Fractional Flow Reserve: Does a Cut-off Value add Value?

PubMed Central

Mohdnazri, Shah R; Keeble, Thomas R

2016-01-01

Fractional flow reserve (FFR) has been shown to improve outcomes when used to guide percutaneous coronary intervention (PCI). There have been two proposed cut-off points for FFR. The first was derived by comparing FFR against a series of non-invasive tests, with a value of ≤0.75 shown to predict a positive ischaemia test. It was then shown in the DEFER study that a vessel FFR value of ≥0.75 was associated with safe deferral of PCI. During the validation phase, a ‘grey zone’ for FFR values of between 0.76 and 0.80 was demonstrated, where a positive non-invasive test may still occur, but sensitivity and specificity were sub-optimal. Clinical judgement was therefore advised for values in this range. The FAME studies then moved the FFR cut-off point to ≤0.80, with a view to predicting outcomes. The ≤0.80 cut-off point has been adopted into clinical practice guidelines, whereas the lower value of ≤0.75 is no longer widely used. Here, the authors discuss the data underpinning these cut-off values and the practical implications for their use when using FFR guidance in PCI. PMID:29588700

Critical analysis of forensic cut-offs and legal thresholds: A coherent approach to inference and decision.

PubMed

Biedermann, A; Taroni, F; Bozza, S; Augsburger, M; Aitken, C G G

2018-07-01

In this paper we critically discuss the definition and use of cut-off values by forensic scientists, for example in forensic toxicology, and point out when and why such values - and ensuing categorical conclusions - are inappropriate concepts for helping recipients of expert information with their questions of interest. Broadly speaking, a cut-off is a particular value of results of analyses of a target substance (e.g., a toxic substance or one of its metabolites in biological sample from a person of interest), defined in a way such as to enable scientists to suggest conclusions regarding the condition of the person of interest. The extent to which cut-offs can be reliably defined and used is not unanimously agreed within the forensic science community, though many practitioners - especially in operational laboratories - rely on cut-offs for reasons such as ease of use and simplicity. In our analysis, we challenge this practice by arguing that choices made for convenience should not be to the detriment of balance and coherence. To illustrate our discussion, we will choose the example of alcohol markers in hair, used widely by forensic toxicologists to reach conclusions regarding the drinking behaviour of individuals. Using real data from one of the co-authors' own work and recommendations of cut-offs published by relevant professional organisations, we will point out in what sense cut-offs are incompatible with current evaluative guidelines (e.g., [31]) and show how to proceed logically without cut-offs by using a standard measure for evidential value. Our conclusions run counter to much current practice, but are inevitable given the inherent definitional and conceptual shortcomings of scientific cut-offs. We will also point out the difference between scientific cut-offs and legal thresholds and argue that the latter - but not the former - are justifiable and can be dealt with in logical evaluative procedures. Copyright © 2018 Elsevier B.V. All rights reserved.

HPV self-sampling in CIN2+ detection: sensitivity and specificity of different RLU cut-off of HC2 in specimens from 786 women.

PubMed

Bottari, F; Igidbashian, S; Boveri, S; Tricca, A; Gulmini, C; Sesia, M; Spolti, N; Sideri, M; Landoni, F; Sandri, M T

2017-04-01

Mortality for cervical cancer varies between the different regions of the world, with high rates in low-income countries where screening programmes are not present and organised. However, increasing screening coverage is still a priority in all countries: one way to do that is to base screening on self-sampled screening. The success of a self-sampling screening strategy depends on capacity to recruit unscreened women, on the performance and acceptability of the device and on the clinical performance of the high-risk human papillomavirus (HPV) test. This study based on 786 enrolled women investigates the best cut-off value of Hybrid Capture 2 HPV test (HC2) for self-sampled specimens in terms of sensitivity and specificity. In this population, we found that the sensitivity and the specificity for cervical intraepithelial neoplasia grade 2 or more detection of HC2 performed on self-sampled specimens were 82.5% and 82.8%, respectively considering the relative light units (RLU) cut-off value of 1. Increasing the cut-off value the sensitivity decreases and the specificity raises and the best area under the curve for the RLU cut-off value is 1. Our results confirm that the cut-off value of 1 suggested by Qiagen for PreservCyt specimen is the best cut-off value also for self-sampled specimens. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

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.

Parametric response mapping cut-off values that predict survival of hepatocellular carcinoma patients after TACE.

PubMed

Nörthen, Aventinus; Asendorf, Thomas; Shin, Hoen-Oh; Hinrichs, Jan B; Werncke, Thomas; Vogel, Arndt; Kirstein, Martha M; Wacker, Frank K; Rodt, Thomas

