Browsing by Subject "AGREEMENT"

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  • Ruokolainen, Teemu; Kauppinen, Pekka; Silfverberg, Miikka; Lindén, Krister (2020)
    We present a corpus of Finnish news articles with a manually prepared named entity annotation. The corpus consists of 953 articles (193,742 word tokens) with six named entity classes (organization, location, person, product, event, and date). The articles are extracted from the archives of Digitoday, a Finnish online technology news source. The corpus is available for research purposes. We present baseline experiments on the corpus using a rule-based and two deep learning systems on two, in-domain and out-of-domain, test sets.
  • Yoon, Sangwon; Speyer, Renée; Cordier, Reinie; Aunio, Pirjo; Hakkarainen, Airi (2021)
    Aims: Child maltreatment (CM) is global public health issue with devastating lifelong consequences. Global organizations have endeavored to eliminate CM; however, there is lack of consensus on what instruments are most suitable for the investigation and prevention of CM. This systematic review aimed to appraise the psychometric properties (other than content validity) of all current parent- or caregiver-reported CM instruments and recommend the most suitable for use. Method: A systematic search of the CINAHL, Embase, ERIC, PsycINFO, PubMed, and Sociological Abstracts databases was performed. The evaluation of psychometric properties was conducted according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines for systematic reviews of patient-report outcome measures. Responsiveness was beyond the scope of this systematic review, and content validity has been reported on in a companion paper (Part 1). Only instruments developed and published in English were included. Results: Twenty-five studies reported on selected psychometric properties of 15 identified instruments. The methodological quality of the studies was overall adequate. The psychometric properties of the instruments were generally indeterminate or not reported due to incomplete or missing psychometric data; high-quality evidence on the psychometric properties was limited. Conclusions: No instruments could be recommended as most suitable for use in clinic and research. Nine instruments were identified as promising based on current psychometric data but would need further psychometric evidence for them to be recommended.
  • Palojoki, Sari; Makela, Matti; Lehtonen, Lasse; Saranto, Kaija (2017)
    The aim of this study was to analyse electronic health record-related patient safety incidents in the patient safety incident reporting database in fully digital hospitals in Finland. We compare Finnish data to similar international data and discuss their content with regard to the literature. We analysed the types of electronic health record-related patient safety incidents that occurred at 23 hospitals during a 2-year period. A procedure of taxonomy mapping served to allow comparisons. This study represents a rare examination of patient safety risks in a fully digital environment. The proportion of electronic health record-related incidents was markedly higher in our study than in previous studies with similar data. Human-computer interaction problems were the most frequently reported. The results show the possibility of error arising from the complex interaction between clinicians and computers.
  • Ranta, Jukka; Ilén, Elina; Palmu, Kirsi; Salama, Jonna; Roienko, Oleksii; Vanhatalo, Sampsa (2021)
    Aim To describe and test the accuracy of respiratory rate assessment in long-term surveillance using an open-source infant wearable, NAPping PAnts (NAPPA). Methods We recorded 24 infants aged 1-9 months using our newly developed infant wearable that is a diaper cover with an integrated programmable electronics with accelerometer and gyroscope sensors. The sensor collects child's respiration rate (RR), activity and body posture in 30-s epochs, to be downloaded afterwards into a mobile phone application. An automated RR quality measure was also implemented using autocorrelation function, and the accuracy of RR estimate was compared with a reference obtained from the simultaneously recorded capnography signal that was part of polysomnography recordings. Results Altogether 88 h 27 min of data were recorded, and 4147 epochs (39% of all data) were accepted after quality detection. The median of patient wise mean absolute errors in RR estimates was 1.5 breaths per minute (interquartile range 1.1-2.6 bpm), and the Blandt-Altman analysis indicated an RR bias of 0.0 bpm with the 95% limits of agreement of -5.7-5.7 bpm. Conclusion Long-term monitoring of RR and posture can be done with reasonable accuracy in out-of-hospital settings using NAPPA, an openly available infant wearable.
