Intra- and Inter-Examiner Reliability and Inter-Method Comparison in Physical Anthropometry and Photogrammetry

Objective: Orthodontic treatment can often effect changes in the facial complex. In order to assess what those changes are, precise and reliable methods for measuring facial structures need to be used. While the techniques used for measuring have become increasingly more sophisticated they have also become more expensive and cumbersome for daily use. This study investigated the reliability of two methods, physical anthropometry and photogrammetry, that were inexpensive and relatively easy to set up. Materials and Methods: Ten examiners measured a sample comprised of 20 dental students (10 male, 10 female) twice over three weeks. Eighteen measurements were acquired directly using a digital caliper. The 18 measurements were comprised of 20 facial landmarks previously defined by Farkas (1981). In addition, standardized facial photographs were made of the 20 participants, and the examiners were asked to identify the same points. The images were then calibrated and the same facial measurements computed. The intra-class correlation coefficient was used to determine the intra- and inter-examiner reliabilities. The Bland-Altman method was used to compare the two methods. Results: Anthropometric intra-examiner reliability was very high for all measurements, while inter-examiner reliability exhibited a wide range of values, Overall the reliabilities were higher for easily identifiable landmarks, such as landmarks around the mouth, eyes, the nose, while bony landmarks covered by soft-tissue produced less reliable measurements. With few exceptions, photogrammetric reliability was high for both inter- and intra-examiner reliabilities. The least reliable measurement was the interlabial gap probably due to placement error of the points which was compounded by the small distances measured. The Altman-Bland plots showed large variability around the average difference. Conclusions: The study found that examiners demonstrate high intra-rater reliability regardless of which method was used. Inter-examiner reliability showed larger variability dependent on the method. When using a caliper the examiner was not as consistent as on a photograph when selecting the facial landmarks. While both methods allow for accurate intra-examiner measurements, this study found that the photogrammetric method had greater inter-examiner agreement. However, large variability was found when comparing the two methods

Intra- and inter-examiner Reliability of Direct Facial Soft Tissue Measurements Using Digital Calipers

Background: The objective of this study is to determine if facial soft tissue measurements using digital calipers can be reliably taken by the same examiner and by a large group of examiners. Materials and Methods: Ten examiners performed a set of 18 in-clinic measurements on 10 female and 10 male dental students using a digital caliper twice over a 3-week period. The intra-class correlation coefficient and the Shrout-Fleiss method were used for the statistical analysis. Results: Anthropometric intra-examiner reliability was high for all measurements (none fell below R = 0.934). However, inter-examiner reliability exhibited a wide range of values, some reliable (nasal width at widest nostrils [R = 0.922] and subnasale to upper lip [R = 0.926]), and others unreliable [base of nose (R = 0.590), mouth height (R = 0.585), and soft tissue B point to gnathion (R = 0.623)]. Conclusions: Soft tissue measurements of clearly identifiable points measured by the same examiner produced highly consistent, accurate and reliable measurements. Soft tissue points with poor definition resulted in average-to-poor reliabilities measurements

The Herpetofauna (Amphibia and Reptilia) of Vrachanska Planina Mountains - Species Composition, Distribution and Conservation

Vrachanska Planina Mts. is located in northwestern Bulgaria and is a relatively well-defined part of Stara Planina Mts. So far, no comprehensive studies on the species composition and distribution of the herpetofauna of Vrachanska Planina Mts. have been published. The current study reports 8 new species of amphibians and reptiles, which are new for the region and confirms all previously known 19 species. All species localities have been mapped in the UTM-grid (1x1 km). The spatial distribution, as well as the vertical distribution and the species richness are analyzed. The importance of the existing protected areas in Vrachanska Planina Mts. and protected Natura2000 zones for the conservation of herpetofauna are discussed. Some potential threats to amphibians and reptiles in the research area (such as drying-up of water basins, fires and road mortality) are reported

Ticagrelor in patients with diabetes and stable coronary artery disease with a history of previous percutaneous coronary intervention (THEMIS-PCI) : a phase 3, placebo-controlled, randomised trial

Background: Patients with stable coronary artery disease and diabetes with previous percutaneous coronary intervention (PCI), particularly those with previous stenting, are at high risk of ischaemic events. These patients are generally treated with aspirin. In this trial, we aimed to investigate if these patients would benefit from treatment with aspirin plus ticagrelor. Methods: The Effect of Ticagrelor on Health Outcomes in diabEtes Mellitus patients Intervention Study (THEMIS) was a phase 3 randomised, double-blinded, placebo-controlled trial, done in 1315 sites in 42 countries. Patients were eligible if 50 years or older, with type 2 diabetes, receiving anti-hyperglycaemic drugs for at least 6 months, with stable coronary artery disease, and one of three other mutually non-exclusive criteria: a history of previous PCI or of coronary artery bypass grafting, or documentation of angiographic stenosis of 50% or more in at least one coronary artery. Eligible patients were randomly assigned (1:1) to either ticagrelor or placebo, by use of an interactive voice-response or web-response system. The THEMIS-PCI trial comprised a prespecified subgroup of patients with previous PCI. The primary efficacy outcome was a composite of cardiovascular death, myocardial infarction, or stroke (measured in the intention-to-treat population). Findings: Between Feb 17, 2014, and May 24, 2016, 11 154 patients (58% of the overall THEMIS trial) with a history of previous PCI were enrolled in the THEMIS-PCI trial. Median follow-up was 3·3 years (IQR 2·8–3·8). In the previous PCI group, fewer patients receiving ticagrelor had a primary efficacy outcome event than in the placebo group (404 [7·3%] of 5558 vs 480 [8·6%] of 5596; HR 0·85 [95% CI 0·74–0·97], p=0·013). The same effect was not observed in patients without PCI (p=0·76, p interaction=0·16). The proportion of patients with cardiovascular death was similar in both treatment groups (174 [3·1%] with ticagrelor vs 183 (3·3%) with placebo; HR 0·96 [95% CI 0·78–1·18], p=0·68), as well as all-cause death (282 [5·1%] vs 323 [5·8%]; 0·88 [0·75–1·03], p=0·11). TIMI major bleeding occurred in 111 (2·0%) of 5536 patients receiving ticagrelor and 62 (1·1%) of 5564 patients receiving placebo (HR 2·03 [95% CI 1·48–2·76], p<0·0001), and fatal bleeding in 6 (0·1%) of 5536 patients with ticagrelor and 6 (0·1%) of 5564 with placebo (1·13 [0·36–3·50], p=0·83). Intracranial haemorrhage occurred in 33 (0·6%) and 31 (0·6%) patients (1·21 [0·74–1·97], p=0·45). Ticagrelor improved net clinical benefit: 519/5558 (9·3%) versus 617/5596 (11·0%), HR=0·85, 95% CI 0·75–0·95, p=0·005, in contrast to patients without PCI where it did not, p interaction=0·012. Benefit was present irrespective of time from most recent PCI. Interpretation: In patients with diabetes, stable coronary artery disease, and previous PCI, ticagrelor added to aspirin reduced cardiovascular death, myocardial infarction, and stroke, although with increased major bleeding. In that large, easily identified population, ticagrelor provided a favourable net clinical benefit (more than in patients without history of PCI). This effect shows that long-term therapy with ticagrelor in addition to aspirin should be considered in patients with diabetes and a history of PCI who have tolerated antiplatelet therapy, have high ischaemic risk, and low bleeding risk