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Current methods of identifying the ionizing source of nebular emission in galaxies are well defined for the era of single-fiber spectroscopy, but still struggle to differentiate the complex and overlapping ionization sources in some galaxies. With the advent of integral field spectroscopy, the limits of these previous classification schemes are more apparent. We propose a new method for distinguishing the ionizing source in resolved galaxy spectra by use of a multidimensional diagnostic diagram that compares emission-line ratios with velocity dispersion on a spaxel-by-spaxel basis within a galaxy. This new method is tested using the Sydney-Australian-Astronomical-Observatory Multi-object Integral-Field Spectrograph Galaxy Survey (SAMI) Data Release 3 (DR3), which contains 3068 galaxies at z < 0.12. Our results are released as ionization maps available alongside the SAMI DR3 public data. Our method accounts for a more diverse range of ionization sources than the standard suite of emission-line diagnostics; we find 1433 galaxies with a significant contribution from non-star-forming ionization using our improved method as compared to 316 galaxies identified using only emission-line ratio diagnostics. Within these galaxies, we further identify 886 galaxies hosting unique signatures inconsistent with standard ionization by H ii regions, active galactic nuclei, or shocks. These galaxies span a wide range of masses and morphological types and comprise a sizable portion of the galaxies used in our sample. With our revised method, we show that emission-line diagnostics alone do not adequately differentiate the multiple ways to ionize gas within a galaxy.

Purpose To review existing classification systems for degenerative spondylolisthesis (DS), propose a novel classification designed to better address clinically relevant radiographic and clinical features of disease, and determine the inter- and intraobserver reliability of this new system for classifying DS. Methods The proposed classification system includes four components: 1) segmental dynamic instability, 2) location of spinal stenosis, 3) sagittal alignment, and 4) primary clinical presentation. To establish the reliability of this system, 12 observers graded 10 premarked test cases twice each. Kappa values were calculated to assess the inter- and intraobserver reliability for each of the four components separately. Results Interobserver reliability for dynamic instability, location of stenosis, sagittal alignment, and clinical presentation was 0.94, 0.80, 0.87, and 1.00, respectively. Intraobserver reliability for dynamic instability, location of stenosis, sagittal alignment, and clinical presentation were 0.91, 0.88, 0.87, and 0.97, respectively. Conclusion The UCSF DS classification system provides a novel framework for assessing DS based on radiographic and clinical parameters with established implications for surgical treatment. The almost perfect interobserver and intraobserver reliability observed for all components of this system demonstrates that it is simple and easy to use. In clinical practice, this classification may allow subclassification of similar patients into groups that may benefit from distinct treatment strategies, leading to the development of algorithms to help guide selection of an optimal surgical approach. Future work will focus on the clinical validation of this system, with the goal of providing for more evidence-based, standardized approaches to treatment and improved outcomes for patients with DS.

IntroductionFatty degeneration of the gluteal muscles on metal artefact reduction sequence (MARS) MRI has been shown to correlate with poor functional outcomes, particularly in patients with total hip arthroplasty (THA). Standardized, reliable classification systems that permit assessment of fatty gluteal infiltration are needed for clinical decision making. This study aimed to compare the reproducibility and accuracy of commonly used MRI classification systems for fatty gluteal atrophy in THA patients.MethodsMARS magnetic resonance images of 82 patients with unilateral THA were analysed by three independent trained observers. The readers evaluated fatty degeneration of the gluteus minimus, gluteus medius, and gluteus maximus according to 3 widely used classification systems: Goutallier, Quartile, and Bal and Lowe. Interobserver and intraobserver repeatability were determined using the weighted Kappa test. Quantitative evaluation of the proportion of intramuscular fat based on MR signal intensities was obtained and represented the gold standard.ResultsMean interobserver agreement for the Quartile classification system (0.93) was higher compared with Goutallier classification system (0.87) and the Bal and Lowe classification system (0.83; range 0.79–0.88; p = 0.04). Intraobserver repeatability was significantly higher for the Quartile classification system (weighted kappa 0.91, 0.89, 0.85) compared with the Bal and Lowe classification system (weighted kappa 0.83, 0.77, 0.75; p < 0.01) and Goutallier classification system (weighted kappa 0.83, 0.77, 0.75; p = 0.04). Agreement with the gold standard measurements was significantly higher in the Quartile classification system (0.88, 0.84, 0.81) compared with the Goutallier classification system (0.80, 0.77, 0.78; p = 0.02) and Bal and Lowe classification system (0.76, 0.74, 0.73; p < 0.01).DiscussionThis study directly compared three clinically used MRI classification systems for fatty gluteal muscle atrophy in THA patients. Our findings demonstrate that although all three classification systems demonstrate good reproducibility and accuracy, the Quartile classification system is superior to the others in terms of intraobserver reliability and accuracy to quantify fatty gluteal degeneration in THA patients.

