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Enforcement is a challenge for effective international cooperation. In human rights and environmental law, along with many other domains of international cooperation, "naming and shaming" is often used as an enforcement mechanism in the absence of stronger alternatives. Naming and shaming hinges on the ability to identify countries whose efforts are inadequate and effectively shame them toward better behavior. Research on this approach has struggled to identify factors that explain when it influences state behavior in ways that lead to more cooperation. Via survey of a large (N = 910) novel sample of experienced diplomats involved in the design of the Paris Agreement, we find support for the proposition that naming and shaming is most accepted and effective in influencing the behavior of countries that have high-quality political institutions, strong internal concern about climate change, and ambitious and credible international climate commitments. Naming and shaming appears less effective in other countries, so further enforcement mechanisms will be needed for truly global cooperation. We also find that the climate diplomacy experts favor a process of naming and shaming that relies on official intergovernmental actors, in contrast with studies suggesting that NGOs, media, and other private actors are more effective at naming and shaming. We suggest that these tensions-the inability for naming and shaming to work effectively within the countries least motivated for climate action and the preference for namers and shamers that seem least likely to be effective-will become central policy debates around making cooperation on climate change more enforceable.
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Mudança Climática , Empregados do Governo , Humanos , Cooperação Internacional , Paris , VergonhaRESUMO
Leveraging artificial neural networks (ANNs) trained on climate model output, we use the spatial pattern of historical temperature observations to predict the time until critical global warming thresholds are reached. Although no observations are used during the training, validation, or testing, the ANNs accurately predict the timing of historical global warming from maps of historical annual temperature. The central estimate for the 1.5 °C global warming threshold is between 2033 and 2035, including a ±1σ range of 2028 to 2039 in the Intermediate (SSP2-4.5) climate forcing scenario, consistent with previous assessments. However, our data-driven approach also suggests a substantial probability of exceeding the 2 °C threshold even in the Low (SSP1-2.6) climate forcing scenario. While there are limitations to our approach, our results suggest a higher likelihood of reaching 2 °C in the Low scenario than indicated in some previous assessments-though the possibility that 2 °C could be avoided is not ruled out. Explainable AI methods reveal that the ANNs focus on particular geographic regions to predict the time until the global threshold is reached. Our framework provides a unique, data-driven approach for quantifying the signal of climate change in historical observations and for constraining the uncertainty in climate model projections. Given the substantial existing evidence of accelerating risks to natural and human systems at 1.5 °C and 2 °C, our results provide further evidence for high-impact climate change over the next three decades.
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Plant genetic resources (PGR), including collections held in national and international gene banks, provide access to a wide array of genetic diversity and are critical to genomics research, conservation efforts, and applied breeding. Yet, there is a general lack of awareness in the research community about the rules and treaties that govern the use of PGR, about access and benefit sharing obligations contained in international treaties and/or national laws, and about how best to comply with potentially applicable requirements. This article provides a brief history and overview of three key international agreements, namely the Convention on Biological Diversity, the Nagoya Protocol, and the International Treaty on Plant Genetic Resources for Food and Agriculture, which collectively address responsibilities and obligations related to the use of much of the world's PGR. By highlighting the coverage and key considerations of each agreement, the article provides a guide for those who use PGR in plant genetics research to better understand when and how international agreements apply, and-where the rules are unclear-to suggest best practices for compliance with existing agreements.
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Melhoramento Vegetal , Plantas , Plantas/genética , Cooperação Internacional , Alimentos , BiodiversidadeRESUMO
Our research activities would be better served if they were communicated in a manner that is openly accessible to the public and all researchers. The research we share is often limited to representative data included in research papers-science would be much more efficient if all reproducible research data were shared alongside detailed methods and protocols, in the paradigm called Open Science. On the other hand, one primary function of research journals is to select manuscripts of good quality, verify the authenticity of the data and its impact, and deliver to the appropriate audience for critical evaluation and verification. In the current paradigm, where publication in a subset of journals is intimately linked to research evaluation, a hypercompetitive "market" has emerged where authors compete to access a limited number of top-tier journals, leading to high rejection rates. Competition among publishers and scientific journals for market dominance resulted in an increase in both the number of journals and the cost of publishing and accessing scientific papers. Here we summarize the current problems and potential solutions from the development of AI technology discussed in the seminar at the 46th Annual Meeting of the Molecular Biology Society of Japan.
