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The potential limitation of the reference ontology is another source of concern.
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However, researchers and CCRs reported some structural limitations of the reference group meetings and also made positive suggestions how these could be improved for future projects.
Because correlations between the questionnaires and the reference instrument (i.e. the accelerometer) are interpreted as measures of the accuracy of the questionnaires, it is desirable to correct for limitations of the reference instrument that reduce these correlations.
Another limitation of the panel of reference samples is that an ELISA test of unknown performance was used to confirm some of the negative control samples.
We discuss the strengths and limitations of the different reference standards further below.
There are strengths and limitations to each of the reference standards.
There are limitations to the reference-based approach.
In addition, due to the limitation of available reference standards for other microcystin congeners, it is conceivable that the supplement contained congeners other than MC-LR and MC-LA.
However it is important to note that the experts who are involved in making judgements and decisions about poorly performing doctors are aware of the limitations with the reference group data and take this into account.
Among the existing binning methods, unsupervised methods base the classification on features extracted from reads, and especially taking advantage in case of the limitation of reference database availability.
Nonetheless, there are two principal limitations relating to the quality of the reference standard (a single radiologist's opinion) and a lack of blinding between the test and the reference standard, raising the potential for review bias.
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