  • Vesterinen, Tiina; Säilä, Jenni; Blom, Sami; Pennanen, Mirkka; Leijon, Helena; Arola, Johanna (2022)
    The Ki-67 proliferation index (PI) is a prognostic factor in neuroendocrine tumors (NETs) and defines tumor grade. Analysis of Ki-67 PI requires calculation of Ki-67-positive and Ki-67-negative tumor cells, which is highly subjective. To overcome this, we developed a deep learning-based Ki-67 PI algorithm (KAI) that objectively calculates Ki-67 PI. Our study material consisted of NETs divided into training (n = 39), testing (n = 124), and validation (n = 60) series. All slides were digitized and processed in the Aiforia(R) Create (Aiforia Technologies, Helsinki, Finland) platform. The ICC between the pathologists and the KAI was 0.89. In 46% of the tumors, the Ki-67 PIs calculated by the pathologists and the KAI were the same. In 12% of the tumors, the Ki-67 PI calculated by the KAI was 1% lower and in 42% of the tumors on average 3% higher. The DL-based Ki-67 PI algorithm yields results similar to human observers. While the algorithm cannot replace the pathologist, it can assist in the laborious Ki-67 PI assessment of NETs. In the future, this approach could be useful in, for example, multi-center clinical trials where objective estimation of Ki-67 PI is crucial.
  • Ylikauma, Laura Anneli; Ohtonen, Pasi Petteri; Erkinaro, Tiina Mari; Vakkala, Merja Annika; Liisanantti, Janne Henrik; Satta, Jari Uolevi; Juvonen, Tatu Sakari; Kaakinen, Timo Ilari (2022)
    The pulmonary artery catheter (PAC) is considered the gold standard for cardiac index monitoring. Recently new and less invasive methods to assess cardiac performance have been developed. The aim of our study was to assess the reliability of a non-invasive monitor utilizing bioreactance (Starling SV) and a non-calibrated mini-invasive pulse contour device (FloTrac/EV1000, fourth-generation software) compared to bolus thermodilution technique with PAC (TDCO) during off-pump coronary artery bypass surgery (OPCAB). In this prospective study, 579 simultaneous intra- and postoperative cardiac index measurements obtained with Starling SV, FloTrac/EV1000 and TDCO were compared in 20 patients undergoing OPCAB. The agreement of data was investigated by Bland-Altman plots, while trending ability was assessed by four-quadrant plots with error grids. In comparison with TDCO, Starling SV was associated with a bias of 0.13 L min(-1) m(-2) (95% confidence interval, 95% CI, 0.07 to 0.18), wide limits of agreement (LOA, - 1.23 to 1.51 L min(-1) m(-2)), a percentage error (PE) of 60.7%, and poor trending ability. In comparison with TDCO, FloTrac was associated with a bias of 0.01 L min(-1) m(-2) (95% CI - 0.05 to 0.06), wide LOA (- 1.27 to 1.29 L min(-1) m(-2)), a PE of 56.8% and poor trending ability. Both Starling SV and fourth-generation FloTrac showed acceptable mean bias but imprecision due to wide LOA and high PE, and poor trending ability. These findings indicate limited reliability in monitoring cardiac index in patients undergoing OPCAB.
  • Salminen, Jarno; van Gils, Mark; Paloheimo, Markku; Yli-Hankala, Arvi (2016)
    Neuromuscular blockade is usually monitored using train-of-four (TOF) stimulation pattern. A TOF ratio of higher than 90 % is recommended to reduce the risk of adverse effects after anaesthesia. TOF ratio 90 % is used in clinical practice with all different neuromuscular monitors. Kinemyography (KMG) is one commercialized method to obtain numerical TOF values. We compared the KMG data obtained with Datex M-NMT MechanoSensor (TM) module, to the EMG data collected with Datex ElectroSensor (TM), during clinical anaesthesia. Ipsilateral comparisons of the sensors were performed in 20 female patients during clinical procedures in propofol-remifentanil anaesthesia. After initial bolus dose of rocuronium (0.6 mg/kg), the spontaneous recovery of TOF ratio and T1 % were monitored. KMG gave higher TOF values than EMG. The difference was significant at KMG TOF values of 40 % or higher. After anaesthetic induction, but before administration of rocuronium, both TOF sensor values drifted from the TOF value of 1.0, showing either significant spontaneous fade (T1 > T4) or tendency of reverse fade (T1 <T4). KMG overestimates the recovery from neuromuscular blockade when compared with EMG. KMG and EMG cannot be used interchangeably, and TOF ratio 90 % cannot be considered as adequate level of recovery with all monitoring devices.
