Characteristics of Helical Flow through Neck Cutoffs

NASA Astrophysics Data System (ADS)

Richards, D.; Konsoer, K. M.; Turnipseed, C.; Willson, C. S.

2017-12-01

Meander cutoffs and oxbows lakes are a ubiquitous feature of riverine landscapes yet there is a paucity of detailed investigations concentrated on the three-dimensional flow structure through evolving neck cutoffs. The purpose of this research is to investigate and characterize helical flow through neck cutoffs with two different planform configurations: elongate meander loops and serpentine loops. Three-dimensional velocity measurements was collected with an acoustic Doppler current profiler for five cutoffs on the White River, Arkansas. Pronounced helical flow was found through all elongate loop cutoff sites, formed from the balance between centrifugal force resulting from the curving of flow through the cutoff channel and pressure gradient force resulting from water surface super-elevation between primary flow and flow at the entrance and exit of the abandoned loop. The sense of motion of the helical flow caused near-surface fluid to travel outward toward the abandoned loop while near-bed fluid was redirected toward the downstream channel. Another characteristic of the helical flow structure for elongate loop cutoffs was the reversal of helical flow over a relatively short distance, causing patterns of secondary circulation that differed from typical patterns observed through curved channels with point bars. Lastly, helical flow was revealed within zones of strong flow recirculation, enhanced by an exchange of streamwise momentum between shear layers.

The Objective Borderline method (OBM): a probability-based model for setting up an objective pass/fail cut-off score in medical programme assessments.

PubMed

Shulruf, Boaz; Turner, Rolf; Poole, Phillippa; Wilkinson, Tim

2013-05-01

The decision to pass or fail a medical student is a 'high stakes' one. The aim of this study is to introduce and demonstrate the feasibility and practicality of a new objective standard-setting method for determining the pass/fail cut-off score from borderline grades. Three methods for setting up pass/fail cut-off scores were compared: the Regression Method, the Borderline Group Method, and the new Objective Borderline Method (OBM). Using Year 5 students' OSCE results from one medical school we established the pass/fail cut-off scores by the abovementioned three methods. The comparison indicated that the pass/fail cut-off scores generated by the OBM were similar to those generated by the more established methods (0.840 ≤ r ≤ 0.998; p < .0001). Based on theoretical and empirical analysis, we suggest that the OBM has advantages over existing methods in that it combines objectivity, realism, robust empirical basis and, no less importantly, is simple to use.

Hyperammonaemia and associated factors in unprovoked convulsive seizures: A cross-sectional study.

PubMed

Sato, Kenichiro; Arai, Noritoshi; Omori, Aki; Hida, Ayumi; Kimura, Akio; Takeuchi, Sousuke

2016-12-01

Hyperammonaemia is frequently observed in patients who have experienced convulsive seizures. Although excessive muscle contraction is presumed to be responsible for the elevated levels of ammonia, the underlying mechanism is poorly understood. The present study aimed to identify the independent factors associated with ammonia elevation using large-scale multivariate analysis. We conducted a cross-sectional study involving 379 adult patients who had been transported to our emergency department and treated for unprovoked convulsive seizures between August 2010 and September 2015. Elevation of venous plasma ammonia levels was set as the primary endpoint, and patients' clinical and laboratory data were obtained. Those with severe liver dysfunction, known hepatic encephalopathy, or convulsions due to cardiovascular or psychogenic causes, and those taking valproate were excluded. Using a cut-off value of 50μg/dL, 183 patients (48.3%) were found to have elevated levels of plasma ammonia. Four factors were identified as independent variables associated with hyperammonaemia following seizures: elevated venous lactate, lowered venous pH, sex (male), and longer duration of convulsion. The results of the present study revealed independent factors associated with hyperammonaemia following unprovoked convulsive seizures in a larger scale and with more plausible statistical analysis. The authors further suggest that the excessive skeletal muscle contraction and/or respiratory failure during/after convulsive seizure may be the primary mechanism of hyperammonaemia. Copyright © 2016. Published by Elsevier Ltd.

26 CFR 1.585-7 - Elective cut-off method of changing from the reserve method of section 585.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 26 Internal Revenue 7 2011-04-01 2009-04-01 true Elective cut-off method of changing from the... § 1.585-7 Elective cut-off method of changing from the reserve method of section 585. (a) General rule...)) may elect to use the cut-off method set forth in this section. Any such election must be made at the...

On the entanglement entropy of quantum fields in causal sets

NASA Astrophysics Data System (ADS)

Belenchia, Alessio; Benincasa, Dionigi M. T.; Letizia, Marco; Liberati, Stefano

2018-04-01

In order to understand the detailed mechanism by which a fundamental discreteness can provide a finite entanglement entropy, we consider the entanglement entropy of two classes of free massless scalar fields on causal sets that are well approximated by causal diamonds in Minkowski spacetime of dimensions 2, 3 and 4. The first class is defined from discretised versions of the continuum retarded Green functions, while the second uses the causal set’s retarded nonlocal d’Alembertians parametrised by a length scale l k . In both cases we provide numerical evidence that the area law is recovered when the double-cutoff prescription proposed in Sorkin and Yazdi (2016 Entanglement entropy in causal set theory (arXiv:1611.10281)) is imposed. We discuss in detail the need for this double cutoff by studying the effect of two cutoffs on the quantum field and, in particular, on the entanglement entropy, in isolation. In so doing, we get a novel interpretation for why these two cutoff are necessary, and the different roles they play in making the entanglement entropy on causal sets finite.

A sensitive assay for urinary cocaine metabolite benzoylecgonine shows more positive results and longer half-lives than those using traditional cut-offs.

PubMed

Nickley, Joyce; Pesce, Amadeo J; Krock, Kevin

2017-08-01

Cocaine is a common drug of abuse. To detect its use, a screening detection concentration for the cocaine metabolite benzoylecgonine is commonly set at 150 ng/mL and its confirmatory cut-off is set at 100 ng/mL. Studies have suggested that these cut-offs may be set too high, allowing some patients with this substance abuse problem to be missed or improperly monitored. With the advent of liquid chromatography-tandem mass spectrometry (LC-MS/MS) technology it is possible to reliably detect and quantify lower concentrations of its metabolite benzoylecgonine as part of a larger drug panel. One purpose of the study was to establish if there was a significant increase in detection of cocaine use with a ten-fold more sensitive cut-off. A very sensitive dilute and shoot assay for benzoylecgonine was developed with a lower limit of quantitation of 5 ng/mL. Validation of the 5 ng/mL cut-off was achieved by plotting all the positive cocaine observations as a frequency distribution on a logarithmic scale. The number of positive results with measurable concentrations below the typical industry 100 ng/mL cut-off level but above the high sensitivity 5 ng/mL cut-off level was observed to be 51.9% of the observed positives. The lower cut-off also allowed a re-evaluation of the window of detection after cessation of use. It was observed to be between 17 and 22 days. © 2016 Precision Diagnostics, LLC. Drug Testing and Analysis published by John Wiley & Sons, Ltd. © 2016 Precision Diagnostics, LLC. Drug Testing and Analysis published by John Wiley & Sons, Ltd.

EUCAST breakpoints for antifungals.

PubMed

Rodríguez-Tudela, Juan L; Arendrup, Maiken C; Cuenca-Estrella, Manuel; Donnelly, J Peter; Lass-Flörl, Cornelia

2010-03-01

Susceptibility testing of fungi and development of interpretative breakpoints has become increasingly important due to the growing incidence of invasive fungal infections, the number and classes of antifungals, and the emerging reports of acquired resistance. The subcommittee on antifungal susceptibility testing of the European Committee on Antibiotic Susceptibility Testing (EUCAST) has developed standards for susceptibility testing of fermentative yeasts and molds as well as proposing breakpoints for fluconazole and voriconazole against Candida. The aim of this work is to describe the EUCAST process of setting breakpoints for antifungals. Five aspects are evaluated during the process of developing breakpoints: 1) the most common dosage used in each European country, 2) the definition of the wild-type population for each target microorganism at the species level and the determination of epidemiological cutoffs, 3) the drug's pharmacokinetics and 4) pharmacodynamics, including Monte Carlo simulations, and 5) the correlation of MICs with clinical outcome of patients treated with the compound. When insufficient data are available (e.g., due to lack of information on the clinical outcome of infections caused by isolates with an elevated MIC), epidemiological cutoff values, rather than breakpoints, are recommended until the necessary information becomes available. Copyright 2010 Prous Science, S.A.U. or its licensors. All rights reserved.

Using Empirical Data to Set Cutoff Scores.

ERIC Educational Resources Information Center

Hills, John R.

Six experimental approaches to the problems of setting cutoff scores and choosing proper test length are briefly mentioned. Most of these methods share the premise that a test is a random sample of items, from a domain associated with a carefully specified objective. Each item is independent and is scored zero or one, with no provision for…

Waist circumference and insulin resistance: a cross-sectional study of Japanese men

PubMed Central

Tabata, Shinji; Yoshimitsu, Shinichiro; Hamachi, Tadamichi; Abe, Hiroshi; Ohnaka, Keizo; Kono, Suminori

2009-01-01

Background Visceral obesity is positively related to insulin resistance. The nature of the relationship between waist circumference and insulin resistance has not been known in Japanese populations. This study examined the relationship between waist circumference and insulin resistance and evaluated the optimal cutoff point for waist circumference in relation to insulin resistance in middle-aged Japanese men. Methods Study subjects included 4800 Japanese men aged 39 to 60 years. Insulin resistance was evaluated by the homeostasis model assessment of insulin resistance (HOMA-IR). The relationship of waist circumference with HOMA-IR was assessed by use of adjusted means of HOMA-IR and odds ratios of elevated HOMA-IR defined as the highest quintile (≥2.00). Receiver operating characteristics (ROC) curve analysis using Youden index and the area under curve (AUC) was employed to determine optimal cutoffs of waist circumference in relation to HOMA-IR. Results Adjusted geometric means of HOMA-IR and prevalence odds of elevated HOMA-IR were progressively higher with increasing levels of waist circumference. In the ROC curve analysis, the highest value of Youden index was obtained for a cutoff point of 85 cm in waist circumference across different values of HOMA-IR. Multiple logistic regression analysis also indicated that the AUC was consistently the largest for a waist circumference of 85 cm. Conclusion Waist circumference is linearly related to insulin resistance, and 85 cm in waist circumference is an optimal cutoff in predicting insulin resistance in middle-aged Japanese men. PMID:19138424

Fetal karyotyping for chromosome abnormalities after an unexplained elevated maternal serum alpha-fetoprotein screening.

PubMed

Feuchtbaum, L B; Cunningham, G; Waller, D K; Lustig, L S; Tompkinson, D G; Hook, E B

1995-08-01

To study the chromosome abnormality rate among women with elevated levels of maternal serum alpha-fetoprotein (MSAFP) and the types of chromosome abnormalities in this population, and to compare this rate with reports in the literature and the rate observed in the general population. We studied 8097 women who chose to undergo amniocentesis and fetal karyotyping after having an elevated MSAFP test of 2.5 multiples of the median (MOM) or higher. All abnormal karyotypes were reviewed and grouped according to whether the elevated MSAFP value could be explained by a ventral wall or neural tube defect. The overall chromosome abnormality rate was 13.83 per 1000 amniocenteses. The rate in the "unexplained" group was 10.92 per 1000 amniocenteses. Just over half (53%) of the abnormal karyotypes were autosomal anomalies, and 47% were sex chromosome abnormalities. The autosomal aneuploidies observed most frequently were triploidy and trisomy 13. The sex chromosome abnormalities observed most frequently were the XXY and XYY karyotypes. Women who have unexplained elevated MSAFP values of 2.5 MOM or greater have a twofold increase in the rate of chromosome abnormalities in their fetuses compared with the general population (P < or = .001). This rate is consistent with other studies that used a 2.5 MOM cutoff. Studies that used a 2.0 MOM cutoff have reported chromosome abnormality rates that do not vary from general population estimates.

The Context Dependency of the Self-Report Version of the Strength and Difficulties Questionnaire (SDQ): A Cross-Sectional Study between Two Administration Settings

PubMed Central

Hoofs, H.; Jansen, N. W. H.; Mohren, D. C. L.; Jansen, M. W. J.; Kant, I. J.

2015-01-01

Background The Strength and Difficulties Questionnaire (SDQ) is a screening instrument for psychosocial problems in children and adolescents, which is applied in “individual” and “collective” settings. Assessment in the individual setting is confidential for clinical applications, such as preventive child healthcare, while assessment in the collective setting is anonymous and applied in (epidemiological) research. Due to administration differences between the settings it remains unclear whether results and conclusions actually can be used interchangeably. This study therefore aims to investigate whether the SDQ is invariant across settings. Methods Two independent samples were retrieved (mean age = 14.07 years), one from an individual setting (N = 6,594) and one from a collective setting (N = 4,613). The SDQ was administered in the second year of secondary school in both settings. Samples come from the same socio-geographic population in the Netherlands. Results Confirmatory factor analysis showed that the SDQ was measurement invariant/equivalent across settings and gender. On average, children in the individual setting scored lower on total difficulties (mean difference = 2.05) and the psychosocial problems subscales compared to those in the collective setting. This was also reflected in the cut-off points for caseness, defined by the 90th percentiles, which were lower in the individual setting. Using cut-off points from the collective in the individual setting therefore resulted in a small number of cases, 2 to 3%, while ∼10% is expected. Conclusion The SDQ has the same connotation across the individual and collective setting. The observed structural differences regarding the mean scores, however, undermine the validity of the cross-use of absolute SDQ-scores between these settings. Applying cut-off scores from the collective setting in the individual setting could, therefore, result in invalid conclusions and potential misuse of the instrument. To correctly apply cut-off scores these should be retrieved from the applied setting. PMID:25886464

EAST ELEVATION OF LOWER TRAM TERMINAL, LOOKING NORTHWEST. TRAM CARS ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

EAST ELEVATION OF LOWER TRAM TERMINAL, LOOKING NORTHWEST. TRAM CARS ENTERED AND EXITED FROM RIGHT,AND DUMPED INTO THE ORE BIN SEEN AT LOWER LEFT. BELOW THE ORE BIN IS A JAW CRUSHER FOUNDATION. THE WOODEN BOX AT CENTER IS FILLED WITH ROCKS, PROVIDING THE COUNTERWEIGHT TO THE TRAMWAY CABLE, WHICH KEEPS IT TAUGHT. - Keane Wonder Mine, Park Route 4 (Daylight Pass Cutoff), Death Valley Junction, Inyo County, CA

Defining the optimal cut-off values for liver enzymes in diagnosing blunt liver injury.

PubMed

Koyama, Tomohide; Hamada, Hirohisa; Nishida, Masamichi; Naess, Paal A; Gaarder, Christine; Sakamoto, Tetsuya

2016-01-25

Patients with blunt trauma to the liver have elevated levels of liver enzymes within a short time post injury, potentially useful in screening patients for computed tomography (CT). This study was performed to define the optimal cut-off values for serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) in patients with blunt liver injury diagnosed with contrast enhanced multi detector-row CT (CE-MDCT). All patients admitted from May 2006 to July 2013 to Teikyo University Hospital Trauma and Critical Care Center, and who underwent abdominal CE-MDCT within 3 h after blunt trauma, were retrospectively enrolled. Using receiver operating characteristic (ROC) curve analysis, the optimal cut-off values for AST and ALT were defined, and sensitivity and specificity were calculated. Of a total of 676 blunt trauma patients 64 patients were diagnosed with liver injury (Group LI+) and 612 patients without liver injury (Group LI-). Group LI+ and LI- were comparable for age, Revised Trauma Score, and Probability of survival. The groups differed in Injury Severity Score [median 21 (interquartile range 9-33) vs. 17 (9-26) (p < 0.01)]. Group LI+ had higher AST than LI- [276 (48-503) vs. 44 (16-73); p < 0.001] and higher ALT [240 (92-388) vs. 32 (16-49); p < 0.001]. Using ROC curve analysis, the optimal cut-off values for AST and ALT were set at 109 U/l and 97 U/l, respectively. Based on these values, AST ≥ 109 U/l had a sensitivity of 81%, a specificity of 82%, a positive predictive value of 32%, and a negative predictive value of 98%. The corresponding values for ALT ≥ 97 U/l were 78, 88, 41 and 98%, respectively, and for the combination of AST ≥ 109 U/l and/or ALT ≥ 97 U/l were 84, 81, 32, 98%, respectively. We have identified AST ≥ 109 U/l and ALT ≥ 97 U/l as optimal cut-off values in predicting the presence of liver injury, potentially useful as a screening tool for CT scan in patients otherwise eligible for observation only or as a transfer criterion to a facility with CT scan capability.

Using Norm-Referenced Data to Set Standards for a Minimum Competency Program in the State of South Carolina.

ERIC Educational Resources Information Center

Garcia-Quintana, Roan A.; Mappus, M. Lynne

1980-01-01

Norm referenced data were utilized for determining the mastery cutoff score on a criterion referenced test. Once a cutoff score on the norm referenced measure is selected, the cutoff score on the criterion referenced measure becomes that score which maximizes proportion of consistent classifications and proportion of improvement beyond change. (CP)

Effect of cutoff radius, long range interaction and temperature controller on thermodynamic properties of fluids: Methanol as an example

NASA Astrophysics Data System (ADS)

Obeidat, Abdalla; Jaradat, Adnan; Hamdan, Bushra; Abu-Ghazleh, Hind

2018-04-01

The best spherical cutoff radius, long range interaction and temperature controller were determined using surface tension, density, and diffusion coefficients of van Leeuwen and Smit methanol. A quite good range of cutoff radii from 0.75 to 1.45 nm has been studied on Coulomb cut-off and particle mesh Ewald (PME) long range interaction to determine the best cutoff radius and best long range interaction as well for four sets of temperature: 200, 230, 270 and 300 K. To determine the best temperature controller, the cutoff radius of 1.25 nm was fixed using PME long range interaction on calculating the above properties at low temperature range: 200-300 K.

Is glycated albumin useful for differential diagnosis between fulminant type 1 diabetes mellitus and acute-onset autoimmune type 1 diabetes mellitus?

PubMed

Koga, Masafumi; Kanehara, Hideo; Bando, Yukihiro; Morita, Shinya; Kasayama, Soji

2015-12-07

Markedly elevated plasma glucose and relatively low HbA1c compared to plasma glucose is one diagnostic criterion for fulminant type 1 diabetes mellitus (FT1DM). Glycated albumin (GA) is a glycemic control marker that reflects glycemic control in shorter period than HbA1c. This study investigated whether GA is useful for differential diagnosis between FT1DM and acute-onset autoimmune type 1 diabetes mellitus (T1ADM) or not. This study included 38 FT1DM patients and 31 T1ADM patients in whom both HbA1c and GA were measured at the time of diagnosis. In FT1DM patients, as compared to T1ADM patients, both HbA1c and GA were significantly lower (HbA1c; 6.6±0.9% vs. 11.7±2.6%, P<0.0001, GA; 22.9±4.8% vs. 44.3±8.3%, P<0.0001). For differential diagnosis between FT1DM and T1ADM, ROC analysis showed that the optimum cut-off value for GA was 33.5% with sensitivity and specificity of 97.4% and 96.8%, respectively, while the optimum cut-off value for HbA1c was 8.7% with sensitivity and specificity of 100% and 83.9%, respectively. GA also may be useful for the differential diagnosis between FT1DM and T1ADM when the cut-off value can be set at 33.5%. Copyright © 2015 Elsevier B.V. All rights reserved.

The New Substance Abuse and Mental Health Services Administration Oral Fluid Cutoffs for Cocaine and Heroin-Related Analytes Applied to an Addiction Medicine Setting: Important, Unanticipated Findings with LC-MS/MS.

PubMed

Flood, James G; Khaliq, Tahira; Bishop, Kenneth A; Griggs, David A

2016-05-01

We implemented oral fluid (OF) as an alternative specimen type to urine for detection of cocaine (COC) and opiate abuse in outpatient addiction medicine clinics. We implemented a 2-μg/L limit of quantification OF LC-MS/MS assay and compiled and reviewed all findings from a 22-month collection period for COC, benzoylecgonine (BZE), codeine (COD), 6-acetylmorphine (MAM), and morphine (MOR). We also compared the results of our clinical samples at different OF cutoffs and analytes specified in the new 2015 SAMHSA OF guidelines. Of 3608 OF samples, COC and BZE were positive in 593 and 508, respectively. COC or BZE was positive in 662 samples. Importantly and unexpectedly, 154 samples were COC positive and BZE negative, with 125 having COC 2.0-7.9 μg/L. A simulation with the new guideline cutoffs confirmed 65% (430 of 662) of all COC- or BZE-positive data set samples. Similarly, the new guidelines confirmed 44% (263 of 603) of data set samples positive for MOR or COD. Simulation found that the new, lower MAM guideline cutoffs detected 89% of the 382 MAM-positive samples in the data set, 104 of which the new guidelines had identified as negative for MOR and COD. COC (not BZE) is the dominant low-concentration OF analyte in an addiction medicine setting. This information will aid OF test interpretation. It also illustrates the importance of the 2015 guideline's new immunoassay cross-reactivity requirements and the likely improvement in detection of heroin use stemming from the new, lower MAM cutoffs. © 2016 American Association for Clinical Chemistry.

Establishing ultrasound based transient elastography cutoffs for different stages of hepatic fibrosis and cirrhosis in Egyptian chronic hepatitis C patients.

PubMed

Elsharkawy, Aisha; Alboraie, Mohamed; Fouad, Rabab; Asem, Noha; Abdo, Mahmoud; Elmakhzangy, Hesham; Mehrez, Mai; Khattab, Hany; Esmat, Gamal

2017-12-01

Transient elastography is widely used to assess fibrosis stage in chronic hepatitis C (CHC). We aimed to establish and validate different transient elastography cut-off values for significant fibrosis and cirrhosis in CHC genotype 4 patients. The data of 100 treatment-naive CHC patients (training set) and 652 patients (validation set) were analysed. The patients were subjected to routine pretreatment laboratory investigations, liver biopsy and histopathological staging of hepatic fibrosis according to the METAVIR scoring system. Transient elastography was performed before and in the same week as liver biopsy using FibroScan (Echosens, Paris, France). Transient elastography results were correlated to different stages of hepatic fibrosis in both the training and validation sets. ROC curves were constructed. In the training set, the best transient elastography cut-off values for significant hepatic fibrosis (≥F2 METAVIR), advanced hepatic fibrosis (≥F3 METAVIR) and cirrhosis (F4 METAVIR) were 7.1, 9 and 12.2 kPa, with sensitivities of 87%, 87.5% and 90.9% and specificities of 100%, 99.9% and 99.9%, respectively. The application of these cut-offs in the validation set showed sensitivities of 85.5%, 82.8% and 92% and specificities of 86%, 89.4% and 99.01% for significant hepatic fibrosis, advanced hepatic fibrosis and cirrhosis, respectively. Transient elastography performs well for significant hepatic fibrosis, advanced hepatic fibrosis and cirrhosis, with validated cut-offs of 7.1, 9 and 12.2 kPa, respectively, in genotype 4 CHC patients. Copyright © 2017 Pan-Arab Association of Gastroenterology. Published by Elsevier B.V. All rights reserved.

Method and system for assigning a confidence metric for automated determination of optic disc location

DOEpatents

Karnowski, Thomas P [Knoxville, TN; Tobin, Jr., Kenneth W.; Muthusamy Govindasamy, Vijaya Priya [Knoxville, TN; Chaum, Edward [Memphis, TN

2012-07-10

A method for assigning a confidence metric for automated determination of optic disc location that includes analyzing a retinal image and determining at least two sets of coordinates locating an optic disc in the retinal image. The sets of coordinates can be determined using first and second image analysis techniques that are different from one another. An accuracy parameter can be calculated and compared to a primary risk cut-off value. A high confidence level can be assigned to the retinal image if the accuracy parameter is less than the primary risk cut-off value and a low confidence level can be assigned to the retinal image if the accuracy parameter is greater than the primary risk cut-off value. The primary risk cut-off value being selected to represent an acceptable risk of misdiagnosis of a disease having retinal manifestations by the automated technique.

Derivation & validation of glycosylated haemoglobin (HbA1c) cut-off value as a diagnostic test for type 2 diabetes in south Indian population

PubMed Central

Mohan, Alladi; Reddy, S. Aparna; Sachan, Alok; Sarma, K.V.S.; Kumar, D. Prabath; Panchagnula, Mahesh V.; Rao, P.V.L.N. Srinivasa; Kumar, B. Siddhartha; Krishnaprasanthi, P.

2016-01-01

Background & Objectives: Glycosylated haemoglobin (HbA1c) has been in use for more than a decade, as a diagnostic test for type 2 diabetes. Validity of HbA1c needs to be established in the ethnic population in which it is intended to be used. The objective of this study was to derive and validate a HbA1c cut-off value for the diagnosis of type 2 diabetes in the ethnic population of Rayalaseema area of south India. Methods: In this cross-sectional study, consecutive patients suspected to have type 2 diabetes underwent fasting plasma glucose (FPG) and 2 h post-load plasma glucose (2 h-PG) measurements after a 75 g glucose load and HbA1c estimation. They were classified as having diabetes as per the American Diabetes Association criteria [(FPG ≥7 mmol/l (≥126 mg/dl) and/or 2 h-PG ≥11.1 mmol/l (≥200 mg/dl)]. In the training data set (n = 342), optimum cut-off value of HbA1c for defining type 2 diabetes was derived by receiver-operator characteristic (ROC) curve method using oral glucose tolerance test results as gold standard. This cut-off was validated in a validation data set (n = 341). Results: On applying HbA1c cut-off value of >6.3 per cent (45 mmol/mol) to the training data set, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for diagnosing type 2 diabetes were calculated to be 90.6, 85.2, 80.8 and 93.0 per cent, respectively. When the same cut-off value was applied to the validation data set, sensitivity, specificity, PPV and NPV were 88.8, 81.9, 74.0 and 92.7 per cent, respectively, although the latter were consistently smaller than the proportions for the training data set, the differences being not significant. Interpretation & conclusions: HbA1c >6.3 per cent (45 mmol/mol) appears to be the optimal cut-off value for the diagnosis of type 2 diabetes applicable to the ethnic population of Rayalaseema area of Andhra Pradesh state in south India. PMID:27934801

In Search of Golden Rules: Comment on Hypothesis-Testing Approaches to Setting Cutoff Values for Fit Indexes and Dangers in Overgeneralizing Hu and Bentler's (1999) Findings

ERIC Educational Resources Information Center

Marsh, Herbert W.; Hau, Kit-Tai; Wen, Zhonglin

2004-01-01

Goodness-of-fit (GOF) indexes provide "rules of thumb"?recommended cutoff values for assessing fit in structural equation modeling. Hu and Bentler (1999) proposed a more rigorous approach to evaluating decision rules based on GOF indexes and, on this basis, proposed new and more stringent cutoff values for many indexes. This article discusses…

Clinicopathologic and prognostic significance of C-reactive protein/albumin ratio in patients with solid tumors: an updated systemic review and meta-analysis.

PubMed

Wu, Jiayuan; Tan, Wenkai; Chen, Lin; Huang, Zhe; Mai, Shao

2018-03-02

C-reactive protein/albumin ratio (CAR) was originally used as a novel inflammation-based prognostic score in predicting outcomes in septic patients. Recently, more and more studies have reported the prognostic value of pretreatment CAR in solid tumors. However, the results remain controversial rather than conclusive. We conducted a meta-analysis based on 24 studies with 10203 patients to explore the relationship between CAR and survival outcomes in patients with solid tumors. The correlation between CAR and clinicopathological parameters was also assessed. Hazard ratio (HR) or odds ratio (OR) with its 95% confidence interval (CI) was applied to be the effect size estimate. The overall results showed that elevated CAR was associated with shorter overall survival (OS) (including 23 studies and 10067 patients) and poorer disease-free survival (DFS) (including 6 studies and 2904 patients). Significant associations between high CAR level and poor OS were also found in the subgroup analyses of study region, cancer type, primary treatment, clinical stage, cut-off selection, sample size, and cut-off value. Moreover, subgroup analyses demonstrated that study region, primary treatment, clinical stage, sample size, and cut-off value did not alter the prognostic value of CAR for DFS. Furthermore, elevated CAR was correlated with certain phenotypes of tumor aggressiveness, such as poor histological grade, serious clinical stage, advanced tumor depth, positive lymph node metastasis, and positive distant metastasis. Together, our meta-analysis suggests that elevated level of serum CAR predicts worse survival and unfavorable clinical characteristics in cancer patients, and CAR may serve as an effective prognostic factor for solid tumors.

Lower waist circumference in mildly-stunted adolescents is associated with elevated insulin concentration.

PubMed

Clemente, Ana Paula Grotti; Santos, Carla Danusa da Luz; Martins, Vinicius J B; Albuquerque, Maria Paula; Fachim, Mariana B; Sawaya, Ana Lydia

2014-01-01

Augmented waist circumference (WC) is associated with non-communicable diseases and could represent a valuable marker in screening for metabolic dysfunctions in subjects with insufficient linear growth. The objective of the present study was to determine whether biochemical and hemodynamic parameters and waist circumference vary between mildly-stunted and non-stunted adolescents from impoverished communities of São Paulo, Brazil. The cross-sectional study involved 206 subjects, aged between 9 and 19 years and living in impoverished areas of São Paulo, Brazil. The sample population was divided according to height-for-age Z-score (HAZ) into stunted (-1 > HAZ ≥ -2) and non-stunted (HAZ ≥ -1) groups, and was sub-divided according to gender. Logistic regression analysis was employed to compare individuals with elevated (> 75th percentile) insulin concentrations. The receiver operating characteristic curves were constructed to determine WC cut-off points that could be used to identify stunted and non-stunted individuals with elevated insulin concentrations. WC cut-off points of 58.25cm and 67.2cm allowed for correct classification of 90.7% of stunted and 88.7% of non-stunted individuals in the studied population. While the sensitivity of the model was high for stunted and non-stunted subjects (98.8% and 97.2%, respectively), the specificity was modest (57.1% and 41.2%, respectively). The results presented herein suggest that an increase in plasma insulin is one of the primary metabolic modifications in stunted individuals, and that this alteration could be identified at a lower WC cut-off point than in non-stunted counterparts. Copyright © 2014 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

The utility of serum CA-125 in predicting extra-uterine disease in apparent early-stage endometrial cancer.

PubMed

Nicklin, James; Janda, Monika; Gebski, Val; Jobling, Thomas; Land, Russell; Manolitsas, Tom; McCartney, Anthony; Nascimento, Marcelo; Perrin, Lewis; Baker, Jannah F; Obermair, Andreas

2012-08-15

Surgical staging in early-stage uterine cancer is controversial. Preoperative serum CA-125 may be of clinical value in predicting the presence of extra-uterine disease in patients with apparent early-stage endometrial cancer. Between October 6, 2005, and June 17, 2010, 760 patients were enrolled in an international, multicentre, prospective randomized trial (LACE) comparing laparotomy with laparoscopy in the management of endometrial cancer apparently confined to the uterus. Of these, 657 patients with endometrial adenocarcinoma had a preoperative serum CA-125 value recorded. Multiple cross-validation analysis was undertaken to correlate preoperative serum CA-125 with stage of disease (Stage I vs. Stage II+) after surgery. Patients' median preoperative serum CA-125 was 14 U/ml. A cutoff point of 30 U/ml was associated with the smallest misclassification error, and using this cutoff, 98 patients (14.9%) had elevated CA-125 levels. Of those, 36 (36.7%) had evidence of extra-uterine disease. Of the 116 patients (17.7%) with evidence of extra-uterine disease, 31.0% had an elevated CA-125 level. On univariate and multivariable logistic regression analysis, only preoperative CA-125 level, but no other preoperative clinical characteristics were found to be associated with extra-uterine spread of disease. Utilizing a cutoff point of 30 U/ml achieved a sensitivity, specificity, positive predictive value and negative predictive value of 31.0, 88.5, 36.7 and 85.7%, respectively. Elevated CA-125 above 30 U/ml in patients with apparent early-stage disease is a risk factor for the presence of extra-uterine disease and may assist clinicians in the management of patients with clinical Stage I endometrial cancer. Copyright © 2011 UICC.

Body mass index, waist circumference and waist-to-hip ratio cut-off points for categorisation of obesity among Omani Arabs.

PubMed

Al-Lawati, Jawad A; Jousilahti, Pekka

2008-01-01

There are no data on optimal cut-off points to classify obesity among Omani Arabs. The existing cut-off points were obtained from studies of European populations. To determine gender-specific optimal cut-off points for body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) associated with elevated prevalent cardiovascular disease (CVD) risk among Omani Arabs. A community-based cross-sectional study. The survey was conducted in the city of Nizwa in Oman in 2001. The study contained a probabilistic random sample of 1421 adults aged > or =20 years. Prevalent CVD risk was defined as the presence of at least two of the following three risk factors: hyperglycaemia, hypertension and dyslipidaemia. Logistic regression and receiver-operating characteristic (ROC) curve analyses were used to determine optimal cut-off points for BMI, WC and WHR in relation to the area under the curve (AUC), sensitivity and specificity. Over 87% of Omanis had at least one CVD risk factor (38% had hyperglycaemia, 19% hypertension and 34.5% had high total cholesterol). All three indices including BMI (AUC = 0.766), WC (AUC = 0.772) and WHR (AUC = 0.767) predicted prevalent CVD risk factors equally well. The optimal cut-off points for men and women respectively were 23.2 and 26.8 kg m-2 for BMI, 80.0 and 84.5 cm for WC, and 0.91 and 0.91 for WHR. To identify Omani subjects of Arab ethnicity at high risk of CVD, cut-off points lower than currently recommended for BMI, WC and WHR are needed for men while higher cut-off points are suggested for women.

Nonspecific cross-reacting antigen 50/90 is elevated in patients with breast, lung, and colon cancer.

PubMed

Allard, W J; Neaman, I E; Elting, J J; Barnett, T R; Yoshimura, H; Fritsche, H A; Yeung, K K

1994-03-01

A total of 22 genes have been identified in the carcinoembryonic antigen (CEA) gene family. The protein products of this family are highly homologous and include CEA, biliary glycoprotein, nonspecific cross-reacting antigen 50/90 (NCA 50/90), NCA 95, and pregnancy-specific beta-glycoprotein. We used a monoclonal antibody with high affinity to develop a specific enzyme-linked immunosorbent assay (ELISA) method for NCA 50/90 in serum and plasma. Our calibrators were based on affinity-purified recombinant protein from a baculovirus expression system. No significant reactivity with purified CEA, recombinant NCA 95, or recombinant biliary glycoprotein was found by Western blot analysis or in the ELISA method. Only 1 of 15 sera from pregnant women (chorionic gonadotropin > 1000 ng/ml) was positive in the NCA 50/90 ELISA, suggesting that this method does not detect pregnancy-specific glycoprotein. A cutoff value of 18 ng/ml was established based on the 95% value of serum and plasma from 147 healthy volunteers. Only 3 of 31 serum and plasma samples from patients with clinically inactive breast cancer were elevated above the cutoff value, but 44% of 136 samples from patients with clinically active breast cancer were positive. NCA 50/90 measurements were elevated in 7 of 25 patients with active breast cancer whose CEA and CA 15-3 values were below cutoff, and NCA 50/90 values do not correlate with CEA in breast cancer. In addition, we found sensitivities of 70, 39, and 42% for lung cancer, colon cancer, and leukemia, respectively. The sensitivity for non-small cell lung cancer was 85%, however, compared to 50% for small cell lung cancer. Serum from leukemia patients showed an overall sensitivity of 43%, but 71% (10 of 14) sera from patients with chronic myelogenous leukemia were positive compared to, for example, chronic lymphocytic leukemia where 0 of 7 sera had NCA 50/90 values above the cutoff. These studies suggest that NCA 50/90 may have clinical utility in the management of patients with a variety of cancers.

Clinical Significance of Tissue Factor Pathway Inhibitor 2, a Serum Biomarker Candidate for Ovarian Clear Cell Carcinoma

PubMed Central

Arakawa, Noriaki; Kobayashi, Hiroshi; Yonemoto, Naohiro; Masuishi, Yusuke; Ino, Yoko; Shigetomi, Hiroshi; Furukawa, Naoto; Ohtake, Norihisa; Miyagi, Yohei; Hirahara, Fumiki; Hirano, Hisashi; Miyagi, Etsuko

2016-01-01

Background There is currently no reliable serum biomarker for ovarian clear cell carcinoma (CCC), a highly lethal histological subtype of epithelial ovarian cancer (EOC). Previously, using a proteome-based approach, we identified tissue factor pathway inhibitor 2 (TFPI2) as a candidate serum biomarker for CCC. In this study, we sought to evaluate the clinical diagnostic performance of TFPI2 in preoperative prediction of CCC. Methods Serum TFPI2 levels were measured in serum samples from a retrospective training set consisting of patients with benign and borderline ovarian tumors, EOC subtypes, and uterine diseases. Via receiver operating characteristic (ROC) analyses, we compared the diagnostic performance of TFPI2 with that of CA125 in discrimination of patients with ovarian CCC from other patient groups. The observed diagnostic performances were examined in a prospective validation set. Results The 268-patient training set included 29 patients with ovarian CCC. Unlike CA125, which was also elevated in patients with endometriosis and several EOC subtypes, serum TFPI2 levels were specifically elevated only in ovarian CCC patients, consistent with the mRNA expression pattern in tumor tissues. The area under the ROC curve (AUC) of serum TFPI2 was obviously higher than that of CA125 for discrimination of CCC from other ovarian diseases (AUC = 0.891 versus 0.595). Applying a cut-off value of 280 pg/mL, TFPI2 could distinguish early-stage (FIGO I and II) CCC from endometriosis with 72.2% sensitivity, 93.3% specificity, and 88.8% accuracy. Similar results were confirmed in an independent 156-patient prospective validation set. Conclusions TFPI2 is a useful serum biomarker for preoperative clinical diagnosis of CCC. PMID:27798689

Clinical Significance of Tissue Factor Pathway Inhibitor 2, a Serum Biomarker Candidate for Ovarian Clear Cell Carcinoma.

PubMed

Arakawa, Noriaki; Kobayashi, Hiroshi; Yonemoto, Naohiro; Masuishi, Yusuke; Ino, Yoko; Shigetomi, Hiroshi; Furukawa, Naoto; Ohtake, Norihisa; Miyagi, Yohei; Hirahara, Fumiki; Hirano, Hisashi; Miyagi, Etsuko

2016-01-01

There is currently no reliable serum biomarker for ovarian clear cell carcinoma (CCC), a highly lethal histological subtype of epithelial ovarian cancer (EOC). Previously, using a proteome-based approach, we identified tissue factor pathway inhibitor 2 (TFPI2) as a candidate serum biomarker for CCC. In this study, we sought to evaluate the clinical diagnostic performance of TFPI2 in preoperative prediction of CCC. Serum TFPI2 levels were measured in serum samples from a retrospective training set consisting of patients with benign and borderline ovarian tumors, EOC subtypes, and uterine diseases. Via receiver operating characteristic (ROC) analyses, we compared the diagnostic performance of TFPI2 with that of CA125 in discrimination of patients with ovarian CCC from other patient groups. The observed diagnostic performances were examined in a prospective validation set. The 268-patient training set included 29 patients with ovarian CCC. Unlike CA125, which was also elevated in patients with endometriosis and several EOC subtypes, serum TFPI2 levels were specifically elevated only in ovarian CCC patients, consistent with the mRNA expression pattern in tumor tissues. The area under the ROC curve (AUC) of serum TFPI2 was obviously higher than that of CA125 for discrimination of CCC from other ovarian diseases (AUC = 0.891 versus 0.595). Applying a cut-off value of 280 pg/mL, TFPI2 could distinguish early-stage (FIGO I and II) CCC from endometriosis with 72.2% sensitivity, 93.3% specificity, and 88.8% accuracy. Similar results were confirmed in an independent 156-patient prospective validation set. TFPI2 is a useful serum biomarker for preoperative clinical diagnosis of CCC.

The influence of aminotransferase levels on liver stiffness assessed by Acoustic Radiation Force Impulse Elastography: a retrospective multicentre study.

PubMed

Bota, Simona; Sporea, Ioan; Peck-Radosavljevic, Markus; Sirli, Roxana; Tanaka, Hironori; Iijima, Hiroko; Saito, Hidetsugu; Ebinuma, Hirotoshi; Lupsor, Monica; Badea, Radu; Fierbinteanu-Braticevici, Carmen; Petrisor, Ana; Friedrich-Rust, Mireen; Sarrazin, Christoph; Takahashi, Hirokazu; Ono, Naofumi; Piscaglia, Fabio; Marinelli, Sara; D'Onofrio, Mirko; Gallotti, Anna; Salzl, Petra; Popescu, Alina; Danila, Mirela

2013-09-01

Acoustic Radiation Force Impulse Elastography is a new method for non-invasive evaluation of liver fibrosis. To evaluate the impact of elevated alanine aminotransferase levels on liver stiffness assessment by Acoustic Radiation Force Impulse Elastography. A multicentre retrospective study including 1242 patients with chronic liver disease, who underwent liver biopsy and Acoustic Radiation Force Impulse. Transient Elastography was also performed in 512 patients. The best Acoustic Radiation Force Impulse cut-off for predicting significant fibrosis was 1.29 m/s in cases with normal alanine aminotransferase levels and 1.44 m/s in patients with alanine aminotransferase levels>5 × the upper limit of normal. The best cut-off for predicting liver cirrhosis were 1.59 and 1.75 m/s, respectively. Acoustic Radiation Force Impulse cut-off for predicting significant fibrosis and cirrhosis were relatively similar in patients with normal alanine aminotransferase and in those with alanine aminotransferase levels between 1.1 and 5 × the upper limit of normal: 1.29 m/s vs. 1.36 m/s and 1.59 m/s vs. 1.57 m/s, respectively. For predicting cirrhosis, the Transient Elastography cut-offs were significantly higher in patients with alanine aminotransferase levels between 1.1 and 5 × the upper limit of normal compared to those with normal alanine aminotransferase: 12.3 kPa vs. 9.1 kPa. Liver stiffness values assessed by Acoustic Radiation Force Impulse and Transient Elastography are influenced by high aminotransferase levels. Transient Elastography was also influenced by moderately elevated aminotransferase levels. Copyright © 2013 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

A geomorphic explanation for a meander cutoff following channel relocation of a coarse-bedded river.

PubMed

Thompson, Douglas M

2003-03-01

The Veteran's Fishing section of the Blackledge River in central Connecticut was relocated in the late 1950s. The relocation resulted in an unstable channel despite extensive efforts to prevent erosion. Overbank erosion and meander cutoffs were investigated using detailed survey data, characterizations of sediment deposits, flow modeling, and a moment-stability analysis. Limited reworking of revetment boulders indicate that riprap bank material was immobile during a 1979 flood event responsible for the formation of the cutoff channel. A moment-stability analysis factor-of-safety value of 1.1 supports the conclusion that riprap was not directly eroded from the banks. Alluvial particles with d(95) values ranging up to 120 mm were deposited along a bar downstream from the cutoff channel at flows estimated to be below a 1.5-year recurrence interval flow. Development of the bar deposit resulted in locally elevated water surfaces at high flow. The resulting overbank flow across the meander neck to the adjacent downstream bend led to the creation of an upstream migrating knickpoint, the erosion of approximately 16,000-year-old sediments, and the subsequent meander cutoff. The results of the study indicate that traditional erosion-control measures cannot prevent extreme channel adjustments if the geomorphic processes that control sediment continuity also are not considered.

Systematic approach to cutoff frequency selection in continuous-wave electron paramagnetic resonance imaging

NASA Astrophysics Data System (ADS)

Hirata, Hiroshi; Itoh, Toshiharu; Hosokawa, Kouichi; Deng, Yuanmu; Susaki, Hitoshi

2005-08-01

This article describes a systematic method for determining the cutoff frequency of the low-pass window function that is used for deconvolution in two-dimensional continuous-wave electron paramagnetic resonance (EPR) imaging. An evaluation function for the criterion used to select the cutoff frequency is proposed, and is the product of the effective width of the point spread function for a localized point signal and the noise amplitude of a resultant EPR image. The present method was applied to EPR imaging for a phantom, and the result of cutoff frequency selection was compared with that based on a previously reported method for the same projection data set. The evaluation function has a global minimum point that gives the appropriate cutoff frequency. Images with reasonably good resolution and noise suppression can be obtained from projections with an automatically selected cutoff frequency based on the present method.

Epidemiological cut-off values for Flavobacterium psychrophilum MIC data generated by a standard test protocol.

PubMed

Smith, P; Endris, R; Kronvall, G; Thomas, V; Verner-Jeffreys, D; Wilhelm, C; Dalsgaard, I

2016-02-01

Epidemiological cut-off values were developed for application to antibiotic susceptibility data for Flavobacterium psychrophilum generated by standard CLSI test protocols. The MIC values for ten antibiotic agents against Flavobacterium psychrophilum were determined in two laboratories. For five antibiotics, the data sets were of sufficient quality and quantity to allow the setting of valid epidemiological cut-off values. For these agents, the cut-off values, calculated by the application of the statistically based normalized resistance interpretation method, were ≤16 mg L(-1) for erythromycin, ≤2 mg L(-1) for florfenicol, ≤0.025 mg L(-1) for oxolinic acid (OXO), ≤0.125 mg L(-1) for oxytetracycline and ≤20 (1/19) mg L(-1) for trimethoprim/sulphamethoxazole. For ampicillin and amoxicillin, the majority of putative wild-type observations were 'off scale', and therefore, statistically valid cut-off values could not be calculated. For ormetoprim/sulphadimethoxine, the data were excessively diverse and a valid cut-off could not be determined. For flumequine, the putative wild-type data were extremely skewed, and for enrofloxacin, there was inadequate separation in the MIC values for putative wild-type and non-wild-type strains. It is argued that the adoption of OXO as a class representative for the quinolone group would be a valid method of determining susceptibilities to these agents. © 2014 John Wiley & Sons Ltd.

Lower Cutoffs for LC-MS/MS Urine Drug Testing Indicates Better Patient Compliance.

PubMed

Krock, Kevin; Pesce, Amadeo; Ritz, Dennis; Thomas, Richard; Cua, Agnes; Rogers, Ryan; Lipnick, Phil; Kilbourn, Kristen

2017-11-01

Urine drug testing is used by health care providers to determine a patient's compliance to their prescribed regimen and to detect non-prescribed medications and illicit drugs. However, the cutoff levels used by clinical labs are often arbitrarily set and may not reflect the urine drug concentrations of compliant patients. Our aim was to test the hypothesis that commonly used cutoffs for many prescribed and illicit drugs were set too high, and methods using these cutoffs may yield a considerable number of false-negative results. The goals of this study were to outline the way to analyze patient results and estimate a more appropriate cutoff, develop and validate a high sensitivity analytical method capable of quantitating drugs and metabolites at lower than the commonly used cutoffs, and determine the number of true positive results that would have been missed when using the common cutoffs. This was a retrospective study of urine specimens submitted for urine drug testing as part of the monitoring of prescription drug compliance described in chronic opioid therapy treatment guidelines. The study was set in a clinical toxicology laboratory, using specimens submitted for routine analysis by health care providers in the normal course of business. Lognormal distributions of test results were generated and fitted with a trendline to estimate the required cutoff level necessary to capture the normal distributions of each drug for the patient population study. A validated laboratory derived liquid chromatography tandem mass spectrometry (LC-MS/MS) analysis capable of achieving the required cutoff levels was developed for each drug and/or metabolite. The study shows that a lognormal distribution of patient urine test results fitted with a trendline is appropriate for estimating the required cutoff levels needed to assess medication adherence. The study showed a wide variation in the false-negative rate, ranging from 1.5% to 94.3% across a range of prescribed and illicit drugs. The patient specimens were largely sourced from patients in either a long-term pain management program or in treatment for substance use disorder in the US. These specimens may not be representative of patients in other types of treatment or in countries with different approaches to these issues. The high-sensitivity method reduces false-negative results which could negatively impact patient care. Clinicians using less sensitive methods for detecting and quantifying drugs and metabolites in urine should exercise caution in assessing patient adherence using and changing the treatment plan based on those results. Urine drug testing, patient adherence, clinical toxicology, immunoassay, LC-MS, definitive drug testing, REMS, negative test results, false negative.

Raised BMI cut-off for overweight in Greenland Inuit--a review.

PubMed

Andersen, Stig; Fleischer Rex, Karsten; Noahsen, Paneeraq; Sørensen, Hans Christian Florian; Mulvad, Gert; Laurberg, Peter

2013-01-01

Obesity is associated with increased morbidity and premature death. Obesity rates have increased worldwide and the WHO recommends monitoring. A steep rise in body mass index (BMI), a measure of adiposity, was detected in Greenland from 1963 to 1998. Interestingly, the BMI starting point was in the overweight range. This is not conceivable in a disease-free, physically active, pre-western hunter population. This led us to reconsider the cut-off point for overweight among Inuit in Greenland. We found 3 different approaches to defining the cut-off point of high BMI in Inuit. First, the contribution to the height by the torso compared to the legs is relatively high. This causes relatively more kilograms per centimetre of height that increases the BMI by approximately 10% compared to Caucasian whites. Second, defining the cut-off by the upper 90-percentile of BMI from height and weight in healthy young Inuit surveyed in 1963 estimated the cut-off point to be around 10% higher compared to Caucasians. Third, if similar LDL-cholesterol and triglycerides are assumed for a certain BMI in Caucasians, the corresponding BMI in Inuit in both Greenland and Canada is around 10% higher. However, genetic admixture of Greenland Inuit and Caucasian Danes will influence this difference and hamper a clear distinction with time. Defining overweight according to the WHO cut-off of a BMI above 25 kg/m(2) in Greenland Inuit may overestimate the number of individuals with elevated BMI.

Raised BMI cut-off for overweight in Greenland Inuit – a review

PubMed Central

Andersen, Stig; Fleischer Rex, Karsten; Noahsen, Paneeraq; Sørensen, Hans Christian Florian; Mulvad, Gert; Laurberg, Peter

2013-01-01

Background Obesity is associated with increased morbidity and premature death. Obesity rates have increased worldwide and the WHO recommends monitoring. A steep rise in body mass index (BMI), a measure of adiposity, was detected in Greenland from 1963 to 1998. Interestingly, the BMI starting point was in the overweight range. This is not conceivable in a disease-free, physically active, pre-western hunter population. Objective This led us to reconsider the cut-off point for overweight among Inuit in Greenland. Design and findings We found 3 different approaches to defining the cut-off point of high BMI in Inuit. First, the contribution to the height by the torso compared to the legs is relatively high. This causes relatively more kilograms per centimetre of height that increases the BMI by approximately 10% compared to Caucasian whites. Second, defining the cut-off by the upper 90-percentile of BMI from height and weight in healthy young Inuit surveyed in 1963 estimated the cut-off point to be around 10% higher compared to Caucasians. Third, if similar LDL-cholesterol and triglycerides are assumed for a certain BMI in Caucasians, the corresponding BMI in Inuit in both Greenland and Canada is around 10% higher. However, genetic admixture of Greenland Inuit and Caucasian Danes will influence this difference and hamper a clear distinction with time. Conclusion Defining overweight according to the WHO cut-off of a BMI above 25 kg/m2 in Greenland Inuit may overestimate the number of individuals with elevated BMI. PMID:23986904

Women With Breast Cancer: Self-Reported Distress in Early Survivorship

PubMed Central

Lester, Joanne; Crosthwaite, Kara; Stout, Robin; Jones, Rachel N.; Holloman, Christopher; Shapiro, Charles; Andersen, Barbara L.

2015-01-01

Purpose/Objectives To identify and compare levels of distress and sources of problems among patients with breast cancer in early survivorship. Design Descriptive, cross-sectional. Setting A National Cancer Institute–designated comprehensive cancer center. Sample 100 breast cancer survivors were selected to represent four time points in the cancer trajectory. Methods Distress was self-reported using the Distress Thermometer and its 38-item problem list. Analysis of variance and chi-square analyses were performed as appropriate. Main Research Variables Distress scores, problem reports, and time groups. Findings Participants scored in range of the cutoff of more than 4 (range = 4.1–5.1) from treatment through three months post-treatment. At six months post-treatment, distress levels were significantly lower. Significant differences were found between groups on the total problem list score (p = 0.007) and emotional (p = 0.01) and physical subscale scores (p = 0.003). Conclusions Comparison of groups at different points in the cancer trajectory found similar elevated levels from diagnosis through three months. Distress remained elevated in early survivorship but significantly decreased at six months post-treatment. Implications for Nursing Interventions to reduce or prevent distress may improve outcomes in early survivorship. PMID:25542330

Determination of the optimal cutoff value for a serological assay: an example using the Johne's Absorbed EIA.

PubMed Central

Ridge, S E; Vizard, A L

1993-01-01

Traditionally, in order to improve diagnostic accuracy, existing tests have been replaced with newly developed diagnostic tests with superior sensitivity and specificity. However, it is possible to improve existing tests by altering the cutoff value chosen to distinguish infected individuals from uninfected individuals. This paper uses data obtained from an investigation of the operating characteristics of the Johne's Absorbed EIA to demonstrate a method of determining a preferred cutoff value from several potentially useful cutoff settings. A method of determining the financial gain from using the preferred rather than the current cutoff value and a decision analysis method to assist in determining the optimal cutoff value when critical population parameters are not known with certainty are demonstrated. The results of this study indicate that the currently recommended cutoff value for the Johne's Absorbed EIA is only close to optimal when the disease prevalence is very low and false-positive test results are deemed to be very costly. In other situations, there were considerable financial advantages to using cutoff values calculated to maximize the benefit of testing. It is probable that the current cutoff values for other diagnostic tests may not be the most appropriate for every testing situation. This paper offers methods for identifying the cutoff value that maximizes the benefit of medical and veterinary diagnostic tests. PMID:8501227

Removal of methadone by extended dialysis using a high cut-off dialyzer: implications for the treatment of overdose and for pain management in patients undergoing light chain removal.

PubMed

Arelin, Viktor; Schmidt, Julius J; Kayser, Nathalie; Kühn-Velten, W Nikolaus; Suhling, Hendrik; Eden, Gabriele; Kielstein, Jan T

2016-06-01

The synthetic opioid methadone hydrochloride has a low molecular weight of 346 D, a high volume of distribution (4 - 7 L/kg), and is lipophilic. It is used as an analgesic and for the maintenance treatment of opiate dependence. In drug addicts, methadone is frequently involved in mixed intoxications that can lead to death. Here we present the case of a drug addict in whom a high cut-off dialysis membrane together with extended dialysis was used in the setting of suspected overdose and acute kidney injury. Although the observed dialyzer plasma clearance (31.5 mL/min) and reduction ratio (38%) were higher than previously reported for standard hemodialysis, the total amount of methadone in the spent dialysate after 1 extended dialysis session was quite low. Hence, even extended dialysis with a high cut-off membrane does not seem to offer a clinically relevant benefit in the setting of overdose for enhanced methadone removal. On the other hand, in patients undergoing high cut-off dialysis for the removal of light chains, methadone could still be used as an analgesic without an additional dose after high cut-off hemodialysis.

Reference intervals for plasma free metanephrines with an age adjustment for normetanephrine for optimized laboratory testing of phaeochromocytoma.

PubMed

Eisenhofer, Graeme; Lattke, Peter; Herberg, Maria; Siegert, Gabriele; Qin, Nan; Därr, Roland; Hoyer, Jana; Villringer, Arno; Prejbisz, Aleksander; Januszewicz, Andrzej; Remaley, Alan; Martucci, Victoria; Pacak, Karel; Ross, H Alec; Sweep, Fred C G J; Lenders, Jacques W M

2013-01-01

Measurements of plasma normetanephrine and metanephrine provide a useful diagnostic test for phaeochromocytoma, but this depends on appropriate reference intervals. Upper cut-offs set too high compromise diagnostic sensitivity, whereas set too low, false-positives are a problem. This study aimed to establish optimal reference intervals for plasma normetanephrine and metanephrine. Blood samples were collected in the supine position from 1226 subjects, aged 5-84 y, including 116 children, 575 normotensive and hypertensive adults and 535 patients in whom phaeochromocytoma was ruled out. Reference intervals were examined according to age and gender. Various models were examined to optimize upper cut-offs according to estimates of diagnostic sensitivity and specificity in a separate validation group of 3888 patients tested for phaeochromocytoma, including 558 with confirmed disease. Plasma metanephrine, but not normetanephrine, was higher (P < 0.001) in men than in women, but reference intervals did not differ. Age showed a positive relationship (P < 0.0001) with plasma normetanephrine and a weaker relationship (P = 0.021) with metanephrine. Upper cut-offs of reference intervals for normetanephrine increased from 0.47 nmol/L in children to 1.05 nmol/L in subjects over 60 y. A curvilinear model for age-adjusted compared with fixed upper cut-offs for normetanephrine, together with a higher cut-off for metanephrine (0.45 versus 0.32 nmol/L), resulted in a substantial gain in diagnostic specificity from 88.3% to 96.0% with minimal loss in diagnostic sensitivity from 93.9% to 93.6%. These data establish age-adjusted cut-offs of reference intervals for plasma normetanephrine and optimized cut-offs for metanephrine useful for minimizing false-positive results.

Reference intervals for plasma free metanephrines with an age adjustment for normetanephrine for optimized laboratory testing of phaeochromocytoma

PubMed Central

Eisenhofer, Graeme; Lattke, Peter; Herberg, Maria; Siegert, Gabriele; Qin, Nan; Därr, Roland; Hoyer, Jana; Villringer, Arno; Prejbisz, Aleksander; Januszewicz, Andrzej; Remaley, Alan; Martucci, Victoria; Pacak, Karel; Ross, H Alec; Sweep, Fred C G J; Lenders, Jacques W M

2016-01-01

Background Measurements of plasma normetanephrine and metanephrine provide a useful diagnostic test for phaeochromocytoma, but this depends on appropriate reference intervals. Upper cut-offs set too high compromise diagnostic sensitivity, whereas set too low, false-positives are a problem. This study aimed to establish optimal reference intervals for plasma normetanephrine and metanephrine. Methods Blood samples were collected in the supine position from 1226 subjects, aged 5–84 y, including 116 children, 575 normotensive and hypertensive adults and 535 patients in whom phaeochromocytoma was ruled out. Reference intervals were examined according to age and gender. Various models were examined to optimize upper cut-offs according to estimates of diagnostic sensitivity and specificity in a separate validation group of 3888 patients tested for phaeochromocytoma, including 558 with confirmed disease. Results Plasma metanephrine, but not normetanephrine, was higher (P < 0.001) in men than in women, but reference intervals did not differ. Age showed a positive relationship (P < 0.0001) with plasma normetanephrine and a weaker relationship (P = 0.021) with metanephrine. Upper cut-offs of reference intervals for normetanephrine increased from 0.47 nmol/L in children to 1.05 nmol/L in subjects over 60 y. A curvilinear model for age-adjusted compared with fixed upper cut-offs for normetanephrine, together with a higher cut-off for metanephrine (0.45 versus 0.32 nmol/L), resulted in a substantial gain in diagnostic specificity from 88.3% to 96.0% with minimal loss in diagnostic sensitivity from 93.9% to 93.6%. Conclusions These data establish age-adjusted cut-offs of reference intervals for plasma normetanephrine and optimized cut-offs for metanephrine useful for minimizing false-positive results. PMID:23065528

Diagnosis of preeclampsia with soluble Fms-like tyrosine kinase 1/placental growth factor ratio: an inter-assay comparison.

PubMed

Andersen, Louise Bjørkholt; Frederiksen-Møller, Britta; Work Havelund, Kathrine; Dechend, Ralf; Jørgensen, Jan Stener; Jensen, Boye L; Nielsen, Jan; Lykkedegn, Sine; Barington, Torben; Christesen, Henrik Thybo

2015-02-01

The angiogenic factor ratio soluble Fms-kinase 1 (sFlt-1)/placental growth factor (PlGF) is a novel diagnostic tool for preeclampsia. We compared the efficacy of the KRYPTOR (BRAHMS) automated assays for sFlt-1 and PlGF with the Elecsys (Roche) assays in a routine clinical setting. Preeclamptic women (n = 39) were included shortly after the time of diagnosis. Normotensive control pregnancies were matched by gestational age (n = 76). The KRYPTOR assays performed comparably or superior to Elecsys (sFlt-1/PlGF area under the curve 0.746 versus 0.735; P = .09; for non-obese 0.820 versus 0.805, P = .047). For early-onset preeclampsia, KRYPTOR area under the curve increased to 0.929 with a 100% specificity for preeclampsia at cut-off 85 and an 88.9% sensitivity for preeclampsia at cut-off 33. For women with preeclampsia and preterm delivery or Hemolysis, Elevated Liver enzymes, Low Platelet count (HELLP) syndrome, the KRYPTOR sFlt-1/PlGF ratio was manifold increased (P < .01). The sFlt-1/PlGF ratio proved especially useful in early-onset preeclampsia, preeclampsia with preterm delivery or HELLP, and among non-obese women. Copyright © 2015 American Society of Hypertension. Published by Elsevier Inc. All rights reserved.

Non-high-density lipoprotein cholesterol and other lipid indices vs elevated glucose risk in Arab adolescents.

PubMed

Al-Daghri, Nasser M; Aljohani, Naji J; Al-Attas, Omar S; Al-Saleh, Yousef; Wani, Kaiser; Alnaami, Abdullah M; Alfawaz, Hanan; Al-Ajlan, Abdulrahman S M; Kumar, Sudhesh; Chrousos, George P; Alokail, Majed S

2015-01-01

Non-high-density lipoprotein cholesterol (non-HDL-C) has been identified as a significant predictor of various cardiovascular events in adults. Limited studies have been conducted in the pediatric population with diverse results, depending on ethnic origin. None has been conducted in the Arabic adolescent population so far; this study aims to fill this gap. In this cross-sectional study, 1690 Saudi school adolescents (968 boys [mean age 14.8 ± 1.7] and 722 girls [mean age 14.6 ± 1.7]) were recruited. Anthropometrics were obtained. Fasting blood glucose and lipid profiles were quantified routinely. Non-HDL-C was calculated and screening was done for dyslipidemia using cutoffs obtained from the cohort and elevated fasting glucose. Using the 90th percentile cutoff obtained, the overall prevalence of high non-HDL-C (≥4.26 mmol/L) was 10.1%. Prevalence was slightly higher in girls (10.5%) than boys (9.9%). Non-HDL-C was similar to other lipids in terms of significant associations with anthropometric measures and glucose in both boys and girls. Elevated triglycerides was most predictive of elevated glucose in both girls (odds ratio 2.41; confidence interval 1.43-4.08; P = .001) and boys (odds ratio 2.61; confidence interval 1.70-4.0); P < .001). Non-HDL-C appears to be gender-specific and is cardiometabolically more associated with Saudi boys, despite higher levels in girls. It is inferior compared with triglycerides in assessing elevated glucose risk. Further investigations may provide a more definite value for non-HDL-C use as a biomarker in assessing cardiometabolic risk in the Arab adolescent population. Copyright © 2015 National Lipid Association. Published by Elsevier Inc. All rights reserved.

Dynamic balance performance and noncontact lower extremity injury in college football players: an initial study.

PubMed

Butler, Robert J; Lehr, Michael E; Fink, Michael L; Kiesel, Kyle B; Plisky, Phillip J

2013-09-01

Field expedient screening tools that can identify individuals at an elevated risk for injury are needed to minimize time loss in American football players. Previous research has suggested that poor dynamic balance may be associated with an elevated risk for injury in athletes; however, this has yet to be examined in college football players. To determine if dynamic balance deficits are associated with an elevated risk of injury in collegiate football players. It was hypothesized that football players with lower performance and increased asymmetry in dynamic balance would be at an elevated risk for sustaining a noncontact lower extremity injury. Prospective cohort study. Fifty-nine collegiate American football players volunteered for this study. Demographic information, injury history, and dynamic balance testing performance were collected, and noncontact lower extremity injuries were recorded over the course of the season. Receiver operator characteristic curves were calculated based on performance on the Star Excursion Balance Test (SEBT), including composite score and asymmetry, to determine the population-specific risk cut-off point. Relative risk was then calculated based on these variables, as well as previous injury. A cut-off point of 89.6% composite score on the SEBT optimized the sensitivity (100%) and specificity (71.7%). A college football player who scored below 89.6% was 3.5 times more likely to get injured. Poor performance on the SEBT may be related to an increased risk for sustaining a noncontact lower extremity injury over the course of a competitive American football season. College football players should be screened preseason using the SEBT to identify those at an elevated risk for injury based upon dynamic balance performance to implement injury mitigation strategies to this specific subgroup of athletes.

Effect of bank protection measures, Stehekin River, Chelan County, Washington

USGS Publications Warehouse

Nelson, L.M.

1986-01-01

An investigation of the lower Stehekin River was conducted to study the effects on flood elevations and velocities from four bank protection and flood prevention measures that are being contemplated as a means of reducing erosional losses of river bank property. These measures are: bank armoring, armored revetment levees, spur dikes, and redevelopment of old cutoff channels. The banks at seven study sites could be armored without adverse effect on the flood velocities and elevations. The largest increases due to armoring--up to 1.6 ft/sec in velocity and 1 ft in elevation--occurred in the vicinity of sites 5, 6, and 7 where the gradient of the river channel is about 50 ft/mi and the velocities are high to begin with (about 6 to 13 ft/sec). The use of a levee in conjunction with armoring on the northeast bank from sites 5 to 7 would increase the velocities as much as 2.8 ft/sec and increase the elevation as much as 1 ft, but it would also provide some flood protection to the east bank, which is frequently inundated. Spur dikes were considered a practical alternative only at site 3, where reduced bank erosion may occur without aggravating flood inundation or erosion elsewhere. The rerouting of flood flow through an old cutoff channel near site 1 increased the velocity by 3.2 ft/sec and the elevation by 1 ft for the 100-year flood; however, it would move floodwater away from residential property where bank erosion is a problem. The few other old channels that shortcut river bends where much erosion occurs are apparently already part of the channel during floods. (Author 's abstract)

Performance characteristics of the PTSD Checklist in retired firefighters exposed to the World Trade Center disaster.

PubMed

Chiu, Sydney; Webber, Mayris P; Zeig-Owens, Rachel; Gustave, Jackson; Lee, Roy; Kelly, Kerry J; Rizzotto, Linda; McWilliams, Rita; Schorr, John K; North, Carol S; Prezant, David J

2011-05-01

Since the World Trade Center (WTC) attacks on September 11, 2001, the Fire Department, City of New York Monitoring Program has provided physical and mental health screening services to rescue/recovery workers. This study evaluated performance of the self-report PTSD Checklist (PCL) as a screening tool for risk of posttraumatic stress disorder (PTSD) in firefighters who worked at Ground Zero, compared with the interviewer-administered Diagnostic Interview Schedule (DIS). From December 2005 to July 2007, all retired firefighter enrollees completed the PCL and DIS on the same day. Sensitivity, specificity, receiver operating characteristic (ROC) curves, and Youden index (J) were used to assess properties of the PCL and to identify an optimum cutoff score. Six percent of 1,915 retired male firefighters were diagnosed with PTSD using the DIS to assess DSM-IV criteria. Depending on the PCL cutoff, the prevalence of elevated risk relative to DSM-IV criteria varied from 16% to 22%. Youden index identified an optimal cutoff score of 39, in contrast with the frequently recommended cutoff of 44. At 39, PCL sensitivity was 0.85, specificity was 0.82, and the area under the ROC curve was 0.91 relative to DIS PTSD diagnosis. This is the first study to validate the PCL in retired firefighters and determine the optimal cutoff score to maximize opportunities for PTSD diagnosis and treatment.

Mini Neutron Monitors at Concordia Research Station, Central Antarctica

NASA Astrophysics Data System (ADS)

Poluianov, Stepan; Usoskin, Ilya; Mishev, Alexander; Moraal, Harm; Kruger, Helena; Casasanta, Giampietro; Traversi, Rita; Udisti, Roberto

2015-12-01

Two mini neutron monitors are installed at Concordia research station (Dome C, Central Antarctica, 75° 06' S, 123° 23' E, 3,233 m.a.s.l.). The site has unique properties ideal for cosmic ray measurements, especially for the detection of solar energetic particles: very low cutoff rigidity < 0.01 GV, high elevation and poleward asymptotic acceptance cones pointing to geographical latitudes > 75° S. The instruments consist of a standard neutron monitor and a "bare" (lead-free) neutron monitor. The instrument operation started in mid-January 2015. The barometric correction coefficients were computed for the period from 1 February to 31 July 2015. Several interesting events, including two notable Forbush decreases on 17 March 2015 and 22 June 2015, and a solar particle event of 29 October 2015 were registered. The data sets are available at cosmicrays.oulu.fi and nmdb.eu.

Optic Nerve Sheath Diameter: Translating a Terrestrial Focused Technique into a Clinical Monitoring Tool for Spaceflight

NASA Technical Reports Server (NTRS)

Mason, Sara; Foy, Millennia; Sargsyan, Ashot; Garcia, Kathleen; Wear, Mary L.; Bedi, Deepak; Ernst, Randy; Van Baalen, Mary

2015-01-01

Ultrasonography is increasingly used to quickly measure optic nerve sheath diameter (ONSD) when increased intracranial pressure (ICP) is suspected. NASA Space and Clinical Operations Division has been using ground and on-orbit ultrasound since 2009 as a proxy for ICP in non-acute monitoring for space medicine purposes. In the terrestrial emergency room population, an ONSD greater than 0.59 cm is considered highly predictive of elevated intracranial pressure. However, this cut-off limit is not applicable to the spaceflight setting since over 50% of US Operating Segment (USOS) astronauts have an ONSD greater than 0.60 cm even before launch. Crew Surgeon clinical decision-making is complicated by the fact that many astronauts have history of previous spaceflights. Our data characterize the distribution of baseline ONSD in the astronaut corps, its longitudinal trends in long-duration spaceflight, and the predictive power of this measure related to increased ICP outcomes.

Serum retinol concentrations demonstrate high specificity after correcting for inflammation but questionable sensitivity compared with liver stores calculated from isotope dilution in determining vitamin A deficiency in Thai and Zambian children.

PubMed

Suri, Devika J; Tanumihardjo, Jacob P; Gannon, Bryan M; Pinkaew, Siwaporn; Kaliwile, Chisela; Chileshe, Justin; Tanumihardjo, Sherry A

2015-11-01

The WHO estimates that 190 million preschool children have vitamin A deficiency (VAD). Serum retinol (SR) concentration is a common indicator of vitamin A (VA) status, but SR is homeostatically controlled and suppressed during inflammation, which may lead to misdiagnosis. The sensitivity and specificity of SR compared with VA total liver reserves (TLRs) were evaluated for VAD in children from Thailand (n = 37) and Zambia (n = 128). SR was adjusted for inflammation in the Zambian children. Each child was classified as VA-deficient or not based on cutoffs of <0.1 μmol VA/g liver with the use of retinol isotope dilution and <0.7 μmol/L for SR concentrations. Four categories of infection status in the Zambian children were based on elevated C-reactive protein (CRP) and α1-acid glycoprotein (AGP). Sensitivity and specificity were calculated with the use of unadjusted and inflammation marker-adjusted SR cutoffs. VAD was 65% and 0% according to TLRs and SR, respectively, in Thai children and 0% and 17%, respectively, in Zambian children. No true positive VAD cases occurred; thus, sensitivity was 0% and indeterminable, respectively; specificity was 100% and 82.8%, respectively. CRP was elevated in 26.6% of Zambian children, whereas 97.7% had elevated AGP, categorizing them as having no infection (2.3%) or in early (26.6%) or late (58.6%) convalescence. With the use of marker-adjusted SR cutoffs of 0.6 μmol/L for late convalescence and 0.5 μmol/L for early convalescence, the adjusted prevalence of SR deficiency was 2.3%, increasing specificity to 97.3%. No cases of VAD were identified by both TLRs and SR (true positives) in Thai or Zambian children. Specificity of SR to evaluate VAD was high, but additional research is needed to investigate sensitivity. Adjusting SR cutoffs for inflammation improved specificity by reducing false positives. SR as a VAD indicator may depend on infection rates, which should be taken into consideration. These studies were registered at clinicaltrials.gov as NCT01061307 (for Thailand) and NCT01814891 (for Zambia). © 2015 American Society for Nutrition.

Are lower TSH cutoffs in neonatal screening for congenital hypothyroidism warranted?

PubMed Central

Lain, Samantha; Trumpff, Caroline; Grosse, Scott D; Olivieri, Antonella; Van Vliet, Guy

2018-01-01

When newborn screening (NBS) for congenital hypothyroidism (CH) using thyroid-stimulating hormone (TSH) as a primary screening test was introduced, typical TSH screening cutoffs were 20–50 U/L of whole blood. Over the years, lowering of TSH cutoffs has contributed to an increased prevalence of detected CH. However, a consensus on the benefit deriving from lowering TSH cutoffs at screening is lacking. The present paper outlines arguments both for and against the lowering of TSH cutoffs at NBS. It includes a review of recently published evidence from Australia, Belgium and Italy. A section focused on economic implications of lowering TSH cutoffs is also provided. One issue that bears further examination is the extent to which mild iodine deficiency at the population level might affect the association of neonatal TSH values with cognitive and developmental outcomes. A debate on TSH cutoffs provides the opportunity to reflect on how to make NBS for CH more effective and to guarantee optimum neurocognitive development and a good quality of life to babies with mild as well as with severe CH. All authors of this debate article agree on the need to establish optimal TSH cutoffs for screening programs in various settings and to ensure the benefits of screening and access to care for newborns worldwide. PMID:28694389

Standard Setting Methods for Pass/Fail Decisions on High-Stakes Objective Structured Clinical Examinations: A Validity Study.

PubMed

Yousuf, Naveed; Violato, Claudio; Zuberi, Rukhsana W

2015-01-01

CONSTRUCT: Authentic standard setting methods will demonstrate high convergent validity evidence of their outcomes, that is, cutoff scores and pass/fail decisions, with most other methods when compared with each other. The objective structured clinical examination (OSCE) was established for valid, reliable, and objective assessment of clinical skills in health professions education. Various standard setting methods have been proposed to identify objective, reliable, and valid cutoff scores on OSCEs. These methods may identify different cutoff scores for the same examinations. Identification of valid and reliable cutoff scores for OSCEs remains an important issue and a challenge. Thirty OSCE stations administered at least twice in the years 2010-2012 to 393 medical students in Years 2 and 3 at Aga Khan University are included. Psychometric properties of the scores are determined. Cutoff scores and pass/fail decisions of Wijnen, Cohen, Mean-1.5SD, Mean-1SD, Angoff, borderline group and borderline regression (BL-R) methods are compared with each other and with three variants of cluster analysis using repeated measures analysis of variance and Cohen's kappa. The mean psychometric indices on the 30 OSCE stations are reliability coefficient = 0.76 (SD = 0.12); standard error of measurement = 5.66 (SD = 1.38); coefficient of determination = 0.47 (SD = 0.19), and intergrade discrimination = 7.19 (SD = 1.89). BL-R and Wijnen methods show the highest convergent validity evidence among other methods on the defined criteria. Angoff and Mean-1.5SD demonstrated least convergent validity evidence. The three cluster variants showed substantial convergent validity with borderline methods. Although there was a high level of convergent validity of Wijnen method, it lacks the theoretical strength to be used for competency-based assessments. The BL-R method is found to show the highest convergent validity evidences for OSCEs with other standard setting methods used in the present study. We also found that cluster analysis using mean method can be used for quality assurance of borderline methods. These findings should be further confirmed by studies in other settings.

Triglycerides/High density lipoprotein cholesterol ratio as a cardiometabolic risk marker in children and adolescents from Mérida city, Venezuela.

PubMed

Aguirre, Miguel; Briceño, Yajaira; Gómez-Pérez, Roald; Zerpa, Yajaira; Camacho, Nolis; Paoli, Mariela

2018-02-01

To determine the behavior of the triglycerides/HDL-cholesterol ratio (TG/HDL) as a cardiometabolic risk marker in children and adolescents from Mérida, Venezuela. A total of 1292 children and adolescents aged 7-18 years who attended educational institutions in the Libertador Municipality were enrolled into this study. Anthropometric measurements and blood pressure values were recorded. Fasting blood glucose, insulin and lipid levels were measured. The TG/HDL ratio, HOMA-IR, and QUICKI indexes were calculated. Subjects were categorized as with and without cardiometabolic risk based on the presence or absence of 2or more risk factors. Cut-off points for the TG/HDL ratio were determined by constructing ROC curves. Significantly higher mean TG/HDL ratios were found in pubertal (2.2 ± 1.7) as compared to prepubertal subjects (1.8 ± 1.5; P=.001), with no sex differences. Two or more risk factors were found in 14.7% (n=192) of the participants, in whom TG/HDL ratios were significantly higher as compared to those with no risk (3.5±2.9 versus 1.6±0.8 in prepubertal and 4.1 ± 3.5 versus 1.8 ± 0.9 in pubertal subjects; P=.0001). According to cardiometabolic risk, cut-off points for the TG/HDL ratio of 1.8 and 2.5 were found for prepubertal and pubertal children respectively. These cut-off points showed risks (odds ratio) higher than 2.5 for conditions such as metabolic syndrome, elevated non-HDL-C, abdominal obesity, and elevated HOMA-IR. In this sample of children and adolescents, an elevated TG/HDLc ratio was found to be a good marker for predicting cardiometabolic risk. Copyright © 2017 SEEN y SED. Publicado por Elsevier España, S.L.U. All rights reserved.

Optimal Waist-to-Height Ratio Values for Cardiometabolic Risk Screening in an Ethnically Diverse Sample of South African Urban and Rural School Boys and Girls

PubMed Central

Matsha, Tandi E.; Kengne, Andre-Pascal; Yako, Yandiswa Y.; Hon, Gloudina M.; Hassan, Mogamat S.; Erasmus, Rajiv T.

2013-01-01

Background The proposed waist-to-height ratio (WHtR) cut-off of 0.5 is less optimal for cardiometabolic risk screening in children in many settings. The purpose of this study was to determine the optimal WHtR for children from South Africa, and investigate variations by gender, ethnicity and residence in the achieved value. Methods Metabolic syndrome (MetS) components were measured in 1272 randomly selected learners, aged 10–16 years, comprising of 446 black Africans, 696 mixed-ancestry and 130 Caucasians. The Youden’s index and the closest-top-left (CTL) point approaches were used to derive WHtR cut-offs for diagnosing any two MetS components, excluding the waist circumference. Results The two approaches yielded similar cut-off in girls, 0.465 (sensitivity 50.0, specificity 69.5), but two different values in boys, 0.455 (42.9, 88.4) and 0.425 (60.3, 67.7) based on the Youden’s index and the CTL point, respectively. Furthermore, WHtR cut-off values derived differed substantially amongst the regions and ethnic groups investigated, whereby the highest cut-off was observed in semi-rural and white children, respectively, Youden’s index0.505 (31.6, 87.1) and CTL point 0.475 (44.4, 75.9). Conclusion The WHtR cut-off of 0.5 is less accurate for screening cardiovascular risk in South African children. The optimal value in this setting is likely gender and ethnicity-specific and sensitive to urbanization. PMID:23967160

Appraisal and standardization of curvilinear velocity (VCL) cut-off values for CASA analysis of Japanese quail (Coturnix japonica) sperm.

PubMed

Farooq, U; Malecki, I A; Mahmood, M; Martin, G B

2017-06-01

One of the basic steps in objective analysis of sperm motility is the subdivision of a motile sperm population into slow, medium and rapid categories based on their velocity. However, for CASA analysis of quail sperm, the velocity values for categorization of slow, medium and rapid sperm have not yet been standardized. To identify the cut-off values of "velocity curvilinear" (VCL) for quail sperm categorization, we captured and analysed 22,300 tracks of quail sperm using SCA ® -CASA. The median and mean VCL values were 85 and 97 μm/s. To define the VCL cut-off values, we used two methods. In the first, we identified the upper (rapid sperm) and lower (slow sperm) cut-off values using: (i) median VCL ± 25% or ± 50% or ± 75% of median VCL value; (ii) first and third quartile values of VCL data (i.e. 25% cut-off setting); and (iii) 33% and 66% of VCL data. Among these settings, sperm categories and their corresponding motility characteristics recorded using the "25%" setting (i.e. slow ≤36 ≤ medium ≤154 ≤ rapid) were found the most realistic and coherent with male ranking by fertility. In the second method, we calculated heteroscedasticity in the total VCL data using PCA and the two-step clustering method. With this approach, the mean of the high and low clusters was 165 and 51 μm/s, respectively. Together, the mean from two methods suggested that, for SCA ® -CASA categorization of quail sperm, sperm should be classed as "rapid" at VCL ≥160 μm/s and "slow" at VCL ≤45 μm/s. © 2017 Blackwell Verlag GmbH.

Prevalence of elevated mean arterial pressure and how fitness moderates its association with BMI in youth.

PubMed

Ogunleye, Ayodele A; Sandercock, Gavin R; Voss, Christine; Eisenmann, Joey C; Reed, Katharine

2013-11-01

Cardiorespiratory fitness is known to be cardioprotective and its association with the components of the metabolic syndrome in children is becoming clearer. The aim of the present study was to examine the extent to which cardiorespiratory fitness may offset the weight-related association with mean arterial pressure (MAP) in schoolchildren. Cross-sectional study. Schoolchildren from the East of England, U.K. A total of 5983 (48% females) schoolchildren, 10 to 16 years of age, had height, weight and blood pressure measured by standard procedures and cardiorespiratory fitness assessed by the 20 m shuttle-run test. Participants were classified as fit or unfit using internationally accepted fitness cut-off points; and as normal weight, overweight or obese based on BMI, again using international cut-off points. Age-adjusted ANCOVA was used to determine the main effects and interaction of fitness and BMI on MAP Z-score. Logistic regression models were used to estimate odds ratios of elevated MAP. Prevalence of elevated MAP in schoolchildren was 14.8% overall and 35.7% in those who were obese-unfit. Approximately 21% of participants were overweight and 5% obese, while 23% were classified as unfit. MAP generally increased across BMI categories and was higher in the aerobically unfit participants. Obese-fit males had lower MAP compared with obese-unfit males (P < 0.001); this trend was similar in females (P = 0.05). Increasing fitness level may have a positive impact on the weight-related elevations of MAP seen in obese and overweight schoolchildren.

Elevated phenylalanine on newborn screening: follow-up testing may reveal undiagnosed galactosaemia.

PubMed

Shakespeare, Lynette; Downing, Melanie; Allen, Joyce; Casbolt, Ann-Marie; Ellin, Sheila; Maloney, Martin; Race, Gillian; Bonham, Jim

2010-11-01

Introduction Newborn screening for phenylketonuria (PKU) can reveal other conditions which lead to an increased blood spot phenylalanine (Phe) concentration. We have investigated the proportion of blood spot samples that gave a positive screen due to clinically significant conditions other than PKU, compared the positive predictive value (PPV) of our referral Phe cut-off with that recommended by the UK Newborn Screening Programme Centre (UKNSPC) (>210 and >240 μmol/L, respectively) and evaluated the effectiveness of reflex testing for galactosaemia using a lower blood spot Phe cut-off concentration of 130 μmol/L. All blood spot samples that screened positive, for an increased Phe concentration, between April 2001 and March 2008, were identified from the records of the Sheffield Newborn Screening Laboratory and the diagnoses noted. In addition, all cases of galactosaemia detected in or notified to our screening laboratory within this time were also examined and the screened Phe concentrations compared. Out of 438,674 babies who were screened, 67 had Phe concentration >210 μmol/L (15 per 100,000). Of these, 40 had PKU or persistent hyperphenylalaninaemia with a Phe concentration identified by screening between 270 and 2350 μmol/L. A further 11 were diagnosed with another clinically significant disorder: galactosaemia (n = 8), biopterin defects (n = 2), tyrosinaemia Type 1 (n = 1). In addition, 16 had transient elevations in Phe. In total, nine cases of galactosaemia were identified, of whom, three had Phe concentrations <240 μmol/L with one asymptomatic individual having a concentration <210 μmol/L. Adoption of the UKNSPC recommended cut-off (>240 μmol/L) will not affect the detection rate of classical PKU, but will improve the PPV from 76% to 80%. The use of a lower cut-off (130 μmol/L) for reflex galactosaemia testing enables the timely identification of asymptomatic cases that benefit particularly from early treatment, without prompting any unnecessary clinical referrals or delaying any referrals. This intervention may reduce mortality in this vulnerable group.

Floods at Mount Clemens, Michigan

USGS Publications Warehouse

Wiitala, S.W.; Ash, Arlington D.

1962-01-01

The approximate areas inundated during the flood of April 5-6, 1947, by Clinton River, North Branch and Middle Branch of Clinton River, and Harrington Drain, in Clinton Township, Macomb County, Mich., are shown on a topographic map base to record the flood hazard in graphical form. The flood of April 1947 is the highest known since 1934 and probably since 1902. Greater floods are possible, but no attempt was made to define their probable overflow limits.The Clinton River Cut-Off Canal, a flood-relief channel which diverts flow directly into Lake St. Clair from a point about 1500 feet downstream from Gratiot Avenue (about 9 miles upstream from the mouth) has been in operation since October 1951. The approximate limits of overflow that would results from a flood equivalent in discharge to that of April 1947, and occurring with the Cut-Off Canal in operation, are also shown. Although the Cut-Off Canal may reduce the frequency and depth of flooding it will not necessarily eliminate future flooding in the area. Improvements and additions to the drainage systems in the basin, expanding urbanization, new highways, and other cultural changes may influence the inundation pattern of future floods.The preparation of this flood inundation map was financed through a cooperative agreement between Clinton Township, Macomb County, Mich., and the U.S. Geological Survey.Backwater curves used to define the profile for a hypothetical flood on the Clinton River downstream from Moravian Drive, equivalent in discharge to the 1947 flood, but occurring with the present Cut-Off Canal in operation; flood stage established at the gaging station on Clinton River at Mount Clemens; and supplementary floodmark elevations were furnished by the Corps of Engineers.Bench-mark elevations and field survey data, used in the analysis of floods on Harrington Drain, were furnished by the Macomb County Drain Commission.

Basal progesterone level as the main determinant of progesterone elevation on the day of hCG triggering in controlled ovarian stimulation cycles.

PubMed

Papaleo, Enrico; Corti, Laura; Vanni, Valeria Stella; Pagliardini, Luca; Ottolina, Jessica; De Michele, Francesca; La Marca, Antonio; Viganò, Paola; Candiani, Massimo

2014-07-01

Modest increases of serum progesterone at human chorionic gonadotrophin (hCG) administration in controlled ovarian hyperstimulation (COH) cycles have been shown to have a negative impact on pregnancy outcomes. The aim of this study was to identify early predictors of progesterone elevation at hCG. Pregnancy outcome of 303 consecutive patients undergoing COH and fresh day-3 embryo transfer was analysed. Considering the non-linear relationship between progesterone at hCG triggering and pregnancy outcomes, partial area under the curve (pAUC) analysis was used to implement marker identification potential of receiver operating characteristic (ROC) curve analysis. Multivariate logistic analysis was then performed to identify predictors of progesterone rise. Pregnancy outcomes could be predicted by pAUC analysis (pAUC = 0.58, 95 % CI 0.51-0.66, p = 0.02) and a significant detrimental cut-off could be calculated (progesterone at hCG > 1.35 ng/ml). Total dose of rFSH administered, E2 level at hCG but mostly basal progesterone level (OR = 12.21, 95 % CI 1.82-81.70) were predictors of progesterone rise above the cut-off. Basal progesterone is shown to be the main prognostic factor for progesterone elevation. This observation should be taken into consideration in the clinical management of IVF/ICSI cycles to improve pregnancy outcomes.

Interatrial septal motion as a novel index to predict left atrial pressure.

PubMed

Masai, Kumiko; Kishima, Hideyuki; Takahashi, Satoshi; Ashida, Kenki; Goda, Akiko; Mine, Takanao; Asakura, Masanori; Ishihara, Masaharu; Masuyama, Tohru

2018-01-22

We investigated whether the interatrial septal (IAS) motion of each heartbeat which is observed by transesophageal echocardiography reflects left atrial pressure (LAP) in patients with atrial fibrillation (AF). We studied 100 patients (70 males, age 67 ± 9 years) who underwent catheter ablation for AF. The amplitude of IAS motion was measured using M-mode and averaged for five cardiac cycles. Left and right atrial pressures, the left to right atrial pressure gradient were directly measured during the catheter ablation. In patients with sinus rhythm during measurement, elevated mean LAP, larger maximum left to right atrial pressure gradient, and greater left atrial emptying fraction were associated with IAS motion. The optimal cut-off value of the IAS motion for predicting high LAP (mean LAP > 15 mmHg) was 8.5 mm (sensitivity 100%, specificity 70.1%) in patients with sinus rhythm during pressure measurement. In addition, all patients were divided into 6 groups based on rhythm during measurement and cutoff value of IAS motion. In patients with sinus rhythm during measurement, low IAS motion group had a highest prevalence of elevated LAP compared with high IAS motion group (64 vs. 0%, P < 0.0001). The amplitude of interatrial septal motion during sinus rhythm reflects left atrial pressure in patients with atrial fibrillation. Interatrial septal motion could be a new index to predict elevated left atrial pressure.

Open pit mining profit maximization considering selling stage and waste rehabilitation cost

NASA Astrophysics Data System (ADS)

Muttaqin, B. I. A.; Rosyidi, C. N.

2017-11-01

In open pit mining activities, determination of the cut-off grade becomes crucial for the company since the cut-off grade affects how much profit will be earned for the mining company. In this study, we developed a cut-off grade determination mode for the open pit mining industry considering the cost of mining, waste removal (rehabilitation) cost, processing cost, fixed cost, and selling stage cost. The main goal of this study is to develop a model of cut-off grade determination to get the maximum total profit. Secondly, this study is also developed to observe the model of sensitivity based on changes in the cost components. The optimization results show that the models can help mining company managers to determine the optimal cut-off grade and also estimate how much profit that can be earned by the mining company. To illustrate the application of the models, a numerical example and a set of sensitivity analysis are presented. From the results of sensitivity analysis, we conclude that the changes in the sales price greatly affects the optimal cut-off value and the total profit.

Re-evaluation of cosmic ray cutoff terminology

NASA Technical Reports Server (NTRS)

Cooke, D. J.; Humble, J. E.; Shea, M. A.; Smart, D. F.; Lund, N.; Rasmussen, I. L.; Byrnak, B.; Goret, P.; Petrou, N.

1985-01-01

The study of cosmic ray access to locations inside the geomagnetic field has evolved in a manner that has led to some misunderstanding and misapplication of the terminology originally developed to describe particle access. This paper presents what is believed to be a useful set of definitions for cosmic ray cutoff terminology for use in theoretical and experimental cosmic ray studies.

Preliminary analysis of posttraumatic stress disorder screening within specialty clinic setting for OIF/OEF veterans seeking care for neck or back pain.

PubMed

Dunn, Andrew S; Julian, Terri; Formolo, Lance R; Green, Bart N; Chicoine, David R

2011-01-01

Escalating prevalence estimates of posttraumatic stress disorder (PTSD) among recently returning Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) veterans highlight the need for early detection and management for reducing chronic mental illness and disability. Because PTSD and chronic pain are common comorbid conditions among veterans, PTSD screening within specialty clinic settings addressing musculoskeletal pain may be of value. This retrospective study evaluated measures of diagnostic value for the PTSD Checklist (PCL) for a sample (n = 79) of OIF/OEF veterans seeking care for neck or back pain within a Department of Veterans Affairs specialty clinic. Because published accounts of optimal PCL cutoff scores vary considerably, we used receiver operating characteristic curves to identify whether the optimal PCL cutoff score for the sample differed from a conventional cutoff score of 50. A clinical psychologist experienced in diagnosing and managing PTSD confirmed the diagnosis of PTSD for 37 veterans through a review of clinical records. The prevalence of diagnosed PTSD was 46.8%, with an optimal PCL cutoff score of 44. These findings may guide future research and influence clinical practice regarding PTSD screening for recently returning veterans with chronic pain.