2018-04-21

Parametric response mapping (PRM) is a novel image-analysis technique applicable to assess tumor viability and predict intrahepatic recurrence of hepatocellular carcinoma (HCC) patients treated with transarterial chemoembolization (TACE). However, to date, the prognostic value of PRM for prediction of overall survival in HCC patients undergoing TACE is unclear. The objective of this explorative, single-center study was to identify cut-off values for voxel-specific PRM parameters that predict the post TACE overall survival in HCC patients. PRM was applied to biphasic CT data obtained at baseline and following 3 TACE treatments of 20 patients with HCC tumors ≥ 2 cm. The individual portal venous phases were registered to the arterial phases followed by segmentation of the largest lesion, i.e., the region of interest (ROI). Segmented voxels with their respective arterial and portal venous phase density values were displayed as a scatter plot. Voxel-specific PRM parameters were calculated and compared to patients' survival at 1, 2, and 3 years post treatment to identify the maximal predictive parameters. The hypervascularized tissue portion of the ROI was found to represent an independent predictor of the post TACE overall survival. For this parameter, cut-off values of 3650, 2057, and 2057 voxels, respectively, were determined to be optimal to predict overall survival at 1, 2, and 3 years after TACE. Using these cut points, patients were correctly classified as having died with a sensitivity of 80, 92, and 86% and as still being alive with a specificity of 60, 75, and 83%, respectively. The prognostic accuracy measured by area under the curve (AUC) values ranged from 0.73 to 0.87. PRM may have prognostic value to predict post TACE overall survival in HCC patients.

Performance of new thresholds of the Glasgow Blatchford score in managing patients with upper gastrointestinal bleeding.

PubMed

Laursen, Stig B; Dalton, Harry R; Murray, Iain A; Michell, Nick; Johnston, Matt R; Schultz, Michael; Hansen, Jane M; Schaffalitzky de Muckadell, Ove B; Blatchford, Oliver; Stanley, Adrian J

2015-01-01

Upper gastrointestinal hemorrhage (UGIH) is a common cause of hospital admission. The Glasgow Blatchford score (GBS) is an accurate determinant of patients' risk for hospital-based intervention or death. Patients with a GBS of 0 are at low risk for poor outcome and could be managed as outpatients. Some investigators therefore have proposed extending the definition of low-risk patients by using a higher GBS cut-off value, possibly with an age adjustment. We compared 3 thresholds of the GBS and 2 age-adjusted modifications to identify the optimal cut-off value or modification. We performed an observational study of 2305 consecutive patients presenting with UGIH at 4 centers (Scotland, England, Denmark, and New Zealand). The performance of each threshold and modification was evaluated based on sensitivity and specificity analyses, the proportion of low-risk patients identified, and outcomes of patients classified as low risk. There were differences in age (P = .0001), need for intervention (P < .0001), mortality (P < .015), and GBS (P = .0001) among sites. All systems identified low-risk patients with high levels of sensitivity (>97%). The GBS at cut-off values of ≤1 and ≤2, and both modifications, identified low-risk patients with higher levels of specificity (40%-49%) than the GBS with a cut-off value of 0 (22% specificity; P < .001). The GBS at a cut-off value of ≤2 had the highest specificity, but 3% of patients classified as low-risk patients had adverse outcomes. All GBS cut-off values, and score modifications, had low levels of specificity when tested in New Zealand (2.5%-11%). A GBS cut-off value of ≤1 and both GBS modifications identify almost twice as many low-risk patients with UGIH as a GBS at a cut-off value of 0. Implementing a protocol for outpatient management, based on one of these scores, could reduce hospital admissions by 15% to 20%. Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights reserved.

On determining the most appropriate test cut-off value: the case of tests with continuous results

PubMed Central

Habibzadeh, Parham; Yadollahie, Mahboobeh

2016-01-01

There are several criteria for determination of the most appropriate cut-off value in a diagnostic test with continuous results. Mostly based on receiver operating characteristic (ROC) analysis, there are various methods to determine the test cut-off value. The most common criteria are the point on ROC curve where the sensitivity and specificity of the test are equal; the point on the curve with minimum distance from the left-upper corner of the unit square; and the point where the Youden’s index is maximum. There are also methods mainly based on Bayesian decision analysis. Herein, we show that a proposed method that maximizes the weighted number needed to misdiagnose, an index of diagnostic test effectiveness we previously proposed, is the most appropriate technique compared to the aforementioned ones. For determination of the cut-off value, we need to know the pretest probability of the disease of interest as well as the costs incurred by misdiagnosis. This means that even for a certain diagnostic test, the cut-off value is not universal and should be determined for each region and for each disease condition. PMID:27812299

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.

[Research progress on the clinical value of Ki-67 in breast cancer and its cut-off definition].

PubMed

Chen, Qing; Wu, Kejin

2015-08-01

Ki-67 has an important application value in clinical practice. However, it is still a little tough in clinical application because of the debate on the cut-off definition of Ki-67 index. This review summarizes most studies on the prognostic and predictive value of Ki-67, analyzes the reasons for the discrepancies among the studies cited, and presents the necessity and clinical significance of scientifically defining the cut-off of Ki-67 index, providing a theoretical basis for Ki-67 in clinical application.

Microscopic study of spin cut-off factors of nuclear level densities

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

Gholami, M.; Kildir, M.; Behkami, A. N.

Level densities and spin cut-off factors have been investigated within the microscopic approach based on the BCS Hamiltonian. In particular, the spin cut-off parameters have been calculated at neutron binding energies over a large range of nuclear mass using the BCS theory. The spin cut-off parameters {sigma}{sup 2}(E) have also been obtained from the Gilbert and Cameron expression and from rigid body calculations. The results were compared with their corresponding macroscopic values. It was found that the values of {sigma}{sup 2}(E) did not increase smoothly with A as expected based on macroscopic theory. Instead, the values of {sigma}{sup 2}(E) showmore » structure reflecting the angular momentum of the shell model orbitals near the Fermi energy.« less

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.