  • Lenzen, Christoph; Rybicki, Joel; Suomela, Jukka (2017)
    Consider a complete communication network of n nodes, where the nodes receive a common clock pulse. We study the synchronous c-counting problem: given any starting state and up to f faulty nodes with arbitrary behavior, the task is to eventually have all correct nodes labeling the pulses with increasing values modulo c in agreement. Thus, we are considering algorithms that are self-stabilizing despite Byzantine failures. In this work, we give new algorithms for the synchronous counting problem that (1) are deterministic, (2) have optimal resilience, (3) have a linear stabilization time in f (asymptotically optimal), (4) use a small number of states, and, consequently, (5) communicate a small number of bits per round. Prior algorithms either resort to randomization, use a large number of states and need high communication bandwidth, or have suboptimal resilience. In particular, we achieve an exponential improvement in both state complexity and message size for deterministic algorithms. Moreover, we present two complementary approaches for reducing the number of bits communicated during and after stabilization.
  • Ilmarinen, Ville-Juhani; Vainikainen, Mari-Pauliina; Verkasalo, Markku Johannes; Lonnqvist, Jan-Erik (2017)
    Even though homophily (love of the same) is often thought of as a standard feature of friendships, the empirical evidence for attraction based on personality trait similarity is mixed at best. One reason for the inconsistent findings across studies could be variation in the large-scale social environment in which the studies have been conducted. We investigated whether diversity in the everyday social ecologies of 7- to 8-year-old children (N=549) moderates whether friendships are formed on the basis of similar personality traits and similar levels of Cognitive ability. Moderated polynomial regression and response surface analyses showed that classroom size moderated homophily based on Openness to Experience: children similar in Openness were more likely to form friendship ties, but only in larger classrooms. Moreover, we found homophily for Cognitive ability, especially among girls. The results for Openness and Cognitive ability were independent of each other. We discuss the social relevance of trait Openness and the notion that capacity to reciprocate underlies homophily based on Cognitive ability. Copyright (c) 2017 European Association of Personality Psychology
  • Kauppila, Mirjam; Backman, Janne T.; Niemi, Mikko; Lapatto-Reiniluoto, Outi (2021)
    Purpose To investigate the characteristics of ADRs in patients admitting at the emergency room of a tertiary hospital. Methods We collected the patient records of 1600 emergency room visits of a university hospital in 2018. The patient files were studied retrospectively and all possible ADRs were identified and registered. Patient characteristics, drugs associated with ADRs, causality, severity, preventability, and the role of pharmacogenetics were assessed. Results There were 125 cases with ADRs, resulting in a 7.8% overall incidence among emergency visits. The incidence was greatest in visits among elderly patients, reaching 14% (men) to 19% (women) in the 80-89 years age group. The most common causative drugs were warfarin, acetylsalicylic acid (ASA), apixaban, and docetaxel, and the most common ADRs were bleedings and neutropenia and/or severe infections. Only two of the cases might have been prevented by pharmacogenetic testing, as advised in Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines. Conclusion The same ATC classes, antithrombotics and cytostatics, were involved in ADRs causing university clinic hospitalizations as those identified previously in drug-related hospital fatalities. It seems difficult to prevent these events totally, as the treatments are vitally important and their risk-benefit-relationships have been considered thoroughly, and as pharmacogenetic testing could have been useful in only few cases.