Scoring the DSM-IV personality disorders using the Five-Factor Model: development and validation of normative scores for North American, French, and Dutch-Flemish samples.

PubMed

Miller, Joshua D; Lynam, Donald R; Rolland, Jean-Pierre; De Fruyt, Filip; Reynolds, Sarah K; Pham-Scottez, Alexandra; Baker, Spencer R; Bagby, R Michael

2008-10-01

Five-Factor Model (FFM) personality disorder (PD) counts have demonstrated significant convergent and discriminant validity with DSM-IV PD symptoms. However, these FFM PD counts are of limited clinical use without normative data because it is difficult to determine what a specific score means with regard to the relative level of elevation. The current study presents data from three large normative samples that can be used as norms for the FFM PD counts in the respective countries: United States (N = 1,000), France (N = 801), and Belgium-Netherlands (N = 549). The present study also examines the performance, with regard to diagnostic efficiency, of statistically-defined cut-offs at 1.5 standard deviations above the mean (T > or = 65) versus previously identified cut-offs using receiver-operator characteristics (ROC) analyses. These cut-offs are tested in three clinical samples-one from each of the aforementioned countries. In general, the T > or = 65 cut-offs performed similarly to those identified using ROC analyses and manifested properties relevant to a screening instrument. These normative data allow FFM data to be used in a flexible and comprehensive manner, which may include scoring this type of personality data in order to screen for DSM-IV PD constructs.

Reliability and Validity of 10 Different Standard Setting Procedures.

ERIC Educational Resources Information Center

Halpin, Glennelle; Halpin, Gerald

Research indicating that different cut-off points result from the use of different standard-setting techniques leaves decision makers with a disturbing dilemma: Which standard-setting method is best? This investigation of the reliability and validity of 10 different standard-setting approaches was designed to provide information that might help…

Anthropometric cutoff values for predicting metabolic syndrome in a Saudi community: from the SAUDI-DM study.

PubMed

Al-Rubean, Khalid; Youssef, Amira M; AlFarsi, Yousuf; Al-Sharqawi, Ahmad H; Bawazeer, Nahla; AlOtaibi, Mohammad T; AlRumaih, Fahd Issa; Zaidi, Muhammad Shoaib

2017-01-01

The prevalence of metabolic syndrome varies widely by ethnicity and by the criteria used in its definition. To identify the optimal cutoff values for waist circumference (WC), waist-to-hip ratio (WHR) and body mass index (BMI) for identifying metabolic syndrome among the Saudi population. Nationwide household cross-sectional population-based survey. Thirteen health sectors in Saudi Arabia. We used data for subjects in the Saudi Abnormal Glucose Metabolism and Diabetes Impact Study (SAUDI-DM), which was conducted from 2007 to 2009. Using International Diabetes Federation (IDF) criteria, metabolic syndrome and its different components were assessed using anthropometric measurements, blood pressure, fasting plasma glucose, triglycerides and HDL cholesterol. Receiver operating characteristic (ROC) curves were generated to assess sensitivity and specificity for different cutoff values of WC, WHR, and BMI. The Youden index was used to calculate the optimal cutoff value for each anthropometric measurement. Optimal cutoff value for WC, WHR, and BMI for identifying the risk of metabolic syndrome. The prevalence of two or more risk factors for metabolic syndrome was observed in 43.42% of the total cohort of 12126 study participants >=18 years of age. The presence of two or more risk factors were significantly higher among men (46.81%) than women (40.53%) (P < .001). The optimal cutoff values for WC, WHR, and BMI were 92 cm, 0.89, and 25 kg/m2 for men and 87 cm, 0.81 and 28 kg/m2 for women for identifying the risk of metabolic syndrome. The prevalence of elevated triglycerides, blood pressure, and fasting plasma glucose significantly increased with age for both genders. The proposed WC cutoff values were better than WHR and BMI in predicting metabolic syndrome and could be used for screening people at high risk for metabolic syndrome in the Saudi population. No direct measure of body fatness and fat distribution, cross-sectional design.

Prediction of infarct severity from triiodothyronine levels in patients with ST-elevation myocardial infarction.

PubMed

Kim, Dong Hun; Choi, Dong-Hyun; Kim, Hyun-Wook; Choi, Seo-Won; Kim, Bo-Bae; Chung, Joong-Wha; Koh, Young-Youp; Chang, Kyong-Sig; Hong, Soon-Pyo

2014-07-01

The aim of the present study was to evaluate the relationship between thyroid hormone levels and infarct severity in patients with ST-elevation myocardial infarction (STEMI). We retrospectively reviewed thyroid hormone levels, infarct severity, and the extent of transmurality in 40 STEMI patients evaluated via contrast-enhanced cardiac magnetic resonance imaging. The high triiodothyronine (T3) group (≥ 68.3 ng/dL) exhibited a significantly higher extent of transmural involvement (late transmural enhancement > 75% after administration of gadolinium contrast agent) than did the low T3 group (60% vs. 15%; p = 0.003). However, no significant difference was evident between the high- and low-thyroid-stimulating hormone/free thyroxine (FT4) groups. When the T3 cutoff level was set to 68.3 ng/dL using a receiver operating characteristic curve, the sensitivity was 80% and the specificity 68% in terms of differentiating between those with and without transmural involvement. Upon logistic regression analysis, high T3 level was an independent predictor of transmural involvement after adjustment for the presence of diabetes mellitus (DM) and the use of glycoprotein IIb/IIIa inhibitors (odds ratio, 40.62; 95% confidence interval, 3.29 to 502; p = 0.004). The T3 level predicted transmural involvement that was independent of glycoprotein IIb/IIIa inhibitor use and DM positivity.

Elevated and variable groundwater iron in rural northwestern Bangladesh.

PubMed

Merrill, Rebecca D; Labrique, Alain B; Shamim, Abu Ahmed; Schulze, Kerry; Christian, Parul; Merrill, Robert K; West, Keith P

2010-12-01

Over the past 30 years, tubewells have become a ubiquitous source of potable groundwater in South Asia. Considered safer than surface water, groundwater naturally contains minerals that may impact human health; however, few data exist on tubewell water mineral content or its association with human nutritional or health conditions. We surveyed iron concentration in tubewell water across a 435 km2, contiguous, rural area in northwestern Bangladesh to map and quantify levels of iron in drinking water. One tubewell was randomly sampled from each of 948 adjacent grid cells 675 m2 in size. Water sampling was standardized and iron concentration measured using a field-based colorimetric kit. The median (interquartile range) concentration of iron in tubewell water was 7.6 (1.6, 17.6) mg l(-1). There was high geographic variation (range of 0-46.5 mg l(-1)), and iron in only 3% of surveyed tubewells fell below the WHO aesthetic cut-off of 0.3 mg l(-1) suggesting elevated levels of iron throughout the area. Villagers accurately perceived groundwater iron concentration, based on a 4-point ('none', 'a little', 'medium', 'a lot') scale (p<0.001). Water source iron content can be readily quantified in population settings offering the potential to evaluate the health relevance of groundwater iron exposure in rural communities.

Z mode radiation in Jupiter's magnetosphere - The source of Jovian continuum radiation

NASA Technical Reports Server (NTRS)

Barbosa, D. D.; Kurth, W. S.; Moses, S. L.; Scarf, F. L.

1990-01-01

Observations of Z-mode waves in Jupiter's magnetosphere are analyzed. The assumption that the frequency of the intensity minimum, which isolates the signal, corresponds to the electron plasma frequency provides a consistent interpretation of all spectral features in terms of plasma resonances and cutoffs. It is shown that the continuum radiation is composed of both left-hand and right-hand polarized waves with distinct cutoffs observed at the plasma frequency and right-hand cutoff frequency, respectively. It is found that the Z-mode peak frequency lies close to the left-hand cutoff frequency, suggesting that the observed characteristics of the emission are the result of wave reflection at the cutoff layer. Another distinct emission occurring near the upper hybrid resonance frequency is detected simultaneously with the Z mode. The entire set of observations gives strong support to the linear mode theory of the conversion of upper hybrid waves to continuum radiation mediated by the Z mode via the Budden radio window mechanism.

A Method of Implementing Cutoff Conditions for Saturn V Lunar Missions Out of Earth Parking Orbit Assuming a Continuous Ground Launch Window

NASA Technical Reports Server (NTRS)

Cooper, F. D.

1965-01-01

A method of implementing Saturn V lunar missions from an earth parking orbit is presented. The ground launch window is assumed continuous over a four and one-half hour period. The iterative guidance scheme combined with a set of auxiliary equations that define suitable S-IVB cutoff conditions, is the approach taken. The four inputs to the equations that define cutoff conditions are represented as simple third-degree polynomials as a function of ignition time. Errors at lunar arrival caused by the separate and combined effects of the guidance equations, cutoff conditions, hypersurface errors, and input representations are shown. Vehicle performance variations and parking orbit injection errors are included as perturbations. Appendix I explains how aim vectors were computed for the cutoff equations. Appendix II presents all guidance equations and related implementation procedures. Appendix III gives the derivation of the auxiliary cutoff equations. No error at lunar arrival was large enough to require a midcourse correction greater than one meter per second assuming a transfer time of three days and the midcourse correction occurs five hours after injection. Since this result is insignificant when compared to expected hardware errors, the implementation procedures presented are adequate to define cutoff conditions for Saturn V lunar missions.

Validity of Alternative Cut-Off Scores for the Back-Saver Sit and Reach Test

ERIC Educational Resources Information Center

Looney, Marilyn A.; Gilbert, Jennie

2012-01-01

The purpose of the study was to determine if currently used FITNESSGRAM[R] cut-off scores for the Back Saver Sit and Reach Test had the best criterion-referenced validity evidence for 6-12 year old children. Secondary analyses of an existing data set focused on the passive straight leg raise and Back Saver Sit and Reach Test flexibility scores of…

The life of a meander bend: Connecting shape and dynamics via analysis of a numerical model

NASA Astrophysics Data System (ADS)

Schwenk, Jon; Lanzoni, Stefano; Foufoula-Georgiou, Efi

2015-04-01

Analysis of bend-scale meandering river dynamics is a problem of theoretical and practical interest. This work introduces a method for extracting and analyzing the history of individual meander bends from inception until cutoff (called "atoms") by tracking backward through time the set of two cutoff nodes in numerical meander migration models. Application of this method to a simplified yet physically based model provides access to previously unavailable bend-scale meander dynamics over long times and at high temporal resolutions. We find that before cutoffs, the intrinsic model dynamics invariably simulate a prototypical cutoff atom shape we dub simple. Once perturbations from cutoffs occur, two other archetypal cutoff planform shapes emerge called long and round that are distinguished by a stretching along their long and perpendicular axes, respectively. Three measures of meander migration—growth rate, average migration rate, and centroid migration rate—are introduced to capture the dynamic lives of individual bends and reveal that similar cutoff atom geometries share similar dynamic histories. Specifically, through the lens of the three shape types, simples are seen to have the highest growth and average migration rates, followed by rounds, and finally longs. Using the maximum average migration rate as a metric describing an atom's dynamic past, we show a strong connection between it and two metrics of cutoff geometry. This result suggests both that early formative dynamics may be inferred from static cutoff planforms and that there exists a critical period early in a meander bend's life when its dynamic trajectory is most sensitive to cutoff perturbations. An example of how these results could be applied to Mississippi River oxbow lakes with unknown historic dynamics is shown. The results characterize the underlying model and provide a framework for comparisons against more complex models and observed dynamics.

Mach Cutoff Analysis and Results from NASA's Farfield Investigation of No-Boom Thresholds

NASA Technical Reports Server (NTRS)

Cliatt, Larry J., II; Hill, Michael A.; Haering, Edward A, Jr.

2016-01-01

In support of the ongoing effort by the National Aeronautics and Space Administration (NASA) to bring supersonic commercial travel to the public, the NASA Armstrong Flight Research Center and the NASA Langley Research Center,in partnership with other industry organizations and academia, conducted a flight research experiment to analyze acoustic propagation in the Mach cutoff shadow zone. The effort was conducted in fall of 2012 and named the Farfield Investigation of No-boom Thresholds (FaINT). The test helped to build a data set that will go toward further understanding of the unique acoustic propagation characteristics below Mach cutoff altitude.

Active CMV and EBV infections in renal transplant recipients with unexplained fever and elevated serum creatinine.

PubMed

Hasannia, Tahereh; Moosavi Movahed, Seyed Majid; Vakili, Rosita; Rafatpanah, Houshang; Hekmat, Reza; Valizadeh, Narges; Rezaee, Seyed Abdolrahim

2016-10-01

Proper identification of active cytomegalovirus (CMV) and Epstein-Barr virus (EBV) infections are helpful for monitoring antiviral treatment in transplant recipients. Qualitative and quantitative CMV, EBV DNA PCR techniques in the context of serological tests are performed for early detection and differentiation of active and latent CMV and EBV infections in renal transplantation. Basically, 129 renal transplanted recipients monitored carefully and hospitalized for unexplained elevated creatinine levels or high fever and 21 of their donors were studied. CMV DNA was detected in 63.5% of the febrile episodes following transplantation and in 46.42% of readmitted patients using qualitative PCR method. In the first group, 15% of the patients and in the second group 42.85% of the patients had copy numbers more than cutoff point (900 copies/mL). Cutoff point had 100% sensitivity and 82.5% specificity for active and symptomatic CMV infection. Only 15.5% of the subjects were positive for EBV infection by qualitative PCR method. Among them 5% had >2000 copies/mL and were symptomatic. One subject with a history of three times hospitalization had higher EBV viral load and developed post-transplant lymphoproliferative disorder. CMV load was significantly correlated with elevated creatinine levels (OR = 3.1, p = 0.006), abnormal heart sounds (OR = 4.7; p = 0.02) and hypertension (OR = 3.6; p = 0.03). Only qRT-PCR could differentiate between latent and active infections and might be clinically useful for monitoring symptomatic CMV and EBV infections and initiation of the antiviral therapy. Elevated creatinine levels, hypertension, and abnormal heart sounds could be considered as main manifestations of HCMV infection in kidney recipients.

Measurement of four tumor marker antigens in the sera of pregnant women.

PubMed

Cheli, C D; Morris, D L; Neaman, I E; Dai, J; Allard, W J; Yeung, K K

1999-01-01

We sought to determine the maternal serum levels of four tumor-associated antigens during the three trimesters of pregnancy in healthy women. CEA, CA 228, CA 15-3, and Her2/neu oncogene product p105 assay values were determined for 90 healthy pregnant women during the three trimesters of pregnancy at five participating evaluation sites. Results were compared to means and cut-off values determined for healthy nonpregnant women. Differences in assay values in the 1st and 3rd trimester were analyzed for statistical significance (Student's t-test). CEA, CA 228 and CA 15-3 assay values in general were found to be within the normal range. CA 15-3 and Her2/neu p105 serum assay values were above the cut-off (3.3% and 8.2%, respectively) and were significantly elevated in the 3rd trimester as compared to the 1st trimester of pregnancy (P < 0.05 and P < 0.001, respectively). CEA and CA 228 may be of potential value in monitoring pregnant women with malignant disease. Normal elevations in 3rd trimester serum Her2/neu p105 and CA 15-3 assay values should be considered when monitoring a pregnant patient with malignant disease.

Elevated serum tartrate-resistant acid phosphatase isoform 5a levels in metabolic syndrome.

PubMed

Huang, Yi-Jhih; Huang, Tsai-Wang; Chao, Tsu-Yi; Sun, Yu-Shan; Chen, Shyi-Jou; Chu, Der-Ming; Chen, Wei-Liang; Wu, Li-Wei

2017-09-29

Tartrate-resistant phosphatase isoform 5a is expressed in tumor-associated macrophages and is a biomarker of chronic inflammation. Herein, we correlated serum tartrate-resistant phosphatase isoform 5a levels with metabolic syndrome status and made comparisons with traditional markers of inflammation, including c-reactive protein and interleukin-6. One hundred healthy volunteers were randomly selected, and cut-off points for metabolic syndrome related inflammatory biomarkers were determined using receiver operating characteristic curves. Linear and logistic regression models were subsequently used to correlate inflammatory markers with the risk of metabolic syndrome. Twenty-two participants met the criteria for metabolic syndrome, and serum tartrate-resistant phosphatase isoform 5a levels of >5.8 μg/L were associated with metabolic syndrome (c-statistics, 0.730; p = 0.001; 95% confidence interval, 0.618-0.842). In addition, 1 μg/L increases in tartrate-resistant phosphatase isoform 5a levels were indicative of a 1.860 fold increase in the risk of metabolic syndrome (p = 0.012). Elevated serum tartrate-resistant phosphatase isoform 5a levels are associated with the risk of metabolic syndrome, with a cut-off level of 5.8 μg/L.

Setting apart the affected: the use of behavioral criteria in animal models of post traumatic stress disorder.

PubMed

Cohen, Hagit; Zohar, Joseph; Matar, Michael A; Zeev, Kaplan; Loewenthal, Uri; Richter-Levin, Gal

2004-11-01

Post-traumatic stress disorder (PTSD) affects about 20-30% of exposed individuals. Clinical studies of PTSD generally employ stringent criteria for inclusion in study populations, and yet in animal studies the data collection and analysis are generally expressed as a function of exposed vs nonexposed populations, regardless of individual variation in response. Prior data support an approach to animal models analogous to inclusion criteria in clinical studies. This series of studies sought to assess prevalence rates of maladaptive vs adaptive responses determined according to a more stringent approach to the concept of inclusion/exclusion criteria (cutoff behavioral criteria-CBC), consisting of two successive behavioral tests (elevated plus maze and acoustic startle response tests). The rats were exposed to stressors in two different paradigms; exposure to a predator and underwater trauma. The prevalence rates of maladaptive responses to stress in these two distinct models dropped over time from 90% in the acute phase to 25% enduring/maladaptive response at 7 days, to remain constant over 30 days. As setting the affected individuals apart from the unaffected approximates clinical studies, it might also help to clarify some of the pending issues in PTSD research.

Reliability and validity of the Dutch pediatric Voice Handicap Index.

PubMed

Veder, Laura; Pullens, Bas; Timmerman, Marieke; Hoeve, Hans; Joosten, Koen; Hakkesteegt, Marieke

2017-05-01

The pediatric voice handicap index (pVHI) has been developed to provide a better insight into the parents' perception of their child's voice related quality of life. The purpose of the present study was to validate the Dutch pVHI by evaluating its internal consistency and reliability. Furthermore, we determined the optimal cut-off point for a normal pVHI score. All items of the English pVHI were translated into Dutch. Parents of children in our dysphonic and control group were asked to fill out the questionnaire. For the test re-test analysis we used a different study group who filled out the pVHI twice as part of a large follow up study. Internal consistency was analyzed through Cronbach's α coefficient. The test-retest reliability was assessed by determining Pearson's correlation coefficient. Mann-Whitney test was used to compare the scores of the questionnaire of the control group with the dysphonic group. By calculating receiver operating characteristic (ROC) curves, sensitivity and specificity we were able to set a cut-off point. We obtained data from 122 asymptomatic children and from 79 dysphonic children. The scores of the questionnaire significantly differed between both groups. The internal consistency showed an overall Cronbach α coefficient of 0.96 and an excellent test-retest reliability of the total pVHI questionnaire with a Pearson's correlation coefficient of 0.90. A cut-off point for the total pVHI questionnaire was set at 7 points with a specificity of 85% and sensitivity of 100%. A cut-off point for the VAS score was set at 13 with a specificity of 93% and sensitivity of 97%. The Dutch pVHI is a valid and reliable tool for the assessment of children with voice problems. By setting a cut-off point for the score of the total pVHI questionnaire of 7 points and the VAS score of 13, the pVHI might be used as a screening tool to assess dysphonic complaints and the pVHI might be a useful and complementary tool to identify children with dysphonia. Copyright © 2017 Elsevier B.V. All rights reserved.

Preoperative serum HER2 extracellular domain levels in primary invasive breast cancer.

PubMed

Lee, Sae Byul; Lee, Jong Won; Yu, Jong Han; Ko, Beom Seok; Kim, Hee Jeong; Son, Byung Ho; Gong, Gyungyub; Lee, Hee Jin; Kim, Sung-Bae; Jung, Kyung Hae; Ahn, Jin-Hee; Lee, Woochang; Sung, Joohon; Ahn, Sei-Hyun

2014-12-10

Despite the preclinical outcomes and biologic significance of the presence of the human epidermal growth factor receptor-2 (HER2) extracellular domain (ECD), there is little evidence supporting the measurement of ECD levels in any clinical setting. The aim of this study was to determine the prevalence of elevated serum HER2 ECD levels, the association between these levels and tissue HER2 overexpression, and the potential clinical prognostic value of HER2 ECD in primary invasive breast cancer. Serum HER2 ECD levels were examined preoperatively in 2,862 consecutive stage I-III primary breast cancer patients between 2007 and 2009. Serum HER2 ECD levels were measured by chemiluminescence immunoassay (ADVIA Centaur), and the tissue HER2 status was assessed by immunohistochemistry and fluorescence in situ hybridization. The cutoff value for the serum level of HER2 ECD was set at 15.2 ng/ml. Among the 2,862 patients, 126 (4.4%) had elevated serum HER2 ECD levels, and HER2 was overexpressed in the tumor tissue of 692 patients (24.2%), with a concordance of 78.7%. Multivariate analysis revealed that elevated serum HER2 ECD was a significant independent prognostic factor for worse distant-metastasis-free survival [DMFS; hazard ratio (HR) = 2.50, 95% confidence interval (CI) = 1.5-4.3, P = 0.001] and breast-cancer-specific survival (BCSS; HR = 2.0, 95% CI = 1.1-3.8, P = 0.036), which were much stronger in patients with tissue HER2-positive tumors (DMFS: HR = 3.8, 95% CI = 2.0-7.0, P < 0.001; BCSS: HR = 2.6, 95% CI = 1.2-5.3, P = 0.012). Given the prevalence of HER2 expression, its measurement as an independent prognostic factor can be clinically useful, particularly in patients with tissue HER2-positive tumors.

Physical and genetic-interaction density reveals functional organization and informs significance cutoffs in genome-wide screens

PubMed Central

Dittmar, John C.; Pierce, Steven; Rothstein, Rodney; Reid, Robert J. D.

2013-01-01

Genome-wide experiments often measure quantitative differences between treated and untreated cells to identify affected strains. For these studies, statistical models are typically used to determine significance cutoffs. We developed a method termed “CLIK” (Cutoff Linked to Interaction Knowledge) that overlays biological knowledge from the interactome on screen results to derive a cutoff. The method takes advantage of the fact that groups of functionally related interacting genes often respond similarly to experimental conditions and, thus, cluster in a ranked list of screen results. We applied CLIK analysis to five screens of the yeast gene disruption library and found that it defined a significance cutoff that differed from traditional statistics. Importantly, verification experiments revealed that the CLIK cutoff correlated with the position in the rank order where the rate of true positives drops off significantly. In addition, the gene sets defined by CLIK analysis often provide further biological perspectives. For example, applying CLIK analysis retrospectively to a screen for cisplatin sensitivity allowed us to identify the importance of the Hrq1 helicase in DNA crosslink repair. Furthermore, we demonstrate the utility of CLIK to determine optimal treatment conditions by analyzing genome-wide screens at multiple rapamycin concentrations. We show that CLIK is an extremely useful tool for evaluating screen quality, determining screen cutoffs, and comparing results between screens. Furthermore, because CLIK uses previously annotated interaction data to determine biologically informed cutoffs, it provides additional insights into screen results, which supplement traditional statistical approaches. PMID:23589890

Exercise-induced rhabdomyolysis.

PubMed

Lee, George

2014-11-03

Exercise-induced rhabdomyolysis, or exertional rhabdomyolysis (ER), is a clinical entity typically considered when someone presents with muscle stiffness, swelling, and pain out of proportion to the expected fatigue post exercise. The diagnosis is confirmed by myoglobinuria, and an elevated serum Creatinine Phosphokinase (CPK) level, usually 10 times the normal range. However, an elevation in CPK is seen in most forms of strenuous exercise, up to 20 times the upper normal range. Therefore, there is no definitive pathologic CPK cut-off. Fortunately the dreaded complication of acute renal failure is rare compared to other forms rhabdomyolysis. We review the risks, diagnosis, clinical course and treatment for exercise- induced rhabdomyolysis.

Fatigue life analysis of cracked gas receiver of emergency cut-off system in gas gathering station

NASA Astrophysics Data System (ADS)

Hu, Junzhi; Zhou, Jiyong; Li, Siyuan

2017-06-01

Small-scale air compressor and gas receiver are used as the driving gas of the emergency cut-off system in gas gathering station. Operation of block valve is ensured by starting and stopping compressor automatically. The frequent start-stop of compressor and the pressure fluctuation pose a threat to the service life of gas receiver, and then affect normal operation of the emergency cut-off system and security of gas gathering station. In this paper, the fatigue life of a pressure vessel with axial semi-elliptical surface crack in the inner wall is analyzed under the varying pressure by means of the theory of fracture mechanics. The influences of the amplitude of pressure fluctuation and the initial crack size on the residual life of gas receiver are discussed. It provides a basis for setting the working parameters of gas receiver of emergency cut-off system and determining the maintenance cycle.

Optic Nerve Sheath Diameter: Translating a Terrestrial Focused Technique Into a Clinical Monitoring Tool for Space Flight

NASA Technical Reports Server (NTRS)

Mason, Sara S.; Foy, Millennia; Sargsyan, Ashot; Garcia, Kathleen; Wear, Mary L.; Bedi, Deepak; Ernst, Randy; Van Baalen, Mary

2014-01-01

Emergency medicine physicians recently adopted the use of ultrasonography to quickly measure optic nerve sheath diameter (ONSD) as concomitant with increased intracranial pressure. NASA Space and Clinical Operations Division has been using ground and on-orbit ultrasound capabilities since 2009 to consider this anatomical measure as a proxy for intracranial pressure in the microgravity environment. In the terrestrial emergency room population, an ONSD greater than 0.59 cm is considered highly predictive of elevated intracranial pressure. However, this cut-off limit is not applicable to the spaceflight setting since over 50% of US Operating Segment (USOS) astronauts have an ONSD greater than 0.60 cm even before missions. Crew Surgeon clinical decision-making is complicated by the fact that many astronauts have history of previous spaceflights. Data will be presented characterizing the distribution of baseline ONSD in the astronaut corps, longitudinal trends in-flight, and the predictive power of this measure related to increased intracranial pressure outcomes.

Anti-aliasing filters for deriving high-accuracy DEMs from TLS data: A case study from Freeport, Texas

NASA Astrophysics Data System (ADS)

Xiong, L.; Wang, G.; Wessel, P.

2017-12-01

Terrestrial laser scanning (TLS), also known as ground-based Light Detection and Ranging (LiDAR), has been frequently applied to build bare-earth digital elevation models (DEMs) for high-accuracy geomorphology studies. The point clouds acquired from TLS often achieve a spatial resolution at fingerprint (e.g., 3cm×3cm) to handprint (e.g., 10cm×10cm) level. A downsampling process has to be applied to decimate the massive point clouds and obtain portable DEMs. It is well known that downsampling can result in aliasing that causes different signal components to become indistinguishable when the signal is reconstructed from the datasets with a lower sampling rate. Conventional DEMs are mainly the results of upsampling of sparse elevation measurements from land surveying, satellite remote sensing, and aerial photography. As a consequence, the effects of aliasing have not been fully investigated in the open literature of DEMs. This study aims to investigate the spatial aliasing problem and implement an anti-aliasing procedure of regridding dense TLS data. The TLS data collected in the beach and dune area near Freeport, Texas in the summer of 2015 are used for this study. The core idea of the anti-aliasing procedure is to apply a low-pass spatial filter prior to conducting downsampling. This article describes the successful use of a fourth-order Butterworth low-pass spatial filter employed in the Generic Mapping Tools (GMT) software package as anti-aliasing filters. The filter can be applied as an isotropic filter with a single cutoff wavelength or as an anisotropic filter with different cutoff wavelengths in the X and Y directions. The cutoff wavelength for the isotropic filter is recommended to be three times the grid size of the target DEM.

Neutrophil-to-lymphocyte ratio as prognostic indicator in gastrointestinal cancers: a systematic review and meta-analysis.

PubMed

Bowen, Randy C; Little, Nancy Ann B; Harmer, Joshua R; Ma, Junjie; Mirabelli, Luke G; Roller, Kyle D; Breivik, Andrew Mackay; Signor, Emily; Miller, Alec B; Khong, Hung T

2017-05-09

An accurate, time efficient, and inexpensive prognostic indicator is needed to reduce cost and assist with clinical decision making for cancer management. The neutrophil-to-lymphocyte ratio (NLR), which is derived from common serum testing, has been explored in a variety of cancers. We sought to determine its prognostic value in gastrointestinal cancers and performed a meta-analysis of published studies using the Meta-analysis Of Observational Studies in Epidemiology guidelines. Included were randomized control trials and observational studies that analyzed humans with gastrointestinal cancers that included NLR and hazard ratios (HR) with overall survival (OS), disease-free survival (DFS), progression-free survival (PFS), and/or cancer-specific survival (CSS).We analyzed 144 studies comprising 45,905 patients, two-thirds of which were published after 2014. The mean, median, and mode cutoffs for NLR reporting OS from multivariate models were 3.4, 3.0, 5.0 (±IQR 2.5-5.0), respectively. Overall, NLR greater than the cutoff was associated with a HR for OS of 1.63 (95% CI, 1.53-1.73; P < 0.001). This association was observed in all subgroups based on tumor site, stage, and geographic region. HR for elevated NLR for DFS, PFS, and CSS were 1.70 (95% CI, 1.52-1.91, P < 0.001), 1.64 (95% CI, 1.36-1.97, P < 0.001), and 1.83 (95% CI, 1.50-2.23, P < 0.001), respectively.Available evidence suggests that NLR greater than the cutoff reduces OS, independent of geographic location, gastrointestinal cancer type, or stage of cancer. Furthermore, DFS, PFS, and CSS also have worse outcomes with elevated NLR.

Neutrophil-to-lymphocyte ratio as prognostic indicator in gastrointestinal cancers: a systematic review and meta-analysis

PubMed Central

Bowen, Randy C.; Little, Nancy Ann B.; Harmer, Joshua R.; Ma, Junjie; Mirabelli, Luke G.; Roller, Kyle D.; Breivik, Andrew Mackay; Signor, Emily; Miller, Alec B.; Khong, Hung T.

2017-01-01

An accurate, time efficient, and inexpensive prognostic indicator is needed to reduce cost and assist with clinical decision making for cancer management. The neutrophil-to-lymphocyte ratio (NLR), which is derived from common serum testing, has been explored in a variety of cancers. We sought to determine its prognostic value in gastrointestinal cancers and performed a meta-analysis of published studies using the Meta-analysis Of Observational Studies in Epidemiology guidelines. Included were randomized control trials and observational studies that analyzed humans with gastrointestinal cancers that included NLR and hazard ratios (HR) with overall survival (OS), disease-free survival (DFS), progression-free survival (PFS), and/or cancer-specific survival (CSS). We analyzed 144 studies comprising 45,905 patients, two-thirds of which were published after 2014. The mean, median, and mode cutoffs for NLR reporting OS from multivariate models were 3.4, 3.0, 5.0 (±IQR 2.5-5.0), respectively. Overall, NLR greater than the cutoff was associated with a HR for OS of 1.63 (95% CI, 1.53-1.73; P < 0.001). This association was observed in all subgroups based on tumor site, stage, and geographic region. HR for elevated NLR for DFS, PFS, and CSS were 1.70 (95% CI, 1.52-1.91, P < 0.001), 1.64 (95% CI, 1.36-1.97, P < 0.001), and 1.83 (95% CI, 1.50-2.23, P < 0.001), respectively. Available evidence suggests that NLR greater than the cutoff reduces OS, independent of geographic location, gastrointestinal cancer type, or stage of cancer. Furthermore, DFS, PFS, and CSS also have worse outcomes with elevated NLR. PMID:28418870

Anti-aliasing filters for deriving high-accuracy DEMs from TLS data: A case study from Freeport, Texas

NASA Astrophysics Data System (ADS)

Xiong, Lin.; Wang, Guoquan; Wessel, Paul

2017-03-01

Terrestrial laser scanning (TLS), also known as ground-based Light Detection and Ranging (LiDAR), has been frequently applied to build bare-earth digital elevation models (DEMs) for high-accuracy geomorphology studies. The point clouds acquired from TLS often achieve a spatial resolution at fingerprint (e.g., 3 cm×3 cm) to handprint (e.g., 10 cm×10 cm) level. A downsampling process has to be applied to decimate the massive point clouds and obtain manageable DEMs. It is well known that downsampling can result in aliasing that causes different signal components to become indistinguishable when the signal is reconstructed from the datasets with a lower sampling rate. Conventional DEMs are mainly the results of upsampling of sparse elevation measurements from land surveying, satellite remote sensing, and aerial photography. As a consequence, the effects of aliasing caused by downsampling have not been fully investigated in the open literature of DEMs. This study aims to investigate the spatial aliasing problem of regridding dense TLS data. The TLS data collected from the beach and dune area near Freeport, Texas in the summer of 2015 are used for this study. The core idea of the anti-aliasing procedure is to apply a low-pass spatial filter prior to conducting downsampling. This article describes the successful use of a fourth-order Butterworth low-pass spatial filter employed in the Generic Mapping Tools (GMT) software package as an anti-aliasing filter. The filter can be applied as an isotropic filter with a single cutoff wavelength or as an anisotropic filter with two different cutoff wavelengths in the X and Y directions. The cutoff wavelength for the isotropic filter is recommended to be three times the grid size of the target DEM.

A general equation to obtain multiple cut-off scores on a test from multinomial logistic regression.

PubMed

Bersabé, Rosa; Rivas, Teresa

2010-05-01

The authors derive a general equation to compute multiple cut-offs on a total test score in order to classify individuals into more than two ordinal categories. The equation is derived from the multinomial logistic regression (MLR) model, which is an extension of the binary logistic regression (BLR) model to accommodate polytomous outcome variables. From this analytical procedure, cut-off scores are established at the test score (the predictor variable) at which an individual is as likely to be in category j as in category j+1 of an ordinal outcome variable. The application of the complete procedure is illustrated by an example with data from an actual study on eating disorders. In this example, two cut-off scores on the Eating Attitudes Test (EAT-26) scores are obtained in order to classify individuals into three ordinal categories: asymptomatic, symptomatic and eating disorder. Diagnoses were made from the responses to a self-report (Q-EDD) that operationalises DSM-IV criteria for eating disorders. Alternatives to the MLR model to set multiple cut-off scores are discussed.

Cross-Study Homogeneity of Psoriasis Gene Expression in Skin across a Large Expression Range

PubMed Central

Kerkof, Keith; Timour, Martin; Russell, Christopher B.

2013-01-01

Background In psoriasis, only limited overlap between sets of genes identified as differentially expressed (psoriatic lesional vs. psoriatic non-lesional) was found using statistical and fold-change cut-offs. To provide a framework for utilizing prior psoriasis data sets we sought to understand the consistency of those sets. Methodology/Principal Findings Microarray expression profiling and qRT-PCR were used to characterize gene expression in PP and PN skin from psoriasis patients. cDNA (three new data sets) and cRNA hybridization (four existing data sets) data were compared using a common analysis pipeline. Agreement between data sets was assessed using varying qualitative and quantitative cut-offs to generate a DEG list in a source data set and then using other data sets to validate the list. Concordance increased from 67% across all probe sets to over 99% across more than 10,000 probe sets when statistical filters were employed. The fold-change behavior of individual genes tended to be consistent across the multiple data sets. We found that genes with <2-fold change values were quantitatively reproducible between pairs of data-sets. In a subset of transcripts with a role in inflammation changes detected by microarray were confirmed by qRT-PCR with high concordance. For transcripts with both PN and PP levels within the microarray dynamic range, microarray and qRT-PCR were quantitatively reproducible, including minimal fold-changes in IL13, TNFSF11, and TNFRSF11B and genes with >10-fold changes in either direction such as CHRM3, IL12B and IFNG. Conclusions/Significance Gene expression changes in psoriatic lesions were consistent across different studies, despite differences in patient selection, sample handling, and microarray platforms but between-study comparisons showed stronger agreement within than between platforms. We could use cut-offs as low as log10(ratio) = 0.1 (fold-change = 1.26), generating larger gene lists that validate on independent data sets. The reproducibility of PP signatures across data sets suggests that different sample sets can be productively compared. PMID:23308107

Comparison of clonazepam compliance by measurement of urinary concentration by immunoassay and LC-MS/MS in pain management population.

PubMed

West, Robert; Pesce, Amadeo; West, Cameron; Crews, Bridgit; Mikel, Charles; Almazan, Perla; Rosenthal, Murray; Latyshev, Sergey

2010-01-01

Physicians determine patient compliance with their medications by use of urine drug testing. It is known that measurement of benzodiazepines is limited by immunoassay specificity and cutoff limits and therefore does not offer physicians an accurate picture of their patients' compliance with these medications. A few studies have used lower cutoffs to demonstrate patient compliance. To define more appropriate cutoffs for compliance monitoring of patients prescribed clonazepam as determined using immunoassay and liquid chromatography-tandem mass spectrometry (LC-MS/MS). A diagnostic accuracy study of the urinary excretion of clonazepam. Millennium Laboratories performed measurements on the urinary excretion of pain patients prescribed clonazepam as the indicator test. This benzodiazepine was chosen because it forms one major metabolite, 7-aminoclonazepam which is specific for that drug. Patients whose only benzodiazepine medication was clonazepam were selected as the test population. The Millennium Laboratories test database was filtered first to select patients on clonazepam, then a second filter was used to eliminate patients with any other listed benzodiazepine medications. Samples were tested using the Microgenics DRI benzodiazepine assay with a 200 ng/mL cutoff. The same samples were quantitatively assessed for 7-aminoclonazepam by LC-MS/MS with a cutoff of 40 ng/mL. The results from the immunoassay were scored as positive or negative while the quantitative results from the LC-MS/MS were also scored as positive or negative depending upon their concentration. Samples from 180 patients met these medication criteria. The positivity rates were 21% (38 samples) by immunoassay. The positivity rate was 70% (126 samples) if the LC-MS/MS cutoff was set at 200 ng/mL. However, the positivity rate was 87% (157 samples) if the LC-MS/MS was set at 40 ng/mL. Concentration distributions revealed a significant fraction (7%) in the 40 - 100 ng/mL range. A limitation of the study was the inability to measure lower than 40 ng/mL. There may be another fraction of the population that was positive below the cutoff value. The difference in positivity rate between the immunoassay and the LC-MS/MS result showed that the nominal 200 ng/mL cutoff of the immunoassay did not apply to 7-aminoclonazepam. This low immunoassay positivity rate is inconsistent with the manufacturer's published cross reactivity data for clonazepam and 7-aminoclonazepam. These data illustrate the limitations of using a 200 ng/mL cutoff to monitor clonazepam compliance and suggest that a cutoff of 40 ng/mL or less is needed to reliably monitor use of this drug.

The critical wave speed for the Fisher Kolmogorov Petrowskii Piscounov equation with cut-off

NASA Astrophysics Data System (ADS)

Dumortier, Freddy; Popovic, Nikola; Kaper, Tasso J.

2007-04-01

The Fisher-Kolmogorov-Petrowskii-Piscounov (FKPP) equation with cut-off was introduced in (Brunet and Derrida 1997 Shift in the velocity of a front due to a cut-off Phys. Rev. E 56 2597-604) to model N-particle systems in which concentrations less than ɛ = 1/N are not attainable. It was conjectured that the cut-off function, which sets the reaction terms to zero if the concentration is below the small threshold ɛ, introduces a substantial shift in the propagation speed of the corresponding travelling waves. In this paper, we prove the conjecture of Brunet and Derrida, showing that the speed of propagation is given by c_crit(\\varepsilon)=2-{\\pi^2}/{(\\ln\\varepsilon)^2}+\\cal{O}((\\ln\\varepsilon)^{-3}) , as ɛ → 0, for a large class of cut-off functions. Moreover, we extend this result to a more general family of scalar reaction-diffusion equations with cut-off. The main mathematical techniques used in our proof are the geometric singular perturbation theory and the blow-up method, which lead naturally to the identification of the reasons for the logarithmic dependence of ccrit on ɛ as well as for the universality of the corresponding leading-order coefficient (π2).

SU-F-T-376: The Efficiency of Calculating Photonuclear Reaction On High-Energy Photon Therapy by Monte Carlo Method

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hirayama, S; Fujibuchi, T

Purpose: Secondary-neutrons having harmful influences to a human body are generated by photonuclear reaction on high-energy photon therapy. Their characteristics are not known in detail since the calculation to evaluate them takes very long time. PHITS(Particle and Heavy Ion Transport code System) Monte Carlo code since versions 2.80 has the new parameter “pnimul” raising the probability of occurring photonuclear reaction forcibly to make the efficiency of calculation. We investigated the optimum value of “pnimul” on high-energy photon therapy. Methods: The geometry of accelerator head based on the specification of a Varian Clinac 21EX was used for PHITS ver. 2.80. Themore » phantom (30 cm * 30 cm * 30 cm) filled the composition defined by ICRU(International Commission on Radiation Units) was placed at source-surface distance 100 cm. We calculated the neutron energy spectra in the surface of ICRU phantom with “pnimal” setting 1, 10, 100, 1000, 10000 and compared the total calculation time and the behavior of photon using PDD(Percentage Depth Dose) and OCR(Off-Center Ratio). Next, the cutoff energy of photon, electron and positron were investigated for the calculation efficiency with 4, 5, 6 and 7 MeV. Results: The calculation total time until the errors of neutron fluence become within 1% decreased as increasing “pnimul”. PDD and OCR showed no differences by the parameter. The calculation time setting the cutoff energy like 4, 5, 6 and 7 MeV decreased as increasing the cutoff energy. However, the errors of photon become within 1% did not decrease by the cutoff energy. Conclusion: The optimum values of “pnimul” and the cutoff energy were investigated on high-energy photon therapy. It is suggest that using the optimum “pnimul” makes the calculation efficiency. The study of the cutoff energy need more investigation.« less

The 2013 Frank Stinchfield Award: Diagnosis of infection in the early postoperative period after total hip arthroplasty.

PubMed

Yi, Paul H; Cross, Michael B; Moric, Mario; Sporer, Scott M; Berger, Richard A; Della Valle, Craig J

2014-02-01

Diagnosis of periprosthetic joint infection (PJI) can be difficult in the early postoperative period after total hip arthroplasty (THA) because normal cues from the physical examination often are unreliable, and serological markers commonly used for diagnosis are elevated from the recent surgery. The purposes of this study were to determine the optimal cutoff values for erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), synovial fluid white blood cell (WBC) count, and differential for diagnosing PJI in the early postoperative period after primary THA. We reviewed 6033 consecutive primary THAs and identified 73 patients (1.2%) who underwent reoperation for any reason within the first 6 weeks postoperatively. Thirty-six of these patients were infected according to modified Musculoskeletal Infection Society criteria. Mean values for the diagnostic tests were compared between groups and receiver operating characteristic curves generated along with an area under the curve (AUC) to determine test performance and optimal cutoff values to diagnose infection. The best test for the diagnosis of PJI was the synovial fluid WBC count (AUC = 98%; optimal cutoff value 12,800 cells/μL) followed by the CRP (AUC = 93%; optimal cutoff value 93 mg/L), and synovial fluid differential (AUC = 91%; optimal cutoff value 89% PMN). The mean ESR (infected = 69 mm/hr, not infected = 46 mm/hr), CRP (infected = 192 mg/L, not infected = 30 mg/L), synovial fluid WBC count (infected = 84,954 cells/μL, not infected = 2391 cells/μL), and differential (infected = 91% polymorphonuclear cells [PMN], not infected = 63% PMN) all were significantly higher in the infected group. Optimal cutoff values for the diagnosis of PJI in the acute postoperative period were higher than those traditionally used for the diagnosis of chronic PJI. The serum CRP is an excellent screening test, whereas the synovial fluid WBC count is more specific.

Mental health and psychosocial problems in the aftermath of the Nepal earthquakes: findings from a representative cluster sample survey.

PubMed

Kane, J C; Luitel, N P; Jordans, M J D; Kohrt, B A; Weissbecker, I; Tol, W A

2018-06-01

Two large earthquakes in 2015 caused widespread destruction in Nepal. This study aimed to examine frequency of common mental health and psychosocial problems and their correlates following the earthquakes. A stratified multi-stage cluster sampling design was employed to randomly select 513 participants (aged 16 and above) from three earthquake-affected districts in Nepal: Kathmandu, Gorkha and Sindhupalchowk, 4 months after the second earthquake. Outcomes were selected based on qualitative preparatory research and included symptoms of depression and anxiety (Hopkins Symptom Checklist-25); post-traumatic stress disorder (PTSD Checklist-Civilian); hazardous alcohol use (AUDIT-C); symptoms indicating severe psychological distress (WHO-UNHCR Assessment Schedule of Serious Symptoms in Humanitarian Settings (WASSS)); suicidal ideation (Composite International Diagnostic Interview); perceived needs (Humanitarian Emergency Settings Perceived Needs Scale (HESPER)); and functional impairment (locally developed scale). A substantial percentage of participants scored above validated cut-off scores for depression (34.3%, 95% CI 28.4-40.4) and anxiety (33.8%, 95% CI 27.6-40.6). Hazardous alcohol use was reported by 20.4% (95% CI 17.1-24.3) and 10.9% (95% CI 8.8-13.5) reported suicidal ideation. Forty-two percent reported that 'distress' was a serious problem in their community. Anger that was out of control (symptom from the WASSS) was reported by 33.7% (95% CI 29.5-38.2). Fewer people had elevated rates of PTSD symptoms above a validated cut-off score (5.2%, 95% CI 3.9-6.8), and levels of functional impairment were also relatively low. Correlates of elevated symptom scores were female gender, lower caste and greater number of perceived needs. Residing in Gorkha and Sindhupalchowk districts and lower caste were also associated with greater perceived needs. Higher levels of impaired functioning were associated with greater odds of depression and anxiety symptoms; impaired functioning was less strongly associated with PTSD symptoms. Four months after the earthquakes in Nepal, one out of three adults experienced symptoms of depression and distressing levels of anger, one out of five engaged in hazardous drinking, and one out of ten had suicidal thoughts. However, posttraumatic stress symptoms and functional impairment were comparatively less frequent. Taken together, the findings suggest that there were significant levels of psychological distress but likely low levels of disorder. The findings highlight the importance of indicated prevention strategies to reduce the risk of distress progressing to disorder within post-disaster mental health systems of care.

Interfering Effect of Black Tea Consumption on Diagnosis of Pancreatic Cancer by CA 19-9.

PubMed

Al-Janabi, Ali Abdul Hussein S; Tawfeeq, Ekhlas F

2017-06-01

The study aims to determine the possible effects of black tea consumption on the level of CA 19-9 antigen in the human body. The level of CA 19-9 was measured in 270 healthy individuals who consumed heavy amounts of black tea. About 43.3 % of involved individuals were revealed to have elevated levels of CA 19-9. Males with high values of CA 19-9 represented the greatest number of involved individuals. The cutoff value of high levels of CA 19-9 in all individuals was ranged 69-105 U/ml. Consuming heavy amounts of black tea could be considered an important interfering factor that affects the levels of CA 19-9. The cutoff or predictive value of CA 19-9 in heavy-consuming people of black tea was determined.

Using Hashimoto thyroiditis as gold standard to determine the upper limit value of thyroid stimulating hormone in a Chinese cohort.

PubMed

Li, Yu; Chen, Dong-Ning; Cui, Jing; Xin, Zhong; Yang, Guang-Ran; Niu, Ming-Jia; Yang, Jin-Kui

2016-11-06

Subclinical hypothyroidism, commonly caused by Hashimoto thyroiditis (HT), is a risk factor for cardiovascular diseases. This disorder is defined as merely having elevated serum thyroid stimulating hormone (TSH) levels. However, the upper limit of reference range for TSH is debated recently. This study was to determine the cutoff value for the upper normal limit of TSH in a cohort using the prevalence of Hashimoto thyroiditis as "gold" calibration standard. The research population was medical staff of 2856 individuals who took part in health examination annually. Serum free triiodothyronine (FT3), free thyroxine (FT4), TSH, thyroid peroxidase antibody (TPAb), thyroglobulin antibody (TGAb) and other biochemistry parameters were tested. Meanwhile, thyroid ultrasound examination was performed. The diagnosis of HT was based on presence of thyroid antibodies (TPAb and TGAb) and abnormalities of thyroid ultrasound examination. We used two different methods to estimate the cutoff point of TSH based on the prevalence of HT. Joinpoint regression showed the prevalence of HT increased significantly at the ninth decile of TSH value corresponding to 2.9 mU/L. ROC curve showed a TSH cutoff value of 2.6 mU/L with the maximized sensitivity and specificity in identifying HT. Using the newly defined cutoff value of TSH can detect patients with hyperlipidemia more efficiently, which may indicate our approach to define the upper limit of TSH can make more sense from the clinical point of view. A significant increase in the prevalence of HT occurred among individuals with a TSH of 2.6-2.9 mU/L made it possible to determine the cutoff value of normal upper limit of TSH.

Intra-abdominal fat measurement by ultrasonography: association with anthropometry and metabolic syndrome in adolescents.

PubMed

Novais, Rommel L R; Café, Ana Carolina C; Morais, Aisha A; Bila, Wendell C; Santos, Gilson D da S; Lopes, Carlos Alexandre de O; Belo, Vinícius S; Romano, Márcia Christina C; Lamounier, Joel A

2018-04-27

To associate intra-abdominal fat thickness measured by ultrasonography to the factors related to metabolic syndrome and to determine cutoff points of intra-abdominal fat measurement associated with a greater chance of metabolic syndrome in adolescents. This was a cross-sectional study, with 423 adolescents from public schools. Intra-abdominal fat was measured by ultrasonography. Anthropometric data were collected, and biochemical analyses were performed. Intra-abdominal fat was measured by ultrasonography, showing a statistically significant association with the diagnosis of metabolic syndrome (p=0.037), body mass index (p<0.001), elevated triglyceride levels (p=0.012), decreased plasma HDL levels (p=0.034), and increased systemic blood pressure values (p=0.023). Cutoff values of intra-abdominal fat thickness measurements were calculated by ultrasound to estimate the individuals most likely to develop metabolic syndrome. In the logistic regression models, the cutoff values that showed the highest association with metabolic syndrome in males were 4.50, 5.35, 5.46, 6.24, and 6.50cm for the ages of 14, 15, 16, 17, and 18/19 years, respectively. In the female gender, the cutoff values defined for the same age groups were 4.46, 4.55, 4.45, 4.90, and 6.46cm. In an overall analysis using the ROC curve, without gender and age stratification, the cut-off of 3.67cm showed good sensitivity, but low specificity. Ultrasonography is a useful method to estimate intra-abdominal adipose tissue in adolescents, which is associated with the main factors related to obesity and metabolic syndrome. Copyright © 2018 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

Levels of Office Blood Pressure and Their Operating Characteristics for Detecting Masked Hypertension Based on Ambulatory Blood Pressure Monitoring

PubMed Central

Lin, Feng-Chang; Tuttle, Laura A.; Shimbo, Daichi; Diaz, Keith M.; Olsson, Emily; Stankevitz, Kristin; Hinderliter, Alan L.

2015-01-01

BACKGROUND Masked hypertension (MH)—nonelevated office blood pressure (BP) with elevated out-of-office BP average—conveys cardiovascular risk similar to or approaching sustained hypertension, making its detection of potential clinical importance. However, it may not be feasible or cost-effective to perform ambulatory BP monitoring (ABPM) on all patients with a nonelevated office BP. There likely exists a level of office BP below which ABPM is not warranted because the probability of MH is low. METHODS We analyzed data from 294 adults aged ≥30 years not on BP-lowering medication with office BP <140/90mm Hg, all of whom underwent 24-hour ABPM. We calculated sensitivity, false-positive rate, and likelihood ratios (LRs) for the range of office BP cutoffs from 110 to 138mm Hg systolic and from 68 to 88mm Hg diastolic for detecting MH. RESULTS The systolic BP cutoff with the highest +LR for detecting MH (1.8) was 120mm Hg, and the diastolic cutoff with the highest +LR (2.4) was 82mm Hg. However, the systolic level of 120mm Hg had a false-positive rate of 42%, and the diastolic level of 82mm Hg had a sensitivity of only 39%. CONCLUSIONS The cutoff of office BP with the best overall operating characteristics for diagnosing MH is approximately 120/82mm Hg. However, this cutoff may have an unacceptably high false-positive rate. Clinical risk tools to identify patients with nonelevated office BP for whom ABPM should be considered will likely need to include factors in addition to office BP. PMID:24898379

Procalcitonin as a biomarker for severe Plasmodium falciparum disease: a critical appraisal of a semi-quantitative point-of-care test in a cohort of travellers with imported malaria.

PubMed

Hesselink, Dennis A; Burgerhart, Jan-Steven; Bosmans-Timmerarends, Hanna; Petit, Pieter; van Genderen, Perry J J

2009-09-01

Imported malaria occurs as a relatively rare event in developed countries. As a consequence, most clinicians have little experience in making clinical assessments of disease severity and decisions regarding the need for parenteral therapy or high-level monitoring. In this study, the diagnostic accuracy of procalcitonin (PCT) for severe Plasmodium falciparum disease was assessed in a cohort of 100 consecutive travellers with various species of imported malaria. In all patients, PCT was measured on admission with a semi-quantitative 'point-of-care' test. Patients with severe P. falciparum malaria had significantly higher median PCT levels on admission as compared with patients with uncomplicated P. falciparum disease. In addition, PCT levels in patients with non-falciparum malaria were also higher compared with patients with non-severe falciparum malaria but lower compared with severe P. falciparum malaria. At a cut-off point of 10 ng/mL, PCT had a sensitivity of 0,67 and a specificity of 0,94 for severe falciparum disease. However, at lower cut-off points the specificity and positive predictive value were rather poor although the sensitivity and negative predictive value remained high. Potential drawbacks in the interpretation of elevated PCT levels on admission may be caused by infections with non-falciparum species and by concomitant bacterial infections. Semi-quantitative determination of PCT on admission is of limited use in the initial clinical assessment of disease severity in travellers with imported malaria, especially in settings with limited experience with the treatment of malaria.

ICU versus Non-ICU Hospital Death: Family Member Complicated Grief, Posttraumatic Stress, and Depressive Symptoms.

PubMed

Probst, Danielle R; Gustin, Jillian L; Goodman, Lauren F; Lorenz, Amanda; Wells-Di Gregorio, Sharla M

2016-04-01

Family members of patients who die in an ICU are at increased risk of psychological sequelae compared to those who experience a death in hospice. This study explored differences in rates and levels of complicated grief (CG), posttraumatic stress disorder (PTSD), and depression between family members of patients who died in an ICU versus a non-ICU hospital setting. Differences in family members' most distressing experiences at the patient's end of life were also explored. The study was an observational cohort. Subjects were next of kin of 121 patients who died at a large, Midwestern academic hospital; 77 died in the ICU. Family members completed measures of CG, PTSD, depression, and end-of-life experiences. Participants were primarily Caucasian (93%, N = 111), female (81%, N = 98), spouses (60%, N = 73) of the decedent, and were an average of nine months post-bereavement. Forty percent of family members met the Inventory of Complicated Grief CG cut-off, 31% met the Impact of Events Scale-Revised PTSD cut-off, and 51% met the Center for Epidemiologic Studies Depression Scale depression cut-off. There were no significant differences in rates or levels of CG, PTSD, or depressive symptoms reported by family members between hospital settings. Several distressing experiences were ranked highly by both groups, but each setting presented unique distressing experiences for family members. Psychological distress of family members did not differ by hospital setting, but the most distressing experiences encountered at end of life in each setting highlight potentially unique interventions to reduce distress post-bereavement for family members.

Global warming precipitation accumulation increases above the current-climate cutoff scale

PubMed Central

Sahany, Sandeep; Stechmann, Samuel N.; Bernstein, Diana N.

2017-01-01

Precipitation accumulations, integrated over rainfall events, can be affected by both intensity and duration of the storm event. Thus, although precipitation intensity is widely projected to increase under global warming, a clear framework for predicting accumulation changes has been lacking, despite the importance of accumulations for societal impacts. Theory for changes in the probability density function (pdf) of precipitation accumulations is presented with an evaluation of these changes in global climate model simulations. We show that a simple set of conditions implies roughly exponential increases in the frequency of the very largest accumulations above a physical cutoff scale, increasing with event size. The pdf exhibits an approximately power-law range where probability density drops slowly with each order of magnitude size increase, up to a cutoff at large accumulations that limits the largest events experienced in current climate. The theory predicts that the cutoff scale, controlled by the interplay of moisture convergence variance and precipitation loss, tends to increase under global warming. Thus, precisely the large accumulations above the cutoff that are currently rare will exhibit increases in the warmer climate as this cutoff is extended. This indeed occurs in the full climate model, with a 3 °C end-of-century global-average warming yielding regional increases of hundreds of percent to >1,000% in the probability density of the largest accumulations that have historical precedents. The probabilities of unprecedented accumulations are also consistent with the extension of the cutoff. PMID:28115693

Global warming precipitation accumulation increases above the current-climate cutoff scale

NASA Astrophysics Data System (ADS)

Neelin, J. David; Sahany, Sandeep; Stechmann, Samuel N.; Bernstein, Diana N.

2017-02-01

Precipitation accumulations, integrated over rainfall events, can be affected by both intensity and duration of the storm event. Thus, although precipitation intensity is widely projected to increase under global warming, a clear framework for predicting accumulation changes has been lacking, despite the importance of accumulations for societal impacts. Theory for changes in the probability density function (pdf) of precipitation accumulations is presented with an evaluation of these changes in global climate model simulations. We show that a simple set of conditions implies roughly exponential increases in the frequency of the very largest accumulations above a physical cutoff scale, increasing with event size. The pdf exhibits an approximately power-law range where probability density drops slowly with each order of magnitude size increase, up to a cutoff at large accumulations that limits the largest events experienced in current climate. The theory predicts that the cutoff scale, controlled by the interplay of moisture convergence variance and precipitation loss, tends to increase under global warming. Thus, precisely the large accumulations above the cutoff that are currently rare will exhibit increases in the warmer climate as this cutoff is extended. This indeed occurs in the full climate model, with a 3 °C end-of-century global-average warming yielding regional increases of hundreds of percent to >1,000% in the probability density of the largest accumulations that have historical precedents. The probabilities of unprecedented accumulations are also consistent with the extension of the cutoff.

Global warming precipitation accumulation increases above the current-climate cutoff scale

DOE Office of Scientific and Technical Information (OSTI.GOV)

Neelin, J. David; Sahany, Sandeep; Stechmann, Samuel N.

Precipitation accumulations, integrated over rainfall events, can be affected by both intensity and duration of the storm event. Thus, although precipitation intensity is widely projected to increase under global warming, a clear framework for predicting accumulation changes has been lacking, despite the importance of accumulations for societal impacts. Theory for changes in the probability density function (pdf) of precipitation accumulations is presented with an evaluation of these changes in global climate model simulations. We show that a simple set of conditions implies roughly exponential increases in the frequency of the very largest accumulations above a physical cutoff scale, increasing withmore » event size. The pdf exhibits an approximately power-law range where probability density drops slowly with each order of magnitude size increase, up to a cutoff at large accumulations that limits the largest events experienced in current climate. The theory predicts that the cutoff scale, controlled by the interplay of moisture convergence variance and precipitation loss, tends to increase under global warming. Thus, precisely the large accumulations above the cutoff that are currently rare will exhibit increases in the warmer climate as this cutoff is extended. This indeed occurs in the full climate model, with a 3 °C end-of-century global-average warming yielding regional increases of hundreds of percent to >1,000% in the probability density of the largest accumulations that have historical precedents. The probabilities of unprecedented accumulations are also consistent with the extension of the cutoff.« less

Global warming precipitation accumulation increases above the current-climate cutoff scale.

PubMed

Neelin, J David; Sahany, Sandeep; Stechmann, Samuel N; Bernstein, Diana N

2017-02-07

Precipitation accumulations, integrated over rainfall events, can be affected by both intensity and duration of the storm event. Thus, although precipitation intensity is widely projected to increase under global warming, a clear framework for predicting accumulation changes has been lacking, despite the importance of accumulations for societal impacts. Theory for changes in the probability density function (pdf) of precipitation accumulations is presented with an evaluation of these changes in global climate model simulations. We show that a simple set of conditions implies roughly exponential increases in the frequency of the very largest accumulations above a physical cutoff scale, increasing with event size. The pdf exhibits an approximately power-law range where probability density drops slowly with each order of magnitude size increase, up to a cutoff at large accumulations that limits the largest events experienced in current climate. The theory predicts that the cutoff scale, controlled by the interplay of moisture convergence variance and precipitation loss, tends to increase under global warming. Thus, precisely the large accumulations above the cutoff that are currently rare will exhibit increases in the warmer climate as this cutoff is extended. This indeed occurs in the full climate model, with a 3 °C end-of-century global-average warming yielding regional increases of hundreds of percent to >1,000% in the probability density of the largest accumulations that have historical precedents. The probabilities of unprecedented accumulations are also consistent with the extension of the cutoff.

Global warming precipitation accumulation increases above the current-climate cutoff scale

DOE PAGES

Neelin, J. David; Sahany, Sandeep; Stechmann, Samuel N.; ...

2017-01-23

Precipitation accumulations, integrated over rainfall events, can be affected by both intensity and duration of the storm event. Thus, although precipitation intensity is widely projected to increase under global warming, a clear framework for predicting accumulation changes has been lacking, despite the importance of accumulations for societal impacts. Theory for changes in the probability density function (pdf) of precipitation accumulations is presented with an evaluation of these changes in global climate model simulations. We show that a simple set of conditions implies roughly exponential increases in the frequency of the very largest accumulations above a physical cutoff scale, increasing withmore » event size. The pdf exhibits an approximately power-law range where probability density drops slowly with each order of magnitude size increase, up to a cutoff at large accumulations that limits the largest events experienced in current climate. The theory predicts that the cutoff scale, controlled by the interplay of moisture convergence variance and precipitation loss, tends to increase under global warming. Thus, precisely the large accumulations above the cutoff that are currently rare will exhibit increases in the warmer climate as this cutoff is extended. This indeed occurs in the full climate model, with a 3 °C end-of-century global-average warming yielding regional increases of hundreds of percent to >1,000% in the probability density of the largest accumulations that have historical precedents. The probabilities of unprecedented accumulations are also consistent with the extension of the cutoff.« less

Prediction of infarct severity from triiodothyronine levels in patients with ST-elevation myocardial infarction

PubMed Central

Kim, Dong Hun; Kim, Hyun-Wook; Choi, Seo-Won; Kim, Bo-Bae; Chung, Joong-Wha; Koh, Young-Youp; Chang, Kyong-Sig; Hong, Soon-Pyo

2014-01-01

Background/Aims The aim of the present study was to evaluate the relationship between thyroid hormone levels and infarct severity in patients with ST-elevation myocardial infarction (STEMI). Methods We retrospectively reviewed thyroid hormone levels, infarct severity, and the extent of transmurality in 40 STEMI patients evaluated via contrast-enhanced cardiac magnetic resonance imaging. Results The high triiodothyronine (T3) group (≥ 68.3 ng/dL) exhibited a significantly higher extent of transmural involvement (late transmural enhancement > 75% after administration of gadolinium contrast agent) than did the low T3 group (60% vs. 15%; p = 0.003). However, no significant difference was evident between the high- and low-thyroid-stimulating hormone/free thyroxine (FT4) groups. When the T3 cutoff level was set to 68.3 ng/dL using a receiver operating characteristic curve, the sensitivity was 80% and the specificity 68% in terms of differentiating between those with and without transmural involvement. Upon logistic regression analysis, high T3 level was an independent predictor of transmural involvement after adjustment for the presence of diabetes mellitus (DM) and the use of glycoprotein IIb/IIIa inhibitors (odds ratio, 40.62; 95% confidence interval, 3.29 to 502; p = 0.004). Conclusions The T3 level predicted transmural involvement that was independent of glycoprotein IIb/IIIa inhibitor use and DM positivity. PMID:25045293

A method for identifying color vision deficiency malingering.

PubMed

Pouw, Andrew; Karanjia, Rustum; Sadun, Alfredo

2017-03-01

To propose a new test to identify color vision deficiency malingering. An online survey was distributed to 130 truly color vision deficient participants and 160 participants willing to simulate color vision deficiency. The survey contained three sets of six color-adjusted versions of the standard Ishihara color plates each, as well as one set of six control plates. The plates that best discriminated both participant groups were selected for a "balanced" test emphasizing both sensitivity and specificity. A "specific" test that prioritized high specificity was also created by selecting from these plates. Statistical measures of the test (sensitivity, specificity, and Youden index) were assessed at each possible cut-off threshold, and a receiver operating characteristic (ROC) function with its area under the curve (AUC) charted. The redshift plate set was identified as having the highest difference of means between groups (-58%, CI: -64 to -52%), as well as the widest gap between group modes. Statistical measures of the "balanced" test show an optimal cut-off of at least two incorrectly identified plates to suggest malingering (Youden index: 0.773, sensitivity: 83.3%, specificity: 94.0%, AUC of ROC 0.918). The "specific" test was able to identify color vision deficiency simulators with a specificity of 100% when using a cut-off of at least two incorrectly identified plates (Youden index 0.599, sensitivity 59.9%, specificity 100%, AUC of ROC 0.881). Our proposed test for identifying color vision deficiency malingering demonstrates a high degree of reliability with AUCs of 0.918 and 0.881 for the "balanced" and "specific" tests, respectively. A cut-off threshold of at least two missed plates on the "specific" test was able to identify color vision deficiency simulators with 100% specificity.

Extending the Fellegi-Sunter probabilistic record linkage method for approximate field comparators.

PubMed

DuVall, Scott L; Kerber, Richard A; Thomas, Alun

2010-02-01

Probabilistic record linkage is a method commonly used to determine whether demographic records refer to the same person. The Fellegi-Sunter method is a probabilistic approach that uses field weights based on log likelihood ratios to determine record similarity. This paper introduces an extension of the Fellegi-Sunter method that incorporates approximate field comparators in the calculation of field weights. The data warehouse of a large academic medical center was used as a case study. The approximate comparator extension was compared with the Fellegi-Sunter method in its ability to find duplicate records previously identified in the data warehouse using different demographic fields and matching cutoffs. The approximate comparator extension misclassified 25% fewer pairs and had a larger Welch's T statistic than the Fellegi-Sunter method for all field sets and matching cutoffs. The accuracy gain provided by the approximate comparator extension grew as less information was provided and as the matching cutoff increased. Given the ubiquity of linkage in both clinical and research settings, the incremental improvement of the extension has the potential to make a considerable impact.

Quantitative measurements of tumoral p95HER2 protein expression in metastatic breast cancer patients treated with trastuzumab: independent validation of the p95HER2 clinical cutoff.

PubMed

Duchnowska, Renata; Sperinde, Jeff; Chenna, Ahmed; Haddad, Mojgan; Paquet, Agnes; Lie, Yolanda; Weidler, Jodi M; Huang, Weidong; Winslow, John; Jankowski, Tomasz; Czartoryska-Arłukowicz, Bogumiła; Wysocki, Piotr J; Foszczyńska-Kłoda, Małgorzata; Radecka, Barbara; Litwiniuk, Maria M; Zok, Jolanta; Wiśniewski, Michał; Zuziak, Dorota; Biernat, Wojciech; Jassem, Jacek

2014-05-15

P95HER2 (p95) is a truncated form of the HER2, which lacks the trastuzumab-binding site and contains a hyperactive kinase domain. Previously, an optimal clinical cutoff of p95 expression for progression-free survival (PFS) and overall survival (OS) was defined using a quantitative VeraTag assay (Monogram Biosciences) in a training set of trastuzumab-treated metastatic breast cancer (MBC) patients. In the current study, the predictive value of the p95 VeraTag assay cutoff established in the training set was retrospectively validated for PFS and OS in an independent series of 240 trastuzumab-treated MBC patients from multiple institutions. In the subset of 190 tumors assessed as HER2-total (H2T)-positive using the quantitative HERmark assay (Monogram Biosciences), p95 VeraTag values above the predefined cutoff correlated with shorter PFS (HR = 1.43; P = 0.039) and shorter OS (HR = 1.94; P = 0.0055) where both outcomes were stratified by hormone receptor status and tumor grade. High p95 expression correlated with shorter PFS (HR = 2.41; P = 0.0003) and OS (HR = 2.57; P = 0.0025) in the hormone receptor-positive subgroup of patients (N = 78), but not in the hormone receptor-negative group. In contrast with the quantitative p95 VeraTag measurements, p95 immunohistochemical expression using the same antibody was not significantly correlated with outcomes. The consistency in the p95 VeraTag cutoff across different cohorts of patients with MBC treated with trastuzumab justifies additional studies using blinded analyses in larger series of patients. ©2014 American Association for Cancer Research.

Identification of hazardous drinking with the Young Adult Alcohol Consequences Questionnaire: Relative operating characteristics as a function of gender.

PubMed

Read, Jennifer P; Haas, Amie L; Radomski, Sharon; Wickham, Robert E; Borish, Sarah E

2016-10-01

Heavy and problematic drinking is common on college campuses and is associated with myriad hazardous outcomes. The Young Adult Alcohol Consequences Questionnaire (YAACQ; Read et al., 2006) was developed to provide comprehensive and expedient assessment of negative consequences of young adult drinking and has been used in a number of research and clinical settings. To date, no empirically derived cutoffs for the YAACQ have been available for use in the identification of those drinkers at greatest risk. This was the objective of the present study. In a large (N = 1,311) and demographically heterogeneous multisite sample, we identified cutoff scores for the YAACQ, and the contrasted detection of hazardous drinking using these cutoffs with those recommended for the Alcohol Use Disorders Identification Test (AUDIT). We also examined whether cutoffs differed by gender. Results of receiver operating characteristic (ROC) analysis yielded cutoffs that delineate 3 levels (or zones) of hazardous drinking risk: low, moderate, and high. A cutoff of 8 differentiated those at low risk from those at moderate risk or greater, and a cutoff of 16 differentiated between moderate and high risk. These zones corresponded to other indices of risky drinking, including heavy episodic "binge" drinking, more frequent alcohol consumption, and engagement in alcohol risk behaviors. Scores differentiating low to moderate risk differed for men (8) and women (10), whereas the cutoff for high risk was the same (16) across the sexes. Findings suggest that the YAACQ can be used to reliably assess level of drinking risk among college students. Furthermore, these cut scores may be used to refer to interventions varying in intensity level, based on level of indicated alcohol risk. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Use of the Azimuth Wavelength Cut-Off to Retrieve the Sea Surface Wind Speed from Sentinel 1 and COSMO-SkyMed SAR Data

NASA Astrophysics Data System (ADS)

Grieco, G.; Nirchio, F.; Montuori, A.; Migliaccio, M.; Lin, W.; Portabella, M.

2016-08-01

The dependency of the azimuth wavelength cut-off on the wind speed has been studied through a dataset of Sentinel-1 multi look SAR images co-located with wind speed measurements, significant wave height and mean wave direction from ECMWF operational output.A Geophysical Model Function (GMF) has been fitted and a retrieval exercise has been done comparing the results to a set of independent wind speed scatterometer measurements of the Chinese mission HY-2A. The preliminary results show that the dependency of the azimuth cut-off on the wind speed is linear only for fully developed sea states and that the agreement between the retrieved values and the measurements is good especially for high wind speed.A similar approach has been used to assess the dependency of the azimuth cut-off also for X-band COSMO-SkyMed data. The dataset is still incomplete but the preliminary results show a similar trend.

Predictive Accuracy of Calf Circumference Measurements to Detect Decreased Skeletal Muscle Mass and European Society for Clinical Nutrition and Metabolism-Defined Malnutrition in Hospitalized Older Patients.

PubMed

Maeda, Keisuke; Koga, Takayuki; Nasu, Tomomi; Takaki, Miki; Akagi, Junji

2017-01-01

The ability to readily diagnose sarcopenia and malnutrition in a clinical setting is essential. This study is aimed at clarifying the calf circumference (CC) cut-off values for decreased skeletal muscle mass (SMM), according to the Asian Work Group for Sarcopenia's criteria definition of sarcopenia, and those for European Society for Clinical Nutrition and Metabolism-defined malnutrition, in hospitalized Japanese patients. The study involved 1,164 patients aged ≥65 years. Predictive CC cut-off values were determined using receiver operating curve (ROC) analyses. The predictive validity of the cut-off values was confirmed against in-hospital mortality. There were 654 females and 510 males (mean age, 83.5 ± 8.2 years). Decreased SMM and malnutrition were observed in 80.4 and 32.8% of all patients, respectively. ROC analyses identified CCs of ≤29 cm (female, area under the curve [AUC] 0.791) and ≤30 cm (male, AUC 0.832) as cut-off values for decreased SMM, and CCs of ≤26 cm (female, AUC 0.798) and ≤28 cm (male, AUC 0.837) for malnutrition. CC cut-off values for SMM and malnutrition were independently correlated with in-hospital mortality. The study determined appropriate cut-off values for CC to identify decreased SMM and malnutrition according to the relevant guidelines. © 2017 S. Karger AG, Basel.

Wallops Low Elevation Link Analysis for the Constellation Launch/Ascent Links

NASA Technical Reports Server (NTRS)

Cheung, Keith; Ho, C.; Kantak, A.; Lee, C.; Tye, R.; Richards, E.; Sham, C.; Schlesinger, A.; Barritt, B.

2011-01-01

To execute the President's Vision for Space Exploration, the Constellation Program (CxP) was formed to build the next generation spacecraft Orion and launch vehicles Ares, to transport human and cargo to International Space Station (ISS), moon, and Mars. This paper focuses on the detailed link analysis for Orion/Ares s launch and ascent links with Wallops 11.3m antenna (1) Orion's Dissimilar Voice link: 10.24 Kbps, 2-way (2) Ares Developmental Flight Instrument link, 20 Mbps, downlink. Three launch trajectories are considered: TD7-E, F (Feb), and G (Aug). In certain launch scenarios, the critical events of main engine cutoff (MECO) and Separation occur during the low elevation regime of WFF s downrange -- less than 5 degree elevation angle. The goal of the study is to access if there is enough link margins for WFF to track the DV and DFI links.

Comparison of midupper arm circumference and weight-for-height z score for assessing acute malnutrition in Bangladeshi children aged 6-60 mo: an analytical study.

PubMed

Hossain, Md Iqbal; Ahmed, Tahmeed; Arifeen, Shams El; Billah, Sk Masum; Faruque, Asg; Islam, M Munirul; Jackson, Alan A

2017-11-01

Background : In clinical settings, wasting in childhood has primarily been assessed with the use of a weight-for-height z score (WHZ), and in community settings, it has been assessed via the midupper arm circumference (MUAC) with a cutoff <115 mm for severe wasting and <115-125 mm for moderate wasting. Our recent experience indicates that many wasted children were not identified when these cutoffs for MUAC were used. Objective: We determined the cutoffs for MUAC to detect wasting in Bangladeshi children aged 6-60 mo. Design: A secondary analysis was carried out on data from 27,767 children aged 6-59 mo. This analysis comprised 1 ) 9131 children across Bangladesh and 2 ) 18,636 children enrolled in a surveillance study in the Dhaka Hospital of icddr,b during 1996-2014. The area under the receiver operating curve was used to indicate the most appropriate choice for cutoffs that related MUAC with WHZ. Results: The mean ± SD age for the entire group was 21 ± 14 mo, WHZ was -1.18 ± 1.23, height-for-age z score was -1.63 ± 1.39, MUAC was 136 ± 14 mm, and 45% of subjects were girls. MUAC correlated with the WHZ ( r : 0.618, P < 0.001). Age-stratified analyses revealed that, for ages 6-24 mo, MUAC cutoffs were <120 mm for a WHZ <-3 and <125 mm for a WHZ <-2 with a sensitivity of 72.9% and 63.2%, respectively, and a specificity of 84.7% and 85.3%, respectively; for ages 25-36 mo, MUAC cutoffs were <125 mm for a WHZ <-3 and <135 mm for a WHZ <-2 with a sensitivity of 55.0% and 71.7%, respectively, and a specificity of 92.8% and 78.7% respectively; and for ages 37-60 mo, MUAC cutoffs were <135 mm for a WHZ <-3 and <140 mm for a WHZ <-2 with a sensitivity of 71.4% and 70.4%, respectively, and a specificity of 84.6% and 80.3%, respectively. Conclusion: The respective cutoffs for MUAC to better capture the vulnerability and risk of severe (WHZ <-3) and moderate (WHZ <-2) wasting would be <120 and <125 mm for ages 6-24 mo, <125 and <135 mm for ages 25-36 mo, and <135 and <140 mm for ages 37-60 mo. © 2017 American Society for Nutrition.

Elevated S100A8 protein expression in breast cancer cells and breast tumor stroma is prognostic of poor disease outcome.

PubMed

Miller, P; Kidwell, K M; Thomas, D; Sabel, M; Rae, J M; Hayes, D F; Hudson, B I; El-Ashry, D; Lippman, M E

2017-11-01

Elevated S100A8 expression has been observed in cancers of the bladder, esophagus, colon, ovary, and breast. S100A8 is expressed by breast cancer cells as well as by infiltrating immune and myeloid cells. Here we investigate the association of elevated S100A8 protein expression in breast cancer cells and in breast tumor stroma with survival outcomes in a cohort of breast cancer patients. Tissue microarrays (TMA) were constructed from breast cancer specimens from 417 patients with stage I-III breast cancer treated at the University of Michigan Comprehensive Cancer Center between 2004 and 2006. Representative regions of non-necrotic tumor and distant normal tissue from each patient were used to construct the TMA. Automated quantitative immunofluorescence (AQUA) was used to measure S100A8 protein expression, and samples were scored for breast cancer cell and stromal S100A8 expression. S100A8 staining intensity was assessed as a continuous value and by exploratory dichotomous cutoffs. Associations between breast cancer cell and stromal S100A8 expression with disease-free survival and overall survival were determined using the Kaplan-Meier method and Cox proportional hazard models. High breast cancer cell S100A8 protein expression (as indicated by AQUA scores), as a continuous measure, was a significant prognostic factor for OS [univariable hazard ratio (HR) 1.24, 95% confidence interval (CI) 1.00-1.55, p = 0.05] in this patient cohort. Exploratory analyses identified optimal S100A8 AQUA score cutoffs within the breast cancer cell and stromal compartments that significantly separated survival curves for the complete cohort. Elevated breast cancer cell and stromal S100A8 expression, indicated by higher S100A8 AQUA scores, significantly associates with poorer breast cancer outcomes, regardless of estrogen receptor status. Elevated breast cancer cell and stromal S1008 protein expression are significant indicators of poorer outcomes in early stage breast cancer patients. Evaluation of S100A8 protein expression may provide additional prognostic information beyond traditional breast cancer prognostic biomarkers.

C-reactive protein is differentially modulated by co-existing infections, vitamin deficiencies and maternal factors in pregnant and lactating indigenous Panamanian women.

PubMed

González-Fernández, Doris; Pons, Emérita Del Carmen; Rueda, Delfina; Sinisterra, Odalis Teresa; Murillo, Enrique; Scott, Marilyn E; Koski, Kristine G

2017-06-02

The usefulness of C-reactive protein (CRP) as a non-specific marker of inflammation during pregnancy and lactation is unclear in impoverished populations where co-existing infections and vitamin deficiencies are common. This cross-sectional study in Panama recruited 120 pregnant and 99 lactating Ngäbe-Buglé women from 14 communities in rural Panama. Obstetric history, indoor wood smoke exposure, fieldwork, BMI, vitamins A, B 12 , D, and folic acid, and inflammation markers (CRP, neutrophil/lymphocyte ratio (NLR), plateletcrit and cytokines) were measured. Multiple regressions explored both associations of CRP with other inflammatory markers and associations of CRP and elevated CRP based on trimester-specific cut-offs with maternal factors, infections and vitamin deficiencies. CRP was higher in pregnancy (51.4 ± 4.7 nmol/L) than lactation (27.8 ± 3.5 nmol/L) and was elevated above trimester specific cut-offs in 21% of pregnant and 30% of lactating women. Vitamin deficiencies were common (vitamin A 29.6%; vitamin D 68.5%; vitamin B 12 68%; folic acid 25.5%) and over 50% of women had two or more concurrent deficiencies as well as multiple infections. Multiple regression models highlighted differences in variables associated with CRP between pregnancy and lactation. In pregnancy, CRP was positively associated with greater indoor wood smoke exposure, caries and hookworm and negatively associated with Ascaris and vaginal Lactobacillus and Bacteroides/Gardnerella scores. Consistent with this, greater wood smoke exposure, caries as well as higher diplococcal infection score increased the odds of trimester-elevated CRP concentrations whereas longer gestational age lowered the likelihood of a trimester-elevated CRP. During lactation, folic acid deficiency was associated with higher CRP whereas parity, number of eosinophils and Mobiluncus score were associated with lower CRP. Also, a higher BMI and Trichomonas vaginalis score increased the likelihood of an elevated CRP whereas higher parity and number of eosinophils were associated with lower likelihood of an elevated CRP. Infections both raise and lower CRP concentrations in pregnant and lactating mothers. Only folic acid deficiency during lactation was associated with higher CRP concentrations. Caution is required when interpreting CRP concentrations in pregnant and lactating women who have co-existing nutrient deficiencies and multiple infections.

Prognostic role of platelet to lymphocyte ratio in non-small cell lung cancers: A meta-analysis including 3,720 patients.

PubMed

Zhao, Qing-Tao; Yuan, Zheng; Zhang, Hua; Zhang, Xiao-Peng; Wang, Hui-En; Wang, Zhi-Kang; Duan, Guo-Chen

2016-07-01

Platelet to lymphocyte ratio (PLR) was recently reported as a useful index in predicting the prognosis of lung cancer. However, the prognostic role of PLR in lung cancer remains controversial. The aim of this study was to evaluate the association between PLR and clinical outcome of lung cancer patients through a meta-analysis. Relevant literatures were retrieved from PubMed, Ovid, the Cochrane Library and Web of Science databases. Meta-analysis was performed using hazard ratio (HR) and 95% confidence intervals (CIs) as effect measures. A total of 5,314 patients from 13 studies were finally enrolled in the meta-analysis. The summary results showed that elevated PLR predicted poorer overall survival (OS) (HR: 1.526, 95%CI: 1.268-1.836, p < 0.001) in patients with lung cancer and OS (HR: 1.631, 95%CI: 1.447-1.837, p < 0.001) in patients with nonsmall cell lung cancer (NSCLC). Subgroup analysis revealed that increased PLR was also associated with poor OS in NSCLC treated by surgical resection (HR: 1.884, 95%CI: 1.308-2.714, P < 0.001) and non-surgery (HR: 1.570, 95%CI: 1.323-1.863, P < 0.001). In addition, PLR Cut-off value ≤ 160 (HR: 1.506, 95%CI: 1.292-1.756, P < 0.001) and PLR Cut-off value>160 (HR: 1.842, 95%CI: 1.523-2.228, P < 0.001). In contrast, elevated PLR was not associated with OS (HR: 1.117, 95%CI: 0.796-1.569, P > 0.05) in patients with small cell lung cancer (SCLC).This meta-analysis result suggested that elevated PLR might be a predicative factor of poor prognosis for NSCLC patients. © 2016 UICC.

National Dam Inspection Program. Lake Housatonic Dam and Dike (CT 00026 and CT 01714). Connecticut Coastal Basin, Housatonic River, Derby-Shelton, Connecticut. Phase I Inspection Report.

DTIC Science & Technology

1981-08-01

elevation 47.5) is 394,000 cfs. , "C. Elevations (feet above NGVD) (1) Streambed at toe of dam (approximate) 0.0 (2) Botton of cutoff Unknown (3) Maximum...diameter. Condition of Discharge Channel Canal appears to be silted in. Two parking lots have been constructed in the canal, but culverts were...Checked ~ ~ t Date ’ 4J~ aw a7W 4r Śewww APajd1 ~/v’* ccuot AM 4W r1.0W OWj M49AA a 44r0 OA, Te J~xOOr 0. SS40Wl llhwWl 4/ toS~ Al fA ~w~’~y’ XV0

Validation of the AUDIT-C in adults seeking help with their drinking online.

PubMed

Khadjesari, Zarnie; White, Ian R; McCambridge, Jim; Marston, Louise; Wallace, Paul; Godfrey, Christine; Murray, Elizabeth

2017-01-04

The abbreviated Alcohol Use Disorder Identification Test for Consumption (AUDIT-C) is rapidly becoming the alcohol screening tool of choice for busy practitioners in clinical settings and by researchers keen to limit assessment burden and reactivity. Cut-off scores for detecting drinking above recommended limits vary by population, setting, country and potentially format. This validation study aimed to determine AUDIT-C thresholds that indicated risky drinking among a population of people seeking help over the Internet. The data in this study were collected in the pilot phase of the Down Your Drink trial, which recruited people seeking help over the Internet and randomised them to a web-based intervention or an information-only website. Sensitivity, specificity, and positive and negative likelihood ratios were calculated for AUDIT-C scores, relative to weekly consumption that indicated drinking above limits and higher risk drinking. Receiver-operating characteristic (ROC) curves were created to assess the performance of different cut-off scores on the AUDIT-C for men and women. Past week alcohol consumption was used as the reference-standard and was collected via the TOT-AL, a validated online measure of past week drinking. AUDIT-C scores were obtained from 3720 adults (2053 female and 1667 male) searching the internet for help with drinking, mostly from the UK. The area under the ROC curve for risky drinking was 0.84 (95% CI 0.80, 0.87) (female) and 0.80 (95% CI 0.76, 0.84) (male). AUDIT-C cut-off scores for detecting risky drinking that maximise the sum of sensitivity and specificity were ≥8 for women and ≥8 for men; whereas those identifying the highest proportion of correctly classified individuals were ≥4 for women and ≥5 for men. AUDIT-C cut-off scores for detecting higher risk drinking were also calculated. AUDIT-C cut-off scores for identifying alcohol consumption above weekly limits in this largely UK based study population were substantially higher than those reported in other validation studies. Researchers and practitioners should select AUDIT-C cut-off scores according to the purpose of identifying risky drinkers and hence the relative importance of sensitivity and/or specificity.

Comparison of Circulating Endothelial Cell/Platelet Count Ratio to Aspartate Transaminase/Platelet Ratio Index for Identifying Patients with Cirrhosis

PubMed Central

Sethi, Saurabh; Simonetto, Douglas A; Abdelmoneim, Soha S; Campion, Michael B; Kaloiani, Irakli; Clayton, Amy C; Kremers, Walter K; Halling, Kevin C; Kamath, Patrick S; Talwalkar, Jayant; Shah, Vijay H

2012-01-01

Background/Objectives Circulating endothelial cells (CECs) are indicative of vascular injury and correlate with severity of vascular diseases. A pilot study showed that the ratio of CEC to platelet count (CEC/PC) was effective in predicting cirrhosis. Therefore, we evaluated CEC/PC in a larger cohort of patients, correlated it with cirrhosis, and compared its operating characteristics with previously described biomarker for cirrhosis, the AST/platelet ratio index (APRI). Methods Fifty-three patients with cirrhosis, 20 matched healthy controls, and 9 patients with noncirrhotic liver disease were recruited. Peripheral blood sample was collected and analyzed to enumerate nucleated CEC CD146+, CD105+, CD45– using a commercial assay. Results Median CEC counts were significantly higher in patients with cirrhosis (62 cells/4 mL, interquartile range [IQR]: 43.5–121) as compared with controls (31 cells/4 mL, IQR: 22.2–40). The CEC/PC was also significantly elevated in cirrhotics (0.69, IQR: 0.39–1.48) compared with controls (0.12, IQR: 0.09–0.20) and noncirrhotics (0.21, IQR: 0.08–0.43). Receiver operator characteristic (ROC) analysis revealed that CEC cutoff value of ≥37 cells/4 mL showed sensitivity of 81% and specificity of 75% for differentiating cirrhosis from controls (area under the curve [AUC]: 0.80; 95% confidence interval [CI] 0.67–0.91). The CEC/PC ratio cutoff value of ≥0.23 showed sensitivity of 91% and specificity of 82% (AUC: 0.92; 95% CI 0.83–0.99). The APRI cutoff value of ≥0.4 showed sensitivity of 94% and specificity of 85% for differentiating cirrhosis from control patients (AUC: 0.96; 95% CI 0.90–1.0). A product of CEC and APRI, termed CAPRI (CEC-APRI), effectively distinguished patients with cirrhosis from controls; with cutoff value of ≥12.7, showing higher sensitivity of 98% and specificity of 85% (AUC: 0.98; 95% CI 0.96–1.0). Conclusion The CEC/PC ratio is significantly elevated in patients with cirrhosis and demonstrates comparable operating characteristics to previously described APRI. Furthermore, CAPRI, compiled as product of CEC to APRI showed outstanding ability to distinguish patients with cirrhosis from controls, although larger studies are necessary for validation. PMID:25755402

CosmoCalc: An Excel add-in for cosmogenic nuclide calculations

NASA Astrophysics Data System (ADS)

Vermeesch, Pieter

2007-08-01

As dating methods using Terrestrial Cosmogenic Nuclides (TCN) become more popular, the need arises for a general-purpose and easy-to-use data reduction software. The CosmoCalc Excel add-in calculates TCN production rate scaling factors (using Lal, Stone, Dunai, and Desilets methods); topographic, snow, and self-shielding factors; and exposure ages, erosion rates, and burial ages and visualizes the results on banana-style plots. It uses an internally consistent TCN production equation that is based on the quadruple exponential approach of Granger and Smith (2000). CosmoCalc was designed to be as user-friendly as possible. Although the user interface is extremely simple, the program is also very flexible, and nearly all default parameter values can be changed. To facilitate the comparison of different scaling factors, a set of converter tools is provided, allowing the user to easily convert cut-off rigidities to magnetic inclinations, elevations to atmospheric depths, and so forth. Because it is important to use a consistent set of scaling factors for the sample measurements and the production rate calibration sites, CosmoCalc defines the production rates implicitly, as a function of the original TCN concentrations of the calibration site. The program is best suited for 10Be, 26Al, 3He, and 21Ne calculations, although basic functionality for 36Cl and 14C is also provided. CosmoCalc can be downloaded along with a set of test data from http://cosmocalc.googlepages.com.

Screening of depression in cardiology: A study on 617 cardiovascular patients.