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Acesso à Informação , Editoração , JapãoRESUMO
The influence of effort expenditure on the subjective value in feedback involving material reward has been the focus of previous research. However, little is known about the impact of effort expenditure on subjective value evaluations when feedback involves reward that is produced in the context of social interaction (e.g. self-other agreement). Moreover, how effort expenditure influences confidence (second-order subjective value) in feedback evaluations remains unclear. Using electroencephalography, this study aimed to address these questions. Event-related potentials showed that, after exerting high effort, participants exhibited increased reward positivity difference in response to self-other (dis)agreement feedback. After exerting low effort, participants reported high confidence, and the self-other disagreement feedback evoked a larger P3a. Time-frequency analysis showed that the high-effort task evoked increased frontal midline theta power. In the low (vs. high)-effort task, the frontal midline delta power for self-other disagreement feedback was enhanced. These findings suggest that, at the early feedback evaluation stage, after exerting high effort, individuals exhibit an increased sensitivity of subjective value evaluation in response to self-other agreement feedback. At the later feedback evaluation stage, after completing the low-effort task, the self-other disagreement feedback violates the individuals'high confidence and leads to a metacognitive mismatch.
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Encéfalo , Gastos em Saúde , Humanos , Retroalimentação , Encéfalo/fisiologia , Eletroencefalografia , Potenciais Evocados/fisiologia , Recompensa , Retroalimentação Psicológica/fisiologiaRESUMO
In a first-of-its-kind study, we assessed the capabilities of large language models (LLMs) in making complex decisions in haematopoietic stem cell transplantation. The evaluation was conducted not only for Generative Pre-trained Transformer 4 (GPT-4) but also conducted on other artificial intelligence models: PaLm 2 and Llama-2. Using detailed haematological histories that include both clinical, molecular and donor data, we conducted a triple-blind survey to compare LLMs to haematology residents. We found that residents significantly outperformed LLMs (p = 0.02), particularly in transplant eligibility assessment (p = 0.01). Our triple-blind methodology aimed to mitigate potential biases in evaluating LLMs and revealed both their promise and limitations in deciphering complex haematological clinical scenarios.
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Inteligência Artificial , Transplante de Células-Tronco Hematopoéticas , Humanos , Idioma , Doadores de TecidosRESUMO
Commercially available assays for measuring severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) anti-spike (S) or anti-nucleocapsid (N) antibodies differ in units, making results comparisons challenging. This study aimed to develop conversion equations between five quantitative anti-S antibody tests and to assess the agreement over time between three qualitative anti-N antibody tests. Blood samples from 24 216 vaccinated healthcare workers in Hiroshima Prefecture, Japan, were analyzed for anti-S antibodies using five quantitative tests (Abbott, Fujirebio, Ortho, Sysmex, Roche) and for anti-N antibodies using three qualitative tests (Abbott, Sysmex, Roche). Geometric mean regression was performed to establish equations for converting measured values between the five quantitative tests. Fleiss κ statistic was used to assess the agreement between the three qualitative tests. A strong correlation (Pearson's coefficient r > 0.9) was found for each pair of the five quantitative tests measuring anti-S antibodies, enabling the development of equations to convert values between each pair. Using these equations, which are based on the original output unit of each test, values obtained from one test can be transformed to be equivalent to the corresponding values in another test. For the three tests for anti-N antibodies, the agreement was substantial in the total sample (Fleiss' κ, 0.74) and moderate among those with self-reported past coronavirus disease 2019 (COVID-19) infection (Fleiss' κ, 0.39). The agreement decreased with time after infection. Reduced agreement between anti-N antibodies tests over time suggests caution in comparing seroepidemiological studies of COVID-19 exposure based on anti-N antibodies measurement. The findings could help improve antibody measurement systems and inform public health decision-makers.
