Reproducibility of endometrial intraepithelial neoplasia diagnosis is good, but influenced by the diagnostic style of pathologists

Endometrial intraepithelial neoplasia (EIN) applies specific diagnostic criteria to designate a monoclonal endometrial preinvasive glandular proliferation known from previous studies to confer a 45-fold increased risk for endometrial cancer. In this international study we estimate accuracy and precision of EIN diagnosis among 20 reviewing pathologists in different practice environments, and with differing levels of experience and training. Sixty-two endometrial biopsies diagnosed as benign, EIN, or adenocarcinoma by consensus of two expert subspecialty pathologists were used as a reference comparison to assess diagnostic accuracy of 20 reviewing pathologists. Interobserver reproducibility among the 20 reviewers provided a measure of diagnostic precision. Before evaluating cases, observers were self-trained by reviewing published textbook and/or online EIN diagnostic guidelines. Demographics of the reviewing pathologists, and their impressions regarding implementation of EIN terminology were recorded. Seventy-nine percent of the 20 reviewing pathologists' diagnoses were exactly concordant with the expert consensus (accuracy). The interobserver weighted kappa values of 3-class EIN scheme (benign, EIN, carcinoma) diagnoses between expert consensus and each of reviewing pathologists averaged 0.72 (reproducibility, or precision). Reviewing pathologists demonstrated one of three diagnostic styles, which varied in the repertoire of diagnoses commonly used, and their nonrandom response to potentially confounding diagnostic features such as endometrial polyp, altered differentiation, background hormonal effects, and technically poor preparations. EIN diagnostic strategies can be learned and implemented from standard teaching materials with a high degree of reproducibility, but is impacted by the personal diagnostic style of each pathologist in responding to potential diagnostic confounders

Assessing Proportionality Assumption In The Adjacent Category Logistic Regression Model

Ordinal logistic regression models are classified as either proportional odds models, continuation ratio models or adjacent category models. The common model assumption of these models is that the log odds do not depend on the outcome category. This assumption is also known as the "proportionality" or "parallel logits" assumption. Non-proportional and partial proportional models are proposed for the proportional odds and continuation ratio model. The non-proportional and the partial proportional versions of the adjacent category model are also feasible. Prior to fitting any of the ordinal logistic regression models, it is important to check whether the assumption of proportionality is satisfied by each independent variable. In the proportional odds model, the proportional odds assumption is checked by Brant's Wald test statistic, and the standard Wald test statistic can be used in the continuation ratio model. However there is no valid approach to test whether the proportionality assumption is satisfied by each independent variable in the adjacent category model. The aim of the study is to determine the variables in the adjacent category model that violate the proportionality assumption. For this purpose, a Wald test is proposed for testing the proportionality assumption in the adjacent category model. The validity of the proposed test is examined under H-0 with a Monte Carlo simulation study. Moreover, the proposed method is compared with the likelihood ratio test in terms of type I error rate and power under different scenarios.WoSScopu

Measuring the inequality of accessible trams in Melbourne

In Melbourne, public policy has recently been enacted to improve access to the tram service with an emphasis upon people with a disability. Achieving that objective requires two elements. One is a low-floor tram and two is an elevated tram stop platform that facilitates boarding the tram. Currently the fleet of trams in Melbourne is made up of high-floor and low-floor designs, thus accessible services are unevenly distributed. In addition, construction of new tram stop platforms has been uneven. This suggests a form of inequality in accessible tram services for the disabled. Several studies of transport services have addressed this issue using the Gini coefficient and Lorenz curve calculations as seen in studies of disadvantaged groups such as the elderly. This research utilizes those approaches to estimate the current access of the disabled population to trams services in Melbourne. The approach compares the geography of the total and accessible tram services with the geography of the total and disabled population using the Gini coefficient and Lorenz curve. The results show that there is inequality in the accessible trams amongst people with a disability in Melbourne (Gini = 0.66) as 70% of the disabled population has access to only 22% of the accessible tram supply. In comparison, considering the total tram supply and the entire population, (Gini = 0.48) 70% of the population shares 40% of the tram supply. Hence, at this stage the provision of accessible tram services for people with a disability falls well below that of the general population. These results provide an insight into the current tram service inequality and can be used as a reference for future tram system investment. Further, the approach could be used to increase awareness of this matter and encourage an inclusive and sustainable public transport planning and development in both local and global contexts

