Sexing skulls using discriminant function analysis of visually assessed traits

The accuracy of sex determinations based on visual assessments of the mental eminence, orbital margin, glabellar area, nuchal area, and mastoid process was tested on a series of 304 skulls of known age and sex from people of European American, African American, and English ancestry as well as on an ancient Native American sample of 156 individuals whose sex could be reliably determined based on pelvic morphology. Ordinal scores of these sexually dimorphic traits were used to compute sex determination discriminant functions. Linear, kth-nearest-neighbor, logistic, and quadratic discriminant analysis models were evaluated based on their capacity to minimize both misclassifications and sex biases in classification errors. Logistic regression discriminant analysis produced the best results: a logistic model containing all five cranial trait scores correctly classified 88% of the modern skulls with a negligible sex bias of 0.1%. Adding age at death, birth year, and population affinity to the model did not appreciably improve its performance. For the ancient Native American sample, the best logistic regression model assigned the correct pelvic sex to 78% of the individuals with a sex bias of only 0.2%. Similar cranial trait frequency distributions were found in same-sex comparisons of the modern African American, European American, and English samples. The sexual dimorphism of these modern people contrasts markedly with that of the ancient Native Americans. Because of such population differences, discriminant functions like those presented in this paper should be used with caution on populations other than those for which they were developed.     

Assessment of observer variability in the classification of human cataracts.

An in vitro cataract classification system was developed in our laboratories and used to demonstrate a relationship between sustained aspirin intake and the apparent deceleration or retardation of human cataract formation. The purpose of this investigation was to assess the reliability of this cataract classification schema. Sets of extracted human cataractous lenses, which had been photographed in vitro, were randomly assigned to five observers. The task was to classify the lenses on the basis of nuclear and cortical involvement, as reflected in color and area changes along five groupings. Assessments were made on the basis of both intraobserver and interobserver agreement levels, corrected for chance (weighted kappa values). All five examiners evidenced levels of intraobserver agreement which ranged between "Good" and "Fair" and "Excellent" (.46-.83). Each of the five observers was ranked on the basis of his agreement levels with the remaining four observers. The results followed a predictable pattern such that the more experienced the observer in classifying cataracts, the more consistent his rankings vis-à-vis the remaining four evaluators. These results are discussed in the general context of observer variability studies in the field of medicine.     

A Novel Method for Measuring Anterior Segment Area of the Eye on Ultrasound Biomicroscopic Images Using Photoshop

Purpose

To describe a novel method for quantitative measurement of area parameters in ocular anterior segment ultrasound biomicroscopy (UBM) images using Photoshop software and to assess its intraobserver and interobserver reproducibility.

Methods

Twenty healthy volunteers with wide angles and twenty patients with narrow or closed angles were consecutively recruited. UBM images were obtained and analyzed using Photoshop software by two physicians with different-level training on two occasions. Borders of anterior segment structures including cornea, iris, lens, and zonules in the UBM image were semi-automatically defined by the Magnetic Lasso Tool in the Photoshop software according to the pixel contrast and modified by the observers. Anterior chamber area (ACA), posterior chamber area (PCA), iris cross-section area (ICA) and angle recess area (ARA) were drawn and measured. The intraobserver and interobserver reproducibilities of the anterior segment area parameters and scleral spur location were assessed by limits of agreement, coefficient of variation (CV), and intraclass correlation coefficient (ICC).

Results

All of the parameters were successfully measured by Photoshop. The intraobserver and interobserver reproducibilities of ACA, PCA, and ICA were good, with no more than 5% CV and more than 0.95 ICC, while the CVs of ARA were within 20%. The intraobserver and interobserver reproducibilities for defining the spur location were more than 0.97 ICCs. Although the operating times for both observers were less than 3 minutes per image, there was significant difference in the measuring time between two observers with different levels of training (p<0.001).