  • Kilmartin, Darren; O'Loughlin, Mark; Andreu, Xavier; Bago-Horvath, Zsuzsanna; Bianchi, Simonetta; Chmielik, Ewa; Cserni, Gabor; Figueiredo, Paulo; Floris, Giuseppe; Foschini, Maria Pia; Kovacs, Aniko; Heikkilä, Päivi; Kulka, Janina; Laenkholm, Anne-Vibeke; Liepniece-Karele, Inta; Marchio, Caterina; Provenzano, Elena; Regitnig, Peter; Reiner, Angelika; Ryska, Ales; Sapino, Anna; Stovgaard, Elisabeth Specht; Quinn, Cecily; Zolota, Vasiliki; Webber, Mark; Roshan, Davood; Glynn, Sharon A.; Callagy, Grace (2021)
    Simple Summary The stromal tumour infiltrating lymphocytes (sTILs) within a tumour are a strong predictor of outcome for patients with triple negative breast cancer (TNBC). However, the assessment of sTILs is subject to variation and needs to be standardized in order for it to be used more widely as a biomarker. The aim of this study was to determine the level of consistency that can be achieved when an internet-based scoring aid is used to assist with evaluation of sTILs. Twenty-three breast pathologists across Europe scored sTILs in 49 cases of TNBC taken from a routine diagnostic practice using this aid. The consistency of scoring sTILs was good. However, variation in the distribution of sTILs within the tumour resulted in discordance between pathologists scoring cases, particularly as it caused variability in the selection of regions of the tumour to score. More rigorous training of pathologists is needed for standardization of sTILs assessment, which may potentially be improved using automated approaches. Stromal tumour infiltrating lymphocytes (sTILs) are a strong prognostic marker in triple negative breast cancer (TNBC). Consistency scoring sTILs is good and was excellent when an internet-based scoring aid developed by the TIL-WG was used to score cases in a reproducibility study. This study aimed to evaluate the reproducibility of sTILs assessment using this scoring aid in cases from routine practice and to explore the potential of the tool to overcome variability in scoring. Twenty-three breast pathologists scored sTILs in digitized slides of 49 TNBC biopsies using the scoring aid. Subsequently, fields of view (FOV) from each case were selected by one pathologist and scored by the group using the tool. Inter-observer agreement was good for absolute sTILs (ICC 0.634, 95% CI 0.539-0.735, p < 0.001) but was poor to fair using binary cutpoints. sTILs heterogeneity was the main contributor to disagreement. When pathologists scored the same FOV from each case, inter-observer agreement was excellent for absolute sTILs (ICC 0.798, 95% CI 0.727-0.864, p < 0.001) and good for the 20% (ICC 0.657, 95% CI 0.561-0.756, p < 0.001) and 40% (ICC 0.644, 95% CI 0.546-0.745, p < 0.001) cutpoints. However, there was a wide range of scores for many cases. Reproducibility scoring sTILs is good when the scoring aid is used. Heterogeneity is the main contributor to variance and will need to be overcome for analytic validity to be achieved.
  • Wikstrom, Miia; Kouvonen, Anne; Joensuu, Matti (2021)
    Objectives The Abilitator is a patient-reported outcome measure (PROM) of work ability and functioning of those in a weak labour market position. It covers items for work ability and self-rated health, for example, and summary scales for social, psychological, cognitive and physical functioning, as well as everyday skills. The aim of this study was to evaluate the intrarater test-retest reliability, internal consistency and basic psychometric properties of the Finnish version of the Abilitator. Design, setting and outcome The test-retest study was conducted in European Social Fund projects in 2018-2019. The participants completed two Abilitator questionnaires over 7-14 days. The internal consistency analysis was based on data collected in 2017-2019 in services for the long-term unemployed. The reliability was assessed using correlations (r, r(s) , intraclass correlation coefficient (ICC)), agreement with Bland-Altman analysis and internal consistency with Cronbach's alpha. Participants The test-retest study had 67 participants (52% men, mean age 43.9 years) and the internal consistency study 10 923 (48% men, mean age 38.58 years), respectively. Of all the participants, 80% had been unemployed for over a year. Results The test-retest r or r(s) ranged from 0.71 to 0.93 and ICC from 0.74 to 0.93 for the items and summary scales. An exception was the life satisfaction item, with an r(s) of 0.60 and ICC of 0.45. A statistically significant difference was observed in the summary scale for social functioning (t=-2.01, p=0.049). Agreement was observed for all variables except social functioning. Alphas for summary scales ranged from 0.74 to 0.91. Conclusions The Finnish version of the Abilitator is a reliable PROM for the target group and has acceptable to excellent intrarater test-retest reliability and internal consistency, apart from the life satisfaction item. Further testing is needed for the social functioning summary scale.