PubMed

Tesio, Valentina; Marra, Sebastiano; Molinaro, Stefania; Torta, Riccardo; Gaita, Fiorenzo; Castelli, Lorys

2017-10-15

Depression screening in the cardiovascular disease (CVD) care setting is under-performed, also because the issue of the optimal screening tools cut-off is still open. We analysed which HADS (Hospital Anxiety and Depression Scale) total score cut-off value shows the best properties in two groups of 357 Acute Coronary Syndrome (ACS) and 260 Chronic Coronary Artery Disease (CAD) hospitalized patients. A Receiver Operating Characteristics (ROC) curve was plotted for both groups using the Montgomery-Asberg Depression Rating Scale (MADRS) as the criterion. Accuracy, positive (PPV) and negative (NPV) predictive values were computed for different cut-off scores. The ROC curves confirmed the excellent/very good accuracy of the HADS in both groups, with an area under the curve of 0.911 for the ACS and 0.893 for the CAD patients. The cut-off of 14 showed the best compromise between high sensitivity and good specificity in both groups, with high negative predicted values (95.5% and 92.4%, respectively). Using a cut-off value of 14, the HADS could be considered a good screening tool to identify hospitalized CAD and ACS patients requiring a more accurate depression assessment, in order to promptly plan the most appropriate treatment strategies and prevent the negative effects of depression in CVD patients. Copyright © 2017 Elsevier B.V. All rights reserved.

Estimating the change in asymptotic direction due to secular changes in the geomagnetic field

NASA Technical Reports Server (NTRS)

Flueckiger, E. O.; Smart, D. F.; Shea, M. A.; Gentile, L. C.; Bathurat, A. A.

1985-01-01

The concept of geomagnetic optics, as described by the asymptotic directions of approach, is extremely useful in the analysis of cosmic radiation data. However, when changes in cutoff occur as a result of evolution in the geomagnetic field, there are corresponding changes in the asymptotic cones of acceptance. A method is introduced of estimating the change in the asymptotic direction of approach for vertically incident cosmic ray particles from a reference set of directions at a specific epoch by considering the change in the geomagnetic cutoff.

Changes In the Pickup Ion Cutoff Under Variable Solar Wind Conditions

NASA Astrophysics Data System (ADS)

Bower, J.; Moebius, E.; Taut, A.; Berger, L.; Drews, C.; Lee, M. A.; Farrugia, C. J.

2017-12-01

We present the first systematic analysis to determine pickup ion (PUI) cutoff speed variations,both during compression regions, identified by their structure, and during times of highly variablesolar wind (SW) speed or magnetic field strength. This study is motivated by the attempt toremove or correct these effects on the determination of the longitude of the interstellar neutralgas flow from the flow pattern related variation of the PUI cutoff with ecliptic longitude. At thesame time, this study sheds light on the physical mechanisms that lead to energy transferbetween the SW and the embedded PUI population. Using 2007-2014 STEREO A PLASTICobservations we identify compression regions in the solar wind and analyze the PUI velocitydistribution function (VDF). We developed a routine to identify stream interaction regions andCIRs, by identifying the stream interface and the successive velocity increase in the solar windspeed and density. Characterizing these individual compression events and combining them in asuperposed epoch analysis allows us to analyze the PUI population in similar conditions andfind the local cutoff shift with adequate statistics. The result of this method yields cutoff shifts forcompression regions with large solar wind speed gradients. Additionally, through sorting theentire set of PUI VDFs at high time resolution we obtain a noticeable correlation of the cutoffshift with gradients in the SW speed and interplanetary magnetic field strength. We willdiscuss implications for the understanding of the PUI VDF evolution and the PUI cutoff analysisof the interstellar gas flow.

Experimental Characterization of Soot Formation in Diffusion Flames and Explosive Fireballs

DTIC Science & Technology

2012-04-01

49 Figure 48. A side view of the elevated pressure-opposed flow rig on the test stand. The IR cutoff filter is shown in front of the...turbulent flows of mixed gasses in excited states. To perform this measurement, we have built and characterized a sensitive, selective infrared ( IR ...tool for TDLAS (Kosterev and Tittel, 2002). The QCL operates near room temperature and provides a powerful (~10 mW), stable, single-mode, mid- IR

Multi-GNSS real-time precise orbit/clock/UPD products and precise positioning service at GFZ

NASA Astrophysics Data System (ADS)

Li, Xingxing; Ge, Maorong; Liu, Yang; Fritsche, Mathias; Wickert, Jens; Schuh, Harald

2016-04-01

The rapid development of multi-constellation GNSSs (Global Navigation Satellite Systems, e.g., BeiDou, Galileo, GLONASS, GPS) and the IGS (International GNSS Service) Multi-GNSS Experiment (MGEX) bring great opportunities and challenges for real-time precise positioning service. In this contribution, we present a GPS+GLONASS+BeiDou+Galileo four-system model to fully exploit the observations of all these four navigation satellite systems for real-time precise orbit determination, clock estimation and positioning. A rigorous multi-GNSS analysis is performed to achieve the best possible consistency by processing the observations from different GNSS together in one common parameter estimation procedure. Meanwhile, an efficient multi-GNSS real-time precise positioning service system is designed and demonstrated by using the Multi-GNSS Experiment (MGEX) and International GNSS Service (IGS) data streams including stations all over the world. The addition of the BeiDou, Galileo and GLONASS systems to the standard GPS-only processing, reduces the convergence time almost by 70%, while the positioning accuracy is improved by about 25%. Some outliers in the GPS-only solutions vanish when multi-GNSS observations are processed simultaneous. The availability and reliability of GPS precise positioning decrease dramatically as the elevation cutoff increases. However, the accuracy of multi-GNSS precise point positioning (PPP) is hardly decreased and few centimeters are still achievable in the horizontal components even with 40° elevation cutoff.

Maternal Serum and Amniotic Fluid Inhibin A Levels in Women who Subsequently Develop Severe Preeclampsia

PubMed Central

Kim, Shin-Young; Yang, Jae-Hyug; Kim, Moon-Young; Ahn, Hyun-Kyong; Shin, Joong-Sik; Choi, Jun-Seek; Park, So-Yeon; Kim, Jin-Mi; Lee, Bom-Yi; Kim, Do-Jin

2006-01-01

The purpose of this study was to evaluate whether maternal serum (MS) and amniotic fluid (AF) inhibin A levels are elevated in patients who subsequently develop severe preecalmpsia, and to investigate the correlation between MS and AF inhibin A levels in the second trimester. The study included 40 patients who subsequently developed severe preecalmpsia and 80 normal pregnant women. Inhibin A levels in MS and AF were measured with enzyme-linked immunosorbent assay (ELISA). The MS and AF inhibin A levels in patients who developed severe preeclampsia were significantly higher than those in the control group (both for p<0.001). There was a positive correlation between MS and AF inhibin A levels in patients who developed severe preeclampsia (r=0.397, p=0.011), but not in the control group (r=0.185, p=0.126). The best cutoff values of MS and AF inhibin A levels for the prediction of severe preeclampsia were 427 pg/mL and 599 pg/mL, respectively; the estimated ORs that were associated with these cut-off values were 9.95 (95% CI 3.8-25.9, p<0.001) and 6.0 (95% CI 2.3-15.8, p<0.001). An elevated level of inhibin A in MS and AF at the time of second trimester amniocentesis may be a risk factor for the subsequent development of severe preeclampsia. PMID:16778388

Resting and post-exercise serum biomarkers of cardiac and skeletal muscle damage in adolescent runners.

PubMed

Nie, J; Tong, T K; George, K; Fu, F H; Lin, H; Shi, Q

2011-10-01

This study examined the response of serum biomarkers of cardiac and skeletal muscle damage at rest and after a routine workout of 21 km run in 12 male adolescent (16.2±0.6 years) long-distance runners. Biomarkers of cardiac [troponins (cTnT, cTnI), creatine kinase MB mass (CK-Mbmass)] and skeletal muscle [creatine kinase (CK), lactate dehydrogenase (LDH), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and hydroxybutyrate dehydrogenase (HBD)] damage were assayed at rest, 2, 4 and 24 h post-exercise. At rest, cTnT and cTnI were not detectable; however, CK, CK-MBmass, AST, ALT and HBD were above corresponding clinical cut-off values. Post-exercise significant elevations above rest were observed for all biomarkers, except ALT, 2 and 4 h following the run, and remained elevated in cTnI, CK, CK-MBmass, LDH and AST 24 h post-workout. A significant increase in data points above clinical cut-off values from rest to post-exercise was reported for cTnT, cTnI and CK at 2 and 4 h, and in cTnI and CK 24 h post-exercise. In conclusion, a 21 km run in adolescent runners increased post-exercise biomarkers of cardiac and skeletal muscle damage. © 2010 John Wiley & Sons A/S.

CXCL13 as a Cerebrospinal Fluid Marker for Neurosyphilis in HIV-infected Patients with Syphilis

PubMed Central

Marra, Christina M.; Tantalo, Lauren C.; Sahi, Sharon K.; Maxwell, Clare L.; Lukehart, Sheila A.

2010-01-01

Background Asymptomatic neurosyphilis is more difficult to diagnose in HIV-infected patients because HIV itself can cause cerebrospinal fluid (CSF) pleocytosis. The proportion of CSF lymphocytes that are B cells is elevated in neurosyphilis, suggesting that the CSF concentration of the B cell chemoattractant, chemokine (C-X-C motif) ligand 13 (CXCL13) concentration may also be elevated. Methods CSF and blood were collected from 199 HIV-infected patients with syphilis and neurosyphilis. Serum and CSF CXCL13 concentrations were determined. Results Patients with neurosyphilis had higher CSF and serum CXCL13 concentrations compared to patients with syphilis but not neurosyphilis. The odds of having symptomatic neurosyphilis were increased by 2.23 fold for every log increase in CSF CXCL13 concentration and were independent of CSF WBC and plasma HIV RNA concentrations, peripheral blood CD4+ T cell count and use of antiretroviral medications. A cut-off of 10 pg/mL CSF CXCL13 had high sensitivity and a cut-off of 250 pg/mL or evidence of intrathecal synthesis of CXCL13 had high specificity for diagnosis of both symptomatic and asymptomatic neurosyphilis. CSF concentrations of CXCL13 declined after treatment for neurosyphilis. Conclusions CSF CXCL13 concentration may be particularly useful for diagnosis of neurosyphilis in HIV-infected patients because it is independent of CSF pleocytosis and markers of HIV disease. PMID:20393380

A Comparison of Standard-Setting Procedures for an OSCE in Undergraduate Medical Education.

ERIC Educational Resources Information Center

Kaufman, David M.; Mann, Karen V.; Muijtjens, Arno M. M.; van der Vleuten, Cees P. M.

2000-01-01

Compared four standard-setting procedures for an objective structure clinical examination (OSCE) in medical education. Applied Angoff, borderline, relative, and holistic procedures to the data used to establish a cutoff score for a pass/fail decision. The Angoff and borderline procedures gave similar results; however, the relative and holistic…

Concordance of the late night salivary cortisol in patients with Cushing's syndrome and elevated urine-free cortisol.

PubMed

Doi, Suhail A R; Clark, Justin; Russell, Anthony W

2013-04-01

The concordance of the late night salivary cortisol (LNSC) results with the 24-h urine-free cortisol (UFC) results in the biochemical screening for Cushing's syndrome is unknown. We investigated this in a population of Cushing's syndrome subjects. We used meta-analytic methods to pool proportions of LNSC-positive subjects from diagnostic evaluations of Cushing's syndrome subjects where both tests were performed and the UFC was elevated (any level). Cushing's syndrome was confirmed in all subjects by two out of three conventional tests. LNSC was collected between 22:00 to 24:00 h and measured around the same time period as the UFC. Minimum cutoffs of ≥4 and ≥10 nmol/L were used to determine concordance with the UFC and studies were limited to those that used radioimmunoassays or electrochemiluminiscence immunoassays for LNSC. The concordance of LNSC ≥4 nmol/L was 97 % (95 % CI 95-99 %) and studies were homogeneous. With LNSC ≥10 nmol/L, there was heterogeneity and two groups were discernible with a pooled concordance of 69 % (95 % CI 60-77 %) and 95 % (95 % CI 92-97 %). Within these sub-groups, studies were homogeneous and there was no difference between them in collection methods, assays used, geographic location, year of publication, or the quality of the underlying studies. The LNSC at a very specific cutoff detects at best 95 % of cases and at worst 69 % of cases of Cushing's syndrome that are UFC positive. The two tests become equivalent at the more sensitive cutoff (>4 nmol/L). We conclude that, given its many benefits and the currently documented equivalence to the UFC, the LNSC should replace the conventional 24-h UFC as the frontline test when screening for Cushing's syndrome.

Anti-Cyclic Citrullinated Peptide Assays Differ in Subjects at Elevated Risk for Rheumatoid Arthritis and Subjects with Established Disease

PubMed Central

Demoruelle, M. Kristen; Parish, Mark C.; Derber, Lezlie A.; Kolfenbach, Jason R.; Hughes-Austin, Jan M.; Weisman, Michael H.; Gilliland, William; Edison, Jess D.; Buckner, Jane H.; Mikuls, Ted R.; O’Dell, James R.; Keating, Richard M.; Gregersen, Peter K.; Norris, Jill M.; Holers, V. Michael; Deane, Kevin D.

2013-01-01

Objective To compare commonly-available tests for antibodies to citrullinated protein antigens (ACPAs) for diagnostic accuracy and assay agreement in established rheumatoid arthritis (RA) and subjects at elevated risk for RA. Methods ELISA testing for anti-cyclic citrullinated peptide (anti-CCP) antibodies was performed using CCP2 (Axis-Shield) and CCP3.1 (IgA/IgG INOVA) in the following subjects: 1) probands with established RA (N=340) from the Studies of the Etiology of RA (SERA), 2) first degree relatives (FDRs) without RA (family members of SERA RA probands; N=681), 3) Department of Defense Serum Repository (DoDSR) RA cases with pre-diagnosis samples (N=83; 47/83 also had post-diagnosis samples), and 4) blood-donor and DoDSR controls (N=283). Results In established RA, CCP2 was more specific (99.2% vs. 93.1%, p<0.01), but less sensitive (58.7% vs. 67.4%, p=0.01) than CCP3.1, with specificity of CCP3.1 increasing to 97.2% if levels ≥3 times the standard cut-off level were considered. In all subjects, at standard cut-off levels, CCP3.1 positivity was more prevalent. In DoDSR cases, CCP2 was more specific than CCP3.1 for a future diagnosis of RA, and higher CCP levels trended towards greater specificity for disease onset within 2 years. At standard cut-off levels, assay agreement was good in established RA (kappa=0.76), but poor in FDRs without inflammatory arthritis (kappa=0.25). Conclusion Anti-CCP assays differ to an extent that may be meaningful in diagnosing RA in patients with inflammatory arthritis, and in evaluating the natural history of RA development in subjects at-risk for future RA. Mechanisms underlying these differences in test performance need further investigation. PMID:23686569

MiOXSYS: a novel method of measuring oxidation reduction potential in semen and seminal plasma.

PubMed

Agarwal, Ashok; Sharma, Rakesh; Roychoudhury, Shubhadeep; Du Plessis, Stefan; Sabanegh, Edmund

2016-09-01

To measure oxidative reduction potential (ORP) in semen and seminal plasma and to establish their reference levels. ORP levels were measured in semen and seminal plasma. Tertiary hospital. Twenty-six controls and 33 infertile men. None. Static ORP (sORP) and capacitance ORP (cORP) were measured in semen and seminal plasma at time 0 and 120 minutes. Correlation of ORP was assessed between [1] semen and seminal plasma and [2] time 0 and 120 minutes. The association with sperm parameters was studied in (a) controls and (b) infertile patients, and a receiver operating characteristic curve was generated to establish the sORP cutoff. Semen sORP and cORP levels were associated with seminal plasma levels at time 0 and time 120 minutes. In controls and infertile patients, an inverse relationship of sORP levels was established with concentration and total sperm count in semen as well as seminal plasma at time 0 and 120 minutes. Classification of subjects based on sperm motility showed that subjects with abnormal motility present with poor concentration, total count, morphology, and elevated levels of semen and seminal plasma sORP at time 120 minutes. The sORP cutoff of 1.48 in semen and 2.09 in seminal plasma based on motility was able to distinguish subjects with normal semen quality from those with abnormal semen quality. The MiOXSYS System can reliably measure ORP levels in semen and seminal plasma. ORP levels are not affected by semen age, making this new technology easy to employ in a clinical setting. Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Predictive Value of IL-8 for Sepsis and Severe Infections after Burn Injury - A Clinical Study

PubMed Central

Kraft, Robert; Herndon, David N; Finnerty, Celeste C; Cox, Robert A; Song, Juquan; Jeschke, Marc G

2014-01-01

The inflammatory response induced by burn injury contributes to increased incidence of infections, sepsis, organ failure, and mortality. Thus, monitoring post-burn inflammation is of paramount importance but so far there are no reliable biomarkers available to monitor and/or predict infectious complications after burn. As IL-8 is a major mediator for inflammatory responses, the aim of our study was to determine whether IL-8 expression can be used to predict post-burn sepsis, infections, and mortality other outcomes post-burn. Plasma cytokines, acute phase proteins, constitutive proteins, and hormones were analyzed during the first 60 days post injury from 468 pediatric burn patients. Demographics and clinical outcome variables (length of stay, infection, sepsis, multiorgan failure (MOF), and mortality were recorded. A cut-off level for IL-8 was determined using receiver operating characteristic (ROC) analysis. Statistical significance is set at (p<0.05). ROC analysis identified a cut-off level of 234 pg/ml for IL-8 for survival. Patients were grouped according to their average IL-8 levels relative to this cut off and stratified into high (H) (n=133) and low (L) (n=335) groups. In the L group, regression analysis revealed a significant predictive value of IL-8 to percent of total body surface area (TBSA) burned and incidence of MOF (p<0.001). In the H group IL-8 levels were able to predict sepsis (p<0.002). In the H group, elevated IL-8 was associated with increased inflammatory and acute phase responses compared to the L group (p<0.05). High levels of IL-8 correlated with increased MOF, sepsis, and mortality. These data suggest that serum levels of IL-8 may be a valid biomarker for monitoring sepsis, infections, and mortality in burn patients. PMID:25514427

Prediction of clinical infection in women with preterm labour with intact membranes: a score based on ultrasonographic, clinical and biological markers.

PubMed

Kayem, Gilles; Maillard, Françoise; Schmitz, Thomas; Jarreau, Pierre H; Cabrol, Dominique; Breart, Gérard; Goffinet, François

2009-07-01

To predict maternal and neonatal clinical infection at admission in women hospitalized for preterm labour (PTL) with intact membranes. Prospective study of 371 women hospitalized for preterm labour with intact membranes. The primary outcome was clinical infection, defined by clinical chorioamnionitis at delivery or early-onset neonatal infection. Clinical infection was identified in 21 cases (5.7%) and was associated with earlier gestational age at admission for PTL, elevated maternal C-reactive protein (CRP) and white blood cell count (WBC), shorter cervical length, and a cervical funnelling on ultrasound. We used ROC curves to determine the cut-off values that minimized the number of false positives and false negatives. The cut-off points chosen were 30 weeks for gestational age at admission, 25 mm for cervical length, 8 mg/l for CRP and 12,000 c/mm(3) for WBC. Each of these variables was assigned a weight on the basis of the adjusted odds ratios in a clinical infection risk score (CIRS). We set a threshold corresponding to a specificity close to 90%, and calculated the positive and negative predictive values and likelihood ratios of each marker and of the CIRS. The CIRS had a sensitivity of 61.9%, while the sensitivity of the other markers ranged from 19.0% to 42.9%. Internal cross-validation was used to estimate the performance of the CIRS in new subjects. The diagnostic values found remained close to the initial values. A clinical infection risk score built from data known at admission for preterm labour helps to identify women and newborns at high risk of clinical infection.

Transverse vetoes with rapidity cutoff in SCET

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hornig, Andrew; Kang, Daekyoung; Makris, Yiannis

We consider di-jet production in hadron collisions where a transverse veto is imposed on radiation for (pseudo-)rapidities in the central region only, where this central region is defined with rapidity cutoff. For the case where the transverse measurement (e.g., transverse energy or min p T for jet veto) is parametrically larger relative to the typical transverse momentum beyond the cutoff, the cross section is insensitive to the cutoff parameter and is factorized in terms of collinear and soft degrees of freedom. The virtuality for these degrees of freedom is set by the transverse measurement, as in typical transverse-momentum dependent observablesmore » such as Drell-Yan, Higgs production, and the event shape broadening. This paper focuses on the other region, where the typical transverse momentum below and beyond the cutoff is of similar size. In this region the rapidity cutoff further resolves soft radiation into (u)soft and soft-collinear radiation with different rapidities but identical virtuality. This gives rise to rapidity logarithms of the rapidity cutoff parameter which we resum using renormalization group methods. We factorize the cross section in this region in terms of soft and collinear functions in the framework of soft-collinear effective theory, then further refactorize the soft function as a convolution of the (u)soft and soft-collinear functions. All these functions are calculated at one-loop order. As an example, we calculate a differential cross section for a specific partonic channel, qq ' → qq ' , for the jet shape angularities and show that the refactorization allows us to resum the rapidity logarithms and significantly reduce theoretical uncertainties in the jet shape spectrum.« less

Transverse vetoes with rapidity cutoff in SCET

DOE PAGES

Hornig, Andrew; Kang, Daekyoung; Makris, Yiannis; ...

2017-12-11

We consider di-jet production in hadron collisions where a transverse veto is imposed on radiation for (pseudo-)rapidities in the central region only, where this central region is defined with rapidity cutoff. For the case where the transverse measurement (e.g., transverse energy or min p T for jet veto) is parametrically larger relative to the typical transverse momentum beyond the cutoff, the cross section is insensitive to the cutoff parameter and is factorized in terms of collinear and soft degrees of freedom. The virtuality for these degrees of freedom is set by the transverse measurement, as in typical transverse-momentum dependent observablesmore » such as Drell-Yan, Higgs production, and the event shape broadening. This paper focuses on the other region, where the typical transverse momentum below and beyond the cutoff is of similar size. In this region the rapidity cutoff further resolves soft radiation into (u)soft and soft-collinear radiation with different rapidities but identical virtuality. This gives rise to rapidity logarithms of the rapidity cutoff parameter which we resum using renormalization group methods. We factorize the cross section in this region in terms of soft and collinear functions in the framework of soft-collinear effective theory, then further refactorize the soft function as a convolution of the (u)soft and soft-collinear functions. All these functions are calculated at one-loop order. As an example, we calculate a differential cross section for a specific partonic channel, qq ' → qq ' , for the jet shape angularities and show that the refactorization allows us to resum the rapidity logarithms and significantly reduce theoretical uncertainties in the jet shape spectrum.« less

Determination of glucose-6-phosphate dehydrogenase cut-off values in a Tunisian population.

PubMed

Laouini, Naouel; Sahli, Chaima Abdelhafidh; Jouini, Latifa; Haloui, Sabrine; Fredj, Sondes Hadj; Daboubi, Rym; Siala, Hajer; Ouali, Faida; Becher, Meriam; Toumi, Nourelhouda; Bibi, Amina; Messsaoud, Taieb

2017-07-26

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the commonest enzymopathy worldwide. The incidence depends essentially on the methods used for the assessment. In this respect, we attempted in this study to set cut-off values of G6PD activity to discriminate among normal, heterozygous, and deficient individuals using the World Health Organization (WHO) classification and the receiver operating characteristics (ROC) curve analysis. Blood samples from 250 female and 302 male subjects were enrolled in this study. The G6PD activity was determined using a quantitative assay. The common G6PD mutations in Tunisia were determined using the amplification refractory mutation system (ARMS-PCR) method. The ROC curve was used to choice the best cut-off. Normal G6PD values were 7.69±2.37, 7.86±2.39, and 7.51±2.35 U/g Hb for the entire, male, and female groups, respectively. Cut-off values for the total, male, and female were determined using the WHO classification and ROC curves analysis. In the male population, both cut-offs established using ROC curve analysis (4.00 U/g Hb) and the 60% level (3.82 U/g Hb), respectively are sensitive and specific resulting in a good efficiency of discrimination between deficient and normal males. For the female group the ROC cut-off (5.84 U/g Hb) seems better than the 60% level cut-off (3.88 U/g Hb) to discriminate between normal and heterozygote or homozygote women with higher Youden Index. The establishment of the normal values for a population is important for a better evaluation of the assay result. The ROC curve analysis is an alternative method to determine the status of patients since it correlates DNA analysis and G6PD activity.

Ambient air pollution and cancer in California Seventh-day Adventists.

PubMed

Mills, P K; Abbey, D; Beeson, W L; Petersen, F

1991-01-01

Cancer incidence and mortality in a cohort of 6,000 Seventh-day Adventist nonsmokers who were residents of California were monitored for a 6-y period, and relationships with long-term ambient concentrations of total suspended particulates (TSPs) and ozone (O3) were studied. Ambient concentrations were expressed as mean concentrations and exceedance frequencies, which are the number of hours during which concentrations exceeded specified cutoffs (e.g., federal and California air quality standards). Risk of malignant neoplasms in females increased concurrently with exceedance frequencies for all TSP cutoffs, except the lowest, and these increased risks were highly statistically significant. An increased risk of respiratory cancers was associated with only one cutoff of O3, and this result was of borderline significance. These results are presented in the context of setting standards for these two air pollutants.

[Uniform analyzes of drugs in urine needed for rule of law].

PubMed

Hansson, Therese; Helander, Anders; Beck, Olof; Elmgren, Anders; Kugelberg, Fredrik; Kronstrand, Robert

2015-09-22

Drugs of abuse testing is used in various areas of society for detection and follow-up of drug use. In routine laboratory drug testing, immunoassays are employed for initial screening of specimens to indicate the presence of drugs. To confirm a positive screening test, a secondary analysis by mass spectrometry is performed. The "cut-off" is the pre-defined concentration threshold of a drug or drug metabolite above which the sample is considered positive. A reading below this level implies a negative test result. Swedish drug testing laboratories currently employ varying cut-offs to distinguish between a positive and a negative test result. Because a positive drug test may have serious legal consequences to the individual, it is of importance that testing is performed and judged equally, regardless of where it is performed. A national harmonization of cut-offs is therefore warranted. Based on data from four major Swedish drug testing laboratories, and considering the recommendations in international guidelines, a proposal for national harmonization of urine cut-offs for the most common set of drugs of abuse is presented.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chang, Yongbin; White, R. D.

In the calculation of the linearized Boltzmann collision operator for an inverse-square force law interaction (Coulomb interaction) F(r)=κ/r{sup 2}, we found the widely used scattering angle cutoff θ≥θ{sub min} is a wrong practise since the divergence still exists after the cutoff has been made. When the correct velocity change cutoff |v′−v|≥δ{sub min} is employed, the scattering angle can be integrated. A unified linearized Boltzmann collision operator for both inverse-square force law and rigid-sphere interactions is obtained. Like many other unified quantities such as transition moments, Fokker-Planck expansion coefficients and energy exchange rates obtained recently [Y. B. Chang and L. A.more » Viehland, AIP Adv. 1, 032128 (2011)], the difference between the two kinds of interactions is characterized by a parameter, γ, which is 1 for rigid-sphere interactions and −3 for inverse-square force law interactions. When the cutoff is removed by setting δ{sub min}=0, Hilbert's well known kernel for rigid-sphere interactions is recovered for γ = 1.« less

Evaluation of APRI and FIB-4 for noninvasive assessment of significant fibrosis and cirrhosis in HBeAg-negative CHB patients with ALT ≤ 2 ULN

PubMed Central

Li, Qiang; Ren, Xiaojing; Lu, Chuan; Li, Weixia; Huang, Yuxian; Chen, Liang

2017-01-01

Abstract To evaluate the performance of aspartate transaminase-to-platelet ratio index (APRI) and fibrosis index based on four factors (FIB-4) to predict significant fibrosis and cirrhosis in hepatitis B virus e antigen (HBeAg)-negative chronic hepatitis B (CHB) patients with alanine transaminase (ALT) ≤ twice the upper limit of normal (2 ULN). Histologic and laboratory data of 236 HBeAg-negative CHB patients with ALT ≤ 2 ULN were analyzed. Predicted fibrosis stage, based on established scales and cut-offs for APRI and FIB-4, was compared with METAVIR scores obtained from liver biopsy. In this study, the areas under the receiver operating characteristic curves (AUROCs) of APRI were lower than that of FIB-4 (0.62 vs 0.69; P = 0.019) for diagnosing significant fibrosis; however APRI and FIB-4 were comparable for diagnosing cirrhosis (0.77 vs 0.81; P = 0.374). When the cut-off proposed by WHO HBV guideline for APRI (>2.0) was used, no cirrhotic patients were correctly predicted. For FIB-4, the WHO proposed cut-off of 3.25 correctly identified significant fibrosis 83% of the time; but for APRI, the WHO proposed cut-off of 1.5 identified significant fibrosis 56%. In ruling out significant fibrosis, the WHO proposed APRI cut-off of 0.5 had a predictive value of 39%, and the FIB-4 cut-off of 1.45 correctly identified lack of significant fibrosis in 47% of the patients. In this study, based on ROC analysis, the optimal cut-offs were 0.46 and 0.65 for APRI, and 1.05 and 1.29 for FIB-4, for diagnosing significant fibrosis and cirrhosis, respectively. When the new cut-off of APRI (>0.65) was used, 82% of the cirrhotic patients were correctly predicted. In ruling out significant fibrosis, the new APRI cut-off (<0.46) had a predictive value of 80%, and new FIB-4 cut-off (<1.05) correctly identified lack of significant fibrosis in 84% of the patients. The WHO guidelines proposed cut-offs might be higher for HBeAg-negative CHB patients with ALT ≤2 ULN, and might underestimate the proportion of significant fibrosis and cirrhosis. A new set of cut-offs should be used to predict significant fibrosis and cirrhosis in this specific population. PMID:28328813

Evaluation of APRI and FIB-4 for noninvasive assessment of significant fibrosis and cirrhosis in HBeAg-negative CHB patients with ALT ≤ 2 ULN: A retrospective cohort study.

PubMed

Li, Qiang; Ren, Xiaojing; Lu, Chuan; Li, Weixia; Huang, Yuxian; Chen, Liang

2017-03-01

To evaluate the performance of aspartate transaminase-to-platelet ratio index (APRI) and fibrosis index based on four factors (FIB-4) to predict significant fibrosis and cirrhosis in hepatitis B virus e antigen (HBeAg)-negative chronic hepatitis B (CHB) patients with alanine transaminase (ALT) ≤ twice the upper limit of normal (2 ULN).Histologic and laboratory data of 236 HBeAg-negative CHB patients with ALT ≤ 2 ULN were analyzed. Predicted fibrosis stage, based on established scales and cut-offs for APRI and FIB-4, was compared with METAVIR scores obtained from liver biopsy.In this study, the areas under the receiver operating characteristic curves (AUROCs) of APRI were lower than that of FIB-4 (0.62 vs 0.69; P = 0.019) for diagnosing significant fibrosis; however APRI and FIB-4 were comparable for diagnosing cirrhosis (0.77 vs 0.81; P = 0.374). When the cut-off proposed by WHO HBV guideline for APRI (>2.0) was used, no cirrhotic patients were correctly predicted. For FIB-4, the WHO proposed cut-off of 3.25 correctly identified significant fibrosis 83% of the time; but for APRI, the WHO proposed cut-off of 1.5 identified significant fibrosis 56%. In ruling out significant fibrosis, the WHO proposed APRI cut-off of 0.5 had a predictive value of 39%, and the FIB-4 cut-off of 1.45 correctly identified lack of significant fibrosis in 47% of the patients. In this study, based on ROC analysis, the optimal cut-offs were 0.46 and 0.65 for APRI, and 1.05 and 1.29 for FIB-4, for diagnosing significant fibrosis and cirrhosis, respectively. When the new cut-off of APRI (>0.65) was used, 82% of the cirrhotic patients were correctly predicted. In ruling out significant fibrosis, the new APRI cut-off (<0.46) had a predictive value of 80%, and new FIB-4 cut-off (<1.05) correctly identified lack of significant fibrosis in 84% of the patients.The WHO guidelines proposed cut-offs might be higher for HBeAg-negative CHB patients with ALT ≤2 ULN, and might underestimate the proportion of significant fibrosis and cirrhosis. A new set of cut-offs should be used to predict significant fibrosis and cirrhosis in this specific population.

Retrospective analysis of insulin responses to standard dosed oral glucose tests (OGTs) via naso-gastric tubing towards definition of an objective cut-off value.

PubMed

Warnken, Tobias; Delarocque, Julien; Schumacher, Svenja; Huber, Korinna; Feige, Karsten

2018-01-19

Insulin dysregulation (ID) with basal or postprandial hyperinsulinemia is one of the key findings in horses and ponies suffering from the equine metabolic syndrome (EMS). Assessment of ID can easily be performed in clinical settings by the use of oral glucose challenge tests. Oral glucose test (OGT) performed with 1 g/kg bodyweight (BW) glucose administered via naso-gastric tube allows the exact administration of a defined glucose dosage in a short time. However, reliable cut-off values have not been available so far. Therefore, the aim of the study was to describe variations in insulin response to OGT via naso-gastric tubing and to provide a clinical useful cut-off value for ID when using the insulin quantification performed with an equine-optimized insulin enzyme-linked immunosorbent assay. Data visualization revealed no clear separation in the serum insulin concentration of insulin sensitive and insulin dysregulated horses during OGT. Therefore, a model based clustering method was used to circumvent the use of an arbitrary limit for categorization. This method considered all data-points for the classification, taking into account the individual insulin trajectory during the OGT. With this method two clusters were differentiated, one with low and one with high insulin responses during OGT. The cluster of individuals with low insulin response was consistently detected, independently of the initialization parameters of the algorithm. In this cluster the 97.5% quantile of insulin is 110 µLU/mL at 120 min. We suggest using this insulin concentration of 110 µLU/mL as a cut-off value for samples obtained at 120 min in OGT. OGT performed with 1 g/kg BW glucose and administration via naso-gastric tubing can easily be performed under clinical settings. Application of the cut-off value of 110 µLU/mL at 120 min allows assessment of ID in horses.

Evidence for a maximum mass cut-off in the neutron star mass distribution and constraints on the equation of state

NASA Astrophysics Data System (ADS)

Alsing, Justin; Silva, Hector O.; Berti, Emanuele

2018-07-01

We infer the mass distribution of neutron stars in binary systems using a flexible Gaussian mixture model and use Bayesian model selection to explore evidence for multimodality and a sharp cut-off in the mass distribution. We find overwhelming evidence for a bimodal distribution, in agreement with previous literature, and report for the first time positive evidence for a sharp cut-off at a maximum neutron star mass. We measure the maximum mass to be 2.0 M⊙ < mmax < 2.2 M⊙ (68 per cent), 2.0 M⊙ < mmax < 2.6 M⊙ (90 per cent), and evidence for a cut-off is robust against the choice of model for the mass distribution and to removing the most extreme (highest mass) neutron stars from the data set. If this sharp cut-off is interpreted as the maximum stable neutron star mass allowed by the equation of state of dense matter, our measurement puts constraints on the equation of state. For a set of realistic equations of state that support >2 M⊙ neutron stars, our inference of mmax is able to distinguish between models at odds ratios of up to 12:1, whilst under a flexible piecewise polytropic equation-of-state model our maximum mass measurement improves constraints on the pressure at 3-7× the nuclear saturation density by ˜ 30-50 per cent compared to simply requiring mmax > 2 M⊙. We obtain a lower bound on the maximum sound speed attained inside the neutron star of c_ s^max > 0.63c (99.8 per cent), ruling out c_ s^max < c/√{3} at high significance. Our constraints on the maximum neutron star mass strengthen the case for neutron star-neutron star mergers as the primary source of short gamma-ray bursts.

The diagnostic efficiency of the extended German Brøset Violence Checklist to assess the risk of violence.

PubMed

Rechenmacher, Josef; Müller, Gerhard; Abderhalden, Christoph; Schulc, Eva

2014-01-01

The prevention of aggression and violence of patients is part of the challenge for the psychiatric inpatient care. Resources needed are a systematic risk assessment and taking preventive measures according to the risk. The extended Brøset Violence Checklist (BVC-CH) is an assessment instrument for the short-term assessment of the risk of violence for physical attacks toward medical staff and other patients. Until now, the instrument was only validated in the context of the development phase of the instrument. The aim of this study was to investigate how valid the BVC-CH scale is for adult psychiatry in acute inpatient care facilities. In a prospective cohort study, 232 consecutively admitted patients were assessed using the BVC-CH. The calculation of the predictive values was based on a contingency table. The discriminatory power of the instrument and the determination of the cutoff point were done using the receiver operating characteristic (ROC) curve analysis. Physical attacks were registered with the Staff Observation of Aggression Scale-Revised (SOAS-R). The sensitivity was 58.8% and the specificity was 96.8% by a cutoff point of > or = 7. By choosing a cutoff point of > or = 6, the sensitivity was 64.7% and the specificity was 95.1%. A value of .93 was determined for the area under the curve receiver operating characteristic (AUC(ROC)). Overall, the BVC-CH is a valid instrument for the short-term prediction of physical attacks. Further research of the BVC-CH is recommended but in particular for the cutoff point.

Application of nonlinear deterministic decomposition to the prediction and energy dissipation of long-crested irregular ocean surface waves

NASA Astrophysics Data System (ADS)

Meza Conde, Eustorgio

The Hybrid Wave Model (HWM) is a deterministic nonlinear wave model developed for the computation of wave properties in the vicinity of ocean wave measurements. The HWM employs both Mode-Coupling and Phase Modulation Methods to model the wave-wave interactions in an ocean wave field. Different from other nonlinear wave models, the HWM decouples the nonlinear wave interactions from ocean wave field measurements and decomposes the wave field into a set of free-wave components. In this dissertation the HWM is applied to the prediction of wave elevation from pressure measurements and to the quantification of energy during breaking of long-crested irregular surface waves. 1.A transient wave train was formed in a two-dimensional wave flume by sequentially generating a series of waves from high to low frequencies that superposed at a downstream location. The predicted wave elevation using the HWM based on the pressure measurement of a very steep transient wave train is in excellent agreement with the corresponding elevation measurement, while that using Linear Wave Theory (LWT) has relatively large discrepancies. Furthermore, the predicted elevation using the HWM is not sensitive to the choice of the cutoff frequency, while that using LWT is very sensitive. 2.Several transient wave trains containing an isolated plunging or spilling breaker at a prescribed location were generated in a two-dimensional wave flume using the same superposition technique. Surface elevation measurements of each transient wave train were made at locations before and after breaking. Applying the HWM nonlinear deterministic decomposition to the measured elevation, the free-wave components comprising the transient wave train were derived. By comparing the free-wave spectra before and after breaking it is found that energy loss was almost exclusively from wave components at frequencies higher than the spectral peak frequency. Even though the wave components near the peak frequency are the largest, they do not significantly gain or lose energy after breaking. It was also observed that wave components of frequencies significantly below or near the peak frequency gain a small portion of energy lost by the high-frequency waves. These findings may have important implications to the ocean wave energy budget.

An Application of Multifaceted Rasch Measurement in the Yes/No Angoff Standard Setting Procedure

ERIC Educational Resources Information Center

Hsieh, Mingchuan

2013-01-01

When implementing standard setting procedures, there are two major concerns: variance between panelists and efficiency in conducting multiple rounds of judgments. With regard to the former, there is concern over the consistency of the cutoff scores made by different panelists. If the cut scores show an inordinately wide range then further rounds…

A Primer-Test Centered Equating Method for Setting Cut-Off Scores

ERIC Educational Resources Information Center

Zhu, Weimo; Plowman, Sharon Ann; Park, Youngsik

2010-01-01

This study evaluated the use of a new primary field test method based on test equating to address inconsistent classification among field tests. We analyzed students' information on the Progressive Aerobic Cardiovascular Endurance Run (PACER), mile run (MR), and VO[subscript 2]max from three data sets (college: n = 94; middle school: n = 39;…

Error analysis for a spaceborne laser ranging system

NASA Technical Reports Server (NTRS)

Pavlis, E. C.

1979-01-01

The dependence (or independence) of baseline accuracies, obtained from a typical mission of a spaceborne ranging system, on several factors is investigated. The emphasis is placed on a priori station information, but factors such as the elevation cut-off angle, the geometry of the network, the mean orbital height, and to a limited extent geopotential modeling are also examined. The results are obtained through simulations, but some theoretical justification is also given. Guidelines for freeing the results from these dependencies are suggested for most of the factors.

From genus to phylum: large-subunit and internal transcribed spacer rRNA operon regions show similar classification accuracies influenced by database composition.

PubMed

Porras-Alfaro, Andrea; Liu, Kuan-Liang; Kuske, Cheryl R; Xie, Gary

2014-02-01

We compared the classification accuracy of two sections of the fungal internal transcribed spacer (ITS) region, individually and combined, and the 5' section (about 600 bp) of the large-subunit rRNA (LSU), using a naive Bayesian classifier and BLASTN. A hand-curated ITS-LSU training set of 1,091 sequences and a larger training set of 8,967 ITS region sequences were used. Of the factors evaluated, database composition and quality had the largest effect on classification accuracy, followed by fragment size and use of a bootstrap cutoff to improve classification confidence. The naive Bayesian classifier and BLASTN gave similar results at higher taxonomic levels, but the classifier was faster and more accurate at the genus level when a bootstrap cutoff was used. All of the ITS and LSU sections performed well (>97.7% accuracy) at higher taxonomic ranks from kingdom to family, and differences between them were small at the genus level (within 0.66 to 1.23%). When full-length sequence sections were used, the LSU outperformed the ITS1 and ITS2 fragments at the genus level, but the ITS1 and ITS2 showed higher accuracy when smaller fragment sizes of the same length and a 50% bootstrap cutoff were used. In a comparison using the larger ITS training set, ITS1 and ITS2 had very similar accuracy classification for fragments between 100 and 200 bp. Collectively, the results show that any of the ITS or LSU sections we tested provided comparable classification accuracy to the genus level and underscore the need for larger and more diverse classification training sets.

From Genus to Phylum: Large-Subunit and Internal Transcribed Spacer rRNA Operon Regions Show Similar Classification Accuracies Influenced by Database Composition

PubMed Central

Liu, Kuan-Liang; Kuske, Cheryl R.

2014-01-01

We compared the classification accuracy of two sections of the fungal internal transcribed spacer (ITS) region, individually and combined, and the 5′ section (about 600 bp) of the large-subunit rRNA (LSU), using a naive Bayesian classifier and BLASTN. A hand-curated ITS-LSU training set of 1,091 sequences and a larger training set of 8,967 ITS region sequences were used. Of the factors evaluated, database composition and quality had the largest effect on classification accuracy, followed by fragment size and use of a bootstrap cutoff to improve classification confidence. The naive Bayesian classifier and BLASTN gave similar results at higher taxonomic levels, but the classifier was faster and more accurate at the genus level when a bootstrap cutoff was used. All of the ITS and LSU sections performed well (>97.7% accuracy) at higher taxonomic ranks from kingdom to family, and differences between them were small at the genus level (within 0.66 to 1.23%). When full-length sequence sections were used, the LSU outperformed the ITS1 and ITS2 fragments at the genus level, but the ITS1 and ITS2 showed higher accuracy when smaller fragment sizes of the same length and a 50% bootstrap cutoff were used. In a comparison using the larger ITS training set, ITS1 and ITS2 had very similar accuracy classification for fragments between 100 and 200 bp. Collectively, the results show that any of the ITS or LSU sections we tested provided comparable classification accuracy to the genus level and underscore the need for larger and more diverse classification training sets. PMID:24242255

Relationships between the Definition of the Hyperplane Width to the Fidelity of Principal Component Loading Patterns.

NASA Astrophysics Data System (ADS)

Richman, Michael B.; Gong, Xiaofeng

1999-06-01

When applying eigenanalysis, one decision analysts make is the determination of what magnitude an eigenvector coefficient (e.g., principal component (PC) loading) must achieve to be considered as physically important. Such coefficients can be displayed on maps or in a time series or tables to gain a fuller understanding of a large array of multivariate data. Previously, such a decision on what value of loading designates a useful signal (hereafter called the loading `cutoff') for each eigenvector has been purely subjective. The importance of selecting such a cutoff is apparent since those loading elements in the range of zero to the cutoff are ignored in the interpretation and naming of PCs since only the absolute values of loadings greater than the cutoff are physically analyzed. This research sets out to objectify the problem of best identifying the cutoff by application of matching between known correlation/covariance structures and their corresponding eigenpatterns, as this cutoff point (known as the hyperplane width) is varied.A Monte Carlo framework is used to resample at five sample sizes. Fourteen different hyperplane cutoff widths are tested, bootstrap resampled 50 times to obtain stable results. The key findings are that the location of an optimal hyperplane cutoff width (one which maximized the information content match between the eigenvector and the parent dispersion matrix from which it was derived) is a well-behaved unimodal function. On an individual eigenvector, this enables the unique determination of a hyperplane cutoff value to be used to separate those loadings that best reflect the relationships from those that do not. The effects of sample size on the matching accuracy are dramatic as the values for all solutions (i.e., unrotated, rotated) rose steadily from 25 through 250 observations and then weakly thereafter. The specific matching coefficients are useful to assess the penalties incurred when one analyzes eigenvector coefficients of a lower absolute value than the cutoff (termed coefficient in the hyperplane) or, alternatively, chooses not to analyze coefficients that contain useful physical signal outside of the hyperplane. Therefore, this study enables the analyst to make the best use of the information available in their PCs to shed light on complicated data structures.

The elevation, slope, and curvature spectra of a wind roughened sea surface

NASA Technical Reports Server (NTRS)

Pierson, W. J., Jr.; Stacy, R. A.

1973-01-01

The elevation, slope and curvature spectra are defined as a function of wave number and depend on the friction velocity. There are five wave number ranges of definition called the gravity wave-gravity equilibrium range, the isotropic turbulence range, the connecting range due to Leykin Rosenberg, the capillary range, and the viscous cutoff range. The higher wave number ranges are strongly wind speed dependent, and there is no equilibrium (or saturated) capillary range, at least for winds up to 30 meters/sec. Some properties of the angular variation of the spectra are also found. For high wave numbers, especially in the capillary range, the results are shown to be consistent with the Rayleigh-Rice backscattering theory (Bragg scattering), and certain properties of the angular variation are deduced from backscatter measurements.

HMMER Cut-off Threshold Tool (HMMERCTTER): Supervised classification of superfamily protein sequences with a reliable cut-off threshold.

PubMed

Pagnuco, Inti Anabela; Revuelta, María Victoria; Bondino, Hernán Gabriel; Brun, Marcel; Ten Have, Arjen

2018-01-01

Protein superfamilies can be divided into subfamilies of proteins with different functional characteristics. Their sequences can be classified hierarchically, which is part of sequence function assignation. Typically, there are no clear subfamily hallmarks that would allow pattern-based function assignation by which this task is mostly achieved based on the similarity principle. This is hampered by the lack of a score cut-off that is both sensitive and specific. HMMER Cut-off Threshold Tool (HMMERCTTER) adds a reliable cut-off threshold to the popular HMMER. Using a high quality superfamily phylogeny, it clusters a set of training sequences such that the cluster-specific HMMER profiles show cluster or subfamily member detection with 100% precision and recall (P&R), thereby generating a specific threshold as inclusion cut-off. Profiles and thresholds are then used as classifiers to screen a target dataset. Iterative inclusion of novel sequences to groups and the corresponding HMMER profiles results in high sensitivity while specificity is maintained by imposing 100% P&R self detection. In three presented case studies of protein superfamilies, classification of large datasets with 100% precision was achieved with over 95% recall. Limits and caveats are presented and explained. HMMERCTTER is a promising protein superfamily sequence classifier provided high quality training datasets are used. It provides a decision support system that aids in the difficult task of sequence function assignation in the twilight zone of sequence similarity. All relevant data and source codes are available from the Github repository at the following URL: https://github.com/BBCMdP/HMMERCTTER.

HMMER Cut-off Threshold Tool (HMMERCTTER): Supervised classification of superfamily protein sequences with a reliable cut-off threshold

PubMed Central

Pagnuco, Inti Anabela; Revuelta, María Victoria; Bondino, Hernán Gabriel; Brun, Marcel

2018-01-01

Background Protein superfamilies can be divided into subfamilies of proteins with different functional characteristics. Their sequences can be classified hierarchically, which is part of sequence function assignation. Typically, there are no clear subfamily hallmarks that would allow pattern-based function assignation by which this task is mostly achieved based on the similarity principle. This is hampered by the lack of a score cut-off that is both sensitive and specific. Results HMMER Cut-off Threshold Tool (HMMERCTTER) adds a reliable cut-off threshold to the popular HMMER. Using a high quality superfamily phylogeny, it clusters a set of training sequences such that the cluster-specific HMMER profiles show cluster or subfamily member detection with 100% precision and recall (P&R), thereby generating a specific threshold as inclusion cut-off. Profiles and thresholds are then used as classifiers to screen a target dataset. Iterative inclusion of novel sequences to groups and the corresponding HMMER profiles results in high sensitivity while specificity is maintained by imposing 100% P&R self detection. In three presented case studies of protein superfamilies, classification of large datasets with 100% precision was achieved with over 95% recall. Limits and caveats are presented and explained. Conclusions HMMERCTTER is a promising protein superfamily sequence classifier provided high quality training datasets are used. It provides a decision support system that aids in the difficult task of sequence function assignation in the twilight zone of sequence similarity. All relevant data and source codes are available from the Github repository at the following URL: https://github.com/BBCMdP/HMMERCTTER. PMID:29579071

Comparative analysis of positioning and zenith total delay retrieval using GPS-, GLONASS-only, and GPS/GLONASS combined precise point positioning

NASA Astrophysics Data System (ADS)

Zhou, Feng; Li, Xingxing; Cai, Miaomiao; Chen, Wen; Dong, Danan; Schuh, Harald

2017-04-01

Since October 2011, the Russian GLONASS has been revitalized and is now fully operational with 24 satellites in orbit. It is critical to assess the benefits and problems of using GLONASS observations (i.e. GLONASS-only or combined GPS/GLONASS) for precise positioning and zenith total delay (ZTD) retrieval on a global scale using the precise point positioning (PPP) technique. In this contribution, extensive evaluations are conducted with GNSS data sets collected from 251 globally distributed stations of the International GNSS Service (IGS) network in July 2016. The stations are divided into 30 groups by antenna/radome types to investigate whether there are antenna/radome-dependent biases in position and ZTD results derived from GLONASS-only PPP. The positioning results do not show obvious antenna/radome-dependent biases except the stations with JAV_RINGANT_G3T/NONE. The averaged biases of the stations with JAV_RINGANT_G3T/NONE in horizontal component especially in north component can even achieve -9.0 mm. The standard deviation (STD) and root mean square (RMS) are used as indicators of positioning repeatability and accuracy, respectively. Compared with GPS-only PPP, smaller averaged STD and RMS values of GLONASS-only PPP are achieved in horizontal component, while larger ones in vertical component. Furthermore, the STD and RMS values of GPS/GLONASS combined PPP solutions are the smallest in horizontal and vertical components, indicating that adding GLONASS observations can achieve better positioning performance than GPS-only PPP. Meanwhile, better positioning repeatability and accuracy are found in north component than that in east component, which may be caused by the configuration of GNSS satellite orbit. With respect to GPS-only PPP-derived ZTD, the ZTD biases, accuracy, and correlation derived from GLONASS-only and GPS/GLONASS PPP solutions are antenna/radome-independent, while the biases and accuracy are slightly latitude- or Geometric Dilution of Precisions (GDOP)-dependent, as well as the ZTD correlation are highly latitude- or GDOP-dependent. We also studied the impact of the chosen elevation cutoff angles on the positioning and ZTD retrieval. GLONASS-only PPP is found more sensitive with the elevation cutoff angles than GPS-only PPP.

Boundary value problem for the solution of magnetic cutoff rigidities and some special applications

NASA Technical Reports Server (NTRS)

Edmonds, Larry

1987-01-01

Since a planet's magnetic field can sometimes provide a spacecraft with some protection against cosmic ray and solar flare particles, it is important to be able to quantify this protection. This is done by calculating cutoff rigidities. An alternate to the conventional method (particle trajectory tracing) is introduced, which is to treat the problem as a boundary value problem. In this approach trajectory tracing is only needed to supply boundary conditions. In some special cases, trajectory tracing is not needed at all because the problem can be solved analytically. A differential equation governing cutoff rigidities is derived for static magnetic fields. The presense of solid objects, which can block a trajectory and other force fields are not included. A few qualititative comments, on existence and uniqueness of solutions, are made which may be useful when deciding how the boundary conditions should be set up. Also included are topics on axially symmetric fields.

Acoustic mode measurements in the inlet of a model turbofan using a continuously rotating rake

NASA Astrophysics Data System (ADS)

Heidelberg, Laurence J.; Hall, David G.

1993-01-01

Comprehensive measurements of the spinning acoustic mode structure in the inlet of the Advanced Ducted Propeller (ADP) have been completed. These measurements were taken using a unique and previously untried method which was first proposed by T.G. Sofrin. A continuously rotating microphone system was employed. The ADP model was designed and built by Pratt & Whitney and tested in the NASA Lewis 9- by 15-foot Anechoic Wind Tunnel. Three inlet configurations were tested with cut-on and cutoff stator vane sets. The cutoff stator was designed to suppress all modes at the blade passing frequency. Rotating rake measurements indicate that several extraneous circumferential modes were active. The mode orders suggest that their source was an interaction between the rotor and small interruptions in the casing tip treatment. The cut-on stator produced the expected circumferential modes plus higher levels of the unexpected modes seen with the cutoff stator.

Acoustic Mode Measurements in the Inlet of a Model Turbofan Using a Continuously Rotating Rake

NASA Technical Reports Server (NTRS)

Heidelberg, Laurence J.; Hall, David G.

1992-01-01

Comprehensive measurements of the spinning acoustic mode structure in the inlet of the Advanced Ducted Propeller (ADP) have been completed. These measurements were taken using a unique and previously untried method which was first proposed by T.G. Sofrin. A continuously rotating microphone system was employed. The ADP model was designed and built by Pratt & Whitney and tested in the NASA Lewis 9- by 15-foot Anechoic Wind Tunnel. Three inlet configurations were tested with cut-on and cutoff stator vane sets. The cutoff stator was designed to suppress all modes at the blade passing frequency. Rotating rake measurements indicate that several extraneous circumferential modes were active. The mode orders suggest that their source was an interaction between the rotor and small interruptions in the casing tip treatment. The cut-on stator produced the expected circumferential modes plus higher levels of the unexpected modes seen with the cutoff stator.

A method to validate quantitative high-frequency power doppler ultrasound with fluorescence in vivo video microscopy.

PubMed

Pinter, Stephen Z; Kim, Dae-Ro; Hague, M Nicole; Chambers, Ann F; MacDonald, Ian C; Lacefield, James C

2014-08-01

Flow quantification with high-frequency (>20 MHz) power Doppler ultrasound can be performed objectively using the wall-filter selection curve (WFSC) method to select the cutoff velocity that yields a best-estimate color pixel density (CPD). An in vivo video microscopy system (IVVM) is combined with high-frequency power Doppler ultrasound to provide a method for validation of CPD measurements based on WFSCs in mouse testicular vessels. The ultrasound and IVVM systems are instrumented so that the mouse remains on the same imaging platform when switching between the two modalities. In vivo video microscopy provides gold-standard measurements of vascular diameter to validate power Doppler CPD estimates. Measurements in four image planes from three mice exhibit wide variation in the optimal cutoff velocity and indicate that a predetermined cutoff velocity setting can introduce significant errors in studies intended to quantify vascularity. Consistent with previously published flow-phantom data, in vivo WFSCs exhibited three characteristic regions and detectable plateaus. Selection of a cutoff velocity at the right end of the plateau yielded a CPD close to the gold-standard vascular volume fraction estimated using IVVM. An investigator can implement the WFSC method to help adapt cutoff velocity to current blood flow conditions and thereby improve the accuracy of power Doppler for quantitative microvascular imaging. Copyright © 2014 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

Cognitive and physical functions related to the level of supervision and dependence in the toileting of stroke patients.

PubMed

Sato, Atsushi; Okuda, Yutaka; Fujita, Takaaki; Kimura, Norihiko; Hoshina, Noriyuki; Kato, Sayaka; Tanaka, Shigenari

2016-01-01

This study aimed to clarify which cognitive and physical factors are associated with the need for toileting assistance in stroke patients and to calculate cut-off values for discriminating between independent supervision and dependent toileting ability. This cross-sectional study included 163 first-stroke patients in nine convalescent rehabilitation wards. Based on their FIM Ⓡ instrument score for toileting, the patients were divided into an independent-supervision group and a dependent group. Multiple logistic regression analysis and receiver operating characteristic analysis were performed to identify factors related to toileting performance. The Minimental State Examination (MMSE); the Stroke Impairment Assessment Set (SIAS) score for the affected lower limb, speech, and visuospatial functions; and the Functional Assessment for Control of Trunk (FACT) were analyzed as independent variables. The multiple logistic regression analysis showed that the FIM Ⓡ instrument score for toileting was associated with the SIAS score for the affected lower limb function, MMSE, and FACT. On receiver operating characteristic analysis, the SIAS score for the affected lower limb function cut-off value was 8/7 points, the MMSE cut-off value was 25/24 points, and the FACT cut-off value was 14/13 points. Affected lower limb function, cognitive function, and trunk function were related with the need for toileting assistance. These cut-off values may be useful for judging whether toileting assistance is needed in stroke patients.

Association between impaired fasting glycaemia in pediatric obesity and type 2 diabetes in young adulthood.

PubMed

Hagman, E; Danielsson, P; Brandt, L; Ekbom, A; Marcus, C

2016-08-22

In adults, impaired fasting glycemia (IFG) increases the risk for type 2 diabetes mellitus (T2DM). This study aimed to investigate to which extent children with obesity develop T2DM during early adulthood, and to determine whether IFG and elevated hemoglobin A1c (HbA1c) in obese children are risk markers for early development of T2DM. In this prospective cohort study, 1620 subjects from the Swedish Childhood Obesity Treatment Registry - BORIS who were ⩾18 years at follow-up and 8046 individuals in a population-based comparison group, matched on gender age and living area, were included. IFG was defined according to both ADA (cut-off 5.6 mmol l(-1)) and WHO (6.1 mmol l(-1)). Elevated HbA1c was defined according to ADA (cut-off 39 mmol l(-1)). Main outcome was T2DM medication, as a proxy for T2DM. Data on medications were retrieved from a national registry. The childhood obesity cohort were 24 times more likely to receive T2DM medications in early adulthood compared with the comparison group (95% confidence interval (CI): 12.52-46). WHO-defined IFG predicted future use of T2DM medication with an adjusted hazard ratio (HR) of 3.73 (95% CI: 1.87-7.45) compared with those who had fasting glucose levels <5.6 mmol l(-1). A fasting glucose level of 5.6-6.0 mmol l(-1), that is, the IFG-interval added by American Diabetes Association (ADA), did not increase the use of T2DM medication more than pediatric obesity itself, adjusted HR=1.72 (0.84-3.52). Elevated levels of HbA1c resulted in an adjusted HR=3.12 (1.50-6.52). More severe degree of obesity also increased the future T2DM risk. IFG according to WHO and elevated HbA1c (39-48 mmol l(-1)), but not the additional fasting glucose interval added by ADA (5.6-6.0 mmol l(-1)), can be considered as prediabetes in the obese pediatric population in Sweden.

Specificity and sensitivity of the Beck Hopelessness Scale for suicidal ideation among adolescents entering early intervention service.

PubMed

Granö, Niklas; Oksanen, Jorma; Kallionpää, Santeri; Roine, Mikko

2017-01-01

Previous studies have shown an association between hopelessness and suicidal behaviour in clinical populations. The aim of the study was to investigate sensitivity, specificity, and predictive validity of the Beck Hopelessness Scale (BHS) for suicidal ideation in adolescents who show early risk signs on the psychiatric disorder continuum. Three-hundred and two help-seeking adolescents (mean age = 15.5 years) who were entering an early intervention team at Helsinki University Central Hospital, Finland, completed questionnaires of BHS and suicidal ideation, derived from Beck Depression Inventory (BDI-II). Results suggest that a BHS cut-off score ≥8 (sensitivity = 0.70, specificity = 0.76) or cut-off score ≥9 (sensitivity = 0.63, specificity = 0.80) may be useful to detect suicidal ideation with BHS in help-seeking adolescents population. Results remain mainly the same in a separate analysis with adolescents at risk for psychosis. The results support previous cut-off points for BHS in identification of suicidal ideation. The results suggest also that lower cut-off scores may be useful in sense of sensitivity, especially in clinical settings.

The Impact of Estimating High-Resolution Tropospheric Gradients on Multi-GNSS Precise Positioning

PubMed Central

Zhou, Feng; Li, Xingxing; Li, Weiwei; Chen, Wen; Dong, Danan; Wickert, Jens; Schuh, Harald

2017-01-01

Benefits from the modernized US Global Positioning System (GPS), the revitalized Russian GLObal NAvigation Satellite System (GLONASS), and the newly-developed Chinese BeiDou Navigation Satellite System (BDS) and European Galileo, multi-constellation Global Navigation Satellite System (GNSS) has emerged as a powerful tool not only in positioning, navigation, and timing (PNT), but also in remote sensing of the atmosphere and ionosphere. Both precise positioning and the derivation of atmospheric parameters can benefit from multi-GNSS observations. In this contribution, extensive evaluations are conducted with multi-GNSS datasets collected from 134 globally-distributed ground stations of the International GNSS Service (IGS) Multi-GNSS Experiment (MGEX) network in July 2016. The datasets are processed in six different constellation combinations, i.e., GPS-, GLONASS-, BDS-only, GPS + GLONASS, GPS + BDS, and GPS + GLONASS + BDS + Galileo precise point positioning (PPP). Tropospheric gradients are estimated with eight different temporal resolutions, from 1 h to 24 h, to investigate the impact of estimating high-resolution gradients on position estimates. The standard deviation (STD) is used as an indicator of positioning repeatability. The results show that estimating tropospheric gradients with high temporal resolution can achieve better positioning performance than the traditional strategy in which tropospheric gradients are estimated on a daily basis. Moreover, the impact of estimating tropospheric gradients with different temporal resolutions at various elevation cutoff angles (from 3° to 20°) is investigated. It can be observed that with increasing elevation cutoff angles, the improvement in positioning repeatability is decreased. PMID:28368346

The Impact of Estimating High-Resolution Tropospheric Gradients on Multi-GNSS Precise Positioning.

PubMed

Zhou, Feng; Li, Xingxing; Li, Weiwei; Chen, Wen; Dong, Danan; Wickert, Jens; Schuh, Harald

2017-04-03

Benefits from the modernized US Global Positioning System (GPS), the revitalized Russian GLObal NAvigation Satellite System (GLONASS), and the newly-developed Chinese BeiDou Navigation Satellite System (BDS) and European Galileo, multi-constellation Global Navigation Satellite System (GNSS) has emerged as a powerful tool not only in positioning, navigation, and timing (PNT), but also in remote sensing of the atmosphere and ionosphere. Both precise positioning and the derivation of atmospheric parameters can benefit from multi-GNSS observations. In this contribution, extensive evaluations are conducted with multi-GNSS datasets collected from 134 globally-distributed ground stations of the International GNSS Service (IGS) Multi-GNSS Experiment (MGEX) network in July 2016. The datasets are processed in six different constellation combinations, i.e., GPS-, GLONASS-, BDS-only, GPS + GLONASS, GPS + BDS, and GPS + GLONASS + BDS + Galileo precise point positioning (PPP). Tropospheric gradients are estimated with eight different temporal resolutions, from 1 h to 24 h, to investigate the impact of estimating high-resolution gradients on position estimates. The standard deviation (STD) is used as an indicator of positioning repeatability. The results show that estimating tropospheric gradients with high temporal resolution can achieve better positioning performance than the traditional strategy in which tropospheric gradients are estimated on a daily basis. Moreover, the impact of estimating tropospheric gradients with different temporal resolutions at various elevation cutoff angles (from 3° to 20°) is investigated. It can be observed that with increasing elevation cutoff angles, the improvement in positioning repeatability is decreased.

Alexithymia Associated with Nightmare Distress in Idiopathic REM Sleep Behavior Disorder

PubMed Central

Godin, Isabelle; Montplaisir, Jaques; Gagnon, Jean-François; Nielsen, Tore

2013-01-01

Study Objectives: Idiopathic REM sleep behavior disorder (iRBD) is characterized by atypical REM sleep motor activity, vivid dreams and nightmares, and dream-enacting behaviors that can result in injuries to the patient and bed partner. It is also a known predictor of Parkinson disease (PD). Alexithymia has been associated with disturbances in sleep and dreaming (e.g., nightmares) and is a non-motor symptom of PD. We assessed alexithymia and disturbed dreaming in iRBD patients with the aim of determining if these two factors are elevated and interrelated among this population. Design: Questionnaire study of clinically diagnosed patients. Setting: Clinical sleep disorders center. Patients or participants: Thirty-two iRBD patients and 30 healthy age- and sex-matched control participants. Measurements and Results: Participants completed the 20-item Toronto Alexithymia Scale (TAS-20), the Dream Questionnaire, and the Beck Depression Inventory. iRBD patients obtained higher TAS-20 total scores (62.16 ± 13.90) than did controls (52.84 ± 7.62; F1,59 = 10.44, P < 0.01), even when controlling for depressive symptoms, and more frequently attained the suggested cutoff for alexithymia than did controls (P < 0.01). iRBD patients obtained higher scores on the Difficulty Identifying Feelings alexithymia subscale. For both iRBD and control groups, the Difficulty Indentifying Feelings subscale correlated positively with the Nightmare Distress scale of the Dream Questionnaire. Conclusions: Elevated alexithymia scores among idiopathic rapid eye movement sleep behavior disorder patients, and especially a difficulty in identifying feelings, parallels evidence of dysautonomia in this population. The higher incidence of distressing nightmares and the association of nightmares with alexithymia further extend similar findings for both clinical and non-clinical samples and suggest that an affect regulation disturbance may be common to the two sets of symptoms. Citation: Godin I; Montplaisir J; Gagnon JF; Nielsen T. Alexithymia associated with nightmare distress in idiopathic REM sleep behavior disorder. SLEEP 2013;36(12):1957-1962. PMID:24293771

MORBIDITY AND SURVIVAL PROBABILITY IN BURN PATIENTS IN MODERN BURN CARE

PubMed Central

Jeschke, Marc G.; Pinto, Ruxandra; Kraft, Robert; Nathens, Avery B.; Finnerty, Celeste C.; Gamelli, Richard L.; Gibran, Nicole S.; Klein, Matthew B.; Arnoldo, Brett D.; Tompkins, Ronald G.; Herndon, David N.

2014-01-01

Objective Characterizing burn sizes that are associated with an increased risk of mortality and morbidity is critical because it would allow identifying patients who might derive the greatest benefit from individualized, experimental, or innovative therapies. Although scores have been established to predict mortality, few data addressing other outcomes exist. The objective of this study was to determine burn sizes that are associated with increased mortality and morbidity after burn. Design and Patients Burn patients were prospectively enrolled as part of the multicenter prospective cohort study, Inflammation and the Host Response to Injury Glue Grant, with the following inclusion criteria: 0–99 years of age, admission within 96 hours after injury, and >20% total body surface area burns requiring at least one surgical intervention. Setting Six major burn centers in North America. Measurements and Main Results Burn size cutoff values were determined for mortality, burn wound infection (at least two infections), sepsis (as defined by ABA sepsis criteria), pneumonia, acute respiratory distress syndrome, and multiple organ failure (DENVER2 score >3) for both children (<16 years) and adults (16–65 years). Five-hundred seventy-three patients were enrolled, of which 226 patients were children. Twenty-three patients were older than 65 years and were excluded from the cutoff analysis. In children, the cutoff burn size for mortality, sepsis, infection, and multiple organ failure was approximately 60% total body surface area burned. In adults, the cutoff for these outcomes was lower, at approximately 40% total body surface area burned. Conclusions In the modern burn care setting, adults with over 40% total body surface area burned and children with over 60% total body surface area burned are at high risk for morbidity and mortality, even in highly specialized centers. PMID:25559438

Prediction of Response to Sorafenib in Hepatocellular Carcinoma: A Putative Marker Panel by Multiple Reaction Monitoring-Mass Spectrometry (MRM-MS).

PubMed

Kim, Hyunsoo; Yu, Su Jong; Yeo, Injun; Cho, Young Youn; Lee, Dong Hyeon; Cho, Yuri; Cho, Eun Ju; Lee, Jeong-Hoon; Kim, Yoon Jun; Lee, Sungyoung; Jun, Jongsoo; Park, Taesung; Yoon, Jung-Hwan; Kim, Youngsoo

2017-07-01

Sorafenib is the only standard treatment for unresectable hepatocellular carcinoma (HCC), but it provides modest survival benefits over placebo, necessitating predictive biomarkers of the response to sorafenib. Serum samples were obtained from 115 consecutive patients with HCC before sorafenib treatment and analyzed by multiple reaction monitoring-mass spectrometry (MRM-MS) and ELISA to quantify candidate biomarkers. We verified a triple-marker panel to be predictive of the response to sorafenib by MRM-MS, comprising CD5 antigen-like (CD5L), immunoglobulin J (IGJ), and galectin-3-binding protein (LGALS3BP), in HCC patients. This panel was a significant predictor (AUROC > 0.950) of the response to sorafenib treatment, having the best cut-off value (0.4) by multivariate analysis. In the training set, patients who exceeded this cut-off value had significantly better overall survival (median, 21.4 months) than those with lower values (median, 8.6 months; p = 0.001). Further, a value that was lower than this cutoff was an independent predictor of poor overall survival [hazard ratio (HR), 2.728; 95% confidence interval (CI), 1.312-5.672; p = 0.007] and remained an independent predictive factor of rapid progression (HR, 2.631; 95% CI, 1.448-4.780; p = 0.002). When applied to the independent validation set, levels of the cut-off value for triple-marker panel maintained their prognostic value for poor clinical outcomes. On the contrast, the triple-marker panel was not a prognostic factor for patients who were treated with transarterial chemoembolization (TACE). The discriminatory signature of a triple-marker panel provides new insights into targeted proteomic biomarkers for individualized sorafenib therapy. © 2017 by The American Society for Biochemistry and Molecular Biology, Inc.

Electrocardiography cannot reliably differentiate transient left ventricular apical ballooning syndrome from anterior ST-segment elevation myocardial infarction.

PubMed

Bybee, Kevin A; Motiei, Arashk; Syed, Imran S; Kara, Tomas; Prasad, Abhiram; Lennon, Ryan J; Murphy, Joseph G; Hammill, Stephen C; Rihal, Charanjit S; Wright, R Scott

2007-01-01

The presentation and electrocardiographic (ECG) characteristics of transient left ventricular apical ballooning syndrome (TLVABS) can be similar to that of anterior ST-segment elevation myocardial infarction (STEMI). We tested the hypothesis that the ECG on presentation could reliably differentiate these syndromes. Between January 1, 2002 and July 31, 2004, we identified 18 consecutive patients with TLVABS who were matched with 36 subjects presenting with acute anterior STEMI due to atherothrombotic left anterior descending coronary artery occlusion. All patients with TLVABS were women (mean age, 72.0 +/- 13.1 years). The heart rate, PR interval, QRS duration, and corrected QT interval were similar between groups. Distribution of ST elevation was similar, but patients with anterior STEMI exhibited greater ST elevation. Regressive partitioning analysis indicated that the combination of ST elevation in lead V2 of less than 1.75 mm and ST-segment elevation in lead V3 of less than 2.5 mm was a suggestive predictor of TLVABS (sensitivity, 67%; specificity, 94%). Conditional logistic regression indicated that the formula: (3 x ST-elevation lead V2) + (ST-elevation V3) + (2 x ST-elevation V5) allowed possible discrimination between TLVABS and anterior STEMI with an optimal cutoff level of less than 11.5 mm for TLVABS (sensitivity, 94%; specificity, 72%). Patients with TLVABS were less likely to have concurrent ST-segment depression (6% vs 44%; P = .003). Women presenting with TLVABS have similar ECG findings to patients with anterior infarct but with less-prominent ST-segment elevation in the anterior precordial ECG leads. These ECG findings are relatively subtle and do not have sufficient predictive value to allow reliable emergency differentiation of these syndromes.

Percentage body fat ranges associated with metabolic syndrome risk: results based on the third National Health and Nutrition Examination Survey (1988-1994).

PubMed

Zhu, Shankuan; Wang, ZiMian; Shen, Wei; Heymsfield, Steven B; Heshka, Stanley

2003-08-01

Increasing attention has focused on the association between body fatness and related metabolic risk factors. The quantitative link between percentage body fat (%BF) and the risk of metabolic syndrome is unknown. The objectives were to determine the risk [odds ratios (ORs)] of metabolic syndrome based on %BF in black and white men and women in the United States and to provide corresponding ranges of %BF associated with a risk equivalent to body mass index (BMI; in kg/m(2)). The subjects were participants in the third National Health and Nutrition Examination Survey and were divided into those with and without the metabolic syndrome. OR equations were derived from logistic regression models for %BF and BMI, with the 25th percentile in the study population as the reference. Ranges were developed by associating %BF with the equivalent risk of metabolic syndrome based on established BMI cutoffs. Four sets (men, women, black, and white) of OR curves were generated for %BF and for BMI by using data from 8259 adults. The ORs for metabolic syndrome were lower in blacks than in whites at any given %BF or BMI. The developed cutoffs for %BF differed between men and women but showed only small race and age effects. A simplified set of sex-specific %BF ranges for the risk of metabolic syndrome were developed. The risk of metabolic syndrome can be established from measured %BF by using either the developed OR curves or %BF thresholds at traditional BMI cutoffs. This information should prove useful in both clinical and research settings.

Association of dioxins, furans and dioxin-like PCBs in human blood with nephropathy among US teens and young adults.

PubMed

Everett, Charles J; Thompson, Olivia M

2016-06-01

We assessed the association of three chlorinated dibenzo-p-dioxins, a chlorinated dibenzofuran, and four dioxin-like polychlorinated biphenyls (PCBs) in human blood with nephropathy (microalbuminuria or macroalbuminuria) among teens and young adults (12-30 years old) having normal glycohemoglobin (A1c <5.7%). The data were derived from the 1999-2004 National Health and Nutrition Examination Survey (unweighted n=1504, population estimate=38,806,338). In this paper, nephropathy refers to normal A1c with nephropathy. In an all-adult sample (Everett CJ, Thompson OM. Dioxins, furans and dioxin-like PCBs in human blood: causes or consequences of diabetic nephropathy? Environ Res 2014;132:126-31), the cut-offs for these chemicals being considered elevated, were defined as the 75th percentile. Using these same cut-offs again, the proportion of those with one or more of the eight dioxin-like compounds elevated was 9.9%. The four chemicals associated with nephropathy were 1,2,3,6,7,8-hexachlorodibenzo-p-dioxin, PCB 126, PCB 169, and PCB 156. The proportion with one or more of these four dioxin-like chemicals elevated was 3.9% (unweighted n=46) and the odds ratio (OR) for nephropathy was 7.1 [95% confidence interval (CI) 1.8-28.1]. The association was strong among females (OR 17.4, 95% CI 3.4-88.6), but among males there were no cases of nephropathy when one or more of the four dioxin-like chemicals were elevated, and therefore no association. In a separate analysis, elevated toxic equivalency, defined using the eight dioxin-like chemicals (TEQ8), was associated with nephropathy. TEQ8 ≥50.12 fg/g included 2.6% of the sample (unweighted n=28) and had an OR of 5.8 (95% 1.3-25.9) for nephropathy. As found in the analysis of one or more of four dioxin-like chemicals elevated, TEQ8 ≥50.12 fg/g was associated with nephropathy among females (OR 11.9, 95% CI 1.6-87.2), but not males. Trends for least-squares means also differed by gender, but there were no significant differences in mean TEQ8 between normal subjects and those having nephropathy in either males or females. We also evaluated pre-diabetes (A1c 5.7-6.4%) without nephropathy and found no associations when one or more of four dioxin-like compounds were elevated, or when TEQ8 was ≥50.12 fg/g. In this study, associations of dioxin-like chemicals with nephropathy were found among females at an early age. Prospective studies are needed to determine if dioxin-like compounds cause nephropathy, or if these relationships are cases of reverse causation.

Estimating the extent of subclinical arteriosclerosis of persons with prediabetes and diabetes mellitus among Japanese urban workers and their families: a cross-sectional study.

PubMed

Namekata, Tsukasa; Shirai, Kohji; Tanabe, Naohito; Miyanishi, Kunio; Nakata, Mitsuko; Suzuki, Kenji; Arai, Chikao; Ishizuka, Norio

2016-02-24

Diabetes mellitus (hereafter called diabetes) is considered to accelerate arteriosclerosis leading to coronary heart disease and stroke. Thus, it is important to quantitatively estimate the extent of subclinical arteriosclerosis. A new method called cardio-ankle vascular index (CAVI) is developed to reflect arterial stiffness independently from blood pressure at the time of measurement. Then, we examined if CAVI scores could discriminate the extent of arteriosclerosis between persons with prediabetes (or borderline diabetes) and with diabetes among Japanese urban workers and their families. Subjects were 9881 men and 12033 women of company employees and their families who participated in cardiovascular disease screening in Japan. Persons having diabetes and prediabetes were defined based on the criteria set by American Diabetes Association. CAVI scores were measured by VaSera VS-1000. We applied the established age-sex specific cutoff points of CAVI scores above which were determined to be abnormally high or advanced level of arteriosclerosis. To examine the association of prediabetes and diabetes with CAVI scores, CAVI scores of screening participants were converted to a binary variable: 1 for less than cutoff points and 2 for equal or greater than cutoff points or abnormally high CAVI scores. Logistic regression method was used to examine the association of prediabetes and diabetes with CAVI scores after adjusting for major cardiovascular disease (CVD) risk factors. Prevalence of abnormally high CAVI scores was significantly higher after 40 years of age among persons with diabetes than either among persons with prediabetes or among normal persons in both genders. Significantly elevated odds ratios (ORs) of abnormally high CAVI scores appeared among persons with prediabetes: 1.29 (95 % confidence interval (CI), 1.11-1.48) for men and 1.14 (CI, 1.01-1.28) for women, and among persons with diabetes: 2.41 (CI, 1.97-2.95) for men and 2.52 (CI, 1.94-3.28) for women. The extent of subclinical arteriosclerosis (including arterial stiffness and atherosclerosis) was moderately enhanced among persons with prediabetes and was further advanced among persons with diabetes. Thus, it is important to introduce earlier interventions for changing lifestyle and diet of persons with prediabetes in order to prevent them from developing diabetes and further advancing arteriosclerosis.

Automated Screening of Children With Obstructive Sleep Apnea Using Nocturnal Oximetry: An Alternative to Respiratory Polygraphy in Unattended Settings

PubMed Central

Álvarez, Daniel; Alonso-Álvarez, María L.; Gutiérrez-Tobal, Gonzalo C.; Crespo, Andrea; Kheirandish-Gozal, Leila; Hornero, Roberto; Gozal, David; Terán-Santos, Joaquín; Del Campo, Félix

2017-01-01

Study Objectives: Nocturnal oximetry has become known as a simple, readily available, and potentially useful diagnostic tool of childhood obstructive sleep apnea (OSA). However, at-home respiratory polygraphy (HRP) remains the preferred alternative to polysomnography (PSG) in unattended settings. The aim of this study was twofold: (1) to design and assess a novel methodology for pediatric OSA screening based on automated analysis of at-home oxyhemoglobin saturation (SpO2), and (2) to compare its diagnostic performance with HRP. Methods: SpO2 recordings were parameterized by means of time, frequency, and conventional oximetric measures. Logistic regression models were optimized using genetic algorithms (GAs) for three cutoffs for OSA: 1, 3, and 5 events/h. The diagnostic performance of logistic regression models, manual obstructive apnea-hypopnea index (OAHI) from HRP, and the conventional oxygen desaturation index ≥ 3% (ODI3) were assessed. Results: For a cutoff of 1 event/h, the optimal logistic regression model significantly outperformed both conventional HRP-derived ODI3 and OAHI: 85.5% accuracy (HRP 74.6%; ODI3 65.9%) and 0.97 area under the receiver operating characteristics curve (AUC) (HRP 0.78; ODI3 0.75) were reached. For a cutoff of 3 events/h, the logistic regression model achieved 83.4% accuracy (HRP 85.0%; ODI3 74.5%) and 0.96 AUC (HRP 0.93; ODI3 0.85) whereas using a cutoff of 5 events/h, oximetry reached 82.8% accuracy (HRP 85.1%; ODI3 76.7) and 0.97 AUC (HRP 0.95; ODI3 0.84). Conclusions: Automated analysis of at-home SpO2 recordings provide accurate detection of children with high pretest probability of OSA. Thus, unsupervised nocturnal oximetry may enable a simple and effective alternative to HRP and PSG in unattended settings. Citation: Álvarez D, Alonso-Álvarez ML, Gutiérrez-Tobal GC, Crespo A, Kheirandish-Gozal L, Hornero R, Gozal D, Terán-Santos J, Del Campo F. Automated screening of children with obstructive sleep apnea using nocturnal oximetry: an alternative to respiratory polygraphy in unattended settings. J Clin Sleep Med. 2017;13(5):693–702. PMID:28356177

Measurement of asthma control according to global initiative for asthma guidelines: a comparison with the asthma control questionnaire

PubMed Central

2012-01-01

Introduction Asthma Control Questionnaire (ACQ) is a validated tool to measure asthma control. Cut-off points that best discriminate “well-controlled” or “not well-controlled” asthma have been suggested from the analysis of a large randomized clinical trial but they may not be adequate for daily clinical practice. Aims To establish cut-off points of the ACQ that best discriminate the level of control according to Global Initiative for Asthma (GINA) 2006 guidelines in patients with asthma managed at Allergology and Pulmonology Departments as well as Primary Care Centers in Spain. Patients and methods An epidemiological descriptive study, with prospective data collection. Asthma control following GINA-2006 classification and 7-item ACQ was assessed. The study population was split in two parts: 2/3 for finding the cut-off points (development population) and 1/3 for validating the results (validation population). Results A total of 1,363 stable asthmatic patients were included (mean age 38 ± 14 years, 60.3% women; 69.1% non-smokers). Patient classification according to GINA-defined asthma control was: controlled 13.6%, partially controlled 34.2%, and uncontrolled 52.3%. The ACQ cut-off points that better agreed with GINA-defined asthma control categories were calculated using receiver operating curves (ROC). The analysis showed that ACQ < 0.5 was the optimal cut-off point for “controlled asthma” (sensitivity 74.1%, specificity 77.5%) and 1.00 for “uncontrolled asthma” (sensitivity 73%, specificity 88.2%). Kappa index between GINA categories and ACQ was 0.62 (p < 0.001). Conclusion The ACQ cut-off points associated with GINA-defined asthma control in a real-life setting were <0.5 for controlled asthma and ≥1 for uncontrolled asthma. PMID:22726416

Diagnostic performance of matrix-assisted laser desorption ionisation time-of-flight mass spectrometry in blood bacterial infections: a systematic review and meta-analysis.

PubMed

Scott, Jamie S; Sterling, Sarah A; To, Harrison; Seals, Samantha R; Jones, Alan E

2016-07-01

Matrix-assisted laser desorption ionisation time-of-flight mass spectrometry (MALDI-TOF MS) has shown promise in decreasing time to identification of causative organisms compared to traditional methods; however, the utility of MALDI-TOF MS in a heterogeneous clinical setting is uncertain. To perform a systematic review on the operational performance of the Bruker MALDI-TOF MS system and evaluate published cut-off values compared to traditional blood cultures. A comprehensive literature search was performed. Studies were included if they performed direct MALDI-TOF MS analysis of blood culture specimens in human patients with suspected bacterial infections using the Bruker Biotyper software. Sensitivities and specificities of the combined studies were estimated using a hierarchical random effects linear model (REML) incorporating cut-off scores of ≥1.7 and ≥2.0. Fifty publications were identified, with 11 studies included after final review. The estimated sensitivity utilising a cut-off of ≥2.0 from the combined studies was 74.6% (95% CI = 67.9-89.3%), with an estimated specificity of 88.0% (95% CI = 74.8-94.7%). When assessing a cut-off of ≥1.7, the combined sensitivity increases to 92.8% (95% CI = 87.4-96.0%), but the estimated specificity decreased to 81.2% (95% CI = 61.9-96.6%). In this analysis, MALDI-TOF MS showed acceptable sensitivity and specificity in bacterial speciation with the current recommended cut-off point compared to blood cultures; however, lowering the cut-off point from ≥2.0 to ≥1.7 would increase the sensitivity of the test without significant detrimental effect on the specificity, which could improve clinician confidence in their results.

Measurement of asthma control according to Global Initiative for Asthma guidelines: a comparison with the Asthma Control Questionnaire.

PubMed

Olaguibel, José María; Quirce, Santiago; Juliá, Berta; Fernández, Cristina; Fortuna, Ana María; Molina, Jesús; Plaza, Vicente

2012-06-22

Asthma Control Questionnaire (ACQ) is a validated tool to measure asthma control. Cut-off points that best discriminate "well-controlled" or "not well-controlled" asthma have been suggested from the analysis of a large randomized clinical trial but they may not be adequate for daily clinical practice. To establish cut-off points of the ACQ that best discriminate the level of control according to Global Initiative for Asthma (GINA) 2006 guidelines in patients with asthma managed at Allergology and Pulmonology Departments as well as Primary Care Centers in Spain. An epidemiological descriptive study, with prospective data collection. Asthma control following GINA-2006 classification and 7-item ACQ was assessed. The study population was split in two parts: 2/3 for finding the cut-off points (development population) and 1/3 for validating the results (validation population). A total of 1,363 stable asthmatic patients were included (mean age 38 ± 14 years, 60.3% women; 69.1% non-smokers). Patient classification according to GINA-defined asthma control was: controlled 13.6%, partially controlled 34.2%, and uncontrolled 52.3%. The ACQ cut-off points that better agreed with GINA-defined asthma control categories were calculated using receiver operating curves (ROC). The analysis showed that ACQ < 0.5 was the optimal cut-off point for "controlled asthma" (sensitivity 74.1%, specificity 77.5%) and 1.00 for "uncontrolled asthma" (sensitivity 73%, specificity 88.2%). Kappa index between GINA categories and ACQ was 0.62 (p < 0.001). The ACQ cut-off points associated with GINA-defined asthma control in a real-life setting were <0.5 for controlled asthma and ≥1 for uncontrolled asthma.

Cutoff value of thyroid uptake of (99m)Tc-pertechnetate to discriminate between Graves' disease and painless thyroiditis: a single center retrospective study.

PubMed

Uchida, Toyoyoshi; Suzuki, Ruriko; Kasai, Takatoshi; Onose, Hiroyuki; Komiya, Koji; Goto, Hiromasa; Takeno, Kageumi; Ishii, Shinya; Sato, Junko; Honda, Akira; Kawano, Yui; Himuro, Miwa; Yamada, Emiko; Yamada, Tetsu; Watada, Hirotaka

2016-01-01

Thyroid uptake of (99m)Tc-pertechnetate is a useful way to determine the cause of thyrotoxicosis. In daily clinical practice, (99m)Tc-pertechnetate uptake is used to discriminate between Graves' disease and painless thyroiditis when clinical information is not enough to make the distinction. However, since the optimal cutoff value of (99m)Tc-pertechnetate uptake has not yet been elucidated, our aim was to determine this value. We recruited patients with thyrotoxicosis in whom (99m)Tc-pertechnetate uptake was measured in clinical settings between 2009 and 2013. Three experienced endocrinologists (who were blinded to the value of (99m)Tc-pertechnetate uptake and initial treatment) diagnosed the cause of thyrotoxicosis based on thyrotropin, free triiodothyronine, free thyroxine, and thyrotropin receptor antibody levels, and by ultrasound findings and using images of thyroid uptake of (99m)Tc-pertechnetate without the actual values. Ninety-four patients diagnosed as having Graves' disease or painless thyroiditis were finally included. According to the diagnosis, the optimal cutoff value of (99m)Tc-pertechnetate uptake was determined by receiver operating characteristics analysis. A cutoff value of 1.0% provided optimal sensitivity and specificity of 96.6% and 97.1%, respectively. Then, its validity was confirmed in 78 patients with confirmed Graves' disease or painless thyroiditis diagnosed at another institute. Applying this cutoff value to the patients with thyrotoxicosis revealed positive and negative predictive values for Graves' disease of 100% and 88.9%, respectively. In conclusion, a cutoff value for (99m)Tc-pertechnetate uptake of 1.0% was useful to discriminate between Graves' disease and painless thyroiditis.

The cutoff values of indirect indices for measuring insulin resistance for metabolic syndrome in Korean children and adolescents.

PubMed

Kim, Jun Woo; Park, Sang Hoo; Kim, Yoojin; Im, Minji; Han, Heon-Seok

2016-09-01

The prevalence rates of metabolic syndrome (MetS) and percentile distribution of insulin resistance (IR) among Korean children and adolescents were investigated. The cutoff values of IR were calculated to identify high-risk MetS groups. Data from 3,313 Korean subjects (1,756 boys and 1,557 girls, aged 10-18 years) were included from the Korean National Health and Nutrition Examination Survey conducted during 2007-2010. Three different sets of criteria for MetS were used. Indirect measures of IR were homeostasis model assessment (HOMA-IR) and triglyceride and glucose (TyG) index. The cutoff values of the HOMA-IR and TyG index were obtained from the receiver operation characteristic curves. According to the MetS criteria of de Ferranti el al., Cook et al., and the International Diabetes Federation, the prevalence rates in males and females were 13.9% and 12.3%, 4.6% and 3.6%, and 1.4% and 1.8%, respectively. Uses these 3 criteria, the cutoff values of the HOMA-IR and TyG index were 2.94 and 8.41, 3.29 and 8.38, and 3.54 and 8.66, respectively. The cutoff values using each of the 3 criteria approximately corresponds to the 50th-75th, 75th, and 75th-90th percentiles of normal HOMA-IR and TyG index levels. This study describes the prevalence rates of MetS in Korean children and adolescents, an index of IR, and the cutoff values for MetS with the aim of detecting high-risk groups. The usefulness of these criteria needs to be verified by further evaluation.

N-tuple topological/geometric cutoffs for 3D N-linear algebraic molecular codifications: variability, linear independence and QSAR analysis.

PubMed

García-Jacas, C R; Marrero-Ponce, Y; Barigye, S J; Hernández-Ortega, T; Cabrera-Leyva, L; Fernández-Castillo, A

2016-12-01

Novel N-tuple topological/geometric cutoffs to consider specific inter-atomic relations in the QuBiLS-MIDAS framework are introduced in this manuscript. These molecular cutoffs permit the taking into account of relations between more than two atoms by using (dis-)similarity multi-metrics and the concepts related with topological and Euclidean-geometric distances. To this end, the kth two-, three- and four-tuple topological and geometric neighbourhood quotient (NQ) total (or local-fragment) spatial-(dis)similarity matrices are defined, to represent 3D information corresponding to the relations between two, three and four atoms of the molecular structures that satisfy certain cutoff criteria. First, an analysis of a diverse chemical space for the most common values of topological/Euclidean-geometric distances, bond/dihedral angles, triangle/quadrilateral perimeters, triangle area and volume was performed in order to determine the intervals to take into account in the cutoff procedures. A variability analysis based on Shannon's entropy reveals that better distribution patterns are attained with the descriptors based on the cutoffs proposed (QuBiLS-MIDAS NQ-MDs) with regard to the results obtained when all inter-atomic relations are considered (QuBiLS-MIDAS KA-MDs - 'Keep All'). A principal component analysis shows that the novel molecular cutoffs codify chemical information captured by the respective QuBiLS-MIDAS KA-MDs, as well as information not captured by the latter. Lastly, a QSAR study to obtain deeper knowledge of the contribution of the proposed methods was carried out, using four molecular datasets (steroids (STER), angiotensin converting enzyme (ACE), thermolysin inhibitors (THER) and thrombin inhibitors (THR)) widely used as benchmarks in the evaluation of several methodologies. One to four variable QSAR models based on multiple linear regression were developed for each compound dataset following the original division into training and test sets. The results obtained reveal that the novel cutoff procedures yield superior performances relative to those of the QuBiLS-MIDAS KA-MDs in the prediction of the biological activities considered. From the results achieved, it can be suggested that the proposed N-tuple topological/geometric cutoffs constitute a relevant criteria for generating MDs codifying particular atomic relations, ultimately useful in enhancing the modelling capacity of the QuBiLS-MIDAS 3D-MDs.