Conclusion

Measurements of ocular anterior segment areas on UBM images by Photoshop showed good intraobserver and interobserver reproducibilties. The methodology was easy to adopt and effective in measuring.     

Évaluation de l’exactitude de latéralisation du foyer épileptogène par la tomographie par émission de positons au 18f-fluorodésoxyglucose dans le bilan préopératoire de l’épilepsie temporale : analyse visuelle simple et par index d’asymétrie inter-hémisphérique par soustraction d’images,analyse quantitative par statistical parametric mapping

IntroductionInter-ictal 18F-2-fluoro-deoxy-D-glucose-positron emission tomography (FDG-PET) plays a key role for the preoperative evaluation of patients with pharmacoresistant temporal lobe epilepsy. PET images are usually analyzed visually, a way that is reported to provide a high diagnostic value but that remains subjective, depending on the expertise and experience of the observer. By contrast, the voxel-based quantitative analyses, such as statistical parametric mapping (SPM), are objective and therefore, observer independent methods of analyses. In this study, the accuracy of the analyses of brain FDG-PET images to lateralize the temporal lobe epileptogenic zone was compared between: (1) a conventional visual method, (2) a quantitative SPM analysis, and (3) a visual analysis of inter-hemispheric asymmetry (IHA) obtained after images substraction.Materials and methodsFDG-PET scans of 31 patients presenting a severe temporal epilepsy and whom the temporal foci had been accurately lateralized (successful subsequent surgical treatment) were retrospectively analysed by (1) a consensual visual analysis from two experienced observers; (2) SPM analysis with voxel-wise comparisons of FDG-PET images of patients with those of age-matched healthy controls, using various statistical threshold (P) and cluster (k) values; and (3) visual assessment by the two same observers of images obtained for assessing the IHA. For this purpose, a flipped image was initially obtained by reversing in the left-right direction the FDG-PET images, which had been previously spacially normalized with the SPM template. Then, flipped and non-flipped images were substracted.ResultsThe temporal hypometabolic area was accurately identified: (1) by the conventional visual analysis in 87 % of patients and with a satisfactory interobserver reproducibility (interobserver Cohen's coefficient = 0.79); (2) by SPM analysis, in 90 % of patients (when using optimal thresholds of 0.01 for P value and of 50 voxels (400 mm³) for k value); and (3) with the visual analysis of IHA in 97 % of patients with an excellent interobserver reproductibility (interobserver Cohen's coefficient = 1).ConclusionIn patients presenting severe temporal epilepsy, visual assessment of FDG-PET images from IHA seems more accurate for lateralizing the epileptogenic temporal areas when compared with either conventional visual or quantitative SPM analyses. Moreover, this method is very easy to use in clinical practice, contrary to the quantitative method using SPM     

Lateral angle: a method for sexing using the petrous bone

We report on the results of applying the so-called lateral angle method for sex determination on skeletal remains. The lateral angle denotes the angle of the internal auditory canal in relation to the medial surface of the petrous part of the temporal bone. The method involves making a small cast of the proximal part of the internal acoustic canal and determining the angle at which the canal opens up to the surface of the petrous bone. The method has the great advantage of utilizing one of the sturdiest bone elements of the human skeleton, and may thus be especially suited for analyses of very fragmented skeletal remains or cremated bones, where the petrous bone may still be readily recognizable. The method was tested using a forensic sample of 113 petrous bones with known sex. Intra- and interobserver testing was also performed. We found a statistically significant difference in angle size between males and females (mean angle size of males, 39.3 degrees ; mean angle size of females, 48.2 degrees ; P < 0.001). There was no bilateral difference in angle size. In blind trials, 83.2% of petrous bones were assigned to the correct sex. We also tested the lateral angle method against an archaeological skeletal sample. True sex was not known for this sample; instead, sexing had been carried out by assessing pelvic and cranial morphology in independent trials. We found a higher concordance between the lateral angle and "pelvic" sex than for lateral angle and "cranial" sex. Finally, we note that subadult sexing may also be possible with this method.     

