potentially malignant epithelial oral lesions (PMEL). PATIENTS AND METHODS: We submitted 45 patients with PMEL to clinical examination and obtained a biopsy from each. The results of histological diagnosis were compared to the clinical diagnosis. RESULTS: Clinical diagnosis showed that the most common PMEL was leukoplakia followed by lichen planus and by actinic cheilitis associated with leukoplakia. The most common site was the buccal mucosa. Histological diagnosis revealed that 46.7% of the PMEL were lichen planus. The discrepancy index between clinical and histological diagnosis was 24.4%. The higher discrepancy index occurred among leukoplakias. The prevalence of epithelial dysplasia and carcinoma was 17.8%. CONCLUSIONS: We conclude that all PMEL should be submitted to a microscopic analysis because the discrepancy between clinical and histological diagnosis was present in a quarter of these lesions. Otherwise, the epithelial dysplasia and carcinoma were more frequent in the leukoplakias.

Discrepancies between abstracts presented at international association for dental research annual sessions from 2004 to 2005 and full-text publication

Purpose. The purpose of this study was to evaluate the discrepancies between abstracts presented at the IADR meeting (2004-2005) and their full-text publication. Material and Methods. Abstracts from the Prosthodontic Section of IADR meeting were obtained. The following information was collected: abstract title, number of authors, study design, statistical analysis, outcome, and funding source. PubMed was used to identify the full-text publication of the abstracts. The discrepancies between the abstract and the full-text publication were examined, categorized as major and minor discrepancies, and quantified. The data were collected and analyzed using descriptive analysis. Frequency and percentage of major and minor discrepancies were calculated. Results. A total of 109 (95.6%) articles showed changes from their abstracts. Seventy-four (65.0%) and 105 (92.0%) publications had at least one major and one minor discrepancies, respectively. Minor discrepancies were more prevalent (92.0%) than major discrepancies (65.0%). The most common minor discrepancy was observed in the title (80.7%), and most common major discrepancies were seen in results (48.2%). Conclusion. Minor discrepancies were more prevalent than major discrepancies. The data presented in this study may be useful to establish a more comprehensive structured abstract requirement for future meetings. © 2012 Soni Prasad et al.