  • Participating Labs (2019)
    BACKGROUND: The Islet Autoantibody Standardization Program (IASP) aims to improve the performance of immunoassays measuring type 1 diabetes (T1D)-associated autoantibodies and the concordance of results among laboratories. IASP organizes international interlaboratory assay comparison studies in which blinded serum samples are distributed to participating laboratories, followed by centralized collection and analysis of results, providing participants with an unbiased comparative assessment. In this report, we describe the results of glutamic acid decarboxylase autoantibody (GADA) assays presented in the IASP 2018 workshop. METHODS: In May 2018, IASP distributed to participants uniquely coded sera from 43 new-onset T1D patients, 7 multiple autoantibody-positive nondiabetic individuals, and 90 blood donors. Results were analyzed for the following metrics: sensitivity, specificity, accuracy, area under the ROC curve (ROC-AUC), partial ROC-AUC at 95% specificity (pAUC95), and concordance of qualitative and quantitative results. RESULTS: Thirty-seven laboratories submitted results from a total of 48 different GADA assays adopting 9 different formats. The median ROC-AUC and pAUC95 of all assays were 0.87 [interquartile range (IQR), 0.83-0.89] and 0.036 (IQR, 0.032-0.039), respectively. Large differences in pAUC95 (range, 0.001-0.0411) were observed across assays. Of formats widely adopted, bridge ELISAs showed the best median pAUC95 (0.039; range, 0.036-0.041). CONCLUSIONS: Several novel assay formats submitted to this study showed heterogeneous performance. In 2018, the majority of the best performing GADA immunoassays consisted of novel or established nonradioactive tests that proved on a par or superior to the radiobinding assay, the previous gold standard assay format for GADA measurement. (C) 2019 American Association for Clinical Chemistry
  • Aavikko, Anni; Lohman, Martina; Ristolainen, Leena; Kautiainen, Hannu; Österman, Kalevi; Schlenzka, Dietrich; Lund, Teija (2022)
    Purpose In this prospective observational cohort study, the development of lumbar intervertebral discs (LIVD) on magnetic resonance imaging (MRI) was investigated from childhood to adulthood with emphasis on the possible association of disc degeneration (DD) to low back pain (LBP). Methods In 2021, 89 subjects who were enrolled in 1994 in a longitudinal study with lumbar spine MRI at ages 8, 11 and 18 were invited to participate in a long-term follow-up comprising a clinical examination, selected patient-reported outcome measures and a lumbar spine MRI. We assessed all MRIs (three lowest LIVDs) with the Pfirrmann summary score, and the ratio of signal intensity of nucleus pulposus to signal intensity of cerebrospinal fluid (SINDL). We further analyzed whether disc changes at any age were associated with self-reported LBP at age 34. Results Of the 48 subjects in the follow-up, 35 reported LBP at age 34. The Pfirrmann summary score significantly increased with age (p < 0.001). Subjects reporting LBP at age 34 demonstrated statistically significantly higher summary scores at age 18 and 34 compared to asymptomatic subjects (p = 0.004 at age 18, and p = 0.039 at age 34). SINDL significantly decreased with age (p < 0.001 for all levels separately), but no significant differences between subjects with or without LBP at age 34 were noticed. Conclusion Subjects with LBP at age 34 had more widespread or severe DD already at age 18 compared to those without LBP.