Geometric morphometric assessment of sexually dimorphic characteristics of the distal humerus

A number of recent studies investigated the use of morphological characteristics of the distal humerus to estimate the sex of unknown individuals. Using visual assessment, accuracies ranging from 74% to more than 90% were reported. The aim of this study was to assess these traits with geometric morphometrics, in order to determine if they corroborate the findings described with pure visual assessment. A total sample of 155 female and 175 male humeri of South Africans were used. All humeri were photographed in standardized positions from a posterior and inferior view, and homologous landmarks assigned. Olecranon fossa shape, angle of the medial epicondyle and trochlear symmetry were assessed. Males and females could be separated with accuracies ranging from 78% to 91%. The results of this study confirm the existence of these traits and their usability in assessment of sex from skeletal remains, and the observed anatomical characteristics largely agree with what have been described by visual assessment.     

Sex differences in heat pain thresholds as a function of assessment method and rate of rise

Studies of sex differences in the responses to experimentally induced pain demonstrate greater pain sensitivity among females than males. However, studies investigating heat pain responses have produced inconsistent results. Differences in stimulus characteristics and assessment methods probably account for this variability. This study examined sex differences in the heat pain threshold as a function of two different assessment methods and varying rates of rise. Nineteen female and 18 male healthy volunteers underwent heat pain threshold assessment via the method of levels and the method of limits. In addition, both fast (4.0 C/s) and slow (0.5 C/s) rates of rise were used for the method of levels assessments. In order to examine the reliability of threshold values, each subject participated in two sessions, separated by approximately 8 days. Females evinced lower thresholds than males for the method of levels assessments with both slow and fast rates of rise ( ps < 0.05), while no sex differences emerged for the threshold assessed via the method of limits. Test-retest reliability coefficients were relatively high. However, thresholds generally increased significantly from session 1 to session 2. Between method correlations were generally low to moderate. These findings indicate that the method of levels may be more sensitive to sex differences than the more commonly used method of limits. Also, thresholds appear to increase from session 1 to session 2, and thresholds assessed via different methods are not strongly correlated. Potential implications of these results for experimental pain assessment are discussed.     

Interobserver And Intraobserver Agreement In Parathyroid Scintigraphy: How Can Parathyroid Scintigraphy Be Made More Reliable?

ObjectiveTo determine the intraobserver and interobserver agreement levels in the evaluation of technetium Tc 99m sestamibi parathyroid scintigraphic images.MethodsNinety-eight patients with hyperparathyroidism were included in the study, and their parathyroid images were evaluated by 4 experienced nuclear medicine observers. The 98 cases were evaluated twice by each observer within an interval of 2 weeks. The evaluations were performed directly on workstations with use of digital images. A questionnaire was completed by each observer. The presence of a lesion, the number and the localizations of the lesions, and whether the lesion was clear or doubtful were all evaluated. Cohen kappa statistics and total agreement percentages were calculated by using SPSS version 11.0 software.ResultsThe 4 observers performed 8 different evaluations and identified a minimum of 38 and a maximum of 43 cases with a parathyroid lesion (or lesions). Both the intraobserver and the interobserver agreements were “very good” for the presence of a parathyroid lesion. The intraobserver agreement was also “very good” and the interobserver agreement was “good” (for only 1 pair of observers) or “very good” for the evaluation of the number of parathyroid lesions. The intraobserver agreement was “very good” or “good” and the interobserver agreement was “good” for the lesion localization and for the presence of a doubtful lesion.ConclusionParathyroid scintigraphy seems to be an observer independent method in the detection of a parathyroid lesion, in the determination of the number of lesions, and in the localizations of the lesions. The measured high agreement between observers increases the reliability of parathyroid scintigraphy. (Endocr Pract. 2012;18: 538-548)     

Intraobserver and interobserver variability in the diagnosis of epithelial abnormalities in cervical smears