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Anticorpos Antivirais , Teste Sorológico para COVID-19 , COVID-19 , SARS-CoV-2 , Glicoproteína da Espícula de Coronavírus , Humanos , Glicoproteína da Espícula de Coronavírus/imunologia , Anticorpos Antivirais/sangue , COVID-19/diagnóstico , COVID-19/imunologia , SARS-CoV-2/imunologia , Teste Sorológico para COVID-19/métodos , Japão , Proteínas do Nucleocapsídeo de Coronavírus/imunologia , Pessoal de Saúde , FosfoproteínasRESUMO
OBJECTIVES: To introduce and evaluate a simple method for assessing joint inflammation and structural damage on whole-body MRI (WBMRI) in juvenile idiopathic arthritis (JIA), which is usable in clinical practice. METHODS: The proposed system utilises post-contrast Dixon WBMRI scans. Joints are assessed for synovitis (grade 0-2) and structural damage (present/absent) at 81 sites. The synovitis grading is based on features including above-normal intensity synovial enhancement, synovial hypertrophy, joint effusion, subarticular bone marrow oedema and peri-articular soft tissue oedema.This system was evaluated in a prospective study of 60 young people (47 patients with JIA and 13 controls with non-inflammatory musculoskeletal pain) who underwent a WBMRI. Three readers (blinded to diagnosis) independently reviewed all images and re-reviewed 20 individual scans. The intra- and inter-reader overall agreement (OA) and the intra- and inter-reader Gwet's agreement coefficients 2 (GAC2) were measured for the detection of a) participants with ≥1 joint with inflammation or structural damage and b) joint inflammation or structural damage for each joint. RESULTS: The inter-reader OA for detecting patients with ≥1 joint with inflammation, defined as grade 2 synovitis (G2), and ≥1 joint with structural damage were 80% and 73%, respectively. The intra-reader OA for readers 1-3 were 80-90% and 75-90% respectively. The inter-reader OA and GAC2 for joint inflammation (G2) at each joint were both ≥85% for all joints but were lower if grade 1 synovitis was included as positive. CONCLUSION: The intra- and inter-reader agreements of this WBMRI assessment system are adequate for assessing objective joint inflammation and damage in JIA.
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It is important for people to feel listened to in professional and personal communications, and yet they can feel unheard even when others have listened well. We propose that this feeling may arise because speakers conflate agreement with listening quality. In 11 studies (N = 3,396 adults), we held constant or manipulated a listener's objective listening behaviors, manipulating only after the conversation whether the listener agreed with the speaker. Across various topics, mediums (e.g., video, chat), and cues of objective listening quality, speakers consistently perceived disagreeing listeners as worse listeners. This effect persisted after controlling for other positive impressions of the listener (e.g., likability). This effect seemed to emerge because speakers believe their views are correct, leading them to infer that a disagreeing listener must not have been listening very well. Indeed, it may be prohibitively difficult for someone to simultaneously convey that they disagree and that they were listening.