Purpose Ultrasound evaluation of thyroid nodules is the preferred technique, but it is dependent on operator interpretation, leading to inter-observer variability. The current study aimed to determine the inter-physician consensus on nodular characteristics, risk categorization in the classification systems, and the need for fine needle aspiration puncture. Methods Four endocrinologists from the same center blindly evaluated 100 ultrasound images of thyroid nodules from 100 different patients. The following ultrasound features were evaluated: composition, echogenicity, margins, calcifications, and microcalcifications. Nodules were also classified according to ATA, EU-TIRADS, K-TIRADS, and ACR-TIRADS classifications. Krippendorff’s alpha test was used to assess interobserver agreement. Results The interobserver agreement for ultrasound features was: Krippendorff’s coefficient 0.80 (0.71–0.89) for composition, 0.59 (0.47–0.72) for echogenicity, 0.73 (0.57–0.88) for margins, 0.55 (0.40–0.69) for calcifications, and 0.50 (0.34–0.67) for microcalcifications. The concordance for the classification systems was 0.7 (0.61–0.80) for ATA, 0.63 (0.54–0.73) for EU-TIRADS, 0.64 (0.55–0.73) for K-TIRADS, and 0.68 (0.60–0.77) for K-TIRADS. The concordance in the indication of fine needle aspiration puncture (FNA) was 0.86 (0.71–1), 0.80 (0.71–0.88), 0.77 0.67–0.87), and 0.73 (0.64–0.83) for systems previously described respectively. Conclusions Interobserver agreement was acceptable for the identification of nodules requiring cytologic study using various classification systems. However, limited concordance was observed in risk stratification and many ultrasonographic characteristics of the nodules.

Background PRO-CTCAE is a library of items that measure cancer treatment-related symptomatic adverse events (NCI Contracts: HHSN261201000043C and HHSN 261201000063C). The objective of this study is to examine the equivalence and acceptability of the three data collection modes (Web-enabled touchscreen tablet computer, Interactive voice response system [IVRS], and paper) available within the US National Cancer Institute (NCI) Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) measurement system. Methods Participants ( n  = 112; median age 56.5; 24 % high school or less) receiving treatment for cancer at seven US sites completed 28 PRO-CTCAE items (scoring range 0–4) by three modes (order randomized) at a single study visit. Subjects completed one page (approx. 15 items) of the EORTC QLQ-C30 between each mode as a distractor. Item scores by mode were compared using intraclass correlation coefficients (ICC); differences in scores within the 3-mode crossover design were evaluated with mixed-effects models. Difficulties with each mode experienced by participants were also assessed. Results 103 (92 %) completed questionnaires by all three modes. The median ICC comparing tablet vs IVRS was 0.78 (range 0.55–0.90); tablet vs paper: 0.81 (0.62–0.96); IVRS vs paper: 0.78 (0.60–0.91); 89 % of ICCs were ≥0.70. Item-level mean differences by mode were small (medians [ranges] for tablet vs. IVRS = −0.04 [−0.16–0.22]; tablet vs paper = −0.02 [−0.11–0.14]; IVRS vs paper = 0.02 [−0.07–0.19]), and 57/81 (70 %) items had bootstrapped 95 % CI around the effect sizes within +/−0.20. The median time to complete the questionnaire by tablet was 3.4 min; IVRS: 5.8; paper: 4.0. The proportion of participants by mode who reported “no problems” responding to the questionnaire was 86 % tablet, 72 % IVRS, and 98 % paper. Conclusions Mode equivalence of items was moderate to high, and comparable to test-retest reliability (median ICC = 0.80). Each mode was acceptable to a majority of respondents. Although the study was powered to detect moderate or larger discrepancies between modes, the observed ICCs and very small mean differences between modes provide evidence to support study designs that are responsive to patient or investigator preference for mode of administration, and justify comparison of results and pooled analyses across studies that employ different PRO-CTCAE modes of administration. Trial registration NCT Clinicaltrials.gov identifier: NCT02158637

PurposeThe need for inclusive and logically consistent representation of diverse and even confronting viewpoints on the domain knowledge has been widely discussed in the literature in the past decade. The purpose of this paper is to propose a generic model for building an open coherent diversified knowledge organization system (KOS).Design/methodology/approachThe proposed model incorporates a generic epistemological component, the validity scope type, assigned to each statement in the constructed KOS. Statements are clustered by their association with various validity scope types into internally coherent subsystems. These subsystems form a knowledge organization network connected through the universal (consensual) subsystems with more than one validity scope type. The model extends the Galili’s Cultural Content Representation paradigm, which divides the knowledge content of a scientific theory into two confronting parts: body and periphery.FindingsThe knowledge organization network model makes it possible to comparatively examine similarities and differences among various viewpoints and theories on the domain knowledge. The presented approach conforms with the principle of Open Knowledge Network initiative for creation of open accessible knowledge.Practical implicationsThe proposed model can be used for ontological reasoning by a variety of information services, such as ontology-based decision-support and learning systems, diversified search and customer management applications.Social implicationsThe model enables explicit representation of social and cultural minority voices and historical knowledge in the KOS.Originality/valueThe main contribution of the proposed model is that it generalizes and enhances various previously proposed representations of epistemological aspects of KOS and allows for multiple inter-linked subsystems to coherently co-exist as part of the extensible network.

