Investigation of Theileria camelensis in camels infested by Hyalomma dromedarii ticks in Upper Egypt

In the present study, a total of 224 camels infested with Hyalomma dromedarii ticks were investigated for the presence of Theileria camelensis infection in Upper Egypt. The role of Hyalomma dromedarii ticks as the vector of this parasite was also investigated by haemolymph smear examination. Results revealed that 15 (6.75%) of 224 camels were harboring Theileria camelensis in erythrocytes. Furthermore, the theilerial schizont was also seen in lymphocytes. These 15 camels did not show any abnormal clinical signs except three cases that showed enlargement of superficial lymph node and fever. Examination of ticks showed various developmental stages of different shapes and forms of Theileria species

Establishment of diagnostic reference levels in cardiac computed tomography

The aim of this study was to determine diagnostic reference levels (DRLs) for cardiac computed tomography (CCT) in Jordan. Volume computed tomography dose index (CTDIvol) and dose–length product (DLP) were collected from 228 CCTs performed at seven Jordanian hospitals specialized in cardiac CT. DRLs for cardiac CT were defined at the 75th percentile of CTDIvol and DLP. CTDIvol and DLP were collected from 30 successive cardiac CT in each center except for one center (18 scans). The 75th percentile of the CTDIvol and the DLP of the centers calculated from mixed retrospective and prospective gated modes were 47.74 milligray (mGy) and 1035 mGy/cm, respectively. This study demonstrated wide dose variations among the surveyed hospitals for cardiac CT scans; there was a 5.1-fold difference between the highest and lowest median DLP with a range of 223.2–1146.7 mGy/cm. Differences were associated with variations in the mAs and kVp. This study confirmed large variability in CTDIvol and DLP for cardiac CT scans; variation was associated with acquisition protocols and highlights the need for dose optimization. DRLs are proposed for CCT; there remains substantial potential for optimization of cardiac CT examinations for adults in Jordan

The auditory brainstem response (ABR): an objective or subjective measure?

Objectives: This thesis describes three studies investigating the consistency and reliability of ABR testing procedures, the extent of inter-and intra-rater variability and performance, the impact of additional case information on ABR testing results. Methods: The participants for all studies were audiologists who conduct ABR testing. Study 1 consisted of a 69-item survey regarding ABR testing protocols that was completed online. In studies 2 and 3, a test set of infant ABR traces was obtained from a large public peadiatric audiology clinic in Sydney, Australia. In Study 2, 61 audiologists estimated hearing threshold for 15 ABR cases that were each presented twice in order to estimate inter and intra-reader variability. In study 3, 14 audiologists were asked to estimate the hearing threshold for 16 infants twice in two sessions at least 5 months apart; with and without provision of standard clinical information. Results: Audiologists vary in how they conduct ABR testing and there are differences in the training period audiologists undertake before starting ABR testing. Audiologists show good levels of agreement when assessing repeated ABR traces, however, optimum performance was not achieved. No significant differences were found for sensitivity, specificity or accuracy when clinical history information was provided compared to when it was not provided. Conclusions: There is a need for greater emphasis on the importance of following evidence-based guidelines for ABR testing whenever it is possible. Audiologists’ experience and ABR training periods significantly predicts accuracy of ABR reading. Good levels of agreement were found between and within audiologists. ABR traces are interpreted with the same accuracy regardless of whether patients ‘history information is available or not. The data provided should contribute to an improvement in the service of infants hearing diagnostics and help reduce audiologists’ variability

Review : Inter and intra-reader agreement among audiologists in reading auditory brainstem response waves = Revue : Concordances entre audiologistes et chez le même audiologiste pour la lecture des ondes des potentiels évoqués auditifs du tronc cérébral

This paper presents a review conducted to evaluate the scientific evidence regarding variability in audiologists’ interpretation of auditory brainstem response (ABR) tests and to determine the factors that may affect audiologists’ performance when reading ABRs. A search of the literature on Pubmed, Medline (Ovid), ScienceDirect and Google scholar yielded 4,735 articles. After culling, only six articles remained which investigated audiologists’ variability in interpreting ABR, and the findings were inconsistent. Four of the six studies reported evidence that audiologists were variable when reading ABR waves, while two studies reported that audiologists were highly consistent when reading ABR waves. This conflict may be explained by the heterogeneity in the methods used in the six studies. More experienced audiologists were likely to show less variability in interpretation, but no other factors were shown to predict variability

Breast lesion shape and margin evaluation : BI-RADS based metrics understate radiologists' actual levels of agreement

