{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T23:30:33Z","timestamp":1777591833202,"version":"3.51.4"},"reference-count":19,"publisher":"BMJ","issue":"1","funder":[{"DOI":"10.13039\/100004330","name":"GlaxoSmithKline","doi-asserted-by":"publisher","award":["90063241"],"award-info":[{"award-number":["90063241"]}],"id":[{"id":"10.13039\/100004330","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["OPP1084286"],"award-info":[{"award-number":["OPP1084286"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["OPP1117483"],"award-info":[{"award-number":["OPP1117483"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000061","name":"Fogarty International Center","doi-asserted-by":"publisher","award":["K01TW009988"],"award-info":[{"award-number":["K01TW009988"]}],"id":[{"id":"10.13039\/100000061","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Resp Res"],"published-print":{"date-parts":[[2019,4]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>To evaluate WHO chest radiograph interpretation processes during a pneumococcal vaccine effectiveness study of children aged 3\u201335 months with suspected pneumonia in Sylhet, Bangladesh.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Eight physicians masked to all data were standardised to WHO methodology and interpreted chest radiographs between 2015 and 2017. Each radiograph was randomly assigned to two primary readers. If the primary readers were discordant for image interpretability or the presence or absence of primary endpoint pneumonia (PEP), then another randomly selected, masked reader adjudicated the image (arbitrator). If the arbitrator disagreed with both primary readers, or concluded no PEP, then a masked expert reader finalised the interpretation. The expert reader also conducted blinded quality control (QC) for 20% of randomly selected images. We evaluated agreement between primary readers and between the expert QC reading and the final panel interpretation using per cent agreement, unadjusted Cohen\u2019s kappa, and a prevalence and bias-adjusted kappa.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among 9723 images, the panel classified 21.3% as PEP, 77.6% no PEP and 1.1% uninterpretable. Two primary readers agreed on interpretability for 98% of images (kappa, 0.25; prevalence and bias-adjusted kappa, 0.97). Among interpretable radiographs, primary readers agreed on the presence or absence of PEP in 79% of images (kappa, 0.35; adjusted kappa, 0.57). Expert QC readings agreed with final panel conclusions on the presence or absence of PEP for 92.9% of 1652 interpretable images (kappa, 0.75; adjusted kappa, 0.85).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Primary reader performance and QC results suggest the panel effectively applied the WHO chest radiograph criteria for pneumonia.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjresp-2018-000393","type":"journal-article","created":{"date-parts":[[2019,4,16]],"date-time":"2019-04-16T06:26:41Z","timestamp":1555396001000},"page":"e000393","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Chest radiograph reading panel performance in a Bangladesh pneumococcal vaccine effectiveness study"],"prefix":"10.1136","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1872-5566","authenticated-orcid":false,"given":"Eric D","family":"McCollum","sequence":"first","affiliation":[{"name":"Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA"},{"name":"Global Program in Respiratory Sciences, Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland, USA"},{"name":"Health Systems, Department of International Health, Johns Hopkins Hospital and Health System, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Salahuddin","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Johns Hopkins University \u2013 Bangladesh, Dhaka, Bangladesh"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nabidul H","family":"Chowdhury","sequence":"additional","affiliation":[{"name":"Johns Hopkins University \u2013 Bangladesh, Dhaka, Bangladesh"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Syed J R","family":"Rizvi","sequence":"additional","affiliation":[{"name":"Johns Hopkins University \u2013 Bangladesh, Dhaka, Bangladesh"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahad M","family":"Khan","sequence":"additional","affiliation":[{"name":"Johns Hopkins University \u2013 Bangladesh, Dhaka, Bangladesh"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arun D","family":"Roy","sequence":"additional","affiliation":[{"name":"Johns Hopkins University \u2013 Bangladesh, Dhaka, Bangladesh"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abu AM","family":"Hanif","sequence":"additional","affiliation":[{"name":"Johns Hopkins University \u2013 Bangladesh, Dhaka, Bangladesh"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Farhan","family":"Pervaiz","sequence":"additional","affiliation":[{"name":"Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA"},{"name":"Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA"},{"name":"Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"ASM Nawshad U","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Dhaka Shishu Hospital, Dhaka, Bangladesh"},{"name":"Child Health Research Foundation, Dhaka, Bangladesh"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ehteshamul H","family":"Farrukee","sequence":"additional","affiliation":[{"name":"Department of Radiology and Imaging, LabAid Cardiac Hospital, Dhaka, Bangladesh"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mahmuda","family":"Monowara","sequence":"additional","affiliation":[{"name":"Department of Radiology and Imaging, Dhaka Shishu Hospital, Dhaka, Bangladesh"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammad M","family":"Hossain","sequence":"additional","affiliation":[{"name":"Department of Radiology and Imaging, Dhaka Shishu Hospital, Dhaka, Bangladesh"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fatema","family":"Doza","sequence":"additional","affiliation":[{"name":"Department of Radiology and Imaging, National Institute of Cardiovascular Diseases, Dhaka, Bangladesh"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bidoura","family":"Tanim","sequence":"additional","affiliation":[{"name":"Department of Radiology and Imaging, National Institute of Ophthalmology, Dhaka, Bangladesh"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Farzana","family":"Alam","sequence":"additional","affiliation":[{"name":"Department of Radiology and Imaging, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicole","family":"Simmons","sequence":"additional","affiliation":[{"name":"Health Systems, Department of International Health, Johns Hopkins Hospital and Health System, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Megan E","family":"Reller","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA"},{"name":"Duke Hubert-Yeargan Center for Global Health, Durham, North Carolina, USA"},{"name":"Duke Global Health Institute, Durham, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meagan","family":"Harrison","sequence":"additional","affiliation":[{"name":"Health Systems, Department of International Health, Johns Hopkins Hospital and Health System, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Holly B","family":"Schuh","sequence":"additional","affiliation":[{"name":"Health Systems, Department of International Health, Johns Hopkins Hospital and Health System, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdul","family":"Quaiyum","sequence":"additional","affiliation":[{"name":"Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samir K","family":"Saha","sequence":"additional","affiliation":[{"name":"Child Health Research Foundation, Dhaka, Bangladesh"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nazma","family":"Begum","sequence":"additional","affiliation":[{"name":"Johns Hopkins University \u2013 Bangladesh, Dhaka, Bangladesh"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mathuram","family":"Santosham","sequence":"additional","affiliation":[{"name":"Health Systems, Department of International Health, Johns Hopkins Hospital and Health System, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lawrence H","family":"Moulton","sequence":"additional","affiliation":[{"name":"Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William","family":"Checkley","sequence":"additional","affiliation":[{"name":"Program in Global Disease Epidemiology and Control, Department of 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Pneumococcal conjugate vaccine impact assessment in Bangladesh. 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