  • Abdi, Omid; Uusitalo, Jori; Kivinen, Veli-Pekka (2022)
    Logging trails are one of the main components of modern forestry. However, spotting the accurate locations of old logging trails through common approaches is challenging and time consuming. This study was established to develop an approach, using cutting-edge deep-learning convolutional neural networks and high-density laser scanning data, to detect logging trails in different stages of commercial thinning, in Southern Finland. We constructed a U-Net architecture, consisting of encoder and decoder paths with several convolutional layers, pooling and non-linear operations. The canopy height model (CHM), digital surface model (DSM), and digital elevation models (DEMs) were derived from the laser scanning data and were used as image datasets for training the model. The labeled dataset for the logging trails was generated from different references as well. Three forest areas were selected to test the efficiency of the algorithm that was developed for detecting logging trails. We designed 21 routes, including 390 samples of the logging trails and non-logging trails, covering all logging trails inside the stands. The results indicated that the trained U-Net using DSM (k = 0.846 and IoU = 0.867) shows superior performance over the trained model using CHM (k = 0.734 and IoU = 0.782), DEMavg (k = 0.542 and IoU = 0.667), and DEMmin (k = 0.136 and IoU = 0.155) in distinguishing logging trails from non-logging trails. Although the efficiency of the developed approach in young and mature stands that had undergone the commercial thinning is approximately perfect, it needs to be improved in old stands that have not received the second or third commercial thinning.
  • Voutilainen, Liisa; Henttonen, Pentti; Stevanovic, Melisa; Kahri, Mikko; Peräkylä, Anssi (2019)
    In her influential paper on stance, alignment, and affiliation in conversational storytelling, Tanya Stivers argued that two basic conversational means of receiving a story, nods and vocal continuers, differ in their function: whereas vocal continuers display alignment with the telling activity, nods, during the mid-telling, convey affiliation with the storytellers' affective stance. In this paper, we elaborate these insights on the basis of a quantitative study informed by conversation analysis. Using a database of 317 stories told in Finnish, we analyzed how story recipients' nods and continuers in different phases of storytelling (before and after the story climax) predict naive raters' judgments of the story recipients' empathy toward the storyteller. We found that vocal continuers accounted for the perception of empathy during mid-telling, whereas the effect of nods remained weak. The study offers further support to the notion of structural organization of storytelling, and suggests that the significance of vocal continuers as a vehicle of empathy may be greater than has been generally thought of.
  • Stevenson, Nathan J.; Tataranno, Maria-Luisa; Kaminska, Anna; Pavlidis, Elena; Clancy, Robert R.; Griesmaier, Elke; Roberts, James A.; Klebermass-Schrehof, Katrin; Vanhatalo, Sampsa (2020)
    Objectives: To determine the accuracy of, and agreement among, EEG and aEEG readers' estimation of maturity and a novel computational measure of functional brain age (FBA) in preterm infants. Methods: Seven experts estimated the postmenstrual ages (PMA) in a cohort of recordings from preterm infants using cloud-based review software. The FBA was calculated using a machine learning-based algorithm. Error analysis was used to determine the accuracy of PMA assessments and intraclass correlation (ICC) was used to assess agreement between experts. Results: EEG recordings from a PMA range 25 to 38 weeks were successfully interpreted. In 179 recordings from 62 infants interpreted by all human readers, there was moderate agreement between experts (aEEG ICC = 0.724; 95%CI:0.658-0.781 and EEG ICC = 0.517; 95%CI:0.311-0.664). In 149 recordings from 61 infants interpreted by all human readers and the FBA algorithm, random and systematic errors in visual interpretation of PMA were significantly higher than the computational FBA estimate. Tracking of maturation in individual infants showed stable FBA trajectories, but the trajectories of the experts' PMA estimate were more likely to be obscured by random errors. The accuracy of visual interpretation of PMA estimation was compromised by neurodevelopmental outcome for both aEEG and EEG review. Interpretation: Visual assessment of infant maturity is possible from the EEG or aEEG, with an average of human experts providing the highest accuracy. Tracking PMA of individual infants was hampered by errors in experts' estimates. FBA provided the most accurate maturity assessment and has potential as a biomarker of early outcome.
