Evaluating a new objective grading software for conjunctival hyperaemia

Background/ Aims: Standardised numeric grading scales are used in ophthalmic practice to improve consistency between clinicians in recording the severity of ocular conditions and to facilitate the monitoring of such changes. We investigated the intra- and inter-observer grading reliability and the agreement between subjective Cornea and Contact Lens Research Unit (CCLRU) and Efron grading scales as well as a new Advanced Ophthalmic Systems (AOS) software which uses an objective approach to grading conjunctival hyperaemia. Methods: One experienced observer graded n = 30 bulbar and n = 26 palpebral conjunctival hyperaemia images to 0.1 increments. Masked grading of randomised images was undertaken for all three methods, on two separate occasions. The agreement within and between the grading methods was assessed between sessions, and compared to the results of a novice observer. Results: There were no statistically significant differences (P > 0.05) between test and retest values. However, repeatability in the grading estimates of both bulbar and palpebral conjunctival hyperaemia was improved using the AOS grading method (R2 = 0.998; Coefficient of Repeatability CoR 0.10–0.13), compared to Efron (R2 = 0.926; CoR 0.62) and CCLRU (R2 = 0.885–0.911; CoR 0.50–0.78). Intraclass coefficient correlations (ICC) improved inter-observer agreement using objective (> 0.995) versus subjective methods (0.853–0.959). Conclusion: These subjective and objective grading methods are not interchangeable. Due to the excellent repeatability and improved agreement between experienced and novice observers, the objective grading method provides a more consistent approach when grading ocular abnormalities and may achieve greater reliability in record keeping and clinical monitoring in the future

Damage classification after the 2009 L'Aquila earthquake using multinomial logistic regression and neural networks

Post-earthquake surveys represent a fundamental tool for managing the emergency phase after a strong earthquake. In Italy, the evaluation of the post-earthquake functionality of ordinary buildings is based on the AeDES forms (Agibilitá e Danno nell'Emergenza Sismica, or equivalently, Rapid Post-Earthquake Damage evaluation forms). This form includes information on the building and records of the observed damage classified according to type and intensity in 60 subclasses. Based on the observed damage and expert judgment, the buildings are clustered into six risk classes, from A to F. The assigned class is used to calculate the maximum economic reimbursement owed for the reconstruction or repair of the building. However, often the cluster assignment is not entirely objective due to the inherent responsibility associated with a less conservative assessment. This paper uses the data from the 2009 L'Aquila earthquake to develop classification models based on multinomial logistic regression (MLR) and artificial neural networks (ANN) calibrated with data theoretically less influenced by personal biases. The proposed models, particularly the MLR, are intended to support the decision-making of the evaluation team in future updates of the AeDES forms. This approach cannot substitute expert evaluation, which is always necessary for complex scenarios but may mitigate the impact of subjectivity and can provide an indication of the expected outcome of the survey

Chromogenic in situ hybridisation test for breast cancer patients with equivocal IHC results - A study from Iran

Background: HER2/neu overexpression on cell membranes of breast cancer cells is due to HER2/neu gene amplification and it is important to identify potential candidates for anti HER2 therapy with trastuzumab. IHC, FISH and CISH are standard FDA approved assays currently used to determine HER2 status in routine practice. The aim of this study was to determine HER2 gene amplification, using the CISH method in breast carcinoma samples which had IHC +2 reactions. Materials and Methods: This study was conducted from 2008-2010 using 334 consecutive breast carcinoma samples referred from local laboratories to Mehr Hospital. CISH assays were performed for all cases, and IHC tests were also done for determining efficacy and accuracy of local labs. HER2 status in local IHC tests was compared with central IHC and CISH results. Results: Of 334 breast cancer patients, 16 were negative for HER2 IHC (0, +1), 201 cases were equivocal (+2), and 31 positive (+3). Of 334 referral cases, 88 were CISH positive (26.3) and 246 were CISH negative (73.7). Of 201 IHC +2 cases, HER2 gene amplification was observed in 42 cases (kappa: 0.42). A 29.9 concordance was found between local IHC and central IHC. Sensitivity and specificity of local IHC were 90 and 53.8, respectively. Conclusions: Low accuracy of IHC results in local labs was associated with the following factors: using former FDA-approved criteria for HER2 interpretation, utilizing non-validated kits, and lack of any quality assurance program. Therefore, following the new 2014 ASCO/CAP guideline and comprehensive quality assurance should be implemented to ensure accuracy of HER2 testing

Adults miscoded and misdiagnosed as having pneumonia: results from the British Thoracic Society pneumonia audit