SPRUCE Bog Surface Elevation Assessments with SET Instrument Beginning in 2013

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hanson, Paul J; Phillips, Jana R; Brice, Deanne J

This data set reports plot-specific bog surface elevation measurements collected with the SPRUCE Elevation Transect (SET) instrument. Measurements are reported as absolute elevation in meters above mean sea level for two locations in each of the SPRUCE experimental treatment plots and additional ambient boardwalk plots -- 4, 5, 6, 7, 8, 9, 10, 11, 13, 14, 15, 16, 17, 19, 20 and 21. This data set reports measurements collected from June 2013 through August 2017, but it will be appended annually as new data are collected.

Newborn screening of glucose-6-phosphate dehydrogenase deficiency in Guangxi, China: determination of optimal cutoff value to identify heterozygous female neonates.

PubMed

Fu, Chunyun; Luo, Shiyu; Li, Qifei; Xie, Bobo; Yang, Qi; Geng, Guoxing; Lin, Caijuan; Su, Jiasun; Zhang, Yue; Wang, Jin; Qin, Zailong; Luo, Jingsi; Chen, Shaoke; Fan, Xin

2018-01-16

The aim of this study is to assess the disease incidence and mutation spectrum of glucose-6-phosphate dehydrogenase (G6PD) deficiency in Guangxi, China, and to determine an optimal cutoff value to identify heterozygous female neonates. A total of 130, 635 neonates were screened from the year of 2013 to 2017. Neonates suspected for G6PD deficiency were further analyzed by quantitatively enzymatic assay and G6PD mutation analysis. The overall incidence of G6PD deficiency was 7.28%. A total of 14 G6PD mutations were identified, and different mutations lead to varying levels of G6PD enzymatic activities. The best cut-off value of G6PD activity in male subjects is 2.2 U/g Hb, same as conventional setting. In female population, however, the cut-off value is found to be 2.8 U/g Hb (sensitivity: 97.5%, specificity: 87.7%, AUC: 0.964) to best discriminate between normal and heterozygotes, and 1.6 U/g Hb (sensitivity: 82.2%, specificity: 85.9%, AUC: 0.871) between heterozygotes and deficient subjects. In conclusion, we have conducted a comprehensive newborn screening of G6PD deficiency in a large cohort of population from Guangxi, China, and first established a reliable cut-off value of G6PD activity to distinguish heterozygous females from either normal or deficient subjects.

The reliability and validity of the Alcohol Use Disorders Identification Test (AUDIT) in a German general practice population sample.

PubMed

Dybek, Inga; Bischof, Gallus; Grothues, Janina; Reinhardt, Susa; Meyer, Christian; Hapke, Ulfert; John, Ulrich; Broocks, Andreas; Hohagen, Fritz; Rumpf, Hans-Jürgen

2006-05-01

Our goal was to analyze the retest reliability and validity of the Alcohol Use Disorders Identification Test (AUDIT) in a primary-care setting and recommend a cut-off value for the different alcohol-related diagnoses. Participants recruited from general practices (GPs) in two northern German cities received the AUDIT, which was embedded in a health-risk questionnaire. In total, 10,803 screenings were conducted. The retest reliability was tested on a subsample of 99 patients, with an intertest interval of 30 days. Sensitivity and specificity at a number of different cut-off values were estimated for the sample of alcohol consumers (n=8237). For this study, 1109 screen-positive patients received a diagnostic interview. Individuals who scored less than five points in the AUDIT and also tested negative in a second alcohol-related screen were defined as "negative" (n=6003). This definition was supported by diagnostic interviews of 99 screen-negative patients from which no false negatives could be detected. As the gold standard for detection of an alcohol-use disorder (AUD), we used the Munich-Composite International Diagnostic Interview (MCIDI), which is based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. On the item level, the reliability, measured by the intraclass correlation coefficient (ICC), ranged between .39 (Item 9) and .98 (Item 10). For the total score, the ICC was .95. For cut-off values of eight points and five points, 87.5% and 88.9%, respectively, of the AUDIT-positives, and 98.9% and 95.1%, respectively, of the AUDIT-negatives were identically identified at retest, with kappa = .86 and kappa = .81. At the cut-off value of five points, we determined good combinations of sensitivity and specificity for the following diagnoses: alcohol dependence (sensitivity and specificity of .97 and .88, respectively), AUD (.97 and .92), and AUD and/or at-risk consumption (.97 and .91). Embedded in a health-risk questionnaire in primary-care settings, the AUDIT is a reliable and valid screening instrument to identify at-risk drinkers and patients with an AUD. Our findings strongly suggest a lowering of the recommended cut-off value of eight points.

The importance of local criteria in the diagnosis of metabolic syndrome in Saudi Arabia

PubMed Central

Al Raddadi, Rajaa M.

2013-01-01

The clustering of risk factors predisposing an individual to cardiovascular morbidity and mortality are usually referred to as the ‘metabolic syndrome’ (MS). Several definitions exist, causing confusion to practicing clinicians. A consensus definition was reached by several major organizations stating that the presence of any three of five risk factors (abdominal obesity, elevated triglyceride, reduced high-density lipoprotein cholesterol, elevated blood pressure, and elevated fasting glucose) constitutes a diagnosis. Cutoff points for each of the risk factors were defined, taking into account ethnicity in case of abdominal obesity. The prevalence of MS has been reported to be on the rise globally, and was mainly attributed to changes in diet and lifestyle, in addition to genetic factors and metabolic susceptibility. The risk of cardiovascular disease (CVD) has almost doubled and the risk of developing type 2 diabetes mellitus (T2DM) has increased fivefold in individuals diagnosed with MS. The prevalence T2DM in Saudi Arabia is increasing, making it an epidemic health hazard. Intervention programs to decrease the risk of progression from MS to full T2DM, and later CVD have been successful in many countries. Therefore, diagnosing MS is important to address risk factors and to prevent progression to the more serious chronic conditions. The prevalence of MS in Saudi adults varies from 16% to 40% depending on the definition used and the study location. Use of the consensus definition might decrease the number of missed cases. However, in the absence of local cutoff points for various risk factors for MS, the use of ratios such as waist/hip ratio and low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio, and family history of diabetes and CVD might aid diagnosis. Priority should be given to establishing national normal ranges, screening programs for hyperglycemia and hypertension, and community-directed programs to combat obesity and inactivity. PMID:23626902

Depression, obesity, and metabolic syndrome: prevalence and risks of comorbidity in a population-based representative sample of Mexican Americans.

PubMed

Olvera, Rene L; Williamson, Douglas E; Fisher-Hoch, Susan P; Vatcheva, Kristina P; McCormick, Joseph B

2015-10-01

We examined the prevalence of depression, obesity, and metabolic syndrome and associations between them in a population-based representative cohort of Mexican Americans living on the United States-Mexico border. The sample in this cross-sectional analysis consisted of 1,768 Mexican American adults (≥ 18 years of age) assessed between the years 2004 and 2010, with whom we tested our central hypothesis of a significant relationship between obesity and depression. Depression was measured using the Center for Epidemiologic Studies-Depression scale (CES-D) with a cutoff score of ≥ 16 for depression and a cutoff score of ≥ 27 for severe depression. We categorized body mass index (BMI) values as obese (≥ 30kg/m(2)) and later subdivided the obese subjects into obese (30-39 kg/m(2)[inclusive]) and morbidly obese (≥ 40 kg/m(2)). Metabolic syndrome was defined using the American Heart Association definition requiring at least 3 of the following: increased waist circumference, elevated triglycerides, reduced high-density lipoprotein (HDL) cholesterol, elevated blood pressure, and elevated fasting glucose. Weighted data were analyzed to establish prevalence of depression, obesity, and metabolic syndrome. Univariate and multivariable weighted regression models were used to test potential associations between these disorders. Using weighted prevalence, we observed high rates of depression (30%), obesity (52%), and metabolic syndrome (45%). Univariate models revealed female gender (P = .0004), low education (P = .003), low HDL level (P = .009), and increased waist circumference (P = .03) were associated with depression. Female gender (P = .01), low education (P = .003), and morbid obesity (P = .002) were risk factors for severe depression and remained significant in multivariable models. In this large cohort of Mexican Americans, obesity, female gender, and low education were identified risk factors for depression. These indicators may serve as targets for early detection, prevention, and intervention in this population. © Copyright 2015 Physicians Postgraduate Press, Inc.

Additional diagnostic and prognostic value of copeptin ultra-sensitive for diagnosis of non-ST-elevation myocardial infarction in older patients presenting to the emergency department.

PubMed

Bahrmann, Philipp; Bahrmann, Anke; Breithardt, Ole-A; Daniel, Werner G; Christ, Michael; Sieber, Cornel C; Bertsch, Thomas

2013-06-01

Identifying older patients with non-ST- elevation myocardial infarction (NSTEMI) within the very large proportion with elevated high-sensitive cardiac troponin T (hs-cTnT) is a diagnostic challenge because they often present without clear symptoms or electrocardiographic features of acute coronary syndrome to the emergency department (ED). We prospectively investigated the diagnostic and prognostic performance of copeptin ultra-sensitive (copeptin-us) and hs-cTnT compared to hs-cTnT alone for NSTEMI at prespecified cut-offs in unselected older patients. We consecutively enrolled 306 non-surgical patients ≥70 years presenting to the ED. In addition to clinical examination, copeptin-us and hs-cTnT were measured at admission. Two cardiologists independently adjudicated the final diagnosis of NSTEMI after reviewing all available data. All patients were followed up for cardiovascular-related death within the following 12 months. NSTEMI was diagnosed in 38 (12%) patients (age 81±6 years). The combination of copeptin-us ≥14 pmol/L and hs-cTnT ≥0.014 µg/L compared to hs-cTnT ≥0.014 µg/L alone had a positive predictive value of 21% vs. 19% to rule in NSTEMI. The combination of copeptin-us <14 pmol/L and hs-cTnT <0.014 µg/L compared to hs-cTnT <0.014 µg/L alone had a negative predictive value of 100% vs. 99% to rule out NSTEMI. Hs-cTnT ≥0.014 µg/L alone was significantly associated with outcome. When copeptin-us ≥14 pmol/L was added, the net reclassification improvement for outcome was not significant (p=0.809). In unselected older patients presenting to the ED, the additional use of copeptin-us at predefined cut-offs may help to reliably rule out NSTEMI but may not help to increase predicted risk for outcome compared to hs-cTnT alone.

Analysis of the Fibrinogen and Neutrophil–Lymphocyte Ratio in Esophageal Squamous Cell Carcinoma

PubMed Central

Arigami, Takaaki; Okumura, Hiroshi; Matsumoto, Masataka; Uchikado, Yasuto; Uenosono, Yoshikazu; Kita, Yoshiaki; Owaki, Tetsuhiro; Mori, Shinichiro; Kurahara, Hiroshi; Kijima, Yuko; Ishigami, Sumiya; Natsugoe, Shoji

2015-01-01

Abstract Esophageal squamous cell carcinoma (ESCC) is one of the most aggressive malignancies in gastrointestinal tract cancers and even patients with early ESCC have a high metastatic potential. Difficulties are associated with clinically predicting tumor progression and prognosis based on conventional tumor markers determined from preoperative blood examinations. The aim of the present study was to measure plasma fibrinogen levels and the neutrophil–lymphocyte ratio (NLR) in blood and compare the clinical impacts of their combined values (fibrinogen and neutrophil–lymphocyte ratio score—F-NLR score) and the modified Glasgow Prognostic Score (mGPS) in patients with ESCC. We classified 238 patients with ESCC based on cut-off values for hyperfibrinogenemia (>400 mg/dL) and high NLR (>3.0) as F-NLR scores of 2 (both of these hematological abnormalities), 1 (one of these abnormalities), or 0 (neither abnormality). We also categorized patients based on cut-off values for high C-reactive protein (CRP) (>0.5 mg/dL) and hypoalbuminemia (<3.8 g/dL) as mGPS of 2 (elevated CRP and hypoalbuminemia), 1 (either elevated CRP or hypoalbuminemia), or 0 (neither elevated CRP nor hypoalbuminemia). The F-NLR score correlated with the depth of tumor invasion, lymph node metastasis, lymphovascular invasion, tumor size, and stage (all P < 0.05). Prognoses among the groups based on the F-NLR score and mGPS significantly differed (all P < 0.001). A multivariate analysis identified the depth of tumor invasion, lymph node metastasis, and F-NLR score as independent prognostic factors (P = 0.002, P = 0.007, and P = 0.037, respectively). The results of the present study showed that the F-NLR score is a promising blood predictor for tumor progression and outcomes in patients with ESCC. PMID:26496280

Analytic energy derivatives for the calculation of the first-order molecular properties using the domain-based local pair-natural orbital coupled-cluster theory

NASA Astrophysics Data System (ADS)

Datta, Dipayan; Kossmann, Simone; Neese, Frank

2016-09-01

The domain-based local pair-natural orbital coupled-cluster (DLPNO-CC) theory has recently emerged as an efficient and powerful quantum-chemical method for the calculation of energies of molecules comprised of several hundred atoms. It has been demonstrated that the DLPNO-CC approach attains the accuracy of a standard canonical coupled-cluster calculation to about 99.9% of the basis set correlation energy while realizing linear scaling of the computational cost with respect to system size. This is achieved by combining (a) localized occupied orbitals, (b) large virtual orbital correlation domains spanned by the projected atomic orbitals (PAOs), and (c) compaction of the virtual space through a truncated pair natural orbital (PNO) basis. In this paper, we report on the implementation of an analytic scheme for the calculation of the first derivatives of the DLPNO-CC energy for basis set independent perturbations within the singles and doubles approximation (DLPNO-CCSD) for closed-shell molecules. Perturbation-independent one-particle density matrices have been implemented in order to account for the response of the CC wave function to the external perturbation. Orbital-relaxation effects due to external perturbation are not taken into account in the current implementation. We investigate in detail the dependence of the computed first-order electrical properties (e.g., dipole moment) on the three major truncation parameters used in a DLPNO-CC calculation, namely, the natural orbital occupation number cutoff used for the construction of the PNOs, the weak electron-pair cutoff, and the domain size cutoff. No additional truncation parameter has been introduced for property calculation. We present benchmark calculations on dipole moments for a set of 10 molecules consisting of 20-40 atoms. We demonstrate that 98%-99% accuracy relative to the canonical CCSD results can be consistently achieved in these calculations. However, this comes with the price of tightening the threshold for the natural orbital occupation number cutoff by an order of magnitude compared to the DLPNO-CCSD energy calculations.

Watershed boundaries and digital elevation model of Oklahoma derived from 1:100,000-scale digital topographic maps

USGS Publications Warehouse

Cederstrand, J.R.; Rea, A.H.

1995-01-01

This document provides a general description of the procedures used to develop the data sets included on this compact disc. This compact disc contains watershed boundaries for Oklahoma, a digital elevation model, and other data sets derived from the digital elevation model. The digital elevation model was produced using the ANUDEM software package, written by Michael Hutchinson and licensed from the Centre for Resource and Environmental Studies at The Australian National University. Elevation data (hypsography) and streams (hydrography) from digital versions of the U.S. Geological Survey 1:100,000-scale topographic maps were used by the ANUDEM package to produce a hydrologically conditioned digital elevation model with a 60-meter cell size. This digital elevation model is well suited for drainage-basin delineation using automated techniques. Additional data sets include flow-direction, flow-accumulation, and shaded-relief grids, all derived from the digital elevation model, and the hydrography data set used in producing the digital elevation model. The watershed boundaries derived from the digital elevation model have been edited to be consistent with contours and streams from the U.S. Geological Survey 1:100,000-scale topographic maps. The watershed data set includes boundaries for 11-digit Hydrologic Unit Codes (watersheds) within Oklahoma, and 8-digit Hydrologic Unit Codes (cataloging units) outside Oklahoma. Cataloging-unit boundaries based on 1:250,000-scale maps outside Oklahoma for the Arkansas, Red, and White River basins are included. The other data sets cover Oklahoma, and where available, portions of 1:100,000-scale quadrangles adjoining Oklahoma.

The Stroop test as a measure of performance validity in adults clinically referred for neuropsychological assessment.

PubMed

Erdodi, Laszlo A; Sagar, Sanya; Seke, Kristian; Zuccato, Brandon G; Schwartz, Eben S; Roth, Robert M

2018-06-01

This study was designed to develop performance validity indicators embedded within the Delis-Kaplan Executive Function Systems (D-KEFS) version of the Stroop task. Archival data from a mixed clinical sample of 132 patients (50% male; M Age = 43.4; M Education = 14.1) clinically referred for neuropsychological assessment were analyzed. Criterion measures included the Warrington Recognition Memory Test-Words and 2 composites based on several independent validity indicators. An age-corrected scaled score ≤6 on any of the 4 trials reliably differentiated psychometrically defined credible and noncredible response sets with high specificity (.87-.94) and variable sensitivity (.34-.71). An inverted Stroop effect was less sensitive (.14-.29), but comparably specific (.85-90) to invalid performance. Aggregating the newly developed D-KEFS Stroop validity indicators further improved classification accuracy. Failing the validity cutoffs was unrelated to self-reported depression or anxiety. However, it was associated with elevated somatic symptom report. In addition to processing speed and executive function, the D-KEFS version of the Stroop task can function as a measure of performance validity. A multivariate approach to performance validity assessment is generally superior to univariate models. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

STS-114: Engine Cut-Off Sensors Are a No-Go: Teaching Notes for NASA Case Study

NASA Technical Reports Server (NTRS)

Ransom, Khadijah S.; Johnson, Grace K.

2013-01-01

This case study format is intended to simulate the experience of facing the same difficult challenges and making the same critical decisions as managers, engineers, and scientists in the Space Shuttle Program. It has been designed for use in the classroom setting to help students develop skills related to decision-making. Students will read about the engine cut-off sensor anomaly which created challenges during the STS-114 mission and have the opportunity to make decisions as lead NASA engineers and Mission Management Team members. Included within this document are three case study presentation options - class discussion, group activity, and open-ended research. Please read the full case prior to in-class presentation to allow ample time for students' analysis and reflection, as well as to prepare additional questions. activities or exercises, material selection, etc. Depending upon the setting of your presentation and the number of participants, please choose at least one presentation format beforehand and plan accordingly. You may expect the following learning objectives by using the proposed formats. Learning Objectives: To enable students to experience the responsibilities of NASA management, engineers, and analysis; to discover possible procedures for investigating system anomalies; to become familiar with the liquid hydrogen low level engine cut-off sensor, including its function, connecting components, and location within the Space Shuttle; and to encourage critical analysis and stimulating discussion of Space Shuttle mission challenges.

Dual expression of MYC and BCL2 proteins predicts worse outcomes in diffuse large B-cell lymphoma.

PubMed

Clark Schneider, Kelli M; Banks, Peter M; Collie, Angela M B; Lanigan, Christopher P; Manilich, Elena; Durkin, Lisa M; Hill, Brian T; Hsi, Eric D

2016-07-01

Recent studies suggested that MYC and BCL2 protein co-expression is an independent indicator of poor prognosis in diffuse large B-cell lymphoma. However, the immunohistochemistry protocols for dual-expression staining and the scoring cut-offs vary by study. Sixty-nine cases of diffuse large B-cell lymphoma were evaluated for MYC and BCL2 protein expression using various cut-offs that have been recommended in prior studies. Independent of the International Prognostic Index risk group, cases with dual protein expression of BCL2 and MYC using ≥50%/40% cut-offs and ≥70%/40% had significantly shorter overall survival than cases without. It was verified in this patient population that the use of BCL2 and MYC immunohistochemistry, performed with available in vitro diagnostic-cleared antibodies, provides rapid prognostic information in patients with de novo diffuse large B-cell lymphoma. This study has practical implications for diagnostic laboratories and serves as a guide for implementation in the setting of future clinical trials.

Tilting at wave beams: a new perspective on the St Andrew's Cross

NASA Astrophysics Data System (ADS)

Akylas, T. R.; Kataoka, T.; Ghaemsaidi, S. J.; Holzenberger, N.; Peacock, T.

2017-11-01

The generation of internal gravity waves by a vertically oscillating cylinder that is tilted to the horizontal in a stratified fluid of constant buoyancy frequency, is investigated theoretically and experimentally. This forcing arrangement leads to a variant of the classical St Andrew's Cross that has certain unique features: (i) radiation of wave beams is limited due to a lower cut-off frequency set by the cylinder tilt angle to the horizontal; (ii) the response is essentially three-dimensional, as end effects eventually come into play when the cut-off frequency is approached, however long a cylinder might be. These results follow from kinematic considerations and are also confirmed by laboratory experiments. The kinematic analysis, moreover, suggests a resonance phenomenon near the cut-off frequency, where viscous and nonlinear effects are likely to play an important part. This scenario is examined by an asymptotic model as well as experimentally. Supported in part by NSF Grant DMS-1512925.

Limit circuit prevents overdriving of operational amplifier

NASA Technical Reports Server (NTRS)

Openshaw, F. L.

1967-01-01

Cutoff-type high gain amplifier coupled by a diode prevents overdriving of operational amplifier. An amplified feedback signal offsets the excess input signal that tends to cause the amplifier to exceed its preset limit. The output is, therfore, held to the set clamp level.

Elevated Blood Pressure and Obesity in Childhood: A Cross-Sectional Evaluation of 4,609 Schoolchildren

PubMed Central

Rosaneli, Caroline Filla; Baena, Cristina Pellegrio; Auler, Flavia; Nakashima, Alika Terumi Arasaki; Netto-Oliveira, Edna Regina; Oliveira, Amauri Bássoli; Guarita-Souza, Luiz César; Olandoski, Marcia; Faria-Neto, José Rocha

2014-01-01

Background: The incidence of obesity in children is increasing worldwide, primarily in urbanized, high-income countries, and hypertension development is a detrimental effect of this phenomenon. Objective: In this cross-sectional study, we evaluated the prevalence of excess weight and its association with high blood pressure (BP) in schoolchildren. Methods: Here 4,609 male and female children, aged 6 to 11 years, from 24 public and private schools in Maringa, Brazil, were evaluated. Nutritional status was assessed by body mass index (BMI) according to cutoff points adjusted for sex and age. Blood pressure (BP) levels above 90th percentile for gender, age and height percentile were considered elevated. Results: The prevalence of excess weight among the schoolchildren was 24.5%; 16.9% were overweight, and 7.6% were obese. Sex and socioeconomic characteristics were not associated with elevated BP. In all age groups, systolic and diastolic BP correlated with BMI and waist and hip measurements, but not with waist-hip ratio. The prevalence of elevated BP was 11.2% in eutrophic children, 20.6% in overweight children [odds ratio (OR), 1.99; 95% confidence interval (CI), 1.61-2.45], and 39.7% in obese children (OR, 5.4; 95% CI, 4.23-6.89). Conclusion: Obese and overweight children had a higher prevalence of elevated BP than normal-weight children. Our data confirm that the growing worldwide epidemic of excess weight and elevated BP in schoolchildren may also be ongoing in Brazil. PMID:25076178

Elevated blood pressure and obesity in childhood: a cross-sectional evaluation of 4,609 schoolchildren.

PubMed

Rosaneli, Caroline Filla; Baena, Cristina Pellegrio; Auler, Flavia; Nakashima, Alika Terumi Arasaki; Netto-Oliveira, Edna Regina; Oliveira, Amauri Bássoli; Guarita-Souza, Luiz César; Olandoski, Marcia; Faria-Neto, José Rocha

2014-09-01

The incidence of obesity in children is increasing worldwide, primarily in urbanized, high-income countries, and hypertension development is a detrimental effect of this phenomenon. In this cross-sectional study, we evaluated the prevalence of excess weight and its association with high blood pressure (BP) in schoolchildren. Here 4,609 male and female children, aged 6 to 11 years, from 24 public and private schools in Maringa, Brazil, were evaluated. Nutritional status was assessed by body mass index (BMI) according to cutoff points adjusted for sex and age. Blood pressure (BP) levels above 90th percentile for gender, age and height percentile were considered elevated. The prevalence of excess weight among the schoolchildren was 24.5%; 16.9% were overweight, and 7.6% were obese. Sex and socioeconomic characteristics were not associated with elevated BP. In all age groups, systolic and diastolic BP correlated with BMI and waist and hip measurements, but not with waist-hip ratio. The prevalence of elevated BP was 11.2% in eutrophic children, 20.6% in overweight children [odds ratio (OR), 1.99; 95% confidence interval (CI), 1.61-2.45], and 39.7% in obese children (OR, 5.4; 95% CI, 4.23-6.89). Obese and overweight children had a higher prevalence of elevated BP than normal-weight children. Our data confirm that the growing worldwide epidemic of excess weight and elevated BP in schoolchildren may also be ongoing in Brazil.

Screen for intracranial dural arteriovenous fistulae with carotid duplex sonography.

PubMed

Tsai, L-K; Yeh, S-J; Chen, Y-C; Liu, H-M; Jeng, J-S

2009-11-01

Early diagnosis and management of intracranial dural arteriovenous fistulae (DAVF) may prevent the occurrence of stroke. This study aimed to identify the best carotid duplex sonography (CDS) parameters for screening DAVF. 63 DAVF patients and 170 non-DAVF patients received both CDS and conventional angiography. The use of seven CDS haemodynamic parameter sets related to the resistance index (RI) of the external carotid artery (ECA) for the diagnosis of DAVF was validated and the applicability of the best CDS parameter set in 20 400 patients was tested. The CDS parameter set (ECA RI (cut-off point = 0.7) and internal carotid artery (ICA) to ECA RI ratio (cut-off point = 0.9)) had the highest specificity (99%) for diagnosis of DAVF with moderate sensitivity (51%). Location of the DAVF was a significant determinant of sensitivity of detection, which was 70% for non-cavernous DAVF and 0% for cavernous sinus DAVF (p<0.001). The above parameter set detected abnormality in 92 of 20 400 patients. These abnormalities included DAVF (n = 25), carotid stenosis (n = 32), vertebral artery stenosis (n = 7), intracranial arterial stenosis (n = 6), head and neck tumour (n = 3) and unknown aetiology (n = 19). Combined CDS parameters of ECA RI and ICA to ECA RI ratio can be used as a screening tool for the diagnosis of DAVF.

Influence of erroneous patient records on population pharmacokinetic modeling and individual bayesian estimation.

PubMed

van der Meer, Aize Franciscus; Touw, Daniël J; Marcus, Marco A E; Neef, Cornelis; Proost, Johannes H

2012-10-01

Observational data sets can be used for population pharmacokinetic (PK) modeling. However, these data sets are generally less precisely recorded than experimental data sets. This article aims to investigate the influence of erroneous records on population PK modeling and individual maximum a posteriori Bayesian (MAPB) estimation. A total of 1123 patient records of neonates who were administered vancomycin were used for population PK modeling by iterative 2-stage Bayesian (ITSB) analysis. Cut-off values for weighted residuals were tested for exclusion of records from the analysis. A simulation study was performed to assess the influence of erroneous records on population modeling and individual MAPB estimation. Also the cut-off values for weighted residuals were tested in the simulation study. Errors in registration have limited the influence on outcomes of population PK modeling but can have detrimental effects on individual MAPB estimation. A population PK model created from a data set with many registration errors has little influence on subsequent MAPB estimates for precisely recorded data. A weighted residual value of 2 for concentration measurements has good discriminative power for identification of erroneous records. ITSB analysis and its individual estimates are hardly affected by most registration errors. Large registration errors can be detected by weighted residuals of concentration.

IRIS II Study: Sensitivity and specificity of intact proinsulin, adiponectin, and the proinsulin/adiponectin ratio as markers for insulin resistance.

PubMed

Langenfeld, Matthias R; Forst, Thomas; Standl, Eberhard; Strotmann, Hermann-Josef; Lübben, Georg; Pahler, Sabine; Kann, Peter; Pfützner, Andreas

2004-12-01

This study was performed to compare the specificity and sensitivity of intact proinsulin, adiponectin, and their ratio (proinsulin/adiponectin) in the prediction of insulin resistance as assessed by the homeostasis model assessment (HOMA) score (> or =2 = resistant). Using a cross-sectional approach, 500 orally treated patients with type 2 diabetes (272 women, 238 men; mean +/- SD age, 64.8 +/- 11.6 years; hemoglobin A1c, 7.0 +/- 1.5%; disease duration, 5.8 +/- 6.1 years) were investigated. Various cutoffs for body mass index-adjusted adiponectin and proinsulin/adiponectin were compared with the established cutoff value of 10 pmol/L for fasting proinsulin. Fasting proinsulin correlated more closely with the HOMA score (r = 0.560, P < 0.001) than fasting adiponectin (r = -0.204, P < 0.001) or proinsulin/adiponectin (r = 0.355, P < 0.001). For proinsulin, specificity and sensitivity for insulin resistance in correlation to the HOMA score results were 96% and 70%, respectively. At a comparable specificity level to proinsulin, adiponectin did not reach a comparable sensitivity (14%), while the proinsulin/adiponectin ratio almost reached the same sensitivity (65%). Overall, patients with elevated proinsulin had a higher prevalence of micro- and macrovascular disease [odds ratio 1.47 (adiponectin, 1.08; proinsulin/ adiponectin, 1.48) and 1.34 (adiponectin, 1.32; proinsulin/adiponectin, 1.27), respectively]. Elevation of fasting intact proinsulin seems to be the more specific marker for insulin resistance and increased cardiovascular risk than suppression of fasting adiponectin. Formation of the ratio does not lead to a further increase in the predictive value.

What is the role of florine-18 fluorodeoxyglucose/positron emission tomography/computed tomography imaging in well-differentiated thyroid cancers with negative iodine-131 scan high thyroglobulin and normal anti-thyroglobulin levels.

PubMed

Döner, Rana Kaya; Sager, Sait; Görtan, Fatma Arzu; Topuz, Özge Vural; Akyel, Reşit; Vatankulu, Betül; Baran, Ahmet; Teksoz, Serkan; Sönmezoglu, Kerim

2016-01-01

This retrospective study aims to assess the cut-off value of thyroglobulin (Tg) levels in nux or metastatic well-differentiated thyroid cancers (DTCs) with normal anti-Tg levels using with fluorodeoxyglucose/positron emission tomography/computed tomography (FDG PET/CT). We reviewed FDG PET/CT images of 104 patients with well DTC (28 men, 76 women) whose: Iodine-131 (131 I) whole-body scanning was negative but had elevated Tg with normal anti-Tg levels. The overall sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of florine-18-FDG PET/CT findings were found to be 95.92%, 87.27%, 87.04%, 96.00%, and 91.35%, respectively. The best Tg cut-off value was found to be 10.4 ng/ml. In the Tg level <10.4 ng/ml group, the sensitivity, specificity, PPV, NPV, and accuracy of FDG PET/CT were found to be 94.1%, 91.30%, 88.8%, 95.4%, and 92.5%, respectively. In the other group, which Tg level ≥10.4 ng/ml, sensitivity, specificity, PPV, NPV, and accuracy of FDG PET/CT exams were found to be 96.8%, 84.3%, 86.1%, 96.4%, and 90.6%, respectively. FDG PET/CT imaging is a valuable imaging method in the evaluation of patients with elevated serum Tg levels and normal anti-Tg levels. Furthermore, it has potential utility in the dedifferentiation of active foci that are present, and in assessing optimal decision making during follow-up.

Otoacoustic emissions in the general adult population of Nord-Trøndelag, Norway: III. Relationships with pure-tone hearing thresholds.

PubMed

Engdahl, Bo; Tambs, Kristian; Borchgrevink, Hans M; Hoffman, Howard J

2005-01-01

This study aims to describe the association between otoacoustic emissions (OAEs) and pure-tone hearing thresholds (PTTs) in an unscreened adult population (N =6415), to determine the efficiency by which TEOAEs and DPOAEs can identify ears with elevated PTTs, and to investigate whether a combination of DPOAE and TEOAE responses improves this performance. Associations were examined by linear regression analysis and ANOVA. Test performance was assessed by receiver operator characteristic (ROC) curves. The relation between OAEs and PTTs appeared curvilinear with a moderate degree of non-linearity. Combining DPOAEs and TEOAEs improved performance. Test performance depended on the cut-off thresholds defining elevated PTTs with optimal values between 25 and 45 dB HL, depending on frequency and type of OAE measure. The unique constitution of the present large sample, which reflects the general adult population, makes these results applicable to population-based studies and screening programs.

Effect of diurnal temperature range on cardiovascular markers in the elderly in Seoul, Korea

NASA Astrophysics Data System (ADS)

Lim, Youn-Hee; Kim, Ho; Kim, Jin Hee; Bae, Sanghyuk; Hong, Yun-Chul

2013-07-01

While diurnal temperature range (DTR) has been found to be a risk factor for mortality, evaluation of the underlying mechanisms involved in this association are lacking. To explain the association between DTR and health effects, we investigated how cardiovascular markers responded to DTR. Data was obtained from 560 participants who regularly attended a community elderly welfare center located in Seoul, Korea. Data collection was conducted a total of five times over a 3-year period beginning in August, 2008. We examined systolic and diastolic blood pressure (BP), heart rate (HR), and heart rate variability (HRV). Mixed-effects models and generalized additive mixed models were used to assess the relationship of DTR with BP, HR, and HRV. BP was not associated significantly with rapid temperature changes during the day. While HR was associated linearly with increments of DTR, the relationship between DTR and HRV showed nonlinear associations, or the presence of a cutoff around median DTR. At the cutoff level of DTR determined by an inflection point in the graph, standard deviation of normal-to-normal intervals (SDNN) and root mean square successive difference (RMSSD) were peaked, whereas the low frequency:high frequency (LF:HF) ratio was elevated with decreasing DTR below the cutoff level. The study demonstrated that HR increases with increasing temperature range during the day, and that HRV is reduced at small or large DTR, which suggests minimal cardiovascular stress around the median level of temperature range during the day.

Development and Standardization of the Diagnostic Adaptive Behavior Scale: Application of Item Response Theory to the Assessment of Adaptive Behavior.

PubMed

Tassé, Marc J; Schalock, Robert L; Thissen, David; Balboni, Giulia; Bersani, Henry Hank; Borthwick-Duffy, Sharon A; Spreat, Scott; Widaman, Keith F; Zhang, Dalun; Navas, Patricia

2016-03-01

The Diagnostic Adaptive Behavior Scale (DABS) was developed using item response theory (IRT) methods and was constructed to provide the most precise and valid adaptive behavior information at or near the cutoff point of making a decision regarding a diagnosis of intellectual disability. The DABS initial item pool consisted of 260 items. Using IRT modeling and a nationally representative standardization sample, the item set was reduced to 75 items that provide the most precise adaptive behavior information at the cutoff area determining the presence or not of significant adaptive behavior deficits across conceptual, social, and practical skills. The standardization of the DABS is described and discussed.

Effects of bandwidth, compression speed, and gain at high frequencies on preferences for amplified music.

PubMed

Moore, Brian C J

2012-09-01

This article reviews a series of studies on the factors influencing sound quality preferences, mostly for jazz and classical music stimuli. The data were obtained using ratings of individual stimuli or using the method of paired comparisons. For normal-hearing participants, the highest ratings of sound quality were obtained when the reproduction bandwidth was wide (55 to 16000 Hz) and ripples in the frequency response were small (less than ± 5 dB). For hearing-impaired participants listening via a simulated five-channel compression hearing aid with gains set using the CAM2 fitting method, preferences for upper cutoff frequency varied across participants: Some preferred a 7.5- or 10-kHz upper cutoff frequency over a 5-kHz cutoff frequency, and some showed the opposite preference. Preferences for a higher upper cutoff frequency were associated with a shallow high-frequency slope of the audiogram. A subsequent study comparing the CAM2 and NAL-NL2 fitting methods, with gains slightly reduced for participants who were not experienced hearing aid users, showed a consistent preference for CAM2. Since the two methods differ mainly in the gain applied for frequencies above 4 kHz (CAM2 recommending higher gain than NAL-NL2), these results suggest that extending the upper cutoff frequency is beneficial. A system for reducing "overshoot" effects produced by compression gave small but significant benefits for sound quality of a percussion instrument (xylophone). For a high-input level (80 dB SPL), slow compression was preferred over fast compression.

Temporal modulation transfer functions for listeners with real and simulated hearing loss

PubMed Central

Desloge, Joseph G.; Reed, Charlotte M.; Braida, Louis D.; Perez, Zachary D.; Delhorne, Lorraine A.

2011-01-01

A functional simulation of hearing loss was evaluated in its ability to reproduce the temporal modulation transfer functions (TMTFs) for nine listeners with mild to profound sensorineural hearing loss. Each hearing loss was simulated in a group of three age-matched normal-hearing listeners through spectrally shaped masking noise or a combination of masking noise and multiband expansion. TMTFs were measured for both groups of listeners using a broadband noise carrier as a function of modulation rate in the range 2 to 1024 Hz. The TMTFs were fit with a lowpass filter function that provided estimates of overall modulation-depth sensitivity and modulation cutoff frequency. Although the simulations were capable of accurately reproducing the threshold elevations of the hearing-impaired listeners, they were not successful in reproducing the TMTFs. On average, the simulations resulted in lower sensitivity and higher cutoff frequency than were observed in the TMTFs of the hearing-impaired listeners. Discrepancies in performance between listeners with real and simulated hearing loss are possibly related to inaccuracies in the simulation of recruitment. PMID:21682411

Investigating sensitivity, specificity, and area under the curve of the Clinical COPD Questionnaire, COPD Assessment Test, and Modified Medical Research Council scale according to GOLD using St George's Respiratory Questionnaire cutoff 25 (and 20) as reference.

PubMed

Tsiligianni, Ioanna G; Alma, Harma J; de Jong, Corina; Jelusic, Danijel; Wittmann, Michael; Schuler, Michael; Schultz, Konrad; Kollen, Boudewijn J; van der Molen, Thys; Kocks, Janwillem Wh

2016-01-01

In the GOLD (Global initiative for chronic Obstructive Lung Disease) strategy document, the Clinical COPD Questionnaire (CCQ), COPD Assessment Test (CAT), or modified Medical Research Council (mMRC) scale are recommended for the assessment of symptoms using the cutoff points of CCQ ≥1, CAT ≥10, and mMRC scale ≥2 to indicate symptomatic patients. The current study investigates the criterion validity of the CCQ, CAT and mMRC scale based on a reference cutoff point of St George's Respiratory Questionnaire (SGRQ) ≥25, as suggested by GOLD, following sensitivity and specificity analysis. In addition, areas under the curve (AUCs) of the CCQ, CAT, and mMRC scale were compared using two SGRQ cutoff points (≥25 and ≥20). Two data sets were used: study A, 238 patients from a pulmonary rehabilitation program; and study B, 101 patients from primary care. Receiver-operating characteristic (ROC) curves were used to assess the correspondence between the recommended cutoff points of the questionnaires. Sensitivity, specificity, and AUC scores for cutoff point SGRQ ≥25 were: study A, 0.99, 0.43, and 0.96 for CCQ ≥1, 0.92, 0.48, and 0.89 for CAT ≥10, and 0.68, 0.91, and 0.91 for mMRC ≥2; study B, 0.87, 0.77, and 0.9 for CCQ ≥1, 0.76, 0.73, and 0.82 for CAT ≥10, and 0.21, 1, and 0.81 for mMRC ≥2. Sensitivity, specificity, and AUC scores for cutoff point SGRQ ≥20 were: study A, 0.99, 0.73, and 0.99 for CCQ ≥1, 0.91, 0.73, and 0.94 for CAT ≥10, and 0.66, 0.95, and 0.94 for mMRC ≥2; study B, 0.8, 0.89, and 0.89 for CCQ ≥1, 0.69, 0.78, and 0.8 for CAT ≥10, and 0.18, 1, and 0.81 for mMRC ≥2. Based on data from these two different samples, this study showed that the suggested cutoff point for the SGRQ (≥25) did not seem to correspond well with the established cutoff points of the CCQ or CAT scales, resulting in low specificity levels. The correspondence with the mMRC scale seemed satisfactory, though not optimal. The SGRQ threshold of ≥20 corresponded slightly better than SGRQ ≥25, recently suggested by GOLD 2015, with the established cutoff points for the CCQ, CAT, and mMRC scale.

Usefulness of N-terminal pro-brain natriuretic Peptide and brain natriuretic peptide to predict cardiovascular outcomes in patients with heart failure and preserved left ventricular ejection fraction.

PubMed

Grewal, Jasmine; McKelvie, Robert S; Persson, Hans; Tait, Peter; Carlsson, Jonas; Swedberg, Karl; Ostergren, Jan; Lonn, Eva

2008-09-15

More than 40% of patients hospitalized with heart failure have preserved left ventricular ejection fraction (HF-PLVEF) and are at high risk for cardiovascular (CV) events. The purpose of this study was to determine the value of N-terminal pro-brain natriuretic peptide (NT-proBNP) and brain natriuretic peptide (BNP) in predicting CV outcomes in patients with HF-PLVEF. Participants with an ejection fraction >40% in the prospective CHARM Echocardiographic Substudy were included in this analysis. Plasma NT-proBNP levels were measured, and 2 cut-offs were selected prospectively at 300 pg/ml and 600 pg/ml. BNP cut-off was set at 100 pg/ml. Clinical characteristics were recorded, and systolic and diastolic function were evaluated by echocardiography. The primary substudy outcome was the composite of CV mortality, hospitalization for heart failure, and myocardial infarction or stroke. A total of 181 patients were included, and there were 17 primary CV events (9.4%) during a median follow-up time of 524 days. In a model including clinical characteristics, echocardiographic measures, and BNP or NT-proBNP, the composite CV event outcome was best predicted by NT-proBNP >300 pg/ml (hazard ratio 5.8, 95% confidence intervals [CI] 1.3 to 26.4, p = 0.02) and moderate or severe diastolic dysfunction on echocardiography. When NT-proBNP >600 pg/ml was used in the model, it was the sole independent predictor of primary CV events (hazard ratio 8.0, 95% CI 2.6 to 24.8, p = 0.0003) as was BNP >100 pg/ml (hazard ratio 3.1, 95% CI 1.2 to 8.2, p = 0.02) in the BNP model. In conclusion, both elevated NT-proBNP and BNP are strong independent predictors of clinical events in patients with HF-PLVEF.

Comparison of four different cardiac troponin assays in patients with end-stage renal disease on chronic haemodialysis.

PubMed

Helleskov Madsen, Lene; Ladefoged, Søren; Hildebrandt, Per; Atar, Dan

2008-01-01

Several studies have documented the importance of troponin elevation as a prognostic marker in end-stage renal disease (ESRD). The reason for the elevated concentrations is not clarified. We do not know whether the different assays recognize the same patients within ESRD populations. The aim of this study was to compare concentrations of troponin measured by four different assays in a cohort of patients with ESRD, to investigate whether haemodialysis affects troponin concentrations, and to compare the prognostic potential of the different assays. We included 109 patients on chronic haemodialysis. Serum cardiac troponin T (cTnT) was measured pre- and postdialysis using Elecsys 2010 and troponin I (cTnI) using Access AccuTnI, Dimension RxL and AIA-600II. The cTnT assay had the highest percentage of elevated concentrations for all chosen cut-offs with a reduction in percentage of patients with elevated concentrations during haemodialysis. Elecsys 2010 and AIA-600II demonstrated a significant increased mortality with raised concentrations of troponin. The diverging results in previous studies are most likely based on substantial differences in the analytical performance of the assays. The prognostic value of cTnT appears superior to cTnI, which amplifies the prognostic significance of this cardiovascular marker in patients with ESRD.

Prognostic significance of pretreatment neutrophil-to-lymphocyte ratio in melanoma patients: A meta-analysis.

PubMed

Zhan, Hui; Ma, Jian-Ying; Jian, Qi-Chao

2018-05-29

Recently, the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) has been widely evaluated in many cancers. Here we assessed the prognostic value of pretreatment NLR in melanoma. A range of online databases was systematically searched up to March,2018 for identify available studies which assessed the prognostic significance of NLR. Data from studies reporting a hazard ratio (HR) and 95% confidence interval (CI) were weighted by generic inverse-variance and pooled in random effects meta-analysis. Twelve studies with 4593 individuals were included. Patients with elevated NLR had a significantly shorter overall survival (OS) (HR: 1.56, 95% CI: 1.28-1.90, p < .001) and disease-free survival (DFS)/progression-free survival (PFS) (HR = 1.86; 95% CI = 1.24-2.80; P = .003). Subgroup analyses showed that the negative prognostic effect of elevated NLR on OS remained substantial in North American and Europen populations and patients with non-metastatic and metastatic stage. Additionally, elevated NLR was related to worse OS in patients with melanoma, regardless of the sample size and the cut-off value. Our findings suggest that elevated pretreatment NLR was associated with poor prognosis in melanoma patients, suggesting NLR might be a prognostic factor in patients with melanoma. Copyright © 2018 Elsevier B.V. All rights reserved.

Determination of Isavuconazole Susceptibility of Aspergillus and Candida Species by the EUCAST Method

PubMed Central

Howard, Susan J.; Lass-Flörl, Cornelia; Cuenca-Estrella, Manuel; Gomez-Lopez, Alicia

2013-01-01

Isavuconazole is a novel expanded-spectrum triazole, which has recently been approved by the FDA as an orphan drug to treat invasive aspergillosis and is currently being studied in phase III clinical trials for invasive candidiasis. The susceptibility of relatively few clinical isolates has been reported. In this study, the isavuconazole susceptibilities of 1,237 Aspergillus and 2,010 Candida geographically diverse clinical isolates were determined by EUCAST methodology at four European mycology laboratories, producing the largest multicenter data set thus far for this compound. In addition, a blinded collection of 30 cyp51A mutant Aspergillus fumigatus clinical isolates and 10 wild-type isolates was tested. From these two data sets, the following preliminary epidemiological cutoff (ECOFF) values were suggested: 2 mg/liter for Aspergillus fumigatus, Aspergillus terreus, and Aspergillus flavus; 4 mg/liter for Aspergillus niger; 0.25 mg/liter for Aspergillus nidulans; and 0.03 mg/liter for Candida albicans, Candida parapsilosis, and Candida tropicalis. Unfortunately, ECOFFs could not be determined for Candida glabrata or Candida krusei due to an unexplained interlaboratory MIC variation. For the blinded collection of A. fumigatus isolates, all MICs were ≤2 mg/liter for wild-type isolates. Differential isavuconazole MICs were observed for triazole-resistant A. fumigatus isolates with different cyp51A alterations: TR34/L98H mutants had elevated isavuconazole MICs, whereas isolates with G54 and M220 alterations had MICs in the wild-type range, suggesting that the efficacy of isavuconazole may not be affected by these alterations. This study will be an aid in interpreting isavuconazole MICs for clinical care and an important step in the future process of setting official clinical breakpoints. PMID:23959309

Canadian global village reality: anthropometric surrogate cutoffs and metabolic abnormalities among Canadians of East Asian, South Asian, and European descent.

PubMed

He, Meizi; Li, E T S; Harris, Stewart; Huff, Murray W; Yau, Chun Y; Anderson, G Harvey

2010-05-01

To test the appropriateness of body mass index (BMI) and waist circumference (WC) cutoff points derived in largely white populations (ie, those of European descent) for detecting obesity-related metabolic abnormalities among East Asian and South Asian Canadians. Cross-sectional survey. Primary care and community settings in Ontario. Canadians of East Asian (n = 130), South Asian (n = 113), and European (n = 111) descent. Variables for metabolic syndromes, including BMI, WC, body fat percentage, blood pressure, lipid profile, and fasting blood glucose and insulin levels, were measured. Receiver operating characteristics curve analysis was used to generate BMI and WC cutoff points based on various criteria for metabolic syndromes. Adjusting for sex and age, East Asian Canadians had a significantly lower mean BMI (23.2 kg/m(2)) and mean WC (79.6 cm) than did those of South Asian (26.1 kg/m(2) and 90.3 cm) and European (26.5 kg/m(2) and 89.3 cm) descent (P < .05). The BMI cutoffs for an increased risk of metabolic abnormalities ranged from 23.1 to 24.4 kg/m(2) in East Asian Canadians; 26.6 to 26.8 kg/m(2) in South Asian Canadians; and 26.3 to 28.2 kg/m(2) in European Canadians. Waist circumference cutoffs for increased risk of metabolic abnormalities were relatively low in East Asian men (83.3 to 85.2 cm) and women (74.1 to 76.7 cm), compared with South Asian men (98.8 cm) and women (90.1 to 93.5 cm), as well as European men (91.6 to 95.2 cm) and women (82.8 to 88.3 cm). The BMI and WC cutoffs used for defining risk of metabolic abnormalities should be lowered for East Asian Canadians but not for South Asian Canadians. The World Health Organization ethnic-specific BMI and WC cutoffs should be used with caution, particularly with Asian migrants who have resided in Canada for a long period of time.

Tropospheric products of the second GOP European GNSS reprocessing (1996-2014)

NASA Astrophysics Data System (ADS)

Dousa, Jan; Vaclavovic, Pavel; Elias, Michal

2017-09-01

In this paper, we present results of the second reprocessing of all data from 1996 to 2014 from all stations in International Association of Geodesy (IAG) Reference Frame Sub-Commission for Europe (EUREF) Permanent Network (EPN) as performed at the Geodetic Observatory Pecný (GOP). While the original goal of this research was to ultimately contribute to the realization of a new European Terrestrial Reference System (ETRS), we also aim to provide a new set of GNSS (Global Navigation Satellite System) tropospheric parameter time series with possible applications to climate research. To achieve these goals, we improved a strategy to guarantee the continuity of these tropospheric parameters and we prepared several variants of troposphere modelling. We then assessed all solutions in terms of the repeatability of coordinates as an internal evaluation of applied models and strategies and in terms of zenith tropospheric delays (ZTDs) and horizontal gradients with those of the ERA-Interim numerical weather model (NWM) reanalysis. When compared to the GOP Repro1 (first EUREF reprocessing) solution, the results of the GOP Repro2 (second EUREF reprocessing) yielded improvements of approximately 50 and 25 % in the repeatability of the horizontal and vertical components, respectively, and of approximately 9 % in tropospheric parameters. Vertical repeatability was reduced from 4.14 to 3.73 mm when using the VMF1 mapping function, a priori ZHD (zenith hydrostatic delay), and non-tidal atmospheric loading corrections from actual weather data. Raising the elevation cut-off angle from 3 to 7° and then to 10° increased RMS from coordinates' repeatability, which was then confirmed by independently comparing GNSS tropospheric parameters with the NWM reanalysis. The assessment of tropospheric horizontal gradients with respect to the ERA-Interim revealed a strong sensitivity of estimated gradients to the quality of GNSS antenna tracking performance. This impact was demonstrated at the Mallorca station, where gradients systematically grew up to 5 mm during the period between 2003 and 2008, before this behaviour disappeared when the antenna at the station was changed. The impact of processing variants on long-term ZTD trend estimates was assessed at 172 EUREF stations with time series longer than 10 years. The most significant site-specific impact was due to the non-tidal atmospheric loading followed by the impact of changing the elevation cut-off angle from 3 to 10°. The other processing strategy had a very small or negligible impact on estimated trends.

Diagnostic value of drain amylase for detecting intrathoracic leakage after esophagectomy

PubMed Central

Berkelmans, Gijs HK; Kouwenhoven, Ewout A; Smeets, Boudewijn JJ; Weijs, Teus J; Silva Corten, Luis C; van Det, Marc J; Nieuwenhuijzen, Grard AP; Luyer, Misha DP

2015-01-01

AIM: To investigate the value of elevated drain amylase concentrations for detecting anastomotic leakage (AL) after minimally invasive Ivor-Lewis esophagectomy (MI-ILE). METHODS: This was a retrospective analysis of prospectively collected data in two hospitals in the Netherlands. Consecutive patients undergoing MI-ILE were included. A Jackson-Pratt drain next to the dorsal side of the anastomosis and bilateral chest drains were placed at the end of the thoracoscopic procedure. Amylase levels in drain fluid were determined in all patients during at least the first four postoperative days. Contrast computed tomography scans and/or endoscopic imaging were performed in cases of a clinically suspected AL. Anastomotic leakage was defined as any sign of leakage of the esophago-gastric anastomosis on endoscopy, re-operation, radiographic investigations, post mortal examination or when gastro-intestinal contents were found in drain fluid. Receiver operator characteristic curves were used to determine the cut-off values. Sensitivity, specificity, positive predictive value, negative predictive value, risk ratio and overall test accuracy were calculated for elevated drain amylase concentrations. RESULTS: A total of 89 patients were included between March 2013 and August 2014. No differences in group characteristics were observed between patients with and without AL, except for age. Patients with AL were older than were patients without AL (P = 0.01). One patient (1.1%) without AL died within 30 d after surgery due to pneumonia and acute respiratory distress syndrome. Anastomotic leakage that required any intervention occurred in 15 patients (16.9%). Patients with proven anastomotic leakage had higher drain amylase levels than patients without anastomotic leakage [median 384 IU/L (IQR 34-6263) vs median 37 IU/L (IQR 26-66), P = 0.003]. Optimal cut-off values on postoperative days 1, 2, and 3 were 350 IU/L, 200 IU/L and 160 IU/L, respectively. An elevated amylase level was found in 9 of the 15 patients with AL. Five of these 9 patients had early elevations of their amylase levels, with a median of 2 d (IQR 2-5) before signs and symptoms occurred. CONCLUSION: Measurement of drain amylase levels is an inexpensive and easy tool that may be used to screen for anastomotic leakage soon after MI-ILE. However, clinical validation of this marker is necessary. PMID:26290638

Postoperative Tachycardia: Clinically Meaningful or Benign Consequence of Orthopedic Surgery?

PubMed

Sigmund, Alana E; Fang, Yixin; Chin, Matthew; Reynolds, Harmony R; Horwitz, Leora I; Dweck, Ezra; Iturrate, Eduardo

2017-01-01

To determine the clinical significance of tachycardia in the postoperative period. Individuals 18 years or older undergoing hip and knee arthroplasty were included in the study. Two data sets were collected from different time periods: development data set from January 1, 2011, through December 31, 2011, and validation data set from December 1, 2012, through September 1, 2014. We used the development data set to identify the optimal definition of tachycardia with the strongest association with the vascular composite outcome (pulmonary embolism and myocardial necrosis and infarction). The predictive value of this definition was assessed in the validation data set for each outcome of interest, pulmonary embolism, myocardial necrosis and infarction, and infection using multiple logistic regression to control for known risk factors. In 1755 patients in the development data set, a maximum heart rate (HR) greater than 110 beats/min was found to be the best cutoff as a correlate of the composite vascular outcome. Of the 4621 patients who underwent arthroplasty in the validation data set, 40 (0.9%) had pulmonary embolism. The maximum HR greater than 110 beats/min had an odds ratio (OR) of 9.39 (95% CI, 4.67-18.87; sensitivity, 72.5%; specificity, 78.0%; positive predictive value, 2.8%; negative predictive value, 99.7%) for pulmonary embolism. Ninety-seven patients (2.1%) had myocardial necrosis (elevated troponin). The maximum HR greater than 110 beats/min had an OR of 4.71 (95% CI, 3.06-7.24; sensitivity, 47.4%; specificity, 78.1%; positive predictive value, 4.4%; negative predictive value, 98.6%) for this outcome. Thirteen (.3%) patients had myocardial infarction according to our predetermined definition, and the maximum HR greater than 110 beats/min had an OR of 1.72 (95% CI, 0.47-6.27). Postoperative tachycardia within the first 4 days of surgery should not be dismissed as a postoperative variation in HR, but may precede clinically significant adverse outcomes. Copyright © 2016 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Diagnostic utility of attenuation measurement (Hounsfield units) in computed tomography stonogram in predicting the radio-opacity of urinary calculi in plain abdominal radiographs.

PubMed

Chua, Michael E; Gatchalian, Glenn T; Corsino, Michael Vincent; Reyes, Buenaventura B

2012-10-01

(1) To determine the best cut-off level of Hounsfield units (HU) in the CT stonogram that would predict the appearance of a urinary calculi in plain KUB X-ray; (2) to estimate the sensitivity and specificity of the best cut-off HU; and (3) to determine whether stone size and location affect the in vivo predictability. A prospective cross-sectional study of patients aged 18-85 diagnosed with urolithiases on CT stonogram with concurrent plain KUB radiograph was conducted. Appearance of stones was recorded, and significant difference between radiolucent and radio-opaque CT attenuation level was determined using ANOVA. Receiver operating characteristics (ROC) curve determined the best HU cut-off value. Stone size and location were used for factor variability analysis. A total of 184 cases were included in this study, and the average urolithiasis size on CT stonogram was 0.84 cm (0.3-4.9 cm). On KUB X-ray, 34.2 % of the urolithiases were radiolucent and 65.8 % were radio-opaque. Mean value of CT Hounsfield unit for radiolucent stones was 358.25 (±156), and that for radio-opaque stones was 816.51 (±274). ROC curve determined the best cut-off value of HU at 498.5, with the sensitivity of 89.3 % and specificity of 87.3 %. For >4 mm stones, the sensitivity was 91.3 % and the specificity was 81.8 %. On the other hand, for =<4 mm stones, the sensitivity was 60 % and the specificity was 89.5 %. Based on the constructed ROC curve, a threshold value of 498.5 HU in CT stonogram was established as cut-off in determining whether a calculus is radio-opaque or radiolucent. The determined overall sensitivity and specificity of the set cut-off HU value are optimal. Stone size but not location affects the sensitivity and specificity.

A Comprehensive Analysis of Programmed Cell Death Ligand-1 Expression With the Clone SP142 Antibody in Non-Small-Cell Lung Cancer Patients.

PubMed

Takada, Kazuki; Toyokawa, Gouji; Okamoto, Tatsuro; Shimokawa, Mototsugu; Kozuma, Yuka; Matsubara, Taichi; Haratake, Naoki; Akamine, Takaki; Takamori, Shinkichi; Katsura, Masakazu; Shoji, Fumihiro; Oda, Yoshinao; Maehara, Yoshihiko

2017-09-01

Programmed cell death-1 (PD-1) and programmed cell death ligand-1 (PD-L1) have been identified as novel targets for immunotherapy, with anti-PD-1 therapy currently the standard treatment for non-small-cell lung cancer (NSCLC) patients after the failure of first-line chemotherapy treatment. The recent phase II POPLAR and phase III OAK studies showed that atezolizumab, a representative PD-L1 inhibitor, exhibited a survival benefit compared with standard therapy in patients with NSCLC. We examined PD-L1 expression in NSCLC using the clone SP142 of POPLAR and OAK studies. PD-L1 expression in 499 surgically resected NSCLC patients was evaluated using immunohistochemistry using SP142. We set cutoff values as 1%, 5%, 10%, and 50%. The samples from 189 (37.9%), 119 (23.8%), 71 (14.2%), and 39 (7.8%) patients were positive for PD-L1 expression at cutoff values of 1%, 5%, 10%, and 50%, respectively. Fisher exact tests showed that PD-L1 positivity was significantly associated with male sex, smoking, advanced stage, the presence of vascular invasion, squamous cell carcinoma, and wild type epidermal growth factor receptor gene mutation status at all cutoff values. Univariate and multivariate survival analyses revealed that PD-L1-positive patients had a worse prognosis than PD-L1-negative patients only at the 1% cutoff value. Forest plot analyses showed that the 1% cutoff provided a more sensitive value for the prediction of postoperative prognosis. PD-L1 expression varied greatly according to different cutoff values. This study might be a useful reference to understand the results of POPLAR and OAK studies and to select patients likely to benefit from atezolizumab. Copyright © 2017 Elsevier Inc. All rights reserved.

Amount of balance necessary for the independence of transfer and stair-climbing in stroke inpatients.

PubMed

Fujita, Takaaki; Sato, Atsushi; Ohashi, Yuji; Nishiyama, Kazutaka; Ohashi, Takuro; Yamane, Kazuhiro; Yamamoto, Yuichi; Tsuchiya, Kenji; Otsuki, Koji; Tozato, Fusae

2018-05-01

The purpose of this study was to clarify the amount of balance necessary for the independence of transfer and stair-climbing in stroke patients. This study included 111 stroke inpatients. Simple and multiple regression analyses were conducted to establish the association between the FIM ® instrument scores for transfer or stair-climbing and Berg Balance Scale. Furthermore, receiver operating characteristic curves were used to elucidate the amount of balance necessary for the independence of transfer and stair-climbing. Simple and multiple regression analyses showed that the FIM ® instrument scores for transfer and stair-climbing were strongly associated with Berg Balance Scale. On comparison of the independent and supervision-dependent groups, Berg Balance Scale cut-off values for transfer and stair-climbing were 41/40 and 54/53 points, respectively. On comparison of the independent-supervision and dependent groups, the cut-off values for transfer and stair-climbing were 30/29 and 41/40 points, respectively. The calculated cut-off values indicated the amount of balance necessary for the independence of transfer and stair-climbing, with and without supervision, in stroke patients. Berg Balance Scale has a good discriminatory ability and cut-off values are clinically useful to determine the appropriate independence levels of transfer and stair-climbing in hospital wards. Implications for rehabilitation The Berg Balance Scale's (BBS) strong association with transfer and stair-climbing independence and performance indicates that establishing cut-off values is vitally important for the established use of the BBS clinically. The cut-off values calculated herein accurately demonstrate the level of balance necessary for transfer and stair-climbing independence, with and without supervision, in stroke patients. These criteria should be employed clinically for determining the level of independence for transfer and stair-climbing as well as for setting balance training goals aimed at improving transfer and stair-climbing.

Optimal Transport Destination for Ischemic Stroke Patients With Unknown Vessel Status: Use of Prehospital Triage Scores.

PubMed

Schlemm, Eckhard; Ebinger, Martin; Nolte, Christian H; Endres, Matthias; Schlemm, Ludwig

2017-08-01

Patients with acute ischemic stroke (AIS) and large vessel occlusion may benefit from direct transportation to an endovascular capable comprehensive stroke center (mothership approach) as opposed to direct transportation to the nearest stroke unit without endovascular therapy (drip and ship approach). The optimal transport strategy for patients with AIS and unknown vessel status is uncertain. The rapid arterial occlusion evaluation scale (RACE, scores ranging from 0 to 9, with higher scores indicating higher stroke severity) correlates with the National Institutes of Health Stroke Scale and was developed to identify patients with large vessel occlusion in a prehospital setting. We evaluate how the RACE scale can help to inform prehospital triage decisions for AIS patients. In a model-based approach, we estimate probabilities of good outcome (modified Rankin Scale score of ≤2 at 3 months) as a function of severity of stroke symptoms and transport times for the mothership approach and the drip and ship approach. We use these probabilities to obtain optimal RACE cutoff scores for different transfer time settings and combinations of treatment options (time-based eligibility for secondary transfer under the drip and ship approach, time-based eligibility for thrombolysis at the comprehensive stroke center under the mothership approach). In our model, patients with AIS are more likely to benefit from direct transportation to the comprehensive stroke center if they have more severe strokes. Values of the optimal RACE cutoff scores range from 0 (mothership for all patients) to >9 (drip and ship for all patients). Shorter transfer times and longer door-to-needle and needle-to-transfer (door out) times are associated with lower optimal RACE cutoff scores. Use of RACE cutoff scores that take into account transport times to triage AIS patients to the nearest appropriate hospital may lead to improved outcomes. Further studies should examine the feasibility of translation into clinical practice. © 2017 American Heart Association, Inc.

Diagnostic Accuracy of Fall Risk Assessment Tools in People With Diabetic Peripheral Neuropathy

PubMed Central

Pohl, Patricia S.; Mahnken, Jonathan D.; Kluding, Patricia M.

2012-01-01

Background Diabetic peripheral neuropathy affects nearly half of individuals with diabetes and leads to increased fall risk. Evidence addressing fall risk assessment for these individuals is lacking. Objective The purpose of this study was to identify which of 4 functional mobility fall risk assessment tools best discriminates, in people with diabetic peripheral neuropathy, between recurrent “fallers” and those who are not recurrent fallers. Design A cross-sectional study was conducted. Setting The study was conducted in a medical research university setting. Participants The participants were a convenience sample of 36 individuals between 40 and 65 years of age with diabetic peripheral neuropathy. Measurements Fall history was assessed retrospectively and was the criterion standard. Fall risk was assessed using the Functional Reach Test, the Timed “Up & Go” Test, the Berg Balance Scale, and the Dynamic Gait Index. Sensitivity, specificity, positive and negative likelihood ratios, and overall diagnostic accuracy were calculated for each fall risk assessment tool. Receiver operating characteristic curves were used to estimate modified cutoff scores for each fall risk assessment tool; indexes then were recalculated. Results Ten of the 36 participants were classified as recurrent fallers. When traditional cutoff scores were used, the Dynamic Gait Index and Functional Reach Test demonstrated the highest sensitivity at only 30%; the Dynamic Gait Index also demonstrated the highest overall diagnostic accuracy. When modified cutoff scores were used, all tools demonstrated improved sensitivity (80% or 90%). Overall diagnostic accuracy improved for all tests except the Functional Reach Test; the Timed “Up & Go” Test demonstrated the highest diagnostic accuracy at 88.9%. Limitations The small sample size and retrospective fall history assessment were limitations of the study. Conclusions Modified cutoff scores improved diagnostic accuracy for 3 of 4 fall risk assessment tools when testing people with diabetic peripheral neuropathy. PMID:22836004

Incorporating body-type (apple vs. pear) in STOP-BANG questionnaire improves its validity to detect OSA.

PubMed

Sangkum, Lisa; Klair, Ikrita; Limsuwat, Chok; Bent, Sabrina; Myers, Leann; Thammasitboon, Supat

2017-09-01

The aim of this study is to evaluate whether adding the item of "apple body type" to the STOP-BANG questionnaire enhances diagnostic performance of the questionnaire for detecting obstructive sleep apnea (OSA). Cross-sectional study. Sleep center setting. Two hundred and eight subjects who were referred for an evaluation of possible OSA at Tulane Comprehensive Sleep Center. The exclusion criteria were age<18years old, incomplete or absent questionnaire, incomplete body type identification, polysomnography (PSG) refusal, and pregnant women. STOP-BANG items and body type data were collected on the initial clinic visit. An overnight PSG was performed on every participant. Descriptive analyses of the demographic data and PSG variables were performed. The predictive parameters of STOP and STOP-BANG without and with body type score (STOP-Apple and STOPBANG-Apple) were compared. The STOP questionnaire's sensitivity/specificity/positive likelihood ratio (+LR) (cut-off=2) was 96%/11%/1.1, respectively whereas the STOP-Apple questionnaire (cut-off=3) was 88%/39%/1.5. The STOP-BANG's sensitivity/specificity/+LR (cut-off=3) was 96%/19%/1.2, respectively whereas the STOP-BANG-Apple questionnaire (cut-off=4) was 90%/39%/1.5. The area under the Receiver Operating Characteristic (ROC) curve of STOP-Apple was comparable to the STOP-BANG (P=0.25). The addition of the apple body type item to the STOP-BANG questionnaire in participants with a score≥3 led to increased specificity (67.4%), increased the odds ratio of having OSA of 2.5 (95% CI, 1.2-5.3) and odds ratio of having moderate-severe OSA of 4.7 (95% CI, 2.5-8.7). In the sleep center setting, adding the body type item to the STOP-BANG questionnaire improves not only clinical prediction for PSG confirmed OSA but also predicts moderate to severe of OSA. Published by Elsevier Inc.

Evaluation of keratoconus progression.

PubMed

Shajari, Mehdi; Steinwender, Gernot; Herrmann, Kim; Kubiak, Kate Barbara; Pavlovic, Ivana; Plawetzki, Elena; Schmack, Ingo; Kohnen, Thomas

2018-06-01

To define variables for the evaluation of keratoconus progression and to determine cut-off values. In this retrospective cohort study (2010-2016), 265 eyes of 165 patients diagnosed with keratoconus underwent two Scheimpflug measurements (Pentacam) that took place 1 year apart ±3 months. Variables used for keratoconus detection were evaluated for progression and a correlation analysis was performed. By logistic regression analysis, a keratoconus progression index (KPI) was defined. Receiver-operating characteristic curve (ROC) analysis was performed and Youden Index calculated to determine cut-off values. Variables used for keratoconus detection showed a weak correlation with each other (eg, correlation r=0.245 between RPImin and Kmax, p<0.001). Therefore, we used parameters that took several variables into consideration (eg, D-index, index of surface variance, index for height asymmetry, KPI). KPI was defined by logistic regression and consisted of a Pachymin coefficient of -0.78 (p=0.001), a maximum elevation of back surface coefficient of 0.27 and coefficient of corneal curvature at the zone 3 mm away from the thinnest point on the posterior corneal surface of -12.44 (both p<0.001). The two variables with the highest Youden Index in the ROC analysis were D-index and KPI: D-index had a cut-off of 0.4175 (70.6% sensitivity) and Youden Index of 0.606. Cut-off for KPI was -0.78196 (84.7% sensitivity) and a Youden Index of 0.747; both 90% specificity. Keratoconus progression should be defined by evaluating parameters that consider several corneal changes; we suggest D-index and KPI to detect progression. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Is alcohol binge drinking in early and late pregnancy associated with behavioural and emotional development at age 7 years?

PubMed

Niclasen, Janni; Andersen, Anne-Marie Nybo; Strandberg-Larsen, Katrine; Teasdale, Thomas William

2014-12-01

The purpose of this study was to investigate associations of maternal binge drinking in early and late pregnancy with child behavioural and emotional development at age seven. It was hypothesised that late exposure is associated with more negative outcomes than early exposure. Differences were expected on the continuous outcome measures, but not on above cutoff scale scores. Data were derived from the Danish National Birth Cohort. Three exposure groups were defined according to binge drinking from three interviews regarding binge episodes in early, middle and late pregnancy. A 'no binge' group included women with no binge episodes reported in any of the interviews, the 'early bingers' reported episodes in the first interview only, and the 'late bingers' in the last part of pregnancy only. The outcome measure was the Strengths and Difficulties Questionnaire (SDQ) used as continuous externalising/internalising scores and above cutoff hyperactivity/inattention, conduct, emotional and peer problems scores. Only women with full information concerning binge drinking from the three interviews, together with full-scale SDQ information on their children at age seven and being term-born, were included in the study (N = 37,315). After adjustment for maternal education, psychiatric diagnoses, age and smoking, children exposed to binge drinking in early and late pregnancy had significantly higher mean externalizing scores at age seven than unexposed children, an effect albeit much less for early binge drinking (relative change in mean 1.02, CI 1.00-1.05) than for late binge drinking (relative change in mean 1.21, CI 1.04-1.42). No associations were observed for any of the above cutoff outcomes. Exposure to binge drinking in early and late pregnancy is associated with elevated externalising scores, particularly so in late pregnancy. No increased risk for any of the above cutoff scale scores was observed.

Performance of serum α-fetoprotein levels in the diagnosis of hepatocellular carcinoma in patients with a hepatic mass

PubMed Central

Chan, Stephen L; Mo, Frankie; Johnson, Philip J; Siu, Deyond Y W; Chan, Michael H M; Lau, Wan Y; Lai, Paul B S; Lam, Christopher W K; Yeo, Winnie; Yu, Simon C H

2014-01-01

Objectives The role of serum α-fetoprotein (AFP) measurements in the diagnosis of hepatocellular carcinoma (HCC) remains controversial. Some guidelines have advised against the use of AFP in the diagnosis of HCC. This study was conducted to evaluate the performance of AFP in the diagnosis of HCC, and to identify the optimal cut-off value of serum AFP in the diagnosis of HCC in patients with a hepatic mass. Methods Patients who presented during the period from May 1997 to March 2003 with hepatic lesions, for whom paired data on serum AFP values at baseline and lesion histology were available, were reviewed. The performance of AFP in the diagnosis of HCC was determined using receiver operating characteristic curve analysis. Results Data for a total of 805 patients were evaluated. The mean AFP value was 26 900 ng/ml (range: 0–1 965 461 ng/ml). The histological diagnosis was HCC in 557 patients. The optimal AFP cut-off value was 10 ng/ml (for sensitivity of 82.6% and specificity of 70.4%). At a cut-off level of 200 ng/ml, sensitivity, specificity, and positive and negative predictive values were 47.7%, 97.1%, 97.5% and 44.4%, respectively. The diagnostic performance of AFP remains similar in patients with chronic hepatitis B virus infection, despite a lower negative predictive value. Common aetiologies of liver lesions associated with elevated AFP include cholangiocarcinoma and neuroendocrine tumours. Conclusions In Asian patients with suspicious liver lesions, the cut-off AFP level of 200 ng/ml is useful to achieve a diagnosis of HCC with high specificity and reasonable sensitivity. The measurement of serum AFP should not be excluded from guidelines for the diagnosis of HCC. PMID:23980880

Improved, ACMG-Compliant, in silico prediction of pathogenicity for missense substitutions encoded by TP53 variants.

PubMed

Fortuno, Cristina; James, Paul A; Young, Erin L; Feng, Bing; Olivier, Magali; Pesaran, Tina; Tavtigian, Sean V; Spurdle, Amanda B

2018-05-18

Clinical interpretation of germline missense variants represents a major challenge, including those in the TP53 Li-Fraumeni syndrome gene. Bioinformatic prediction is a key part of variant classification strategies. We aimed to optimize the performance of the Align-GVGD tool used for p53 missense variant prediction, and compare its performance to other bioinformatic tools (SIFT, PolyPhen-2) and ensemble methods (REVEL, BayesDel). Reference sets of assumed pathogenic and assumed benign variants were defined using functional and/or clinical data. Area under the curve and Matthews correlation coefficient (MCC) values were used as objective functions to select an optimized protein multi-sequence alignment with best performance for Align-GVGD. MCC comparison of tools using binary categories showed optimized Align-GVGD (C15 cut-off) combined with BayesDel (0.16 cut-off), or with REVEL (0.5 cut-off), to have the best overall performance. Further, a semi-quantitative approach using multiple tiers of bioinformatic prediction, validated using an independent set of non-functional and functional variants, supported use of Align-GVGD and BayesDel prediction for different strength of evidence levels in ACMG/AMP rules. We provide rationale for bioinformatic tool selection for TP53 variant classification, and have also computed relevant bioinformatic predictions for every possible p53 missense variant to facilitate their use by the scientific and medical community. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

A Comparison of Approaches for Setting Proficiency Standards.

ERIC Educational Resources Information Center

Koffler, Stephen L.

This research compared the cut-off scores estimated from an empirical procedure (Contrasting group method) to those determined from a more theoretical process (Nedelsky method). A methodological and statistical framework was also provided for analysis of the data to obtain the most appropriate standard using the empirical procedure. Data were…

42 CFR 422.260 - Appeals of quality bonus payment determinations.

Code of Federal Regulations, 2012 CFR

2012-10-01

... overall star rating. (ii) The reconsideration official's decision is final and binding unless a request... the star ratings (including the calculation of the overall star ratings); cut-off points for determining measure thresholds; the set of measures included in the star rating system; and the methodology...

42 CFR 422.260 - Appeals of quality bonus payment determinations.

Code of Federal Regulations, 2011 CFR

2011-10-01

... overall star rating. (ii) The reconsideration official's decision is final and binding unless a request... the star ratings (including the calculation of the overall star ratings); cut-off points for determining measure thresholds; the set of measures included in the star rating system; and the methodology...

42 CFR 422.260 - Appeals of quality bonus payment determinations.

Code of Federal Regulations, 2013 CFR

2013-10-01

... overall star rating. (ii) The reconsideration official's decision is final and binding unless a request... the star ratings (including the calculation of the overall star ratings); cut-off points for determining measure thresholds; the set of measures included in the star rating system; and the methodology...

42 CFR 422.260 - Appeals of quality bonus payment determinations.

Code of Federal Regulations, 2014 CFR

2014-10-01

... overall star rating. (ii) The reconsideration official's decision is final and binding unless a request... the star ratings (including the calculation of the overall star ratings); cut-off points for determining measure thresholds; the set of measures included in the star rating system; and the methodology...

Alexithymia associated with nightmare distress in idiopathic REM sleep behavior disorder.

PubMed

Godin, Isabelle; Montplaisir, Jaques; Gagnon, Jean-François; Nielsen, Tore

2013-12-01

Idiopathic REM sleep behavior disorder (iRBD) is characterized by atypical REM sleep motor activity, vivid dreams and nightmares, and dream-enacting behaviors that can result in injuries to the patient and bed partner. It is also a known predictor of Parkinson disease (PD). Alexithymia has been associated with disturbances in sleep and dreaming (e.g., nightmares) and is a non-motor symptom of PD. We assessed alexithymia and disturbed dreaming in iRBD patients with the aim of determining if these two factors are elevated and interrelated among this population. Questionnaire study of clinically diagnosed patients. Clinical sleep disorders center. Thirty-two iRBD patients and 30 healthy age- and sex-matched control participants. Participants completed the 20-item Toronto Alexithymia Scale (TAS-20), the Dream Questionnaire, and the Beck Depression Inventory. iRBD patients obtained higher TAS-20 total scores (62.16 ± 13.90) than did controls (52.84 ± 7.62; F 1,59 = 10.44, P < 0.01), even when controlling for depressive symptoms, and more frequently attained the suggested cutoff for alexithymia than did controls (P < 0.01). iRBD patients obtained higher scores on the Difficulty Identifying Feelings alexithymia subscale. For both iRBD and control groups, the Difficulty Indentifying Feelings subscale correlated positively with the Nightmare Distress scale of the Dream Questionnaire. Elevated alexithymia scores among idiopathic rapid eye movement sleep behavior disorder patients, and especially a difficulty in identifying feelings, parallels evidence of dysautonomia in this population. The higher incidence of distressing nightmares and the association of nightmares with alexithymia further extend similar findings for both clinical and non-clinical samples and suggest that an affect regulation disturbance may be common to the two sets of symptoms.

Increased circulating D-lactate levels predict risk of mortality after hemorrhage and surgical trauma in baboons.

PubMed

Sobhian, Babak; Kröpfl, Albert; Hölzenbein, Thomas; Khadem, Anna; Redl, Heinz; Bahrami, Soheyl

2012-05-01

Patients with hemorrhagic shock and/or trauma are at risk of developing colonic ischemia associated with bacterial translocation that may lead to multiple organ failure and death. Intestinal ischemia is difficult to diagnose noninvasively. The present retrospective study was designed to determine whether circulating plasma D-lactate is associated with mortality in a clinically relevant two-hit model in baboons. Hemorrhagic shock was induced in anesthetized baboons (n = 24) by controlled bleeding (mean arterial pressure, 40 mmHg), base excess (maximum -5 mmol/L), and time (maximum 3 h). To mimic clinical setting more closely, all animals underwent a surgical trauma after resuscitation including midshaft osteotomy stabilized with reamed femoral interlocking nailing and were followed for 7 days. Hemorrhagic shock/surgical trauma resulted in 66% mortality by day 7. In nonsurvivor (n = 16) hemorrhagic shock/surgical trauma baboons, circulating D-lactate levels were significantly increased (2-fold) at 24 h compared with survivors (n = 8), whereas the early increase during hemorrhage and resuscitation declined during the early postresuscitation phase with no difference between survivors and nonsurvivors. Moreover, D-lactate levels remained elevated in the nonsurvival group until death, whereas it decreased to baseline in survivors. Prediction of death (receiver operating characteristic test) by D-lactate was accurate with an area under the curve (days 1-3 after trauma) of 0.85 (95% confidence interval, 0.72-0.93). The optimal D-lactate cutoff value of 25.34 μg/mL produced sensitivity of 73% to 99% and specificity of 50% to 83%. Our data suggest that elevation of plasma D-lactate after 24 h predicts an increased risk of mortality after hemorrhage and trauma.

Chromogranin A as circulating marker for diagnosis and management of neuroendocrine neoplasms: more flaws than fame.

PubMed

Marotta, Vincenzo; Zatelli, Maria Chiara; Sciammarella, Concetta; Ambrosio, Maria Rosaria; Bondanelli, Marta; Colao, Annamaria; Faggiano, Antongiulio

2018-01-01

Owing to the heterogeneity of neuroendocrine neoplasms (NENs), the availability of reliable circulating markers is critical for improving diagnostics, prognostic stratification, follow-up and definition of treatment strategy. This review is focused on chromogranin A (CgA), a hydrophilic glycoprotein present in large dense core vesicles of neuroendocrine cells. Despite being long identified as the most useful NEN-related circulating marker, clinical application of CgA is controversial. CgA assays still lack standardization, thus hampering not only clinical management but also the comparison between different analyses. In the diagnostic setting, clinical utility of CgA is limited as hampered by (a) the variety of oncological and non-oncological conditions affecting marker levels, which impairs specificity; (b) the fact that 30-50% of NENs show normal CgA, which impairs sensitivity. Regarding the prognostic phase, there is prospective evidence which demonstrates that advanced NENs secreting CgA have poorer outcome, as compared with those showing non-elevated marker levels. Although the identification of cut-offs allowing a proper risk stratification of CgA-secreting patients has not been performed, this represents the most important clinical application of the marker. By contrast, based on prospective studies, the trend of elevated circulating CgA does not represent a valid indicator of morphological evolution and has therefore no utility for the follow-up phase. Ultimately, current knowledge about the role of the marker for the definition of treatment strategy is poor and is limited by the small number of available studies, their prevalent retrospective nature and the absence of control groups of untreated subjects. © 2018 Society for Endocrinology.

Procalcitonin Identifies Cell Injury, Not Bacterial Infection, in Acute Liver Failure.

PubMed

Rule, Jody A; Hynan, Linda S; Attar, Nahid; Sanders, Corron; Korzun, William J; Lee, William M

2015-01-01

Because acute liver failure (ALF) patients share many clinical features with severe sepsis and septic shock, identifying bacterial infection clinically in ALF patients is challenging. Procalcitonin (PCT) has proven to be a useful marker in detecting bacterial infection. We sought to determine whether PCT discriminated between presence and absence of infection in patients with ALF. Retrospective analysis of data and samples of 115 ALF patients from the United States Acute Liver Failure Study Group randomly selected from 1863 patients were classified for disease severity and ALF etiology. Twenty uninfected chronic liver disease (CLD) subjects served as controls. Procalcitonin concentrations in most samples were elevated, with median values for all ALF groups near or above a 2.0 ng/mL cut-off that generally indicates severe sepsis. While PCT concentrations increased somewhat with apparent liver injury severity, there were no differences in PCT levels between the pre-defined severity groups-non-SIRS and SIRS groups with no documented infections and Severe Sepsis and Septic Shock groups with documented infections, (p = 0.169). PCT values from CLD patients differed from all ALF groups (median CLD PCT value 0.104 ng/mL, (p ≤0.001)). Subjects with acetaminophen (APAP) toxicity, many without evidence of infection, demonstrated median PCT >2.0 ng/mL, regardless of SIRS features, while some culture positive subjects had PCT values <2.0 ng/mL. While PCT appears to be a robust assay for detecting bacterial infection in the general population, there was poor discrimination between ALF patients with or without bacterial infection presumably because of the massive inflammation observed. Severe hepatocyte necrosis with inflammation results in elevated PCT levels, rendering this biomarker unreliable in the ALF setting.

Uncertainties Associated with Theoretically Calculated N2-Broadened Half-Widths of H2O Lines

NASA Technical Reports Server (NTRS)

Ma, Q.; Tipping, R. H.; Gamache, R. R.

2010-01-01

With different choices of the cut-offs used in theoretical calculations, we have carried out extensive numerical calculations of the N2-broadend Lorentzian half-widths of the H2O lines using the modified Robert-Bonamy formalism. Based on these results, we are able to thoroughly check for convergence. We find that, with the low-order cut-offs commonly used in the literature, one is able to obtain converged values only for lines with large half-widths. Conversely, for lines with small half-widths, much higher cut-offs are necessary to guarantee convergence. We also analyse the uncertainties associated with calculated half-widths, and these are correlated as above. In general, the smaller the half-widths, the poorer the convergence and the larger the uncertainty associated with them. For convenience, one can divide all H2O lines into three categories, large, intermediate, and small, according to their half-width values. One can use this division to judge whether the calculated half-widths are converged or not, based on the cut-offs used, and also to estimate how large their uncertainties are. We conclude that with the current Robert- Bonamy formalism, for lines in category lone can achieve the accuracy requirement set by HITRAN, whereas for lines in category 3, it 'is impossible to meet this goal.

The psychometric properties, sensitivity and specificity of the geriatric anxiety inventory, hospital anxiety and depression scale, and rating anxiety in dementia scale in aged care residents.

PubMed

Creighton, Alexandra S; Davison, Tanya E; Kissane, David W

2018-02-22

Limited research has been conducted into the identification of a valid and reliable screening measure for anxiety in aged care settings, despite it being one of the most common psychological conditions. This study aimed to determine an appropriate anxiety screening tool for aged care by comparing the reliability and validity of three commonly used measures and identifying specific cut-offs for the identification of generalized anxiety disorder (GAD). One-hundred and eighty nursing home residents (M age = 85.39 years) completed the GAI, HADS-A, and RAID, along with a structured diagnostic interview. Twenty participants (11.1%) met DSM-5 criteria for GAD. All measures had good psychometric properties , although reliability estimates for the HADS-A were sub-optimal. Privileging sensitivity , the GAI cut-off score of 9 gave sensitivity of 90.0% and specificity of 86.3%; HADS-A cut-off of 6 gave sensitivity of 90.0% and specificity of 80.6%; and RAID cut-off of 11 gave sensitivity of 85.0% and specificity of 72.5%. While all three measures had adequate reliability, validity, and cut-scores with high levels of sensitivity and specificity to detect anxiety within aged care, the GAI was the most consistently reliable and valid measure for screening for GAD.

The diagnostic utility of the Rarely Missed Index of the Wechsler Memory Scale-Third Edition in detecting response bias in an adult male incarcerated setting.

PubMed

D'Amato, Christopher P; Denney, Robert L

2008-09-01

The purpose of this study was to utilize a known-group research design to evaluate the diagnostic utility of the Rarely Missed Index (RMI) of the Wechsler Memory Scale-Third Edition [Wechsler, D. (1997). Wechsler Adult Intelligence Test-3rd Edition. San Antonio, TX: The Psychological Corporation] in assessing response bias in an adult male incarcerated setting. Archival data from a sample of 60 adult male inmates who presented for neuropsychological testing were reviewed. Evaluees were assigned to one of two groups; probable malingerers (PM; n=30) and a group of valid test responders (n=30) (1999). Using the recommended cut-off score of 136 or less, the sensitivity of the RMI was extremely low at 33%. Its specificity was 83%. The positive predictive power of the RMI with the published base rate of 22.8 was 38%; with a negative predictive power of 81%. The positive predictive power of the RMI with a published base rate of 70.5 was 82%. The negative predictive power using a base rate of 70.5% was 34%. Results of the receiver operating characteristics (ROC) analysis indicated that the RMI score with a cut-off 136 or less performed only slightly better than chance in delineating probable malingerers from valid responders in this setting. Overall, the findings suggest that the RMI may not be a reliable index for detecting response bias in this setting and perhaps in similar settings.

Orogenic plateau growth: Expansion of the Turkish-Iranian Plateau across the Zagros fold-and-thrust belt

NASA Astrophysics Data System (ADS)

Allen, M. B.; Saville, C.; Blanc, E. J.-P.; Talebian, M.; Nissen, E.

2013-03-01

This paper shows how the Turkish-Iranian Plateau grows laterally by incrementally incorporating adjacent parts of the Zagros fold-and-thrust belt. The limit of significant, seismogenic, thrusting in the Zagros (Mw > 5) occurs close to the regional 1250 m elevation contour. The seismicity cutoff is not a significant bedrock geology boundary. Elevations increase northward, toward regional plateau elevations of 2 km, implying that another process produced the extra elevation. Between the seismogenic limit of thrusting and the suture, this process is a plausibly ductile thickening of the basement, suggesting depth-dependent strain during compression. Similar depth-dependant crustal strain may explain why the Tibetan plateau has regional elevations 1500 m greater than the elevation limit of seismogenic thrusting at its margins. We estimate 68 km shortening across the Zagros Simply Folded Belt in the Fars region, and 120 km total shortening of the Arabian plate. The Dezful Embayment is a low strain zone in the western Zagros. Deformation is more intense to its northeast, in the Bakhtyari Culmination. The orogenic taper (across strike topographic gradient) across the Dezful Embayment is 0.0004, and across the Bakhtyari Culmination, 0.022. Lateral plateau growth is more pronounced farther east (Fars), where a more uniform structure has a taper of 0.010 up to elevations of 1750 m. A >100 km wide region of the Zagros further northeast has a taper of 0.002 and is effectively part of the Turkish-Iranian Plateau. Internal drainage enhances plateau development but is not a pre-requisite. Aspects of the seismicity, structure, and geomorphology of the Zagros do not support critical taper models for fold-and-thrust belts.

Protein docking by the interface structure similarity: how much structure is needed?

PubMed

Sinha, Rohita; Kundrotas, Petras J; Vakser, Ilya A

2012-01-01

The increasing availability of co-crystallized protein-protein complexes provides an opportunity to use template-based modeling for protein-protein docking. Structure alignment techniques are useful in detection of remote target-template similarities. The size of the structure involved in the alignment is important for the success in modeling. This paper describes a systematic large-scale study to find the optimal definition/size of the interfaces for the structure alignment-based docking applications. The results showed that structural areas corresponding to the cutoff values <12 Å across the interface inadequately represent structural details of the interfaces. With the increase of the cutoff beyond 12 Å, the success rate for the benchmark set of 99 protein complexes, did not increase significantly for higher accuracy models, and decreased for lower-accuracy models. The 12 Å cutoff was optimal in our interface alignment-based docking, and a likely best choice for the large-scale (e.g., on the scale of the entire genome) applications to protein interaction networks. The results provide guidelines for the docking approaches, including high-throughput applications to modeled structures.

Human hydatid disease: evaluation of an ELISA for diagnosis, population screening and monitoring of control programmes.

PubMed

Biffin, A H; Jones, M A; Palmer, S R

1993-07-01

The routine use of ELISA and complement fixation tests in the diagnosis of suspected clinical cases of hydatid disease was evaluated. In the ELISA test, dialysed and filtered sheep cyst fluid was used as antigen and two positive cut-off points--+3SD and +2SD of the mean absorbance values of the control sera--were evaluated. The predictive values of ELISA tests were 82% and 90% for positive tests, and 86% and 82% for negative tests, respectively with the two cut-off points. In a population survey of blood donors and veterinary workers in Powys, 4% and 8%, respectively, had ELISA values above the lower cut-off point. However, it would not be appropriate to use the same test for diagnostic population screening in Wales since the predictive value of the test is likely to be very low in this setting. Serological surveys with the ELISA may be of use in monitoring the progress of the South Powys Hydatid Control Programme. The use of cumulative percentages was found to be a useful method of comparing whole distributions of results in different populations.

Indication criteria for total hip or knee arthroplasty in osteoarthritis: a state-of-the-science overview.

