Selection of reference films based on reliability assessment of a classification of high-resolution computed tomography for pneumoconioses.

OBJECTIVE: Worldwide demand has increased for the development of a computed tomography (CT) classification system that supplements the ILO classification of radiographs for pneumoconioses. The authors aimed to show preliminary reliability test results for selected referent films for the CT classification system developed through an international effort by researchers from seven countries. METHODS: Reading trials by eight physicians who have considerable experience in pneumoconioses using a total of 114 lung zones consisting of 6 lung zones of 19 CT films of dust-exposed workers were performed to assess reliability of the classification system by weighted kappa. The results were also utilized for selecting reference films. RESULTS: A good agreement was observed for both first and second reading trials for rounded opacities (weighted kappa=0.76, 0.74, first and second trial results, respectively), irregular opacities (0.60, 0.48), emphysema (0.56, 0.70) and honeycombing (0.72, 0.79). Ground glass opacities, on the other hand, showed moderate agreement (0.43, 0.38). Intra-reader agreements among eight readers were shown in the same table as the mean and standard deviation of weighted kappa statistics. The inter-reader agreement for pleural thickening was not as good as for parenchymal lesions. DISCUSSION: The CT classification development may pioneer noble and sensitive medical screening for dust-exposed workers in selected settings. This system may be applied to radiographic borderline cases of profusion 0/1 and 1/0 by the ILO classification, in a setting that assures the occupational safety and health of workers exposed to some newly developed chemical compounds.

Lydia Becker's "School for Science": a challenge to domesticity.

Lydia Becker (1827-1890) is known as a leader of the Women's Suffrage Movement but little is known about her work to include women and girls in science. Before her energy was channelled into politics, she aimed to have a scientific career. Mid-Victorian Britain was a period in which women's intellect and potential were widely debated, and in which the dominant ideology was that their primary role in life was that of wife and mother. Science was widely regarded as a "masculine" subject which women were deliberately discouraged from studying. The author concentrates on the two main areas in which important contributions were made, the British Association for the Advancement of Science, and the Manchester School Board.

Occupational and environmental medicine in the United States.

The history and the current status of occupational and environmental medicine (OEM) research, educational resources, clinical practice patterns, and regulatory framework in the United States are reviewed. Current or anticipated changes in health-care financing, clinical practice patterns, occupational safety and health regulations and enforcement, and funding for research and medical education at the national level are already having an impact on OEM activities in this country.