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Dissidências e Disputas , Humanos , Adulto , Feminino , Masculino , Adulto Jovem , Comunicação , Percepção da Fala , Adolescente , Pessoa de Meia-IdadeRESUMO
In the presence of recombination individuals may inherit different regions of their genome from different ancestors, resulting in a mosaic of phylogenetic histories across their genome. Ancestral recombination graphs (ARGs) can capture how phylogenetic relationships vary across the genome due to recombination, but reconstructing ARGs from genomic sequence data is notoriously difficult. Here, we present a method for reconciling discordant phylogenetic trees and reconstructing ARGs using maximum agreement forests (MAFs). Given two discordant trees, a MAF identifies the smallest possible set of topologically concordant subtrees present in both trees. We show how discordant trees can be reconciled through their MAF in a way that retains discordances strongly supported by sequence data while eliminating conflicts likely attributable to phylogenetic noise. We further show how MAFs and our reconciliation approach can be combined to select a path of local trees across the genome that maximizes the likelihood of the genomic sequence data, minimizes discordance between neighboring local trees, and identifies the recombination events necessary to explain remaining discordances to obtain a fully connected ARG. While heuristic, our ARG reconstruction approach is often as accurate as more exact methods while being much more computationally efficient. Moreover, important demographic parameters such as recombination rates can be accurately estimated from reconstructed ARGs. Finally, we apply our approach to plant infecting RNA viruses in the genus Potyvirus to demonstrate how true recombination events can be disentangled from phylogenetic noise using our ARG reconstruction methods.
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Genoma , Recombinação Genética , Humanos , Filogenia , Modelos Genéticos , AlgoritmosRESUMO
Determining sleep stages accurately is an important part of the diagnostic process for numerous sleep disorders. However, as the sleep stage scoring is done manually following visual scoring rules there can be considerable variation in the sleep staging between different scorers. Thus, this study aimed to comprehensively evaluate the inter-rater agreement in sleep staging. A total of 50 polysomnography recordings were manually scored by 10 independent scorers from seven different sleep centres. We used the 10 scorings to calculate a majority score by taking the sleep stage that was the most scored stage for each epoch. The overall agreement for sleep staging was κ = 0.71 and the mean agreement with the majority score was 0.86. The scorers were in perfect agreement in 48% of all scored epochs. The agreement was highest in rapid eye movement sleep (κ = 0.86) and lowest in N1 sleep (κ = 0.41). The agreement with the majority scoring varied between the scorers from 81% to 91%, with large variations between the scorers in sleep stage-specific agreements. Scorers from the same sleep centres had the highest pairwise agreements at κ = 0.79, κ = 0.85, and κ = 0.78, while the lowest pairwise agreement between the scorers was κ = 0.58. We also found a moderate negative correlation between sleep staging agreement and the apnea-hypopnea index, as well as the rate of sleep stage transitions. In conclusion, although the overall agreement was high, several areas of low agreement were also found, mainly between non-rapid eye movement stages.
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Síndromes da Apneia do Sono , Sono , Humanos , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Fases do Sono , Síndromes da Apneia do Sono/diagnósticoRESUMO
We investigated arousal scoring agreement within full-night polysomnography in a multi-centre setting. Ten expert scorers from seven centres annotated 50 polysomnograms using the American Academy of Sleep Medicine guidelines. The agreement between arousal indexes (ArIs) was investigated using intraclass correlation coefficients (ICCs). Moreover, kappa statistics were used to evaluate the second-by-second agreement in whole recordings and in different sleep stages. Finally, arousal clusters, that is, periods with overlapping arousals by multiple scorers, were extracted. The overall similarity of the ArIs was fair (ICC = 0.41), varying from poor to excellent between the scorer pairs (ICC = 0.04-0.88). The ArI similarity was better in respiratory (ICC = 0.65) compared with spontaneous (ICC = 0.23) arousals. The overall second-by-second agreement was fair (Fleiss' kappa = 0.40), varying from poor to substantial depending on the scorer pair (Cohen's kappa = 0.07-0.68). Fleiss' kappa increased from light to deep sleep (0.45, 0.45, and 0.53 for stages N1, N2, and N3, respectively), was moderate in the rapid eye movement stage (0.48), and the lowest in the wake stage (0.25). Over a half of the arousal clusters were scored by one or two scorers, and less than a third by at least five scorers. In conclusion, the scoring agreement varied depending on the arousal type, sleep stage, and scorer pair, but was overall relatively low. The most uncertain areas were related to spontaneous arousals and arousals scored in the wake stage. These results indicate that manual arousal scoring is generally not reliable, and that changes are needed in the assessment of sleep fragmentation for clinical and research purposes.
