Citral stability in oil-in-water emulsions at pH 3.0 with solid or liquid octadecane was determined. Citral degradation was faster in anionic sodium dodecyl sulfate (SDS)-stabilized emulsions than non-ionic polyoxyethylene (23) lauryl ether (Brij)-stabilized emulsions. Crystallization of octadecane in both Brij- and SDS-stabilized emulsion droplets resulted in faster degradation of citral. Crystallization of octadecane in emulsion droplets increased citral partitioning into the aqueous phase, with 41-53% of the total citral in the aqueous phase when octadecane was solid compared to 18-25% when octadecane was liquid. This research suggests that factors that increase partitioning of citral out of the droplets of oil-in-water emulsions increase citral degradation rates. These results suggest that the stability of citral could be increased in oil-in-water emulsions by technologies that decrease its partitioning and exposure to acidic aqueous phases.

There appears to be very low diagnostic agreement between practitioners. This is an important finding. If unchallenged by further investigation, the recognition of such poor diagnostic consensus may lead to rejection of TCM theory before it has been adequately assessed. Diagnostic agreement must be improved so that future investigations into treatment effectiveness or mechanisms of action are made on a valid basis. Additionally, the current TCM diagnostic format must be altered to allow the application of chance-removed statistics or the calculation of a standard error with open populations. This article is the first of a series of three that report problems in TCM diagnostic reliability and proposes solutions to the issues outlined.

In all cases, overall agreement was much lower with FK than Gwet's AC2. Larger differences occurred when the data were more free marginal. Inter-rater agreement determined with FK statistics is unlikely to be correct unless it can be shown that the data from which agreement is determined are, in fact, fixed marginal. It follows that results obtained on agreement between practitioners with FK are probably incorrect. It is shown that inter-rater agreement evaluated with AC2 statistic is an appropriate measure when fixed marginal data are neither expected nor guaranteed. The AC2 statistic should be used as the standard statistical approach for determining agreement between practitioners.

Objectives: In the first of a series of three articles by the present authors, diagnostic agreement between Traditional Chinese Medicine (TCM) practitioners was found to be low. This was the first time that TCM diagnoses had been evaluated with an open population of patients and this result is a cause of concern. In the second article, incorrect statistics were shown to have often been used to calculate chance-removed inter-rater agreement, and appropriate statistics such as Gwet's Agreement Coefficient 2 (AC2) was recommended for future studies. In this, the third article, a novel approach to recording TCM diagnostic patterns, the Traditional Chinese Medical Diagnostic Descriptor (TCMDD), is presented that allows chance-removed agreement calculation. An example of mapping TCM diagnostic patterns to the TCMDD format is given and diagnostic agreement is evaluated. Design, Settings, Subjects: The same 35 subjects used to report agreement in our first article were also diagnosed by additional practitioners using the TCMDD format during the same experimental sessions at the University of Technology, Sydney Clinic. TCM diagnoses from the first article were also mapped to the TCMDD format. Outcome measures: Linearly weighted simple agreement and the AC2 statistic were utilized and all results compared. Results: Linearly weighted simple agreement using the TCMDD and TCM mapped to TCMDD format averaged 0.80-0.02 compared with 0.19 for TCM. TCMDD and TCM mapped to TCMDD chance-removed agreement, as calculated with AC2, ranged between 0.67 and 0.73-0.03. Conclusions: The TCMDD allows the essence of diagnoses expressed by TCM practitioners to be appropriately compared. This was confirmed by the TCM mapped to TCMDD results. In both cases, simple agreement was significantly greater than that obtained with the TCM format. Chance-removed statistics and error estimates can be reliably calculated with the AC2 and the TCMDD in open populations.