Background: While there is much literature describing the radiologic detection of breast cancer, there are limited data available on the agreement between experts when delineating and classifying breast lesions. The aim of this work is to measure the level of agreement between expert radiologists when delineating and classifying breast lesions as demonstrated through Breast Imaging Reporting and Data System (BI-RADS) and quantitative shape metrics. Methods: Forty mammographic images, each containing a single lesion, were presented to nine expert breast radiologists using a high specification interactive digital drawing tablet with stylus. Each reader was asked to manually delineate the breast masses using the tablet and stylus and then visually classify the lesion according to the American College of Radiology (ACR) BI-RADS lexicon. The delineated lesion compactness and elongation were computed using Matlab software. Intraclass Correlation Coefficient (ICC) and Cohen's kappa were used to assess inter-observer agreement for delineation and classification outcomes, respectively. Results: Inter-observer agreement was fair for BI-RADS shape (kappa = 0.37) and moderate for margin (kappa = 0.58) assessments. Agreement for quantitative shape metrics was good for lesion elongation (ICC = 0.82) and excellent for compactness (ICC = 0.93). Conclusions: Fair to moderate levels of agreement was shown by radiologists for shape and margin classifications of cancers using the BI-RADS lexicon. When quantitative shape metrics were used to evaluate radiologists' delineation of lesions, good to excellent inter-observer agreement was found. The results suggest that qualitative descriptors such as BI-RADS lesion shape and margin understate the actual level of expert radiologist agreement

Evaluating factors affecting audiologists' diagnostic performance in auditory brainstem response reading : training and experience

This study aims to determine if audiologists' experience characteristics in ABR (Auditory Brainstem Response) reading is associated with their performance in interpreting ABR results. Fifteen ABR traces with varying degrees of hearing level were presented twice, making a total of 30. Audiologists were asked to determine the hearing threshold for each of the cases after completing a brief survey regarding their experience and training in ABR administration. Sixty-one audiologists completed all tasks. Correlations between audiologists’ performance measures and experience variables suggested significant associations (p < 0.05) between training period in ABR testing and audiologists’ performance in terms of both sensitivity and accuracy. In addition, the number of years conducting ABR testing correlated with specificity. No other correlations approached significance. While there are relatively few significant correlations between ABR performance and experience, accuracy in ABR reading is associated with audiologists’ length of experience and period of training. To improve audiologists’ performance in reading ABR results, an emphasis on the importance of training should be raised and standardized levels and period for audiologists training in ABR testing should also be set

The impact of clinical history on the threshold estimation of auditory brainstem response results for infants

Purpose: This study assesses the impact of patient clinical history on audiologists’ performance when interpreting auditory brainstem response (ABR) results. Method: Fourteen audiologists’ accuracy in estimating hearing threshold for 16 infants through interpretation of ABR traces was compared on 2 occasions at least 5 months apart. On the 1st occasion, ABR traces were presented to the audiologists with no clinical information except for the age of the child. On the 2nd occasion, audiologists were given a full clinical history for the ABR cases. Results: The addition of clinical history information had no statistically significant impact on sensitivity, specificity, or accuracy of diagnosis. Although the mean numbers of true-negative and true-positive diagnoses were higher when audiologists were given clinical information, the difference was again not statistically significant. Conclusion: This study suggests that if there are circumstances in which case material is incomplete or unavailable, audiologists have no cause for concern regarding the accuracy of their interpretation of ABR traces. In a clinical manner, this may help audiologists with large caseloads or audiologists who need to provide a diagnosis of hearing loss in a short time by allowing them to focus on conducting ABR without the need for case history information

Inter and intra-reader variability in the threshold estimation of auditory brainstem response (ABR) results

Objective: This study aims to examine inter- and intra- reader variability in the ability to estimate hearing threshold through the interpretation of ABR waves of infants. The investigation is based on a large random sample of Australian audiologists. Study design: Sixty-one audiologists were presented with ABR tracings from 15 infants under 12 weeks old. In order to assess inter-rater variability, all cases were presented to all audiologists twice in the same session. Audiologists were asked to nominate a hearing threshold for each of the cases, based purely on their visual judgment of waveforms, and were also asked to answer a brief questionnaire about their experience in ABR testing. Results: Audiologists showed high levels of consistency in reading ABR results. The average inter-reader agreement score was 0.873 and the average intra-reader agreement score was 0.879. Our data show that audiologists’ years of experience in ABR testing significantly correlated with their intra-reader agreement scores (p=0.004). Conclusion: Audiologists showed a good level of inter- and intra-reader-agreement in ABR interpretation. Years of experience in ABR testing were the main factor that contributed to audiologists’ high intra-rater agreement. Therefore, experience in ABR testing is essential in enhancing the outcome of ABR testing and lowering potential misdiagnosis rates

Diagnostic reference levels for paediatric CT in Jordan

This study aimed to investigate the current status of Diagnostic Reference Levels (DRL) in paediatric CT across Jordan. The dose data for four main CT examinations (brain, chest, abdominopelvic, and Chest, Abdomen and Pelvis (CAP)) in hospitals and imaging centres (n = 4) were measured. The volume CT dose index (CTDIvol) and Dose Length Product (DLP) values were compared within the different hospitals and age groups (&amp;lt;1 year, 1-4 years, 5-10 years and 11-18 years). DRL in Jordan were compared to international DRLs. The paediatric population consisted of 1,818 children; 61.4% of them were male. There were significant variations between the DRLs for each CT scanner with an up to four-fold difference in dose between hospitals. There were apparent significant differences between Jordan and other countries with the DLPs in Jordan being relatively high. However, for CTDIvol, the values in Jordan were close to those of other countries. This study confirmed variations in the CTDIvol and DLP values of paediatric CT scans in Jordan. These variations were attributed to the different protocols and equipment used. There is a need to optimise paediatric CT examinations doses in Jordan