A Current Analysis Of Caregivers' Approaches To Fever And Antipyretic Usage

Introduction: The aim of this survey was to investigate the current knowledge, attitudes, and practices of febrile children's caregivers about fever, antipyretic usage, and temperature measurement methods in a tertiary care hospital. Methodology: A 41-item questionnaire was administered to a convenience sample of febrile children's caregivers in face-to-face interviews by two research assistants from January 2012 through June 2012 in an urban region of Turkey. Results: A total of 1,032 caregivers completed the interview. Approximately one-third of caregivers considered a temperature of less than 37.8 degrees C (100 degrees F) to be a fever, and 13% of all respondents would give antipyretics for a body temperature <= 37.8 degrees C. Furthermore, 76% of parents would wake their children from sleep to administer antipyretics. Although a high proportion (89.5%) of respondents believed that fever had harmful effects, 10.5% considered fever to be beneficial. Alternating use of acetaminophen and ibuprofen (44%) and giving antipyretics routinely (71%) before and after immunizations were common parental practices and generally advised by pediatricians. Parents with higher levels of education were more likely to consider fever to be beneficial and to treat fever with antipyretics, and less likely to seek medical attention for mild fever. Most caregivers stated that they were unsure about the right site (90%) and thermometer type (95%) for temperature measurement. Conclusions: Persistent fever anxiety and excessive antipyretic usage may be heightened by the lack of knowledge regarding accurate temperature measurement methods with digital thermometers in our population. Parental education may positively affect the approach to fever and antipyretic usage.WoSScopu

Evaluation of palatal donor site haemostasis and wound healing after free gingival graft surgery

Dolgun, Anil Barak/0000-0002-2693-0666; Bayram, Cem/0000-0001-8717-4668WOS: 000356367300011PubMed: 25892528AimEvaluating effectiveness of a medicinal plant extract (MPE) in achieving haemostasis and early wound healing at free gingival graft (FGG) donor site in a randomized controlled fashion. MethodsForty patients requiring FGG at lower anterior area were randomly assigned into two groups. FGG was performed to all patients and following graft procurement; wet gauze (WG) was applied alone (control: WG group) or with MPE (test: MPE+WG group) for haemostasis. Donor site working time, bleeding (BLE), colour match (CM), pain, epithelization (EP) and sensation loss (SL) were evaluated. ResultsThirty-three participants completed a 6-month period study. In the test group, primary BLE was shorter (p<0.001) and fewer individuals showed secondary BLE during 3days (p<0.001). During the 6days, pain scores were higher in WG patients (p<0.05). Later on, no inter-group difference was observed. EP was relatively faster (p<0.001) and CM was slightly better (p<0.05) in MPE+WG group. ConclusionMPE provided faster and continuous haemostasis that made a positive contribution to the early soft tissue healing to some extent but due to limitations; further trials are needed to demonstrate the efficiency of this material

Evaluation of the adjunctive effect of platelet-rich fibrin to enamel matrix derivative in the treatment of intrabony defects. Six-month results of a randomized, split-mouth, controlled clinical study

Dolgun, Anil Barak/0000-0002-2693-0666WOS: 000388359000009PubMed: 27396428Aim: This study aimed to compare the results obtained with enamel matrix derivative (EMD) and EMD + platelet-rich fibrin (PRF) in the treatment of intrabony defects (IBDs) in chronic periodontitis patients. Materials and Methods: Using a split-mouth design, 28 paired IBDs were randomly treated either with EMD or with EMD + PRF. Clinical and radiographic measurements including clinical attachment level (CAL), probing depth (PD), gingival recession (GR), defect depth (DD), defect width (DW) and defect angle (DA) were recorded at baseline (BL) and at six months following therapy. Results: BL clinical and radiographic measurements were similar for EMD and EMD + PRF groups. Although postsurgical measurements revealed significant reduction for PD and CAL in both groups, no intergroup difference was detected. When EMD and EMD + PRF groups were compared, defect fill was not also statistically different. Conclusions: Both therapies resulted in significant clinical improvement in IBD treatment. Addition of PRF did not improve the clinical and radiographic outcomes

