CD or not CD, that is the question - a digital interobserver agreement study in coeliac disease

OBJECTIVE: Coeliac disease (CD) diagnosis generally depends on histological examination of duodenal biopsies. We present the first study analysing the concordance in examination of duodenal biopsies using digitised whole-slide images (WSIs). We further investigate whether the inclusion of IgA tTG and haemoglobin (Hb) data improves the inter-observer agreement of diagnosis.DESIGN: We undertook a large study of the concordance in histological examination of duodenal biopsies using digitised WSIs in an entirely virtual reporting setting. Our study was organised in two phases: in phase one, 13 pathologists independently classified 100 duodenal biopsies (40 normal; 40 CD; 20 indeterminate enteropathy) in the absence of any clinical or laboratory data. In phase two, the same pathologists examined the (re-anonymised) WSIs with the inclusion of IgA tTG and Hb data.RESULTS: We found the mean probability of two observers agreeing in the absence of additional data to be 0.73 (±0.08) with a corresponding Cohen's kappa of 0.59 (±0.11). We further showed that the inclusion of additional data increased the concordance to 0.80 (±0.06) with a Cohen's kappa coefficient of 0.67 (±0.09).CONCLUSION: We showed that the addition of serological data significantly improves the quality of CD diagnosis. However, the limited inter-observer agreement in CD diagnosis using digitised WSIs, even after the inclusion of IgA tTG and Hb data, indicates the important of interpreting duodenal biopsy in the appropriate clinical context. It further highlights the unmet need for an objective means of reproducible duodenal biopsy diagnosis, such as the automated analysis of WSIs using AI.<br/

Zarządzanie ryzykiem w sektorze rolnym ze szczególnym uwzględnieniem ubezpieczeń

The agricultural sector is highly affected by the weather conditions and losses will likely increase in the future as natural disasters become more frequent (IPCC, 2012). There are a number of tools available in agricultural risk management; in this article we review agricultural insurance schemes of several OECD countries with special attention to the role of the government and the promotion of risk reduction and good agricultural practices. At the end we conclude that while public involvement can significantly increase penetration; the lack of self-efficacy is still a major challenge in many systems, which countries are addressing in different ways. The new Hungarian system could potentially become an example of successful public-private partnership that addresses the self-efficacy problem in an efficient way.Na sektor rolny bardzo duży wpływ mają warunki atmosferyczne, straty prawdopodobnie wzrosną w przyszłości, jako że katastrofy naturalne stają się coraz częstsze (IPCC, 2012). Istnieje wiele dostępnych narzędzi zarządzania ryzykiem w rolnictwie, w tym artykule dokonujemy przeglądu systemów ubezpieczeń rolnych kilku krajach OECD, ze szczególnym uwzględnieniem roli rządu i promocji redukcji ryzyka i dobrych praktyk rolniczych. Na zakończenie dochodzimy do wniosku, że o ile zaangażowanie społeczne może znacznie zwiększyć przenikanie, brak własnej skuteczności jest wciąż głównym wyzwaniem w wielu systemach, które kraje adresują na wiele sposobów. Nowy węgierski system może potencjalnie stać się przykładem udanego partnerstwa publiczno-prywatnego, które dotyczy problemu własnej skuteczności w efektywny sposób

More insurance subsidies for European farmers – is it needed?

In addition to traditional sources of uncertainties, such as market price volatility and animal and plant health-related risks, the impacts of climate change have recently become a major concern in the agricultural sector throughout the world. Insurance has been commonly proposed as a key instrument in farm risk management, and agricultural insurance schemes have become more widespread both in developed and developing countries. We conducted a case study in the UK to investigate farmers’ risk perception and willingness to pay for crop insurance by using contingent valuation method (CVM). Similarly to the experience from developing countries, we found that farmers are less willing to pay for insurance, however they do take actions to reduce their risks. While these results suggest that the provision of premium subsidies to European farmers can be justified; in order to avoid counter-productive policy outcomes, one may consider the introduction of a risk-based approach in agricultural risk management