The increasing application of ultrasound (US) in recent years has led to a greater number of thyroid nodule diagnoses. Consequently, the number of fine needle aspirations performed to evaluate these lesions has increased. Although the majority of thyroid nodules are benign, identifying methods to define specific lesions and tailor risk of malignancy has become vital. Some of the tools employed to stratify thyroid nodule risk include clinical factors, thyroid US findings, and reporting systems for thyroid cytopathology. Establishing high concordance between US features and cytologic diagnoses might help reduce healthcare costs by diminishing unnecessary thyroid procedures and treatment. This review aims to review radiology US classification systems that influence the practice of thyroid cytology.

The Thumbs food classification system was developed to assist remote Australian communities to identify food healthiness. This study aimed to assess: (1) the Thumbs system’s alignment to two other food classification systems, the Health Star Rating (HSR) and the Northern Territory School Canteens Guidelines (NTSCG); (2) its accuracy in classifying ‘unhealthy’ (contributing to discretionary energy and added sugars) and ‘healthy’ products against HSR and NTSCG; (3) areas for optimisation. Food and beverage products sold between 05/2018 and 05/2019 in fifty-one remote stores were classified in each system. System alignment was assessed by cross-tabulating percentages of products, discretionary energy and added sugars sold assigned to the same healthiness levels across the systems. The system/s capturing the highest percentage of discretionary energy and added sugars sold in ‘unhealthy’ products and the lowest levels in ‘healthy’ products were considered the best performing. Cohen’s κ was used to assess agreement between the Thumbs system and the NTSCG for classifying products as healthy. The Thumbs system classified product healthiness in line with the HSR and NTSCG, with Cohen’s κ showing moderate agreement between the Thumbs system and the NTSCG (κ = 0·60). The Thumbs system captured the most discretionary energy sold (92·2 %) and added sugar sold (90·6 %) in unhealthy products and the least discretionary energy sold (0 %) in healthy products. Modifications to optimise the Thumbs system include aligning several food categories to the NTSCG criteria and addressing core/discretionary classification discrepancies of fruit juice/drinks. The Thumbs system offers a classification algorithm that could strengthen the HSR system.

Many indigenous people hold detailed ecological knowledge about their environment and have developed complex classifications of ecosystem types in their own languages. These classification systems may be based on characteristics including the availability of key resources, salient plant species, and cultural factors, among others. Indigenous environmental knowledge has been of interest to (ethno-)ecologists, geographers, anthropologists, and other scientists looking to learn from indigenous people, especially in newly emerging research topics. We identified and interpreted an ecosystem classification system of the Urarina, a small indigenous nation based in the Chambira River basin, a peatland-rich area of Peruvian Amazonia. Our findings, based on semistructured interviews, participatory mapping exercises, and site visits, indicate that the Urarina distinguish between ecosystems according to vegetation physiognomy, certain (palm) tree species, hydrology, and soil appearance, and that their use of natural resources varies between different ecosystems. Two Urarina ecosystems, jiiri and alaka, are almost certainly associated with the presence of peat soils and are of special cultural significance. The Urarina ecosystem classification system thus offers insights and inspiration for ecologists studying peatlands and other wetlands in the Peruvian Amazon who, thus far, have mostly focused on floristic and structural analyses only. Not least, our research highlights the importance of the peatlands for local people, beyond their role for the global climate system as a substantial carbon store.

Patient classification systems (PCS) support clinical decision-making but may rely on incorrect, outdated, or insufficient data. Doctors can sometimes override errors using their experience. However, certain factors such as scarcity of resources could lead to reliance on incorrect PCS recommendations, with consequences for patients. We conducted two experiments where participants interacted with a PCS that incorrectly classified fictitious patients as more or less sensitive to a treatment. Participants had the opportunity to administer the treatment on a series of patients, and use the feedback to learn that the PCS was wrong and all patients were equally sensitive. This was tested in contexts of abundant and scarce resources. Additionally, the treatment was effective in Experiment 1, but ineffective in Experiment 2. Results indicate that people generally trust the PCS recommendation, to some extent neglecting the information they collect during the task. This can lead to uneven resource allocation, especially in scarcity conditions, and incorrect perceptions of effectiveness, which in Experiment 2 implies believing that an ineffective treatment works. We preregistered the experiments, and all data and materials are public.