PubMed

Gademan, Maaike G J; Hofstede, Stefanie N; Vliet Vlieland, Thea P M; Nelissen, Rob G H H; Marang-van de Mheen, Perla J

2016-11-09

This systematic review gives an overview of guidelines and original publications as well as the evidence on which the currently proposed indication criteria are based. Until now such a state-of-the-science overview was lacking. Websites of orthopaedic and arthritis organizations (English/Dutch language) were independently searched by two authors for THA/TKA guidelines for OA. Furthermore, a systematic search strategy in several databases through August 2014 was performed. Quality of the guidelines was assessed with the AGREE II instrument, which consists of 6 domains (maximum summed score of 6 indicating high quality). Also, the level of evidence of all included studies was assessed. We found 6 guidelines and 18 papers, out of 3065 references. The quality of the guidelines summed across 6 domains ranged from 0.46 to 4.78. In total, 12 THA, 10 TKA and 2 THA/TKA indication sets were found. Four studies stated that no evidence-based indication criteria are available. Indication criteria concerning THA/TKA consisted of the following domains: pain (in respectively 11 and 10 sets), function (12 and 7 sets), radiological changes (10 and 9 sets), failed conservative therapy (8 and 4 sets) and other indications (6 and 7 sets). Specific cut-off values or ranges were often not stated and the level of evidence was low. The indication criteria for THA/TKA are based on limited evidence. Empirical research is needed, especially regarding domain specific cut-off values or ranges at which the best postoperative outcomes are achieved for patients, taking into account the limited lifespan of a prosthesis.

Interpretation of diagnostic data: 4. How to do it with a more complex table.

PubMed

1983-10-15

A more complex table is especially useful when a diagnostic test produces a wide range of results and your patient's levels are near one of the extremes. The following guidelines will be useful: Identify the several cut-off points that could be used. Fill in a complex table along the lines of Table I, showing the numbers of patients at each level who have and do not have the target disorder. Generate a simple table for each cut-off point, as in Table II, and determine the sensitivity (TP rate) and specificity (TN rate) at each of them. Select the cut-off point that makes the most sense for your patient's test result and proceed as in parts 2 and 3 of our series. Alternatively, construct an ROC curve by plotting the TP and FP rates that attend each cut-off point. If you keep your tables and ROC curves close at hand, you will gradually accumulate a set of very useful guides. However, if you looked very hard at what was happening, you will probably have noticed that they are not very useful for patients whose test results fall in the middle zones, or for those with just one positive result of two tests; the post-test likelihood of disease in these patients lurches back and forth past 50%, depending on where the cut-off point is. We will show you how to tackle this problem in part 5 of our series. It involves some maths, but you will find that its very powerful clinical application can be achieved with a simple nomogram or with some simple calculations.

Beyond the excised ensemble: modelling elliptic curve L-functions with random matrices

NASA Astrophysics Data System (ADS)

Cooper, I. A.; Morris, Patrick W.; Snaith, N. C.

2016-02-01

The ‘excised ensemble’, a random matrix model for the zeros of quadratic twist families of elliptic curve L-functions, was introduced by Dueñez et al (2012 J. Phys. A: Math. Theor. 45 115207) The excised model is motivated by a formula for central values of these L-functions in a paper by Kohnen and Zagier (1981 Invent. Math. 64 175-98). This formula indicates that for a finite set of L-functions from a family of quadratic twists, the central values are all either zero or are greater than some positive cutoff. The excised model imposes this same condition on the central values of characteristic polynomials of matrices from {SO}(2N). Strangely, the cutoff on the characteristic polynomials that results in a convincing model for the L-function zeros is significantly smaller than that which we would obtain by naively transferring Kohnen and Zagier’s cutoff to the {SO}(2N) ensemble. In this current paper we investigate a modification to the excised model. It lacks the simplicity of the original excised ensemble, but it serves to explain the reason for the unexpectedly low cutoff in the original excised model. Additionally, the distribution of central L-values is ‘choppier’ than the distribution of characteristic polynomials, in the sense that it is a superposition of a series of peaks: the characteristic polynomial distribution is a smooth approximation to this. The excised model did not attempt to incorporate these successive peaks, only the initial cutoff. Here we experiment with including some of the structure of the L-value distribution. The conclusion is that a critical feature of a good model is to associate the correct mass to the first peak of the L-value distribution.

Validity of the Enzyme-linked Immunoelectrotransfer Blot (EITB) for naturally acquired porcine cysticercosis

PubMed Central

Jayashi, César M.; Gonzalez, Armando E.; Neyra, Ricardo Castillo; Rodríguez, Silvia; García, Hector H.; Lightowlers, Marshall W.

2017-01-01

The Enzyme-linked Immunoelectrotransfer Blot (EITB) has been used widely as a screening test for Taenia solium cysticercosis in swine. However, the relation between seropositivity and infection in pig populations from endemic areas has not been well defined. The aim of this study is to relate EITB seropositivity with infection and infection burden, analyse the trade-off between sensitivity and specificity with various cut-off points for the EITB assay, and finally describe the serology changes in a cohort of rural pigs raised under natural conditions. A group of 107 pigs that were used as controls during a vaccination field trial in Peru was our study population. The prevalence of porcine cysticercosis determined by necropsy examination was 16.82% (18/107) in these animals. Using EITB reactivity to ≥ 1 band as a cut-off point for the assay, the sensitivity was 88.89% (65.29-98.62, 95% CI) and the specificity was 48.31% (37.59-59.16, 95% CI). Comparing other cut-off points, involving up to as many as 7 reactive bands, a reactivity of ≥ 3 bands provided the best trade-offs in sensitivity and specificity. Using this cut-off point for the assay, the sensitivity was 77.77% (52.36 - 93.59, 95% CI) and the specificity was 76.40% (66.22 - 84.76, 95% CI). A significant association was found between cyst counts over 100 cysts and reactivity to ≥ 3 bands in the EITB assay (Fisher’s exact test, p<0.05). The results of this study suggest that the use of the EITB assay to study porcine cysticercosis may require setting different cut-offs under field and experimental conditions, and depending upon the objective of the screening process. PMID:24183647

Cut-off values for classifying active children and adolescentes using the Physical Activity Questionnaire: PAQ-C and PAQ-ACut-off values for classifying active children and adolescents using the Physical Activity Questionnaire: PAQ-C and PAQ-A.

PubMed

Benítez-Porres, Javier; Alvero-Cruz, José Ramón; Sardinha, Luis B; López-Fernández, Iván; Carnero, Elvis A

2016-09-20

The Physical Activity Questionnaire for children and adolescents (PAQ-C & PAQ-A) has been widely used in research and field settings. However, there is a lack of information about its final score meaning. To determine PAQ-C and PAQ-A score cut-off values using physical activity (PA) thresholds objectively measured as reference criteria. 146 children (n = 83 boys, n = 63 girls) and 234 adolescents (n = 115 boys, n = 119 girls) participated in this study. Accelerometers (Actigraph GT3X) were used to assess objectively PA during one-week, afterwards PAQ was filled by the participants. As participants met or not the international PA recommendations for total, moderate-vigorous (MVPA) or light PA, three categorical variables of two levels were created. ROC curves procedure were carried out to obtain score cut-off points for identifying the positive category recommendation. ROC curves analysis estimated 2.75 and 2.73 score cut-off points to discriminate > 60 minutes of MVPA for PAQ-A and PAQ-C respectively (PAQ-A AUC = 0.68, p < 0.001 and PAQ-C; AUC = 0.55, p > 0.05). Also 60 minutes of MVPA was achieved with a total volume of 10,664 steps/day in children and 9,701 steps/day in adolescents. Our results suggest that PAQ-A can be a useful tool to classify adolescents as active or inactive following international recommendations as criteria. However, we could not find a significant cut-off for PAQ-C score.

Clinical Utility of Dual-Energy CT Analysis of Bone Marrow Edema in Acute Wrist Fractures.

PubMed

Ali, Ismail T; Wong, William D; Liang, Teresa; Khosa, Faisal; Mian, Memoona; Jalal, Sabeena; Nicolaou, Savvas

2018-04-01

The purpose of this study is to determine the utility of dual-energy CT (DECT) for assessing carpal fractures and to obtain an attenuation value cutoff (in Hounsfield units) to identify bone marrow edema due to an acute carpal fracture. In this retrospective study, 24 patients who presented with wrist fractures from September 3, 2014, through March 9, 2015, underwent imaging with DECT (80 and 140 kVp). Using the three-material decomposition algorithm specific for virtual noncalcium to construct images, two radiologists identified carpal fractures and associated bone marrow edema. Readers noted the attenuation at areas with and without bone marrow edema. The cutoff value was obtained by ROC analysis and was internally validated on 13 separate patients with suspected wrist fractures. A p < 0.05 was considered statistically significant. CT attenuation was significantly higher in areas of bone marrow edema than in areas without it (p < 0.0001, t test). A cutoff of 5.90 HU allows detection of bone marrow edema associated with acute wrist fractures with 100% sensitivity and 99.5% specificity, compared with visual DECT interpretation. In the 13 validation cases, the cutoff of 5.90 HU identified bone marrow edema with 100% accuracy, compared with visual interpretation. Kappa values were 0.83 between the two readings by reader 1, and 0.73 and 0.96 comparing the two readings of reader 1 with the reading by reader 2. DECT is a useful tool for identifying bone marrow edema in the setting of acute wrist fractures, providing an alternative to MRI. A cutoff value of 5.90 HU can be used for accurate diagnosis and exclusion of carpal fractures.

Evidence for a maximum mass cut-off in the neutron star mass distribution and constraints on the equation of state

NASA Astrophysics Data System (ADS)

Alsing, Justin; Silva, Hector O.; Berti, Emanuele

2018-04-01

We infer the mass distribution of neutron stars in binary systems using a flexible Gaussian mixture model and use Bayesian model selection to explore evidence for multi-modality and a sharp cut-off in the mass distribution. We find overwhelming evidence for a bimodal distribution, in agreement with previous literature, and report for the first time positive evidence for a sharp cut-off at a maximum neutron star mass. We measure the maximum mass to be 2.0M⊙ < mmax < 2.2M⊙ (68%), 2.0M⊙ < mmax < 2.6M⊙ (90%), and evidence for a cut-off is robust against the choice of model for the mass distribution and to removing the most extreme (highest mass) neutron stars from the dataset. If this sharp cut-off is interpreted as the maximum stable neutron star mass allowed by the equation of state of dense matter, our measurement puts constraints on the equation of state. For a set of realistic equations of state that support >2M⊙ neutron stars, our inference of mmax is able to distinguish between models at odds ratios of up to 12: 1, whilst under a flexible piecewise polytropic equation of state model our maximum mass measurement improves constraints on the pressure at 3 - 7 × the nuclear saturation density by ˜30 - 50% compared to simply requiring mmax > 2M⊙. We obtain a lower bound on the maximum sound speed attained inside the neutron star of c_s^max > 0.63c (99.8%), ruling out c_s^max < c/√{3} at high significance. Our constraints on the maximum neutron star mass strengthen the case for neutron star-neutron star mergers as the primary source of short gamma-ray bursts.

Gender Difference in Internet Use and Internet Problems among Quebec High School Students.

PubMed

Dufour, Magali; Brunelle, Natacha; Tremblay, Joel; Leclerc, Danielle; Cousineau, Marie-Marthe; Khazaal, Yasser; Légaré, Andrée-Anne; Rousseau, Michel; Berbiche, Djamal

2016-10-01

There are presently no data available concerning Internet addiction (IA) problems among adolescents in Canada and the province of Quebec. The goal of this study is thus to document and compare the influence of gender on Internet use and addiction. The study data were collected from a larger research project on gambling among adolescents. Activities conducted online (applications used and time spent) as well as answers to the Internet Addiction Test (IAT) were collected from 3938 adolescents from grades 9 to 11. The two most often employed cut-off points for the IAT in the literature were documented: (40-69 and 70+) and (50+). Boys spent significantly more time on the Internet than did girls. A greater proportion of the girls made intense use of social networks, whereas a greater proportion of the boys made intense use of massively multiplayer online role-playing games, online games, and adult sites. The proportion of adolescents with a potential IA problem varied according to the cut-off employed. When the cut-off was set at 70+, 1.3% of the adolescents were considered to have an IA, while 41.7% were seen to be at risk. At a 50+ cut-off, 18% of the adolescents were considered to have a problem. There was no significant difference between the genders concerning the proportion of adolescents considered to be at risk or presenting IA problems. Finally, analysis of the percentile ranks would seem to show that a cut-off of 50+ better describes the category of young people at risk. The results of this study make it possible to document Internet use and IA in a large number of Quebec adolescents. © The Author(s) 2016.

[Significance of 2-hour blood glucose after standardized steamed bread meal in diabetic screening].

PubMed

Liu, Yongquan; Tian, Hui; Fang, Fusheng; Xiao, Haiying; Lu, Yanhui; Shao, Yinghong; Li, Chunlin

2014-05-13

To explore the significance of 2-hour blood glucose after standardized steamed bread meal (SB-2 hBG) in diabetic screening. A retrospective study was conducted for diabetic screening data of annual check-up at PLA General Hospital from May 1996 to June 2002. And 100 g standardized steamed bread meal test was performed for non-diabetic subjects. Those subjects with SB-2 h BG ≥ 7.2 mmol/L underwent a 75 g oral glucose tolerance test (OGTT) within 2 weeks to determine whether the diagnosis of diabetes mellitus (DM) could be established (WHO, 1985, 1999, Diagnostic Criteria for Diabetes). By extracting the data for 7 consecutive years, we analyzed the significance and the cut-off point of SB-2 hBG in the diagnosis of DM and investigated the changes of blood glucose curves in different glucose tolerance status after different glucose loading tests. A total of 3 343 subjects with complete information were recruited. There were 3 101 males and 242 females with an age range of 40-94 years. According to the results of OGTT, 429 (12.8%) subjects were diagnosed as DM, 1 405 (42.1%) were diagnosed as impaired glucose regulation (IGR) and 1 509(45.1%) had normal glucose tolerance (NGT).With a deterioration of glucose tolerance status, the difference between SB-2 hBG and OGTT-2 hBG increased gradually in 3 group (P < 0.01), namely the NGT group 1.7 (0.8-2.8) mmol/L, IGR group -0.4 (-1.2-0.6) mmol/L, DM group -2.7(-3.8-1.1) mmol/L. The cut-off points of FBG for the diagnosis of IGR and DM were 5.3 (sensitivity of 46.2%, specificity of 68.5%) and 5.6 (sensitivity of 57.4%, specificity of 76.4%) mmol/L respectively. The cut-off points of SB-2 h BG were 8.2 mmol/L for the diagnosis of IGR (sensitivity of 63.8%, specificity of 59.9%) and 9.2 mmol/L for the diagnosis of DM (sensitivity of 66.4%, specificity of 76.4%).If the cut-off point of SB-2 h BG was set at 7.2 mmol/L, the diagnostic specificity became quite low.However, at 11.1 mmol/L, the sensitivity was 31.5% and the specificity 95.7% for the diagnosis of DM. The coincidences of cut-off points of FBG and SB-2 hBG for the diagnosis of IGR and DM were equal (P > 0.05).When the cut-off point of SB-2 h BG was set at 7.8 mmol/L, the sensitivity was 77.4% and the specificity 41.8% for the diagnosis of IGR. And it was much better than FBG at 5.6 mmol/L (P < 0.01). With a deterioration of glucose tolerance, the difference between SB-2 hBG and OGTT-2 hBG increases gradually. Compared to the diagnostic criteria of OGTT, the optimal cut-off points for the diagnosis of IGR and DM were 5.3 vs 5.6 mmol/L for FBG and 8.2 vs 9.2 mmol/L for SB-2 hBG respectively.For diabetic screening in middle-aged and elders, the cut-off points of FBG at 5.3 mmol/L and SB-2 hBG at 7.8 mmol/L are indicators for further OGTT.

Affect and eating behavior in obese adults with and without elevated depression symptoms.

PubMed

Goldschmidt, Andrea B; Crosby, Ross D; Engel, Scott G; Crow, Scott J; Cao, Li; Peterson, Carol B; Durkin, Nora

2014-04-01

Although there is a modest relation between obesity and depression, mechanisms that contribute to this co-occurrence are unclear. This study examined mood and eating behavior among obese adults with and without elevated depression symptoms. Obese adults (N = 50) were subtyped according to a Beck Depression Inventory (BDI) cutoff of 14, indicating "probable depression." Participants with (BDI ≥ 14; n = 15) and without (BDI < 14; n = 35) elevated depression symptoms were compared on affect- and eating-related variables measured via questionnaire and ecological momentary assessment (EMA) using ANCOVA and mixed model regression. After adjusting for group differences in body mass index (BMI; p = .03), participants with elevated depression symptoms reported greater emotional eating via self-report questionnaire [F(1,50) = 4.3; p = .04], as well as more frequent binge eating (Wald χ(2)  = 13.8; p < .001) and higher daily negative affect (Wald χ(2)  = 7.7; p = .005) on EMA recordings. Emotional eating mediated the relationship between depression status and BMI (indirect effect estimate = 3.79; 95% CI = 1.02-7.46). Emotional eating and binge eating were more commonly reported by obese adults with elevated depression symptoms compared to those without and may occur against a general backdrop of overall low mood. Intervention and prevention programs for obesity and/or depression should address disordered eating to prevent or minimize adverse health consequences. Copyright © 2013 Wiley Periodicals, Inc.

The effect of elevated progesterone levels before HCG triggering in modified natural cycle frozen-thawed embryo transfer cycles.

PubMed

Groenewoud, Eva R; Macklon, Nick S; Cohlen, Ben J

2017-05-01

Recent studies suggest that elevated late follicular phase progesterone concentrations after ovarian stimulation for IVF may result in embryo-endometrial asynchrony, reducing the chance of successful implantation after fresh embryo transfer. It remains unclear to what extent elevated late follicular phase progesterone levels may occur in unstimulated cycles before frozen-thawed embryo transfer, or what affect they may have on outcomes. In this cohort study, 271 patients randomized to the modified natural cycle arm of a randomized controlled trial comparing two endometrial preparation regimens underwent late follicular phase progesterone and LH testing. A receiver operating characteristic curve was constructed to identify a progesterone cut-off level with the best predictive value for live birth (progesterone level ≥4.6 nmol/l). A total of 24.4% of patients revealed an isolated elevated serum progesterone of 4.6 nmol/l or greater, and 44.3% showed an elevated progesterone level in association with a rise in LH. Neither endocrine disruption affected outcomes, with live birth rates of 12.9% versus 10.6% (OR 0.6, 95% CI 0.19 to 1.9) and 11.9% versus 17.5% (OR 1.6, 95% CI 0.79 to 3.1), respectively. Whether monitoring of progesterone and LH in natural cycle frozen-thawed embryo transfer has added clinical value should studied further. Copyright © 2017 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

Ductal carcinoma of breast: nuclear grade as a predictor of S-phase fraction.

PubMed

Dabbs, D J

1993-06-01

Nuclear grade (NG) and S-phase fraction (SPF) are established independent prognostic variables for ductal breast carcinomas. Nuclear grade can be assigned by a pathologist in a simple fashion during histopathologic evaluation of the tumor, while SPF requires flow cytometric evaluation of tumor samples. This prospective study was undertaken to determine whether elevated SPF could be predicted from NG alone and how NG and SPF correlate with c-erbB-2 expression. Eighty-two breast carcinomas of ductal type were assigned an NG of low (grade 1 or grade 2) or high (grade 3). S-phase fraction was recorded initially from fresh-frozen tissue samples and was designated as either low SPF (below the value designated as the cutoff for elevated SPF) or high SPF (a value at or greater than the cutoff value). On fresh tissue the NG predicted the range of SPF (low or high) in 89% of cases. Four percent of the cases that did not correlate could definitely be attributed to sample error. The remaining 7% that did not correlate could have been due to sample error, specimen quality, or tumor heterogeneity, as demonstrated by reversal of SPF range as performed on paraffin blocks of tumor. Eighty-eight percent of the tumors positive for c-erbB-2 were NG 3 and 12% were NG 2. All c-erbB-2 tumors were aneuploid. This study demonstrates the importance of carefully assigning NGs on tissue and indicates the importance of reviewing flow cytometric data side by side with histopathologic parameters to detect discrepancies between these two modalities. Careful nuclear grading assignment can accurately predict the range of SPF.

Investigation of serum Ki-67 as a biomarker in tumor-bearing dogs.

PubMed

Neumann, Stephan; Schuettler, Julia; Frenz, Meike; Kaup, Franz-Josef; Gessler, Frank

2017-02-01

Because of the limited number of tumor markers in veterinary medicine, there is need for identifying new markers. Ki-67 has been investigated as a tissue marker of malignant alterations. We hypothesized that Ki-67 would also be measurable in serum and should therefore be elevated in cases of malignancy. The purpose of this prospective study was to measure Ki-67 in clinically healthy dogs, dogs with nonmalignant diseases, and dogs with malignant tumors. Samples from 8 healthy dogs, 13 dogs with nonmalignant diseases, and 20 dogs with malignant tumors were collected. Ki-67 was measured using the commercially available canine-specific ELISA. Results demonstrated undetectable Ki-67 serum concentrations in healthy dogs. Dogs with nonmalignant diseases displayed low Ki-67 serum concentrations. In contrast, dogs with malignancies showed significantly increased serum Ki-67 concentrations compared with the healthy (p<0.001) or nonmalignant diseased dogs (p<0.001). The degree of malignancy had a positive influence on serum Ki-67 levels. In contrast, no influence of tumor size on Ki-67 serum concentration was observed (p>0.05). Comparing healthy dogs and tumor bearing dogs a sensitivity of 0.75 and a specificity of 1.0 can be calculated using a Ki-67 cut-off value of 5.5pg/mL. When dogs with a low degree of malignancy were compared with dogs of moderate-to-severe degree malignant tumors a sensitivity of 1.0 and a specificity of 1.0 can be observed at a Ki-67 cut-off value of 19.25pg/mL. In conclusion, our results demonstrate an association of malignancies with elevated Ki-67 serum concentrations in dogs. Published by Elsevier Ltd.

Urinary neutrophil gelatinase associated lipocalin as a biomarker in ifosfamide induced chronic renal failure.

PubMed

Kesik, V; Demirkaya, E; Buyukpamukçu, M

2015-12-01

Neutrophil gelatinase associated lipocalin (NGAL) have been used with great success in acute renal failure and in some cases in chronic nephrotoxicity. In this work, we aimed to investigate urinary NGAL as an early marker of chronic renal failure (CRF). We investigated urinary NGAL of 29 children treated with ifosfamide chemotherapy and compared them with those of 12 healthy children. Urinary β2 microglobulin, serum cystatin C, and creatinine clearance analyses were also studied. The median age was 11 years (4-21) and median remission time was 4.3 years (1.8-14.4). The cumulative dose of ifosfamide was 36 g. Glomerular filtration rate was decreased in 41.4% and urine β2 microglobulin levels and serum cystatin C levels were elevated in 31% of the patients. As the remission time increased, serum creatinine and cystatin C levels were also increased. The sensitivity for β2 microglobulin and cystatin C in demonstrating CRF was 35.2% and 23% and specificity was 33.2% and 50% respectively. The 24-hour urine NGAL cut-off level for demonstrating CRF was found to be 1.065 ng/mL/24 hours. The sensitivity and specificity for this cut-off value were 83% and 77%, respectively. NGAL levels were significantly higher in the study group as compared with the control group. Although ifosfamide treatment was suggested to be safe with no complication of renal failure under a dose of 80 g/m2, chronic renal failure and deficits in glomerular and tubular function could be seen when the remission time increased. Elevated NGAL levels may be a good option in determining CRF.

Correlation of Cyfra 21-1 levels in saliva and serum with CK19 mRNA expression in oral squamous cell carcinoma.

PubMed

Malhotra, Rewa; Urs, Aadithya B; Chakravarti, Anita; Kumar, Suman; Gupta, V K; Mahajan, Bhawna

2016-07-01

Oral squamous cell carcinoma (OSCC) accounts for 90 % of malignant lesions of oral cavity. The study assessed the potential of Cyfra 21-1 as a tumor marker in OSCC. The study included 50 patients of OSCC to evaluate levels of Cyfra 21-1 in serum and saliva by electrochemiluminescent immunoassay (ECLIA) and CK19 messenger RNA (mRNA) expression in tissue by florescent quantitative real-time reverse transcriptase polymerase chain reaction (RT-PCR) along with healthy individuals as control. The salivary and serum Cyfra 21-1 levels in patients of OSCC were significantly higher compared to controls (p value < 0.01). There was a 2.75-fold increase in CK19 mRNA expression in OSCC cases compared to controls. A significant positive correlation was found between serum and salivary Cyfra 21-1, serum Cyfra 21-1, and CK19 mRNA expression and between salivary Cyfra 21-1 and CK19 mRNA expression. Among these, correlation between serum and salivary Cyfra 21-1 was highly significant. Salivary and serum Cyfra 21-1 showed significantly elevated levels in grade II OSCC compared to grade I histopathologically. Elevated levels of salivary Cyfra 21-1 were associated with recurrence in OSCC patients. Reverse operating curve constructed using 3 ng/ml as a cutoff for serum Cyfra 21-1 revealed the sensitivity and specificity to be 88 and 78.2 %, respectively. Using a cutoff value of 8.5 ng/ml for salivary Cyfra 21-1, the sensitivity was found to be 93.8 % and specificity 84.3 %. We advocate salivary Cyfra 21-1 as a better diagnostic marker over serum Cyfra 21-1 as well as a potential marker in the prognosis of OSCC.

Combined determination of highly sensitive troponin T and copeptin for early exclusion of acute myocardial infarction: first experience in an emergency department of a general hospital.

PubMed

Lotze, Ulrich; Lemm, Holger; Heyer, Anke; Müller, Karin

2011-01-01

The purpose of this observational study was to test the diagnostic performance of the Elecsys® troponin T high-sensitive system combined with copeptin measurement for early exclusion of acute myocardial infarction (MI) in clinical practice. Troponin T high-sensitive (diagnostic cutoff: <14 pg/mL) and copeptin (diagnostic cutoff: <14 pmol/L) levels were determined at admission in addition to other routine laboratory parameters in patients with suspected acute MI presenting to the emergency department of a general hospital over a period of five months. Data from 142 consecutive patients (mean age 71.2 ± 13.5 years, 76 men) were analyzed. Final diagnoses were acute MI in 13 patients (nine ST elevation MI, four non-ST elevation MI, 9.2%) unstable angina pectoris in three (2.1%), cardiac symptoms not primarily associated with myocardial ischemia in 79 (55.6%), and noncardiac disease in 47 patients (33.1%). The patients with acute MI were younger and had higher troponin T high-sensitive and copeptin values than patients without acute MI. Seventeen patients had very high copeptin values (>150 pmol/L), one of whom had a level of >700 pmol/L and died of pulmonary embolism. A troponin T high-sensitive level of <14 pg/mL in combination with copeptin <14 pmol/L at initial presentation ruled out acute MI in 45 of the 142 patients (31.7%), each with a sensitivity and negative predictive value of 100%. According to this early experience, a single determination of troponin T high-sensitive and copeptin may enable early and accurate exclusion of acute MI in one third of patients, even in an emergency department of a general hospital.

Juice Test for Identification of Nonerosive Reflux Disease in Heartburn Patients.

PubMed

Fernandes, Michel R; De Oliveira, Marina; Callegari-Jacques, Sidia M; Gonçalves, Gissele V R; Fornari, Fernando

2018-04-30

Evaluation of esophageal clearance by orange juice swallowing could be useful to identify different categories of gastroesophageal reflux disease. We determined whether a juice test at the beginning of esophageal pH monitoring can identify nonerosive reflux disease (NERD) among heartburn patients. Multiple swallows of orange juice (pH 3) were performed at the beginning of esophageal pH monitoring in 71 heartburn patients off acid-suppressive therapy. The area between pH drop below 5 and recovery to 5 was calculated from pH tracings and named Delta5 (mmol∙L⁻¹∙sec). Fifteen healthy subjects served to determine Delta5 cutoff (95th percentile). Patients were classified as NERD, non-NERD (a mix of reflux hypersensitivity, functional heartburn, and undetermined), and erosive disease depending on acid exposure, reflux symptom analysis, and upper endoscopy. Delta5 cutoff in healthy subjects was 251 mmol·L⁻¹∙sec. Among 71 patients, 23 had NERD, 26 had non-NERD, and 22 had erosive disease. Compared to non-NERD, Delta5 was higher in both NERD (median [interquartile range]: 316 [213-472] vs 165 [105-225]; P ＜ 0.01) and erosive disease (310 [169-625] vs 165 [105-225]; P ＜ 0.01). An elevated Delta5 (＞ 251 mmol∙L⁻¹∙sec) showed sensitivity of 74% and specificity of 81% for identification of NERD. Positive and negative likelihood ratios were 3.84 and 0.32 respectively, whereas test accuracy was 78%. A juice test with calculation of Delta5 helps in the identification of true NERD among heartburn patients with endoscopy-negative reflux disease. In these patients, an elevated Delta5 could make prolonged reflux testing unnecessary.

An elevated gap between admission and A1C-derived average glucose levels is associated with adverse outcomes in diabetic patients with pyogenic liver abscess.

PubMed

Liao, Wen-I; Sheu, Wayne Huey-Herng; Chang, Wei-Chou; Hsu, Chin-Wang; Chen, Yu-Long; Tsai, Shih-Hung

2013-01-01

To assess whether chronic glycemic control and stress-induced hyperglycemia, determined by the gap between admission glucose levels and A1C-derived average glucose (ADAG) levels adversely affects outcomes in diabetic patients with pyogenic liver abscess (PLA). Clinical, laboratory, and multi-detector computed tomography (MDCT) findings of 329 PLA patients (2004-2010) were retrospectively reviewed. HbA1C levels were used to determine long-term glycemic control status, which were then converted to estimated average glucose values. For the gap between admission glucose levels and ADAG levels, we used receiver operating characteristic (ROC) curve to determine the optimal cut-off values predicting adverse outcomes. Univariate and multivariate logistic regressions were used to identify predictors of adverse outcomes. Diabetic PLA patients with poorer glycemic control had significantly higher Klebsiella pneumoniae (KP) infection rates, lower albumin levels, and longer hospital stays than those with suboptimal and good glycemic control. The ROC curve showed that a glycemic gap of 72 mg/dL was the optimal cut-off value for predicting adverse outcomes and showed a 22.3% relative increase in adverse outcomes compared with a glycemic gap<72 mg/dL. Multivariate analysis revealed that an elevated glycemic gap≥72 mg/dL was important predictor of adverse outcomes. A glycemic gap≥72 mg/dL, rather than admission hyperglycemia or chronic glycemic control, was significantly correlated with adverse outcomes in diabetic PLA patients. Poorer chronic glycemic control in diabetic PLA patients is associated with high incidence of KP infection, hypoalbuminemia and longer hospital stay.

C-reactive protein, fibrinogen, and procalcitonin levels as early markers of staple line leak after laparoscopic sleeve gastrectomy in morbidly obese patients within an Enhanced Recovery After Surgery (ERAS) program.

PubMed

Ruiz-Tovar, Jaime; Muñoz, Jose Luis; Gonzalez, Juan; Garcia, Alejandro; Ferrigni, Carlos; Jimenez, Montiel; Duran, Manuel

2017-12-01

The performance of most bariatric procedures within an Enhanced Recovery After Surgery program has resulted in significant advantages, including a reduction in the length of hospital stay to 2-3 days. However, some postoperative complications may appear after the patient has been discharged. The aim of this study was to investigate the efficacy of various acute-phase parameters determined 24 h after a laparoscopic sleeve gastrectomy for predicting staple line leak in the postoperative course. A prospective study of 208 morbidly obese patients undergoing laparoscopic sleeve gastrectomy as bariatric procedure between 2012 and 2015 was performed. Blood analysis was performed 24 h after surgery. Acute-phase parameters (C-reactive protein, procalcitonin, fibrinogen, and White Blood Cell count) were investigated. Staple line leak appeared in eight patients (3.8%). Using receiver operating characteristic analysis at 24 h postoperatively, a cutoff level of CRP at 9 mg/dL achieved 85% sensitivity and 90% specificity for predicting staple line leak, a cutoff level of procalcitonin at 0.85 ng/mL achieved 70% sensitivity and 90% specificity, and a cutoff level of fibrinogen at 600 mg/dL achieved 80% sensitivity and 87.5% specificity. An elevation of CRP > 9 mg/dL, procalcitonin > 0.85 ng/mL and fibrinogen > 600 mg/dL should alert the surgeon the possibility of occurrence of postoperative staple line leak.

Use of the Pediatric Symptom Checklist for the detection of psychosocial problems in preventive child healthcare

PubMed Central

Reijneveld, Sijmen A; Vogels, Anton GC; Hoekstra, Femke; Crone, Matty R

2006-01-01

Background Early detection and treatment of psychosocial problems by preventive child healthcare may lead to considerable health benefits, and a short questionnaire could support this aim. The aim of this study was to assess whether the Dutch version of the US Pediatric Symptom checklist (PSC) is valid and suitable for the early detection of psychosocial problems among children. Methods We included 687 children (response 84.3%) aged 7–12 undergoing routine health assessments in nine Preventive Child Health Services across the Netherlands. Child health professionals interviewed and examined children and parents. Before the interview, parents completed an authorised Dutch translation of the PSC and the Child Behavior Checklist (CBCL). The CBCL and data on the child's current treatment status were used as criteria for the validity of the PSC. Results The consistency of the Dutch PSC was good (Cronbach alpha 0.89). The area under the ROC curve using the CBCL as a criterion was 0.94 (95% confidence interval 0.92 to 0.96). At the US cut-off (28 and above), the prevalence rate of an increased score and sensitivity were lower than in the USA. At a lower cut-off (22 and above), sensitivity and specificity were similar to that of the US version (71.7% and 93.0% respectively). Information on the PSC also helped in the identification of children with elevated CBCL Total Problems Scores, above solely clinical judgment. Conclusion The PSC is also useful for the early detection of psychosocial problems in preventive child healthcare outside the USA, especially with an adjusted cut-off. PMID:16872535

Analysis of elevation changes detected from multi-temporal LiDAR surveys in forested landslide terrain in western Oregon

USGS Publications Warehouse

Burns, W.J.; Coe, J.A.; Kaya, B.S.; Ma, Liwang

2010-01-01

We examined elevation changes detected from two successive sets of Light Detection and Ranging (LiDAR) data in the northern Coast Range of Oregon. The first set of LiDAR data was acquired during leafon conditions and the second set during leaf-off conditions. We were able to successfully identify and map active landslides using a differential digital elevation model (DEM) created from the two LiDAR data sets, but this required the use of thresholds (0.50 and 0.75 m) to remove noise from the differential elevation data, visual pattern recognition of landslideinduced elevation changes, and supplemental QuickBird satellite imagery. After mapping, we field-verified 88 percent of the landslides that we had mapped with high confidence, but we could not detect active landslides with elevation changes of less than 0.50 m. Volumetric calculations showed that a total of about 18,100 m3 of material was missing from landslide areas, probably as a result of systematic negative elevation errors in the differential DEM and as a result of removal of material by erosion and transport. We also examined the accuracies of 285 leaf-off LiDAR elevations at four landslide sites using Global Positioning System and total station surveys. A comparison of LiDAR and survey data indicated an overall root mean square error of 0.50 m, a maximum error of 2.21 m, and a systematic error of 0.09 m. LiDAR ground-point densities were lowest in areas with young conifer forests and deciduous vegetation, which resulted in extensive interpolations of elevations in the leaf-on, bare-earth DEM. For optimal use of multi-temporal LiDAR data in forested areas, we recommend that all data sets be flown during leaf-off seasons.

Associations between maternal depressive symptoms and child feeding practices in a cross-sectional study of low-income mothers and their young children

PubMed Central

2014-01-01

Background Maternal depression may influence feeding practices important in determining child eating behaviors and weight. However, the association between maternal depressive symptoms and feeding practices has been inconsistent, and most prior studies used self-report questionnaires alone to characterize feeding. The purpose of this study was to identify feeding practices associated with maternal depressive symptoms using multiple methodologies, and to test the hypothesis that maternal depressive symptoms are associated with less responsive feeding practices. Methods In this cross-sectional, observational study, participants (n = 295) included low-income mothers and their 4- to 8-year-old children. Maternal feeding practices were assessed via interviewer-administered questionnaires, semi-structured narrative interviews, and videotaped observations in home and laboratory settings. Maternal depressive symptoms were measured using the Center for Epidemiologic Studies-Depression scale (CES-D). Regression analyses examined associations between elevated depressive symptoms (CES-D score ≥16) and measures of maternal feeding practices, adjusting for: child sex, food fussiness, number of older siblings; and maternal age, body mass index (BMI), education, race/ethnicity, single parent status, perceived child weight, and concern about child weight. Results Thirty-one percent of mothers reported depressive symptoms above the screening cutoff. Mothers with elevated depressive symptoms reported more pressuring of children to eat (β = 0.29; 95% Confidence Interval (CI): 0.03, 0.54) and more overall demandingness (β = 0.16; 95% CI: 0.03, 0.29), and expressed lower authority in child feeding during semi-structured narrative interview (Odds Ratio (OR) for low authority: 2.82; 95% CI: 1.55, 5.12). In homes of mothers with elevated depressive symptoms, the television was more likely audible during meals (OR: 1.91; 95% CI: 1.05, 3.48) and mothers were less likely to eat with children (OR: 0.48; 95% CI: 0.27, 0.85). There were no associations between maternal depressive symptoms and encouragement or discouragement of food in laboratory eating interactions. Conclusions Mothers with elevated depressive symptoms demonstrated less responsive feeding practices than mothers with lower levels of depressive symptoms. These results suggest that screening for maternal depressive symptoms may be useful when counseling on healthy child feeding practices. Given inconsistencies across methodologies, future research should include multiple methods of characterizing feeding practices and direct comparisons of different methodologies. PMID:24935753

Associations between maternal depressive symptoms and child feeding practices in a cross-sectional study of low-income mothers and their young children.

PubMed

Goulding, Alison N; Rosenblum, Katherine L; Miller, Alison L; Peterson, Karen E; Chen, Yu-Pu; Kaciroti, Niko; Lumeng, Julie C

2014-06-16

Maternal depression may influence feeding practices important in determining child eating behaviors and weight. However, the association between maternal depressive symptoms and feeding practices has been inconsistent, and most prior studies used self-report questionnaires alone to characterize feeding. The purpose of this study was to identify feeding practices associated with maternal depressive symptoms using multiple methodologies, and to test the hypothesis that maternal depressive symptoms are associated with less responsive feeding practices. In this cross-sectional, observational study, participants (n = 295) included low-income mothers and their 4- to 8-year-old children. Maternal feeding practices were assessed via interviewer-administered questionnaires, semi-structured narrative interviews, and videotaped observations in home and laboratory settings. Maternal depressive symptoms were measured using the Center for Epidemiologic Studies-Depression scale (CES-D). Regression analyses examined associations between elevated depressive symptoms (CES-D score ≥16) and measures of maternal feeding practices, adjusting for: child sex, food fussiness, number of older siblings; and maternal age, body mass index (BMI), education, race/ethnicity, single parent status, perceived child weight, and concern about child weight. Thirty-one percent of mothers reported depressive symptoms above the screening cutoff. Mothers with elevated depressive symptoms reported more pressuring of children to eat (β = 0.29; 95% Confidence Interval (CI): 0.03, 0.54) and more overall demandingness (β = 0.16; 95% CI: 0.03, 0.29), and expressed lower authority in child feeding during semi-structured narrative interview (Odds Ratio (OR) for low authority: 2.82; 95% CI: 1.55, 5.12). In homes of mothers with elevated depressive symptoms, the television was more likely audible during meals (OR: 1.91; 95% CI: 1.05, 3.48) and mothers were less likely to eat with children (OR: 0.48; 95% CI: 0.27, 0.85). There were no associations between maternal depressive symptoms and encouragement or discouragement of food in laboratory eating interactions. Mothers with elevated depressive symptoms demonstrated less responsive feeding practices than mothers with lower levels of depressive symptoms. These results suggest that screening for maternal depressive symptoms may be useful when counseling on healthy child feeding practices. Given inconsistencies across methodologies, future research should include multiple methods of characterizing feeding practices and direct comparisons of different methodologies.

Associations Between Vitamin D Levels and Depressive Symptoms in Later Life: Evidence From the English Longitudinal Study of Ageing (ELSA).

PubMed

de Oliveira, Cesar; Hirani, Vasant; Biddulph, Jane P

2017-06-22

A possible role of vitamin D in depression has received considerable attention, especially given the significant disability, mortality, and healthcare costs associated to depression and the high prevalence of vitamin D deficiency. We investigated the cross-sectional associations between serum 25-hydroxyvitamin D (25OHD) levels and depressive symptoms (CES-D) in 5,607 older adults from the English Longitudinal Study of Ageing (ELSA). Overall, there was a significant association between low 25OHD levels and elevated depressive symptoms (odds ratio [OR] = 1.58, 95% confidence interval [CI] = 1.20-2.07 for the lowest quartile; OR = 1.45, 95% CI = 1.15-1.83 for <30 nmol/L cut-off and OR = 1.34, 95% CI = 1.10-1.62 for the ≤50 nmol/L cut-off) after adjustment for a wide range of covariates of clinical significance. Fully adjusted models showed that women in the lowest (OR = 1.67, 95% CI = 1.20-2.34) and second lowest (OR = 1.68, 95% CI = 1.20-2.35) quartiles of 25OHD as well as those with 25OHD levels <30 nmol/L (OR = 1.40, 95% CI = 1.06-1.86) and ≤50 nmol/L (OR = 1.35, 95% CI = 1.07-1.72) were more likely to report elevated depressive symptoms. For men, however, this association only remained significant for those with 25OHD levels of <30 nmol/L (OR = 1.60, 95% CI = 1.06-2.42) in the fully adjusted models. The independent and inverse association found between low 25OHD levels and elevated depressive symptoms suggests that vitamin D deficiency may be a risk factor for late-life depression, particularly among women. Whether our findings have any clinical meaning or not, additional data are needed from well-designed randomized controlled trials of vitamin D for the prevention and treatment of late-life depression. © The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America.

Performance Analysis on Carrier Phase-Based Tightly-Coupled GPS/BDS/INS Integration in GNSS Degraded and Denied Environments

PubMed Central

Han, Houzeng; Wang, Jian; Wang, Jinling; Tan, Xinglong

2015-01-01

The integration of Global Navigation Satellite Systems (GNSS) carrier phases with Inertial Navigation System (INS) measurements is essential to provide accurate and continuous position, velocity and attitude information, however it is necessary to fix ambiguities rapidly and reliably to obtain high accuracy navigation solutions. In this paper, we present the notion of combining the Global Positioning System (GPS), the BeiDou Navigation Satellite System (BDS) and low-cost micro-electro-mechanical sensors (MEMS) inertial systems for reliable navigation. An adaptive multipath factor-based tightly-coupled (TC) GPS/BDS/INS integration algorithm is presented and the overall performance of the integrated system is illustrated. A twenty seven states TC GPS/BDS/INS model is adopted with an extended Kalman filter (EKF), which is carried out by directly fusing ambiguity fixed double-difference (DD) carrier phase measurements with the INS predicted pseudoranges to estimate the error states. The INS-aided integer ambiguity resolution (AR) strategy is developed by using a dynamic model, a two-step estimation procedure is applied with adaptively estimated covariance matrix to further improve the AR performance. A field vehicular test was carried out to demonstrate the positioning performance of the combined system. The results show the TC GPS/BDS/INS system significantly improves the single-epoch AR reliability as compared to that of GPS/BDS-only or single satellite navigation system integrated strategy, especially for high cut-off elevations. The AR performance is also significantly improved for the combined system with adaptive covariance matrix in the presence of low elevation multipath related to the GNSS-only case. A total of fifteen simulated outage tests also show that the time to relock of the GPS/BDS signals is shortened, which improves the system availability. The results also indicate that TC integration system achieves a few centimeters accuracy in positioning based on the comparison analysis and covariance analysis, even in harsh environments (e.g., in urban canyons), thus we can see the advantage of positioning at high cut-off elevations that the combined GPS/BDS brings. PMID:25875191

Performance analysis on carrier phase-based tightly-coupled GPS/BDS/INS integration in GNSS degraded and denied environments.

PubMed

Han, Houzeng; Wang, Jian; Wang, Jinling; Tan, Xinglong

2015-04-14

The integration of Global Navigation Satellite Systems (GNSS) carrier phases with Inertial Navigation System (INS) measurements is essential to provide accurate and continuous position, velocity and attitude information, however it is necessary to fix ambiguities rapidly and reliably to obtain high accuracy navigation solutions. In this paper, we present the notion of combining the Global Positioning System (GPS), the BeiDou Navigation Satellite System (BDS) and low-cost micro-electro-mechanical sensors (MEMS) inertial systems for reliable navigation. An adaptive multipath factor-based tightly-coupled (TC) GPS/BDS/INS integration algorithm is presented and the overall performance of the integrated system is illustrated. A twenty seven states TC GPS/BDS/INS model is adopted with an extended Kalman filter (EKF), which is carried out by directly fusing ambiguity fixed double-difference (DD) carrier phase measurements with the INS predicted pseudoranges to estimate the error states. The INS-aided integer ambiguity resolution (AR) strategy is developed by using a dynamic model, a two-step estimation procedure is applied with adaptively estimated covariance matrix to further improve the AR performance. A field vehicular test was carried out to demonstrate the positioning performance of the combined system. The results show the TC GPS/BDS/INS system significantly improves the single-epoch AR reliability as compared to that of GPS/BDS-only or single satellite navigation system integrated strategy, especially for high cut-off elevations. The AR performance is also significantly improved for the combined system with adaptive covariance matrix in the presence of low elevation multipath related to the GNSS-only case. A total of fifteen simulated outage tests also show that the time to relock of the GPS/BDS signals is shortened, which improves the system availability. The results also indicate that TC integration system achieves a few centimeters accuracy in positioning based on the comparison analysis and covariance analysis, even in harsh environments (e.g., in urban canyons), thus we can see the advantage of positioning at high cut-off elevations that the combined GPS/BDS brings.

Analysis of River Profiles in northwestern Bhutan

NASA Astrophysics Data System (ADS)

de Palézieux, Larissa; Leith, Kerry; Loew, Simon

2017-04-01

With large alluvial plains, narrow gorges, prominent knick points, and chains of terraces or cut-off ridges, the deeply-incised valleys in Bhutan reflect an environment of diverse erosional activity. Topography ranges from 97 m to 7570 m, with characteristic postglacial landscapes typically located above ca 4200 m. The lower latitudes below ca 3000 m show high relief and terraced or linear hillslopes indicative of a fluvial origin. Although full channel analyses in the region suggest significant local tectonic contributions to longitudinal river profiles (Adams et al., 2016), we develop a method to isolate rivers in an apparently homogeneous tectonic block in the mid- to upper- elevations. Profiles of rivers in this region show a consistent pattern with a marked topographic step covering 2000 m of elevation change within 10 km. Field observations of knick points, terraces and cut-off ridges associated with the step suggest a regionally consistent signal resulting from changes in relative uplift or erosion rate. Chi plots correlate well for all channels when the base level is chosen to isolate rivers below the main alluvial plain, suggesting similar fluvial erosion histories in upstream regions. Employing third order topographic derivatives (Minár et al., 2013), we identify low angle slope sections/plateaus corresponding to terraces and/or extrapolated ridges that project onto former valley floor levels. Employing similar methods as those used to correlate fluvial knickpoints, these will be used to test for regionally consistent changes in fluvial and hillslope activity that may be tied to major tectonic or climatic changes. REFERENCES Adams, B., Whipple, K. X., Hodges, K. V. & Heimsath, A. M. 2016: In situ development of high-elevation, low-relief landscapes via duplex deformation in the Eastern Himalayan hinterland, Bhutan, in Journal of Geophysical Research: Earth Surface, 925-938. Minár, J., Jenčo, M., Evans, I. S., Minár, J., Kadlec, M., Krcho, J., Pacina, J., Burian, L., and Benová, A., 2013, Third-order geomorphometric variables (derivatives): definition, computation and utilization of changes of curvatures: International Journal of Geographical Information Science, v. 27, no. 7, p. 1381-1402.

Setting limits on Effective Field Theories: the case of Dark Matter

NASA Astrophysics Data System (ADS)

Pobbe, Federico; Wulzer, Andrea; Zanetti, Marco

2017-08-01

The usage of Effective Field Theories (EFT) for LHC new physics searches is receiving increasing attention. It is thus important to clarify all the aspects related with the applicability of the EFT formalism in the LHC environment, where the large available energy can produce reactions that overcome the maximal range of validity, i.e. the cutoff, of the theory. We show that this does not forbid to set rigorous limits on the EFT parameter space through a modified version of the ordinary binned likelihood hypothesis test, which we design and validate. Our limit-setting strategy can be carried on in its full-fledged form by the LHC experimental collaborations, or performed externally to the collaborations, through the Simplified Likelihood approach, by relying on certain approximations. We apply it to the recent CMS mono-jet analysis and derive limits on a Dark Matter (DM) EFT model. DM is selected as a case study because the limited reach on the DM production EFT Wilson coefficient and the structure of the theory suggests that the cutoff might be dangerously low, well within the LHC reach. However our strategy can also be applied, if needed, to EFT's parametrising the indirect effects of heavy new physics in the Electroweak and Higgs sectors.

KSC-07pd3644

NASA Image and Video Library

2007-12-15

KENNEDY SPACE CENTER, FLA. -- On Launch Pad 39A at NASA's Kennedy Space Center, a technician sets up wiring for the tanking test on space shuttle Atlantis' external tank set for Dec. 18. The test wiring has been spliced into an electrical harness in the aft main engine compartment connected with the engine cut-off, or ECO, sensor system. The attached wiring leads to the interior of the mobile launcher platform where the time domain reflectometry, or TDR, test equipment is located. Photo credit: NASA/Kim Shiflett

KSC-07pd3645

NASA Image and Video Library

2007-12-15

KENNEDY SPACE CENTER, FLA. -- On Launch Pad 39A at NASA's Kennedy Space Center, a wiring board has been set up for the tanking test on space shuttle Atlantis' external tank set for Dec. 18. The test wiring has been spliced into an electrical harness in the aft main engine compartment connected with the engine cut-off, or ECO, sensor system. The attached wiring leads to the interior of the mobile launcher platform where the time domain reflectometry, or TDR, test equipment is located. Photo credit: NASA/Kim Shiflett

Duration of the distal compound muscle action potential for diagnosis of chronic inflammatory demyelinating polyneuropathy: effects of low-cut filters.

PubMed

Isose, Sagiri; Misawa, Sonoko; Sonoo, Masahiro; Shimuzu, Toshio; Oishi, Chizuko; Shibuya, Kazumoto; Nasu, Saiko; Sekiguchi, Yukari; Mitsuma, Satsuki; Beppu, Minako; Omori, Shigeki; Komori, Tetsuo; Kokubun, Norito; Inaba, Akira; Hirashima, Fumiko; Kuwabara, Satoshi

2014-10-01

In current electrodiagnostic criteria for chronic inflammatory demyelinating polyneuropathy, the cutoff values of distal compound muscle action potential (DCMAP) duration are defined using electromyogram low-cut filter setting of 20 Hz. We aimed to assess effects of low-cut filter on DCMAP duration (10 vs. 20 Hz). We prospectively measured DCMAP duration in 130 normal controls and 42 patients, fulfilling diagnostic criteria for typical chronic inflammatory demyelinating polyneuropathy by European Federation of Neurological Societies/Peripheral Nerve Society. Distal compound muscle action potential duration was significantly shortened with 20-Hz than 10-Hz filtering. When the cutoff values were defined as the upper limit of normal (ULN, mean + 2.5SD), the sensitivity/specificity was 67%/95% in 10-Hz recordings, and 69%/95% in 20-Hz recordings. This diagnostic accuracy was similar to that defined by receiver operating characteristic analyses. Distal compound muscle action potential duration significantly affected by the low-cut electromyogram filter setting, but with at least 10 and 20 Hz, the diagnostic accuracy is similar.

Childhood stunting: a global perspective

PubMed Central

Branca, Francesco

2016-01-01

Abstract Childhood stunting is the best overall indicator of children's well‐being and an accurate reflection of social inequalities. Stunting is the most prevalent form of child malnutrition with an estimated 161 million children worldwide in 2013 falling below −2 SD from the length‐for‐age/height‐for‐age World Health Organization Child Growth Standards median. Many more millions suffer from some degree of growth faltering as the entire length‐for‐age/height‐for‐age z‐score distribution is shifted to the left indicating that all children, and not only those falling below a specific cutoff, are affected. Despite global consensus on how to define and measure it, stunting often goes unrecognized in communities where short stature is the norm as linear growth is not routinely assessed in primary health care settings and it is difficult to visually recognize it. Growth faltering often begins in utero and continues for at least the first 2 years of post‐natal life. Linear growth failure serves as a marker of multiple pathological disorders associated with increased morbidity and mortality, loss of physical growth potential, reduced neurodevelopmental and cognitive function and an elevated risk of chronic disease in adulthood. The severe irreversible physical and neurocognitive damage that accompanies stunted growth poses a major threat to human development. Increased awareness of stunting's magnitude and devastating consequences has resulted in its being identified as a major global health priority and the focus of international attention at the highest levels with global targets set for 2025 and beyond. The challenge is to prevent linear growth failure while keeping child overweight and obesity at bay. PMID:27187907

The effect of magnetic topography on high-latitude radio emission at Neptune

NASA Technical Reports Server (NTRS)

Sawyer, C. B.; Warwick, James W.; Romig, J. H.

1992-01-01

Occultation by a local elevation on the surface of constant magnetic field is proposed as a new interpretation for the unusual properties of Neptune high-latitude emission. Abrupt changes in intensity and polarization of this broadband smooth radio emission were observed as the Voyager 2 spacecraft passed near the north magnetic pole before closest approach. The observed sequence of cutoffs with polarization reversal would not occur during descent of the spacecraft through regular surfaces of increasing magnetic field. The sequence can be understood in terms of constant-frequency (constant-field) surfaces that are not only offset from the planet center but are locally highly distorted by an elevation that occults the outgoing extraordinary-mode beam. The required occulter is similar to the field enhancement observed directly by the magnetometer team when Voyager reached lower altitude farther to the west. Evidence is presented that the sources of the high-altitude emission are located near the longitude of the minimum-B anomaly associated with the dipole offset and that the local elevation of constant-B surfaces extends eastward from the longitude where it is directly measured by the magnetometer to the longitude where occultation of the remote radio source is observed. Together, the radio and magnetometer experiments indicate that the constant-frequency surfaces are distorted by an elevation that extends 0.3 rad in the longitudinal direction.

Impact of Elevated End-Diastolic Pulmonary Regurgitation Gradient on Worse Clinical Outcomes in Hospitalized Patients With Heart Failure.

PubMed

Honda, Yasuyuki; Nagai, Toshiyuki; Sugano, Yasuo; Honda, Satoshi; Okada, Atsushi; Asaumi, Yasuhide; Aiba, Takeshi; Noguchi, Teruo; Kusano, Kengo; Ogawa, Hisao; Yasuda, Satoshi; Anzai, Toshihisa

2017-02-15

The echo Doppler end-diastolic pulmonary regurgitation (EDPR) gradient correlates well with catheter-derived pulmonary artery diastolic pressure. An elevated EDPR gradient is associated with worse clinical outcomes in patients with stable coronary artery disease. However, the prognostic significance of EDPR gradient in patients with heart failure (HF) is unclear. The aim of the present study was to investigate the prognostic impact of EDPR gradient in HF. We retrospectively examined 751 consecutive hospitalized patients with acute HF. Those with acute coronary syndrome or in-hospital death and those without accessible EDPR gradient data at discharge were excluded. Finally, 265 patients were examined and divided into 2 groups according to EDPR gradient (cutoff 9 mm Hg). Adverse events were defined as worsening HF and death. Patients with elevated EDPR gradient had higher B-type natriuretic peptide, lower age, and lower left ventricular ejection fraction at discharge than those with nonelevated EDPR gradient. During a median follow-up of 429 days, elevated EDPR gradient was independently associated with adverse events (hazard ratio 2.34, 95% CI 1.44 to 3.78, p <0.001) after adjustment for confounders. In conclusion, echo Doppler EDPR gradient might be a noninvasive predictor of clinical outcomes in hospitalized patients with HF. Copyright © 2016 Elsevier Inc. All rights reserved.

Feasibility and predictive performance of the Hendrich Fall Risk Model II in a rehabilitation department: a prospective study.

PubMed

Campanini, Isabella; Mastrangelo, Stefano; Bargellini, Annalisa; Bassoli, Agnese; Bosi, Gabriele; Lombardi, Francesco; Tolomelli, Stefano; Lusuardi, Mirco; Merlo, Andrea

2018-01-11

Falls are a common adverse event in both elderly inpatients and patients admitted to rehabilitation units. The Hendrich Fall Risk Model II (HIIFRM) has been already tested in all hospital wards with high fall rates, with the exception of the rehabilitation setting. This study's aim is to address the feasibility and predictive performances of HIIFRM in a hospital rehabilitation department. A 6 months prospective study in a Italian rehabilitation department with patients from orthopaedic, pulmonary, and neurological rehabilitation wards. All admitted patients were enrolled and assessed within 24 h of admission by means of the HIIFRM. The occurrence of falls was checked and recorded daily. HIIFRM feasibility was assessed as the percentage of successful administrations at admission. HIIFRM predictive performance was determined in terms of area under the Receiver Operating Characteristic (ROC) curve (AUC), best cutoff, sensitivity, specificity, positive and negative predictive values, along with their asymptotic 95% confidence intervals (95% CI). One hundred ninety-one patents were admitted. HIIFRM was feasible in 147 cases (77%), 11 of which suffered a fall (7.5%). Failures in administration were mainly due to bedridden patients (e.g. minimally conscious state, vegetative state). AUC was 0.779(0.685-0.873). The original HIIFRM cutoff of 5 led to a sensitivity of 100% with a mere specificity of 49%(40-57%), thus suggesting using higher cutoffs. Moreover, the median score for non-fallers at rehabilitation units was higher than that reported in literature for geriatric non fallers. The best trade-off between sensitivity and specificity was obtained by using a cutoff of 8. This lead to sensitivity = 73%(46-99%), specificity = 72%(65-80%), positive predictive value = 17% and negative predictive value = 97%. These results support the use of the HIIFRM as a predictive tool. The HIIFRM showed satisfactory feasibility and predictive performances in rehabilitation wards. Based on both available literature and these results, the prediction of falls among all hospital wards, with high risk of falling, could be achieved by means of a unique tool and two different cutoffs: a standard cutoff of 5 in geriatric wards and an adjusted higher cutoff in rehabilitation units, with predictive performances similar to those of the best-preforming pathology specific tools for fall-risk assessment.

Population-based colorectal cancer screening programmes using a faecal immunochemical test: should faecal haemoglobin cut-offs differ by age and sex?

PubMed

Arana-Arri, Eunate; Idigoras, Isabel; Uranga, Begoña; Pérez, Raquel; Irurzun, Ana; Gutiérrez-Ibarluzea, Iñaki; Fraser, Callum G; Portillo, Isabel

2017-08-29

The Basque Colorectal Cancer Screening Programme has both high participation rate and high compliance rate of colonoscopy after a positive faecal occult blood test (FIT). Although, colorectal cancer (CRC) screening with biannual (FIT) has shown to reduce CRC mortality, the ultimate effectiveness of the screening programmes depends on the accuracy of FIT and post-FIT colonoscopy, and thus, harms related to false results might not be underestimated. Current CRC screening programmes use a single faecal haemoglobin concentration (f-Hb) cut-off for colonoscopy referral for both sexes and all ages. We aimed to determine optimum f-Hb cut-offs by sex and age without compromising neoplasia detection and interval cancer proportion. Prospective cohort study using a single-sample faecal immunochemical test (FIT) on 444,582 invited average-risk subjects aged 50-69 years. A result was considered positive at ≥20 μg Hb/g faeces. Outcome measures were analysed by sex and age for a wide range of f-Hb cut-offs. We analysed 17,387 positive participants in the programme who underwent colonoscopy. Participation rate was 66.5%. Men had a positivity rate for f-Hb of 8.3% and women 4.8% (p < 0.0001). The detection rate for advanced neoplasia (cancer plus advanced adenoma) was 44.0‰ for men and 15.9‰ for women (p < 0.0001). The number of colonoscopies required decreased in both sexes and all age groups through increasing the f-Hb cut-off. However, the loss in CRC detection increased by up to 28.1% in men and 22.9% in women. CRC missed were generally at early stages (Stage I-II: from 70.2% in men to 66.3% in women). This study provides detailed outcomes in men and women of different ages at a range of f-Hb cut-offs. We found differences in positivity rates, neoplasia detection rate, number needed to screen, and interval cancers in men and women and in younger and older groups. However, there are factors other than sex and age to consider when consideration is given to setting the f-Hb cut-off.

Identifying depression with the PHQ-2: A diagnostic meta-analysis.

PubMed

Manea, Laura; Gilbody, Simon; Hewitt, Catherine; North, Alice; Plummer, Faye; Richardson, Rachel; Thombs, Brett D; Williams, Bethany; McMillan, Dean

2016-10-01

There is interest in the use of very brief instruments to identify depression because of the advantages they offer in busy clinical settings. The PHQ-2, consisting of two questions relating to core symptoms of depression (low mood and loss of interest or pleasure), is one such instrument. A systematic review was conducted to identify studies that had assessed the diagnostic performance of the PHQ-2 to detect major depression. Embase, MEDLINE, PsychINFO and grey literature databases were searched. Reference lists of included studies and previous relevant reviews were also examined. Studies were included that used the standard scoring system of the PHQ-2, assessed its performance against a gold-standard diagnostic interview and reported data on its performance at the recommended (≥3) or an alternative cut-off point (≥2). After assessing heterogeneity, where appropriate, data from studies were combined using bivariate diagnostic meta-analysis to derive sensitivity, specificity, likelihood ratios and diagnostic odds ratios. 21 studies met inclusion criteria totalling N=11,175 people out of which 1529 had major depressive disorder according to a gold standard. 19 of the 21 included studies reported data for a cut-off point of ≥3. Pooled sensitivity was 0.76 (95% CI =0.68-0.82), pooled specificity was 0.87 (95% CI =0.82-0.90). However there was substantial heterogeneity at this cut-off (I(2)=81.8%). 17 studies reported data on the performance of the measure at cut-off point ≥2. Heterogeneity was I(2)=43.2% pooled sensitivity at this cut-off point was 0.91 (95% CI =0.85-0.94), and pooled specificity was 0.70 (95% CI =0.64-0.76). The generally lower sensitivity of the PHQ-2 at cut-off ≥3 than the original validation study (0.83) suggests that ≥2 may be preferable if clinicians want to ensure that few cases of depression are missed. However, in situations in which the prevalence of depression is low, this may result in an unacceptably high false-positive rate because of the associated modest specificity. These results, however, need to be interpreted with caution given the possibility of selectively reported cut-offs. Copyright © 2016. Published by Elsevier B.V.

Assessment of interchangeability rate between 2 methods of measurements: An example with a cardiac output comparison study.

PubMed

Lorne, Emmanuel; Diouf, Momar; de Wilde, Robert B P; Fischer, Marc-Olivier

2018-02-01

The Bland-Altman (BA) and percentage error (PE) methods have been previously described to assess the agreement between 2 methods of medical or laboratory measurements. This type of approach raises several problems: the BA methodology constitutes a subjective approach to interchangeability, whereas the PE approach does not take into account the distribution of values over a range. We describe a new methodology that defines an interchangeability rate between 2 methods of measurement and cutoff values that determine the range of interchangeable values. We used a simulated data and a previously published data set to demonstrate the concept of the method. The interchangeability rate of 5 different cardiac output (CO) pulse contour techniques (Wesseling method, LiDCO, PiCCO, Hemac method, and Modelflow) was calculated, in comparison with the reference pulmonary artery thermodilution CO using our new method. In our example, Modelflow with a good interchangeability rate of 93% and a cutoff value of 4.8 L min, was found to be interchangeable with the thermodilution method for >95% of measurements. Modelflow had a higher interchangeability rate compared to Hemac (93% vs 86%; P = .022) or other monitors (Wesseling cZ = 76%, LiDCO = 73%, and PiCCO = 62%; P < .0001). Simulated data and reanalysis of a data set comparing 5 CO monitors against thermodilution CO showed that, depending on the repeatability of the reference method, the interchangeability rate combined with a cutoff value could be used to define the range of values over which interchangeability remains acceptable.

Screening for alcohol use disorders and at-risk drinking in the general population: psychometric performance of three questionnaires.

PubMed

Rumpf, Hans-Jürgen; Hapke, Ulfert; Meyer, Christian; John, Ulrich

2002-01-01

Most screening questionnaires are developed in clinical settings and there are few data on their performance in the general population. This study provides data on the area under the receiver-operating characteristic (ROC) curve, sensitivity, specificity, and internal consistency of the Alcohol Use Disorders Identification Test (AUDIT), the consumption questions of the AUDIT (AUDIT-C) and the Lübeck Alcohol Dependence and Abuse Screening Test (LAST) among current drinkers (n = 3551) of a general population sample in northern Germany. Alcohol dependence and misuse according to DSM-IV and at-risk drinking served as gold standards to assess sensitivity and specificity and were assessed with the Munich-Composite Diagnostic Interview (M-CIDI). AUDIT and LAST showed insufficient sensitivity for at-risk drinking and alcohol misuse using standard cut-off scores, but satisfactory detection rates for alcohol dependence. The AUDIT-C showed low specificity in all criterion groups with standard cut-off. Adjusted cut-points are recommended. Among a subsample of individuals with previous general hospital admission in the last year, all questionnaires showed higher internal consistency suggesting lower reliability in non-clinical samples. In logistic regression analyses, having had a hospital admission increased the sensitivity in detecting any criterion group of the LAST, and the number of recent general practice visits increased the sensitivity of the AUDIT in detecting alcohol misuse. Women showed lower scores and larger areas under the ROC curves. It is concluded that setting specific instruments (e.g. primary care or general population) or adjusted cut-offs should be used.

Reliability and Validity of Instruments for Assessing Perinatal Depression in African Settings: Systematic Review and Meta-Analysis

PubMed Central

Tsai, Alexander C.; Scott, Jennifer A.; Hung, Kristin J.; Zhu, Jennifer Q.; Matthews, Lynn T.; Psaros, Christina; Tomlinson, Mark

2013-01-01

Background A major barrier to improving perinatal mental health in Africa is the lack of locally validated tools for identifying probable cases of perinatal depression or for measuring changes in depression symptom severity. We systematically reviewed the evidence on the reliability and validity of instruments to assess perinatal depression in African settings. Methods and Findings Of 1,027 records identified through searching 7 electronic databases, we reviewed 126 full-text reports. We included 25 unique studies, which were disseminated in 26 journal articles and 1 doctoral dissertation. These enrolled 12,544 women living in nine different North and sub-Saharan African countries. Only three studies (12%) used instruments developed specifically for use in a given cultural setting. Most studies provided evidence of criterion-related validity (20 [80%]) or reliability (15 [60%]), while fewer studies provided evidence of construct validity, content validity, or internal structure. The Edinburgh postnatal depression scale (EPDS), assessed in 16 studies (64%), was the most frequently used instrument in our sample. Ten studies estimated the internal consistency of the EPDS (median estimated coefficient alpha, 0.84; interquartile range, 0.71-0.87). For the 14 studies that estimated sensitivity and specificity for the EPDS, we constructed 2 x 2 tables for each cut-off score. Using a bivariate random-effects model, we estimated a pooled sensitivity of 0.94 (95% confidence interval [CI], 0.68-0.99) and a pooled specificity of 0.77 (95% CI, 0.59-0.88) at a cut-off score of ≥9, with higher cut-off scores yielding greater specificity at the cost of lower sensitivity. Conclusions The EPDS can reliably and validly measure perinatal depression symptom severity or screen for probable postnatal depression in African countries, but more validation studies on other instruments are needed. In addition, more qualitative research is needed to adequately characterize local understandings of perinatal depression-like syndromes in different African contexts. PMID:24340036

Evaluation of Normalization Methods on GeLC-MS/MS Label-Free Spectral Counting Data to Correct for Variation during Proteomic Workflows

NASA Astrophysics Data System (ADS)

Gokce, Emine; Shuford, Christopher M.; Franck, William L.; Dean, Ralph A.; Muddiman, David C.

2011-12-01

Normalization of spectral counts (SpCs) in label-free shotgun proteomic approaches is important to achieve reliable relative quantification. Three different SpC normalization methods, total spectral count (TSpC) normalization, normalized spectral abundance factor (NSAF) normalization, and normalization to selected proteins (NSP) were evaluated based on their ability to correct for day-to-day variation between gel-based sample preparation and chromatographic performance. Three spectral counting data sets obtained from the same biological conidia sample of the rice blast fungus Magnaporthe oryzae were analyzed by 1D gel and liquid chromatography-tandem mass spectrometry (GeLC-MS/MS). Equine myoglobin and chicken ovalbumin were spiked into the protein extracts prior to 1D-SDS- PAGE as internal protein standards for NSP. The correlation between SpCs of the same proteins across the different data sets was investigated. We report that TSpC normalization and NSAF normalization yielded almost ideal slopes of unity for normalized SpC versus average normalized SpC plots, while NSP did not afford effective corrections of the unnormalized data. Furthermore, when utilizing TSpC normalization prior to relative protein quantification, t-testing and fold-change revealed the cutoff limits for determining real biological change to be a function of the absolute number of SpCs. For instance, we observed the variance decreased as the number of SpCs increased, which resulted in a higher propensity for detecting statistically significant, yet artificial, change for highly abundant proteins. Thus, we suggest applying higher confidence level and lower fold-change cutoffs for proteins with higher SpCs, rather than using a single criterion for the entire data set. By choosing appropriate cutoff values to maintain a constant false positive rate across different protein levels (i.e., SpC levels), it is expected this will reduce the overall false negative rate, particularly for proteins with higher SpCs.

Evaluation of the optimal neutrophil gelatinase-associated lipocalin value as a screening biomarker for urinary tract infections in children.

PubMed

Kim, Bo Hyun; Yu, Nae; Kim, Hye Ryoun; Yun, Ki Wook; Lim, In Seok; Kim, Tae Hyoung; Lee, Mi-Kyung

2014-09-01

Neutrophil gelatinase-associated lipocalin (NGAL) is a promising biomarker in the detection of kidney injury. Early diagnosis of urinary tract infection (UTI), one of the most common infections in children, is important in order to avert long-term consequences. We assessed whether serum NGAL (sNGAL) or urine NGAL (uNGAL) would be reliable markers of UTI and evaluated the appropriate diagnostic cutoff value for the screening of UTI in children. A total of 812 urine specimens and 323 serum samples, collected from pediatric patients, were analyzed. UTI was diagnosed on the basis of culture results and symptoms reported by the patients. NGAL values were measured by using ELISA. NGAL values were more elevated in the UTI cases than in the non-UTI cases, but the difference between the values were not statistically significant (P=0.190 for sNGAL and P=0.064 for uNGAL). The optimal diagnostic cutoff values of sNGAL and uNGAL for UTI screening were 65.25 ng/mL and 5.75 ng/mL, respectively. We suggest that it is not appropriate to use NGAL as a marker for early diagnosis of UTI in children.

Validity of the MCMI Drug Abuse Scale varies as a function of drug choice, race, and axis II subtypes.

PubMed

Calsyn, D A; Saxon, A J; Daisy, F

1991-06-01

The validity of the Drug Abuse Scale (T) from the Million Clinical Multiaxial Inventory (MCMI) was studied by administering the MCMI to 110 male veterans seeking treatment for opioid or cocaine dependence. Only 26 and 23% of the sample obtained base rate (BR) scores above the clinical relevant cutoffs of 84 and 74, respectively. Covariables associated with elevated scores on the T Scale were Black race, presence of narcissistic/antisocial personality features, and more severe psychopathology in general. The authors urge caution in using the Drug Abuse Scale for the purpose of identifying drug abusers.

[PHQ-2 as First Screening Instrument of Prenatal Depression in Primary Health Care, Spain].

PubMed

Rodríguez-Muñoz, María de la Fe; Castelao Legazpi, Pilar Carolina; Olivares Crespo, María Eugenia; Soto Balbuena, Cristina; Izquierdo Méndez, Nuria; Ferrer Barrientos, Francisco Javier; Huynh-Nhu, Le

2017-01-30

Prenatal depression is a major public health problem that is barely treated. Based on existing literature, depression during this period is associated with negative consequences for the mother and the baby. Therefore it is important to make an adequate screening in this population. The aim of this study was to determine the discriminant validity and cut-off of the Patient Health Questionnaire (PHQ-2) as a screening tool to identify the depression in pregnant women living in Spain. The sample included 1,019 female participants, aged between 19 and 45 years, who participated voluntarily, and received prenatal care during the first trimester. Participants completed a sociodemographic questionnaire, PHQ-2 andPHQ-9. The research has been developed within the Obstetrics and Gynecology department at two public hospitals in two different Spanish Regions. The research was conducted between 2014 and 2016 performing a ROC curve analysis to determine the discriminative capacity and cut-off for PHQ-2. 11,1 % out of 1019 participants were diagnosed with depression. The area under the curve of PHQ-2 was 0,84 p smaller than 0,001. With the cutoff 2 the sensitivity and specificity of 85,4 % and 79,5% respectively. A score Equal or greater than 2 is an appropriate cut-off in PHQ-2 to detect depression during pregnancy. The use of PHQ-2 could precede PHQ-9 as a brief screening tool for antenatal depression in obstetric settings.

Discrimination and prediction of cultivation age and parts of Panax ginseng by Fourier-transform infrared spectroscopy combined with multivariate statistical analysis.

PubMed

Lee, Byeong-Ju; Kim, Hye-Youn; Lim, Sa Rang; Huang, Linfang; Choi, Hyung-Kyoon

2017-01-01

Panax ginseng C.A. Meyer is a herb used for medicinal purposes, and its discrimination according to cultivation age has been an important and practical issue. This study employed Fourier-transform infrared (FT-IR) spectroscopy with multivariate statistical analysis to obtain a prediction model for discriminating cultivation ages (5 and 6 years) and three different parts (rhizome, tap root, and lateral root) of P. ginseng. The optimal partial-least-squares regression (PLSR) models for discriminating ginseng samples were determined by selecting normalization methods, number of partial-least-squares (PLS) components, and variable influence on projection (VIP) cutoff values. The best prediction model for discriminating 5- and 6-year-old ginseng was developed using tap root, vector normalization applied after the second differentiation, one PLS component, and a VIP cutoff of 1.0 (based on the lowest root-mean-square error of prediction value). In addition, for discriminating among the three parts of P. ginseng, optimized PLSR models were established using data sets obtained from vector normalization, two PLS components, and VIP cutoff values of 1.5 (for 5-year-old ginseng) and 1.3 (for 6-year-old ginseng). To our knowledge, this is the first study to provide a novel strategy for rapidly discriminating the cultivation ages and parts of P. ginseng using FT-IR by selected normalization methods, number of PLS components, and VIP cutoff values.

Discrimination and prediction of cultivation age and parts of Panax ginseng by Fourier-transform infrared spectroscopy combined with multivariate statistical analysis

PubMed Central

Lim, Sa Rang; Huang, Linfang

2017-01-01

Panax ginseng C.A. Meyer is a herb used for medicinal purposes, and its discrimination according to cultivation age has been an important and practical issue. This study employed Fourier-transform infrared (FT-IR) spectroscopy with multivariate statistical analysis to obtain a prediction model for discriminating cultivation ages (5 and 6 years) and three different parts (rhizome, tap root, and lateral root) of P. ginseng. The optimal partial-least-squares regression (PLSR) models for discriminating ginseng samples were determined by selecting normalization methods, number of partial-least-squares (PLS) components, and variable influence on projection (VIP) cutoff values. The best prediction model for discriminating 5- and 6-year-old ginseng was developed using tap root, vector normalization applied after the second differentiation, one PLS component, and a VIP cutoff of 1.0 (based on the lowest root-mean-square error of prediction value). In addition, for discriminating among the three parts of P. ginseng, optimized PLSR models were established using data sets obtained from vector normalization, two PLS components, and VIP cutoff values of 1.5 (for 5-year-old ginseng) and 1.3 (for 6-year-old ginseng). To our knowledge, this is the first study to provide a novel strategy for rapidly discriminating the cultivation ages and parts of P. ginseng using FT-IR by selected normalization methods, number of PLS components, and VIP cutoff values. PMID:29049369

Evaluation of the indirect fluorescent antibody test as a diagnostic tool for East Coast fever in eastern Zambia.

PubMed

Billiouw, M; Brandt, J; Vercruysse, J; Speybroeck, N; Marcotty, T; Mulumba, M; Berkvens, D

2005-02-28

Serological surveys using the schizont indirect fluorescence antibody test (IFAt) are routinely carried out to monitor the Theileria parva infection prevalence. The present study evaluates the diagnostic accuracy of the IFAt in eastern Zambia, where the transmission of T. parva is highly seasonal. The data set resulted from a sentinel herd (n = 105 animals) study carried out between 1995 and 2000 and was split into an epidemic period, during which the majority of the cattle became infected, and an endemic period with seasonal disease incidence in calves. In the epidemic period the T. parva seroprevalence followed closely the build up of the herd immunity. In the endemic period the seroprevalence fluctuates considerably although most of the animals had been infected. Overall, the diagnostic sensitivity of the IFA test was 55% at cut-off titre 1:40 and 28% at cut-off 1:160. The specificity of the test was 86 and 95%, respectively. A logistic regression model demonstrates that the sensitivity is significantly lower when the T. parva transmission is low (p < 0.01). The analysis of receiver operator characteristic curves classifies the test as moderately accurate (area under the curve, AUC = 0.79) during the epidemic period and less accurate in the endemic period (AUC = 0.63). Neonatal serology surveys yield a better estimate of the infection prevalence. The sensitivity of the neonatal test was 73% at cut-off titre 1:40 and 24% at cut-off 1:160.

Weibull thermodynamics: Subexponential decay in the energy spectrum of cosmic-ray nuclei

NASA Astrophysics Data System (ADS)

Tomaschitz, Roman

2017-10-01

The spectral number density of cosmic-ray nuclei is shown to be a multiply broken power law with subexponential spectral cutoff. To this end, a spectral fit is performed to data sets covering the 1GeV - 1011GeV interval of the all-particle cosmic-ray spectrum. The flux points of the ultra-high energy spectral tail measured with the Telescope Array indicate a Weibull cutoff exp(-(E /(kB T)) σ) and permit a precise determination of the cutoff temperature kB T =(2 . 5 ± 0 . 1) × 1010 GeV and the spectral index σ = 0 . 66 ± 0 . 02. Based on the spectral number density inferred from the least-squares fit, the thermodynamics of this stationary non-equilibrium system, a multi-component mixture of relativistic nuclei, is developed. The derivative of entropy with respect to internal energy defines the effective temperature of the nuclei, S,U = 1 /Teff ,kBTeff ≈ 16 . 1 GeV, and the functional dependence between the cutoff temperature in the Weibull exponential and the effective gas temperature is determined. The equipartition ratio is found to be U /(NkBTeff) ≈ 0 . 30. The isochoric and isobaric heat capacities of the nuclear gas are calculated, as well as the isothermal and adiabatic compressibilities and the isobaric expansion coefficient, and it is shown that this non-equilibrated relativistic gas mixture satisfies the thermodynamic inequalities 0

Estimating conditional proportion curves by regression residuals.

PubMed

Han, Bing; Lim, Nelson

2010-06-15

Researchers often derive a categorical outcome from an observed continuous measurement y. For example, human obesity status can be defined by the body mass index. They proceed to estimate the conditional proportion curve p(x) = P(y

Examination of the Phenomenology and Clinical Correlates of Emetophobia in a Sample of Salvadorian Youths.

PubMed

Wu, Monica S; Selles, Robert R; Novoa, Juan Carlos; Zepeda, Raquel; Guttfreund, Daniel; McBride, Nicole M; Storch, Eric A

2017-06-01

Emetophobia is an under-researched disorder characterized by a specific fear of vomiting. There is a paucity of research on this impairing condition, with extant examinations being largely limited to adult samples and online communities. The present study examined the incidence, phenomenology, and correlates of emetophobia in 305 Salvadorian youths. Caregivers completed a battery of questionnaires regarding the youth's symptoms of emetophobia, internalizing/externalizing symptoms, health anxiety, and obsessive-compulsive symptoms. Approximately 7.5 % of the sample was elevated on emetophobia symptoms, and higher levels of emetophobia symptoms were correlated with higher levels of internalizing, externalizing, health anxiety, and obsessive-compulsive symptoms, and lower levels of adaptive functioning. Youths meeting the cutoff for elevated emetophobia symptoms versus those who did not demonstrated significantly higher levels of externalizing behaviors, as well as general obsessive-compulsive symptoms, especially doubting/checking and neutralizing behaviors. These findings are hoped to help improve the conceptualization and treatment of this poorly understood disorder.

Undetectable Concentrations of a Food and Drug Administration-approved High-sensitivity Cardiac Troponin T Assay to Rule Out Acute Myocardial Infarction at Emergency Department Arrival.

PubMed

McRae, Andrew D; Innes, Grant; Graham, Michelle; Lang, Eddy; Andruchow, James E; Ji, Yunqi; Vatanpour, Shabnam; Abedin, Tasnima; Yang, Hong; Southern, Danielle A; Wang, Dongmei; Seiden-Long, Isolde; DeKoning, Lawrence; Kavsak, Peter

2017-10-01

The objective of this study was to quantify the sensitivity of very low concentrations of high-sensitivity cardiac troponin T (hsTnT) at ED arrival for acute myocardial infarction (AMI) in a large cohort of chest pain patients evaluated in real-world clinical practice. This retrospective study included consecutive ED patients with suspected cardiac chest pain evaluated in four urban EDs, excluding those with ST-elevation AMI, cardiac arrest or abnormal kidney function. The primary outcomes were AMI at 7, 30, and 90 days. Secondary outcomes included major adverse cardiac events (MACE; all-cause mortality, AMI, and revascularization) and the individual MACE components. Test characteristics were calculated for hsTnT values from 3 to 200 ng/L . A total of 7,130 patients met inclusion criteria. AMI incidences at 7, 30, and 90 days were 5.8, 6.0, and 6.2%. When the hsTnT assay was performed at ED arrival, the limit of blank of the assay (3 ng/L) ruled out 7-day AMI in 15.5% of patients with 100% sensitivity and negative predictive value (NPV). The limit of detection of the assay (5 ng/L) ruled out AMI in 33.6% of patients with 99.8% sensitivity and 99.95% NPV for 7-day AMI. The limit of quantification (the Food and Drug Administration [FDA]-approved cutoff for lower the reportable limit) of 6 ng/L ruled out AMI in 42.2% of patients with 99.8% sensitivity and 99.95% NPV. The sensitivities of the cutoffs of <3, <5, and <6 ng/L for 7-day MACE were 99.6, 97.4, and 96.6%, respectively. The NPVs of the cutoffs of <3, <5, and <6 ng/L for 7-day MACE were 99.8, 99.5, and 99.4%, respectively. A secondary analysis was performed in a subgroup of 3,549 higher-risk patients who underwent serial troponin testing. In this subgroup, a cutoff of 3 ng/L ruled out 7-day AMI in 9.6% of patients with 100% sensitivity and NPV, a cutoff of 5 ng/L ruled out 7-day AMI in 23.3% of patients with 99.7% sensitivity and 99.9% NPV, and a cutoff of 6 ng/L ruled out 7-day AMI in 29.8% of patients with 99.7 and 99.9% NPV. In the higher-risk subgroup, the sensitivities of cutoffs of <3, <5, and <6 ng/L for 7-day MACE were 99.8, 97.4, and 96.6%, respectively. In this higher-risk subgroup, the NPV of cutoffs of <3, <5, and <6 ng/L for 7-day MACE were 99.7, 98.5, and 98.4%, respectively. When used in real-world clinical practice conditions, hsTnT concentrations < 6 ng/L (below the lower reportable limit for an FDA-approved assay) at the time of ED arrival can rule out AMI with very high sensitivity and NPV. The sensitivity for MACE is unacceptably low, and thus a single-troponin rule-out strategy should only be used in the context of a structured risk evaluation. © 2017 The Authors. Academic Emergency Medicine published by Wiley Periodicals, Inc. on behalf of Society for Academic Emergency Medicine.

Action-oriented colour-coded foot length calliper for primary healthcare workers as a proxy for birth weight & gestational period.

PubMed

Pratinidhi, Asha K; Bagade, Abhijit C; Kakade, Satish V; Kale, Hemangi P; Kshirsagar, Vinayak Y; Babar, Rohini; Bagal, Shilpa

2017-03-01

Foot length of the newborn has a good correlation with the birth weight and is recommended to be used as a proxy measure. There can be variations in the measurement of foot length. A study was, therefore, carried out to develop a foot length calliper for accurate foot length measurement and to find cut-off values for birth weight and gestational age groups to be used by primary healthcare workers. This study was undertaken on 645 apparently healthy newborn infants with known gestational age. Nude birth weight was taken within 24 h of birth on a standard electronic weighing machine. A foot length calliper was developed. Correlation between foot length and birth weight as well as gestational age was calculated. Correctness of cut-off values was tested using another set of 133 observations on the apparently healthy newborns. Action-oriented colour coding was done to make it easy for primary healthcare workers to use it. There was a significant correlation of foot length with birth weight (r=0.75) and gestational age (r=0.63). Cut-off values for birth weight groups were 6.1, 6.8 and 7.3 cm and for gestational age of 6.1, 6.8 and 7.0 cm. Correctness of these cut-off values ranged between 77.1 and 95.7 per cent for birth weight and 60-93.3 per cent for gestational age. Considering 2.5 kg as cut-off between normal birth weight and low birth weight (LBW), cut-off values of 6.1, 6.8 and 7.3 were chosen. Action-oriented colour coding was done by superimposing the colours on the scale of the calliper, green indicating home care, yellow indicating supervised home care, orange indicating care at newborn care units at primary health centres and red indicating Neonatal Intensive Care Unit care for infants. A simple device was developed so that the primary health care workers and trained Accredited Social Health Activist workers can identify the risk of LBW in the absence of accurate weighing facilities and decide on the type of care needed by the newborn and take action accordingly.

Nucleon structure in lattice QCD with dynamical domain-wall fermions quarks

NASA Astrophysics Data System (ADS)

Ohta, Shigemi

2006-12-01

We report RBC and RBC/UKQCD lattice QCD numerical calculations of nucleon electroweak matrix elements with dynamical domain-wall fermions (DWF) quarks. The first, RBC, set of dynamical DWF ensembles employs two degenerate flavors of DWF quarks and the DBW2 gauge action. Three sea quark mass values of 0.04, 0.03 and 0.02 in lattice units are used with about 200 gauge configurations each. The lattice cutoff is a-1 ˜ 1.7GeV and the spatial volume is about (1.9fm)3 . Despite the small volume, the ratio of the isovector vector and axial charges gA /gV and that of structure function moments x u-d / x u- d are in agreement with experiment, and show only very mild quark mass dependence. The second, RBC/UK, set of ensembles employs one strange and two degenerate (up and down) dynamical DWF quarks and Iwasaki gauge action. The strange quark mass is set at 0.04, and three up/down mass values of 0.03, 0.02 and 0.01 in lattice units are used. The lattice cutoff is a-1 ˜ 1.6GeV and the spatial volume is about (3.0fm)3 . Even with preliminary statistics of 25-30 gauge configurations, the ratios gA /gV and x u-d / x u- d are consistent with experiment and show only very mild quark mass dependence. Another structure function moment, d1 , though yet to be renormalized, appears small in both sets.

7. Southeast elevation showing building in setting; view to northwest; ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

7. Southeast elevation showing building in setting; view to northwest; Highway 101 in foreground, State Street at right. - V.E. Wood Auto Building, 315 State Street, Santa Barbara, Santa Barbara County, CA

Deep-subwavelength waveguiding via inhomogeneous second-harmonic generation.

PubMed

Roppo, Vito; Vincenti, Maria Antonietta; de Ceglia, Domenico; Scalora, Michael

2012-08-01

We theoretically investigate second-harmonic generation in extremely narrow, subwavelength semiconductor and dielectric waveguides. We discuss a guiding mechanism characterized by the inhibition of diffraction and the suppression of cutoff limits in the context of a light trapping phenomenon that sets in under conditions of general phase and group velocity mismatch between the fundamental and the generated harmonic.

Differentiation, Self-Other Representations, and Rupture-Repair Processes: Predicting Child Maltreatment Risk

ERIC Educational Resources Information Center

Skowron, Elizabeth A.; Kozlowski, JoEllen M.; Pincus, Aaron L.

2010-01-01

This set of studies was designed to examine the relational underpinnings of child abuse potential in a sample of 51 urban families. In Study 1, lower maternal differentiation of self--most notably, greater emotional reactivity and greater emotional cutoff--along with self-attacking introjects distinguished mothers at higher risk (vs. lower risk)…

What determines skin sensitization potency: Myths, maybes and realities. The 500 molecular weight cut-off: An updated analysis

EPA Science Inventory

It is widely considered to be a self-evident truth that substances must have a molecular weight (MW) less than 500 to effectively penetrate through the skin in order to induce sensitisation. However, Roberts et al. 2010, evaluated a data set of 699 substances taken from the TIME...

Screening for Drug Abuse Among College Students: Modification of the Michigan Alcoholism Screening Test

ERIC Educational Resources Information Center

Cannell, M. Barry; Favazza, Armando R.

1978-01-01

Modified version of the Michigan Alcoholism Screening Test was anonymously given to 245 college students on two Midwestern university campuses. Cutoff score for suspected drug abuse was set at five points. The percent of students scoring five or more points was 25 and 22 from campuses A and B respectively. (Author)

A depth-adjusted ambient distribution approach for setting numeric removal targets for a Great Lakes Area of Concern beneficial use impairment: Degraded benthos

EPA Science Inventory

We compiled and modelled macroinvertebrate assemblage data from samples collected in 1995-2014 from the estuarine portion of the St. Louis River Area of Concern (AOC) of western Lake Superior. Our objective to create depth-adjusted cutoff values for benthos condition classes (po...

Index of Free and Inexpensive Food and Nutrition Information Materials.

