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Initially, some CHWs were uncomfortable with preparing the RDT in front of an observer, which may have affected the quality of their performance.
Different surgical intervention techniques are used for correction of cleft lip and palate, but the results are generally analyzed subjectively and without standardization and depend on the particular perspective of the observer, which may be influenced by ethnic or cultural background as well as age, making interpretation difficult.
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Finally, images were evaluated visually by two observers, which may have created a bias.
It used external observers which may provide more accurate data than that obtained by self-report.
We note that this observer's onset percept durations with the rotating walker were significantly longer than any other observer's, which may underlie this large positive drift.
Another limitation of this study was that, in order to avoid learning curves, only experienced observers were used, which may not always be the case in daily practice.
Although there was just one observer in this study, which may be considered as a potential limitation, there was a high degree of intra-observer agreement.
The observers were all doctors, which may introduce a degree of bias, although this was minimised by using a clear proforma for data capture with little observer subjectivity.
One observer deselected these particular contours, whereas the other observer included this contour part, which may explain the measurement difference.
As he said: "It is certainly not possible for the observer to influence the events which may appear under the conditions he has arranged" (APHK, p.51).
However, some detailed information on school life and symptoms of elementary school students were provided by their teachers, which may contain observer bias or recall bias.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com