In a study of variability in the diagnosis of epithelial abnormalities, cervical smears with abnormalities of different severity were rescreened twice by 19 observers with an interval of six months. The observers focused on grading atypicality of squamous, squamous metaplastic and endocervical columnar epithelial cells; their results were compared (1) for the two screenings to assess intraobserver variability and (2) to "review" (final) diagnoses to assess interobserver variability. When the same observer rescreened a smear, 83.3% of the diagnoses did not differ more than one grade between two screenings; however, average intraobserver variability differed considerably for individual observers. The intraobserver variability was only slightly (not significantly) influenced by the years of experience in cytopathology of the observers. Intraobserver variability proved to be an important factor in incorrect diagnoses: 49.1% of the smears with false-negative and 52.9% with false-positive diagnoses at the first rescreening were correctly assessed at the second rescreening. Of all diagnoses made at rescreening, 80.9% were in agreement with the review diagnosis. The interobserver variability also showed considerable differences between observers; however, there was a strong influence of the experience of the observer on the interobserver variability. Atypicality grading of endocervical columnar epithelium by the observers showed a low correlation with the review diagnoses. The relatively low accuracy in the evaluation of this kind of epithelial abnormality is likely to be attributable to the low incidence of abnormal changes of endocervical columnar epithelium. The results of this study point to intraobserver variability as the main cause of false diagnoses. When wrongly diagnosed, severe epithelial abnormalities are more often underestimated than completely overlooked. Apart from training in cytopathology, the establishment of laboratory protocols for multiple screening of even minor abnormalities seem to be the most effective means of reducing the number of false diagnoses.     

Selection on male sex pheromone composition contributes to butterfly reproductive isolation

Selection can facilitate diversification by inducing character displacement in mate choice traits that reduce the probability of maladaptive mating between lineages. Although reproductive character displacement (RCD) has been demonstrated in two-taxa case studies, the frequency of this process in nature is still debated. Moreover, studies have focused primarily on visual and acoustic traits, despite the fact that chemical communication is probably the most common means of species recognition. Here, we showed in a large, mostly sympatric, butterfly genus, a strong pattern of recurrent RCD for predicted male sex pheromone composition, but not for visual mate choice traits. Our results suggest that RCD is not anecdotal, and that selection for divergence in male sex pheromone composition contributed to reproductive isolation within the Bicyclus genus. We propose that selection may target olfactory mate choice traits as a more common sensory modality to ensure reproductive isolation among diverging lineages than previously envisaged.     

Sex determination using the femur in an ancient Japanese population

Determination of sex from the femur measurements has been attempted in several populations and various studies have demonstrated the importance of population specific standards in the metric assessment of sex. The present study attempts to establish metric standards for sex determination by using femur measurements for ancient Japanese populations. Osteometric data were obtained from 151 adult skeletal remains from Jomon period, Yoshigo human skeletal collection. Eight femur measurements were taken and the data were analyzed by discriminant analysis using SPSS version 10.0. For the univariate discriminant function derived, precision of sex determination was 93% with the condyle breadth. Prediction values showed that sex differentiation could be done by femur measurements with reliability between 66.9 and 100%, with values for males higher than for females. It is suggested that discriminant formulas developed by femur measurements in this study, can be used for sex determination accurately on fragmentary skeletal remains in ancient Japanese populations.     

Assessment of Prosthesis Alignment after Revision Total Knee Arthroplasty Using EOS 2D and 3D Imaging: A Reliability Study

Introduction

A new low-dose X-ray device, called EOS, has been introduced for determining lower-limb alignment in 2D and 3D. Reliability has not yet been assessed when using EOS on lower limbs containing a knee prosthesis. Therefore purpose of this study was to determine intraobserver and interobserver reliability of EOS 2D and 3D knee prosthesis alignment measurements after revision total knee arthroplasty (rTKA).