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Nível de Alerta , Polissonografia , Fases do Sono , Humanos , Polissonografia/normas , Nível de Alerta/fisiologia , Fases do Sono/fisiologia , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Sono/fisiologia , Reprodutibilidade dos TestesRESUMO
Laboratory polysomnography provides gold-standard measures of sleep physiology, but multi-night investigations are resource intensive. We assessed the night-to-night stability via reproducibility metrics for sleep macrostructure and electroencephalography oscillations in a group of cognitively normal adults attending two consecutive polysomnographies. Electroencephalographies were analysed using an automatic algorithm for detection of slow-wave activity, spindle and K-complex densities. Average differences between nights for sleep macrostructure, electroencephalography oscillations and sleep apnea severity were assessed, and test-retest reliability was determined using two-way intraclass correlations. Agreement was calculated using the smallest real differences between nights for all measures. Night 2 polysomnographies showed significantly greater time in bed, total sleep time (6.3â hr versus 6.8 hr, p < 0.001) and percentage of rapid eye movement sleep (17.5 versus 19.7, p < 0.001). Intraclass correlations were low for total sleep time, percentage of rapid eye movement sleep and sleep efficiency, moderate for percentage of slow-wave sleep and percentage of non-rapid eye movement 2 sleep, good for slow-wave activity and K-complex densities, and excellent for spindles and apnea-hypopnea index with hypopneas defined according to 4% oxygen desaturation criteria only. The smallest real difference values were proportionally high for most sleep macrostructure measures, indicating moderate agreement, and proportionally lower for most electroencephalography microstructure variables. Slow waves, K-complexes, spindles and apnea severity indices are highly reproducible across two consecutive nights of polysomnography. In contrast, sleep macrostructure measures all demonstrated poor reproducibility as indicated by low intraclass correlation values and moderate agreement. Although there were average differences in percentage of rapid eye movement sleep and total sleep time, these were numerically small and perhaps functionally or clinically less significant. One night of in-laboratory polysomnography is enough to provide stable, reproducible estimates of an individual's sleep concerning measures of slow-wave activity, spindles, K-complex densities and apnea severity.
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PURPOSE: Prostate cancer (PCa) histology, particularly the Gleason score, is an independent prognostic predictor in PCa. Little is known about the inter-reader variability in grading of targeted prostate biopsy based on magnetic resonance imaging (MRI). The aim of this study was to assess inter-reader variability in Gleason grading of MRI-targeted biopsy among uropathologists and its potential impact on a population-based randomized PCa screening trial (ProScreen). METHODS: From June 2014 to May 2018, 100 men with clinically suspected PCa were retrospectively selected. All men underwent prostate MRI and 86 underwent targeted prostate of the prostate. Six pathologists individually reviewed the pathology slides of the prostate biopsies. The five-tier ISUP (The International Society of Urological Pathology) grade grouping (GG) system was used. Fleiss' weighted kappa (κ) and Model-based kappa for associations were computed to estimate the combined agreement between individual pathologists. RESULTS: GG reporting of targeted prostate was highly consistent among the trial pathologists. Inter-reader agreement for cancer (GG1-5) vs. benign was excellent (Model-based kappa 0.90, Fleiss' kappa κ = 0.90) and for clinically significant prostate cancer (csPCa) (GG2-5 vs. GG0 vs. GG1), it was good (Model-based kappa 0.70, Fleiss' kappa κ 0.67). CONCLUSIONS: Inter-reader agreement in grading of MRI-targeted biopsy was good to excellent, while it was fair to moderate for MRI in the same cohort, as previously shown. Importantly, there was wide consensus by pathologists in assigning the contemporary GG on MRI-targeted biopsy suggesting high reproducibility of pathology reporting in the ProScreen trial.