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

The need for re-defining cut-off values in heart failure: From obesity to iron deficiency.

PubMed

Konishi, Masaaki; von Haehling, Stephan

2017-01-01

The health status of older people is frequently complicated by one or more chronic diseases. Some conditions might have a different meaning in certain groups of elderly subjects, like in frail people or older patients with heart failure. Cut-off values defining these conditions may require adjustment in such groups. Indeed, several such conditions (e.g. obesity and hypercholesterolemia) have been discussed recently in light of so-called paradoxical situations, which are - counter-intuitively - associated with better outcome instead of a negative impact on survival in the general population. Therefore, different cut-off values may be needed in some groups of older subjects. The pathophysiological mechanisms for these paradoxical situations need to be understood in at least two different ways, causal and non-causal. The aim of this review is to provide an overview of a variety of conditions (obesity, dyslipidaemia, hypertension, and diabetes) in which new cut-offs may have diagnostic, clinical, or prognostic value, focusing on heart failure as a chronic disease, which is frequently observed in older patients. Haemoglobin concentration may need a different cut-off in heart failure for a reason other than paradox. Namely, underlying iron deficiency itself, both in those with or without anaemia, can have effects on symptoms and quality of life. Further studies will be needed for re-defining cut-off values in heart failure and maybe in the other chronic illnesses. Copyright © 2016 Elsevier Inc. All rights reserved.

Psychometric goodness of the Mini Sleep Questionnaire.

PubMed

Natale, Vincenzo; Fabbri, Marco; Tonetti, Lorenzo; Martoni, Monica

2014-07-01

The current study was conducted to evaluate the psychometric properties and analyze the convergent validity of the Italian version of the Mini Sleep Questionnaire (MSQ). In addition, it was aimed to put forward cut-off values to be used in screening protocols. The MSQ was administered to 1830 participants (age range 18-87 years), of whom 1208 also completed the Sleep Disorder Questionnaire (age range 18-87 years). A subgroup of 187 (age range 18-71 years) participants was randomly chosen to test the test-retest reliability. A complete psychometric evaluation was performed on the MSQ. To study the validity of the tool, the Sleep Disorder Questionnaire was used as an external criterion to validate the MSQ. Using the Youden index, we calculated the cut-off values that performed best. Finally, we created receiver-operator curves to test the accuracy of each cut-off value identified. For the MSQ, Cronbach's alpha score was 0.77 while homogeneity was 0.26. Factorial analyses confirmed the presence of two dimensions: sleep (Cronbach's alpha 0.75; homogeneity 0.37) and wake (Cronbach's alpha 0.75; homogeneity 0.44). For each dimension, a cut-off value was identified (>16 and >14, respectively). Both cut-off values obtained an area under the curve higher than 0.80. Psychometric evaluation of the MSQ was satisfactory. The cut-off values analyzed in the present study showed good performance. On the whole, the results of this study suggest that the MSQ can be a useful screening tool. © 2014 The Authors. Psychiatry and Clinical Neurosciences © 2014 Japanese Society of Psychiatry and Neurology.

Accuracy and adequacy of waist circumference cut-off points currently recommended in Brazilian adults.

PubMed

Vianna, Carolina Avila; da Silva Linhares, Rogério; Bielemann, Renata Moraes; Machado, Eduardo Coelho; González-Chica, David Alejandro; Matijasevich, Alicia Manitto; Gigante, Denise Petrucci; da Silva Dos Santos, Iná

2014-04-01

To evaluate the adequacy and accuracy of cut-off values currently recommended by the WHO for assessment of cardiovascular risk in southern Brazil. Population-based study aimed at determining the predictive ability of waist circumference for cardiovascular risk based on the use of previous medical diagnosis for hypertension, diabetes mellitus and/or dyslipidaemia. Descriptive analysis was used for the adequacy of current cut-off values of waist circumference, receiver operating characteristic curves were constructed and the most accurate criteria according to the Youden index and points of optimal sensitivity and specificity were identified. Pelotas, southern Brazil. Individuals (n 2112) aged ≥20 years living in the city were selected by multistage sampling, since these individuals did not report the presence of previous myocardial infarction, angina pectoris or stroke. The cut-off values currently recommended by WHO were more appropriate in men than women, with overestimation of cardiovascular risk in women. The area under the receiver operating characteristic curve showed moderate predictive ability of waist circumference in men (0.74, 95% CI 0.71, 0.76) and women (0.75, 95% CI 0.73, 0.77). The method of optimal sensitivity and specificity showed better performance in assessing the accuracy, identifying the values of 95 cm in men and 87 cm in women as the best cut-off values of waist circumference to assess cardiovascular risk. The cut-off values currently recommended for waist circumference are not suitable for women. Longitudinal studies should be conducted to evaluate the consistency of the findings.

The relationship between walking, manual dexterity, cognition and activity/participation in persons with multiple sclerosis.