Methods

Forty anteroposterior and lateral images of 37 rTKA patients were included. Two observers independently performed measurements on these images twice. Varus/valgus angles were measured in 2D (VV2D) and 3D (VV3D). Intraclass correlation coefficients and the Bland and Altman method were used to determine reliability. T-tests were used to test potential differences.

Results

Intraobserver and interobserver reliability were excellent for VV2D and VV3D. No significant difference or bias between the first and second measurements or the two observers was found. A significant mean and absolute difference of respectively 1.00° and 1.61° existed between 2D and 3D measurements.

Conclusions

EOS provides reliable varus/valgus measurements in 2D and 3D for the alignment of the knee joint with a knee prosthesis. However, significant differences exist between varus/valgus measurements in 2D and 3D.     

Intra and Interobserver Reliability and Agreement of Semiquantitative Vertebral Fracture Assessment on Chest Computed Tomography

Objectives

To evaluate the reliability of semiquantitative Vertebral Fracture Assessment (VFA) on chest Computed Tomography (CT).

Methods

Four observers performed VFA twice upon sagittal reconstructions of 50 routine clinical chest CTs. Intra- and interobserver agreement (absolute agreement or 95% Limits of Agreement) and reliability (Cohen''s kappa or intraclass correlation coefficient(ICC)) were calculated for the visual VFA measures (fracture present, worst fracture grade, cumulative fracture grade on patient level) and for percentage height loss of each fractured vertebra compared to the adjacent vertebrae.

Results

Observers classified 24–38% patients as having at least one vertebral fracture, giving rise to kappa''s of 0.73–0.84 (intraobserver) and 0.56–0.81 (interobserver). For worst fracture grade we found good intraobserver (76–88%) and interobserver (74–88%) agreement, and excellent reliability with square-weighted kappa''s of 0.84–0.90 (intraobserver) and 0.84–0.94 (interobserver). For cumulative fracture grade the 95% Limits of Agreement were maximally ±1,99 (intraobserver) and ±2,69 (interobserver) and the reliability (ICC) varied from 0.84–0.94 (intraobserver) and 0.74–0.94 (interobserver). For percentage height-loss on a vertebral level the 95% Limits of Agreement were maximally ±11,75% (intraobserver) and ±12,53% (interobserver). The ICC was 0.59–0.90 (intraobserver) and 0.53–0–82 (interobserver). Further investigation is needed to evaluate the prognostic value of this approach.

Conclusion

In conclusion, these results demonstrate acceptable reproducibility of VFA on CT.     

The measurement of interobserver agreement based on categorical scales

The Kappa statistic is used to measure the interobserver similarity based on categorical scales. The cases of two or more observers with two or more rating categories are considered. Allowance is made for the attachment of disagreement weights, based on rational or clinical grounds, to different rating categories. Tests of hypotheses about the conditions Kappa = 0 and Kappa greater than 0 are conducted.     

Sex determination using the femur in an ancient Anatolian population

Determination of sex from the femur measurements has been attempted in several populations. Numerous studies have also demonstrated the importance of creating population specific standards in the metric assessment of sex. The present study attempts to establish metric standards for sex determination by using femur measurements for ancient Anatolian populations. Osteometric data were obtained from skeletal remains of 130 adults (67 males and 63 females) from the Dilkaya medieval collection. Eight femur measurements were taken and the data were analyzed using t-test and discriminant analysis with the help of Statistical Package for the Social Sciences (SPSS). The basic statistics showed that all measurements were sexually dimorphic. For the univariate discriminant function derived, precision of sex determination was 86.5 % with the condyle breadth. Our prediction values showed that sex differentiation can be done by femur measurements with reliability between 76 % and 88.5 %, with values for female slightly higher than for males. It is suggested that discriminant formulas developed by combinations of femur measurements in this study can be used for sex determination accurately on fragmentary skeletal remains in ancient Anatolian populations.     