ERIC Educational Resources Information Center

Gordon, Kathleen, Comp.; And Others

This annotated index contains approximately 2,000 free or inexpensive pamphlets or brochures about food and nutrition. The prime criterion for inclusion of materials was that they be easily available and inexpensive; the cut-off cost was set at $3.00. The majority of materials listed were produced in either Canada or the United States. These…

Assessing coastal wetland vulnerability to sea-level rise along the northern Gulf of Mexico coast: Gaps and opportunities for developing a coordinated regional sampling network

PubMed Central

Griffith, Kereen T.; Larriviere, Jack C.; Feher, Laura C.; Cahoon, Donald R.; Enwright, Nicholas M.; Oster, David A.; Tirpak, John M.; Woodrey, Mark S.; Collini, Renee C.; Baustian, Joseph J.; Breithaupt, Joshua L.; Cherry, Julia A.; Conrad, Jeremy R.; Cormier, Nicole; Coronado-Molina, Carlos A.; Donoghue, Joseph F.; Graham, Sean A.; Harper, Jennifer W.; Hester, Mark W.; Howard, Rebecca J.; Krauss, Ken W.; Kroes, Daniel E.; Lane, Robert R.; McKee, Karen L.; Mendelssohn, Irving A.; Middleton, Beth A.; Moon, Jena A.; Piazza, Sarai C.; Rankin, Nicole M.; Sklar, Fred H.; Steyer, Greg D.; Swanson, Kathleen M.; Swarzenski, Christopher M.; Vervaeke, William C.; Willis, Jonathan M.; Wilson, K. Van

2017-01-01

Coastal wetland responses to sea-level rise are greatly influenced by biogeomorphic processes that affect wetland surface elevation. Small changes in elevation relative to sea level can lead to comparatively large changes in ecosystem structure, function, and stability. The surface elevation table-marker horizon (SET-MH) approach is being used globally to quantify the relative contributions of processes affecting wetland elevation change. Historically, SET-MH measurements have been obtained at local scales to address site-specific research questions. However, in the face of accelerated sea-level rise, there is an increasing need for elevation change network data that can be incorporated into regional ecological models and vulnerability assessments. In particular, there is a need for long-term, high-temporal resolution data that are strategically distributed across ecologically-relevant abiotic gradients. Here, we quantify the distribution of SET-MH stations along the northern Gulf of Mexico coast (USA) across political boundaries (states), wetland habitats, and ecologically-relevant abiotic gradients (i.e., gradients in temperature, precipitation, elevation, and relative sea-level rise). Our analyses identify areas with high SET-MH station densities as well as areas with notable gaps. Salt marshes, intermediate elevations, and colder areas with high rainfall have a high number of stations, while salt flat ecosystems, certain elevation zones, the mangrove-marsh ecotone, and hypersaline coastal areas with low rainfall have fewer stations. Due to rapid rates of wetland loss and relative sea-level rise, the state of Louisiana has the most extensive SET-MH station network in the region, and we provide several recent examples where data from Louisiana’s network have been used to assess and compare wetland vulnerability to sea-level rise. Our findings represent the first attempt to examine spatial gaps in SET-MH coverage across abiotic gradients. Our analyses can be used to transform a broadly disseminated and unplanned collection of SET-MH stations into a coordinated and strategic regional network. This regional network would provide data for predicting and preparing for the responses of coastal wetlands to accelerated sea-level rise and other aspects of global change. PMID:28902904

Assessing coastal wetland vulnerability to sea-level rise along the northern Gulf of Mexico coast: Gaps and opportunities for developing a coordinated regional sampling network

USGS Publications Warehouse

Osland, Michael J.; Griffith, Kereen T.; Larriviere, Jack C.; Feher, Laura C.; Cahoon, Donald R.; Enwright, Nicholas M.; Oster, David A.; Tirpak, John M.; Woodrey, Mark S.; Collini, Renee C.; Baustian, Joseph J.; Breithaupt, Joshua L.; Cherry, Julia A; Conrad, Jeremy R.; Cormier, Nicole; Coronado-Molina, Carlos A.; Donoghue, Joseph F.; Graham, Sean A.; Harper, Jennifer W.; Hester, Mark W.; Howard, Rebecca J.; Krauss, Ken W.; Kroes, Daniel; Lane, Robert R.; Mckee, Karen L.; Mendelssohn, Irving A.; Middleton, Beth A.; Moon, Jena A.; Piazza, Sarai; Rankin, Nicole M.; Sklar, Fred H.; Steyer, Gregory D.; Swanson, Kathleen M.; Swarzenski, Christopher M.; Vervaeke, William; Willis, Jonathan M; Van Wilson, K.

2017-01-01

Coastal wetland responses to sea-level rise are greatly influenced by biogeomorphic processes that affect wetland surface elevation. Small changes in elevation relative to sea level can lead to comparatively large changes in ecosystem structure, function, and stability. The surface elevation table-marker horizon (SET-MH) approach is being used globally to quantify the relative contributions of processes affecting wetland elevation change. Historically, SET-MH measurements have been obtained at local scales to address site-specific research questions. However, in the face of accelerated sea-level rise, there is an increasing need for elevation change network data that can be incorporated into regional ecological models and vulnerability assessments. In particular, there is a need for long-term, high-temporal resolution data that are strategically distributed across ecologically-relevant abiotic gradients. Here, we quantify the distribution of SET-MH stations along the northern Gulf of Mexico coast (USA) across political boundaries (states), wetland habitats, and ecologically-relevant abiotic gradients (i.e., gradients in temperature, precipitation, elevation, and relative sea-level rise). Our analyses identify areas with high SET-MH station densities as well as areas with notable gaps. Salt marshes, intermediate elevations, and colder areas with high rainfall have a high number of stations, while salt flat ecosystems, certain elevation zones, the mangrove-marsh ecotone, and hypersaline coastal areas with low rainfall have fewer stations. Due to rapid rates of wetland loss and relative sea-level rise, the state of Louisiana has the most extensive SET-MH station network in the region, and we provide several recent examples where data from Louisiana’s network have been used to assess and compare wetland vulnerability to sea-level rise. Our findings represent the first attempt to examine spatial gaps in SET-MH coverage across abiotic gradients. Our analyses can be used to transform a broadly disseminated and unplanned collection of SET-MH stations into a coordinated and strategic regional network. This regional network would provide data for predicting and preparing for the responses of coastal wetlands to accelerated sea-level rise and other aspects of global change.

Assessing coastal wetland vulnerability to sea-level rise along the northern Gulf of Mexico coast: Gaps and opportunities for developing a coordinated regional sampling network.

PubMed

Osland, Michael J; Griffith, Kereen T; Larriviere, Jack C; Feher, Laura C; Cahoon, Donald R; Enwright, Nicholas M; Oster, David A; Tirpak, John M; Woodrey, Mark S; Collini, Renee C; Baustian, Joseph J; Breithaupt, Joshua L; Cherry, Julia A; Conrad, Jeremy R; Cormier, Nicole; Coronado-Molina, Carlos A; Donoghue, Joseph F; Graham, Sean A; Harper, Jennifer W; Hester, Mark W; Howard, Rebecca J; Krauss, Ken W; Kroes, Daniel E; Lane, Robert R; McKee, Karen L; Mendelssohn, Irving A; Middleton, Beth A; Moon, Jena A; Piazza, Sarai C; Rankin, Nicole M; Sklar, Fred H; Steyer, Greg D; Swanson, Kathleen M; Swarzenski, Christopher M; Vervaeke, William C; Willis, Jonathan M; Wilson, K Van

2017-01-01

Coastal wetland responses to sea-level rise are greatly influenced by biogeomorphic processes that affect wetland surface elevation. Small changes in elevation relative to sea level can lead to comparatively large changes in ecosystem structure, function, and stability. The surface elevation table-marker horizon (SET-MH) approach is being used globally to quantify the relative contributions of processes affecting wetland elevation change. Historically, SET-MH measurements have been obtained at local scales to address site-specific research questions. However, in the face of accelerated sea-level rise, there is an increasing need for elevation change network data that can be incorporated into regional ecological models and vulnerability assessments. In particular, there is a need for long-term, high-temporal resolution data that are strategically distributed across ecologically-relevant abiotic gradients. Here, we quantify the distribution of SET-MH stations along the northern Gulf of Mexico coast (USA) across political boundaries (states), wetland habitats, and ecologically-relevant abiotic gradients (i.e., gradients in temperature, precipitation, elevation, and relative sea-level rise). Our analyses identify areas with high SET-MH station densities as well as areas with notable gaps. Salt marshes, intermediate elevations, and colder areas with high rainfall have a high number of stations, while salt flat ecosystems, certain elevation zones, the mangrove-marsh ecotone, and hypersaline coastal areas with low rainfall have fewer stations. Due to rapid rates of wetland loss and relative sea-level rise, the state of Louisiana has the most extensive SET-MH station network in the region, and we provide several recent examples where data from Louisiana's network have been used to assess and compare wetland vulnerability to sea-level rise. Our findings represent the first attempt to examine spatial gaps in SET-MH coverage across abiotic gradients. Our analyses can be used to transform a broadly disseminated and unplanned collection of SET-MH stations into a coordinated and strategic regional network. This regional network would provide data for predicting and preparing for the responses of coastal wetlands to accelerated sea-level rise and other aspects of global change.

7. (Second sheet of a twosheet set entitled 'Kongensgade 5154') ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

7. (Second sheet of a two-sheet set entitled 'Kongensgade 51-54') KONGENSGADE (FRONT) ELEVATIONS OF KONGENSGADE 53 (only part of this elevation shown, for full elevation overlap with complementary photograph VI-50-6), & KONGENSGADE 54 (LEFT TO RIGHT) - King Street Area Study, Kongensgade 5-18, 36, 37B, 51-58 (Houses), 5-18, 36-37B, 51-58 King Street, Frederiksted, St. Croix, VI

Determining an anthropometric surrogate measure for identifying low birth weight babies in Uganda: a hospital-based cross sectional study.

PubMed

Elizabeth, Nabiwemba L; Christopher, Orach Garimoi; Patrick, Kolsteren

2013-04-12

Achieving Millennium Development Goal 4 is dependent on significantly reducing neonatal mortality. Low birth weight is an underlying factor in most neonatal deaths. In developing countries the missed opportunity for providing life saving care is mainly a result of failure to identify low birth weight newborns. This study aimed at identifying a reliable anthropometric measurement for screening low birth weight and determining an operational cut-off point in the Uganda setting. This simple measurement is required because of lack of weighing scales in the community, and sometimes in the health facilities. This was a hospital-based cross-sectional study. Two midwives weighed 706 newborns and measured their foot length, head, chest, thigh and mid-upper arm circumferences within 24 hours after birth.Data was analysed using STATA version 10.0. Correlation with birth weight using Pearson's correlation coefficient and Receiver Operating Characteristics curve analysis were done to determine the measure that best predicts birth weight. Sensitivity and specificity were calculated for a range of measures to obtain operational cut-off points; and Likelihood Ratios and Diagnostic Odds Ratio were determined for each cut-off point. Birth weights ranged from 1370-5350 grams with a mean of 3050 grams (SD 0.53) and 85 (12%) babies weighed less than 2500 grams. All anthropometric measurements had a positive correlation with birth weight, with foot length showing the strongest (r = 0.76) and thigh circumference the weakest (r = 0.62) correlations. Foot length had the highest predictive value for low birth weight (AUC = 0.97) followed by mid-upper arm circumference (AUC = 0.94). Foot length and chest circumference had the highest sensitivity (94%) and specificity (90%) respectively for screening low birth weight babies at the selected cut-off points. Chest circumference had a significantly higher positive likelihood ratio (8.7) than any other measure, and foot length had the lowest negative likelihood ratio. Chest circumference and foot length had diagnostic odds ratios of 97% and 77% respectively. Foot length was easier to measure and it involved minimal exposure of the baby to cold. A cut-off of foot length 7.9 cm had sensitivity of 94% and specificity of 83% for predicting low birth weight. This study suggests foot length as the most appropriate predictor for low birth weight in comparison to chest, head, mid-upper arm and thigh circumference in the Uganda setting. Use of low cost and easy to use tools to identify low birth weight babies by village health teams could support community efforts to save newborns.

Social cognitive correlates of physical activity among persons with multiple sclerosis: Influence of depressive symptoms.

PubMed

Ensari, Ipek; Kinnett-Hopkins, Dominique; Motl, Robert W

2017-10-01

Physical inactivity and elevated depressive symptoms are both highly prevalent and correlated among persons with multiple sclerosis (MS). Variables from Social Cognitive Theory (SCT) might be differentially correlated with physical activity in persons with MS who have elevated depressive symptoms. This study investigated the influence of elevated depressive symptoms on correlates of physical activity based on SCT in persons with MS. Participants (mean age = 50.3 years, 87% female, 69% Caucasian) completed questionnaires on physical activity, depressive symptoms, self-efficacy, social support, outcome expectations, functional limitations, and goal setting. The questionnaires were delivered and returned through the U.S. Postal Service. The sample (N = 551) was divided into 2 subgroups (i.e., elevated vs non-elevated levels of depressive symptoms) for statistical analyses. Bivariate correlations and stepwise multiple regressions were conducted using SPSS. Self-efficacy (r = 0.16), functional limitations (r = 0.22) and goal-setting (r = 0.42) were significantly (p < 0.05) associated with physical activity among the elevated depressive sample. The regression analysis indicated that self-efficacy predicted physical activity in Step 1 (β = 0.16, p < 0.05), but was no longer significant when goal-setting (β = 0.06, p > 0.05) entered the model. All social cognitive variables were significantly associated with physical activity levels (r = 0.16-0.40, p < 0.001) among the non-elevated depressive sample. Self-efficacy predicted physical activity in Step 1 (β = 0.24, p < 0.001), but it was no longer significant once goal-setting, functional limitations, and self-evaluative outcome expectations entered the model. Based on SCT, self-efficacy and goal-setting represent possible targets of behavior interventions for increasing physical activity among persons with MS who have elevated depressive symptoms. There is a larger set of targets among those with MS who do not have elevated symptoms. Copyright © 2017 Elsevier Inc. All rights reserved.

Distributional fold change test – a statistical approach for detecting differential expression in microarray experiments

PubMed Central

2012-01-01

Background Because of the large volume of data and the intrinsic variation of data intensity observed in microarray experiments, different statistical methods have been used to systematically extract biological information and to quantify the associated uncertainty. The simplest method to identify differentially expressed genes is to evaluate the ratio of average intensities in two different conditions and consider all genes that differ by more than an arbitrary cut-off value to be differentially expressed. This filtering approach is not a statistical test and there is no associated value that can indicate the level of confidence in the designation of genes as differentially expressed or not differentially expressed. At the same time the fold change by itself provide valuable information and it is important to find unambiguous ways of using this information in expression data treatment. Results A new method of finding differentially expressed genes, called distributional fold change (DFC) test is introduced. The method is based on an analysis of the intensity distribution of all microarray probe sets mapped to a three dimensional feature space composed of average expression level, average difference of gene expression and total variance. The proposed method allows one to rank each feature based on the signal-to-noise ratio and to ascertain for each feature the confidence level and power for being differentially expressed. The performance of the new method was evaluated using the total and partial area under receiver operating curves and tested on 11 data sets from Gene Omnibus Database with independently verified differentially expressed genes and compared with the t-test and shrinkage t-test. Overall the DFC test performed the best – on average it had higher sensitivity and partial AUC and its elevation was most prominent in the low range of differentially expressed features, typical for formalin-fixed paraffin-embedded sample sets. Conclusions The distributional fold change test is an effective method for finding and ranking differentially expressed probesets on microarrays. The application of this test is advantageous to data sets using formalin-fixed paraffin-embedded samples or other systems where degradation effects diminish the applicability of correlation adjusted methods to the whole feature set. PMID:23122055

Measurement of geomagnetic cutoff rigidities and particle fluxes below geomagnetic cutoff near Palestine, Texas.

NASA Technical Reports Server (NTRS)

Pennypacker, C. R.; Smoot, G. F.; Buffington, A.; Muller, R. A.; Smith, L. H.

1973-01-01

We report a high-statistics magnetic spectrometer measurement of the geomagnetic cutoff rigidity and related effects at Palestine, Texas. The effective cutoffs we observe are in agreement with computer-calculated cutoffs. We also report measured spectra of albedo and atmospheric secondary particles that come below geomagnetic cutoff.

Measurement of geomagnetic cutoff rigidities and particle fluxes below geomagnetic cutoff near Palestine, Texas

DOE Office of Scientific and Technical Information (OSTI.GOV)

Pennypacker, C.R.; Smoot, G.F.; Buffington, A.

1973-04-01

A high-statistics magnetic spectrometer measurement of the geomagnetic cutoff rigidity and related effects at Palestine, Texas is reported. The effective cutoffs observed are in agreement with computer-calculated cutoffs. Measured spectra of albedo and atmospheric secondary particles that come below geomagnetic cutoff are also reported. (auth)

Yield and Water Productivity Responses to Irrigation Cut-off Strategies after Fruit Set Using Stem Water Potential Thresholds in a Super-High Density Olive Orchard

PubMed Central

Ahumada-Orellana, Luis E.; Ortega-Farías, Samuel; Searles, Peter S.; Retamales, Jorge B.

2017-01-01

An increase in the land area dedicated to super-high density olive orchards has occurred in Chile in recent years. Such modern orchards have high irrigation requirements, and optimizing water use is a priority. Moreover, this region presents low water availability, which makes necessary to establish irrigation strategies to improve water productivity. An experiment was conducted during four consecutive growing seasons (2010–2011 to 2013–2014) to evaluate the responses of yield and water productivity to irrigation cut-off strategies. These strategies were applied after fruit set using midday stem water potential (Ψstem) thresholds in a super-high density olive orchard (cv. Arbequina), located in the Pencahue Valley, Maule Region, Chile. The experimental design was completely randomized with four irrigation cut-off treatments based on the Ψstem thresholds and four replicate plots per treatment (five trees per plot). Similar to commercial growing conditions in our region, the Ψstem in the T1 treatment was maintained between -1.4 and -2.2 MPa (100% of actual evapotranspiration), while T2, T3 and T4 treatments did not receive irrigation from fruit set until they reached a Ψstem threshold of approximately -3.5, -5.0, and -6.0 MPa, respectively. Once the specific thresholds were reached, irrigation was restored and maintained as T1 in all treatments until fruits were harvested. Yield and its components were not significantly different between T1 and T2, but fruit yield and total oil yield, fruit weight, and fruit diameter were decreased by the T3 and T4 treatments. Moreover, yield showed a linear response with water stress integral (SΨ), which was strongly influenced by fruit load. Total oil content (%) and pulp/stone ratio were not affected by the different irrigation strategies. Also, fruit and oil water productivities were significantly greater in T1 and T2 than in the T3 and T4. Moreover, the T2, T3, and T4 treatments averaged 37, 51, and 72 days without irrigation which represented 75–83, 62–76, and 56–70% of applied water compared with T1, respectively. These results suggest that using the T2 irrigation cut-off strategy could be applied in a super-high density olive orchard (cv. Arbequina) because it maintained yields, saving 20% of the applied water. PMID:28785274

Role of fetal sex in amniotic fluid alphafetoprotein screening.

PubMed

Knippel, Alexander Johannes

2002-10-01

Previous studies have shown that fetal gender has influence on various pregnancy complications and prenatal diagnostic biochemical markers. We have evaluated, whether elevation of amniotic fluid alphafetoprotein (AF AFP) is associated with fetal sex and whether a sex-related difference can help to identify pregnancies with AFP-associated malformations or fetal loss. From our database we obtained 6461 singleton gestations with AF AFP measurements for the period April 1997-March 1999. Patients with AF AFP >1.9 MoM were identified, details of pregnancy outcome were obtained and compared to matched-pair controls having AF AFP <2 MoM. In 232 of 262 patients having AF AFP levels >1.9 MoM outcome information was available. Of these fetuses, significantly more had male gender (147 male fetuses versus 85 female). Having a screen-positive result the risk of AFP-associated malformations was significantly higher for female fetuses (25 female fetuses (29.4%) versus 22 male fetuses (15%) with AFP-associated malformations). Adjusting the cut-off MoM to 2.5 for male and to 2.0 for female fetuses halves the false positive rate from 3.4 to 1.7% without affecting the detection rate of 95%. Pregnancies with false positive AF AFP had a significantly higher risk for fetal loss compared with pregnancies having normal AF AFP (ten fetal losses from 185 versus two fetal losses from 232), but fetal gender had no significant influence. Adjusting AF AFP MoM cut-offs for fetal gender could increase performance of AF-AFP screening. Larger studies are required to determine suitable sex-adjusted cut-off levels. Copyright 2002 John Wiley & Sons, Ltd.

An Elevated Maternal Plasma Soluble fms-Like Tyrosine Kinase-1 to Placental Growth Factor Ratio at Midtrimester Is a Useful Predictor for Preeclampsia.

PubMed

Hassan, Mahmoud Fathy; Rund, Nancy Mohamed Ali; Salama, Ahmed Husseiny

2013-01-01

Background. To assess the ability of mid-trimester sFlt-1/PlGF ratio for prediction of preeclampsia in two different Arabic populations. Methods. This study measured levels of sFlt-1, PlGF, and sFlt-1/PlGF ratio at midtrimester in 83 patients who developed preeclampsia with contemporary 250 matched controls. Results. Women subsequently developed preeclampsia had significantly lower PlGF levels and higher sFlt-1 and sFlt-1/PlGF ratio levels than women with normal pregnancies (P < 0.0001 for all). Women who with preterm preeclampsia had significantly higher sFlt-1 and sFlt-1/PlGF ratio than term preeclamptic women (P = 0.01, 0.003, resp.). A cutoff value of 3198 pg/mL for sFlt-1 was able to predict preeclampsia with sensitivity, specificity, and accuracy of 88%, 83.6%, and 84.7%, respectively, with odds ratio (OR) 37.2 [95% confidence interval (CI) 17.7-78.1]. PIGF at cutoff value of 138 pg/mL was able to predict preeclampsia with sensitivity, specificity, and accuracy of 85.5%, 77.2%, and 79.3%, respectively, with OR 20 [95% CI, 10.2-39.5]. The sFlt-1/PIGF ratio at cutoff value of 24.5 was able to predict preeclampsia with sensitivity, specificity, and accuracy of 91.6%, 86.4%, and 87.7%, respectively with OR 67 [95% CI, 29.3-162.1]. Conclusion. Midtrimester sFlt-1/PlGF ratio displayed the highest sensitivity, specificity, accuracy, and OR for prediction of preeclampsia, demonstrating that it may stipulate more effective prediction of preeclampsia development than individual factor assay.

Prognostic value of the Ortho Vitros cardiac troponin I assay in patients with symptoms of myocardial ischemia. Risk stratification using European Society of Cardiology/American College of Cardiology recommended cutoff values.

PubMed

Apple, Fred S; Murakami, MaryAnn M; Quist, Heidi H; Pearce, Lesly A; Wieczorek, Stacey; Wu, Alan H B

2003-07-01

We evaluated the risk assessment value of a commercial cardiac troponin (cTn; Ortho Vitros ECi, Ortho-Clinical Diagnostics, Raritan, NJ) I assay in patients with symptoms of myocardial ischemia suggestive of acute coronary syndrome and compared findings with those for a commercial cTnT assay in the same population. The cTn levels were measured by both assays in plasma samples from 273 patients during 24 hours after admission. Baseline and maximum concentrations were used for risk stratification; cutoffs were the 99th percentile and 10% coefficient of variation. End points were all-cause death and cardiac events within 60 days. Relative risks (RRs) were estimated using Cox proportional hazards regression models and Kaplan-Meier curves. RRs of cardiac events and death were significantly higher with increased baseline and maximum concentrations using either cTnI cutoff. The respective mortality rates for baseline cTnI of more than 0.08 microgram/L vs 0.08 microgram/L or less were 17.4% vs 2.9% (P = .001); cardiac event rates were 11.5% vs 3.6% (P = .03). Exclusion of patients with ST-segment elevation had no significant effect on rates for either assay. Mortality was higher in the intermediate (0.09-0.2 microgram/L) than in the low (< or = 0.08 microgram/L) group for cTnI, with directionally similar results for cTnT. Our findings validate the Ortho cTnI assay as a risk stratification biomarker in patients with symptoms of myocardial ischemia.

Development of norms for executive functions in typically-developing Indian urban preschool children and its association with nutritional status.

PubMed

Selvam, Sumithra; Thomas, Tinku; Shetty, Priya; Thennarasu, K; Raman, Vijaya; Khanna, Deepti; Mehra, Ruchika; Kurpad, Anura V; Srinivasan, Krishnamachari

2018-02-01

Executive functions (EFs) are essential and important for achieving success in children's everyday lives and play a fundamental role in children's cognitive, academic, social, emotional and behavioral functioning. A cross-sectional study was carried out to develop age- and sex-specific norms for EFs using the Behavior Rating Inventory of Executive Function - Preschool Version (BRIEF-P) among 2- to 5-year-olds from urban Bangalore, India. In addition, the association between EFs and anthropometric measures, a marker of nutritional status, is also examined. Primary caregivers of 412 children, equally distributed by age and sex, participated. Raw scores for each domain and indices were converted to standard t-scores and percentiles were computed. A t-score at or above 63 corresponding to the 90th percentile was considered as the cutoff for executive dysfunction in this sample. The prevalence of executive dysfunction is 10% based on the Global Executive Composite score of the BRIEF-P. The cutoff score for identifying executive dysfunction using existing United States (US) norms is higher compared to the cutoff score obtained in the current study. Therefore, using US norms for Indian children could result in the prevalence of executive dysfunction been underestimated. Multiple linear regression analysis revealed that stunted and underweight children have significantly elevated EF scores after adjusting for age, sex and socioeconomic status (SES; p < .01). A greater understanding of EFs in preschool children is important for the early identification of executive dysfunction and implementing interventions to improve their future prospects. This study also shows that undernourished children are more likely to have executive dysfunction.

[Alanine aminotransferase (ALAT, GPT): a reevaluation of exclusion limits for blood donors].

PubMed

Grunenberg, R; Banik, N; Krüger, J

1995-06-01

The screening policy of alanine aminotransferase (ALT) testing in blood donors was reassessed. The cutoff value for ALT levels according to German guidelines has always been controversial. In this study the activity and distribution of ALT in a blood donor population were reevaluated and new exclusion levels were defined. 5,706 blood donors were tested for ALT activities with the Reflotron system at 37 degrees C. Donors with ALT levels > 51 IU/l were deferred, a detailed physical examination and additional serologic and biochemical testing were done. ALT values of blood donors were transformed in logarithmic values in order to get a Gaussian distribution. The mean transformed value +/- SD was calculated with 1.24 +/- 0.14 for females and with 1.35 +/- 0.16 for males, corresponding to mean values of ALT activity of 17.6 and 22.5 IU/l, respectively. Exclusion levels of > 33.4 IU/l for female and > 46.7 IU/l for male blood donors (geometric mean +2.0 SD) predict a loss of donations of 2.8 and 2.7%, respectively, cutoff values of > 39.1 or > 56.1 IU/l (geometric mean +2.5 SD) a loss of 1.8 and 1.4%, respectively. The most likely causes of elevated ALT levels in 166 of our donors included daily alcohol use (82), infections with/without antibiotic medication (29), therapy with hepatotoxic drugs (8), strenuous exercises (5), bodybuilding complemented by anabolic steroids (2), acute infections with HCV (1), HBV (1) and CMV (1), alcohol/drug abuse and detection of HCV antibodies (1). ALT screening is still considered a useful indicator of risk donors despite its nonspecificity and limited predictive value. The selection of the appropriate cutoff value has always been disputed. The present exclusion level of > 45 IU/l (25 degrees C), analogous to > 81.8 IU/l (37 degrees C), does not even take into account such a variable as sex. The cutoff value above 4.5 SD of the geometric mean for females and above 3.5 SD for males seems to be of limited medical and practical value.

6. (First sheet of a twosheet set entitled 'Kongensgade 5154') ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

6. (First sheet of a two-sheet set entitled 'Kongensgade 51-54') KONGENSGADE (FRONT) ELEVATIONS OF KONGENSGADE 51, 52 & 53 (only part of Kongensgade 53 elevation shown, for full elevation overlap with complementary photograph VI-50-7) (LEFT TO RIGHT) - King Street Area Study, Kongensgade 5-18, 36, 37B, 51-58 (Houses), 5-18, 36-37B, 51-58 King Street, Frederiksted, St. Croix, VI

Waist-to-Height Ratio: a simple, effective and practical screening tool for childhood obesity and metabolic syndrome.

PubMed

Zhou, Dan; Yang, Min; Yuan, Zhe-Ping; Zhang, Dan-Dan; Liang, Li; Wang, Chun-Lin; Zhang, Shuai; Zhu, Hong-Hong; Lai, Mao-De; Zhu, Yi-Min

2014-10-01

This study aimed to evaluate the diagnostic value of Waist-to-Height Ratio in early detection of obesity and metabolic syndrome in Chinese children and adolescents. A cross-sectional study was conducted in six cities in China in 2010 with 16,914 children and adolescents aged 7-17 years. Participants were randomly divided into the training and testing sets. Diagnostic values were estimated using sensitivity, specificity and areas under receiver operating characteristic curves. The coefficients of variation of Waist-to-Height Ratio among age groups were lower than that of body mass index and waist circumstance. The area under receiver operating characteristic curve of Waist-to-Height Ratio was 0.968 in boys and 0.949 in girls for general obesity evaluation, and 0.983 in boys and 0.984 in girls for central obesity. The optimal cut-offs of Waist-to-Height Ratio were 0.47 in boys and 0.45 in girls in the training set and validated in the testing set. For metabolic syndrome evaluation, the sensitivity and specificity were 0.858 and 0.825 in boys, 0.864 and 0.812 in girls under the suggested cut-offs. Waist-to-Height Ratio was a simple, effective and practical tool for mass screening childhood obesity and metabolic syndrome in China. It will have potential values in public health practice. Copyright © 2014 Elsevier Inc. All rights reserved.

An Appropriate Cutoff Value for Determining the Colonization of Helicobacter pylori by the Pyrosequencing Method: Comparison with Conventional Methods.

PubMed

Kim, Jaeyeon; Kim, Nayoung; Jo, Hyun Jin; Park, Ji Hyun; Nam, Ryoung Hee; Seok, Yeong-Jae; Kim, Yeon-Ran; Kim, Joo Sung; Kim, Jung Mogg; Kim, Jung Min; Lee, Dong Ho; Jung, Hyun Chae

2015-10-01

Sequencing of 16S ribosomal RNA (rRNA) gene has improved the characterization of microbial communities. It enabled the detection of low abundance gastric Helicobacter pylori sequences even in subjects that were found to be H. pylori negative with conventional methods. The objective of this study was to obtain a cutoff value for H. pylori colonization in gastric mucosa samples by pyrosequencing method. Gastric mucosal biopsies were taken from 63 subjects whose H. pylori status was determined by a combination of serology, rapid urease test, culture, and histology. Microbial DNA from mucosal samples was amplified by PCR using universal bacterial primers. 16S rDNA amplicons were pyrosequenced. ROC curve analysis was performed to determine the cutoff value for H. pylori colonization by pyrosequencing. In addition, temporal changes in the stomach microbiota were observed in eight initially H. pylori-positive and eight H. pylori-negative subjects at a single time point 1-8 years later. Of the 63 subjects, the presence of H. pylori sequences was detected in all (28/28) conventionally H. pylori-positive samples and in 60% (21/35) of H. pylori-negative samples. The average percent of H. pylori reads in each sample was 0.67 ± 1.09% in the H. pylori-negative group. Cutoff value for clinically positive H. pylori status was approximately 1.22% based on ROC curve analysis (AUC = 0.957; p < .001). Helicobacter pylori was successfully eradicated in five of seven treated H. pylori-positive subjects (71.4%), and the percentage of H. pylori reads in these five subjects dropped from 1.3-95.18% to 0-0.16% after eradication. These results suggest that the cutoff value of H. pylori sequence percentage for H. pylori colonization by pyrosequencing could be set at approximately 1%. It might be helpful to analyze gastric microbiota related to H. pylori sequence status. © 2015 John Wiley & Sons Ltd.

The Examination of Patient-Reported Outcomes and Postural Control Measures in Patients With and Without a History of ACL Reconstruction: A Case Control Study.

PubMed

Hoch, Johanna M; Sinnott, Cori W; Robinson, Kendall P; Perkins, William O; Hartman, Jonathan W

2018-03-01

There is a lack of literature to support the diagnostic accuracy and cut-off scores of commonly used patient-reported outcome measures (PROMs) and clinician-oriented outcomes such as postural-control assessments (PCAs) when treating post-ACL reconstruction (ACLR) patients. These scores could help tailor treatments, enhance patient-centered care and may identify individuals in need of additional rehabilitation. To determine if differences in 4-PROMs and 3-PCAs exist between post-ACLR and healthy participants, and to determine the diagnostic accuracy and cut-off scores of these outcomes. Case control. Laboratory. A total of 20 post-ACLR and 40 healthy control participants. The participants completed 4-PROMs (the Disablement in the Physically Active Scale [DPA], The Fear-Avoidance Belief Questionnaire [FABQ], the Knee Osteoarthritis Outcomes Score [KOOS] subscales, and the Tampa Scale of Kinesiophobia [TSK-11]) and 3-PCAs (the Balance Error Scoring System [BESS], the modified Star Excursion Balance Test [SEBT], and static balance on an instrumented force plate). Mann-Whitney U tests examined differences between groups. Receiver operating characteristic (ROC) curves were employed to determine sensitivity and specificity. The Area Under the Curve (AUC) was calculated to determine the diagnostic accuracy of each instrument. The Youdin Index was used to determine cut-off scores. Alpha was set a priori at P < 0.05. There were significant differences between groups for all PROMs (P < 0.05). There were no differences in PCAs between groups. The cut-off scores should be interpreted with caution for some instruments, as the scores may not be clinically applicable. Post-ACLR participants have decreased self-reported function and health-related quality of life. The PROMs are capable of discriminating between groups. Clinicians should consider using the cut-off scores in clinical practice. Further use of the instruments to examine detriments after completion of standard rehabilitation may be warranted.

Efficacy of PET/CT to exclude leiomyoma in patients with lesions suspicious for uterine sarcoma on MRI.

PubMed

Kusunoki, Soshi; Terao, Yasuhisa; Ujihira, Takafumi; Fujino, Kazunari; Kaneda, Hiroshi; Kimura, Miki; Ota, Tsuyoshi; Takeda, Satoru

2017-08-01

To analyze the efficacy of positron emission tomography/computed tomography (PET/CT) for the diagnosis of uterine sarcoma. Thirty-four patients evaluated between January 2010 and March 2015 were retrospectively enrolled. All patients in whom uterine sarcoma was suspected based on contrast-enhanced magnetic resonance imaging (MRI) findings (heterogeneous, high signal intensity on T2-weighted images and/or high intensity on T1-weighted images) underwent PET/CT for further assessment. Patients were divided into 2 groups based on postoperative pathological findings: uterine sarcoma (n = 15) and leiomyoma (n = 19). The maximum standardized uptake value (SUVmax) of all lesions was measured using PET/CT; we calculated the optimal cutoff value for diagnosing sarcoma. The median SUVmax for uterine sarcoma and leiomyoma was 12 and 4.1, respectively; these values were significantly different. An SUVmax of greater than 7.5 was able to exclude leiomyoma with 80.8% sensitivity and 100% specificity (area under the curve, 95.3%). A cutoff SUVmax of 7.5 yields 100% specificity, and a cutoff SUVmax of 4.4 yields a 100% negative predictive value (NPV). The combination of PET/CT and lactate dehydrogenase (LDH) levels had a sensitivity of 86.6%, specificity of 100%, positive predictive value of 100%, and an NPV of 90.4%. No relation between histopathology or International Federation of Gynecology and Obstetrics (FIGO) stage and 18-fluoro-2-deoxy-d-glucose uptake value on PET/CT was seen. The surgical outcome trended toward a correlation with the SUVmax, although this was not statistically significant. In patients with MRI findings consistent with either uterine sarcoma or leiomyoma, PET/CT can decrease the false-positive rate by setting an optimal cutoff SUVmax of 7.5. Using this cutoff can avoid unnecessary surgery. Copyright © 2017. Published by Elsevier B.V.

The prevalence, predictors and associated health outcomes of high nicotine dependence using three measures among US smokers.

PubMed

Schnoll, Robert A; Goren, Amir; Annunziata, Kathy; Suaya, Jose A

2013-11-01

Using the Fagerström Test of Nicotine Dependence (FTND), the Heaviness of Smoking Index (HSI) and the time-to-first-cigarette (TTFC), this study estimated prevalence, evaluated optimal scale cut-offs, identified predictors and assessed potential impact on health, productivity and health-care use of high nicotine dependence among US smokers. This cross-sectional study used 2011 National Health and Wellness Survey data (n = 50 000). Nicotine dependence, demographic data, measures of health, productivity and health-care use and health attitudes were assessed. The prevalence of high nicotine dependence ranged from 23% (TTFC < 5 minutes) to 63.6% (TTFC < 30 minutes). Based on diagnostic accuracy, the cut-offs for high nicotine dependence using HSI and TTFC varied according to FTND cut-off: if FTND > 4, then HSI > 3 and TTFC < 30 minutes represented optimal cut-offs; if FTND > 5, HSI > 4 and TTFC < 5 minutes represented optimal cut-offs. Across all measures, high nicotine dependence was related significantly to being male, single, age 45-64 years and Caucasian; lower education; lack of health insurance; under/unemployment; comorbid respiratory or cardiovascular disease, diabetes or psychiatric illness; and lower rates of exercise and concern for weight control. Controlling for demographic variables and comorbid physical and psychiatric illness, high nicotine dependence, measured by FTND, HSI or TTFC, was associated significantly with reduced mental and physical quality of life, reduced work-place productivity and more health-care use. High nicotine dependence is associated with lower quality of life, lower work productivity and higher health-care use. The Heaviness of Smoking Index and the time-to-first-cigarette can provide useful screening measures of nicotine dependence in clinical and research settings. © 2013 Society for the Study of Addiction.

The Alcohol Use Disorders Identification Test (AUDIT): Exploring the Factor Structure and Cutoff Thresholds in a Representative Post-Conflict Population in Northern Uganda.

PubMed

Blair, Alden Hooper; Pearce, Margo Ellen; Katamba, Achilles; Malamba, Samuel S; Muyinda, Herbert; Schechter, Martin T; Spittal, Patricia M

2017-05-01

Despite increased use of the Alcohol Use Disorders Identification Test (AUDIT) in sub-Saharan Africa, few studies have assessed its underlying conceptual framework, and none have done so in post-conflict settings. Further, significant inconsistencies exist between definitions used for problematic consumption. Such is the case in Uganda, facing one of the highest per-capita alcohol consumption levels regionally, which is thought to be hindering rebuilding in the North after two decades of civil war. This study explores the impact of varying designation cutoff thresholds in the AUDIT as well as its conceptual factor structure in a representative sample of the population. In all, 1720 Cango Lyec Project participants completed socio-economic and mental health questionnaires, provided blood samples and took the AUDIT. Participant characteristics and consumption designations were compared at AUDIT summary score thresholds of ≥3, ≥5 and ≥8. Confirmatory factor analyses (CFA) explored one-, two- and three-factor level models overall and by sex with relative and absolute fit indicators. There were no significant differences in participant demographic characteristics between thresholds. At higher cutoffs, the test increased in specificity to identify those with hazardous drinking, disordered drinking and suffering from alcohol-related harms. All conceptual models indicated good fit, with three-factor models superior overall and within both sexes. In Northern Uganda, a three-factor AUDIT model best explores alcohol use in the population and is appropriate for use in both sexes. Lower cutoff thresholds are recommended to identify those with potentially disordered drinking to best plan effective interventions and treatments. A CFA of the AUDIT showed good fit for one-, two, and three-factor models overall and by sex in a representative sample in post-conflict Northern Uganda. A three-plus total AUDIT cutoff score is suggested to screen for hazardous drinking in this or similar populations. © The Author 2016. Medical Council on Alcohol and Oxford University Press. All rights reserved.

Identifying Aboriginal-specific AUDIT-C and AUDIT-3 cutoff scores for at-risk, high-risk, and likely dependent drinkers using measures of agreement with the 10-item Alcohol Use Disorders Identification Test.

PubMed

Calabria, Bianca; Clifford, Anton; Shakeshaft, Anthony P; Conigrave, Katherine M; Simpson, Lynette; Bliss, Donna; Allan, Julaine

2014-09-01

The Alcohol Use Disorders Identification Test (AUDIT) is a 10-item alcohol screener that has been recommended for use in Aboriginal primary health care settings. The time it takes respondents to complete AUDIT, however, has proven to be a barrier to its routine delivery. Two shorter versions, AUDIT-C and AUDIT-3, have been used as screening instruments in primary health care. This paper aims to identify the AUDIT-C and AUDIT-3 cutoff scores that most closely identify individuals classified as being at-risk drinkers, high-risk drinkers, or likely alcohol dependent by the 10-item AUDIT. Two cross-sectional surveys were conducted from June 2009 to May 2010 and from July 2010 to June 2011. Aboriginal Australian participants (N = 156) were recruited through an Aboriginal Community Controlled Health Service, and a community-based drug and alcohol treatment agency in rural New South Wales (NSW), and through community-based Aboriginal groups in Sydney NSW. Sensitivity, specificity, and positive and negative predictive values of each score on the AUDIT-C and AUDIT-3 were calculated, relative to cutoff scores on the 10-item AUDIT for at-risk, high-risk, and likely dependent drinkers. Receiver operating characteristic (ROC) curve analyses were conducted to measure the detection characteristics of AUDIT-C and AUDIT-3 for the three categories of risk. The areas under the receiver operating characteristic (AUROC) curves were high for drinkers classified as being at-risk, high-risk, and likely dependent. Recommended cutoff scores for Aboriginal Australians are as follows: at-risk drinkers AUDIT-C ≥ 5, AUDIT-3 ≥ 1; high-risk drinkers AUDIT-C ≥ 6, AUDIT-3 ≥ 2; and likely dependent drinkers AUDIT-C ≥ 9, AUDIT-3 ≥ 3. Adequate sensitivity and specificity were achieved for recommended cutoff scores. AUROC curves were above 0.90.

Heart-type fatty acid binding protein (H-FABP) in patients in an emergency department setting, suspected of acute coronary syndrome: optimal cut-off point, diagnostic value and future opportunities in primary care.

PubMed

Willemsen, Robert T A; van Severen, Evie; Vandervoort, Pieter M; Grieten, Lars; Buntinx, Frank; Glatz, Jan F C; Dinant, Geert Jan

2015-01-01

Most patients presenting chest complaints in primary care are referred to secondary care facilities, whereas only a few are diagnosed with acute coronary syndrome (ACS). The aim is to determine the optimal cut-off value for a point-of-care heart-type fatty acid binding protein (H-FABP) test in patients presenting to the emergency department and to evaluate a possible future role of H-FABP in safely ruling out ACS in primary care. Serial plasma H-FABP (index test) and high sensitivity troponin T (hs-cTnT) (reference test) were determined in patients with any new-onset chest complaint. In a receiver operating characteristic (ROC) curve, the optimal cut-off value of H-FABP for ACS was determined. Predictive values of H-FABP for ACS were calculated. For 202 consecutive patients (prevalence ACS 59%), the ROC curve based on the results of the first H-FABP was equal to the ROC curve of hs-cTnT (AUC 0.79 versus 0.80). Using a cut-off value of 4.0 ng/ml for H-FABP, sensitivity for ACS of the H-FABP (hs-cTnT) tests was 73.9% (70.6%). Negative predictive value (NPV) of H-FABP for ACS in a population representative for primary care (incidence of ACS 22%) thus could reach 90.8%. In patients presenting chest pain, plasma H-FABP reaches the highest diagnostic value when a cut-off value of 4 ng/ml is used. Diagnostic values of an algorithm combining point-of-care H-FABP measurement and a score of signs and symptoms should be studied in primary care, to learn if such an algorithm could safely reduce referral rate by GPs.

The voluntary-threat approach to control nonpoint source pollution under uncertainty.

PubMed

Li, Youping

2013-11-15

This paper extends the voluntary-threat approach of Segerson and Wu (2006) to the case that the ambient level of nonpoint source pollution is stochastic. It is shown that when the random component is bounded from the above, fine-tuning the cutoff value of the tax payments avoids the actual imposition of the tax while the threat of such payments retains necessary incentive for the polluters to engage in abatements at the optimal level. If the random component is not bounded, the imposition of the tax cannot be completely avoided but the probability can be reduced by setting a higher cutoff value. It is also noted that the regulator has additional flexibility in randomizing the tax imposition but the randomization process has to be credible. Copyright © 2013 Elsevier Ltd. All rights reserved.

Investigating Various Thresholds as Immunohistochemistry Cutoffs for Observer Agreement.

PubMed

Ali, Asif; Bell, Sarah; Bilsland, Alan; Slavin, Jill; Lynch, Victoria; Elgoweini, Maha; Derakhshan, Mohammad H; Jamieson, Nigel B; Chang, David; Brown, Victoria; Denley, Simon; Orange, Clare; McKay, Colin; Carter, Ross; Oien, Karin A; Duthie, Fraser R

2017-10-01

Clinical translation of immunohistochemistry (IHC) biomarkers requires reliable and reproducible cutoffs or thresholds for interpretation of immunostaining. Most IHC biomarker research focuses on the clinical relevance (diagnostic, prognostic, or predictive utility) of cutoffs, with less emphasis on observer agreement using these cutoffs. From the literature, we identified 3 commonly used cutoffs of 10% positive epithelial cells, 20% positive epithelial cells, and moderate to strong staining intensity (+2/+3 hereafter) to use for investigating observer agreement. A series of 36 images of microarray cores stained for 4 different IHC biomarkers, with variable staining intensity and percentage of positive cells, was used for investigating interobserver and intraobserver agreement. Seven pathologists scored the immunostaining in each image using the 3 cutoffs for positive and negative staining. Kappa (κ) statistic was used to assess the strength of agreement for each cutoff. The interobserver agreement between all 7 pathologists using the 3 cutoffs was reasonably good, with mean κ scores of 0.64, 0.59, and 0.62, respectively, for 10%, 20%, and +2/+3 cutoffs. A good agreement was observed for experienced pathologists using the 10% cutoff, and their agreement was statistically higher than for junior pathologists (P=0.02). In addition, the mean intraobserver agreement for all 7 pathologists using the 3 cutoffs was reasonably good, with mean κ scores of 0.71, 0.60, and 0.73, respectively, for 10%, 20%, and +2/+3 cutoffs. For all 3 cutoffs, a positive correlation was observed with perceived ease of interpretation (P<0.003). Finally, cytoplasmic-only staining achieved higher agreement using all 3 cutoffs than mixed staining patterns. All 3 cutoffs investigated achieve reasonable strength of agreement, modestly decreasing interobserver and intraobserver variability in IHC interpretation. These cutoffs have previously been used in cancer pathology, and this study provides evidence that these cutoffs can be reproducible between practicing pathologists.

Oocyte-triggering day progesterone levels and endometrial appearance in normoresponders undergoing IVF/ICSI cycles: a hypothesis and a study protocol.

PubMed

Siristatidis, Charalampos; Drakopoulos, Panagiotis; Vogiatzi, Paraskevi; Karageorgiou, Vasilios; Daskalakis, George

2018-05-16

In this report, we propose a study protocol capable of improving IVF outcomes in subfertile women with expected normal ovarian response. This proposal derives from conflicting published data and observations in our daily practice, concerning the negative impact of progesterone (P4) elevation at the day of oocyte triggering on pregnancy outcomes. Our hypothesis points to the combination of two previous "suspects" of reduced success after assisted reproduction techniques (ART) - the endometrium ultrasonographic parameters and P4 elevation at the day of oocyte triggering on their impact on pregnancy outcomes. Up-to-the minute data show that, there is a different impact of elevated P4 in fresh, frozen and donor cycles, whereas there are plenty of reports pointing to a different endometrial gene expression on different P4 measurements. Gaps in the literature are linked with a variation of the measurements of P4, its cycle-to-cycle reproducibility, the different cut-off levels used, the impact of various protocols of ovarian stimulation and the limitations of systematic reviews originating from the initial studies. Our hypothesis states that the combination of P4 values and endometrial ultrasound parameters at the day of oocyte triggering can affect clinical pregnancy rates in normal responders undergoing ART.

Acute posttraumatic stress symptoms and depression after exposure to the 2005 Saskatchewan Centennial Air Show disaster: prevalence and predictors.

PubMed

Taylor, Steven; Asmundson, Gordon J G; Carleton, R Nicholas; Brundin, Peter

2007-01-01

The purpose of this study was to determine the prevalence of acute distress-that is, clinically significant posttraumatic stress symptoms (PTSS) and depression-and to identify predictors of each in a sample of people who witnessed a fatal aircraft collision at the 2005 Saskatchewan Centennial Air Show. Air Show attendees (N = 157) were recruited by advertisements in the local media and completed an Internet-administered battery of questionnaires. Based on previously established cut-offs, 22 percent respondents had clinically significant PTSS and 24 percent had clinically significant depressive symptoms. Clinically significant symptoms were associated with posttrauma impairment in social and occupational functioning. Acute distress was associated with several variables, including aspects of Air Show trauma exposure, severity of prior trauma exposure, low posttrauma social support (ie, negative responses by others), indices of poor coping (eg, intolerance of uncertainty, rumination about the trauma), and elevated scores on anxiety sensitivity, the personality trait of absorption, and dissociative tendencies. Results suggest that clinically significant acute distress is common in the aftermath of witnessed trauma. The statistical predictors (correlates) of acute distress were generally consistent with the results of studies of other forms of trauma. People with elevated scores on theoretical vulnerability factors (eg, elevated anxiety sensitivity) were particularly likely to develop acute distress.

Elevational Patterns in Archaeal Diversity on Mt. Fuji

PubMed Central

Singh, Dharmesh; Takahashi, Koichi; Adams, Jonathan M.

2012-01-01

Little is known of how archaeal diversity and community ecology behaves along elevational gradients. We chose to study Mount Fuji of Japan as a geologically and topographically uniform mountain system, with a wide range of elevational zones. PCR-amplified soil DNA for the archaeal 16 S rRNA gene was pyrosequenced and taxonomically classified against EzTaxon-e archaeal database. At a bootstrap cut-off of 80%, most of the archaeal sequences were classified into phylum Thaumarchaeota (96%) and Euryarchaeota (3.9%), with no sequences classified into other phyla. Archaeal OTU richness and diversity on Fuji showed a pronounced ‘peak’ in the mid-elevations, around 1500 masl, within the boreal forest zone, compared to the temperate forest zone below and the alpine fell-field and desert zones above. Diversity decreased towards higher elevations followed by a subtle increase at the summit, mainly due to an increase in the relative abundance of the group I.1b of Thaumarchaeota. Archaeal diversity showed a strong positive correlation with soil NH4 +, K and NO3 − . Archaeal diversity does not parallel plant diversity, although it does roughly parallel bacterial diversity. Ecological hypotheses to explain the mid diversity bulge on Fuji include intermediate disturbance effects, and the result of mid elevations combining a mosaic of upper and lower slope environments. Our findings show clearly that archaeal soil communities are highly responsive to soil environmental gradients, in terms of both their diversity and community composition. Distinct communities of archaea specific to each elevational zone suggest that many archaea may be quite finely niche-adapted within the range of soil environments. A further interesting finding is the presence of a mesophilic component of archaea at high altitudes on a mountain that is not volcanically active. This emphasizes the importance of microclimate – in this case solar heating of the black volcanic ash surface – for the ecology of soil archaea. PMID:22970233

Utility of the PHQ-9 to identify major depressive disorder in adult patients in Spanish primary care centres.

PubMed

Muñoz-Navarro, Roger; Cano-Vindel, Antonio; Medrano, Leonardo Adrián; Schmitz, Florian; Ruiz-Rodríguez, Paloma; Abellán-Maeso, Carmen; Font-Payeras, Maria Antonia; Hermosilla-Pasamar, Ana María

2017-08-09

The prevalence of major depressive disorder (MDD) in Spanish primary care (PC) centres is high. However, MDD is frequently underdiagnosed and consequently only some patients receive the appropriate treatment. The present study aims to determine the utility of the Patient Health Questionnaire-9 (PHQ-9) to identify MDD in a subset of PC patients participating in the large PsicAP study. A total of 178 patients completed the full PHQ test, including the depression module (PHQ-9). Also, a Spanish version of the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) was implemented by clinical psychologists that were blinded to the PHQ-9 results. We evaluated the psychometric properties of the PHQ-9 as a screening tool as compared to the SCID-I as a reference standard. The psychometric properties of the PHQ-9 for a cut-off value of 10 points were as follows: sensitivity, 0.95; specificity, 0.67. Using a cut-off of 12 points, the values were: sensitivity, 0.84; specificity, 0.78. Finally, using the diagnostic algorithm for depression (DSM-IV criteria), the sensitivity was 0.88 and the specificity 0.80. As a screening instrument, the PHQ-9 performed better with a cut-off value of 12 versus the standard cut-off of 10. However, the best psychometric properties were obtained with the DSM-IV diagnostic algorithm for depression. These findings indicate that the PHQ-9 is a highly satisfactory tool that can be used for screening MDD in the PC setting. Current Controlled Trials ISRCTN58437086 . Registered 20 May 2013.

Child obesity cut-offs as derived from parental perceptions: cross-sectional questionnaire.

PubMed

Black, James A; Park, MinHae; Gregson, John; Falconer, Catherine L; White, Billy; Kessel, Anthony S; Saxena, Sonia; Viner, Russell M; Kinra, Sanjay

2015-04-01

Overweight children are at an increased risk of premature mortality and disease in adulthood. Parental perceptions and clinical definitions of child obesity differ, which may lessen the effectiveness of interventions to address obesity in the home setting. The extent to which parental and objective weight status cut-offs diverge has not been documented. To compare parental perceived and objectively derived assessment of underweight, healthy weight, and overweight in English children, and to identify sociodemographic characteristics that predict parental under- or overestimation of a child's weight status. Cross-sectional questionnaire completed by parents linked with objective measurement of height and weight by school nurses, in English children from five regions aged 4-5 and 10-11 years old. Parental derived cut-offs for under- and overweight were derived from a multinomial model of parental classification of their own child's weight status against school nurse measured body mass index (BMI) centile. Measured BMI centile was matched with parent classification of weight status in 2976 children. Parents become more likely to classify their children as underweight when they are at the 0.8th centile or below, and overweight at the 99.7th centile or above. Parents were more likely to underestimate a child's weight if the child was black or South Asian, male, more deprived, or the child was older. These values differ greatly from the BMI centile cut-offs for underweight (2nd centile) and overweight (85th). Clinical and parental classifications of obesity are divergent at extremes of the weight spectrum. © British Journal of General Practice 2015.

Optimal Cut-Off Points on the Health Anxiety Inventory, Illness Attitude Scales and Whiteley Index to Identify Severe Health Anxiety

PubMed Central

Hedman, Erik; Lekander, Mats; Ljótsson, Brjánn; Lindefors, Nils; Rück, Christian; Andersson, Gerhard; Andersson, Erik

2015-01-01

Background Health anxiety can be viewed as a dimensional phenomenon where severe health anxiety in form of DSM-IV hypochondriasis represents a cut-off where the health anxiety becomes clinically significant. Three of the most reliable and used self-report measures of health anxiety are the Health Anxiety Inventory (HAI), the Illness Attitude Scales (IAS) and the Whiteley Index (WI). Identifying the optimal cut-offs for classification of presence of a diagnosis of severe health anxiety on these measures has several advantages in clinical and research settings. The aim of this study was therefore to investigate the HAI, IAS and WI as proximal diagnostic instruments for severe health anxiety defined as DSM-IV hypochondriasis. Methods We investigated sensitivity, specificity and predictive value on the HAI, IAS and WI using a total of 347 adult participants of whom 158 had a diagnosis of severe health anxiety, 97 had obsessive-compulsive disorder and 92 were healthy non-clinical controls. Diagnostic assessments were conducted using the Anxiety Disorder Interview Schedule. Results Optimal cut-offs for identifying a diagnosis of severe health anxiety was 67 on the HAI, 47 on the IAS, and 5 on the WI. Sensitivity and specificity were high, ranging from 92.6 to 99.4%. Positive and negative predictive values ranged from 91.6 to 99.4% using unadjusted prevalence rates. Conclusions The HAI, IAS and WI have very good properties as diagnostic indicators of severe health anxiety and can be used as cost-efficient proximal estimates of the diagnosis. PMID:25849477

Sensitivity and specificity of the gain short-screener for predicting substance use disorders in a large national sample of emerging adults.

PubMed

Smith, Douglas C; Bennett, Kyle M; Dennis, Michael L; Funk, Rodney R

2017-05-01

Emerging Adults (ages 18-25) have the highest prevalence of substance use disorders and rarely receive treatment from the specialty care system. Thus, it is important to have screening instruments specifically developed for emerging adults for use in Screening, Brief Intervention and Referral to Treatment (SBIRT) models. Optimal cutoffs for the widely-used GAIN Short-Screener's (GAIN-SS) Substance Disorder Screener (SDScrY) are not established specifically for emerging adults. Therefore, this study examined the sensitivity and specificity of the SDScrY in predicting emerging adult (ages 18-25) substance use disorders. We analyzed data from emerging adults in a large clinical sample (n=9,808) who completed both the five-item SDScrY (α=0.85) and the full criteria set for DSM-IV Substance Use Disorders. We estimated the sensitivity, specificity and area under the curve to determine optimal cutoffs. Analyses revealed a high correlation between the SDScrY screener and its longer parent scale (r=0.95, p<0.001). Sensitivity (83%) and specificity (95%) were highest at a cutoff score of two (AUC=94%) on the SDScrY for any past year substance use disorder. Sensitivity (85%) was also high at a cutoff score of two on the SDScrY for any past year alcohol disorder. The five-item Substance Use Disorder Screener is a sensitive and specific screener for emerging adults, and could be used to identify emerging adults who may benefit from SBIRT interventions. Copyright © 2017 Elsevier Ltd. All rights reserved.

Detecting paraprotein interference on a direct bilirubin assay by reviewing the photometric reaction data.

PubMed

García-González, Elena; Aramendía, Maite; González-Tarancón, Ricardo; Romero-Sánchez, Naiara; Rello, Luis

2017-07-26

The direct bilirubin (D-Bil) assay on the AU Beckman Coulter instrumentation can be interfered by paraproteins, which may result in spurious D-Bil results. In a previous work, we took advantage of this fact to detect this interference, thus helping with the identification of patients with unsuspected monoclonal gammopathies. In this work, we investigate the possibility to detect interference based on the review of the photometric reactions, regardless of the D-Bil result. The D-Bil assay was carried out in a set of 2164 samples. It included a group of 164 samples with paraproteins (67 of which caused interference on the assay), as well as different groups of samples for which high absorbance background readings could also be expected (i.e. hemolyzed, lipemic, or icteric samples). Photometric reaction data were reviewed and receiver operating characteristics (ROC) curves were used to establish a cut-off for absorbance that best discriminates interference. The best cut-off was 0.0100 for the absorbance at the first photometric point of the complementary wavelength in the blank cuvette. Once the optimal cut-off for probable interference was selected, all samples analyzed in our laboratory that provided absorbance values above this cut-off were further investigated to try to discover paraproteins. During a period of 6 months, we detected 44 samples containing paraproteins, five of which belonged to patients with non-diagnosed monoclonal gammopathies. Review of the photometric reaction data permits the systematic detection of paraprotein interference on the D-Bil AU assay, even for samples for which reasonable results are obtained.

Estimation of Cutoff Values of Cotinine in Urine and Saliva for Pregnant Women in Poland

PubMed Central

Polańska, Kinga

2013-01-01

Setting appropriate cutoff values and the use of a highly sensitive analytical method allow for correct classification of the smoking status. Urine-saliva pairs samples of pregnant women in the second and third trimester, and saliva only in the first trimester were collected. Offline SPE and LC-ESI-MS/MS method was developed in the broad concentration range (saliva 0.4–1000 ng/mL, urine 0.8–4000 ng/mL). The mean recoveries were 3.7 ± 7.6% for urine and 99.1 ± 2.6% for saliva. LOD for saliva was 0.12 ng/mL and for urine 0.05 ng/mL; LOQ was 0.4 ng/mL and 0.8 ng/mL, respectively. Intraday and interday precision equaled, respectively, 1.2% and 3.4% for urine, and 2.3% and 6.4% for saliva. There was a strong correlation between salivary cotinine and the uncorrected cotinine concentration in urine in the second and third trimesters of pregnancy. The cutoff values were established for saliva 12.9 ng/mL and urine 42.3 ng/mL or 53.1 μg/g creatinine with the ROC curve analysis. The developed analytical method was successfully applied to quantify cotinine, and a significant correlation between the urinary and salivary cotinine levels was found. The presented cut-off values for salivary and urinary cotinine ensure a categorization of the smoking status among pregnant women that is more accurate than self-reporting. PMID:24228246

Comparison of Program Effects: The Use of Mastery Scores.

ERIC Educational Resources Information Center

Yeh, Jennie P.; Moy, Raymond

The setting of a cut-off score on a mastery test usually involves a consideration of one or more of the following elements: (1) the distribution of observed test scores; (2) the type of mastery criterion used; (3) the level of acceptable risks of mis-classification; (4) the loss of functions of mis-classifications; and (5) the distribution of true…

Validation of the Finnish Autism Spectrum Screening Questionnaire (ASSQ) for Clinical Settings and Total Population Screening

ERIC Educational Resources Information Center

Mattila, Marja-Leena; Jussila, Katja; Linna, Sirkka-Liisa; Kielinen, Marko; Bloigu, Risto; Kuusikko-Gauffin, Sanna; Joskitt, Leena; Ebeling, Hanna; Hurtig, Tuula; Moilanen, Irma

2012-01-01

We assessed the validity and determined cut-off scores for the Finnish Autism Spectrum Screening Questionnaire (ASSQ). A population sample of 8-year-old children (n = 4,408) was rated via the ASSQ by parents and/or teachers, and a subgroup of 104 children was examined via structured interview, semi-structured observation, IQ measurement, school…

Quantifying the added value of BNP in suspected heart failure in general practice: an individual patient data meta-analysis.

PubMed

Kelder, Johannes C; Cowie, Martin R; McDonagh, Theresa A; Hardman, Suzanna M C; Grobbee, Diederick E; Cost, Bernard; Hoes, Arno W

2011-06-01

Diagnosing early stages of heart failure with mild symptoms is difficult. B-type natriuretic peptide (BNP) has promising biochemical test characteristics, but its diagnostic yield on top of readily available diagnostic knowledge has not been sufficiently quantified in early stages of heart failure. To quantify the added diagnostic value of BNP for the diagnosis of heart failure in a population relevant to GPs and validate the findings in an independent primary care patient population. Individual patient data meta-analysis followed by external validation. The additional diagnostic yield of BNP above standard clinical information was compared with ECG and chest x-ray results. Derivation was performed on two existing datasets from Hillingdon (n=127) and Rotterdam (n=149) while the UK Natriuretic Peptide Study (n=306) served as validation dataset. Included were patients with suspected heart failure referred to a rapid-access diagnostic outpatient clinic. Case definition was according to the ESC guideline. Logistic regression was used to assess discrimination (with the c-statistic) and calibration. Of the 276 patients in the derivation set, 30.8% had heart failure. The clinical model (encompassing age, gender, known coronary artery disease, diabetes, orthopnoea, elevated jugular venous pressure, crackles, pitting oedema and S3 gallop) had a c-statistic of 0.79. Adding, respectively, chest x-ray results, ECG results or BNP to the clinical model increased the c-statistic to 0.84, 0.85 and 0.92. Neither ECG nor chest x-ray added significantly to the 'clinical plus BNP' model. All models had adequate calibration. The 'clinical plus BNP' diagnostic model performed well in an independent cohort with comparable inclusion criteria (c-statistic=0.91 and adequate calibration). Using separate cut-off values for 'ruling in' (typically implying referral for echocardiography) and for 'ruling out' heart failure--creating a grey zone--resulted in insufficient proportions of patients with a correct diagnosis. BNP has considerable diagnostic value in addition to signs and symptoms in patients suspected of heart failure in primary care. However, using BNP alone with the currently recommended cut-off levels is not sufficient to make a reliable diagnosis of heart failure.

Screening for Hypertension and Lowering Blood Pressure for Prevention of Cardiovascular Disease Events.

PubMed

Viera, Anthony J

2017-07-01

Hypertension affects 1 in 3 American adults. Blood pressure (BP)-lowering therapy reduces the risk of cardiovascular disease. The United States Preventive Services Task Force recommends all adults be screened for hypertension. Most patients whose office BP is elevated should have out-of-office monitoring to confirm the diagnosis. Ambulatory BP monitoring is preferred for out-of-office measurement, but home BP monitoring is a reasonable alternative. Guidelines for treatment are stratified by age (<60 vs >60 years) and include cutoffs for recommended treatment BPs and target BP goals. Quality of hypertension care is improved by incorporating population health management using registries and medication titration. Copyright © 2017 Elsevier Inc. All rights reserved.

Screening for bipolar spectrum disorders: A comprehensive meta-analysis of accuracy studies.

PubMed

Carvalho, André F; Takwoingi, Yemisi; Sales, Paulo Marcelo G; Soczynska, Joanna K; Köhler, Cristiano A; Freitas, Thiago H; Quevedo, João; Hyphantis, Thomas N; McIntyre, Roger S; Vieta, Eduard

2015-02-01

Bipolar spectrum disorders are frequently under-recognized and/or misdiagnosed in various settings. Several influential publications recommend the routine screening of bipolar disorder. A systematic review and meta-analysis of accuracy studies for the bipolar spectrum diagnostic scale (BSDS), the hypomania checklist (HCL-32) and the mood disorder questionnaire (MDQ) were performed. The Pubmed, EMBASE, Cochrane, PsycINFO and SCOPUS databases were searched. Studies were included if the accuracy properties of the screening measures were determined against a DSM or ICD-10 structured diagnostic interview. The QUADAS-2 tool was used to rate bias. Fifty three original studies met inclusion criteria (N=21,542). At recommended cutoffs, summary sensitivities were 81%, 66% and 69%, while specificities were 67%, 79% and 86% for the HCL-32, MDQ, and BSDS in psychiatric services, respectively. The HCL-32 was more accurate than the MDQ for the detection of type II bipolar disorder in mental health care centers (P=0.018). At a cutoff of 7, the MDQ had a summary sensitivity of 43% and a summary specificity of 95% for detection of bipolar disorder in primary care or general population settings. Most studies were performed in mental health care settings. Several included studies had a high risk of bias. Although accuracy properties of the three screening instruments did not consistently differ in mental health care services, the HCL-32 was more accurate than the MDQ for the detection of type II BD. More studies in other settings (for example, in primary care) are necessary. Copyright © 2014 Elsevier B.V. All rights reserved.

Unresectable Hepatocellular Carcinoma: MR Imaging after Intraarterial Therapy. Part I. Identification and Validation of Volumetric Functional Response Criteria

PubMed Central

Bonekamp, Susanne; Li, Zhen; Geschwind, Jean-François H.; Halappa, Vivek Gowdra; Corona-Villalobos, Celia Pamela; Reyes, Diane; Pawlik, Timothy M.; Bonekamp, David; Eng, John

2013-01-01

Purpose: To identify and validate the optimal thresholds for volumetric functional MR imaging response criteria to predict overall survival after intraarterial treatment (IAT) in patients with unresectable hepatocellular carcinoma (HCC). Materials and Methods: Institutional review board approval and waiver of informed consent were obtained. A total of 143 patients who had undergone MR imaging before and 3–4 weeks after the first cycle of IAT were included. MR imaging analysis of one representative HCC index lesion was performed with proprietary software after initial treatment. Subjects were randomly divided into training (n = 114 [79.7%]) and validation (n = 29 [20.3%]) data sets. Uni- and multivariate Cox models were used to determine the best cutoffs, as well as survival differences, between response groups in the validation data set. Results: Optimal cutoffs in the training data set were 23% increase in apparent diffusion coefficient (ADC) and 65% decrease in volumetric enhancement in the portal venous phase (VE). Subsequently, 25% increase in ADC and 65% decrease in VE were used to stratify patients in the validation data set. Comparison of ADC responders (n = 12 [58.6%]) with nonresponders (n = 17 [34.5%]) showed significant differences in survival (25th percentile survival, 11.2 vs 4.9 months, respectively; P = .008), as did VE responders (n = 9 [31.0%]) compared with nonresponders (n = 20 [69.0%]; 25th percentile survival, 11.5 vs 5.1 months, respectively; P = .01). Stratification of patients with a combination of the criteria resulted in significant differences in survival between patients with lesions that fulfilled both criteria (n = 6 [20.7%]; too few cases to determine 25th percentile), one criterion (n = 9 [31.0%]; 25th percentile survival, 6.0 months), and neither criterion (n = 14 [48.3%]; 25th percentile survival, 5.1 months; P = .01). The association between the two criteria and overall survival remained significant in a multivariate analysis that included age, sex, Barcelona Clinic for Liver Cancer stage, and number of follow-up treatments. Conclusion: After IAT for unresectable HCC, patients can be stratified into significantly different survival categories based on responder versus nonresponder status according to MR imaging ADC and VE cutoffs. © RSNA, 2013 PMID:23616631

Neck circumference as a predictor of metabolic syndrome, insulin resistance and low-grade systemic inflammation in children: the ACFIES study.

PubMed

Gomez-Arbelaez, Diego; Camacho, Paul Anthony; Cohen, Daniel Dylan; Saavedra-Cortes, Sandra; Lopez-Lopez, Cristina; Lopez-Jaramillo, Patricio

2016-03-08

The current study aims to evaluate the association between neck circumference (NC) and several cardio-metabolic risk factors, to compare it with well-established anthropometric indices, and to determine the cut-off point value of NC for predicting children at increased risk of metabolic syndrome, insulin resistance and low-grade systemic inflammation. A total of 669 school children, aged 8-14, were recruited. Demographic, clinical, anthropometric and biochemical data from all patients were collected. Correlations between cardio-metabolic risk factors and NC and other anthropometric variables were evaluated using the Spearman's correlation coefficient. Multiple linear regression analysis was applied to further examine these associations. We then determined by receiver operating characteristic (ROC) analyses the optimal cut-off for NC for identifying children with elevated cardio-metabolic risk. NC was positively associated with fasting plasma glucose and triglycerides (p = 0.001 for all), and systolic and diastolic blood pressure, C-reactive protein, insulin and HOMA-IR (p < 0.001 for all), and negatively with HDL-C (p = 0.001). Whereas, other anthropometric indices were associated with fewer risk factors. NC could be used as clinically relevant and easy to implement indicator of cardio-metabolic risk in children.

Association between Myeloperoxidase Levels and Risk of Insulin Resistance in Egyptian Obese Women

PubMed Central

Zaki, Moushira; Basha, Walaa; Reyad, Hanaa; Mohamed, Ramy; Hassan, Naglaa; Kholousi, Shams

2018-01-01

BACKGROUND: Myeloperoxidase (MPO) is an enzyme involved in the pathogenesis of several diseases. AIM: The current study aimed to investigate serum MPO levels in obese Egyptian women and assess its relation with insulin resistance (IR) and other biochemical risk parameters. METHODS: The study included 80 obese women and 50 age-and-sex-matched healthy controls. Insulin resistance (IR) was evaluated by the Homeostasis Model Assessment-Insulin Resistance (HOMA-IR). Serum MPO, fasting glucose, insulin and blood lipids and anthropometry were measured. Obese cases were divided into three groups based on MPO tertiles. ROC analysis was performed to obtain the optimal cut-off values of MPO to predicate IR in obese women. RESULTS: The mean serum MPO was significantly higher in obese cases than controls. Cases in the highest MPO tertile had higher HOMA-IR, blood lipids and pressure levels compared with those in the lower tertile. The cutoff point of MPO was > 87.8 (ng/mL) and area under curves was 0.82 (p < 0.01) for diagnosis of IR. MPO levels were higher in obese Egyptian women than healthy controls. CONCLUSION: Elevation of MPO was associated with abnormal metabolic parameters. MPO might be used as an earlier biomarker for IR and metabolic disturbance in obese women. PMID:29731928

Problems of classification in the family Paramyxoviridae.

PubMed

Rima, Bert; Collins, Peter; Easton, Andrew; Fouchier, Ron; Kurath, Gael; Lamb, Robert A; Lee, Benhur; Maisner, Andrea; Rota, Paul; Wang, Lin-Fa

2018-05-01

A number of unassigned viruses in the family Paramyxoviridae need to be classified either as a new genus or placed into one of the seven genera currently recognized in this family. Furthermore, numerous new paramyxoviruses continue to be discovered. However, attempts at classification have highlighted the difficulties that arise by applying historic criteria or criteria based on sequence alone to the classification of the viruses in this family. While the recent taxonomic change that elevated the previous subfamily Pneumovirinae into a separate family Pneumoviridae is readily justified on the basis of RNA dependent -RNA polymerase (RdRp or L protein) sequence motifs, using RdRp sequence comparisons for assignment to lower level taxa raises problems that would require an overhaul of the current criteria for assignment into genera in the family Paramyxoviridae. Arbitrary cut off points to delineate genera and species would have to be set if classification was based on the amino acid sequence of the RdRp alone or on pairwise analysis of sequence complementarity (PASC) of all open reading frames (ORFs). While these cut-offs cannot be made consistent with the current classification in this family, resorting to genus-level demarcation criteria with additional input from the biological context may afford a way forward. Such criteria would reflect the increasingly dynamic nature of virus taxonomy even if it would require a complete revision of the current classification.

A Prorating Method for Estimating MMPI-2-RF Scores From MMPI Responses: Examination of Score Fidelity and Illustration of Empirical Utility in the PERSEREC Police Integrity Study Sample.

PubMed

Tarescavage, Anthony M; Corey, David M; Ben-Porath, Yossef S

2016-04-01

The purpose of the current study was to identify Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) correlates of police officer integrity violations and other problem behaviors in an archival database with original MMPI item responses and collateral information regarding integrity violations obtained for 417 male officers. In Study 1, we estimated MMPI-2-RF scores from the MMPI item pool (which includes approximately 80% of the MMPI-2-RF items) in a normative sample, a psychiatric inpatient sample, and a police officer sample, and conducted analyses that demonstrated the comparability of estimated and full scale scores for 41 of the 51 MMPI-2-RF scales. In Study 2, we correlated estimated MMPI-2-RF scores with information about subsequent integrity violations and problem behaviors from the integrity violation data set. Several meaningful associations were obtained, predominately with scales from the emotional, thought, and behavioral dysfunction domains of the MMPI-2-RF. Application of a correction for range restriction yielded substantially improved validity estimates. Finally, we calculated relative risk ratios for the statistically significant findings using cutoffs lower than 65T, which is traditionally used to identify clinically significant elevations, and found several meaningful relative risk ratios. © The Author(s) 2015.

Program Merges SAR Data on Terrain and Vegetation Heights

NASA Technical Reports Server (NTRS)

Siqueira, Paul; Hensley, Scott; Rodriguez, Ernesto; Simard, Marc

2007-01-01

X/P Merge is a computer program that estimates ground-surface elevations and vegetation heights from multiple sets of data acquired by the GeoSAR instrument [a terrain-mapping synthetic-aperture radar (SAR) system that operates in the X and bands]. X/P Merge software combines data from X- and P-band digital elevation models, SAR backscatter magnitudes, and interferometric correlation magnitudes into a simplified set of output topographical maps of ground-surface elevation and tree height.

Anti-citrullinated protein antibodies are associated with neutrophil extracellular traps in the sputum in relatives of rheumatoid arthritis patients

PubMed Central

Demoruelle, M. Kristen; Harrall, Kylie K.; Ho, Linh; Purmalek, Monica M.; Seto, Nickie L.; Rothfuss, Heather M.; Weisman, Michael H.; Solomon, Joshua J.; Fischer, Aryeh; Okamoto, Yuko; Kelmenson, Lindsay B.; Parish, Mark C.; Feser, Marie; Fleischer, Chelsie; Anderson, Courtney; Mahler, Michael; Norris, Jill M.; Kaplan, Mariana J.; Cherrington, Brian D.; Holers, V. Michael; Deane, Kevin D.

2017-01-01

Objectives Studies suggest that rheumatoid arthritis (RA)-related autoimmunity is initiated at a mucosal site. However, the factors associated with the mucosal generation of this autoimmunity are unknown, especially in individuals who are at-risk for future RA. Therefore, we tested anti-cyclic citrullinated peptide (anti-CCP) antibodies in the sputum of RA-free first-degree relatives (FDRs) of RA patients and patients with classifiable RA. Methods We evaluated induced sputum and serum from 67 FDRs and 20 RA subjects for anti-CCP-IgA and anti-CCP-IgG, with cut-off levels for positivity determined in a control population. Sputum was also evaluated for cell counts, neutrophil extracellular traps (NETs) using sandwich ELISAs for protein/nucleic acid complexes, and total citrulline. Results Sputum anti-CCP-IgA and/or anti-CCP-IgG was positive in 17/67 (25%) FDRs and 14/20 (70%) RA subjects, including a portion of FDRs who were serum anti-CCP negative. In FDRs, elevations of sputum anti-CCP-IgA and anti-CCP-IgG were associated with elevated sputum cell counts and levels of NET complexes. Anti-CCP-IgA was associated with ever-smoking and elevated sputum citrulline levels. Conclusions Anti-CCP is elevated in the sputum of FDRs, including seronegative FDRs, suggesting the lung may be one site of anti-CCP generation in this population. The association of anti-CCP with elevated cell counts and NET levels in FDRs supports a hypothesis that local airway inflammation and NET formation may drive anti-CCP production in the lung and may promote the early stages of RA development. Longitudinal studies are needed to follow the evolution of these processes relative to the development of systemic autoimmunity and articular RA. PMID:28182854

Serum anti-Ku86 is a potential biomarker for early detection of hepatitis C virus-related hepatocellular carcinoma

DOE Office of Scientific and Technical Information (OSTI.GOV)

Nomura, Fumio, E-mail: fnomura@faculty.chiba-u.jp; Sogawa, Kazuyuki; Noda, Kenta

Highlights: Black-Right-Pointing-Pointer Overexpression of Ku86 in human liver cancer was shown by immunohistochemistry. Black-Right-Pointing-Pointer Serum anti-Ku86 was significantly elevated in early hepatocellular carcinoma. Black-Right-Pointing-Pointer Anti-Ku86 may be more sensitive than the conventional markers for early detection. Black-Right-Pointing-Pointer Serum anti-Ku86 significantly decreased after surgical resection of liver tumors. Black-Right-Pointing-Pointer Elevation of serum anti-Ku86 in other non-liver solid tumors was minimal. -- Abstract: Hepatocellular carcinoma (HCC), the predominant form of primary liver cancer, is one of the most common cancers worldwide and the third most common cause of cancer-related death. Imaging studies including ultrasound and computed tomography are recommended for early detectionmore » of HCC, but they are operator dependent, costly and involve radiation. Therefore, there is a need for simple and sensitive serum markers for the early detection of hepatocellular carcinoma (HCC). In our recent proteomic studies, a number of proteins overexpressed in HCC tissues were identified. We thought if the serum autoantibodies to these overexpressed proteins were detectable in HCC patients. Of these proteins, we focused on Ku86, a nuclear protein involved in multiple biological processes and aimed to assess the diagnostic value of serum anti-Ku86 in the early detection of HCC. Serum samples were obtained prior to treatment from 58 consecutive patients with early or relatively early hepatitis C virus (HCV)-related HCC and 137 patients with HCV-related liver cirrhosis without evidence of HCC. Enzyme immunoassays were used to measure serum levels of autoantibodies. Serum levels of anti-Ku86 antibodies were significantly elevated in HCC patients compared to those in liver cirrhosis patients (0.41 {+-} 0.28 vs. 0.18 {+-} 0.08 Abs at 450 nm, P < 0001). Setting the cut-off level to give 90% specificity, anti-Ku86 was positive in 60.7% of stage I solitary tumor <2 cm in diameter, whereas the sensitivities of alpha-fetoprotein (AFP) and protein induced by vitamin K absence or antagonist II (PIVKA-II) were 17.8% and 21.4%, respectively. The results of ROC analyses indicated the better performance of anti-Ku86 for early detection of HCC. Serum anti-Ku86 levels decreased after surgical resection of the tumors in the 12 HCC cases tested, Elevation of anti-Ku86 in solid tumors other than liver was minimal. Serum anti-Ku86 is a potential biomarker for early detection of HCV-related HCC. Further studies in a larger number of HCC patients with various etiologies are needed to further evaluate the diagnostic and pathophysiological roles of elevation of serum anti-Ku86 in early HCC.« less

Estimating relative sea-level rise and submergence potential at a coastal wetland

USGS Publications Warehouse

Cahoon, Donald R.

2015-01-01

A tide gauge records a combined signal of the vertical change (positive or negative) in the level of both the sea and the land to which the gauge is affixed; or relative sea-level change, which is typically referred to as relative sea-level rise (RSLR). Complicating this situation, coastal wetlands exhibit dynamic surface elevation change (both positive and negative), as revealed by surface elevation table (SET) measurements, that is not recorded at tide gauges. Because the usefulness of RSLR is in the ability to tie the change in sea level to the local topography, it is important that RSLR be calculated at a wetland that reflects these local dynamic surface elevation changes in order to better estimate wetland submergence potential. A rationale is described for calculating wetland RSLR (RSLRwet) by subtracting the SET wetland elevation change from the tide gauge RSLR. The calculation is possible because the SET and tide gauge independently measure vertical land motion in different portions of the substrate. For 89 wetlands where RSLRwet was evaluated, wetland elevation change differed significantly from zero for 80 % of them, indicating that RSLRwet at these wetlands differed from the local tide gauge RSLR. When compared to tide gauge RSLR, about 39 % of wetlands experienced an elevation rate surplus and 58 % an elevation rate deficit (i.e., sea level becoming lower and higher, respectively, relative to the wetland surface). These proportions were consistent across saltmarsh, mangrove, and freshwater wetland types. Comparison of wetland elevation change and RSLR is confounded by high levels of temporal and spatial variability, and would be improved by co-locating tide gauge and SET stations near each other and obtaining long-term records for both.

The surface elevation table: marker horizon method for measuring wetland accretion and elevation dynamics

USGS Publications Warehouse

Callaway, John C.; Cahoon, Donald R.; Lynch, James C.

2014-01-01

Tidal wetlands are highly sensitive to processes that affect their elevation relative to sea level. The surface elevation table–marker horizon (SET–MH) method has been used to successfully measure these processes, including sediment accretion, changes in relative elevation, and shallow soil processes (subsidence and expansion due to root production). The SET–MH method is capable of measuring changes at very high resolution (±millimeters) and has been used worldwide both in natural wetlands and under experimental conditions. Marker horizons are typically deployed using feldspar over 50- by 50-cm plots, with replicate plots at each sampling location. Plots are sampled using a liquid N2 cryocorer that freezes a small sample, allowing the handling and measurement of soft and easily compressed soils with minimal compaction. The SET instrument is a portable device that is attached to a permanent benchmark to make high-precision measurements of wetland surface elevation. The SET instrument has evolved substantially in recent decades, and the current rod SET (RSET) is widely used. For the RSET, a 15-mm-diameter stainless steel rod is pounded into the ground until substantial resistance is achieved to establish a benchmark. The SET instrument is attached to the benchmark and leveled such that it reoccupies the same reference plane in space, and pins lowered from the instrument repeatedly measure the same point on the soil surface. Changes in the height of the lowered pins reflect changes in the soil surface. Permanent or temporary platforms provide access to SET and MH locations without disturbing the wetland surface.

The cutoff phenomenon in finite Markov chains.

PubMed Central

Diaconis, P

1996-01-01

Natural mixing processes modeled by Markov chains often show a sharp cutoff in their convergence to long-time behavior. This paper presents problems where the cutoff can be proved (card shuffling, the Ehrenfests' urn). It shows that chains with polynomial growth (drunkard's walk) do not show cutoffs. The best general understanding of such cutoffs (high multiplicity of second eigenvalues due to symmetry) is explored. Examples are given where the symmetry is broken but the cutoff phenomenon persists. PMID:11607633

The ALADINO Study: A National Study of Prevalence of Overweight and Obesity in Spanish Children in 2011

PubMed Central

Pérez-Farinós, Napoleón; López-Sobaler, Ana M.; Dal Re, M. Ángeles; Villar, Carmen; Labrado, Estefanía; Robledo, Teresa; Ortega, Rosa M.

2013-01-01

The aim of the study was to determine the prevalence of overweight and obesity in children in Spain using different sets of cut-off criteria, through a community-based cross-sectional study. The study was conducted in a representative sample of Spanish children between 6 and 9 years, recruited in Spanish schools, between October 2010 and May 2011. 7,569 boys and girls were selected. All were weighed and measured, and their parents were asked about their socioeconomic background, food habits and physical activity. The BMI of each was calculated, and the prevalence of overweight and obesity was determined by age and sex using Spanish reference tables (SPART), IOTF reference values, and WHO growth standards. The prevalence of overweight in boys ranged from 14.1% to 26.7%, and in girls from 13.8% to 25.7%, depending on the cut-off criteria. The prevalence of obesity in boys ranged from 11.0% to 20.9%, and in girls from 11.2% to 15.5%. The prevalence of obesity was the highest among those same children when using the SPART or WHO criteria. Overweight and obesity remain widespreading among Spanish children; a consensus on the definition of overweight and obesity cut-off criteria is necessary. PMID:24089663

When does the Autism Spectrum Screening Questionnaire (ASSQ) predict autism spectrum disorders in primary school-aged children?

PubMed

Mattila, Marja-Leena; Jussila, Katja; Kuusikko, Sanna; Kielinen, Marko; Linna, Sirkka-Liisa; Ebeling, Hanna; Bloigu, Risto; Joskitt, Leena; Pauls, David; Moilanen, Irma

2009-08-01

The aims of this study were, firstly, to study the association between parents' and teachers' ratings for the Finnish version of the Autism Spectrum Screening Questionnaire (ASSQ), secondly, to find out whether the original cut-off scores of the ASSQ identify primary school-aged children with Asperger syndrome (AS) or autism by using the Finnish ASSQ, and thirdly, to evaluate the validity of the ASSQ. Parents and/or teachers of higher-functioning (full-scale intelligence quotient > or = 50) 8-year-old total population school children (n = 4,408) and 7-12-year-old outpatients with AS/autism (n = 47) completed the Finnish version of the ASSQ. Agreement between informants was slight. In the whole total population, low positive correlation was found between parents' and teachers' ratings, while in the sample of high-scoring children the correlation turned out to be negative. A cut-off of 30 for parents' and teacher's summed score and 22 for teachers' single score is recommended. A valid cut-off for parents' single score could not been estimated. The clinicians are reminded that the ASSQ is a screening instrument, not a diagnosing instrument. The importance of using both parents' and teachers' ratings for screening in clinical settings is underlined.

A novel assay for detecting canine parvovirus using a quartz crystal microbalance biosensor.

PubMed

Kim, Yong Kwan; Lim, Seong-In; Choi, Sarah; Cho, In-Soo; Park, Eun-Hye; An, Dong-Jun

2015-07-01

Rapid and accurate diagnosis is crucial to reduce both the shedding and clinical signs of canine parvovirus (CPV). The quartz crystal microbalance (QCM) is a new tool for measuring frequency changes associated with antigen-antibody interactions. In this study, the QCM biosensor and ProLinker™ B were used to rapidly diagnosis CPV infection. ProLinker™ B enables antibodies to be attached to a gold-coated quartz surface in a regular pattern and in the correct orientation for antigen binding. Receiver operating characteristics (ROC) curves were used to set a cut-off value using reference CPVs (two groups: one CPV-positive and one CPV-negative). The ROC curves overlapped and the point of intersection was used as the cut-off value. A QCM biosensor with a cut-off value of -205 Hz showed 95.4% (104/109) sensitivity and 98.0% (149/152) specificity when used to test 261 field fecal samples compared to PCR. In conclusion, the QCM biosensor described herein is eminently suitable for the rapid diagnosis of CPV infection with high sensitivity and specificity. Therefore, it is a promising analytical tool that will be useful for clinical diagnosis, which requires rapid and reliable analyses. Copyright © 2015 Elsevier B.V. All rights reserved.

Relationship between CT densitometry with a slice thickness of 0.5 mm and audiometry in otosclerosis.

PubMed

Kawase, Setsuko; Naganawa, Shinji; Sone, Michihiko; Ikeda, Mitsuru; Ishigaki, Takeo

2006-06-01

The appropriate cutoff Hounsfield unit (HU) value for the diagnosis of otosclerosis was determined and the correlation between the bone conduction threshold and the findings of computed tomography (CT) densitometry investigated. CT images, 0.5-mm thick, were evaluated in 24 ears with otosclerosis and 19 control ears. Eight regions of interest were set around the otic capsule. The mean HU values in the area anterior to the oval window (A-OW) and anterior to the internal auditory canal (A-IAC) were significantly lower in otosclerosis than in controls. Based on receiver operating characteristic (ROC) analysis, the cutoff HU value in A-OW was determined to be 2,187.3 HU. The mean HU value in retrofenestral otosclerosis was significantly lower in the area A-OW, A-IAC and around the cochlea than in controls. Based on ROC analysis, the cutoff HU value in the latter was determined to be 2,045 HU. A statistically significant correlation was found between the density of the area A-OW and the hearing level at 500 and 1,000 Hz, and between the density of the area around the cochlea and the hearing level at most frequencies. These results suggest the semi-automated diagnosis of otosclerosis may be possible.

Validation of Shear Wave Elastography Cutoff Values on the Supersonic Aixplorer for Practical Clinical Use in Liver Fibrosis Staging.

PubMed

Dhyani, Manish; Grajo, Joseph R; Bhan, Atul K; Corey, Kathleen; Chung, Raymond; Samir, Anthony E

2017-06-01

The purpose of this study was to determine the validity of previously established ultrasound shear wave elastography (SWE) cut-off values (≥F2 fibrosis) on an independent cohort of patients with chronic liver disease. In this cross-sectional study, approved by the institutional review board and compliant with the Health Insurance Portability and Accountability Act, 338 patients undergoing liver biopsy underwent SWE using an Aixplorer ultrasound machine (SuperSonic Imagine, Aix-en-Provence, France). Median SWE values were calculated from sets of 10 elastograms. A single blinded pathologist evaluated METAVIR fibrosis staging as the gold standard. The study analyzed 277 patients with a mean age of 48 y. On pathologic examination, 212 patients (76.5%) had F0-F1 fibrosis, whereas 65 (23.5%) had ≥F2 fibrosis. Spearman's correlation of fibrosis with SWE was 0.456 (p < 0.001). A cut-off value of 7.29 kPa yielded sensitivity of 95.4% and specificity of 50.5% for the diagnosis of METAVIR stage ≥F2 liver fibrosis in patients with liver disease using the SuperSonic Imagine Aixplorer SWE system. Copyright © 2017 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

Sensitivity and specificity of blood leukocyte counts as an indicator of mortality in horses after colic surgery.

PubMed

Salciccia, A; Sandersen, C; Grulke, S; de la Rebière de Pouyade, G; Caudron, I; Serteyn, D; Detilleux, J

2013-09-21

The objectives of this study were to describe and relate perioperative changes in blood leukocyte counts to the outcome of surgical colic horses, determine a cut-off value in the early postoperative period to obtain an indicator of the outcome, and compare the obtained value to a validation population of horses. Fifty-three horses undergoing colic surgery were included in the descriptive part of the study. Total leukocyte counts were performed before, during and serially after surgery. A receiver operating characteristic analysis was performed on the leukocyte counts of 45 of these horses to determine a cut-off value for the outcome. The results obtained were validated on a second set of 50 horses that underwent colic surgery in similar conditions. The kinetics of blood leukocytes in survivors was higher than in non-survivors during the first days. Non-survivor horses were more likely to have at least one blood leukocyte count ≤ 3.9 × 10(3)/mm(3) between 28 and 60 hours after surgery than survivor horses. This cut-off value was confirmed in the validation population. These results suggest that routine values of blood leukocyte counts can be used as an additional prognostic indicator after colic surgery alongside other predictors previously associated with the outcome.