A key objective of the British Thoracic Society national community-acquired pneumonia (CAP) audit was to determine the clinical characteristics and outcomes of hospitalised adults given a primary discharge code of pneumonia but who did not fulfil accepted diagnostic criteria for pneumonia. Adults miscoded as having pneumonia (n=1251) were older compared with adults with CAP (n=6660) (median 80 vs 78 years, p<0.001) and had more comorbid disease, significantly fewer respiratory symptoms (fever, cough, dyspnoea, pleuritic pain), more constitutional symptoms (general deterioration, falls) and significantly lower 30-day inpatient mortality (14.3% vs 17.0%, adjusted OR 0.75, p=0.003)

Metal triflates catalyzed efficient synthesis of 3,4-dihydro-2H-1-benzopyrans

Ytterbium triflate efficiently catalyzes an unusual cyclization of o-hydroxybenzaldehydes with 2,3-dihydrofuran and 3,4-dihydro-2H-pyran in the presence of trimethyl orthoformate at ambient temperature to afford a new class of compounds, furo- and pyrano[2,3-b]benzopyrans in excellent yields with high diastereoselectivity. Also, o-hydroxybenzaldehydes reacted smoothly with acetophenones in the presence of a catalytic amount of scandium triflate under similar reaction conditions to give the corresponding 2,4-dialkoxy-2-aryl-3,4-dihydro-2H-1-benzopyrans in high yields

Implementation of Collaborative Governance in Flood Management in the Greater Bandung Area

Indonesia is a country that is prone to natural disasters, especially floods. This disaster usually hits Indonesia during the rainy season. This hurts human life, the economy and the environment. This paper aims to examine collaborative governance implementation in flood management that occurs in the Greater Bandung area. The research method used is a literature study with qualitative methods. The research location is a flood-prone area, namely 4 (four) districts/cities around the Greater Bandung metropolitan area in West Java Province, Indonesia. All of them have a high flood hazard index. In conclusion, sustainable flood management requires the involvement and participation of various stakeholders from the community simultaneously. Flood management in collaborative governance must be carried out with a systematic approach and synergy from multiple disaster management efforts. Therefore, strengthening a sense of crisis, commitment, shared roles and responsibilities, and continuity of cooperation/collaboration in governance networks is needed to maintain effective flood management

Chronic y-secretase inhibition reduces amyloid plaque-associated instability of pre- and postsynaptic structures

The loss of synapses is a strong histological correlate of the cognitive decline in Alzheimer’s disease (AD). Amyloid bpeptide (Ab), a cleavage product of the amyloid precursor protein (APP), exerts detrimental effects on synapses, a process thought to be causally related to the cognitive deficits in AD. Here, we used in vivo two-photon microscopy to characterize the dynamics of axonal boutons and dendritic spines in APP/Presenilin 1 (APPswe/PS1L166P)–green fluorescent protein (GFP) transgenic mice. Time-lapse imaging over 4 weeks revealed a pronounced, concerted instability of pre- and postsynaptic structures within the vicinity of amyloid plaques. Treatment with a novel sulfonamide-type g-secretase inhibitor (GSI) attenuated the formation and growth of new plaques and, most importantly, led to a normalization of the enhanced dynamics of synaptic structures close to plaques. GSI treatment did neither affect spines and boutons distant from plaques in amyloid precursor protein/presenilin 1-GFP (APPPS1-GFP) nor those in GFP-control mice, suggesting no obvious neuropathological side effects of the drug

Optimisation of the Schizosaccharomyces pombe urg1 expression system

The ability to study protein function in vivo often relies on systems that regulate the presence and absence of the protein of interest. Two limitations for previously described transcriptional control systems that are used to regulate protein expression in fission yeast are: the time taken for inducing conditions to initiate transcription and the ability to achieve very low basal transcription in the "OFF-state". In previous work, we described a Cre recombination-mediated system that allows the rapid and efficient regulation of any gene of interest by the urg1 promoter, which has a dynamic range of approximately 75-fold and which is induced within 30-60 minutes of uracil addition. In this report we describe easy-to-use and versatile modules that can be exploited to significantly tune down P urg1 "OFF-levels" while maintaining an equivalent dynamic range. We also provide plasmids and tools for combining P urg1 transcriptional control with the auxin degron tag to help maintain a null-like phenotype. We demonstrate the utility of this system by improved regulation of HO-dependent site-specific DSB formation, by the regulation Rtf1-dependent replication fork arrest and by controlling Rhp18(Rad18)-dependent post replication repair