PubMed

Kierkegaard, Marie; Einarsson, Ulrika; Gottberg, Kristina; von Koch, Lena; Holmqvist, Lotta Widén

2012-05-01

Multiple sclerosis has a vast impact on health, but the relationship between walking, manual dexterity, cognition and activity/participation is unclear. The specific aims were to explore the discriminative ability of measures of walking, manual dexterity and cognition, and to identify cut-off values in these measures, for prediction of independence in personal and instrumental activities of daily living (ADL) and activity/participation in social and lifestyle activities. Data from 164 persons with multiple sclerosis were collected during home visits with the following measures: the 2 × 5 m walk test, the Nine-hole Peg Test, the Symbol Digit Modalities Test, the Katz Personal and Instrumental ADL Indexes, and the Frenchay Activities Index (measuring frequency in social and lifestyle activities). The 2 × 5 m walk test and the Nine-hole Peg Test had high and better discriminative and predictive ability than the Symbol Digit Modalities Test. Cut-off values were identified. The accuracy of predictions was increased above all by combining the 2 × 5 m walk test and the Nine-hole Peg Test. The proposed cut-off values in the 2 × 5 m walk test and the Nine-hole Peg Test may be used as indicators of functioning and to identify persons risking activity limitations and participation restrictions. However, further studies are needed to confirm the usefulness in clinical practice.

Calculation of the ELISA's cut-off based on the change-point analysis method for detection of Trypanosoma cruzi infection in Bolivian dogs in the absence of controls.

PubMed

Lardeux, Frédéric; Torrico, Gino; Aliaga, Claudia

2016-07-04

In ELISAs, sera of individuals infected by Trypanosoma cruzi show absorbance values above a cut-off value. The cut-off is generally computed by means of formulas that need absorbance readings of negative (and sometimes positive) controls, which are included in the titer plates amongst the unknown samples. When no controls are available, other techniques should be employed such as change-point analysis. The method was applied to Bolivian dog sera processed by ELISA to diagnose T. cruzi infection. In each titer plate, the change-point analysis estimated a step point which correctly discriminated among known positive and known negative sera, unlike some of the six usual cut-off formulas tested. To analyse the ELISAs results, the change-point method was as good as the usual cut-off formula of the form "mean + 3 standard deviation of negative controls". Change-point analysis is therefore an efficient alternative method to analyse ELISA absorbance values when no controls are available.

Estimates of success in patients with sciatica due to lumbar disc herniation depend upon outcome measure.

PubMed

Haugen, Anne Julsrud; Grøvle, Lars; Brox, Jens Ivar; Natvig, Bård; Keller, Anne; Soldal, Dag; Grotle, Margreth

2011-10-01

The objectives were to estimate the cut-off points for success on different sciatica outcome measures and to determine the success rate after an episode of sciatica by using these cut-offs. A 12-month multicenter observational study was conducted on 466 patients with sciatica and lumbar disc herniation. The cut-off values were estimated by ROC curve analyses using Completely recovered or Much better on a 7-point global change scale as external criterion for success. The cut-off values (references in brackets) at 12 months were leg pain VAS 17.5 (0-100), back pain VAS 22.5 (0-100), Sciatica Bothersomeness Index 6.5 (0-24), Maine-Seattle Back Questionnaire 4.5 (0-12), and the SF-36 subscales bodily pain 51.5, and physical functioning 81.7 (0-100, higher values indicate better health). In conclusion, the success rates at 12 months varied from 49 to 58% depending on the measure used. The proposed cut-offs may facilitate the comparison of success rates across studies.

Assessment of under nutrition of Bangladeshi adults using anthropometry: can body mass index be replaced by mid-upper-arm-circumference?

PubMed

Sultana, Tania; Karim, Md Nazmul; Ahmed, Tahmeed; Hossain, Md Iqbal

2015-01-01

Body-mass-index (BMI) is widely accepted as an indicator of nutritional status in adults. Mid-upper-arm-circumference (MUAC) is another anthropometric-measure used primarily among children. The present study attempted to evaluate the use of MUAC as a simpler alternative to BMI cut-off <18.5 to detect adult undernutrition, and thus to suggest a suitable cut-off value. A cross-sectional study in 650 adult attendants of the patients of Dhaka-Hospital, of the International Centre for Diarrheal Disease Research, Bangladesh (icddr,b) was conducted during 2012. Height, weight and MUAC of 260 male and 390 female aged 19-60 years were measured. Curve estimation was done to assess the linearity and correlation of BMI and MUAC. Sensitivity and specificity of MUAC against BMI<18.5 was determined. Separate Receiver-operating-characteristic (ROC) analyses were performed for male and female. Area under ROC curve and Youden's index were generated to aid selection of the most suitable cut-off value of MUAC for undernutrition. A value with highest Youden's index was chosen for cut-off. Our data shows strong significant positive correlation (linear) between MUAC and BMI, for males r = 0.81, (p<0.001) and for females r = 0.828, (p<0.001). MUAC cut-off <25.1 cm in males (AUC 0.930) and <23.9 cm in females (AUC 0.930) were chosen separately based on highest corresponding Youden's index. These values best correspond with BMI cut-off for under nutrition (BMI <18.5) in either gender. MUAC correlates closely with BMI. For the simplicity and easy to remember MUAC <25 cm for male and <24 cm for female may be considered as a simpler alternative to BMI cut-off <18.5 to detect adult undernutrition.