  • Palojoki, Sari; Saranto, Kaija; Lehtonen, Lasse (2019)
    The European Union Medical Device Directive 2007/47/EC1 defines software with a medical purpose as a medical device. The implementation of health information technology suffers from patient safety problems that require effective post-market surveillance. The purpose of this study was to review, classify and discuss the incident data submitted to a nationwide database of the Finnish National Competent Authority with other forms of data. We analysed incident reports submitted to the authority database by users of electronic health records from 2010 to 2015. We identified 138 valid reports. Adverse events associated with electronic health record vulnerabilities, clustered around certain error types, cause serious harm and occur in all types of healthcare settings. The low rate of reported incidents raises questions about not only the challenges associated with medical software oversight but also the obstacles for reporting.
  • Hurri, Karoliina (2020)
    Developed countries, defined in the global climate negotiations as the Annex I countries, have been expected to take the lead in tackling climate change. However, given the severity of climate change, reducing China’s emissions is critical. China is a developing country with world’s highest emissions and a leader in the renewable sector. Hence, outside expectations for China’s climate action have been growing. Through constructivist role theory, the article researched what external expectations there are for China’s potential climate leadership role. The leadership ex-pectations of developed countries were examined from the UN climate conference high-level segment statements from 2016 to 2018. Results of the discourse analysis explain the expecta-tions in six storylines: 1) all parties are placed on the same line, 2) the dichotomy of developing and developed countries is deconstructed, 3) the position of developing countries is highlighted, 4) China has a greater responsibility than non-Annex or a regular party, 5) China is recognized as a climate actor, and 6) China is excluded as a major player. The expectations recognize China’s structural climate leadership but acknowledging China as a global climate leader might pose a role conflict for the developed countries. The conclusion suggests that this acknowledgement would require developed countries to rethink their own climate leadership and assign the role with China
  • Sternby, Hanna; Verdonk, Robert C.; Aguilar, Guadalupe; Dimova, Alexandra; Ignatavicius, Povilas; Ilzarbe, Lucas; Koiva, Peeter; Lantto, Eila; Loigom, Tonis; Penttilä, Anne; Regner, Sara; Rosendahl, Jonas; Strahinova, Vanya; Zackrisson, Sophia; Zviniene, Kristina; Bollen, Thomas L. (2016)
    Background: For consistent reporting and better comparison of data in research the revised Atlanta classification (RAC) proposes new computed tomography (CT) criteria to describe the morphology of acute pancreatitis (AP). The aim of this study was to analyse the interobserver agreement among radiologists in evaluating CT morphology by using the new RAC criteria in patients with AP. Methods: Patients with a first episode of AP who obtained a CT were identified and consecutively enrolled at six European centres backwards from January 2013 to January 2012. A local radiologist at each center and a central expert radiologist scored the Cfs separately using the RAC criteria. Center dependent and independent interobserver agreement was determined using Kappa statistics. Results: In total, 285 patients with 388 CTs were included. For most CT criteria, interobserver agreement was moderate to substantial. In four categories, the center independent kappa values were fair: extrapancreatic necrosis (EXPN) (0.326), type of pancreatitis (0.370), characteristics of collections (0.408), and appropriate term of collections (0.356). The fair kappa values relate to discrepancies in the identification of extrapancreatic necrotic material. The local radiologists diagnosed EXPN (33% versus 59%, P <0.0001) and non-homogeneous collections (35% versus 66%, P <0.0001) significantly less frequent than the central expert. Cases read by the central expert showed superior correlation with clinical outcome. Conclusion: Diagnosis of EXPN and recognition of non-homogeneous collections show only fair agreement potentially resulting in inconsistent reporting of morphologic findings. (C) 2016 IAP and EPC. Published by Elsevier B.V. All rights reserved.