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Neoplasias da Próstata , Masculino , Humanos , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/patologia , Detecção Precoce de Câncer , Reprodutibilidade dos Testes , Estudos Retrospectivos , Antígeno Prostático Específico , Biópsia , Imageamento por Ressonância Magnética/métodos , Gradação de Tumores , Biópsia Guiada por ImagemRESUMO
In recent years, several ERP studies have investigated whether the early computation of agreement is permeable to the emotional content of words. Some studies have reported interactive effects of grammaticality and emotionality in the left anterior negativity (LAN) component, while others have failed to replicate these results. Furthermore, novel findings suggest that grammatical processing can elicit different neural patterns across individuals. In this study, we aim to investigate whether the interaction between grammaticality and emotionality is restricted to participants with a specific neural profile. Sixty-one female native speakers of Spanish performed an agreement judgment task in noun phrases composed of a determiner, a noun, and an unpleasant or neutral adjective that could agree or disagree in gender with the preceding noun. Our results support the existence of two different brain profiles: negative and positive dominance (individuals showing either larger LAN or larger P600 amplitudes in ungrammatical stimuli than in grammatical ones, respectively). Interestingly, the neural pattern of these two groups diverged at different points along the time course. Thus, the negative dominance group showed grammaticality effects as early as 200 ms, along with parallel and autonomous processing of grammaticality and emotionality at the LAN/N400 time window. Instead, for the positive dominance group an early interaction was found at around 200 ms, evidencing a grammaticality effect that emerged only for unpleasant words. Our findings confirm the role of individual differences in the interplay between grammar and emotion at the neural level and call for the inclusion of this perspective in studies on syntactic processing.
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AIMS: Single-lead electrocardiograms (ECGs) can be recorded using widely available devices such as smartwatches and handheld ECG recorders. Such devices have been approved for atrial fibrillation (AF) detection. However, little evidence exists on the reliability of single-lead ECG interpretation. We aimed to assess the level of agreement on detection of AF by independent cardiologists interpreting single-lead ECGs and to identify factors influencing agreement. METHODS AND RESULTS: In a population-based AF screening study, adults aged ≥65 years old recorded four single-lead ECGs per day for 1-4 weeks using a handheld ECG recorder. Electrocardiograms showing signs of possible AF were identified by a nurse, aided by an automated algorithm. These were reviewed by two independent cardiologists who assigned participant- and ECG-level diagnoses. Inter-rater reliability of AF diagnosis was calculated using linear weighted Cohen's kappa (κw). Out of 2141 participants and 162 515 ECGs, only 1843 ECGs from 185 participants were reviewed by both cardiologists. Agreement was moderate: κw = 0.48 (95% confidence interval, 0.37-0.58) at participant level and κw = 0.58 (0.53-0.62) at ECG level. At participant level, agreement was associated with the number of adequate-quality ECGs recorded, with higher agreement in participants who recorded at least 67 adequate-quality ECGs. At ECG level, agreement was associated with ECG quality and whether ECGs exhibited algorithm-identified possible AF. CONCLUSION: Inter-rater reliability of AF diagnosis from single-lead ECGs was found to be moderate in older adults. Strategies to improve reliability might include participant and cardiologist training and designing AF detection programmes to obtain sufficient ECGs for reliable diagnoses.