Reference values for voluntary and stimulated single-fibre EMG using concentric needle electrodes: a multicentre prospective study.

PubMed

Kokubun, Norito; Sonoo, Masahiro; Imai, Tomihiro; Arimura, Yumiko; Kuwabara, Satoshi; Komori, Tetsuo; Kobayashi, Masahito; Nagashima, Takahide; Hatanaka, Yuki; Tsuda, Emiko; Misawa, Sonoko; Abe, Tatsuya; Arimura, Kimiyoshi

2012-03-01

The aim of this study is to establish reference values for single-fibre electromyography (SFEMG) using concentric needles in a prospective, multicentre study. Voluntary or stimulated SFEMG at the extensor digitorum communis (EDC) or frontalis (FRO) muscles was conducted in 56-63 of a total of 69 normal subjects below the age of 60years at six Japanese institutes. The cut-off values for mean consecutive difference (MCD) of individual potentials were calculated using +2.5 SD or 95% prediction limit (one-tail) of the upper 10th percentile MCD value for individual subjects. The cut-off values for individual MCD (+2.5 SD) were 56.8μs for EDC-V (voluntary SFEMG for EDC), 58.8μs for EDC-S (stimulated SFEMG for EDC), 56.8μs for FRO-V (voluntary SFEMG for FRO) and 51.0μs for FRO-S (stimulated SFEMG for FRO). The false positive rates using these cut-off values were around 2%. The +2.5 SD and 95% prediction limit might be two optimal cut-off values, depending on the clinical question. The obtained reference values were larger than those reported previously using concentric needles, but might better coincide with conventional values. This is the first multicentre study reporting reference values for SFEMG using concentric needles. The way to determine cut-off values and the statistically correct definition of the percentile were discussed. Copyright © 2011 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

[Applicability of capacity of sexual self-defense assessment scale in psychiatric patients without mental retardation].

PubMed

Liu, Chao; Cai, Wei-Xiong

2013-12-01

To explore the applicability of Capacity of Sexual Self-defense Assessment Scale (CSSAS) in psychiatric patients without mental retardation. Eighty-seven cases required for assessment of the capacity of sexual self-defense were collected and evaluated by trained professionals according to CSSAS, and the results were compared to the experts' opinions. The scores of three grades of capacity of sexual self-defense (none, limited and whole) were 5.97 +/- 5.83, 32.22 +/- 10.15 and 61.60 +/- 13.02, respectively, which were statistically significant among them (P < 0.01). The correlation coefficients between items and total score were 0.59 to 0.91, the Cronbach's alpha value was 0.96, the spilt half Cronbach's alpha value were 0.94 and 0.91, respectively, and the relation coefficient between them was 0.94. According to the original cut off scores, the Kappa value between scale results and experts' opinions was 0.32 (P < 0.01). By redefining the cut off scores, the Kappa value was improved to 0.84 (P < 0.01). Two factors were extracted by means of the factor analysis. The explanation rates of variance were 46.15% and 28.93%, respectively. The accuracy of retrospective cumulative square was 94.30%. The CSSAS could be applied in the psychiatric expertise of the capacity of sexual self-defense in psychiatric patients without mental retardation; however, the cut off scores and the factor weight should be redefined.

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

The theoretical and practical determination of clinical cut-offs for the British Sign Language versions of PHQ-9 and GAD-7.

PubMed

Belk, Rachel A; Pilling, Mark; Rogers, Katherine D; Lovell, Karina; Young, Alys

2016-11-03

The PHQ-9 and the GAD-7 assess depression and anxiety respectively. There are standardised, reliability-tested versions in BSL (British Sign Language) that are used with Deaf users of the IAPT service. The aim of this study is to determine their appropriate clinical cut-offs when used with Deaf people who sign and to examine the operating characteristics for PHQ-9 BSL and GAD-7 BSL with a clinical Deaf population. Two datasets were compared: (i) dataset (n = 502) from a specialist IAPT service for Deaf people; and (ii) dataset (n = 85) from our existing study of Deaf people who self-reported having no mental health difficulties. Parameter estimates, with the precision of AUC value, sensitivity, specificity, positive predicted value (ppv) and negative predicted value (npv), were carried out to provide the details of the clinical cut-offs. Three statistical choices were included: Maximising (Youden: maximising sensitivity + specificity), Equalising (Sensitivity = Specificity) and Prioritising treatment (False Negative twice as bad as False Positive). Standard measures (as defined by IAPT) were applied to examine caseness, recovery, reliable change and reliable recovery for the first dataset. The clinical cut-offs for PHQ-9 BSL and GAD-7 BSL are 8 and 6 respectively. This compares with the original English version cut-offs in the hearing population of 10 and 8 respectively. The three different statistical choices for calculating clinical cut-offs all showed a lower clinical cut-off for the Deaf population with respect to the PHQ-9 BSL and GAD-7 BSL with the exception of the Maximising criteria when used with the PHQ-9 BSL. Applying the new clinical cut-offs, the percentage of Deaf BSL IAPT service users showing reliable recovery is 54.0 % compared to 63.7 % using the cut-off scores used for English speaking hearing people. These compare favourably with national IAPT data for the general population. The correct clinical cut-offs for the PHQ-9 BSL and GAD-7 BSL enable meaningful measures of clinical effectiveness and facilitate appropriate access to treatment when required.