Ct Assessment Of Asymptomatic Hip Joints For The Background Of Femoroacetabular Impingement Morphology

PURPOSE The purposes of this study were to assess the presence of cam and pincer morphology in asymptomatic individuals with a negative femoroacetabular impingement test, and to determine and compare the ranges of alpha angle using two measurement methods. MATERIALS AND METHODS In total, 68 consecutive patients who underwent abdominopelvic computed tomography (CT) for reasons other than hip problems were the patient population. Patients who had a positive femoroacetabular impingement test were excluded. Alpha angle measurements from axial oblique (A(N)) and radial reformat-based images (A(R)) from the anterior through the superior portion of the femoral head-neck junction, as well as femoral head-neck offset, center-edge angle, acetabular version angle measurements, and acetabular crossover sign assessment, were made. RESULTS Overall prevalences of cam (increased alpha angle, decreased femoral head-neck offset) and pincer morphology (increased center-edge angle, decreased acetabular version) were 20.0%, 26.8%, 25.8%, and 10.2% of the hips, respectively. The mean A(R) ranged from 41.64 degrees +/- 4.23 degrees to 48.13 degrees +/- 4.63 degrees, whereas A(N) was 41.10 degrees +/- 4.44 degrees. The values of A(R) were higher than A(N), and the difference was statistically significant (P < 0.001). The highest A(R) values were measured on images from the anterosuperior section of femoral head-neck junction. CONCLUSION In asymptomatic subjects, higher alpha angle values were obtained from radial reformatted images, specifically from the anterosuperior portion of the femoral head-neck junction compared with the axial oblique CT images. Other measurements used for the assessment of cam and pincer morphology can also be beyond the ranges that are considered normal in the general population.WoSScopu

Early Rumour Detection with Temporal Bidirectional Graph Convolutional Networks

Automatic rumour detection has drawn significant research attention and deep learning models are proposed. It is shown that misinformation propagates further and wider on social networks. Existing research has focused on using the information propagation pattern for rumour detection. But the temporal propagation pattern for rumours has been largely ignored. This paper addresses this gap. We propose a temporal Bi-directional Graph Convolutional Network (tBi-GCN) model to learn representations for rumour propagation and rumour dispersion by encoding the temporal information for local graph structures and nodes. Specifically, we constructed a time-weighted adjacency matrix to represent the effect of time delay between nodes on information dissemination. Experimental results across five events of the PHEME dataset show that tBi-GCN can achieve a comparable performance in comparison with several state-of-the-art models for early rumour detectio

The Adjunctive Effect of Platelet-Rich Fibrin to Connective Tissue Graft in the Treatment of Buccal Recession Defects: Results of a Randomized, Parallel-Group Controlled Trial

Dolgun, Anil Barak/0000-0002-2693-0666; Bayram, Cem/0000-0001-8717-4668WOS: 000364162600005PubMed: 26177630Background: Platelet-rich fibrin (PRF) is an autologous preparation that has encouraging effects in healing and regeneration. The aim of this trial is to evaluate the effectiveness of coronally advanced flap (CAF) + connective tissue graft (CTG) + PRF in Miller Class I and II recession treatment compared to CAF + CTG. Methods: Forty patients were treated surgically with either CAF + CTG + PRF (test group) or CAF + CTG (control group). Clinical parameters of plaque index, gingival index, vertical recession (VR), probing depth, clinical attachment level (CAL), keratinized tissue width (KTW), horizontal recession (HR), mucogingival junction localization, and tissue thickness (TT) were recorded at baseline and 3 and 6 months after surgery. Root coverage (RC), complete RC (CRC), attachment gain (AG), and keratinized tissue change (KTC) were also calculated. Results: All individuals completed the entire study period. At baseline, mean VR, HR, CAL, KTW, and TT values were similar (P > 0.05). In both groups, all parameters showed significant improvement after treatment (P < 0.001), and except TT (P < 0.05), no intergroup difference was observed at 6 months after surgery. The amount of RC and AG, but not KTC and CRC, was higher in the PRF-applied group (P < 0.05). Conclusions: According to the results, the addition of PRF did not further develop the outcomes of CAF + CTG treatment except increasing the TT. However, this single trial is not sufficient to advocate the true clinical effect of PRF on recession treatment with CAF + CTG, and additional trials are needed