Some aspects of superconducting accelerator design

The performance of an accelerator can be characterized by the efficiency with which electrical energy, the minimumm energy needed to generate a given beam voltage. The current accelerator improvement program at SLAC aims at raising the beam voltage to 50 GV which will use 240 klystrons each capable of producing a pulse 5 ..mu..s in length at a peak power of 36 MW. The Linear Collider requires 50 MW klystrons to achieve 60 GV which will raise the concomittant power consumption to 32.3 MW. We show that with superconducting elements we can increase the rf and ac conversion efficiencies and achieve the necessary 50 GV using only 1/3 of the present power requirements, provided that we exclude CW operation. We will further demonstrate that this increase in efficiency is crucial and highly significant in the design of a proposed 1000 GV linear accelerator

Drug persistence and need for dose intensification to adalimumab therapy; the importance of therapeutic drug monitoring in inflammatory bowel diseases

Background: Therapeutic drug monitoring (TDM) aid therapeutic decision making in patients with inflammatory bowel disease (IBD) who lose response to anti-TNF therapy. Our aim was to evaluate the frequency and predictive factors of loss of response (LOR) to adalimumab using TDM in IBD patients. Methods: One hundred twelve IBD patients (with 214 TDM measurements, CD/UC 84/28, male/female 50/62, mean age CD/UC: 36/35years) were enrolled in this consecutive cohort from two referral centres in Hungary. Demographic data were comprehensively collected and harmonized monitoring strategy was applied. Previous and current therapy, laboratory data and clinical activity were recorded at the time of TDM. Patients were evaluated either at the time of suspected LOR or during follow-up. TDM measurements were determined by commercial ELISA (LISA TRACKER, Theradiag, France). Results: Among 112 IBD patients, LOR/drug persistence was 25.9%/74.1%. The cumulative ADA positivity (>10ng/mL) and low TL (<5.0μg/mL) was 12.1% and 17.8% after 1 year and 17.3% and 29.5% after 2 years of adalimumab therapy. Dose intensification was needed in 29.5% of the patients. Female gender and ADA positivity were associated with LOR (female gender: p<0.001, OR:7.8 CI 95%: 2.5-24.3, ADA positivity: p=0.007 OR:3.6 CI 95%: 1.4-9.5). Conclusions: ADA development, low TL and need for dose intensification were frequent during adalimumab therapy and support the selective use of TDM in IBD patients treated with adalimumab. ADA positivity and gender were predictors of LOR

Register for bivirkninger ved bruk av kosmetiske produkter 2008-2010

Meldingene som har kommet inn til bivirkningsregisteret viser at bivirkninger ved bruk av kosmetiske produkter utgjør et problem hos forbrukerne. I løpet av de to første årene mottok bivirkningsregisteret 96 meldinger. De fleste meldingene ble sendt inn av apotekfarmasøyter. Kun ni av meldingene kom fra leger og dette er et lavere antall enn forventet. De fleste meldingene omhandlet produkttyper som fuktighetskremer, renseprodukter, solkremer og produkter for hårfarging/bleking. De hyppigst rapporterte bivirkningene er eksem med ødem, blemmedannelse og/eller svie. Det er utført vurdering av årsakssammenhenger for 35 av meldingene som totalt omfatter 33 produkter. For 25 av de 35 meldingene ble det vurdert å være en meget sannsynlig eller sannsynlig sammenheng mellom bruken av produktet og de meldte bivirkningene. Vårt norske register for bivirkninger ved bruk av kosmetiske produkter har mottatt i underkant av 50 meldinger per år. I Nederland mottar de derimot rundt 100 meldinger per måned. Dette registeret har, i motsetning til det norske registeret hvor helsepersonell sender inn meldinger, en internettbasert rapporteringsløsning hvor forbrukerne selv rapporterer om sine bivirkninger. Det høye antallet meldinger til det nederlandske registeret tyder på at bivirkninger etter bruk av kosmetiske produkter forekommer relativt hyppig samtidig som det viser at det en stor grad av underrapportering til det norske registeret. Erfaringer fra de første to årene tyder på at dette skyldes at både forbrukerne og helsepersonell lar være å melde fra om bivirkninger til registeret. En mer komplett rapportering vil kunne gi et mer pålitelig bilde av situasjonen med hensyn til bivirkninger og potensielle problemprodukter. I tiden fremover vil derfor arbeidet med å øke meldefrekvensen være en prioritert oppgave