Critical evaluation of energy intake using the Goldberg cut-off for energy intake:basal metabolic rate. A practical guide to its calculation, use and limitations.

PubMed

Black, A E

2000-09-01

To re-state the principles underlying the Goldberg cut-off for identifying under-reporters of energy intake, re-examine the physiological principles and update the values to be substituted into the equation for calculating the cut-off, and to examine its use and limitations. New values are suggested for each element of the Goldberg equation. The physical activity level (PAL) for comparison with energy intake:basal metabolic rate (EI:BMR) should be selected to reflect the population under study; the PAL value of 1.55 x BMR is not necessarily the value of choice. The suggested value for average within-subject variation in energy intake is 23% (unchanged), but other sources of variation are increased in the light of new data. For within-subject variation in measured and estimated BMR, 4% and 8.5% respectively are suggested (previously 2.5% and 8%), and for total between-subject variation in PAL, the suggested value is 15% (previously 12.5%). The effect of these changes is to widen the confidence limits and reduce the sensitivity of the cut-off. The Goldberg cut-off can be used to evaluate the mean population bias in reported energy intake, but information on the activity or lifestyle of the population is needed to choose a suitable PAL energy requirement for comparison. Sensitivity for identifying under-reporters at the individual level is limited. In epidemiological studies information on home, leisure and occupational activity is essential in order to assign subjects to low, medium or high PAL levels before calculating the cut-offs. In small studies, it is desirable to measure energy expenditure, or to calculate individual energy requirements, and to compare energy intake directly with energy expenditure.

Relation of nutritional status to physiological outcomes after cardiac surgery in elderly patients with diabetes mellitus: a preliminary study.

PubMed

Izawa, Kazuhiro P; Watanabe, Satoshi

2016-12-01

To determine differences in physiological outcome (PO) based on the Geriatric Nutritional Risk Index (GNRI) and cut-off values for PO according to the GNRI in elderly post-cardiac surgery patients complicated by diabetes mellitus (DM). Thirty-five patients (72.9 years) were enrolled and divided by GNRI. Patient characteristics and PO of handgrip strength (HG), knee extensor muscle strength (KEMS), maximum gait speed (GS), and one-leg standing time (OLST) were compared between the groups, and cut-off values for PO were determined. These POs were significantly lower in the low-GNRI group (<92 points) than in the high-GNRI (≥92 points) group. The cut-off values for PO were HG, 22.7 kgf; KEMS, 41.5 %BW; GS, 1.2 m/sec; and OLST, 6.7 s. Nutritional status might influence PO following cardiac surgery. The cut-off values of PO reported here might be indicative of the need to improve patient nutritional status.

Cut-off levels for breath carbon monoxide as a marker for cigarette smoking.

PubMed

Javors, Martin A; Hatch, John P; Lamb, Richard J

2005-02-01

Current clinical studies often use a breath carbon monoxide (BCO) cut-off level of 8 parts per million (p.p.m.) or higher to identify smoking. In this study, the cut-off level of BCO as an indicator of smoking over the past 24 hours was re-examined. BCO and self-reported smoking were obtained each weekday for up to 14 weeks in 213 subjects paid to deliver reduced BCO values. Analysis of 12 386 paired values for reported smoking and BCO were analyzed. The 25% quartile, median and 75% quartile values for BCO were 1, 1 and 2 p.p.m. on non-smoking days and 2, 5 and 12 p.p.m. on smoking days, respectively. Receiver-operating characteristic (ROC) analysis indicated that BCO provided high diagnostic accuracy to distinguish between smoking and non-smoking days [area under the curve (AUC) = 0.853, P < 0.0001]. The highest combined sensitivity and specificity was observed at a BCO cut-off level of 3 p.p.m. (sensitivity = 71.5%; specificity = 84.8%). At a BCO cut-off of 8 p.p.m. sensitivity and specificity were 40.6% and 98.2%, respectively, indicating that many smokers would be falsely classified as abstinent. Finally, the percentage of true tests (positive and negative) was highest at a BCO cut-off of 2 p.p.m. (80.2%). BCO cut-off levels well below 8 p.p.m and as low as 2-3 p.p.m. may be more useful when it is important to maximize identification of smoking abstinence with a high degree of certainty.

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.

Performance of a semi-quantitative whole blood test for human heart-type fatty acid-binding protein (H-FABP).

