Background: Clinical examination of trachoma is used to justify intervention in trachoma-endemic regions. Currently, field graders are certified by determining their concordance with experienced graders using the kappa statistic. Unfortunately, trachoma grading can be highly variable and there are cases where even expert graders disagree (borderline/marginal cases). Prior work has shown that inclusion of borderline cases tends to reduce apparent agreement, as measured by kappa. Here, we confirm those results and assess performance of trainees on these borderline cases by calculating their reliability error, a measure derived from the decomposition of the Brier score.
Methods And Findings: We trained 18 field graders using 200 conjunctival photographs from a community-randomized trial in Niger and assessed inter-grader agreement using kappa as well as reliability error. Three experienced graders scored each case for the presence or absence of trachomatous inflammation-follicular (TF) and trachomatous inflammation-intense (TI). A consensus grade for each case was defined as the one given by a majority of experienced graders. We classified cases into a unanimous subset if all 3 experienced graders gave the same grade. For both TF and TI grades, the mean kappa for trainees was higher on the unanimous subset; inclusion of borderline cases reduced apparent agreement by 15.7% for TF and 12.4% for TI. When we assessed the breakdown of the reliability error, we found that our trainees tended to over-call TF grades and under-call TI grades, especially in borderline cases.
Conclusions: The kappa statistic is widely used for certifying trachoma field graders. Exclusion of borderline cases, which even experienced graders disagree on, increases apparent agreement with the kappa statistic. Graders may agree less when exposed to the full spectrum of disease. Reliability error allows for the assessment of these borderline cases and can be used to refine an individual trainee's grading.
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http://dx.doi.org/10.1371/journal.pntd.0002840 | DOI Listing |
Clin Exp Optom
December 2024
Consultant, Carlsbad, CA, USA.
Clinical Relevance: Clinical evaluation of the optic nerve using 3-D stereo disc photographs is considered the gold standard for estimating vertical cup-to-disc ratios. Ultra-widefield retinal imaging has gained increasing popularity to document and screen the health of the retina and optic nerve.
Background: Glaucoma is often first identified or suspected based on initial optic nerve assessment.
Child Abuse Negl
December 2024
Paul Baerwald School of Social Work and Social Welfare, The Hebrew University of Jerusalem, Mt. Scopus, Jerusalem 91905, Israel. Electronic address:
Background: There is a serious dearth of research on the phenomenon of school violence in the Arab world. Moreover, studies have examined the relationship between students' exposure to family violence (EFV) and school violence.
Objective: This study measured the correlation between Palestinian high schoolers' EFV (i.
Environ Health Insights
November 2024
Industrial Strategies Division, California Air Resources Board, Sacramento, CA, USA.
We examine the influence of exposure to fine particulate matter (PM 2.5) in ambient air over the previous 6 years on the average standardized test score performance in math, English language arts (ELA), and overall for sixth graders at a sample of California public school districts from 2015 through 2018. Public health research suggests that children exposed to localized air pollution may suffer from cognitive impairment during testing or chronic conditions such as asthma that could influence their academic performance.
View Article and Find Full Text PDFSci Rep
October 2024
Ophthalmology Department, Hadassah Medical Center, Jerusalem, Israel.
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