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Algoritmos , Fibrilação Atrial , Eletrocardiografia , Estudos de Viabilidade , Variações Dependentes do Observador , Humanos , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Idoso , Reprodutibilidade dos Testes , Feminino , Masculino , Eletrocardiografia/instrumentação , Eletrocardiografia/métodos , Valor Preditivo dos Testes , Idoso de 80 Anos ou mais , Processamento de Sinais Assistido por Computador , Frequência CardíacaRESUMO
We previously developed a computer-assisted image analysis algorithm to detect and quantify the microscopic features of rodent progressive cardiomyopathy (PCM) in rat heart histologic sections and validated the results with a panel of five veterinary toxicologic pathologists using a multinomial logistic model. In this study, we assessed both the inter-rater and intra-rater agreement of the pathologists and compared pathologists' ratings to the artificial intelligence (AI)-predicted scores. Pathologists and the AI algorithm were presented with 500 slides of rodent heart. They quantified the amount of cardiomyopathy in each slide. A total of 200 of these slides were novel to this study, whereas 100 slides were intentionally selected for repetition from the previous study. After a washout period of more than six months, the repeated slides were examined to assess intra-rater agreement among pathologists. We found the intra-rater agreement to be substantial, with weighted Cohen's kappa values ranging from k = 0.64 to 0.80. Intra-rater variability is not a concern for the deterministic AI. The inter-rater agreement across pathologists was moderate (Cohen's kappa k = 0.56). These results demonstrate the utility of AI algorithms as a tool for pathologists to increase sensitivity and specificity for the histopathologic assessment of the heart in toxicology studies.
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The Paris Agreement and the Minamata Convention on Mercury are two of the most important environmental conventions being implemented concurrently, with a focus on reducing carbon and mercury emissions, respectively. The relation between mercury and carbon influences the interactions and outcomes of these two conventions. This perspective investigates the link between mercury and CO2, assessing the consequences and exploring the policy implications of this link. We present scientific evidence showing that mercury and CO2 levels are negatively correlated under natural conditions. As a result of this negative correlation, the CO2 level under the current mercury reduction scenario is predicted to be 2.4-10.1 ppm higher than the no action scenario by 2050, equivalent to 1.0-4.8 years of CO2 increase due to human activity. The underlying causations of this negative correlation are complex and need further research. Economic analysis indicates that there is a trade-off between the benefits and costs of mercury reduction actions. As reducing mercury emission may inadvertently undermine efforts to achieve climate goals, we advocate for devising a coordinated implementation strategy for carbon and mercury conventions to maximize synergies and reduce trade-offs.
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Dióxido de Carbono , Mercúrio , Humanos , Mercúrio/análise , Políticas , ClimaRESUMO
OBJECTIVES: In the Bland and Altman analysis of agreement studies, there is some controversy whether "to plot the differences between the Standard/actual measurement method and the test/new measurement method against their mean" or "to plot the differences against the standard method". Of course, this is not just a "graphic dispute" as a regression model is inherent in the graphical choice to test the proportional and systematic biases. METHODS: We revised two relevant papers claiming to plot the differences against the standard and outlined their pitfalls taking into account the underlying statistical methodology. Furthermore, we have considered the conditions (correlation between the two measurement methods and ratio of their variances) leading correlation coefficient and regression slope between differences and means or differences and standard different from zero. RESULTS: We have shown the situations in which the regression slope and the correlation coefficient calculated from the differences and means according to Bland and Altman approach or calculated from the differences and standard are closer to zero giving the minimum possible value of spurious proportional error between the two methods. CONCLUSIONS: We highlighted how the calculation of the expected values of the correlation coefficients and, above all, of the regression slope can be very useful for choosing the statistical model in the context of an agreement study between two measurement methods. Finally, we outlined some recommendations for understanding the real possibility of carrying out agreement or calibration studies.
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Modelos Estatísticos , Projetos de Pesquisa , Humanos , Viés , Calibragem , Reprodutibilidade dos TestesRESUMO
State strategies for pharmacist prescribing exist on a continuum from most restrictive to least restrictive. Using human immunodeficiency virus (HIV) pre-exposure prophylaxis and post-exposure prophylaxis as a case study, there are 3 viable pharmacist prescribing models: (1) population-based collaborative practice agreements; (2) government protocols; and (3) standard of care prescribing. The advantages and disadvantages of these 3 models are reviewed.