PubMed

Hiura, Masahito; Nakajima, Osamu; Mori, Toshizumi; Kitano, Katsuya

2005-10-01

We evaluated the accuracy of visually reading the whole blood Rapicheck H-FABP panel test using the quantitative plasma H-FABP concentration as the reference. Consecutive patients with chest pain (n = 237) who were suspected of having acute myocardial infarction were recruited. The appearance of an evident test line within 5 min was given a grade of +3 (strongly positive), appearance within 15 min +2 (moderately positive) and the appearance of a weak test line within 15 min +1 (weakly positive). The concordance rates were 91.8% for positive, 70.1% for negative and 80.2% for overall. Plasma H-FABP concentrations were above the cut-off value for 9.2% of negative (0) results. Fifty percent of weakly positive (+1) and 25.0% of moderately positive (+2) results had H-FABP concentrations lower than the cut-off value. All of the strongly positive (+3) were above the cut-off value. These results suggested that the false-positive and false-negative results of Rapicheck H-FABP were caused by over or underestimation in visual reading when the plasma H-FABP concentration was near the cut-off concentration. Low accuracy of visual reading of Rapicheck H-FABP was due to poor estimation by manual reading around the cut-off value.

Nicotine cut-off value in human hair as a tool to distinguish active from passive smokers: A cross-sectional study in Japanese men.

PubMed

Tsuji, Masayoshi; Kanda, Hideyuki; Hayakawa, Takehito; Mori, Yayoi; Ito, Teruna; Hidaka, Tomoo; Kakamu, Takeyasu; Kumagai, Tomohiro; Osaki, Yoneatsu; Kawazoe, Miki; Sato, Sei; Fukushima, Tetsuhito

2017-07-19

Nicotine concentration in hair is a useful marker of tobacco exposure. Detection of nicotine in the hair of non-smokers indicates passive smoking. Accurate measurement of nicotine among active and passive smokers can help in smoking cessation programs or programs designed to prevent secondhand smoke exposure. To establish, using high-performance liquid chromatography-ultraviolet detection (HPLC/UV), a hair nicotine cut-off value to distinguish active from passive smokers. Hair samples were collected from randomly chosen Japanese men (n= 192) between 2009 and 2011. Nicotine and cotinine levels in hair were measured using HPLC/UV with column-switching. T-tests and chi-square tests were performed to compare active and passive smokers, while receiver operating characteristic curves were used to evaluate the effectiveness of the cut-off value. There were 69 active smokers and 123 passive smokers. The nicotine and cotinine concentrations in hair were significantly higher in active than in passive smokers (p< 0.01). The area under the curve for nicotine was 0.92. A hair nicotine cut-off value of 5.68 ng/mg, with a sensitivity of 94.2% and specificity of 87.0%, was identified as the optimal cut-off value for separating active from passive smokers. Nicotine and cotinine concentrations in hair clearly distinguished active from passive smokers.

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.

Calculating broad neutron resonances in a cut-off Woods-Saxon potential

NASA Astrophysics Data System (ADS)

Baran, Á.; Noszály, Cs.; Salamon, P.; Vertse, T.

2015-07-01

In a cut-off Woods-Saxon (CWS) potential with realistic depth S -matrix poles being far from the imaginary wave number axis form a sequence where the distances of the consecutive resonances are inversely proportional with the cut-off radius value, which is an unphysical parameter. Other poles lying closer to the imaginary wave number axis might have trajectories with irregular shapes as the depth of the potential increases. Poles being close repel each other, and their repulsion is responsible for the changes of the directions of the corresponding trajectories. The repulsion might cause that certain resonances become antibound and later resonances again when they collide on the imaginary axis. The interaction is extremely sensitive to the cut-off radius value, which is an apparent handicap of the CWS potential.

Effect of postural changes on aldosterone to plasma renin ratio in patients with suspected secondary hypertension.

PubMed

Barigou, M; Ah-Kang, F; Orloff, E; Amar, J; Chamontin, B; Bouhanick, B

2015-06-01

To study the influence of postural changes on aldosterone to renin ratio (ARR) in patients with suspected secondary hypertension and to evaluate the sensitivity and specificity of the recommended seated ARR compared to supine and upright ARR for primary aldosteronism screening. Fifty-three hypertensive patients were prospectively hospitalized for secondary hypertension exploration (age: 51 ± 12, 66% males). After withdrawal of drugs interfering with renin angiotensin system, plasma aldosterone and direct renin concentration were measured in the morning, at bed after an overnight supine position, then out of bed after 1 hour of upright position and finally 2 hours later after 15 minutes of seating. Minimal renin value was set at 5 μUI/mL. Referring to ARR cut-off of 23 pg/μUI, the sensitivity of seated ARR was 57.1% and specificity was 92.3%. The negative and positive predictive values were 95.1% and 45.2% respectively. Compared to these results, a cut-off of 19 improved sensitivity to 85.7% with a specificity of 89.7%. Negative and positive predictive values were 98.3% and 41.1% respectively. Seated ARR mean value was lower than supine and upright ARR mean values, due to an overall increase in renin at seating compared to the supine position by factor 1.9 while aldosterone just slightly increased by factor 1.2. Seated ARR correlated to supine and upright ARR: correlation coefficients (r) 0.90 and 0.93 respectively (P<0.001). Current recommended measurement of ARR in the seating position is fairly correlated to supine and upright ARR. A suggested cut-off value of 19 instead of 23 pg/μUI increased the discriminating power of this test. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

[The Alvarado score validation in diagnosing acute appendicitis in children at Braga Hospital].