Evaluating the Bulk Lorentz Factors of Outflow Material: Lessons Learned from the Extremely Energetic Outburst GRB 160625B

NASA Astrophysics Data System (ADS)

Wang, Yuan-Zhu; Wang, Hao; Zhang, Shuai; Liang, Yun-Feng; Jin, Zhi-Ping; He, Hao-Ning; Liao, Neng-Hui; Fan, Yi-Zhong; Wei, Da-Ming

2017-02-01

GRB 160625B is an extremely bright outburst with well-monitored afterglow emission. The geometry-corrected energy is high, up to ˜5.2 × 1052 erg or even ˜8 × 1052 erg, rendering it the most energetic GRB prompt emission recorded so far. We analyzed the time-resolved spectra of the prompt emission and found that in some intervals there were likely thermal-radiation components and the high energy emission was characterized by significant cutoff. The bulk Lorentz factors of the outflow material are estimated accordingly. We found out that the Lorentz factors derived in the thermal-radiation model are consistent with the luminosity-Lorentz factor correlation found in other bursts, as well as in GRB 090902B for the time-resolved thermal-radiation components, while the spectral cutoff model yields much lower Lorentz factors that are in tension with the constraints set by the electron pair Compton scattering process. We then suggest that these spectral cutoffs are more likely related to the particle acceleration process and that one should be careful in estimating the Lorentz factors if the spectrum cuts at a rather low energy (e.g., ˜tens of MeV). The nature of the central engine has also been discussed, and a stellar-mass black hole is favored.

Diagnostic Thresholds for Quantitative REM Sleep Phasic Burst Duration, Phasic and Tonic Muscle Activity, and REM Atonia Index in REM Sleep Behavior Disorder with and without Comorbid Obstructive Sleep Apnea

PubMed Central

McCarter, Stuart J.; St. Louis, Erik K.; Duwell, Ethan J.; Timm, Paul C.; Sandness, David J.; Boeve, Bradley F.; Silber, Michael H.

2014-01-01

Objectives: We aimed to determine whether phasic burst duration and conventional REM sleep without atonia (RSWA) methods could accurately diagnose REM sleep behavior disorder (RBD) patients with comorbid OSA. Design: We visually analyzed RSWA phasic burst durations, phasic, “any,” and tonic muscle activity by 3-s mini-epochs, phasic activity by 30-s (AASM rules) epochs, and conducted automated REM atonia index (RAI) analysis. Group RSWA metrics were analyzed and regression models fit, with receiver operating characteristic (ROC) curves determining the best diagnostic cutoff thresholds for RBD. Both split-night and full-night polysomnographic studies were analyzed. Setting: N/A. Participants: Parkinson disease (PD)-RBD (n = 20) and matched controls with (n = 20) and without (n = 20) OSA. Interventions: N/A. Measurements and Results: All mean RSWA phasic burst durations and muscle activities were higher in PD-RBD patients than controls (P < 0.0001), and RSWA associations with PD-RBD remained significant when adjusting for age, gender, and REM AHI (P < 0.0001). RSWA muscle activity (phasic, “any”) cutoffs for 3-s mini-epoch scorings were submentalis (SM) (15.5%, 21.6%), anterior tibialis (AT) (30.2%, 30.2%), and combined SM/AT (37.9%, 43.4%). Diagnostic cutoffs for 30-s epochs (AASM criteria) were SM 2.8%, AT 11.3%, and combined SM/AT 34.7%. Tonic muscle activity cutoff of 1.2% was 100% sensitive and specific, while RAI (SM) cutoff was 0.88. Phasic muscle burst duration cutoffs were: SM (0.65) and AT (0.79) seconds. Combining phasic burst durations with RSWA muscle activity improved sensitivity and specificity of RBD diagnosis. Conclusions: This study provides evidence for REM sleep without atonia diagnostic thresholds applicable in Parkinson disease-REM sleep behavior disorder (PD-RBD) patient populations with comorbid OSA that may be useful toward distinguishing PD-RBD in typical outpatient populations. Citation: McCarter SJ, St. Louis EK, Duwell EJ, Timm PC, Sandness DJ, Boeve BF, Silber MH. Diagnostic thresholds for quantitative REM sleep phasic burst duration, phasic and tonic muscle activity, and REM atonia index in REM sleep behavior disorder with and without comorbid obstructive sleep apnea. SLEEP 2014;37(10):1649-1662. PMID:25197816

Action-oriented colour-coded foot length calliper for primary healthcare workers as a proxy for birth weight & gestational period

PubMed Central

Pratinidhi, Asha K.; Bagade, Abhijit C.; Kakade, Satish V.; Kale, Hemangi P.; Kshirsagar, Vinayak Y.; Babar, Rohini; Bagal, Shilpa

2017-01-01

Background & objectives: Foot length of the newborn has a good correlation with the birth weight and is recommended to be used as a proxy measure. There can be variations in the measurement of foot length. A study was, therefore, carried out to develop a foot length calliper for accurate foot length measurement and to find cut-off values for birth weight and gestational age groups to be used by primary healthcare workers. Methods: This study was undertaken on 645 apparently healthy newborn infants with known gestational age. Nude birth weight was taken within 24 h of birth on a standard electronic weighing machine. A foot length calliper was developed. Correlation between foot length and birth weight as well as gestational age was calculated. Correctness of cut-off values was tested using another set of 133 observations on the apparently healthy newborns. Action-oriented colour coding was done to make it easy for primary healthcare workers to use it. Results: There was a significant correlation of foot length with birth weight (r=0.75) and gestational age (r=0.63). Cut-off values for birth weight groups were 6.1, 6.8 and 7.3 cm and for gestational age of 6.1, 6.8 and 7.0 cm. Correctness of these cut-off values ranged between 77.1 and 95.7 per cent for birth weight and 60-93.3 per cent for gestational age. Considering 2.5 kg as cut-off between normal birth weight and low birth weight (LBW), cut-off values of 6.1, 6.8 and 7.3 were chosen. Action-oriented colour coding was done by superimposing the colours on the scale of the calliper, green indicating home care, yellow indicating supervised home care, orange indicating care at newborn care units at primary health centres and red indicating Neonatal Intensive Care Unit care for infants. Interpretation & conclusions: A simple device was developed so that the primary health care workers and trained Accredited Social Health Activist workers can identify the risk of LBW in the absence of accurate weighing facilities and decide on the type of care needed by the newborn and take action accordingly. PMID:28749397

Transparency of the 2 μm (5000 cm-1) methane window in Titan's atmosphere and impact on retrieved surface reflectivity

NASA Astrophysics Data System (ADS)

Rannou, Pascal; Seignovert, Benoit; Le Mouélic, Stéphane; Sotin, Christophe

2016-10-01

The study of Titan properties with remote sensing relies on a good knowledge of the atmosphere properties. The in-situ observations made by Huygens combined with recent advances in the definition of methane properties enable to model and interpret observations with a very good accuracy. Thanks to these progresses, we can analyze in this work the observations made at the limb of Titan in order to retrieve information on the haze properties as its vertical profiles and its spectral behaviour along the VIMS/Cassini range (from 0.88 to 5.1 μm). However, for applications to real atmospheres, one need to account for the widening of the spectroscopic lines (e.g., Voigt profile) and apply an empirical cut-off of the far wings. In general, this is a multiplying function of the wavenumber, f(ν), applied to the Voigt profile that allows a faster decay of the wing profile beyond a given distance from the center of the line ν0 : f(ν)=1 if |ν- ν0| ≤ Δν, and f(ν)=exp(-|ν- ν0|/ σ) if |ν- ν0| > Δν. Although the 2-μm window is apparently straitforward to model, it appears that the standard cut-off parameters (that is Δν ~ 26 cm-1 and σ ~ 120 cm-1) which is used for other windows in Titan's atmosphere is not adequat for this window. Other sets of parameter must be used to reproduce Titan spectrum at 2 μm. However, there is no convergence of the results between these works and a large variety of cut-off parameters are used. Alternatively, it was found that some gas absorptions (ethane and another unknown gas) leave a signature around 2-μm and also affect the transparency in this window. In our study we make an exhaustive investigation on the cut-off parameters to determine which are the best couples of parameters to fit the 2-μm window. We also evaluated how gaseous absorptions can allow to reach a satisfactory agreement and, especially, if it allows to match observations with the standard cut-off. Finally, we investigate the impact of the different solutions (different cut-off, with or without supplementary absorptions) on the retrieved surface albedo.

Accuracy estimation of an indirect ELISA for the detection of West Nile Virus antibodies in wild birds using a latent class model.

PubMed

Tamba, Marco; Caminiti, Antonino; Prosperi, Alice; Desprès, Philippe; Lelli, Davide; Galletti, Giorgio; Moreno, Ana; Paternoster, Giulia; Santi, Annalisa; Licata, Elio; Lecollinet, Sylvie; Gelmini, Luca; Rugna, Gianluca; Procopio, Anna; Lavazza, Antonio

2017-10-01

West Nile virus (WNV) and Usutu virus (USUV), genus Flavivirus, are members of the Japanese encephalitis virus antigenic complex, and are maintained primarily in an enzootic cycle between mosquitoes and birds. WNV is zoonotic, and poses a threat to public health, especially in relation to blood transfusion. Serosurveillance of wild birds is suitable for early detection of WNV circulation, although concerns remain to be addressed as regards i) the type of test used, whether ELISA, virus neutralization test (VNT), plaque reduction neutralization test (PRNT), ii) the reagents (antigens, revealing antibodies), iii) the different bird species involved, and iv) potential cross-reactions with other Flaviviruses, such as USUV. The authors developed an indirect IgG ELISA with pan-avian specificity using EDIII protein as antigen and a monoclonal antibody (mAb 1A3) with broad reactivity for avian IgG. A total of 140 serum samples were collected from juvenile European magpies (Pica pica) in areas where both WNV and USUV were co-circulating. The samples were then tested using this in-house ELISA and VNT in parallel. Estimation of test accuracy was performed using different Bayesian two latent class models. At a cut-off set at an optical density percentage (OD%) of 15, the ELISA showed a posterior median of diagnostic sensitivity (DSe) of 88% (95%PCI: 73-99%) and a diagnostic specificity (DSp) of 86% (95%PCI: 68-99%). At this cut-off, ELISA and VNT (cut-off 1/10) performances were comparable: DSe=91% (95%PCI: 79-99%), and DSp=77% (95%PCI: 59-98%). With the cut-off increased to 30 OD%, the ELISA DSe dropped to 78% (95%PCI: 52-99%), and the DSp rose to 94% (95%PCI: 83-100%). In field conditions, the cut-off that yields the best accuracy for the ELISA appears to correspond to 15 OD%. In areas where other Flaviviruses are circulating, however, it might be appropriate to raise the cut-off to 30 OD% in order to achieve higher specificity and reduce the detection of seropositive birds infected by other Flaviviruses, such as USUV. Copyright © 2017 Elsevier B.V. All rights reserved.

Risk factors of early adverse drug reactions with phenytoin: A prospective inpatient cohort.

PubMed

Uribe-San-Martín, Reinaldo; Ciampi, Ethel; Uslar, Wilhelm; Villagra, Silvana; Plaza, Jose; Godoy, Jaime; Mellado, Patricio

2017-11-01

Phenytoin (PHT) is an effective and inexpensive antiepileptic drug (AED). However, its use has been limited for fear of adverse drug reactions (ADRs) and is being replaced by newer AED, increasing the costs and causing major budget problems, particularly for developing countries. The objective of this study was to determine ADR frequency, explore, and establish related risk factors. Prospective data were collected from a cohort of inpatients using PHT for the first time. Pharmacovigilance was performed during hospitalization and after one month from the discharge. Clinical variables, plasma levels, and concomitant medications were collected and their association with the occurrence of different ADRs was explored. One hundred patients were included: 59 were women, and mean age was 59±21years. Thirty-three patients presented ADR, all moderate and idiosyncratic. The most frequent were rash (17%), fever (10%), and elevated transaminases (10%). Female gender (85% vs 52%, p=0.029), younger age (mean age: 49 vs 62years, p=0.032), and higher PHT plasmatic levels after IV-PO load (mean plasmatic levels: 18.6 vs 13.9μg/mL, p=0.040) were found to be associated with rash. A higher number of concomitant medications were also found to be associated with the risk for developing any ADR. The multivariate analysis revealed an association between rash and younger age (cut-off: 35years old; relative risk (RR)=11.7; p=0.026), and higher PHT plasmatic levels (cut-off: 16μg/mL; RR=12.5; p=0.021); and increased risk of elevated transaminases with use of PHT inductors (RR=18; p=0.006). A longer hospital stay was found in patients who developed fever (mean: 43days, p<0.0001) and elevated transaminases (mean: 26days, p=0.041) compared with patients without ADR (mean: 17days). Phenytoin is a widely used AED associated with easily detectable ADR through structured pharmacovigilance. The development of ADR is associated with longer hospital stays. Recognition of local risk factors may lead to ADR prevention in a near future. Larger studies are needed to better define PHT-related ADR risk profile and to individualize treatment regimens. Copyright © 2017 Elsevier Inc. All rights reserved.

Validation and adaptation of the Norwegian version of Hayes Ability Screening Index for intellectual difficulties in a psychiatric sample.

PubMed

Søndenaa, Erik; Nygård, Øyvind; Nøttestad, Jim Aage; Linaker, Olav Martin

2011-02-01

Intellectual disabilities (ID) among psychiatric patients have traditionally been neglected. A lack of convenient instruments and competency in ID may have worsened the conditions and treatment availability for these patients. Validation and adaptation of a screening instrument for ID (Hayes Ability Screening Index; HASI) in a psychiatric hospital setting. This is a cross-sectional study of 50 psychiatric patients in two Norwegian psychiatric hospitals comparing results of the HASI with the Wechsler Abbreviated Scale of Intelligence (WASI). The HASI correlated well with the standard IQ test used (r= 0.67, P< 0.001). At a stated cut-off score of 85, the HASI had a sensitivity of 100% and specificity of 34%. The HASI is a valid and time-saving screening instrument for ID among psychiatric patients. The prescribed cut-off score, however, resulted in a large number of false positives.

On fitting the Pareto Levy distribution to stock market index data: Selecting a suitable cutoff value

NASA Astrophysics Data System (ADS)

Coronel-Brizio, H. F.; Hernández-Montoya, A. R.

2005-08-01

The so-called Pareto-Levy or power-law distribution has been successfully used as a model to describe probabilities associated to extreme variations of stock markets indexes worldwide. The selection of the threshold parameter from empirical data and consequently, the determination of the exponent of the distribution, is often done using a simple graphical method based on a log-log scale, where a power-law probability plot shows a straight line with slope equal to the exponent of the power-law distribution. This procedure can be considered subjective, particularly with regard to the choice of the threshold or cutoff parameter. In this work, a more objective procedure based on a statistical measure of discrepancy between the empirical and the Pareto-Levy distribution is presented. The technique is illustrated for data sets from the New York Stock Exchange (DJIA) and the Mexican Stock Market (IPC).

Development and application of a particle-particle particle-mesh Ewald method for dispersion interactions.

PubMed

Isele-Holder, Rolf E; Mitchell, Wayne; Ismail, Ahmed E

2012-11-07

For inhomogeneous systems with interfaces, the inclusion of long-range dispersion interactions is necessary to achieve consistency between molecular simulation calculations and experimental results. For accurate and efficient incorporation of these contributions, we have implemented a particle-particle particle-mesh Ewald solver for dispersion (r(-6)) interactions into the LAMMPS molecular dynamics package. We demonstrate that the solver's O(N log N) scaling behavior allows its application to large-scale simulations. We carefully determine a set of parameters for the solver that provides accurate results and efficient computation. We perform a series of simulations with Lennard-Jones particles, SPC/E water, and hexane to show that with our choice of parameters the dependence of physical results on the chosen cutoff radius is removed. Physical results and computation time of these simulations are compared to results obtained using either a plain cutoff or a traditional Ewald sum for dispersion.

High frequency data acquisition system for space shuttle main engine testing

NASA Technical Reports Server (NTRS)

Lewallen, Pat

1987-01-01

The high frequency data acquisition system developed for the Space Shuttle Main Engine (SSME) single engine test facility at the National Space Technology Laboratories is discussed. The real time system will provide engineering data for a complete set of SSME instrumentation (approx. 100 measurements) within 4 hours following engine cutoff, a decrease of over 48 hours from the previous analog tape based system.

3. (Photocopy of the second sheet of a threesheet set ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

3. (Photocopy of the second sheet of a three-sheet set entitled 'Kongensgade 45B-51') KING STREET (FRONT) ELEVATION OF KONGENSGADE 48 AND KING STREET (SIDE) ELEVATION OF KONGENS TVAERGADE 2 (2 KINGS CROSS ST.) - King Street Area Study, King Street, Christiansted, St. Croix, VI

Predictive capacity of anthropometric indicators for dyslipidemia screening in children and adolescents.

PubMed

Quadros, Teresa Maria Bianchini; Gordia, Alex Pinheiro; Silva, Rosane Carla Rosendo; Silva, Luciana Rodrigues

2015-01-01

To analyze the predictive capacity of anthropometric indicators and their cut-off values for dyslipidemia screening in children and adolescents. This was a cross-sectional study involving 1139 children and adolescents, of both sexes, aged 6-18 years. Body weight, height, waist circumference, subscapular, and triceps skinfold thickness were measured. The body mass index and waist-to-height ratio were calculated. Children and adolescents exhibiting at least one of the following lipid alterations were defined as having dyslipidemia: elevated total cholesterol, low high-density lipoprotein, elevated low-density lipoprotein, and high triglyceride concentration. A receiver operating characteristic curve was constructed and the area under the curve, sensitivity, and specificity was calculated for the parameters analyzed. The prevalence of dyslipidemia was 62.1%. The waist-to-height ratio, waist circumference, subscapular, body mass index, and triceps skinfold thickness, in this order, presented the largest number of significant accuracies, ranging from 0.59 to 0.78. The associations of the anthropometric indicators with dyslipidemia were stronger among adolescents than among children. Significant differences between accuracies of the anthropometric indicators were only observed by the end of adolescence; the accuracy of waist-to-height ratio was higher than that of subscapular (p=0.048) for females, and the accuracy of waist circumference was higher than that of subscapular (p=0.029) and body mass index (p=0.012) for males. In general, the cut-off values of the anthropometric predictors of dyslipidemia increased with age, except for waist-to-height ratio. Sensitivity and specificity varied substantially between anthropometric indicators, ranging from 75.6 to 53.5 and from 75.0 to 50.0, respectively. The anthropometric indicators studied had little utility as screening tools for dyslipidemia, especially in children. Copyright © 2015 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

The usefulness of fluorine-18 fluorodeoxyglucose PET in the detection of recurrence in patients with differentiated thyroid cancer with elevated thyroglobulin and negative radioiodine whole-body scan.

PubMed

Stangierski, Adam; Kaznowski, Jaroslaw; Wolinski, Kosma; Jodlowska, Elzbieta; Michaliszyn, Piotr; Kubiak, Katarzyna; Czepczynski, Rafal; Ruchala, Marek

2016-09-01

PET/computed tomography (CT) using fluorine-18 fluorodeoxyglucose (F-FDG) has been used in the diagnosis of recurrence and metastases of differentiated thyroid cancer (DTC) in cases of negative whole-body scan (WBS) despite elevated concentrations of stimulated thyroglobulin (Tg). To assess the utility of PET/CT in the detection of recurrence among patients with DTC with increased Tg levels and negative results of WBS. PET/CT results were retrospectively analyzed in patients with DTC with increased Tg and negative results of WBS as well as negative cervical ultrasonography and chest radiography. PET-CT was performed 1-2 weeks after recent diagnostics under conditions of endogenous or exogenous thyroid-stimulating hormone stimulation. PET/CT was performed using a Discovery ST scanner 1 h after an intravenously F-FDG injection (activity 4-5 MBq/kg). To determine the cutoff value of Tg, receiver operating characteristic curves were analyzed. Sixty-nine patients with DTC (48 women, 21 men) aged 22-83 years (mean 50.9±17.5 years) were qualified. In 44 patients (63.8%), PET/CT indicated lesions of DTC. Thirty (43.5%) patients had F-FDG positive findings. In the remaining 14 patients (20.3%), lesions were found in CT only. Patients with a positive PET/CT scan had significantly higher Tg values than patients with a negative PET/CT (mean 143.8 vs. 26.5 ng/ml, P=0.03). The cutoff value of Tg concentration measured with the receiver operating characteristic analysis was 32.9 ng/ml. PET/CT is a useful tool in the detection of recurrence among thyroid cancer patients in cases of conflicting results of standard procedures, particularly for those with high Tg levels and negative WBS. The probability of obtaining a positive PET-CT result increases with the level of Tg.

Long-term systemic metal distribution in patients with stainless steel spinal instrumentation: a case-control study.

PubMed

Savarino, Lucia; Greggi, Tiziana; Martikos, Konstantinos; Lolli, Francesco; Greco, Michelina; Baldini, Nicola

2015-04-01

Case-control study. To verify whether metal ions in the serum of patients bearing spinal stainless steel instrumentation were elevated over the long-term period after implantation of stainless steel prostheses and to determine whether these levels could predict potential unfavorable outcomes. Instrumented spinal arthrodesis, the standard procedure to correct scoliosis, routinely remains in situ for the lifetime of the patient. Elevated metal ion levels have been reported at short-term follow-up, but the long-term status, possibly related to systemic toxic effects, is unknown. Twenty-two patients treated for scoliosis with posterior spinal arthrodesis using stainless steel instrumentation were included. Minimum follow-up was 10 years. Oswestry Disability Index and visual analog scale were recorded. Chromium (Cr) and nickel (Ni) levels were measured (ng/mL) and compared with levels in a control group including 30 healthy subjects. A receiver-operating characteristic curve was calculated on the basis of the clinical assessment (pain and disability) and the x-ray picture; the cutoff values for the parameters were settled, and the ion-testing potential was considered as a surrogate marker for failure. The level of Cr was significantly increased in patients, compared with controls (P=0.018). A remarkable Cr release without any clinical-radiologic sign was recorded in some female patients. A high specificity (93%), positive likelihood ratio (7.00), and overall accuracy (77%) were calculated for Cr; these indicate a high risk of failure when the levels exceeded the cutoff value, which was 0.6 ng/mL. No significant difference between the groups was found for Ni (P=0.7). Cr testing is suggested as a reliable marker for the malfunctioning assessment and as a support for standard procedures, especially with doubtful diagnosis. Furthermore, high levels of Cr ions were observed in female patients. This finding deserves attention especially when counseling young fertile women.

Predictive value of CHA2DS2-VASc and CHA2DS2-VASc-HS scores for failed reperfusion after thrombolytic therapy in patients with ST-elevation myocardial ınfarction.

PubMed

Kilic, Salih; Kocabas, Umut; Can, Levent Hurkan; Yavuzgil, Oğuz; Çetin, Mustafa; Zoghi, Mehdi

2018-03-07

Thrombolytic therapy is recommended for patients with acute ST-segment elevation myocardial infarction (STEMI) who cannot undergo primary percutaneous coronary intervention within the first 120 min. The aim of this study wasz to demonstrate the value of CHA₂DS₂-VASc and CHA₂DS₂-VASc-HS scores in predicting failed reperfusion in STEMI patients treated with thrombolytic therapy. A total of 537 consecutive patients were enrolled in the study; 139 had failed thrombolysis while the remaining 398 fulfilled the criteria for successful thrombolysis. Thrombolysis failure was defined with the lack of symptom relief, < 50% ST resolution-related electrocardiography within 90 min from initiation of the thrombolytic therapy, presence of hemodynamic or electrical instability or in-hospital mortality. CHA₂DS₂-VASc and CHA₂DS₂-VASc-HS scores, which incorporate hyperlipidemia, smoking, switches between female and male gender, were previously shown to be markers of the severity of coronary artery disease (CAD). History of hypertension, diabetes mellitus, hyperlipidemia, heart failure, smoking, and CAD were significantly common in failed reperfusion patients (for all; p < 0.05). For prediction of failed reperfusion, the cut-off value of CHA₂DS₂-VASc score was ≥ 2 with a sensitivity of 80.90% and a specificity of 41.01% (area under curve [AUC] 0.660; 95% confidence interval [CI] 0.618-0.700; p < 0.001) and the cut-off value of CHA₂DS₂-VASc-HS score was ≥ 3 with a sensitivity of 76.13% and a specificity of 67.63% (AUC 0.764; 95% CI 0.725-0.799; p < 0.001). The CHA₂DS₂-VASc-HS score was found to be statistically and significantly better than CHA₂DS₂-VASc score to predict failed reperfusion (p < 0.001). The findings suggest that the CHA₂DS₂-VASc and especially CHA₂DS₂-VASc-HS scores could be considered as predictors of risk of failed reperfusion in STEMI patients.

Temporal deformation pattern in acute and late phases of ST-elevation myocardial infarction: incremental value of longitudinal post-systolic strain to assess myocardial viability.

PubMed

Huttin, Olivier; Marie, Pierre-Yves; Benichou, Maxime; Bozec, Erwan; Lemoine, Simon; Mandry, Damien; Juillière, Yves; Sadoul, Nicolas; Micard, Emilien; Duarte, Kevin; Beaumont, Marine; Rossignol, Patrick; Girerd, Nicolas; Selton-Suty, Christine

2016-10-01

Identification of transmural extent and degree of non-viability after ST-segment elevation myocardial infarction (STEMI) is clinically important. The objective of the present study was to assess the regional mechanics and temporal deformation patterns using speckle tracking echocardiography (STE) in acute and later phases of STEMI to predict myocardial damage in these patients. Ninety-eight patients with first STEMI underwent both echocardiography and cardiac magnetic resonance imaging in acute phase and at 6 months follow-up with 2D STE-derived measurements of peak longitudinal strain (PLS), Pre-STretch index (PST) and post-systolic deformation index (PSI). For each segment, late gadolinium enhancement (LGE) was defined as transmural (LGE >66 %) or non-transmural (<66 %). Global deformation values were significantly correlated with LVEFCMR and infarct size at both visits. A significantly lower value of segmental PLS and higher PSI and PST in necrotic segments were observed comparatively to control, adjacent and remote segments. The best parameters to predict transmural extent in acute phase were PSI with a cutoff value of 8 % (AUC: 0.84) and PLS with a cutoff value of -13 % (AUC: 0.86). PST showed high specificity, but poor sensitivity in predicting transmural extent. More importantly, the addition of PSI and PST to PLS in acute phase was associated with improved prediction of viability at 6 months (integrated discrimination improvement 2.5 % p < 0.01; net reclassification improvement 27 %; p < 0.01). All systolic deformation values separated transmural from non-transmural scarring. PLS combined with additional information relative to post-systolic deformation appears to be the most informative parameters to predict the transmural extent of MI in the early and late phases of MI. http://clinicaltrials.gov/show/NCT01109225 ; NCT01109225.

Big endothelin-1 as a tumour marker for canine haemangiosarcoma.

PubMed

Fukumoto, Shinya; Miyasho, Taku; Hanazono, Kiwamu; Saida, Kaname; Kadosawa, Tsuyoshi; Iwano, Hidetomo; Uchide, Tsuyoshi

2015-06-01

Haemangiosarcoma (HSA) is an important malignant neoplasm of dogs that originates from vascular endothelial cells. This study explored the suitability of using serum big endothelin-1 (ET-1) as a tumour marker for canine spontaneous HSA. Serum big ET-1 was measured in dogs with splenic HSA (n = 14), splenic malignant tumours other than HSA (n = 10), benign splenic lesions (n = 11) and normal healthy dogs (n = 17) by ELISA. Serum big ET-1 levels in dogs with HSA were significantly (P < 0.01) higher than in other dogs. High sensitivity (100%, 95% confidence interval 86-100%) and specificity (95%, 95% confidence interval 86-95%) for HSA diagnosis were obtained using a cut-off of 17 pg/mL according to receiver operating characteristic (ROC) curves (area under ROC curve 0.93). PPET1, ETA, VEGF and Hif1-α mRNA expression, measured by real-time PCR, were elevated in HSA compared with normal tissues. These findings suggest that elevated serum big ET-1 could be used as a diagnostic marker for canine HSA. Copyright © 2015 Elsevier Ltd. All rights reserved.

Usefulness of plasma B-type natriuretic peptide to identify ventricular dysfunction in pediatric and adult patients with congenital heart disease.

PubMed

Law, Yuk M; Keller, Bradley B; Feingold, Brian M; Boyle, Gerard J

2005-02-15

The usefulness of B-type natriuretic peptide (BNP) levels to assess ventricular dysfunction in children and the congenital heart disease population remains largely unknown. We retrospectively analyzed 62 patients with or without known heart disease who had plasma BNP measured for the investigation of new or severity grading of known ventricular dysfunction. BNP levels were significantly higher in patients with ventricular dysfunction (mean 623 +/- 146 pg/ml, range 5 to 5,000) than in patients without ventricular dysfunction (mean 22 +/- 5 pg/ml, range 5 to 63; p <0.01). Using a cutoff of 40 pg/ml, BNP levels detected heart disease associated with ventricular dysfunction at a sensitivity of 85%, specificity of 81%, positive predictive value of 92%, and negative predictive value of 68%. The degree of BNP elevation was also associated with the severity of heart failure and high ventricular filling pressures. Plasma BNP elevation can be a reliable test in children and young adults with various kinds of congenital heart disease resulting in ventricular dysfunction.

A patient with an inborn error of vitamin B12 metabolism (cblF) detected by newborn screening.

PubMed

Armour, Christine M; Brebner, Alison; Watkins, David; Geraghty, Michael T; Chan, Alicia; Rosenblatt, David S

2013-07-01

A neonate, who was found to have an elevated C3/C2 ratio and minimally elevated propionylcarnitine on newborn screening, was subsequently identified as having the rare cblF inborn error of vitamin B12 (cobalamin) metabolism. This disorder is characterized by the retention of unmetabolized cobalamin in lysosomes such that it is not readily available for cellular metabolism. Although cultured fibroblasts from the patient did not show the expected functional abnormalities of the cobalamin-dependent enzymes, methylmalonyl-CoA mutase and methionine synthase, they did show reduced synthesis of the active cobalamin cofactors adenosylcobalamin and methylcobalamin. Mutation analysis of LMBRD1 established that the patient had the cblF disorder. Treatment was initiated promptly, and the patient showed a robust response to regular injections of cyanocobalamin, and she was later switched to hydroxocobalamin. Currently, at 3 years of age, the child is clinically well, with appropriate development. Adjusted newborn screening cutoffs in Ontario allowed detection of a deficiency that might not have otherwise been identified, allowing early treatment and perhaps preventing the adverse sequelae seen in some untreated patients.

Women with breast cancer: self-reported distress in early survivorship.

PubMed

Lester, Joanne; Crosthwaite, Kara; Stout, Robin; Jones, Rachel N; Holloman, Christopher; Shapiro, Charles; Andersen, Barbara L

2015-01-01

To identify and compare levels of distress and sources of problems among patients with breast cancer in early survivorship. Descriptive, cross-sectional. A National Cancer Institute-designated comprehensive cancer center. 100 breast cancer survivors were selected to represent four time points in the cancer trajectory. Distress was self-reported using the Distress Thermometer and its 38-item problem list. Analysis of variance and chi-square analyses were performed as appropriate. Distress scores, problem reports, and time groups. Participants scored in range of the cutoff of more than 4 (range = 4.1-5.1) from treatment through three months post-treatment. At six months post-treatment, distress levels were significantly lower. Significant differences were found between groups on the total problem list score (p = 0.007) and emotional (p = 0.01) and physical subscale scores (p = 0.003). Comparison of groups at different points in the cancer trajectory found similar elevated levels from diagnosis through three months. Distress remained elevated in early survivorship but significantly decreased at six months post-treatment. Interventions to reduce or prevent distress may improve outcomes in early survivorship.

Determining an anthropometric surrogate measure for identifying low birth weight babies in Uganda: a hospital-based cross sectional study

PubMed Central

2013-01-01

Background Achieving Millennium Development Goal 4 is dependent on significantly reducing neonatal mortality. Low birth weight is an underlying factor in most neonatal deaths. In developing countries the missed opportunity for providing life saving care is mainly a result of failure to identify low birth weight newborns. This study aimed at identifying a reliable anthropometric measurement for screening low birth weight and determining an operational cut-off point in the Uganda setting. This simple measurement is required because of lack of weighing scales in the community, and sometimes in the health facilities. Methods This was a hospital-based cross-sectional study. Two midwives weighed 706 newborns and measured their foot length, head, chest, thigh and mid-upper arm circumferences within 24 hours after birth. Data was analysed using STATA version 10.0. Correlation with birth weight using Pearson’s correlation coefficient and Receiver Operating Characteristics curve analysis were done to determine the measure that best predicts birth weight. Sensitivity and specificity were calculated for a range of measures to obtain operational cut-off points; and Likelihood Ratios and Diagnostic Odds Ratio were determined for each cut-off point. Results Birth weights ranged from 1370–5350 grams with a mean of 3050 grams (SD 0.53) and 85 (12%) babies weighed less than 2500 grams. All anthropometric measurements had a positive correlation with birth weight, with foot length showing the strongest (r = 0.76) and thigh circumference the weakest (r = 0.62) correlations. Foot length had the highest predictive value for low birth weight (AUC = 0.97) followed by mid-upper arm circumference (AUC = 0.94). Foot length and chest circumference had the highest sensitivity (94%) and specificity (90%) respectively for screening low birth weight babies at the selected cut-off points. Chest circumference had a significantly higher positive likelihood ratio (8.7) than any other measure, and foot length had the lowest negative likelihood ratio. Chest circumference and foot length had diagnostic odds ratios of 97% and 77% respectively. Foot length was easier to measure and it involved minimal exposure of the baby to cold. A cut-off of foot length 7.9 cm had sensitivity of 94% and specificity of 83% for predicting low birth weight. Conclusions This study suggests foot length as the most appropriate predictor for low birth weight in comparison to chest, head, mid-upper arm and thigh circumference in the Uganda setting. Use of low cost and easy to use tools to identify low birth weight babies by village health teams could support community efforts to save newborns. PMID:23587297

Self-Formed Meanders (With Cutoffs) in a Laboratory Flume

NASA Astrophysics Data System (ADS)

Braudrick, C. A.; Leverich, G. T.; Sklar, L. S.; Dietrich, W. E.

2005-12-01

The development of a mechanistic understanding of channel geometry and morphodynamics has been inhibited by the inability to create self-formed, freely meandering, single thread channels in a laboratory flume. By being able to reliably generate such channels, studies of the influence of sediment supply and flow dynamics as well as bank strength on channel morphology can be experimentally explored. We have found that the key experimental controls are: 1) ratio of bank strength to boundary shear stress exerted on the bank; 2) bedload and suspended load rates; and 3) variable flow discharge. We have been able to create meandering channels in a sand bedded laboratory flume using alfalfa sprouts. The alfalfa sprouts decrease the bank erosion rate so that bank erosion would occur at approximately the same pace as bar growth. The addition of coarse suspended load was necessary to cause deposition on bars to grow to the floodplain height. The sprouts contributed to deposition by creating a rough floodplain surface. Steady discharge failed to produced meandering, apparently due to the lack of suspended load deposition on the bar surface. The channels were created in a 3.6-m wide and 6.1-m long flume with an adjustable slope set at 0.01. We introduced both bedload (sand) and suspended load (crushed silica) into the top of the flume, which has an initial channel with either one or two bends carved into the floodplain. Runs lasted between 1 and 4 hours and occurred once per week. Alfalfa seeds were spread evenly outside the low flow channel following each run and are allowed to grow between runs. With the same material and flow conditions, the channel rapidly braided without the alfalfa sprouts. Braided was also favored under steady flow conditions. Under dynamic flows with banks strengthened by sprouts, the resulting experimental channels had many of the features observed in meandering streams such as oxbow lakes and meander cutoffs. The cutoffs occurred during overbank flows when high flow channels were reoccupied. As the portion of the flow passing through the reoccupied channel increased, an upstream-propagating headcut was initiated. Once the headcut propagated past the upstream junction with the main channel, sediment deposition blocked the upstream end of a secondary channel. The cutoffs became oxbow lakes when rapid bar growth promoted lateral channel migration away from the downstream junction with the cutoff channel. With these results in hand we are completing the construction of a larger flume in which we will set forth experiments on the influence of sediment supply, discharge magnitude and duration, grain size and bank strength on channel geometry.

An assessment of driving fitness in patients with visual impairment to understand the elevated risk of motor vehicle accidents

PubMed Central

Kunimatsu-Sanuki, Shiho; Iwase, Aiko; Araie, Makoto; Aoki, Yuki; Hara, Takeshi; Nakazawa, Toru; Yamaguchi, Takuhiro; Ono, Hiroshi; Sanuki, Tomoyuki; Itoh, Makoto

2015-01-01

Objective To assess the driving fitness of patients with glaucoma by identifying specific areas and degrees of visual field impairment that threaten safe driving. Design Case–control study. Setting, and participants This prospective study included 36 patients with advanced glaucoma, defined as Humphrey field analyzer (HFA; 24-2 SITA standard program) measurements of mean deviation in both eyes of worse than −12 dB, and 36 age-matched and driving exposure time-matched normal subjects. All participants underwent testing in a novel driving simulator (DS) system. Participants were recruited between September 2010 and January 2012. Main outcome measures The number of collisions with simulated hazards and braking response time in 14 DS scenarios was recorded. Monocular HFA 24-2 test results from both eyes were merged to calculate the binocular integrated visual field (IVF). The position of the IVF subfields in which the collision-involved patients had lower sensitivity than the collision-uninvolved patients was compared with the track of the hazard. The cut-off value to predict an elevated risk of collisions was determined, as were its sensitivity and specificity, with the area under the receiver operating characteristic (AUROC) curve. Results Patients with advanced glaucoma were involved in a significantly higher number of collisions in the DS than the age-matched and driving exposure time-matched normal subjects (119 vs 40, respectively, p<0.0001), especially in four specific DS scenarios. In these four scenarios, IVF sensitivity was significantly lower in the collision-involved patients than in the collision-uninvolved patients in subfields on or near the track of the simulated hazard (p<0.05). The subfields with the largest AUROC curve had values ranging from 0.72 to 0.91 and were located in the paracentral visual field just below the horizontal. Conclusions Our novel DS system effectively assessed visual impairment, showing that simulators may have future potential in educating patients. PMID:25724982

Colonization Density of the Upper Respiratory Tract as a Predictor of Pneumonia-Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus, and Pneumocystis jirovecii.

PubMed

Park, Daniel E; Baggett, Henry C; Howie, Stephen R C; Shi, Qiyuan; Watson, Nora L; Brooks, W Abdullah; Deloria Knoll, Maria; Hammitt, Laura L; Kotloff, Karen L; Levine, Orin S; Madhi, Shabir A; Murdoch, David R; O'Brien, Katherine L; Scott, J Anthony G; Thea, Donald M; Ahmed, Dilruba; Antonio, Martin; Baillie, Vicky L; DeLuca, Andrea N; Driscoll, Amanda J; Fu, Wei; Gitahi, Caroline W; Olutunde, Emmanuel; Higdon, Melissa M; Hossain, Lokman; Karron, Ruth A; Maiga, Abdoul Aziz; Maloney, Susan A; Moore, David P; Morpeth, Susan C; Mwaba, John; Mwenechanya, Musaku; Prosperi, Christine; Sylla, Mamadou; Thamthitiwat, Somsak; Zeger, Scott L; Feikin, Daniel R

2017-06-15

There is limited information on the association between colonization density of upper respiratory tract colonizers and pathogen-specific pneumonia. We assessed this association for Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus, and Pneumocystis jirovecii. In 7 low- and middle-income countries, nasopharyngeal/oropharyngeal swabs from children with severe pneumonia and age-frequency matched community controls were tested using quantitative polymerase chain reaction (PCR). Differences in median colonization density were evaluated using the Wilcoxon rank-sum test. Density cutoffs were determined using receiver operating characteristic curves. Cases with a pathogen identified from lung aspirate culture or PCR, pleural fluid culture or PCR, blood culture, and immunofluorescence for P. jirovecii defined microbiologically confirmed cases for the given pathogens. Higher densities of H. influenzae were observed in both microbiologically confirmed cases and chest radiograph (CXR)-positive cases compared to controls. Staphylococcus aureus and P. jirovecii had higher densities in CXR-positive cases vs controls. A 5.9 log10 copies/mL density cutoff for H. influenzae yielded 86% sensitivity and 77% specificity for detecting microbiologically confirmed cases; however, densities overlapped between cases and controls and positive predictive values were poor (<3%). Informative density cutoffs were not found for S. aureus and M. catarrhalis, and a lack of confirmed case data limited the cutoff identification for P. jirovecii. There is evidence for an association between H. influenzae colonization density and H. influenzae-confirmed pneumonia in children; the association may be particularly informative in epidemiologic studies. Colonization densities of M. catarrhalis, S. aureus, and P. jirovecii are unlikely to be of diagnostic value in clinical settings. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.

An Energy-Efficient Algorithm for Wearable Electrocardiogram Signal Processing in Ubiquitous Healthcare Applications

PubMed Central

Sodhro, Ali Hassan; Sodhro, Gul Hassan; Lohano, Sonia; Pirbhulal, Sandeep

2018-01-01

Rapid progress and emerging trends in miniaturized medical devices have enabled the un-obtrusive monitoring of physiological signals and daily activities of everyone’s life in a prominent and pervasive manner. Due to the power-constrained nature of conventional wearable sensor devices during ubiquitous sensing (US), energy-efficiency has become one of the highly demanding and debatable issues in healthcare. This paper develops a single chip-based wearable wireless electrocardiogram (ECG) monitoring system by adopting analog front end (AFE) chip model ADS1292R from Texas Instruments. The developed chip collects real-time ECG data with two adopted channels for continuous monitoring of human heart activity. Then, these two channels and the AFE are built into a right leg drive right leg drive (RLD) driver circuit with lead-off detection and medical graded test signal. Human ECG data was collected at 60 beats per minute (BPM) to 120 BPM with 60 Hz noise and considered throughout the experimental set-up. Moreover, notch filter (cutoff frequency 60 Hz), high-pass filter (cutoff frequency 0.67 Hz), and low-pass filter (cutoff frequency 100 Hz) with cut-off frequencies of 60 Hz, 0.67 Hz, and 100 Hz, respectively, were designed with bilinear transformation for rectifying the power-line noise and artifacts while extracting real-time ECG signals. Finally, a transmission power control-based energy-efficient (ETPC) algorithm is proposed, implemented on the hardware and then compared with the several conventional TPC methods. Experimental results reveal that our developed chip collects real-time ECG data efficiently, and the proposed ETPC algorithm achieves higher energy savings of 35.5% with a slightly larger packet loss ratio (PLR) as compared to conventional TPC (e.g., constant TPC, Gao’s, and Xiao’s methods). PMID:29558433

Prevalence of posttraumatic growth hormone deficiency is highly dependent on the diagnostic set-up: results from The Danish National Study on Posttraumatic Hypopituitarism.

PubMed

Klose, Marianne; Stochholm, Kirstine; Janukonyté, Jourgita; Lehman Christensen, Louise; Frystyk, Jan; Andersen, Marianne; Laurberg, Peter; Christiansen, Jens Sandahl; Feldt-Rasmussen, Ulla

2014-01-01

Recent international guidelines suggest pituitary screening in patients with moderate and severe traumatic brain injury (TBI). Predominantly isolated GH deficiency (GHD) was reported in the literature, raising the question of potential methodological bias. Our objective was to assess the prevalence of GHD in patients admitted in 2008 with TBI, with concurrent assessment of methodological bias. We conducted a nationwide population-based cohort study at tertiary referral university hospitals. Participants were Danish patients with a head trauma diagnosis from the Danish Board of Health diagnostic code registry; 439 patients and 124 healthy controls underwent dynamic assessment of GH secretion 2.5 years (median) after TBI. We evaluated the prevalence of GHD given use of 1) local versus guideline cutoffs, 2) insulin tolerance test (ITT), pyridostigmine (PD)-GHRH or GHRH-arginine (arg) test, 3) single versus repeated testing, and 4) GH assessment by assays with different isoform specificities. The prevalence of GHD was lower by local than by guideline cutoffs (12% vs 19% [PD-GHRH/GHRH-arg, P<.001]; 4.5% vs 5% [ITT, P=.9]), and by ITT than by PD-GHRH/GHRH-arg (P=.006 [local cutoffs]; P<.001 [guideline cutoffs]). Only 1% of patients had GHD according to 2 tests. GH assessment by the Immulite or iSYS assay caused no significant diagnostic differences. The study confirmed a high risk of bias in the management of pituitary testing of patients with TBI and stresses the importance of a proper control group and stringent GH testing including confirmatory testing in cohorts with low a priori likelihood of GHD such as in TBI. Our results question the evidence for newly introduced recommendations for routine pituitary assessment in TBI.

Validation of the self-reporting questionnaire (SRQ 20) in British Pakistani and White European population in the United Kingdom.

PubMed

Husain, Nusrat; Chaudhry, Nasim; Rhouma, Abdulhakim; Sumra, Altaf; Tomenson, Barbara; Waheed, Waquas

2016-01-01

The incidence of depression is difficult to determine because of low clinical depression detection rates in the primary care setting. This low level of detection is a significantly greater problem in people from ethnic minority communities. The availability of culturally validated screening questionnaires might help to improve the detection and treatment of depression. The aim of the study was to assess the validity of the self-reporting questionnaire SRQ 20, (English and Urdu versions) in white Europeans and British Pakistanis and to determine the optimum cut-off scores for detecting depression. Validation of the English and Urdu versions of the SRQ was conducted with a sample of white Europeans and British Pakistani participants. The semi-structured Schedule for Clinical Assessment in Neuropsychiatry (SCAN) was used as the gold standard diagnostic interview, and receiver operating characteristic analysis was used to evaluate SRQ test performance. The SRQ was completed by 1856 participants out of whom 651 completed the SCAN interview. The SRQ sensitivity, specificity, and predictive values versus SCAN indicated a cut-off score of 7 as optimum for white Europeans and a cut-off score of 6 for British Pakistanis. This study focused on depression alone and did not take into consideration comorbid conditions such as anxiety which might have affected the way respondents answered the questions and contributed to comparatively lower optimum cut-off scores in British Pakistanis. The findings of this validation study provide evidence for high sensitivity and specificity of SRQ amongst both white Europeans and British Pakistanis. The SRQ can be used as a routine screening questionnaire for depression in English and Urdu speaking populations in the UK. Crown Copyright © 2015. Published by Elsevier B.V. All rights reserved.

An Energy-Efficient Algorithm for Wearable Electrocardiogram Signal Processing in Ubiquitous Healthcare Applications.

PubMed

Sodhro, Ali Hassan; Sangaiah, Arun Kumar; Sodhro, Gul Hassan; Lohano, Sonia; Pirbhulal, Sandeep

2018-03-20

Rapid progress and emerging trends in miniaturized medical devices have enabled the un-obtrusive monitoring of physiological signals and daily activities of everyone's life in a prominent and pervasive manner. Due to the power-constrained nature of conventional wearable sensor devices during ubiquitous sensing (US), energy-efficiency has become one of the highly demanding and debatable issues in healthcare. This paper develops a single chip-based wearable wireless electrocardiogram (ECG) monitoring system by adopting analog front end (AFE) chip model ADS1292R from Texas Instruments. The developed chip collects real-time ECG data with two adopted channels for continuous monitoring of human heart activity. Then, these two channels and the AFE are built into a right leg drive right leg drive (RLD) driver circuit with lead-off detection and medical graded test signal. Human ECG data was collected at 60 beats per minute (BPM) to 120 BPM with 60 Hz noise and considered throughout the experimental set-up. Moreover, notch filter (cutoff frequency 60 Hz), high-pass filter (cutoff frequency 0.67 Hz), and low-pass filter (cutoff frequency 100 Hz) with cut-off frequencies of 60 Hz, 0.67 Hz, and 100 Hz, respectively, were designed with bilinear transformation for rectifying the power-line noise and artifacts while extracting real-time ECG signals. Finally, a transmission power control-based energy-efficient (ETPC) algorithm is proposed, implemented on the hardware and then compared with the several conventional TPC methods. Experimental results reveal that our developed chip collects real-time ECG data efficiently, and the proposed ETPC algorithm achieves higher energy savings of 35.5% with a slightly larger packet loss ratio (PLR) as compared to conventional TPC (e.g., constant TPC, Gao's, and Xiao's methods).

Cross-cultural differences for adapting translated five-item version of International Index of Erectile Function: results of a Korean study.

PubMed

Ku, Ja Hyeon; Park, Dal Woo; Kim, Soo Woong; Paick, Jae-Seung

2005-06-01

To assess whether the translated Korean version of the International Index of Erectile Function (IIEF-5) developed by Rosen et al. (RIIEF-5) may be adapted for a Korean population to have cross-cultural equivalency to the original version. A total of 151 patients with erectile dysfunction (ED) and 156 controls were prospectively studied. All the patients and controls had had sexual activity or attempted sexual intercourse within the 4-week period before completing the questionnaire. The Classification and Regression Trees program was used to select an optimal set of five items from the IIEF-15 (KIIEF-5) to discriminate between men with and without ED. Then, the optimal cutoff score for the diagnosis of ED was determined using the receiver operating characteristic curve. The optimal cutoff score, sensitivity, and specificity were also calculated using the RIIEF-5. The KIIEF-5 consisted, in order of importance, of items 15, 5, 13, 4, and 2 from the IIEF-15. Item 7 in the original RIIEF-5 was replaced with item 13 in the new KIIEF-5. The optimal cutoff score proved to be 21, with a corresponding sensitivity and specificity of 0.97 and 0.91, respectively. For the original RIIEF-5, the optimal cutoff score was 21 and the corresponding sensitivity and specificity was 0.94 and 0.90, respectively. Although the RIIEF-5 may be adapted for a Korean population, the KIIEF-5 can aid in decreasing the incidence of an incorrect diagnosis of ED and decreasing the number of undiagnosed cases of ED in this population. In addition, our findings suggest that the equivalence of psychometric properties does not imply cross-cultural equivalence.

Colonization Density of the Upper Respiratory Tract as a Predictor of Pneumonia—Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus, and Pneumocystis jirovecii

PubMed Central

Baggett, Henry C.; Howie, Stephen R. C.; Shi, Qiyuan; Watson, Nora L.; Brooks, W. Abdullah; Deloria Knoll, Maria; Hammitt, Laura L.; Kotloff, Karen L.; Levine, Orin S.; Madhi, Shabir A.; Murdoch, David R.; O’Brien, Katherine L.; Scott, J. Anthony G.; Thea, Donald M.; Ahmed, Dilruba; Antonio, Martin; Baillie, Vicky L.; DeLuca, Andrea N.; Driscoll, Amanda J.; Fu, Wei; Gitahi, Caroline W.; Olutunde, Emmanuel; Higdon, Melissa M.; Hossain, Lokman; Karron, Ruth A.; Maiga, Abdoul Aziz; Maloney, Susan A.; Moore, David P.; Morpeth, Susan C.; Mwaba, John; Mwenechanya, Musaku; Prosperi, Christine; Sylla, Mamadou; Thamthitiwat, Somsak; Zeger, Scott L.; Feikin, Daniel R.; O’Brien, Katherine L.; Levine, Orin S.; Knoll, Maria Deloria; Feikin, Daniel R.; DeLuca, Andrea N.; Driscoll, Amanda J.; Fancourt, Nicholas; Fu, Wei; Hammitt, Laura L.; Higdon, Melissa M.; Wangeci Kagucia, E.; Karron, Ruth A.; Li, Mengying; Park, Daniel E.; Prosperi, Christine; Wu, Zhenke; Zeger, Scott L.; Watson, Nora L.; Crawley, Jane; Murdoch, David R.; Abdullah Brooks, W.; Endtz, Hubert P.; Zaman, Khalequ; Goswami, Doli; Hossain, Lokman; Jahan, Yasmin; Ashraf, Hasan; Howie, Stephen R. C.; Ebruke, Bernard E.; Antonio, Martin; McLellan, Jessica; Machuka, Eunice; Shamsul, Arifin; Zaman, Syed M.A.; Mackenzie, Grant; Scott, J. Anthony G.; Awori, Juliet O.; Morpeth, Susan C.; Kamau, Alice; Kazungu, Sidi; Ominde, Micah Silaba; Kotloff, Karen L.; Tapia, Milagritos D.; Sow, Samba O.; Sylla, Mamadou; Tamboura, Boubou; Onwuchekwa, Uma; Kourouma, Nana; Toure, Aliou; Madhi, Shabir A.; Moore, David P.; Adrian, Peter V.; Baillie, Vicky L.; Kuwanda, Locadiah; Mudau, Azwifarwi; Groome, Michelle J.; Mahomed, Nasreen; Baggett, Henry C.; Thamthitiwat, Somsak; Maloney, Susan A.; Bunthi, Charatdao; Rhodes, Julia; Sawatwong, Pongpun; Akarasewi, Pasakorn; Thea, Donald M.; Mwananyanda, Lawrence; Chipeta, James; Seidenberg, Phil; Mwansa, James; wa Somwe, Somwe; Kwenda, Geoffrey; Anderson, Trevor P.; Mitchell, Joanne

2017-01-01

Abstract Background. There is limited information on the association between colonization density of upper respiratory tract colonizers and pathogen-specific pneumonia. We assessed this association for Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus, and Pneumocystis jirovecii. Methods. In 7 low- and middle-income countries, nasopharyngeal/oropharyngeal swabs from children with severe pneumonia and age-frequency matched community controls were tested using quantitative polymerase chain reaction (PCR). Differences in median colonization density were evaluated using the Wilcoxon rank-sum test. Density cutoffs were determined using receiver operating characteristic curves. Cases with a pathogen identified from lung aspirate culture or PCR, pleural fluid culture or PCR, blood culture, and immunofluorescence for P. jirovecii defined microbiologically confirmed cases for the given pathogens. Results. Higher densities of H. influenzae were observed in both microbiologically confirmed cases and chest radiograph (CXR)–positive cases compared to controls. Staphylococcus aureus and P. jirovecii had higher densities in CXR-positive cases vs controls. A 5.9 log10 copies/mL density cutoff for H. influenzae yielded 86% sensitivity and 77% specificity for detecting microbiologically confirmed cases; however, densities overlapped between cases and controls and positive predictive values were poor (<3%). Informative density cutoffs were not found for S. aureus and M. catarrhalis, and a lack of confirmed case data limited the cutoff identification for P. jirovecii. Conclusions. There is evidence for an association between H. influenzae colonization density and H. influenzae–confirmed pneumonia in children; the association may be particularly informative in epidemiologic studies. Colonization densities of M. catarrhalis, S. aureus, and P. jirovecii are unlikely to be of diagnostic value in clinical settings. PMID:28575367

Relationship between the prognostic value of ventilatory efficiency and age in patients with heart failure.

PubMed

Kato, Yuko; Suzuki, Shinya; Uejima, Tokuhisa; Semba, Hiroaki; Nagayama, Osamu; Hayama, Etsuko; Arita, Takuto; Yagi, Naoharu; Kano, Hiroto; Matsuno, Shunsuke; Otsuka, Takayuki; Oikawa, Yuji; Kunihara, Takashi; Yajima, Junji; Yamashita, Takeshi

2018-05-01

Background Ventilatory efficiency decreases with age. This study aimed to investigate the prognostic significance and cut-off value of the minute ventilation/carbon dioxide production (VE/VCO 2 ) slope according to age in patients with heart failure. Methods and results We analysed 1501 patients with heart failure from our observational cohort who performed maximal symptom-limited cardiopulmonary exercise testing and separated them into three age groups (≤55 years, 56-70 years and ≥71 years) in total and according to the three ejection fraction categories defined by European Society of Cardiology guidelines. The endpoint was set as heart failure events, hospitalisation for heart failure or death from heart failure. The VE/VCO 2 slope increased with age. During the median follow-up period of 4 years, 141 heart failure (9%) events occurred. In total, univariate Cox analyses showed that the VE/VCO 2 slope (cont.) was significantly related to heart failure events, while on multivariate analysis, the prognostic significance of the VE/VCO 2 slope (cont.) was poor, accompanied by a significant interaction with age ( P < 0.0001). The cut-off value of the VE/VCO 2 slope increased with the increase in age in not only the total but also the sub-ejection fraction categories. Multivariate analyses with a stepwise method adjusted for estimated glomerular filtration rate, peak oxygen consumption, atrial fibrillation and brain natriuretic peptide, showed that the predictive value of the binary VE/VCO 2 slope separated by the cut-off value varied according to age. There was a tendency for the prognostic significance to increase with age irrespective of ejection fraction. Conclusion The prognostic significance and cut-off value of the VE/VCO 2 slope may increase with advancing age.

Cutoff Finder: A Comprehensive and Straightforward Web Application Enabling Rapid Biomarker Cutoff Optimization

PubMed Central

Budczies, Jan; Klauschen, Frederick; Sinn, Bruno V.; Győrffy, Balázs; Schmitt, Wolfgang D.; Darb-Esfahani, Silvia; Denkert, Carsten

2012-01-01

Gene or protein expression data are usually represented by metric or at least ordinal variables. In order to translate a continuous variable into a clinical decision, it is necessary to determine a cutoff point and to stratify patients into two groups each requiring a different kind of treatment. Currently, there is no standard method or standard software for biomarker cutoff determination. Therefore, we developed Cutoff Finder, a bundle of optimization and visualization methods for cutoff determination that is accessible online. While one of the methods for cutoff optimization is based solely on the distribution of the marker under investigation, other methods optimize the correlation of the dichotomization with respect to an outcome or survival variable. We illustrate the functionality of Cutoff Finder by the analysis of the gene expression of estrogen receptor (ER) and progesterone receptor (PgR) in breast cancer tissues. This distribution of these important markers is analyzed and correlated with immunohistologically determined ER status and distant metastasis free survival. Cutoff Finder is expected to fill a relevant gap in the available biometric software repertoire and will enable faster optimization of new diagnostic biomarkers. The tool can be accessed at http://molpath.charite.de/cutoff. PMID:23251644

Geomagnetic cutoffs: A review for space dosimetry applications

NASA Astrophysics Data System (ADS)

Smart, D. F.; Shea, M. A.

1994-10-01

The earth's magnetic field acts as a shield against charged particle radiation from interplanetary space, technically described as the geomagnetic cutoff. The cutoff rigidity problem (except for the dipole special case) has 'no solution in closed form'. The dipole case yields the Stormer equation which has been repeatedly applied to the earth in hopes of providing useful approximations of cutoff rigidities. Unfortunately the earth's magnetic field has significant deviations from dipole geometry, and the Stormer cutoffs are not adequate for most applications. By application of massive digital computer power it is possible to determine realistic geomagnetic cutoffs derived from high order simulation of the geomagnetic field. Using this technique, 'world-grids' of directional cutoffs for the earth's surface and for a limited number of satellite altitudes have been derived. However, this approach is so expensive and time comsuming it is impractical for most spacecraft orbits, and approximations must be used. The world grids of cutoff rigidities are extensively used as lookup tables, normalization points and interpolation aids to estimate the effective geomagnetic cutoff rigidity of a specific location in space. We review the various options for estimating the cutoff rigidity for earth-orbiting satellites.

Nonlinear frequency compression: effects on sound quality ratings of speech and music.

PubMed

Parsa, Vijay; Scollie, Susan; Glista, Danielle; Seelisch, Andreas

2013-03-01

Frequency lowering technologies offer an alternative amplification solution for severe to profound high frequency hearing losses. While frequency lowering technologies may improve audibility of high frequency sounds, the very nature of this processing can affect the perceived sound quality. This article reports the results from two studies that investigated the impact of a nonlinear frequency compression (NFC) algorithm on perceived sound quality. In the first study, the cutoff frequency and compression ratio parameters of the NFC algorithm were varied, and their effect on the speech quality was measured subjectively with 12 normal hearing adults, 12 normal hearing children, 13 hearing impaired adults, and 9 hearing impaired children. In the second study, 12 normal hearing and 8 hearing impaired adult listeners rated the quality of speech in quiet, speech in noise, and music after processing with a different set of NFC parameters. Results showed that the cutoff frequency parameter had more impact on sound quality ratings than the compression ratio, and that the hearing impaired adults were more tolerant to increased frequency compression than normal hearing adults. No statistically significant differences were found in the sound quality ratings of speech-in-noise and music stimuli processed through various NFC settings by hearing impaired listeners. These findings suggest that there may be an acceptable range of NFC settings for hearing impaired individuals where sound quality is not adversely affected. These results may assist an Audiologist in clinical NFC hearing aid fittings for achieving a balance between high frequency audibility and sound quality.

Reproducibility of the cutoff probe for the measurement of electron density

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kim, D. W.; Oh, W. Y.; You, S. J., E-mail: sjyou@cnu.ac.kr

2016-06-15

Since a plasma processing control based on plasma diagnostics attracted considerable attention in industry, the reproducibility of the diagnostics using in this application has become a great interest. Because the cutoff probe is one of the potential candidates for this application, knowing the reproducibility of the cutoff probe measurement becomes quit important in the cutoff probe application research. To test the reproducibility of the cutoff probe measurement, in this paper, a comparative study among the different cutoff probe measurements was performed. The comparative study revealed remarkable result: the cutoff probe has a great reproducibility for the electron density measurement, i.e.,more » there are little differences among measurements by different probes made by different experimenters. The discussion including the reason for the result was addressed via this paper by using a basic measurement principle of cutoff probe and a comparative experiment with Langmuir probe.« less

Climatological Features of Cutoff Low Systems in the Northern Hemisphere.

NASA Astrophysics Data System (ADS)

Nieto, Raquel; Gimeno, Luis; de La Torre, Laura; Ribera, Pedro; Gallego, David; García-Herrera, Ricardo; Agustín García, José; Nuñez, Marcelino; Redaño, Angel; Lorente, Jerónimo

2005-08-01

This study presents the first multidecadal climatology of cutoff low systems in the Northern Hemisphere. The climatology was constructed by using 41 yr (1958-98) of NCEP-NCAR reanalysis data and identifying cutoff lows by means of an objective method based on imposing the three main physical characteristics of the conceptual model of cutoff low (the 200-hPa geopotential minimum, cutoff circulation, and the specific structure of both equivalent thickness and thermal front parameter fields).Several results were confirmed and climatologically validated: 1) the existence of three preferred areas of cutoff low occurrence (the first one extends through southern Europe and the eastern Atlantic coast, the second one is the eastern North Pacific, and the third one is the northern China-Siberian region extending to the northwestern Pacific coast; the European area is the most favored region); 2) the known seasonal cycle, with cutoff lows forming much more frequently in summer than in winter; 3) the short lifetime of cutoff lows, most cutoff lows lasted 2-3 days and very few lasted more than 5 days; and 4) the mobility of the system, with few cutoff lows being stationary. Furthermore, the long study period has made it possible (i) to find a bimodal distribution in the geographical density of cutoff lows for the European sector in all the seasons (with the exception of winter), a summer displacement to the ocean in the American region, and a summer extension to the continent in the Asian region, and (ii) to detect northward and westward motion especially in the transitions from the second to third day of occurrence and from the third to fourth day of occurrence.The long-term cutoff low database built in this study is appropriate to study the interannual variability of cutoff low occurrence and the links between cutoff lows and jet stream systems, blocking, or major modes of climate variability as well as the global importance of cutoff low in the stratosphere-troposphere exchange mechanism, which will be the focus of a subsequent paper.

High-precision measurements of wetland sediment elevation. I. Recent improvements to the sedimentation--erosion table

USGS Publications Warehouse

Cahoon, D.R.; Lynch, J.C.; Hensel, P.; Boumans, R.; Perez, B.C.; Segura, B.; Day, J.W.

2002-01-01

The sedimentation-erosion table (SET) developed by Boumans and Day (1993) is herein renamed the surface elevation table (SET) to better reflect the conceptual view of the processes being measured. The SET was designed for making high-resolution measurements of small-scale changes in elevation of loose, unconsolidated sediments in shallow water and mudflat habitats. The SET has undergone three major improvements to increase precision and so that it can be used to measure sediment elevation in vegetated wetlands as well as shallow water habitats. The remote-release 'sliding plate' mechanism has been replaced with a single plate, collars (first 2.5 cm then 7.5 cm in length) have been attached to the plate to reduce play in the placement of the measuring pins, and the brass measuring pins have been replaced with fiberglass pins to reduce bending and consequent loss of precision. Under ideal laboratory conditions, the 95% confidence limit for individual pin measurements averaged about A? 1.4 mm (range A? 0.7 to A? 1.9 mm). These modifications have resulted in a reduction of error by about 50%.

Effects of prescribed burning on marsh-elevation change and the risk of wetland loss

USGS Publications Warehouse

McKee, Karen L.; Grace, James B.

2012-01-01

Marsh-elevation change is the net effect of biophysical processes controlling inputs versus losses of soil volume. In many marshes, accumulation of organic matter is an important contributor to soil volume and vertical land building. In this study, we examined how prescribed burning, a common marsh-management practice, may affect elevation dynamics in the McFaddin National Wildlife Refuge, Texas by altering organic-matter accumulation. Experimental plots were established in a brackish marsh dominated by Spartina patens, a grass found throughout the Gulf of Mexico and Atlantic marshes. Experimental plots were subjected to burning and nutrient-addition treatments and monitored for 3.5 years (April 2005 – November 2008). Half of the plots were burned once in 2006; half of the plots were fertilized seasonally with nitrogen, phosphorus, and potassium. Before and after the burns, seasonal measurements were made of soil physicochemistry, vegetation structure, standing and fallen plant biomass, aboveground and belowground production, decomposition, and accretion and elevation change (measured with Surface Elevation Tables (SET)). Movements in different soil strata (surface, root zone, subroot zone) were evaluated to identify which processes were contributing to elevation change. Because several hurricanes occurred during the study period, we also assessed how these storms affected elevation change rates. The main findings of this study were as follows: 1. The main drivers of elevation change were accretion on the marsh surface and subsurface movement below the root zone, but the relative influence of these processes varied temporally. Prior to Hurricanes Gustav and Ike (September 2008), the main driver was subsurface movement; after the hurricane, both accretion and subsurface movement were important. 2. Prior to Hurricanes Gustav and Ike, rates of elevation gain and accretion above a marker horizon were higher in burned plots compared to nonburned plots, whereas nutrient addition had no detectable influence on elevation dynamics. 3. Burning decreased standing and fallen plant litter, reducing fuel load. Hurricanes Gustav and Ike also removed fallen litter from all plots. 4. Aboveground and belowground production rates varied annually but were unaffected by burning and nutrient treatments. 5. Decomposition (of a standard cellulose material) in upper soil layers was increased in burned plots but was unaffected by nutrient treatments. 6. Soil physicochemistry was unaffected by burning or nutrient treatments. 7. The elevation deficit (difference between rate of submergence and vertical land development) prior to hurricanes was less in burned plots (6.2 millimeters per year [mm yr-1]) compared to nonburned plots (7.2 mm yr-1). 8. Storm sediments delivered by Hurricane Ike raised elevations an average of 7.4 centimeters (cm), which countered an elevation deficit that had accrued over 11 years. Our findings provide preliminary insights into elevation dynamics occurring in brackish marshes of the Texas Chenier Plain under prescribed fire management. The results of this study indicate that prescribed burning conducted at 3- to 5-year intervals is not likely to negatively impact the long-term sustainability of S. patens-dominated brackish marshes at McFaddin National Wildlife Refuge and may offset existing elevation deficits by ≈ 1 mm yr-1. The primary drivers of elevation change varied in time and space, leading to a more complex situation in terms of predicting how disturbances may alter elevation trajectories. The potential effect of burning on elevation change in other marshes will depend on several site-specific factors, including geomorphic/ sedimentary setting, tide range, local rate of relative sea level rise, plant species composition, additional management practices (for example, for flood control), and disturbance types and frequency (for example, hurricanes or herbivore grazing). Increasing the scope of inference would require installation of SETs in replicate marshes undergoing different prescribed fire intervals and in different geomorphic settings (with different hurricane frequencies and/or different sedimentary settings). Multiple locations along the Gulf and Atlantic coasts where prescribed fire is used as a management tool could provide the appropriate setting for these installations.

The Effect of Elevation Bias in Interpolated Air Temperature Data Sets on Surface Warming in China During 1951-2015

NASA Astrophysics Data System (ADS)

Wang, Tingting; Sun, Fubao; Ge, Quansheng; Kleidon, Axel; Liu, Wenbin

2018-02-01

Although gridded air temperature data sets share much of the same observations, different rates of warming can be detected due to different approaches employed for considering elevation signatures in the interpolation processes. Here we examine the influence of varying spatiotemporal distribution of sites on surface warming in the long-term trend and over the recent warming hiatus period in China during 1951-2015. A suspicious cooling trend in raw interpolated air temperature time series is found in the 1950s, and 91% of which can be explained by the artificial elevation changes introduced by the interpolation process. We define the regression slope relating temperature difference and elevation difference as the bulk lapse rate of -5.6°C/km, which tends to be higher (-8.7°C/km) in dry regions but lower (-2.4°C/km) in wet regions. Compared to independent experimental observations, we find that the estimated monthly bulk lapse rates work well to capture the elevation bias. Significant improvement can be achieved in adjusting the interpolated original temperature time series using the bulk lapse rate. The results highlight that the developed bulk lapse rate is useful to account for the elevation signature in the interpolation of site-based surface air temperature to gridded data sets and is necessary for avoiding elevation bias in climate change studies.

The surface elevation table and marker horizon technique: A protocol for monitoring wetland elevation dynamics

USGS Publications Warehouse

James C. Lynch,; Phillippe Hensel,; Cahoon, Donald R.

2015-01-01

The National Park Service, in response to the growing evidence and awareness of the effects of climate change on federal lands, determined that monitoring wetland elevation change is a top priority in North Atlantic Coastal parks (Stevens et al, 2010). As a result, the NPS Northeast Coastal and Barrier Network (NCBN) in collaboration with colleagues from the U.S. Geological Survey (USGS) and The National Oceanic and Atmospheric Administration (NOAA) have developed a protocol for monitoring wetland elevation change and other processes important for determining the viability of wetland communities. Although focused on North Atlantic Coastal parks, this document is applicable to all coastal and inland wetland regions. Wetlands exist within a narrow range of elevation which is influenced by local hydrologic conditions. For coastal wetlands in particular, local hydrologic conditions may be changing as sea levels continue to rise. As sea level rises, coastal wetland systems may respond by building elevation to maintain favorable hydrologic conditions for their survival. This protocol provides the reader with instructions and guidelines on designing a monitoring plan or study to: A) Quantify elevation change in wetlands with the Surface Elevation Table (SET). B) Understand the processes that influence elevation change, including vertical accretion (SET and Marker Horizon methods). C) Survey the wetland surface and SET mark to a common reference datum to allow for comparing sample stations to each other and to local tidal datums. D) Survey the SET mark to monitor its relative stability. This document is divided into two parts; the main body that presents an overview of all aspects of monitoring wetland elevation dynamics, and a collection of Standard Operating Procedures (SOP) that describes in detail how to perform or execute each step of the methodology. Detailed instruction on the installation, data collection, data management and analysis are provided in this report and associated SOP’s. A better understanding of these processes will help to determine the present and future viability of coastal wetlands managed by NPS and can help address measures that will ensure these communities exist into the future.

Using computational modeling of river flow with remotely sensed data to infer channel bathymetry

USGS Publications Warehouse

Nelson, Jonathan M.; McDonald, Richard R.; Kinzel, Paul J.; Shimizu, Y.

2012-01-01

As part of an ongoing investigation into the use of computational river flow and morphodynamic models for the purpose of correcting and extending remotely sensed river datasets, a simple method for inferring channel bathymetry is developed and discussed. The method is based on an inversion of the equations expressing conservation of mass and momentum to develop equations that can be solved for depth given known values of vertically-averaged velocity and water-surface elevation. The ultimate goal of this work is to combine imperfect remotely sensed data on river planform, water-surface elevation and water-surface velocity in order to estimate depth and other physical parameters of river channels. In this paper, the technique is examined using synthetic data sets that are developed directly from the application of forward two-and three-dimensional flow models. These data sets are constrained to satisfy conservation of mass and momentum, unlike typical remotely sensed field data sets. This provides a better understanding of the process and also allows assessment of how simple inaccuracies in remotely sensed estimates might propagate into depth estimates. The technique is applied to three simple cases: First, depth is extracted from a synthetic dataset of vertically averaged velocity and water-surface elevation; second, depth is extracted from the same data set but with a normally-distributed random error added to the water-surface elevation; third, depth is extracted from a synthetic data set for the same river reach using computed water-surface velocities (in place of depth-integrated values) and water-surface elevations. In each case, the extracted depths are compared to the actual measured depths used to construct the synthetic data sets (with two- and three-dimensional flow models). Errors in water-surface elevation and velocity that are very small degrade depth estimates and cannot be recovered. Errors in depth estimates associated with assuming water-surface velocities equal to depth-integrated velocities are substantial, but can be reduced with simple corrections.

Unravelling the Drivers of Chute Cutoff and the Commonality of Oxbow Production

NASA Astrophysics Data System (ADS)

Constantine, J. A.; Edmonds, D. A.; David, S.

2017-12-01

Chute cutoff is the principal means of channel shortening along steep, sparsely vegetated, or perturbed meandering river floodplains. Although flood waters are capable of unravelling the floodplain in a variety of ways, only a small number of mechanisms of chute cutoff have been observed in nature, each with seemingly different controls on their occurrence. The complexity of these controls partly explains the difficulty of deterministically incorporating chute cutoff into channel evolution models. Despite the challenges, recent field observations have allowed us not only to identify particular mechanisms but also to highlight first-order controls. We provide a summary of these findings and describe the processes that drive the various mechanisms of cutoff and their resulting oxbow lakes. For example, many agricultural floodplains show evidence of pervasive gully incision as a precursor to chute cutoff. And perhaps surprising given the diversity of cutoff mechanisms, oxbows globally share characteristic dimensions that are a function of the sinuosity and width of the rivers from which they are derived. Our results suggest that, in spite of the many processes involved, aspects of the mechanisms of chute cutoff can be generalised, providing a means for improving cutoff prediction and for assessing the impacts of cutoffs on the meandering river floodplain.

Pooled individual patient data from five countries were used to derive a clinical prediction rule for coronary artery disease in primary care.

PubMed

Aerts, Marc; Minalu, Girma; Bösner, Stefan; Buntinx, Frank; Burnand, Bernard; Haasenritter, Jörg; Herzig, Lilli; Knottnerus, J André; Nilsson, Staffan; Renier, Walter; Sox, Carol; Sox, Harold; Donner-Banzhoff, Norbert

2017-01-01

To construct a clinical prediction rule for coronary artery disease (CAD) presenting with chest pain in primary care. Meta-Analysis using 3,099 patients from five studies. To identify candidate predictors, we used random forest trees, multiple imputation of missing values, and logistic regression within individual studies. To generate a prediction rule on the pooled data, we applied a regression model that took account of the differing standard data sets collected by the five studies. The most parsimonious rule included six equally weighted predictors: age ≥55 (males) or ≥65 (females) (+1); attending physician suspected a serious diagnosis (+1); history of CAD (+1); pain brought on by exertion (+1); pain feels like "pressure" (+1); pain reproducible by palpation (-1). CAD was considered absent if the prediction score is <2. The area under the ROC curve was 0.84. We applied this rule to a study setting with a CAD prevalence of 13.2% using a prediction score cutoff of <2 (i.e., -1, 0, or +1). When the score was <2, the probability of CAD was 2.1% (95% CI: 1.1-3.9%); when the score was ≥ 2, it was 43.0% (95% CI: 35.8-50.4%). Clinical prediction rules are a key strategy for individualizing care. Large data sets based on electronic health records from diverse sites create opportunities for improving their internal and external validity. Our patient-level meta-analysis from five primary care sites should improve external validity. Our strategy for addressing site-to-site systematic variation in missing data should improve internal validity. Using principles derived from decision theory, we also discuss the problem of setting the cutoff prediction score for taking action. Copyright © 2016 Elsevier Inc. All rights reserved.

NUCLEON STRUCTURE IN LATTICE QCD WITH DYNAMICAL DOMAIN--WALL FERMIONS QUARKS.

DOE Office of Scientific and Technical Information (OSTI.GOV)

LIN H.-W.; OHTA, S.

2006-10-02

We report RBC and RBC/UKQCD lattice QCD numerical calculations of nucleon electroweak matrix elements with dynamical domain-wall fermions (DWF) quarks. The first, RBC, set of dynamical DWF ensembles employs two degenerate flavors of DWF quarks and the DBW2 gauge action. Three sea quark mass values of 0.04, 0.03 and 0.02 in lattice units are used with 220 gauge configurations each. The lattice cutoff is a{sup -1} {approx} 1.7GeV and the spatial volume is about (1.9fm){sup 3}. Despite the small volume, the ratio of the isovector vector and axial charges g{sub A}/g{sub V} and that of structure function moments {sub u-d}/{submore » {Delta}u-{Delta}d} are in agreement with experiment, and show only very mild quark mass dependence. The second, RBC/UK, set of ensembles employs one strange and two degenerate (up and down) dynamical DWF quarks and Iwasaki gauge action. The strange quark mass is set at 0.04, and three up/down mass values of 0.03, 0.02 and 0.01 in lattice units are used. The lattice cutoff is a{sup -1} {approx} 1.6GeV and the spatial volume is about (3.0fm){sup 3}. Even with preliminary statistics of 25-30 gauge configurations, the ratios g{sub A}/g{sub V} and {sub u-d}/{sub {Delta}u-{Delta}d} are consistent with experiment and show only very mild quark mass dependence. Another structure function moment, d{sub 1}, though yet to be renormalized, appears small in both sets.« less

Left ventricular ejection fraction to predict early mortality in patients with non-ST-segment elevation acute coronary syndromes.

PubMed

Bosch, Xavier; Théroux, Pierre

2005-08-01

Improvement in risk stratification of patients with non-ST-segment elevation acute coronary syndrome (ACS) is a gateway to a more judicious treatment. This study examines whether the routine determination of left ventricular ejection fraction (EF) adds significant prognostic information to currently recommended stratifiers. Several predictors of inhospital mortality were prospectively characterized in a registry study of 1104 consecutive patients, for whom an EF was determined, who were admitted for an ACS. Multiple regression models were constructed using currently recommended clinical, electrocardiographic, and blood marker stratifiers, and values of EF were incorporated into the models. Age, ST-segment shifts, elevation of cardiac markers, and the Thrombolysis in Myocardial Infarction (TIMI) risk score all predicted mortality (P < .0001). Adding EF into the model improved the prediction of mortality (C statistic 0.73 vs 0.67). The odds of death increased by a factor of 1.042 for each 1% decrement in EF. By receiver operating curves, an EF cutoff of 48% provided the best predictive value. Mortality rates were 3.3 times higher within each TIMI risk score stratum in patients with an EF of 48% or lower as compared with those with higher. The TIMI risk score predicts inhospital mortality in a broad population of patients with ACS. The further consideration of EF adds significant prognostic information.

A pre-marketing ALT signal predicts post-marketing liver safety.

PubMed

Moylan, Cynthia A; Suzuki, Ayako; Papay, Julie I; Yuen, Nancy A; Ames, Michael; Hunt, Christine M

2012-08-01

Drug induced liver injury during drug development is evidenced by a higher incidence of serum alanine aminotransferase (ALT) elevations in treated versus placebo populations and termed an "ALT signal". We sought to quantify whether an ALT signal in pre-marketing clinical trials predicted post-marketing hepatotoxicity. Incidence of ALT elevations (ALT ≥ 3 times upper limits normal [× ULN]) for drug and placebo of new chemical entities and approved drugs associated with hepatotoxicity was calculated using the Food and Drug Administration (FDA) website. Post-marketing liver safety events were identified using the FDA Adverse Event Reporting System (AERS). The association of FDA AERS signal score (EB05 ≥ 2) and excess risk of pre-marketing ALT elevation (difference in incidence of ALT ≥ 3× ULN in treated versus placebo) was examined. An ALT signal of ≥ 1.2% was significantly associated with a post-marketing liver safety signal (p ≤ 0.013) and a 71.4% positive predictive value. An absent ALT signal was associated with a high likelihood of post-marketing liver safety; negative predictive value of 89.7%. Daily drug dose information improved the prediction of post-marketing liver safety. A cut-off of 1.2% increase in ALT ≥ 3× ULN in treated versus placebo groups provides an easily calculated method for predicting post-marketing liver safety. Published by Elsevier Inc.

An Experimental Study of the Effect of Judges' Knowledge of Item Data on Two Forms of the Angoff Standard Setting Method.

ERIC Educational Resources Information Center

Garrido, Mariquita; Payne, David A.

Minimum competency cut-off scores on a statistics exam were estimated under four conditions: the Angoff judging method with item data (n=20), and without data available (n=19); and the Modified Angoff method with (n=19), and without (n=19) item data available to judges. The Angoff method required free response percentage estimates (0-100) percent,…

Waves and instabilities in plasmas

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chen, L.

1987-01-01

The contents of this book are: Plasma as a Dielectric Medium; Nyquist Technique; Absolute and Convective Instabilities; Landau Damping and Phase Mixing; Particle Trapping and Breakdown of Linear Theory; Solution of Viasov Equation via Guilding-Center Transformation; Kinetic Theory of Magnetohydrodynamic Waves; Geometric Optics; Wave-Kinetic Equation; Cutoff and Resonance; Resonant Absorption; Mode Conversion; Gyrokinetic Equation; Drift Waves; Quasi-Linear Theory; Ponderomotive Force; Parametric Instabilities; Problem Sets for Homework, Midterm and Final Examinations.

Threshold Theory Tested in an Organizational Setting: The Relation between Perceived Innovativeness and Intelligence in a Large Sample of Leaders

ERIC Educational Resources Information Center

Christensen, Bo T.; Hartmann, Peter V. W.; Rasmussen, Thomas Hedegaard

2017-01-01

A large sample of leaders (N = 4257) was used to test the link between leader innovativeness and intelligence. The threshold theory of the link between creativity and intelligence assumes that below a certain IQ level (approximately IQ 120), there is some correlation between IQ and creative potential, but above this cutoff point, there is no…

Adrenal androgen excess and body mass index in polycystic ovary syndrome.

PubMed

Moran, Carlos; Arriaga, Monica; Arechavaleta-Velasco, Fabian; Moran, Segundo

2015-01-07

Context: Adrenal hyperandrogenism affects around 25% of polycystic ovary syndrome (PCOS) patients but its relation to obesity is not totally understood. Objective: To assess dehydroepiandrosterone (DHEA) and dehydroepiandrosterone sulfate (DHEAS) levels in relation to body mass index (BMI) in PCOS. Design: Prospective observational study. Setting: Institutional practice at an Obstetrics/Gynecology hospital. Patients or Other Participants: This study included 136 PCOS patients, 20-35 years old, and 42 matched-age control women. The participants were classified with the BMI cutoff value of 27 kg/m 2 as follows: 1) high-BMI PCOS patients; 2) low-BMI PCOS patients; 3) high-BMI control women; and 4) low-BMI control women. The data were reanalyzed with the BMI cutoff value of 30 kg/m 2 to corroborate the findings in obese and non-obese patients. Intervention(s): Blood samples were taken. Main Outcome Measure(s): LH, FSH, insulin, T, androstenedione (A 4 ), DHEA, DHEAS, and glucose levels were determined. Homeostatic model assessment was calculated. Pelvic and abdominal ultrasound for ovarian morphology and adipose tissue, respectively, were performed. Results: Obese PCOS patients presented significantly more insulin resistance than non-obese PCOS patients. The LH levels and LH/FSH ratio were significantly higher in low-BMI than in high-BMI PCOS patients. The A 4 and DHEAS levels were significantly higher in non-obese than in obese PCOS patients. A significant correlation between LH and A 4 in non-obese PCOS patients was observed. The frequency of hyperandrogenism by increased A 4 , and DHEA along with DHEAS was significantly higher in low-BMI PCOS patients compared to high-BMI PCOS patients. Some findings observed with the BMI cutoff value of 27 kg/m 2 changed with the cutoff value of 30 kg/m 2 . Conclusions: Low BMI more than high BMI is associated with increased LH, high A 4 , DHEA and DHEAS levels in PCOS patients. The BMI cutoff value of 27 kg/m 2 classified better than 30 kg/m 2 for hormonal and metabolic characteristics.

Frequent attendance in primary care: comparison and implications of different definitions

PubMed Central

Luciano, Juan V; Fernández, Ana; Pinto-Meza, Alejandra; Luján, Leila; Bellón, Juan A; García-Campayo, Javier; Peñarrubia, María T; Fernández, Rita; Sanavia, Marta; Blanco, María E; Haro, Josep M; Palao, Diego J; Serrano-Blanco, Antoni

2010-01-01

Background The diversity of definitions of frequent attendance in the literature hampers comparison of their precision, validity, and associated factors. Aim To examine different definitions of frequent attendance in order to identify the sociodemographic and clinical factors associated with frequent attendance in primary care, according to each definition. Design of study One-phase cross-sectional study. Setting Seventy-seven primary care centres in Catalonia, Spain. Method A total of 3815 primary care patients were interviewed between October 2005 and March 2006. Three definitions of frequent attendance were tested: (1) frequent attenders as the top 25% and the top 10% consulting patients; (2) frequent attenders as the top 25% and the top 10% consulting patients stratified by age and sex; and (3) frequent attenders as the top 25% and the top 10% consulting patients stratified by the presence of physical/mental conditions (patients with only mental disorders, with only chronic physical conditions, with comorbid conditions, and with no condition). Multilevel logistic regressions were used. Results The following factors were systematically related to frequent attender status: being on sick leave, being born outside of Spain, reporting mental health problems as the main reason for consulting, and having arthritis/rheumatism, or bronchitis. Major depression was related to frequent attendance in two of the three definitions. The factor ‘GP’ was related to frequent attendance when the top decile cut-off point was used. The models with a 10% cut-off point were more discriminative than those with a 25% cut-off point: the area under the receiver operating characteristic curve for models with a 25% cut-off and a 10% cut-off ranged between 0.71 (95% confidence interval [CI] = 0.70 to 0.73) and 0.75 (95% CI = 0.74 to 0.77) and between 0.79 (95% CI = 0.78 to 0.81) and 0.85 (95% CI = 0.83 to 0.86), respectively. Conclusion The way frequent attendance is defined is of crucial importance. It is recommended that a more discriminative definition of frequent attendance is used (the top 10%). PMID:20132693

Identifying Aboriginal-specific AUDIT-C and AUDIT-3 cutoff scores for at-risk, high-risk, and likely dependent drinkers using measures of agreement with the 10-item Alcohol Use Disorders Identification Test

PubMed Central

2014-01-01

Background The Alcohol Use Disorders Identification Test (AUDIT) is a 10-item alcohol screener that has been recommended for use in Aboriginal primary health care settings. The time it takes respondents to complete AUDIT, however, has proven to be a barrier to its routine delivery. Two shorter versions, AUDIT-C and AUDIT-3, have been used as screening instruments in primary health care. This paper aims to identify the AUDIT-C and AUDIT-3 cutoff scores that most closely identify individuals classified as being at-risk drinkers, high-risk drinkers, or likely alcohol dependent by the 10-item AUDIT. Methods Two cross-sectional surveys were conducted from June 2009 to May 2010 and from July 2010 to June 2011. Aboriginal Australian participants (N = 156) were recruited through an Aboriginal Community Controlled Health Service, and a community-based drug and alcohol treatment agency in rural New South Wales (NSW), and through community-based Aboriginal groups in Sydney NSW. Sensitivity, specificity, and positive and negative predictive values of each score on the AUDIT-C and AUDIT-3 were calculated, relative to cutoff scores on the 10-item AUDIT for at-risk, high-risk, and likely dependent drinkers. Receiver operating characteristic (ROC) curve analyses were conducted to measure the detection characteristics of AUDIT-C and AUDIT-3 for the three categories of risk. Results The areas under the receiver operating characteristic (AUROC) curves were high for drinkers classified as being at-risk, high-risk, and likely dependent. Conclusions Recommended cutoff scores for Aboriginal Australians are as follows: at-risk drinkers AUDIT-C ≥ 5, AUDIT-3 ≥ 1; high-risk drinkers AUDIT-C ≥ 6, AUDIT-3 ≥ 2; and likely dependent drinkers AUDIT-C ≥ 9, AUDIT-3 ≥ 3. Adequate sensitivity and specificity were achieved for recommended cutoff scores. AUROC curves were above 0.90. PMID:25179547

7. FLOOR PLAN, PLOT PLAN, ELEVATIONS, SHEET NO. 11044/1 OF ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

7. FLOOR PLAN, PLOT PLAN, ELEVATIONS, SHEET NO. 1-10-44/1 OF 11. (NOTE: BUILDINGS 821-823 WERE CONSTRUCTED FROM A SINGLE SET OF PLANS. SOME DRAWINGS ARE TYPICAL OF ALL 3 STRUCTURES, CERTAIN OTHER DRAWINGS IN THE SAME SET ARE BUILDING-SPECIFIC.) - Oakland Army Base, Storehouse Type, Ukraine & Maritime Streets, Oakland, Alameda County, CA

Cutoff Probe for Tokamak SOL Measurement

NASA Astrophysics Data System (ADS)

Na, Byung-Keun; You, Kwang-Ho; Kim, Dae-Woong; You, Shin-Jae; Kim, Jung-Hyung; Chang, Hong-Young

2013-09-01

Since a cutoff probe was developed, there have been a lot of improvements in methodology and analysis for low temperature plasmas. However, in order to apply the cutoff probe to the Tokamak scrape-off layer (SOL), three important issues should be solved - speed, thermal protection, and short-distance (a few mm) wave propagation in magnetized plasmas. In this presentation, the improvement of cutoff probe for Tokamak is shown. The above problems can be solved using the following methods: (a) the cutoff probe can be used with short impulse of a few nano-seconds for speed improvement. (b) Ceramic covers were used for thermal protection. (c) In magnetized plasmas, the cutoff peak can be analyzed using circuit modeling and CST Microwave studio. To verify the proposed methods, the cutoff probe was applied to a Helicon plasma, and the results were compared to laser Thomson scattering results. Based on the result in the Helicon plasma, the cutoff probe will be applied to far-SOL region at the KSTAR 2013 campaign, and SOL region at the later campaign.

Current MUAC Cut-Offs to Screen for Acute Malnutrition Need to Be Adapted to Gender and Age: The Example of Cambodia

PubMed Central

Fiorentino, Marion; Sophonneary, Prak; Laillou, Arnaud; Whitney, Sophie; de Groot, Richard; Perignon, Marlène; Kuong, Khov; Berger, Jacques; Wieringa, Frank T.