3D identification of trabecular bone fracture zone using an automatic image registration scheme: A validation study

Accurate identification of the local fracture zone is an important step towards the failure assessment of trabecular bone. In previous in-vitro studies, local fracture zones were visually identified in micro-CT images by experienced observers. This is a time-consuming and observer-dependent approach and it prevents any large-scale analysis of local trabecular fracture regions. The scope of this study is the application and validation of a new registration scheme for the automatic identification of trabecular bone fracture zones. Six human trabecular specimens were extracted from different anatomical sites. Five specimens were mechanically tested and scanned using micro-CT. For each specimen pre- and post-failure micro-CT datasets were obtained. The sixth specimen was scanned twice without any mechanical compression and was used to test the accuracy of the proposed scheme. The registration scheme was applied to the acquired datasets for the automatic identification of the fracture zone. The proposed scheme comprises of a three-dimensional (3D) automatic registration method to define the differences between the two datasets, and the application of a criterion for defining slices of the pre-failure dataset as "broken" or "unbroken". Identifications of the fracture zones were qualitatively validated against visual identification of observers. Furthermore, "full 3D" fracture zone identification, based on the presented scheme, was proposed. The proposed scheme proved to be more accurate and significantly faster than the currently used visual process.     

Multiple observers, humidity, and choice of precision statistics: factors influencing craniometric data quality

This study investigates three topics: (1) interobserver measurement error in craniometry, (2) the effects of humidity on craniometric measurements, and (3) the current status of estimators of measurement precision in craniometry and anthropometry. The results of the three-observer error analysis based on 24 linear measurements taken on 47 crania indicate that minor idiosyncratic variations in measurement technique can lead to high levels of statistical discrimination among the data produced by the different observers. The results of the humidity experiment substantiate the contention that increasing levels of relative humidity are associated with cranial expansion. The results of the comparison of 11 univariate precision estimators suggest that the combination of percentage agreement, the mean absolute difference, and Fisher's nonparametric sign test can give an instructive picture of the frequency, magnitude, and directionality of measurement imprecision. Information on the comparability of technique and measurement precision can then be used in the variable selection process prior to the application of multivariate statistical procedures to strengthen the substantive interpretation of craniometric data.     

Variation of functional cranial components in six Anthropoidea species

Sixty male crania from three Platyrrhini and three Catarrhini genera were measured by means of the craniofunctional method. The aim was to analyze functional components of the skull and relate their function and the degree of encephalization to life history variables. We recognized two major and eight minor functional components. The objectives were to test (1) if within-taxa (Platyrrhini or Catarrhini) and/or between-taxa (Platyrrhini and Catarrhini) comparisons showed minor-component differentiation; and (2) if encephalization affects both primate groups differently. After standardization by size and scaling, 15 possible within-taxa and between-taxa comparisons were made. We found a strong phylogenetic signal, i.e., cranial differences were not randomly distributed, with the between-taxa variation being greater than within-taxa. Both hypotheses tested were accepted since: (1) There was no random variation between functional cranial components. They followed definite patterns for ancestral and derived traits. (2) Encephalization was present in all scaled comparisons, with Platyrrhini showing a higher degree of encephalization than Catarrhini. We conclude that major and minor craniofunctional components should be considered as correlated traits related to life history, because we found different patterns between platyrrhines and catarrhines, and within species of both taxa.     

Antenatal screening by measurement of symphysis-fundus height.

A study was undertaken to assess the value of symphysis-fundus measurement as a screening procedure for intrauterine growth retardation. The reproducibility of this measurement was investigated in two groups of six patients, each measured six times by six different observers. The intraobserver coefficient of variation was 4.6% and the interobserver coefficient of variation 6.4%. There was no evidence that experience aided consistency. A chart of symphysis-fundus measurements derived from Cardiff data was found to be similar to others previously published, and one measurement below the 10th centile identified 64% of pregnancies in which the eventual birth weight was below the 10th centile for gestational age. Symphysis-fundus measurement is a useful screening test; one chart could be used for any Caucasian population and should be incorporated into the maternity services "co-operation card."