2016-01-01

Background Early identification of children <5 yrs with acute malnutrition is a priority. Acute malnutrition is defined by the World Health Organization as a mid-upper-arm circumference (MUAC) <12.5 cm or a weight-for-height Z-score (WHZ) <-2. MUAC is a simple and low-cost indicator to screen for acute malnutrition in communities, but MUAC cut-offs currently recommended by WHO do not identify the majority of children with weight-for-height Z-score (<-2 (moderate malnourished) or r<-3 (severe malnourished). Also, no cut-offs for MUAC are established for children >5 yrs. Therefore, this study aimed at defining gender and age-specific cut-offs to improve sensitivity of MUAC as an indicator of acute malnutrition. Methods To establish new age and gender-specific MUAC cut-offs, pooled data was obtained for 14,173 children from 5 surveys in Cambodia (2011–2013). Sensitivity, false positive rates, and areas under receiver-operator characteristic curves (AUC) were calculated using wasting for children <5yrs and thinness for children ≥5yrs as gold standards. Among the highest values of AUC, the cut-off with the highest sensitivity and a false positive rate ≤33% was selected as the optimal cut-off. Results Optimal cut-off values increased with age. Boys had higher cut-offs than girls, except in the 8–10.9 yrs age range. In children <2yrs, the cut-off was lower for stunted children compared to non stunted children. Sensitivity of MUAC to identify WHZ<-2 and <-3 z-scores increased from 24.3% and 8.1% to >80% with the new cut-offs in comparison with the current WHO cut-offs. Conclusion Gender and age specific MUAC cut-offs drastically increased sensitivity to identify children with WHZ-score <-2 z-scores. International reference of MUAC cut-offs by age group and gender should be established to screen for acute malnutrition at the community level. PMID:26840899

Evaluating the Bulk Lorentz Factors of Outflow Material: Lessons Learned from the Extremely Energetic Outburst GRB 160625B

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wang, Yuan-Zhu; Wang, Hao; Zhang, Shuai

2017-02-10

GRB 160625B is an extremely bright outburst with well-monitored afterglow emission. The geometry-corrected energy is high, up to ∼5.2 × 10{sup 52} erg or even ∼8 × 10{sup 52} erg, rendering it the most energetic GRB prompt emission recorded so far. We analyzed the time-resolved spectra of the prompt emission and found that in some intervals there were likely thermal-radiation components and the high energy emission was characterized by significant cutoff. The bulk Lorentz factors of the outflow material are estimated accordingly. We found out that the Lorentz factors derived in the thermal-radiation model are consistent with the luminosity-Lorentz factormore » correlation found in other bursts, as well as in GRB 090902B for the time-resolved thermal-radiation components, while the spectral cutoff model yields much lower Lorentz factors that are in tension with the constraints set by the electron pair Compton scattering process. We then suggest that these spectral cutoffs are more likely related to the particle acceleration process and that one should be careful in estimating the Lorentz factors if the spectrum cuts at a rather low energy (e.g., ∼tens of MeV). The nature of the central engine has also been discussed, and a stellar-mass black hole is favored.« less

The regression discontinuity design showed to be a valid alternative to a randomized controlled trial for estimating treatment effects.

PubMed

Maas, Iris L; Nolte, Sandra; Walter, Otto B; Berger, Thomas; Hautzinger, Martin; Hohagen, Fritz; Lutz, Wolfgang; Meyer, Björn; Schröder, Johanna; Späth, Christina; Klein, Jan Philipp; Moritz, Steffen; Rose, Matthias

2017-02-01

To compare treatment effect estimates obtained from a regression discontinuity (RD) design with results from an actual randomized controlled trial (RCT). Data from an RCT (EVIDENT), which studied the effect of an Internet intervention on depressive symptoms measured with the Patient Health Questionnaire (PHQ-9), were used to perform an RD analysis, in which treatment allocation was determined by a cutoff value at baseline (PHQ-9 = 10). A linear regression model was fitted to the data, selecting participants above the cutoff who had received the intervention (n = 317) and control participants below the cutoff (n = 187). Outcome was PHQ-9 sum score 12 weeks after baseline. Robustness of the effect estimate was studied; the estimate was compared with the RCT treatment effect. The final regression model showed a regression coefficient of -2.29 [95% confidence interval (CI): -3.72 to -.85] compared with a treatment effect found in the RCT of -1.57 (95% CI: -2.07 to -1.07). Although the estimates obtained from two designs are not equal, their confidence intervals overlap, suggesting that an RD design can be a valid alternative for RCTs. This finding is particularly important for situations where an RCT may not be feasible or ethical as is often the case in clinical research settings. Copyright © 2016 Elsevier Inc. All rights reserved.

Validation of the GerdQ questionnaire for the management of gastro-oesophageal reflux disease in Japan

PubMed Central

Matsuzaki, Juntaro; Okada, Sawako; Hirata, Kenro; Fukuhara, Seiichiro; Hibi, Toshifumi

2013-01-01

Background The GerdQ scoring system may be a useful tool for managing gastro-oesophageal reflux disease. However, GerdQ has not been fully validated in Asian countries. Objective To validate the Japanese version of GerdQ and to compare this version to the Carlsson-Dent questionnaire (CDQ) in both general and hospital-based populations. Methods The questionnaires, including the Japanese versions of GerdQ and CDQ, and questions designed to collect demographic information, were sent to a general population via the web, and to a hospital-based population via conventional mail. The optimal cutoff GerdQ score and the differences in the characteristics between GerdQ and CDQ were assessed. Results The answers from 863 web-responders and 303 conventional-mail responders were analysed. When a GerdQ cutoff score was set at 8, GerdQ significantly predicted the presence of reflux oesophagitis. Although the GerdQ scores were correlated with the CDQ scores, the concordance rates were poor. Multivariate analysis results indicated that, the additional use of over-the-counter medications was associated with GerdQ score ≥ 8, but not with CDQ score ≥ 6. Conclusions The GerdQ cutoff score of 8 was appropriate for the Japanese population. Compared with CDQ, GerdQ was more useful for evaluating treatment efficacy and detecting patients’ unmet medical needs. PMID:24917957

49 CFR 229.93 - Safety cut-off device.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 4 2011-10-01 2011-10-01 false Safety cut-off device. 229.93 Section 229.93 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION... Equipment § 229.93 Safety cut-off device. The fuel line shall have a safety cut-off device that— (a) Is...

49 CFR 229.93 - Safety cut-off device.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 4 2010-10-01 2010-10-01 false Safety cut-off device. 229.93 Section 229.93 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION... Equipment § 229.93 Safety cut-off device. The fuel line shall have a safety cut-off device that— (a) Is...

Screening for major and minor depression in a multiethnic sample of Asian primary care patients: a comparison of the nine-item Patient Health Questionnaire (PHQ-9) and the 16-item Quick Inventory of Depressive Symptomatology - Self-Report (QIDS-SR16 ).

PubMed

Sung, Sharon Cohan; Low, Charity Cheng Hong; Fung, Daniel Shuen Sheng; Chan, Yiong Huak

2013-12-01

Depression is common, disabling, and the single most important factor leading to suicide, yet it is underdiagnosed in busy primary care settings. A key challenge facing primary care clinicians in Asia is the selection of instruments to facilitate depression screening. Although the nine-item Patient Health Questionnaire (PHQ-9) and 16-item Quick Inventory of Depressive Symptomatology - Self-Report (QIDS-SR16 ) are used internationally, they have not been directly compared or widely validated in Asian primary care populations. This study aimed to validate the PHQ-9 and QIDS-SR16 against a structured interview diagnosis of Diagnostic and Statistical Manual, 4th Edition, depression based on the Mini-International Neuropsychiatric Interview in a multiethnic Asian sample. From April through August 2011, we enrolled 400 English-speaking Singaporean primary care patients. Participants completed a demographic data form, the PHQ-9, and the QIDS-SR16 . They were assessed independently for major and minor depression using the Mini-International Neuropsychiatric Interview. Sensitivity and specificity for diagnosing major depression were 91.7% and 72.2%, respectively, for the PHQ-9 (optimal cutoff score of 6), and 83.3% and 84.7%, respectively, for the QIDS-SR16 (optimal cutoff score of 9). The QIDS-SR16 also detected minor depression at an optimal cutoff score of 7, with a sensitivity of 94.4% and specificity of 77.9%. The PHQ-9 and QIDS-SR16 showed good internal consistency (Cronbach's α: 0.87 and 0.79, respectively) and good convergent validity (correlation coefficient: r = 0.73, P < 0.001). The overall prevalence of major and minor depressive disorders was 9%. The PHQ-9 and QIDS-SR16 appear to be valid and reliable for depression screening in Asian primary care settings. Copyright © 2013 Wiley Publishing Asia Pty Ltd.

Understanding the many-body expansion for large systems. III. Critical role of four-body terms, counterpoise corrections, and cutoffs.

PubMed

Liu, Kuan-Yu; Herbert, John M

2017-10-28

Papers I and II in this series [R. M. Richard et al., J. Chem. Phys. 141, 014108 (2014); K. U. Lao et al., ibid. 144, 164105 (2016)] have attempted to shed light on precision and accuracy issues affecting the many-body expansion (MBE), which only manifest in larger systems and thus have received scant attention in the literature. Many-body counterpoise (CP) corrections are shown to accelerate convergence of the MBE, which otherwise suffers from a mismatch between how basis-set superposition error affects subsystem versus supersystem calculations. In water clusters ranging in size up to (H 2 O) 37 , four-body terms prove necessary to achieve accurate results for both total interaction energies and relative isomer energies, but the sheer number of tetramers makes the use of cutoff schemes essential. To predict relative energies of (H 2 O) 20 isomers, two approximations based on a lower level of theory are introduced and an ONIOM-type procedure is found to be very well converged with respect to the appropriate MBE benchmark, namely, a CP-corrected supersystem calculation at the same level of theory. Results using an energy-based cutoff scheme suggest that if reasonable approximations to the subsystem energies are available (based on classical multipoles, say), then the number of requisite subsystem calculations can be reduced even more dramatically than when distance-based thresholds are employed. The end result is several accurate four-body methods that do not require charge embedding, and which are stable in large basis sets such as aug-cc-pVTZ that have sometimes proven problematic for fragment-based quantum chemistry methods. Even with aggressive thresholding, however, the four-body approach at the self-consistent field level still requires roughly ten times more processors to outmatch the performance of the corresponding supersystem calculation, in test cases involving 1500-1800 basis functions.

Understanding the many-body expansion for large systems. III. Critical role of four-body terms, counterpoise corrections, and cutoffs

NASA Astrophysics Data System (ADS)

Liu, Kuan-Yu; Herbert, John M.

2017-10-01

Papers I and II in this series [R. M. Richard et al., J. Chem. Phys. 141, 014108 (2014); K. U. Lao et al., ibid. 144, 164105 (2016)] have attempted to shed light on precision and accuracy issues affecting the many-body expansion (MBE), which only manifest in larger systems and thus have received scant attention in the literature. Many-body counterpoise (CP) corrections are shown to accelerate convergence of the MBE, which otherwise suffers from a mismatch between how basis-set superposition error affects subsystem versus supersystem calculations. In water clusters ranging in size up to (H2O)37, four-body terms prove necessary to achieve accurate results for both total interaction energies and relative isomer energies, but the sheer number of tetramers makes the use of cutoff schemes essential. To predict relative energies of (H2O)20 isomers, two approximations based on a lower level of theory are introduced and an ONIOM-type procedure is found to be very well converged with respect to the appropriate MBE benchmark, namely, a CP-corrected supersystem calculation at the same level of theory. Results using an energy-based cutoff scheme suggest that if reasonable approximations to the subsystem energies are available (based on classical multipoles, say), then the number of requisite subsystem calculations can be reduced even more dramatically than when distance-based thresholds are employed. The end result is several accurate four-body methods that do not require charge embedding, and which are stable in large basis sets such as aug-cc-pVTZ that have sometimes proven problematic for fragment-based quantum chemistry methods. Even with aggressive thresholding, however, the four-body approach at the self-consistent field level still requires roughly ten times more processors to outmatch the performance of the corresponding supersystem calculation, in test cases involving 1500-1800 basis functions.

Digital image analysis supports a nuclear-to-cytoplasmic ratio cutoff value of 0.5 for atypical urothelial cells.

PubMed

Hang, Jen-Fan; Charu, Vivek; Zhang, M Lisa; VandenBussche, Christopher J

2017-09-01

An elevated nuclear-to-cytoplasmic (N:C) ratio of ≥0.5 is a required criterion for the diagnosis of atypical urothelial cells (AUC) in The Paris System for Reporting Urinary Cytology. To validate the N:C ratio cutoff value and its predictive power for high-grade urothelial carcinoma (HGUC), the authors retrospectively reviewed the urinary tract cytology specimens of 15 cases of AUC with HGUC on follow-up (AUC-HGUC) and 33 cases of AUC without HGUC on follow-up (AUC-N-HGUC). The number of atypical cells in each case was recorded, and each atypical cell was photographed and digitally examined to calculate the nuclear size and N:C ratio. On average, the maximum N:C ratios of atypical cells were significantly different between the AUC-HGUC and AUC-N-HGUC cohorts (0.53 vs 0.43; P =.00009), whereas the maximum nuclear sizes of atypical cells (153.43 μM 2 vs 201.47 μM 2 ; P = .69) and the number of atypical cells per case (10.13 vs 7.88; P = .12) were not found to be significantly different. Receiver operating characteristic analysis demonstrated that the maximum N:C ratio alone had high discriminatory capacity (area under the curve, 79.19%; 95% confidence interval, 64.19%-94.19%). The optimal maximum N:C ratio threshold was 0.486, giving a sensitivity of 73.3% and a specificity of 84.8% for predicting HGUC on follow-up. The identification of AUC with an N:C ratio >0.486 has a high predictive power for HGUC on follow-up in AUC specimens. This justifies using the N:C ratio as a required criterion for the AUC category. Individual laboratories using different cytopreparation methods may require independent validation of the N:C ratio cutoff value. Cancer Cytopathol 2017;125:710-6. © 2017 American Cancer Society. © 2017 American Cancer Society.

The Lactate/Albumin Ratio: A Valuable Tool for Risk Stratification in Septic Patients Admitted to ICU

PubMed Central

Lichtenauer, Michael; Wernly, Bernhard; Ohnewein, Bernhard; Kabisch, Bjoern; Masyuk, Maryna; Lauten, Alexander; Schulze, Paul Christian; Hoppe, Uta C.; Kelm, Malte; Jung, Christian

2017-01-01

The lactate/albumin ratio has been reported to be associated with mortality in pediatric patients with sepsis. We aimed to evaluate the lactate/albumin ratio for its prognostic relevance in a larger collective of critically ill (adult) patients admitted to an intensive care unit (ICU). A total of 348 medical patients admitted to a German ICU for sepsis between 2004 and 2009 were included. Follow-up of patients was performed retrospectively between May 2013 and November 2013. The association of the lactate/albumin ratio (cut-off 0.15) and both in-hospital and post-discharge mortality was investigated. An optimal cut-off was calculated by means of Youden’s index. The lactate/albumin ratio was elevated in non-survivors (p < 0.001). Patients with an increased lactate/albumin ratio were of similar age, but clinically in a poorer condition and had more pronounced laboratory signs of multi-organ failure. An increased lactate/albumin ratio was associated with adverse in-hospital mortality. An optimal cut-off of 0.15 was calculated and was associated with adverse long-term outcome even after correction for APACHE2 and SAPS2. We matched 99 patients with a lactate/albumin ratio >0.15 to case-controls with a lactate/albumin ratio <0.15 corrected for APACHE2 scores: The group with a lactate/albumin ratio >0.15 evidenced adverse in-hospital outcome in a paired analysis with a difference of 27% (95%CI 10–43%; p < 0.01). Regarding long-term mortality, again, patients in the group with a lactate/albumin ratio >0.15 showed adverse outcomes (p < 0.001). An increased lactate/albumin ratio was significantly associated with an adverse outcome in critically ill patients admitted to an ICU, even after correction for confounders. The lactate/albumin ratio might constitute an independent, readily available, and important parameter for risk stratification in the critically ill. PMID:28869492

The Lactate/Albumin Ratio: A Valuable Tool for Risk Stratification in Septic Patients Admitted to ICU.

PubMed

Lichtenauer, Michael; Wernly, Bernhard; Ohnewein, Bernhard; Franz, Marcus; Kabisch, Bjoern; Muessig, Johanna; Masyuk, Maryna; Lauten, Alexander; Schulze, Paul Christian; Hoppe, Uta C; Kelm, Malte; Jung, Christian

2017-09-02

The lactate/albumin ratio has been reported to be associated with mortality in pediatric patients with sepsis. We aimed to evaluate the lactate/albumin ratio for its prognostic relevance in a larger collective of critically ill (adult) patients admitted to an intensive care unit (ICU). A total of 348 medical patients admitted to a German ICU for sepsis between 2004 and 2009 were included. Follow-up of patients was performed retrospectively between May 2013 and November 2013. The association of the lactate/albumin ratio (cut-off 0.15) and both in-hospital and post-discharge mortality was investigated. An optimal cut-off was calculated by means of Youden's index. The lactate/albumin ratio was elevated in non-survivors ( p < 0.001). Patients with an increased lactate/albumin ratio were of similar age, but clinically in a poorer condition and had more pronounced laboratory signs of multi-organ failure. An increased lactate/albumin ratio was associated with adverse in-hospital mortality. An optimal cut-off of 0.15 was calculated and was associated with adverse long-term outcome even after correction for APACHE2 and SAPS2. We matched 99 patients with a lactate/albumin ratio >0.15 to case-controls with a lactate/albumin ratio <0.15 corrected for APACHE2 scores: The group with a lactate/albumin ratio >0.15 evidenced adverse in-hospital outcome in a paired analysis with a difference of 27% (95%CI 10-43%; p < 0.01). Regarding long-term mortality, again, patients in the group with a lactate/albumin ratio >0.15 showed adverse outcomes ( p < 0.001). An increased lactate/albumin ratio was significantly associated with an adverse outcome in critically ill patients admitted to an ICU, even after correction for confounders. The lactate/albumin ratio might constitute an independent, readily available, and important parameter for risk stratification in the critically ill.

Elevated rates of memory impairment in military service-members and veterans with posttraumatic stress disorder.

PubMed

Stricker, Nikki H; Lippa, Sara M; Green, Deborah L; McGlynn, Susan M; Grande, Laura J; Milberg, William P; McGlinchey, Regina E

2017-10-01

Studies investigating the neurocognitive effects of posttraumatic stress disorder (PTSD) routinely find "deficits" in various cognitive domains. However, the rate of cognitive impairment in individuals with PTSD remains unclear, as studies have focused on null hypothesis testing (NHT) and inferring patterns of impairment rather than empirically determining the rate of cognitive impairment in this sample. This study examined rates of cognitive impairment using a domain-specific approach in non-treatment-seeking Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn service members and veterans with (n = 92) and without (n = 79) PTSD and without substance abuse/dependence who passed a performance validity measure and were matched on age, education, estimated IQ, and ethnicity. Chi-square analyses were used to compare the rate of cognitive impairment across groups based on normative scores using three cutoffs (-1, -1.5, and -2 SDs). NHT was also used to compare performances across groups. Individuals with PTSD showed higher rates of impairment in memory (-1-SD cutoff) than controls, but equivalent rates of impairment in attention, processing speed, and executive functioning; no significant differences were found on NHT. Impairment in any domain was also more prevalent in PTSD (-1-, -1.5-, and -2-SD cutoffs). No differences were found on NHT or rates of impairment in individuals with PTSD with (n = 34) and without (n = 58) depression. Patients with PTSD were more likely to meet criteria for memory impairment and to show impairment in any domain than controls. Patients with PTSD and comorbid depression were no more likely to be impaired in any cognitive domain or to have lower scores on individual cognitive tasks than patients with PTSD alone. Clinicians noting cognitive impairment in individuals with PTSD should exercise caution before ascribing that impairment to another etiology if deficits are limited to memory.

Efficacy of dexamethasone suppression test during the diagnosis of primary pigmented nodular adrenocortical disease in Chinese adrenocorticotropic hormone-independent Cushing syndrome.

PubMed

Chen, Shi; Li, Ran; Lu, Lin; Duan, Lian; Zhang, Xuebin; Tong, Anli; Pan, Hui; Zhu, Huijuan; Lu, Zhaolin

2018-01-01

To evaluate the cut-off value of the ratio of 24 h urinary free cortisol (24 h UFC) levels post-dexamethasone to prior-dexamethasone in dexamethasone suppression test (DST) during the diagnosis of primary pigmented nodular adrenocortical disease in Chinese adrenocorticotropic hormone-independent Cushing syndrome. Retrospective study. The patients diagnosed with primary pigmented nodular adrenocortical disease (PPNAD, n = 25), bilateral macronodular adrenal hyperplasia (BMAH, n = 27), and adrenocortical adenoma (ADA, n = 84) were admitted to the Peking Union Medical College Hospital from 2001 to 2016. Serum cortisol, adrenocorticotropic hormone (ACTH), and 24 h UFC were measured before and after low-dose dexamethasone suppression test (LDDST) and high-dose dexamethasone suppression test (HDDST). After LDDST and HDDST, 24 h UFC elevated in patients with PPNAD (paired t-test, P = 0.007 and P = 0.001), while it remained unchanged in the BMAH group (paired t-test, P = 0.471 and P = 0.414) and decreased in the ADA group (paired t-test, P = 0.002 and P = 0.004). The 24 h UFC level after LDDST was higher in PPNAD and BMAH as compared to ADA (P < 0.017), while no significant difference was observed between PPNAD and BMAH. After HDDST, 24 h UFC was higher in patients with PPNAD as compared to that of ADA and BMAH (P < 0.017). The cut-off value of 24 h UFC (Post-L-Dex)/(Pre-L-Dex) was 1.16 with 64.0% sensitivity and 77.9% specificity, and the cut-off value of 24 h UFC (Post-H-Dex)/(Pre-H-Dex) was 1.08 with 84.0% sensitivity and 75.6% specificity. The ratio of post-dexamethasone to prior-dexamethasone had a unique advantage in distinguishing PPNAD from BMAH and ADA.

VERITAS Observations of the BL Lac Object PG 1553+113

NASA Astrophysics Data System (ADS)

Aliu, E.; Archer, A.; Aune, T.; Barnacka, A.; Behera, B.; Beilicke, M.; Benbow, W.; Berger, K.; Bird, R.; Buckley, J. H.; Bugaev, V.; Byrum, K.; Cardenzana, J. V.; Cerruti, M.; Chen, X.; Ciupik, L.; Connolly, M. P.; Cui, W.; Dickinson, H. J.; Dumm, J.; Eisch, J. D.; Errando, M.; Falcone, A.; Federici, S.; Feng, Q.; Finley, J. P.; Fortin, P.; Fortson, L.; Furniss, A.; Galante, N.; Gillanders, G. H.; Griffin, S.; Griffiths, S. T.; Grube, J.; Gyuk, G.; Håkansson, N.; Hanna, D.; Holder, J.; Hughes, G.; Humensky, T. B.; Johnson, C. A.; Kaaret, P.; Kar, P.; Kertzman, M.; Khassen, Y.; Kieda, D.; Krawczynski, H.; Krennrich, F.; Kumar, S.; Lang, M. J.; Madhavan, A.; McArthur, S.; McCann, A.; Meagher, K.; Millis, J.; Moriarty, P.; Nieto, D.; O'Faoláin de Bhróithe, A.; Ong, R. A.; Orr, M.; Otte, A. N.; Park, N.; Perkins, J. S.; Pohl, M.; Popkow, A.; Prokoph, H.; Pueschel, E.; Quinn, J.; Ragan, K.; Rajotte, J.; Reyes, L. C.; Reynolds, P. T.; Richards, G. T.; Roache, E.; Sembroski, G. H.; Shahinyan, K.; Staszak, D.; Telezhinsky, I.; Tucci, J. V.; Tyler, J.; Varlotta, A.; Vassiliev, V. V.; Wakely, S. P.; Weinstein, A.; Welsing, R.; Wilhelm, A.; Williams, D. A.; Zitzer, B.

2015-01-01

We present results from VERITAS observations of the BL Lac object PG 1553+113 spanning the years 2010, 2011, and 2012. The time-averaged spectrum, measured between 160 and 560 GeV, is well described by a power law with a spectral index of 4.33 ± 0.09. The time-averaged integral flux above 200 GeV measured for this period was (1.69 ± 0.06) × 10-11 photons cm-2 s-1, corresponding to 6.9% of the Crab Nebula flux. We also present the combined γ-ray spectrum from the Fermi Large Area Telescope and VERITAS covering an energy range from 100 MeV to 560 GeV. The data are well fit by a power law with an exponential cutoff at 101.9 ± 3.2 GeV. The origin of the cutoff could be intrinsic to PG 1553+113 or be due to the γ-ray opacity of our universe through pair production off the extragalactic background light (EBL). Given lower limits to the redshift of z > 0.395 based on optical/UV observations of PG 1553+113, the cutoff would be dominated by EBL absorption. Conversely, the small statistical uncertainties of the VERITAS energy spectrum have allowed us to provide a robust upper limit on the redshift of PG 1553+113 of z <= 0.62. A strongly elevated mean flux of (2.50 ± 0.14) × 10-11 photons cm-2 s-1 (10.3% of the Crab Nebula flux) was observed during 2012, with the daily flux reaching as high as (4.44 +/- 0.71) × 10-11 {photons} {cm}-2 {s}-1 (18.3% of the Crab Nebula flux) on MJD 56048. The light curve measured during the 2012 observing season is marginally inconsistent with a steady flux, giving a χ2 probability for a steady flux of 0.03%.

High normal post-load plasma glucose, cardiometabolic risk factors and signs of organ damage in obese children.

PubMed

Di Bonito, Procolo; Licenziati, Maria Rosaria; Baroni, Marco Giorgio; Congiu, Tiziana; Incani, Michela; Iannuzzi, Arcangelo; Maffeis, Claudio; Perrone, Laura; Valerio, Giuliana; Del Giudice, Emanuele Miraglia

2014-08-01

To evaluate normoglycemic overweight/obese (Ow/Ob) children whose post-load plasma glucose (2hPG) cut-point may be significantly associated with cardiometabolic risk factors (CMRFs) and whether this cut-point predicts preclinical signs of organ damage. One thousand seven hundred and thrity four normoglycemic Ow/Ob children were stratified into quintiles of 2hPG, the sixth group was constituted by 101 children with impaired glucose tolerance (IGT). Moving from the lower quintiles of 2hPG to IGT, the groups differed for Prepubertal stage, BMI, fasting PG, insulin levels, blood pressure, and lipids. To evaluate the best cut-off of 2hPG related to CMRFs, the area under the receiver operating characteristic curve and the Youden's index was calculated. Insulin resistance, high blood pressure, and high triglyceride/HDL-C ratio were associated with a 2hPG cut-off of 110 mg/dl. Children with 2hPG ≥110 mg/dl showed 1.3-3.2 fold higher risk to have high levels of ALT (as surrogate of nonalcoholic fatty liver disease) or increased carotid intima-media thickness. This study, performed in a large cohort of Ow/Ob children, shows that an atherogenic risk profile and preclinical signs of organ damage are associated with post-challenge elevations in plasma glucose still considered in the high normal range. Copyright © 2014 The Obesity Society.

Clinical significance of the neutrophil-lymphocyte ratio as an early predictive marker for adverse outcomes in patients with acute pancreatitis

PubMed Central

Jeon, Tae Joo; Park, Ji Young

2017-01-01

AIM To investigated the prognostic value of the neutrophil-lymphocyte ratio (NLR) in patients with acute pancreatitis and determined an optimal cut-off value for the prediction of adverse outcomes in these patients. METHODS We retrospectively analyzed 490 patients with acute pancreatitis diagnosed between March 2007 and December 2012. NLRs were calculated at admission and 24, 48, and 72 h after admission. Patients were grouped according to acute pancreatitis severity and organ failure occurrence, and a comparative analysis was performed to compare the NLR between groups. RESULTS Among the 490 patients, 70 had severe acute pancreatitis with 31 experiencing organ failure. The severe acute pancreatitis group had a significantly higher NLR than the mild acute pancreatitis group on all 4 d (median, 6.14, 6.71, 5.70, and 4.00 vs 4.74, 4.47, 3.20, and 3.30, respectively, P < 0.05). The organ failure group had a significantly higher NLR than the group without organ failure on all 4 d (median, 7.09, 6.72, 6.27, and 6.24 vs 4.85, 4.49, 3.35, and 2.34, respectively, P < 0.05). The optimal cut-off value for baseline NLR was 4.76 in predicting severity and 4.88 in predicting organ failure in acute pancreatitis. CONCLUSION Elevated baseline NLR correlates with severe acute pancreatitis and organ failure. PMID:28638228

Clinical significance of the neutrophil-lymphocyte ratio as an early predictive marker for adverse outcomes in patients with acute pancreatitis.

PubMed

Jeon, Tae Joo; Park, Ji Young

2017-06-07

To investigated the prognostic value of the neutrophil-lymphocyte ratio (NLR) in patients with acute pancreatitis and determined an optimal cut-off value for the prediction of adverse outcomes in these patients. We retrospectively analyzed 490 patients with acute pancreatitis diagnosed between March 2007 and December 2012. NLRs were calculated at admission and 24, 48, and 72 h after admission. Patients were grouped according to acute pancreatitis severity and organ failure occurrence, and a comparative analysis was performed to compare the NLR between groups. Among the 490 patients, 70 had severe acute pancreatitis with 31 experiencing organ failure. The severe acute pancreatitis group had a significantly higher NLR than the mild acute pancreatitis group on all 4 d (median, 6.14, 6.71, 5.70, and 4.00 vs 4.74, 4.47, 3.20, and 3.30, respectively, P < 0.05). The organ failure group had a significantly higher NLR than the group without organ failure on all 4 d (median, 7.09, 6.72, 6.27, and 6.24 vs 4.85, 4.49, 3.35, and 2.34, respectively, P < 0.05). The optimal cut-off value for baseline NLR was 4.76 in predicting severity and 4.88 in predicting organ failure in acute pancreatitis. Elevated baseline NLR correlates with severe acute pancreatitis and organ failure.

Trans-Pacific yellow sand transport observed in April 1998: A numerical simulation

NASA Astrophysics Data System (ADS)

Uno, Itsushi; Amano, Hiroyasu; Emori, Seita; Kinoshita, Kisei; Matsui, Ichiro; Sugimoto, Nobuo

2001-08-01

A yellow sand transport episode from the Asian continent to Japan and North America which occurred in April 1998 is simulated. A new on-line dust tracer model coupled with a regional-scale meteorological model is developed and applied to this dust storm episode. The results for two large dust events that started during April 14-15 and 19-20, 1998, have been analyzed and discussed. The first dust storm was trapped in a cutoff vortex developed over the China plain. A modeled 3-D structure of dust associated with this cutoff vortex agreed with an observed time-height cross section of dust concentration. Results show that the strong subsidence at the backside of the vortex restricted the dust layer below 3 km level. Model analysis revealed that the second dust event that started during April 19-20 over inland China was the origin of a dust episode reported over North America. The trans-Pacific dust transport simulation successfully showed the dust onset near the West Coast of North America. Elevation of the dust layer during the long-range transport was below 3 km. The model is extended to include the transport of an Asian origin anthropogenic tracer over the North Pacific Rim. Both the natural-origin mineral dust and the Asian-origin anthropogenic tracer are simultaneously transported even if their emission regions are different.

Elevated blood pressure in the developing world: a role for clinical pharmacists.

PubMed

Smith, Michael T; Monahan, Megan P; Nelson, Paige; Moruzzi, Matthew; DeLucenay, Alexander J; Birnie, Christine R

2017-09-19

The objective of this study was to evaluate the prevalence and patient knowledge of elevated blood pressure amongst a cross-section of patients in underserved communities in three selected low-income countries worldwide: El Salvador, India and Kenya. Mobile medical clinics were established as part of medical mission trips in El Salvador, India and Kenya. Willing male and female patients, at least 25 years of age, who presented at each clinic were screened for elevated blood pressure, including 332 patients in El Salvador, 847 patients in India and 160 patients in Kenya. Patients were classified into Stage I or II elevated blood pressure based on modified JNCVII guidelines. A questionnaire was completed regarding their knowledge about the existence and management of their disease state. Of the 1339 patients screened, 368 presented with elevated blood pressure (27%). Of these patients, 147 had been previously informed of hypertension or an elevated blood pressure (39.9%), 28 reported receiving antihypertensive medication (7.6%) and 24 reported awareness of non-pharmaceutical treatment options (6.5%). In Kenya, 81 patients were screened in a rural setting and 79 in an urban setting. Patients demonstrating controlled blood pressure were 63 (78%) and 38 (48%), respectively, demonstrating a significant difference between the rural versus urban settings (P = 0.00359). All regions demonstrated similar trends in the prevalence of elevated blood pressure, highlighting the need for increased disease state education in these regions. © 2017 Royal Pharmaceutical Society.

Nonlinear Association Between Cerebrospinal Fluid and Florbetapir F-18 β-Amyloid Measures Across the Spectrum of Alzheimer Disease

PubMed Central

Toledo, Jon B.; Bjerke, Maria; Da, Xiao; Landau, Susan M.; Foster, Norman L; Jagust, William; Jack, Clifford; Weiner, Michael; Davatzikos, Christos; Shaw, Leslie M.; Trojanowski, John Q.

2017-01-01

IMPORTANCE Cerebrospinal fluid (CSF) and positron emission tomographic (PET) amyloid biomarkers have been proposed for the detection of Alzheimer disease (AD) pathology in living patients and for the tracking of longitudinal changes, but the relation between biomarkers needs further study. OBJECTIVE To determine the association between CSF and PET amyloid biomarkers (cross-sectional and longitudinal measures) and compare the cutoffs for these measures. DESIGN, SETTING, AND PARTICIPANTS Longitudinal clinical cohort study from 2005 to 2014 including 820 participants with at least 1 florbetapir F-18 (hereafter referred to as simply florbetapir)–PET scan and at least 1 CSF β-amyloid 1–42 (Aβ1–42) sample obtained within 30 days of each other (501 participants had a second PET scan after 2 years, including 150 participants with CSF Aβ1–42 measurements). Data were obtained from the Alzheimer’s Disease Neuroimaging Initiative database. MAIN OUTCOMES AND MEASURES Four different PET scans processing pipelines from 2 different laboratories were compared. The PET cutoff values were established using a mixture-modeling approach, and different mathematical models were applied to define the association between CSF and PET amyloid measures. RESULTS The values of the CSF Aβ1–42 samples and florbetapir-PET scans showed a nonlinear association (R2 = 0.48–0.66), with the strongest association for values in the middle range. The presence of a larger dynamic range of florbetapir-PET scan values in the higher range compared with the CSF Aβ1–42 plateau explained the differences in correlation with cognition (R2 = 0.36 and R2 = 0.25, respectively). The APOE genotype significantly modified the association between both biomarkers. The PET cutoff values derived from an unsupervised classifier converged with previous PET cutoff values and the established CSF Aβ1–42 cutoff levels. There was no association between longitudinal Aβ1–42 levels and standardized uptake value ratios during follow-up. CONCLUSIONS AND RELEVANCE The association between both biomarkers is limited to a middle range of values, is modified by the APOE genotype, and is absent for longitudinal changes; 4 different approaches in 2 different platforms converge on similar pathological Aβ cutoff levels; and different pipelines to process PET scans showed correlated but not identical results. Our findings suggest that both biomarkers measure different aspects of AD Aβ pathology. PMID:25822737

The effects of wavelet compression on Digital Elevation Models (DEMs)

USGS Publications Warehouse

Oimoen, M.J.

2004-01-01

This paper investigates the effects of lossy compression on floating-point digital elevation models using the discrete wavelet transform. The compression of elevation data poses a different set of problems and concerns than does the compression of images. Most notably, the usefulness of DEMs depends largely in the quality of their derivatives, such as slope and aspect. Three areas extracted from the U.S. Geological Survey's National Elevation Dataset were transformed to the wavelet domain using the third order filters of the Daubechies family (DAUB6), and were made sparse by setting 95 percent of the smallest wavelet coefficients to zero. The resulting raster is compressible to a corresponding degree. The effects of the nulled coefficients on the reconstructed DEM are noted as residuals in elevation, derived slope and aspect, and delineation of drainage basins and streamlines. A simple masking technique also is presented, that maintains the integrity and flatness of water bodies in the reconstructed DEM.

Acceleration levels on board the Space Station and a tethered elevator for micro and variable-gravity applications

NASA Technical Reports Server (NTRS)

Lorenzini, E. C.; Cosmo, M.; Vetrella, S.; Moccia, A.

1988-01-01

This paper investigates the dynamics and acceleration levels of a new tethered system for micro and variable-gravity applications. The system consists of two platforms tethered on opposite sides to the Space Station. A fourth platform, the elevator, is placed in between the Space Station and the upper platform. Variable-g levels on board the elevator are obtained by moving this facility along the upper tether, while micro-g experiments are carried out on board the Space Station. By controlling the length of the lower tether the position of the system CM can be maintained on board the Space Station despite variations of the station's distribution of mass. The paper illustrates the mathematical model, the environmental perturbations and the control techniques which have been adopted for the simulation and control of the system dynamics. Two sets of results from two different simulation runs are shown. The first set shows the system dynamics and the acceleration spectra on board the Space Station and the elevator during station-keeping. The second set of results demonstrates the capability of the elevator to attain a preselected g-level.

Have bird distributions shifted along an elevational gradient on a tropical mountain?

PubMed

Campos-Cerqueira, Marconi; Arendt, Wayne J; Wunderle, Joseph M; Aide, T Mitchell

2017-12-01

An upward shift in elevation is one of the most conspicuous species responses to climate change. Nevertheless, downward shifts and, apparently, the absences of response have also been recently reported. Given the growing evidence of multiple responses of species distributions due to climate change and the paucity of studies in the tropics, we evaluated the response of a montane bird community to climate change, without the confounding effects of land-use change. To test for elevational shifts, we compared the distribution of 21 avian species in 1998 and 2015 using occupancy models. The historical data set was based on point counts, whereas the contemporary data set was based on acoustic monitoring. We detected a similar number of species in historical (36) and contemporary data sets (33). We show an overall pattern of no significant change in range limits for most species, although there was a significant shift in the range limit of eight species (38%). Elevation limits shifted mostly upward, and this pattern was more common for upper than lower limits. Our results highlight the variability of species responses to climate change and illustrate how acoustic monitoring provides an easy and powerful way to monitor animal populations along elevational gradients.

Effect of the Ionosphere on Space and Terrestrial Systems

DTIC Science & Technology

1978-01-01

adequately shielded and filtered, Voyager spacecraft was modified to include arc that the grounding of all conductive elements discharge sources...dependence. Reasons for such a a set of the associated "cutoff orbits ". We choice include the following: A realistic see from Fig. 8 that the included angle...which had been modified to produce an approxima- chronous- orbit spacecraft [De Forest, 1972; tely uniform flood beam up to 10cm in diameter

Time to Positivity and Detection of Growth in Anaerobic Blood Culture Vials Predict the Presence of Candida glabrata in Candidemia: a Two-Center European Cohort Study

PubMed Central

Kaasch, Achim J.; Soriano, Alex; Torres, Jorge-Luis; Vergara, Andrea; Morata, Laura; Zboromyrska, Yuliya; De La Calle, Cristina; Alejo, Izaskun; Hernández, Cristina; Cardozo, Celia; Marco, Franscesc; Del Río, Ana; Almela, Manel; Mensa, Josep; Martínez, José Antonio

2014-01-01

This study shows the accuracy of exclusive or earlier growth in anaerobic vials to predict Candida glabrata in a large series of candidemic patients from two European hospitals using the Bactec 9240 system. Alternatively, C. glabrata can be predicted by a time to positivity cutoff value, which should be determined for each setting. PMID:24899027

10 CFR 26.163 - Cutoff levels for drugs and drug metabolites.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 1 2010-01-01 2010-01-01 false Cutoff levels for drugs and drug metabolites. 26.163... the Department of Health and Human Services § 26.163 Cutoff levels for drugs and drug metabolites. (a) Initial drug testing. (1) HHS-certified laboratories shall apply the following cutoff levels for initial...

10 CFR 26.163 - Cutoff levels for drugs and drug metabolites.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 1 2014-01-01 2014-01-01 false Cutoff levels for drugs and drug metabolites. 26.163... the Department of Health and Human Services § 26.163 Cutoff levels for drugs and drug metabolites. (a) Initial drug testing. (1) HHS-certified laboratories shall apply the following cutoff levels for initial...

10 CFR 26.163 - Cutoff levels for drugs and drug metabolites.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 1 2011-01-01 2011-01-01 false Cutoff levels for drugs and drug metabolites. 26.163... the Department of Health and Human Services § 26.163 Cutoff levels for drugs and drug metabolites. (a) Initial drug testing. (1) HHS-certified laboratories shall apply the following cutoff levels for initial...

10 CFR 26.163 - Cutoff levels for drugs and drug metabolites.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 1 2013-01-01 2013-01-01 false Cutoff levels for drugs and drug metabolites. 26.163... the Department of Health and Human Services § 26.163 Cutoff levels for drugs and drug metabolites. (a) Initial drug testing. (1) HHS-certified laboratories shall apply the following cutoff levels for initial...

10 CFR 26.163 - Cutoff levels for drugs and drug metabolites.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 1 2012-01-01 2012-01-01 false Cutoff levels for drugs and drug metabolites. 26.163... the Department of Health and Human Services § 26.163 Cutoff levels for drugs and drug metabolites. (a) Initial drug testing. (1) HHS-certified laboratories shall apply the following cutoff levels for initial...

40 CFR 53.53 - Test for flow rate accuracy, regulation, measurement accuracy, and cut-off.

Code of Federal Regulations, 2010 CFR

2010-07-01

..., measurement accuracy, and cut-off. 53.53 Section 53.53 Protection of Environment ENVIRONMENTAL PROTECTION..., measurement accuracy, and cut-off. (a) Overview. This test procedure is designed to evaluate a candidate... measurement accuracy, coefficient of variability measurement accuracy, and the flow rate cut-off function. The...

The Effects of Low- and High-Energy Cutoffs on Solar Flare Microwave and Hard X-Ray Spectra

NASA Technical Reports Server (NTRS)

Holman, G. D.; Oegerle, William (Technical Monitor)

2002-01-01

Microwave and hard x-ray spectra provide crucial information about energetic electrons and their environment in solar flares. These spectra are becoming better determined with the Owens Valley Solar Array (OVSA) and the recent launch of the Ramaty High Energy Solar Spectroscopic Imager (RHESSI). The proposed Frequency Agile Solar Radiotelescope (FASR) promises even greater advances in radio observations of solar flares. Both microwave and hard x-ray spectra are sensitive to cutoffs in the electron distribution function. The determination of the high-energy cutoff from these spectra establishes the highest electron energies produced by the acceleration mechanism, while determination of the low-energy cutoff is crucial to establishing the total energy in accelerated electrons. This paper will show computations of the effects of both high- and low-energy cutoffs on microwave and hard x-ray spectra. The optically thick portion of a microwave spectrum is enhanced and smoothed by a low-energy cutoff, while a hard x-ray spectrum is flattened below the cutoff energy. A high-energy cutoff steepens the microwave spectrum and increases the wavelength at which the spectrum peaks, while the hard x-ray spectrum begins to steepen at photon energies roughly an order of magnitude below the electron cutoff energy. This work discusses how flare microwave and hard x-ray spectra can be analyzed together to determine these electron cutoff energies. This work is supported in part by the NASA Sun-Earth Connection Program.

Augmenting groundwater monitoring networks near landfills with slurry cutoff walls.

PubMed

Hudak, Paul F

2004-01-01

This study investigated the use of slurry cutoff walls in conjunction with monitoring wells to detect contaminant releases from a solid waste landfill. The 50 m wide by 75 m long landfill was oriented oblique to regional groundwater flow in a shallow sand aquifer. Computer models calculated flow fields and the detection capability of six monitoring networks, four including a 1 m wide by 50 m long cutoff wall at various positions along the landfill's downgradient boundaries and upgradient of the landfill. Wells were positioned to take advantage of convergent flow induced downgradient of the cutoff walls. A five-well network with no cutoff wall detected 81% of contaminant plumes originating within the landfill's footprint before they reached a buffer zone boundary located 50 m from the landfill's downgradient corner. By comparison, detection efficiencies of networks augmented with cutoff walls ranged from 81 to 100%. The most efficient network detected 100% of contaminant releases with four wells, with a centrally located, downgradient cutoff wall. In general, cutoff walls increased detection efficiency by delaying transport of contaminant plumes to the buffer zone boundary, thereby allowing them to increase in size, and by inducing convergent flow at downgradient areas, thereby funneling contaminant plumes toward monitoring wells. However, increases in detection efficiency were too small to offset construction costs for cutoff walls. A 100% detection efficiency was also attained by an eight-well network with no cutoff wall, at approximately one-third the cost of the most efficient wall-augmented network.

Controls on cutoff formation along a tropical meandering river in the Amazon Basin

NASA Astrophysics Data System (ADS)

Ahmed, J.; Constantine, J. A.

2016-12-01

The termination of meander bends is an inherent part of the evolution of meandering rivers. Cutoffs are produced by one of two mechanisms: neck cutoffs occur when two adjacent meanders converge, while chute cutoffs are generated by flood-driven floodplain incision, resulting in a shorter, steeper channel path. Here we use an annually-resolved record of Landsat imagery, coupled with daily discharge data to assess the role of high-magnitude discharges (Q ≥ QBF) on cutoff formation along the Rio Beni, Bolivia. Our results suggest that despite numerous above-bankfull events, the dominant cutoff mechanism operating on the Beni is neck cutoff. Evaluating the formation of these cutoffs reveals that migration rates accelerate during years of high discharge, and eventually cause the migrating bends to breach. The density of floodplain vegetation and the medium into which the channel migrated was also responsible for the patterns of cutoff documented along this river. The presence of existing floodplain channels permitted the river to divert its flow along shorter courses thereby facilitating cutoff, and limiting sinuosity growth. Understanding the long-term evolution of meandering channels is important since their morphodynamics are responsible for the creation of highly biodiverse riparian habitats, as well as the store and release of alluvial material. Moreover, the interactions between discharge and the channel-floodplain system are integral for the functioning and long-term evolution of these landscapes, particularly in the face of global climate change.

Montreal Cognitive Assessment: One Cutoff Never Fits All.

PubMed

Wong, Adrian; Law, Lorraine S N; Liu, Wenyan; Wang, Zhaolu; Lo, Eugene S K; Lau, Alexander; Wong, Lawrence K S; Mok, Vincent C T

2015-12-01

The objective of this study is to examine the discrepancy between single versus age and education corrected cutoff scores in classifying performance on the Montreal Cognitive Assessment (MoCA) in patients with stroke or transient ischemic attack. MoCA norms were collected from 794 functionally independent and stroke- and dementia-free persons aged ≥65 years. magnetic resonance imaging was used to exclude healthy controls with significant brain pathology and medial temporal lobe atrophy. Cutoff scores at 16th, 7th, and 2nd percentiles by age and education were derived for the MoCA and MoCA 5-minute Protocol. MoCA performance in 919 patients with stroke or transient ischemic attack was classified using the single and norm-derived cutoff scores. The norms for the Hong Kong version of the MoCA total and domain scores and the total score of the MoCA 5-minute protocol are described. Only 65.1% and 25.7% healthy controls and 45.2% and 19.0% patients scored above the conventional cutoff scores of 21/22 and 25/26 on the MoCA. Using classification with norm-derived cutoff scores as reference, locally derived cutoff score of 21/22 yielded a classification discrepancy of ≤42.4%. Discrepancy increased with higher age and lower education level, with the majority being false positives by single cutoffs. With the 25/26 cutoff of the original MoCA, discrepancy further increased to ≤74.3%. Conventional single cutoff scores are associated with substantially high rates of misclassification especially in older and less-educated patients with stroke. These results caution against the use of one-size-fits-all cutoffs on the MoCA. © 2015 American Heart Association, Inc.

Mach Cutoff Analysis and Results from NASA's Farfield Investigation of No-Boom Thresholds

NASA Technical Reports Server (NTRS)

Cliatt, Larry J., II; Hill, Michael A.; Haering, Edward A., Jr.

2016-01-01

In support of the ongoing effort by the National Aeronautics and Space Administration (NASA) to bring supersonic commercial travel to the public, the NASA Armstrong Flight Research Center and the NASA Langley Research Center, in partnership with other industry organizations and academia, conducted a flight research experiment to analyze acoustic propagation in the Mach cutoff shadow zone. The effort was conducted in the fall of 2012 and named the Farfield Investigation of No-boom Thresholds (FaINT). The test helped to build a dataset that will go toward further understanding of the unique acoustic propagation characteristics below Mach cutoff altitude. FaINT was able to correlate sonic boom noise levels measured below cutoff altitude with precise airplane flight conditions, potentially increasing the accuracy over previous studies. A NASA F-18B airplane made supersonic passes such that its Mach cutoff caustic would be at varying distances above a linear 60-microphone, 7375-ft (2247.9 m) long array. A TG-14 motor glider equipped with a microphone on its wing-tip also attempted to capture the same sonic boom waves above ground, but below the Mach cutoff altitude. This paper identified an appropriate metric for sonic boom waveforms in the Mach cutoff shadow zone called Perceived Sound Exposure Level; derived an empirical relationship between Mach cutoff flight conditions and noise levels in the shadow zone; validated a safe cutoff altitude theory presented by previous studies; analyzed the sensitivity of flight below Mach cutoff to unsteady atmospheric conditions and realistic aircraft perturbations; and demonstrated the ability to record sonic boom measurements over 5000 ft (1524.0 m) above ground level, but below Mach cutoff altitude.

Inappropriate Use of Homeostasis Model Assessment Cutoff Values for Diagnosing Insulin Resistance in Pediatric Studies.

PubMed

Fox, Carrie; Bernardino, Lourdes; Cochran, Jill; Essig, Mary; Bridges, Kristie Grove

2017-11-01

Assessing pediatric patients for insulin resistance is one way to identify those who are at a high risk of developing type 2 diabetes mellitus. The homoeostasis model assessment (HOMA) is a measure of insulin resistance based on fasting blood glucose and insulin levels. Although this measure is widely used in research, cutoff values for pediatric populations have not been established. To assess the validity of HOMA cutoff values used in pediatric studies published in peer-reviewed journals. Studies published from January 2010 to December 2015 were identified through MEDLINE. Initial screening of abstracts was done to select studies that were conducted in pediatric populations and used HOMA to assess insulin resistance. Subsequent full-text review narrowed the list to only those studies that used a specific HOMA score to diagnose insulin resistance. Each study was classified as using a predetermined fixed HOMA cutoff value or a cutoff that was a percentile specific to that population. For studies that used a predetermined cutoff value, the references cited to provide evidence in support of that cutoff were evaluated. In the 298 articles analyzed, 51 different HOMA cutoff values were used to classify patients as having insulin resistance. Two hundred fifty-five studies (85.6%) used a predetermined fixed cutoff value, but only 72 (28.2%) of those studies provided a reference that supported its use. One hundred ten studies (43%) that used a fixed cutoff either cited a study that did not mention HOMA or provided no reference at all. Tracing of citation history indicated that the most commonly used cutoff values were ultimately based on studies that did not validate their use for defining insulin resistance. Little evidence exists to support HOMA cutoff values commonly used to define insulin resistance in pediatric studies. These findings highlight the importance of validating study design elements when training medical students and novice investigators. Using available data to generate population ranges for HOMA would improve its clinical utility.

Optimized classification of 18F-Florbetaben PET scans as positive and negative using an SUVR quantitative approach and comparison to visual assessment.

PubMed

Bullich, Santiago; Seibyl, John; Catafau, Ana M; Jovalekic, Aleksandar; Koglin, Norman; Barthel, Henryk; Sabri, Osama; De Santi, Susan

2017-01-01

Standardized uptake value ratios (SUVRs) calculated from cerebral cortical areas can be used to categorize 18 F-Florbetaben (FBB) PET scans by applying appropriate cutoffs. The objective of this work was first to generate FBB SUVR cutoffs using visual assessment (VA) as standard of truth (SoT) for a number of reference regions (RR) (cerebellar gray matter (GCER), whole cerebellum (WCER), pons (PONS), and subcortical white matter (SWM)). Secondly, to validate the FBB PET scan categorization performed by SUVR cutoffs against the categorization made by post-mortem histopathological confirmation of the Aβ presence. Finally, to evaluate the added value of SUVR cutoff categorization to VA. SUVR cutoffs were generated for each RR using FBB scans from 143 subjects who were visually assessed by 3 readers. SUVR cutoffs were validated in 78 end-of life subjects using VA from 8 independent blinded readers (3 expert readers and 5 non-expert readers) and histopathological confirmation of the presence of neuritic beta-amyloid plaques as SoT. Finally, the number of correctly or incorrectly classified scans according to pathology results using VA and SUVR cutoffs was compared. Composite SUVR cutoffs generated were 1.43 (GCER), 0.96 (WCER), 0.78 (PONS) and 0.71 (SWM). Accuracy values were high and consistent across RR (range 83-94% for histopathology, and 85-94% for VA). SUVR cutoff performed similarly as VA but did not improve VA classification of FBB scans read either by expert readers or the majority read but provided higher accuracy than some non-expert readers. The accurate scan classification obtained in this study supports the use of VA as SoT to generate site-specific SUVR cutoffs. For an elderly end of life population, VA and SUVR cutoff categorization perform similarly in classifying FBB scans as Aβ-positive or Aβ-negative. These results emphasize the additional contribution that SUVR cutoff classification may have compared with VA performed by non-expert readers.

Plaque Tissue Morphology-Based Stroke Risk Stratification Using Carotid Ultrasound: A Polling-Based PCA Learning Paradigm.

PubMed

Saba, Luca; Jain, Pankaj K; Suri, Harman S; Ikeda, Nobutaka; Araki, Tadashi; Singh, Bikesh K; Nicolaides, Andrew; Shafique, Shoaib; Gupta, Ajay; Laird, John R; Suri, Jasjit S

2017-06-01

Severe atherosclerosis disease in carotid arteries causes stenosis which in turn leads to stroke. Machine learning systems have been previously developed for plaque wall risk assessment using morphology-based characterization. The fundamental assumption in such systems is the extraction of the grayscale features of the plaque region. Even though these systems have the ability to perform risk stratification, they lack the ability to achieve higher performance due their inability to select and retain dominant features. This paper introduces a polling-based principal component analysis (PCA) strategy embedded in the machine learning framework to select and retain dominant features, resulting in superior performance. This leads to more stability and reliability. The automated system uses offline image data along with the ground truth labels to generate the parameters, which are then used to transform the online grayscale features to predict the risk of stroke. A set of sixteen grayscale plaque features is computed. Utilizing the cross-validation protocol (K = 10), and the PCA cutoff of 0.995, the machine learning system is able to achieve an accuracy of 98.55 and 98.83%corresponding to the carotidfar wall and near wall plaques, respectively. The corresponding reliability of the system was 94.56 and 95.63%, respectively. The automated system was validated against the manual risk assessment system and the precision of merit for same cross-validation settings and PCA cutoffs are 98.28 and 93.92%for the far and the near wall, respectively.PCA-embedded morphology-based plaque characterization shows a powerful strategy for risk assessment and can be adapted in clinical settings.

Mean Normal Portal Vein Diameter Using Sonography among Clients Coming to Radiology Department of Jimma University Hospital, Southwest Ethiopia.

PubMed

Geleto, Gemechu; Getnet, Wondim; Tewelde, Tsegaye

2016-05-01

Mean portal vein diameter is considered as the best indicator for portal hypertension. However, the cutoff point differs from study to study (above 10-15 mm) despite the existence of normal mean portal vein diameter between 10-15 mm in different settings.This implies the existence of limited evidence on normal portal vein diameter for all populations in all countries prior to setting the cutoff points. Therefore, the aim of this study was sonographic assessment of normal mean portal vein diameter among patients referred to The Department of Radiology in Jimma University Hospital. A facility based cross-sectional study was conducted from November to December 2014 at Jimma University Hospital on a total of 195 clients. Data about portal vein diameter for eligible clients were collected by radiologists using Sonography. Data were edited manually, entered and analyzed using SPSS version 16. Data were collected from a total of 195 participants. Among these, 121(62.1%) were males and the median age of the participants was 35 years. The study revealed a normal mean portal vein diameter of 10.6 mm ±1.8 SD with a respirophasic variation of 25.6%. Likewise, the normal mean portal vein diameter seemed to have varied significantly by age and sex. The study revealed a normal mean portal vein diameter ranging below 13 mm. Hence, decisions made in clinical settings should base on these findings. Besides, there is a need for large scale study to determine portal vein diameter variation by age and sex, controlling other confounders.

Young Athletes Cleared for Sports Participation After Anterior Cruciate Ligament Reconstruction: How Many Actually Meet Recommended Return-to-Sport Criterion Cutoffs?

PubMed

Toole, Allison R; Ithurburn, Matthew P; Rauh, Mitchell J; Hewett, Timothy E; Paterno, Mark V; Schmitt, Laura C

2017-11-01

Study Design Prospective cohort study. Background While meeting objective criterion cutoffs is recommended prior to return to sports following anterior cruciate ligament (ACL) reconstruction, the number of young athletes who meet recommended cutoffs and the impact of cutoffs on longitudinal sports participation are unknown. Objectives To test the hypothesis that a higher proportion of young athletes who meet recommended cutoffs will maintain the same level of sports participation over the year following return-to-sport clearance compared to those who do not meet recommended cutoffs. Methods At the time of return-to-sport clearance, the International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC), quadriceps and hamstring strength limb symmetry index (LSI), and single-leg hop test LSI were assessed. Proportions of participants who met individual (IKDC score of 90 or greater; strength and hop test LSIs of 90% or greater) and combined cutoffs were calculated. Proportions of participants who continued at the same level of sports participation over the year following return-to-sport clearance (assessed using the Tegner activity scale) were compared between those who met and did not meet cutoffs. Results Participants included 115 young athletes (88 female). The proportions meeting individual cutoffs ranged from 43.5% to 78.3%. The proportions meeting cutoffs for all hop tests, all strength tests, and all combined measures were 53.0%, 27.8%, and 13.9%, respectively. A higher proportion of participants who met cutoffs for both strength tests maintained the same level of sports participation over the year following return-to-sport clearance than those who did not (81.3% versus 60.2%, P = .02). Conclusion The proportions of young athletes after ACL reconstruction recently cleared for return to sports who met the combined criterion cutoffs were low. Those who met the criterion cutoffs for both strength tests maintained the same level of sports participation at higher proportions than those who did not. Level of Evidence Prognosis, level 2b. J Orthop Sports Phys Ther 2017;47(11):825-833. Epub 7 Oct 2017. doi:10.2519/jospt.2017.7227.

A modified fall risk assessment tool that is specific to physical function predicts falls in community-dwelling elderly people.

PubMed

Hirase, Tatsuya; Inokuchi, Shigeru; Matsusaka, Nobuou; Nakahara, Kazumi; Okita, Minoru

2014-01-01

Developing a practical fall risk assessment tool to predict the occurrence of falls in the primary care setting is important because investigators have reported deterioration of physical function associated with falls. Researchers have used many performance tests to predict the occurrence of falls. These performance tests predict falls and also assess physical function and determine exercise interventions. However, the need for such specialists as physical therapists to accurately conduct these tests limits their use in the primary care setting. Questionnaires for fall prediction offer an easy way to identify high-risk fallers without requiring specialists. Using an existing fall assessment questionnaire, this study aimed to identify items specific to physical function and determine whether those items were able to predict falls and estimate physical function of high-risk fallers. The analysis consisted of both retrospective and prospective studies and used 2 different samples (retrospective, n = 1871; prospective, n = 292). The retrospective study and 3-month prospective study comprised community-dwelling individuals aged 65 years or older and older adults using community day centers. The number of falls, risk factors for falls (15 risk factors on the questionnaire), and physical function determined by chair standing test (CST) and Timed Up and Go Test (TUGT) were assessed. The retrospective study selected fall risk factors related to physical function. The prospective study investigated whether the number of selected risk factors could predict falls. The predictive power was determined using the area under the receiver operating characteristic curve. Seven of the 15 risk factors were related to physical function. The area under the receiver operating characteristic curve for the sum of the selected risk factors of previous falls plus the other risk factors was 0.82 (P = .00). The best cutoff point was 4 risk factors, with sensitivity and specificity of 84% and 68%, respectively. The mean values for the CST and TUGT at the best cutoff point were 12.9 and 12.5 seconds, respectively. In the retrospective study, the values for the CST and TUGT corresponding to the best cutoff point from the prospective study were 13.2 and 11.4 seconds, respectively. This study confirms that a screening tool comprising 7 fall risk factors can be used to predict falls. The values for the CST and TUGT corresponding to the best cutoff point for the selected 7 risk factors determined in our prospective study were similar to the cutoff points for the CST and TUGT in previous studies for fall prediction. We propose that the sum of the selected risk factors of previous falls plus the other risk factors may be identified as the estimated value for physical function. These findings may contribute to earlier identification of high-risk fallers and intervention for fall prevention.

Prognostic impact of C-reactive protein/albumin ratio on the overall survival of patients with advanced nonsmall cell lung cancers receiving palliative chemotherapy

PubMed Central

Koh, Young W.; Lee, Hyun W.

2017-01-01

Abstract Recent studies have indicated that the C-reactive protein (CRP)/albumin (CRP/Alb) ratio is associated with clinical outcomes in patients with various carcinomas. However, no studies have explored the association between the ratio of CRP/Alb and clinical outcome of inoperable patients with nonsmall cell lung cancers (NSCLCs). We examined the prognostic impact of CRP/Alb ratio on 165 stage IV NSCLC receiving palliative chemotherapy. The optimal cutoff level of CRP/Alb ratio was set at 0.195. The median follow-up time was 9 months (range, 1–74 months). On univariate analysis, high CRP/Alb ratio (≥0.195) was correlated (P < .001) with poorer overall survival (OS). Subgroup analysis of adenocarcinoma showed that CRP/Alb ratio was significantly (P < .001) associated with OS. Multivariate analysis showed that CRP/Alb ratio was an independent prognostic factor for OS (hazard ratio: 2.227, P = .001). Subgroup analysis revealed that the CRP/Alb ratio had a significant (P = .001) prognostic impact on adenocarcinoma patients receiving platinum chemotherapy. Elevated CRP/Alb ratio was significantly associated with male gender (P = .002) and smoking history (P = .009). The results of this study suggest that the CRP/Alb ratio might be used as a simple, inexpensive, and independent prognostic factor for OS of patients with advanced lung adenocarcinomas receiving platinum chemotherapy. PMID:28489774

Changes of endocrine and ultrasound markers as ovarian aging in modifying the Stages of Reproductive Aging Workshop (STRAW) staging system with subclassification of mid reproductive age stage.

PubMed

Ding, Ting; Luo, Aiyue; Jiang, Jingjing; Du, Xiaofang; Yang, Shuhong; Lai, Zhiwen; Shen, Wei; Lu, Yunping; Ma, Ding; Wang, Shixuan

2013-01-01

To demonstrate the changes of ovarian aging markers across the Stages of Reproductive Aging Workshop (STRAW) stages and modify it with subclassification of mid reproductive age stage (MR). Healthy females were classified according to the STRAW system. Serum basal FSH, LH, E2, and anti-Müllerian hormone (AMH) were detected, FSH/LH ratio calculated, and antral follicle counts (AFCs) determined in follicular phase. Progression through the whole STRAW stages under MR stage subdivided is associated with elevations in FSH, LH, FSH/LH ratio and decreases in E2, AMH and AFCs (p < 0.001). Both serum AMH and AFCs decreased early (after 25 years) and significantly (p < 0.01) with chronological age in MR stage. 0.982 ng/ml AMH and 3 antral follicles (low level of MR 25-30 years) were set as cutoffs to distinguish MR stage into early mid reproductive age (EMR) and late mid reproductive age (LMR) stages. The women in EMR stage compared with LMR could retrieve more oocytes in IVF treatment (p < 0.05) and has a higher pregnancy chance (57.9%) though not significant. The early and marked fall in serum AMH levels and AFCs suggest fine markers to further categorize and define the MR stage, demonstrating disparate reproductive aging period with reduced ovarian reserve in young age across the STRAW stages.

Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) predictors of police officer problem behavior and collateral self-report test scores.

PubMed

Tarescavage, Anthony M; Fischler, Gary L; Cappo, Bruce M; Hill, David O; Corey, David M; Ben-Porath, Yossef S

2015-03-01

The current study examined the predictive validity of Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF; Ben-Porath & Tellegen, 2008/2011) scores in police officer screenings. We utilized a sample of 712 police officer candidates (82.6% male) from 2 Midwestern police departments. The sample included 426 hired officers, most of whom had supervisor ratings of problem behaviors and human resource records of civilian complaints. With the full sample, we calculated zero-order correlations between MMPI-2-RF scale scores and scale scores from the California Psychological Inventory (Gough, 1956) and Inwald Personality Inventory (Inwald, 2006) by gender. In the hired sample, we correlated MMPI-2-RF scale scores with the outcome data for males only, owing to the relatively small number of hired women. Several scales demonstrated meaningful correlations with the criteria, particularly in the thought dysfunction and behavioral/externalizing dysfunction domains. After applying a correction for range restriction, the correlation coefficient magnitudes were generally in the moderate to large range. The practical implications of these findings were explored by means of risk ratio analyses, which indicated that officers who produced elevations at cutscores lower than the traditionally used 65 T-score level were as much as 10 times more likely than those scoring below the cutoff to exhibit problem behaviors. Overall, the results supported the validity of the MMPI-2-RF in this setting. Implications and limitations of this study are discussed. 2015 APA, all rights reserved

Regional Differences in Stratospheric Intrusions over the USA Investigated using the NASA MERRA-2 Reanalysis

NASA Astrophysics Data System (ADS)

Knowland, K. E.; Ott, L.; Hodges, K.; Wargan, K.; Duncan, B. N.

2016-12-01

Stratospheric intrusions (SI) - the introduction of ozone-rich stratospheric air into the troposphere - have been linked with surface ozone air quality exceedences, especially at the high elevations in the western USA in springtime. However, the impact of SIs in the remaining seasons and over the rest of the USA is less clear. This study investigates the atmospheric dynamics that generate SIs over the western USA and the different mechanisms through which SIs may influence atmospheric chemistry and surface air quality over the eastern USA. An analysis of the spatiotemporal variability of SIs over the continental US is performed using NASA's Modern-Era Retrospective Analysis for Research and Applications Version-2 (MERRA-2) reanalysis dataset and other Goddard Earth Observing System Model, Version 5 (GEOS-5) model products. Both upper-level and lower-level dynamical features are examined on seasonal timescales using the tracking algorithm of Hodges (1995, 1999). We show how upper-level relative vorticity maxima - representing troughs and cut-off lows - can be tracked and related to the lower-level storm tracks. The influence of both sets of tracks on the assimilated MERRA-2 ozone and meteorological parameters throughout the troposphere and lower stratosphere is quantified. By focusing on the major modes of variability that influence the weather patterns in the USA, namely the Pacific North American (PNA) pattern, Arctic Oscillation (AO) and the North Atlantic Oscillation (NAO), predicative patterns in the meteorological fields that are associated with SIs are identified for their regional effects.

Cardiovascular risk assessment of dyslipidemic children: analysis of biomarkers to identify monogenic dyslipidemia[S

PubMed Central

Medeiros, Ana Margarida; Alves, Ana Catarina; Aguiar, Pedro; Bourbon, Mafalda

2014-01-01

The distinction between a monogenic dyslipidemia and a polygenic/environmental dyslipidemia is important for the cardiovascular risk assessment, counseling, and treatment of these patients. The present work aims to perform the cardiovascular risk assessment of dyslipidemic children to identify useful biomarkers for clinical criteria improvement in clinical settings. Main cardiovascular risk factors were analyzed in a cohort of 237 unrelated children with clinical diagnosis of familial hypercholesterolemia (FH). About 40% carried at least two cardiovascular risk factors and 37.6% had FH, presenting mutations in LDLR and APOB. FH children showed significant elevated atherogenic markers and lower concentration of antiatherogenic particles. Children without a molecular diagnosis of FH had higher levels of TGs, apoC2, apoC3, and higher frequency of BMI and overweight/obesity, suggesting that environmental factors can be the underlying cause of their hypercholesterolem≥ia. An apoB/apoA1 ratio ≥0.68 was identified as the best biomarker (area under the curve = 0.835) to differentiate FH from other dyslipidemias. The inclusion in clinical criteria of a higher cut-off point for LDL cholesterol or an apoB/apoA1 ratio ≥0.68 optimized the criteria sensitivity and specificity. The correct identification, at an early age, of all children at-risk is of great importance so that specific interventions can be implemented. apoB/apoA1 can improve the identification of FH patients. PMID:24627126

77 FR 20999 - Final Flood Elevation Determinations

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-09

... set forth below: * Elevation in feet (NGVD) + Elevation in feet (NAVD) Depth in feet Flooding source(s..., and Incorporated Areas Docket No.: FEMA-B-1100 Mississippi River Approximately 11.2 miles +585 City of.... Approximately 12.8 miles +594 upstream of State Highway 136. * National Geodetic Vertical Datum. + North...

Quantitative molecular orbital energies within a G0W0 approximation

NASA Astrophysics Data System (ADS)

Sharifzadeh, S.; Tamblyn, I.; Doak, P.; Darancet, P. T.; Neaton, J. B.

2012-09-01

Using many-body perturbation theory within a G 0 W 0 approximation, with a plane wave basis set and using a starting point based on density functional theory within the generalized gradient approximation, we explore routes for computing the ionization potential (IP), electron affinity (EA), and fundamental gap of three gas-phase molecules — benzene, thiophene, and (1,4) diamino-benzene — and compare with experiments. We examine the dependence of the IP and fundamental gap on the number of unoccupied states used to represent the dielectric function and the self energy, as well as the dielectric function plane-wave cutoff. We find that with an effective completion strategy for approximating the unoccupied subspace, and a well converged dielectric function kinetic energy cutoff, the computed IPs and EAs are in excellent quantitative agreement with available experiment (within 0.2 eV), indicating that a one-shot G 0 W 0 approach can be very accurate for calculating addition/removal energies of small organic molecules.

NMR permeability estimators in 'chalk' carbonate rocks obtained under different relaxation times and MICP size scalings

NASA Astrophysics Data System (ADS)

Rios, Edmilson Helton; Figueiredo, Irineu; Moss, Adam Keith; Pritchard, Timothy Neil; Glassborow, Brent Anthony; Guedes Domingues, Ana Beatriz; Bagueira de Vasconcellos Azeredo, Rodrigo

2016-07-01

The effect of the selection of different nuclear magnetic resonance (NMR) relaxation times for permeability estimation is investigated for a set of fully brine-saturated rocks acquired from Cretaceous carbonate reservoirs in the North Sea and Middle East. Estimators that are obtained from the relaxation times based on the Pythagorean means are compared with estimators that are obtained from the relaxation times based on the concept of a cumulative saturation cut-off. Select portions of the longitudinal (T1) and transverse (T2) relaxation-time distributions are systematically evaluated by applying various cut-offs, analogous to the Winland-Pittman approach for mercury injection capillary pressure (MICP) curves. Finally, different approaches to matching the NMR and MICP distributions using different mean-based scaling factors are validated based on the performance of the related size-scaled estimators. The good results that were obtained demonstrate possible alternatives to the commonly adopted logarithmic mean estimator and reinforce the importance of NMR-MICP integration to improving carbonate permeability estimates.

Rapid cognitive screening in multiple sclerosis accomplished by the Free Recall and Recognition Test.

PubMed

Claesson, I M; Ytterberg, C; Johansson, S; Almkvist, O; von Koch, L

2007-03-01

This study sought to investigate the feasibility of the Free Recall and Recognition Test (FRRT) as a practical screening tool for cognitive impairment in multiple sclerosis (MS). Persons with MS (n = 227) were consecutively recruited and assessed with four cognitive tests; FRRT, Symbol Digit Modalities Test (SDMT), Paced Auditory Serial Addition Test (PASAT), and the Mini-Mental State Examination (MMSE). Disease severity was assessed by the Expanded Disability Status Scale (EDSS). The FRRT, which was completed by 99% of the cohort in approximately 5 minutes per assessment, correlated significantly with the other cognitive tests, as well as with the disease severity rating. A cut-off of 4 for the FRRT recall rendered 90% sensitivity and 25% specificity, and a cut-off of 4.2 for the FRRT recognition resulted in 70% sensitivity and 51% specificity. We conclude that the FRRT proved feasible as a practical screening tool for cognitive impairment in MS within a clinical setting.

Human Sensibility Ergonomics Approach to Vehicle Simulator Based on Dynamics

NASA Astrophysics Data System (ADS)

Son, Kwon; Choi, Kyung-Hyun; Yoon, Ji-Sup

Simulators have been used to evaluate drivers' reactions to various transportation products. Most research, however, has concentrated on their technical performance. This paper considers driver's motion perception on a vehicle simulator through the analysis of human sensibility ergonomics. A sensibility ergonomic method is proposed in order to improve the reliability of vehicle simulators. A simulator in a passenger vehicle consists of three main modules such as vehicle dynamics, virtual environment, and motion representation modules. To evaluate drivers' feedback, human perceptions are categorized into a set verbal expressions collected and investigated to find the most appropriate ones for translation and angular accelerations of the simulator. The cut-off frequency of the washout filter in the representation module is selected as one sensibility factor. Sensibility experiments were carried out to find a correlation between the expressions and the cut-off frequency of the filter. This study suggests a methodology to obtain an ergonomic database that can be applied to the sensibility evaluation of dynamic simulators.

Validity of the AUDIT-C screen for at-risk drinking among students utilizing university primary care.

PubMed

Campbell, Clare E; Maisto, Stephen A

2018-03-22

Research is needed to establish the psychometric properties of brief screens in university primary care settings. This study aimed to assess the construct validity of one such screen, the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C), for detecting at-risk drinking among students who have utilized on-campus primary care. 389 students recently seen in university primary care completed a confidential online survey in December 2014. Bivariate correlations between the AUDIT-C and measures of alcohol consumption and negative drinking consequences provided concurrent evidence for construct validity. Receiver Operating Characteristic curve analyses determined optimal cut-off scores for at-risk drinking. The AUDIT-C significantly correlated with measures of alcohol consumption and negative drinking consequences (p < .001). Analyses support optimal AUDIT-C cut-off scores of 5 for females and 7 for males. The AUDIT-C is a valid screen for at-risk drinking among students who utilize university primary care.

On the Small Mass Limit of Quantum Brownian Motion with Inhomogeneous Damping and Diffusion

NASA Astrophysics Data System (ADS)

Lim, Soon Hoe; Wehr, Jan; Lampo, Aniello; García-March, Miguel Ángel; Lewenstein, Maciej

2018-01-01

We study the small mass limit (or: the Smoluchowski-Kramers limit) of a class of quantum Brownian motions with inhomogeneous damping and diffusion. For Ohmic bath spectral density with a Lorentz-Drude cutoff, we derive the Heisenberg-Langevin equations for the particle's observables using a quantum stochastic calculus approach. We set the mass of the particle to equal m = m0 ɛ , the reduced Planck constant to equal \\hbar = ɛ and the cutoff frequency to equal Λ = E_{Λ}/ɛ , where m_0 and E_{Λ} are positive constants, so that the particle's de Broglie wavelength and the largest energy scale of the bath are fixed as ɛ → 0. We study the limit as ɛ → 0 of the rescaled model and derive a limiting equation for the (slow) particle's position variable. We find that the limiting equation contains several drift correction terms, the quantum noise-induced drifts, including terms of purely quantum nature, with no classical counterparts.

Arctic Cut-Off High Drives the Poleward Shift of a New Greenland Melting Record

NASA Technical Reports Server (NTRS)

Tedesco, M.; Mote, T.; Fettweis, X.; Hanna, E.; Jeyaratnam, J.; Booth, J. F.; Datta, R.; Briggs, K.

2016-01-01

Large-scale atmospheric circulation controls the mass and energy balance of the Greenland ice sheet through its impact on radiative budget, runoff and accumulation. Here, using reanalysis data and the outputs of a regional climate model, we show that the persistence of an exceptional atmospheric ridge, centered over the Arctic Ocean, was responsible for a poleward shift of runoff, albedo and surface temperature records over the Greenland during the summer of 2015. New records of monthly mean zonal winds at 500 hPa and of the maximum latitude of ridge peaks of the 5,700+/-50 m isohypse over the Arctic were associated with the formation and persistency of a cutoff high. The unprecedented (1948-2015) and sustained atmospheric conditions promoted enhanced runoff, increased the surface temperatures and decreased the albedo in northern Greenland, while inhibiting melting in the south, where new melting records were set over the past decade. Subject terms: Earth sciences Atmospheric science Climate science

10 CFR 26.133 - Cutoff levels for drugs and drug metabolites.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 1 2013-01-01 2013-01-01 false Cutoff levels for drugs and drug metabolites. 26.133... § 26.133 Cutoff levels for drugs and drug metabolites. Subject to the provisions of § 26.31(d)(3)(iii), licensees and other entities may specify more stringent cutoff levels for drugs and drug metabolites than...

10 CFR 26.133 - Cutoff levels for drugs and drug metabolites.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 1 2012-01-01 2012-01-01 false Cutoff levels for drugs and drug metabolites. 26.133... § 26.133 Cutoff levels for drugs and drug metabolites. Subject to the provisions of § 26.31(d)(3)(iii), licensees and other entities may specify more stringent cutoff levels for drugs and drug metabolites than...

10 CFR 26.133 - Cutoff levels for drugs and drug metabolites.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 1 2014-01-01 2014-01-01 false Cutoff levels for drugs and drug metabolites. 26.133... § 26.133 Cutoff levels for drugs and drug metabolites. Subject to the provisions of § 26.31(d)(3)(iii), licensees and other entities may specify more stringent cutoff levels for drugs and drug metabolites than...

49 CFR 40.87 - What are the cutoff concentrations for drug tests?

Code of Federal Regulations, 2010 CFR

2010-10-01

... TRANSPORTATION WORKPLACE DRUG AND ALCOHOL TESTING PROGRAMS Drug Testing Laboratories § 40.87 What are the cutoff concentrations for drug tests? (a) As a laboratory, you must use the cutoff concentrations displayed in the... 49 Transportation 1 2010-10-01 2010-10-01 false What are the cutoff concentrations for drug tests...

49 CFR 40.87 - What are the cutoff concentrations for drug tests?

Code of Federal Regulations, 2014 CFR

2014-10-01

... TRANSPORTATION WORKPLACE DRUG AND ALCOHOL TESTING PROGRAMS Drug Testing Laboratories § 40.87 What are the cutoff concentrations for drug tests? (a) As a laboratory, you must use the cutoff concentrations displayed in the... 49 Transportation 1 2014-10-01 2014-10-01 false What are the cutoff concentrations for drug tests...

49 CFR 40.87 - What are the cutoff concentrations for drug tests?

Code of Federal Regulations, 2013 CFR

2013-10-01

... TRANSPORTATION WORKPLACE DRUG AND ALCOHOL TESTING PROGRAMS Drug Testing Laboratories § 40.87 What are the cutoff concentrations for drug tests? (a) As a laboratory, you must use the cutoff concentrations displayed in the... 49 Transportation 1 2013-10-01 2013-10-01 false What are the cutoff concentrations for drug tests...

49 CFR 40.87 - What are the cutoff concentrations for drug tests?

Code of Federal Regulations, 2012 CFR

2012-10-01

... TRANSPORTATION WORKPLACE DRUG AND ALCOHOL TESTING PROGRAMS Drug Testing Laboratories § 40.87 What are the cutoff concentrations for drug tests? (a) As a laboratory, you must use the cutoff concentrations displayed in the... 49 Transportation 1 2012-10-01 2012-10-01 false What are the cutoff concentrations for drug tests...

49 CFR 40.87 - What are the cutoff concentrations for drug tests?

Code of Federal Regulations, 2011 CFR

2011-10-01

... TRANSPORTATION WORKPLACE DRUG AND ALCOHOL TESTING PROGRAMS Drug Testing Laboratories § 40.87 What are the cutoff concentrations for drug tests? (a) As a laboratory, you must use the cutoff concentrations displayed in the... 49 Transportation 1 2011-10-01 2011-10-01 false What are the cutoff concentrations for drug tests...

A severe artifact in simulation of liquid water using a long cut-off length: Appearance of a strange layer structure

NASA Astrophysics Data System (ADS)

Yonetani, Yoshiteru

2005-04-01

We report that a severe artifact appeared in molecular dynamics simulation of bulk water using the long cut-off length 18 Å. Our result shows that increasing the cut-off length does not always improve the simulation result. Moreover, the use of the long cut-off length can lead to a spurious result. It is suggested that the simulation of solvated biomolecules using such a long cut-off length, which has been often performed, may contain an unexpected artifact.

Optimum wall impedance for spinning modes: A correlation with mode cut-off ratio

NASA Technical Reports Server (NTRS)

Rice, E. J.

1978-01-01

A correlating equation relating the optimum acoustic impedance for the wall lining of a circular duct to the acoustic mode cut-off ratio, is presented. The optimum impedance was correlated with cut-off ratio because the cut-off ratio appears to be the fundamental parameter governing the propagation of sound in the duct. Modes with similar cut-off ratios respond in a similar way to the acoustic liner. The correlation is a semi-empirical expression developed from an empirical modification of an equation originally derived from sound propagation theory in a thin boundary layer. This correlating equation represents a part of a simplified liner design method, based upon modal cut-off ratio, for multimodal noise propagation.

ICESat Lidar and Global Digital Elevation Models: Application to DESDynI

NASA Technical Reports Server (NTRS)

Carabajal, Claudia C.; Harding, David J.; Suchdeo, Vijay P.

2010-01-01

Geodetic control is extremely important in the production and quality control of topographic data sets, enabling elevation results to be referenced to an absolute vertical datum. Global topographic data with improved geodetic accuracy achieved using global Ground Control Point (GCP) databases enable more accurate characterization of land topography and its change related to solid Earth processes, natural hazards and climate change. The multiple-beam lidar instrument that will be part of the NASA Deformation, Ecosystem Structure and Dynamics of Ice (DESDynI) mission will provide a comprehensive, global data set that can be used for geodetic control purposes. Here we illustrate that potential using data acquired by NASA's Ice, Cloud and land Elevation Satellite (ICEsat) that has acquired single-beam, globally distributed laser altimeter profiles (+/-86deg) since February of 2003 [1, 2]. The profiles provide a consistently referenced elevation data set with unprecedented accuracy and quantified measurement errors that can be used to generate GCPs with sub-decimeter vertical accuracy and better than 10 m horizontal accuracy. Like the planned capability for DESDynI, ICESat records a waveform that is the elevation distribution of energy reflected within the laser footprint from vegetation, where present, and the ground where illuminated through gaps in any vegetation cover [3]. The waveform enables assessment of Digital Elevation Models (DEMs) with respect to the highest, centroid, and lowest elevations observed by ICESat and in some cases with respect to the ground identified beneath vegetation cover. Using the ICESat altimetry data we are developing a comprehensive database of consistent, global, geodetic ground control that will enhance the quality of a variety of regional to global DEMs. Here we illustrate the accuracy assessment of the Shuttle Radar Topography Mission (SRTM) DEM produced for Australia, documenting spatially varying elevation biases of several meters in magnitude.

Single spot albumin to creatinine ratio: A simple marker of long-term prognosis in non-ST segment elevation acute coronary syndromes.

PubMed

Higa, Claudio Cesar; Novo, Fedor Anton; Nogues, Ignacio; Ciambrone, Maria Graciana; Donato, Maria Sol; Gambarte, Maria Jimena; Rizzo, Natalia; Catalano, Maria Paula; Korolov, Eugenio; Comignani, Pablo Dino

2016-01-01

Microalbuminuria is a known risk factor for cardiovascular morbidity and mortality suggesting that it should be a marker of endothelial dysfunction. Albumin to creatinine ratio (ACR) is an available and rapid test for microalbuminuria determination, with a high correlation with the 24-h urine collection method. There is no prospective study that evaluates the prognostic value of ACR in patients with non ST-segment elevation acute coronary syndromes (NSTE-ACS). The purpose of our study was to detect the long-term prognostic value of ACR in patients with NSTE-ACS. Albumin to creatinine ratio was estimated in 700 patients with NSTE-ACS at admission. Median follow-up time was 18 months. The best cutoff point of ACR for death or acute myocardial infarction was 20 mg/g. Twenty-two percent of patients had elevated ACR. By multivariable Cox regression analysis, ACR was an independent predictor of the clinical endpoint: odds ratio 5.8 (95% confidence interval [CI] 2-16), log-rank 2 p < 0.0001 in a model including age > 65 years, female gender, diabetes mellitus, creatinine clearance, glucose levels at admission, elevated cardiac markers (troponin T/CK-MB) and ST segment depression. The addition of ACR significantly improved GRACE score C-statistics from 0.69 (95% CI 0.59-0.83) to 0.77 (95% CI 0.65-0.88), SE 0.04, 2 p = 0.03, with a good calibration with both models. Albumin to creatinine ratio is an independent and accessible predictor of long-term adverse outcomes in NSTE-ACS, providing additional value for risk stratification.

Elevated pulmonary artery systolic pressure predicts heart failure admissions in African Americans: Jackson Heart Study.

PubMed

Choudhary, Gaurav; Jankowich, Matthew; Wu, Wen-Chih

2014-07-01

Although elevated pulmonary artery systolic pressure (PASP) is associated with heart failure (HF), whether PASP measurement can help predict future HF admissions is not known, especially in African Americans who are at increased risk for HF. We hypothesized that elevated PASP is associated with increased risk of HF admission and improves HF prediction in African American population. We conducted a longitudinal analysis using the Jackson Heart Study cohort (n=3125; 32.2% men) with baseline echocardiography-derived PASP and follow-up for HF admissions. Hazard ratio for HF admission was estimated using Cox proportional hazard model adjusted for variables in the Atherosclerosis Risk in Community (ARIC) HF prediction model. During a median follow-up of 3.46 years, 3.42% of the cohort was admitted for HF. Subjects with HF had a higher PASP (35.6±11.4 versus 27.6±6.9 mm Hg; P<0.001). The hazard of HF admission increased with higher baseline PASP (adjusted hazard ratio per 10 mm Hg increase in PASP: 2.03; 95% confidence interval, 1.67-2.48; adjusted hazard ratio for highest [≥33 mm Hg] versus lowest quartile [<24 mm Hg] of PASP: 2.69; 95% confidence interval, 1.43-5.06) and remained significant irrespective of history of HF or preserved/reduced ejection fraction. Addition of PASP to the ARIC model resulted in a significant improvement in model discrimination (area under the curve=0.82 before versus 0.84 after; P=0.03) and improved net reclassification index (11-15%) using PASP as a continuous or dichotomous (cutoff=33 mm Hg) variable. Elevated PASP predicts HF admissions in African Americans and may aid in early identification of at-risk subjects for aggressive risk factor modification. © 2014 American Heart Association, Inc.

Echocardiographic parameters and brain natriuretic peptide in patients after surgical repair of tetralogy of Fallot.

PubMed

Tatani, Solange B; Carvalho, Antonio Carlos C; Andriolo, Adagmar; Rabelo, Rogério; Campos, Orlando; Moises, Valdir A

2010-04-01

Although the residual lesions after surgical correction of tetralogy of Fallot (TOF) can be evaluated by Doppler echocardiography (DE), the relation of DE parameters with the proBNP level, a potential biomarker of right ventricle overload, is not well known. The objective of this study was to evaluate the DE parameters and their relation to proBNP levels. proBNP plasma level and Doppler echocardiography parameters were obtained on the same day in 49 patients later after repair of TOF (mean age of 14.7 years, 51% female, mean PO time of 9.5 years). The DE parameters studied were the dimensions of the right atrium (RA) and ventricle (RV), RV diastolic and systolic function, and residual pulmonary lesions. The relation between them and proBNP levels were analyzed and the cutoff values of DE parameters for elevated proBNP determined. proBNP was elevated in 53% and correlated with RV diastolic diameter (r = 0.41; P = 0.003), RA longitudinal (r = 0.52; P = 0.0001) and transversal (r = 0.47; P = 0.001) diameters, pressure half time of pulmonary regurgitation (PR) velocity (PHT) (r =-0.42; P = 0.005), and the PR index (r =-0.60; P < 0.001). By multivariate analysis, the PR index (r =-597; P = 0,001; CI: -913.2 to -280.8) and RA longitudinal (r = 7.74; P < 0,001; CI 4.18 to 11.31) were independent predictors of elevated proBNP. PHT lower than 64 msec (0.76) and PRi lower than 0.65 (0.81) had the best accuracy for elevated proBNP. proBNP may be increased in patients after surgical repair of TOF, correlated with the size of right cardiac chambers and the severity of PR.

Clinical Interpretation of Elevated CA 19-9 Levels in Obstructive Jaundice Following Benign and Malignant Pancreatobiliary Disease.

PubMed

Kim, Min Seong; Jeon, Tae Joo; Park, Ji Young; Choi, Jeongmin; Shin, Won Chang; Park, Seong Eun; Seo, Ji Young; Kim, Young Moon

2017-08-25

Elevated carbohydrate antigen (CA) 19-9 level may be unable to differentiate between benign and malignant pancreatobiliary disease with obstructive jaundice. The study aims to determine the clinical interpretation and the diagnostic value of CA 19-9 level in pancreatobiliary diseases with coexistent obstructive jaundice. We retrospectively reviewed the data of 981 patients who underwent biliary drainage due to obstructive jaundice following pancreatobiliary disease at Sanggye Paik Hospital for 5 years. 114 patients with serial follow-up data for CA 19-9 level were included in this study (80 patients with malignancy and 34 patients with benign diseases). We compared the levels of CA 19-9 levels and the biochemical value before and after biliary drainage. The rate of CA 19-9 elevation (>37 U/mL) was significantly different between the benign group and the malignant group (59% vs. 90%, p=0.001). Despite the decrease in serum bilirubin after biliary drainage, CA 19-9 levels remained elevated in 12% of patients in the benign group and in 63% of patients in the malignant group (p<0.001). Finally, 12% of patients in the benign group turned out to have malignant disease. A receiver operating characteristic analysis provided a cut-off value of 38 U/mL for differentiating benign disease from malignant disease after biliary drainage (area under curve, 0.787; 95% confidence interval, 0.703 to 0.871; sensitivity, 62%; specificity, 88%). This study suggested that we should consider the possibility of malignant causes if the CA 19-9 levels remain high or are more than 38 U/mL after resolution of biliary obstruction.

[CEA, CA-19-9 and il-8, sTNFRII and sil-2R in persons at high risk of colorectal cancer].

PubMed

Grotowski, Maciej; Wojtuń, Stanisław

2003-04-01

The aim of the study was to determine whether elevated concentrations of CEA, CA19-9, IL-8, sTNFRII and sIL-2R occur in persons at high risk of colorectal cancer. A group of 37 persons at high risk of colorectal cancer and 40 healthy subjects (control group) were included into this study. In both groups IL-8, sTNFRII and sIL-2R concentrations were measured by ELISA method (R&D Systems Minneapolis, USA). In the group of persons at high risk of colorectal cancer CEA and CA19-9 concentrations were determined using MEIA kits (Abbott Laboratories, USA). Using the 95th percentiles of the distribution in the control group the upper normal limits of IL-8, sTN-FRII and sIL-2R values were calculated. The cut-off value for CEA was 3 ng/ml and that for CA 19-9 was 37 U/ml. The incidence of elevated concentrations of the studied factors and concentrations of CEA and CA19-9 was compared. The association was assessed of elevated concentrations of the studied factors and CEA and CA19-9 with the results of histological examination of pathological changes in the colon and rectum. In the group of persons at high risk of colorectal cancer only CEA concentration was elevated in 2.7%. The percentages of persons with elevated concentrations of IL-8, sIL-2R and sTNFRII were 29.7, 8.1 and 18.9%, respectively. The percentage of persons with elevated concentrations of IL-8 and sTNFRII was higher in comparison with the percentage of persons with elevated concentrations of CEA and CA19-9 (p < 0.05). Pathological lesions in the colon and rectum were detected in 16 persons (43.2%). High-grade dysplasia was detected in 11 cases. Elevated concentration of IL-8 always accompanied high-grade dysplasia in ulcerative colitis. The concentrations of IL-8 were significantly higher in high-grade dysplasia (23.7 pg/ml, SD +/- 7.53) than in cases of its absence (18.9 pg/ml, SD +/- 3.53) (p < 0.05). The obtained results of preliminary studies with IL-8 in persons at high risk of colorectal cancer require a confirmation in population studies.