PubMed

Gonçalves, Jean Pierre; Cerqueira, Arnaldo; Martins, Sofia

2011-12-01

Acute appendicitis (AA) is the leading cause of emergency abdominal surgery in children. The diagnosis is essentially clinical, but some methodologies, such as Alvarado score (AS), have been developed in order to avoid non-therapeutic laparotomy (15-30%). AS ≥ 5 or 6 is compatible with AA and is an indication for the patient to remain on observations, if AS ≥ 7 a laparotomy procedure may be indicated. To validate the AS for the AA diagnosis of children admitted at Braga Hospital. A validation study of diagnostic method (AS) using the histological examination as a gold standard. The study population consisted of 192 children (4-17 years) with abdominal pain that underwent appendectomy in the last 20 months (December 2008 to July 2010). It was determined the values of sensitivity (S), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), likelihood ratio (LR) and the ROC curve for three different cut-off points (SA =5, 6 and 7). We found that as the cut-off point of AS decreases progressively the sensitivity and specificity increases and reduces the VPN and VPP. Assuming a cut-off value of 5, only 18 children would be false negatives, instead of the 67 children if the cut-off point was 7 points. The analysis of ROC curves demonstrated a greater area under the curve for a cut-off equal to or greater than 5 (AUC = 70%). We recommend using a cut-off value of 5 points, since only 18 children with AA were initially classified as appendicitis unlikely, this value would increase to 67 patients for the SA value of ≥ 7. The AS is a valuable tool in screening children with abdominal pain for the diagnosis of AA. Nonetheless the diagnosis and final decision must be based on clinical and systematic reassessment of patients.

Screening for social phobia in medical in- and outpatients with the German version of the Social Phobia Inventory (SPIN).

PubMed

Sosic, Z; Gieler, U; Stangier, U

2008-06-01

To evaluate the German version of the Social Phobia Inventory (SPIN) as a screening device and to report corresponding cut-off scores for different populations. In Study 1, 2043 subjects from a representative sample completed the SPIN. Cut-off values were established on the basis of means and standard deviations. In Study 2, different aspects of validity were examined in a clinical sample comprising 164 subjects, including social phobic individuals, individuals with other anxiety disorders and depression, and non-clinical control subjects. Internal consistency was evaluated. Convergent and divergent validity were explored using several established measures. Finally, the sensitivity and specificity of the German SPIN with regard to social anxiety classification were investigated by means of receiver operating characteristics (ROC) analyses. In Study 1, mean scores and standard deviations were used to determine cut-off scores for the German SPIN. In Study 2, excellent internal consistency and good convergent and divergent validity were obtained. ROC analyses revealed that the German SPIN performed well in discriminating between social phobic individuals on the one hand and psychiatric and non-psychiatric controls on the other. A cut-off score of 25 represented the best balance between sensitivity and specificity. Comparable to the original version, the German SPIN demonstrates solid psychometric properties and shows promise as an economic, reliable, and valid screening device.

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

Optimal cut-off levels to define obesity: body mass index and waist circumference, and their relationship to cardiovascular disease, dyslipidaemia, hypertension and diabetes in Malaysia.

PubMed

Zaher, Zaki Morad Mohd; Zambari, Robayaah; Pheng, Chan Siew; Muruga, Vadivale; Ng, Bernard; Appannah, Geeta; Onn, Lim Teck

2009-01-01

Many studies in Asia have demonstrated that Asian populations may require lower cut-off levels for body mass index (BMI) and waist circumference to define obesity and abdominal obesity respectively, compared to western populations. Optimal cut-off levels for body mass index and waist circumference were determined to assess the relationship between the two anthropometric- and cardiovascular indices. Receiver operating characteristics analysis was used to determine the optimal cut-off levels. The study sample included 1833 subjects (mean age of 44+/-14 years) from 93 primary care clinics in Malaysia. Eight hundred and seventy two of the subjects were men and 960 were women. The optimal body mass index cut-off values predicting dyslipidaemia, hypertension, diabetes mellitus, or at least one cardiovascular risk factor varied from 23.5 to 25.5 kg/m2 in men and 24.9 to 27.4 kg/m2 in women. As for waist circumference, the optimal cut-off values varied from 83 to 92 cm in men and from 83 to 88 cm in women. The optimal cut-off values from our study showed that body mass index of 23.5 kg/m2 in men and 24.9 kg/m2 in women and waist circumference of 83 cm in men and women may be more suitable for defining the criteria for overweight or obesity among adults in Malaysia. Waist circumference may be a better indicator for the prediction of obesity-related cardiovascular risk factors in men and women compared to BMI. Further investigation using a bigger sample size in Asia needs to be done to confirm our findings.

Assessment of Under Nutrition of Bangladeshi Adults Using Anthropometry: Can Body Mass Index Be Replaced by Mid-Upper-Arm-Circumference?

PubMed Central

Sultana, Tania; Karim, Md. Nazmul; Ahmed, Tahmeed; Hossain, Md. Iqbal

2015-01-01

Background and Objective Body-mass-index (BMI) is widely accepted as an indicator of nutritional status in adults. Mid-upper-arm-circumference (MUAC) is another anthropometric-measure used primarily among children. The present study attempted to evaluate the use of MUAC as a simpler alternative to BMI cut-off <18.5 to detect adult undernutrition, and thus to suggest a suitable cut-off value. Methods A cross-sectional study in 650 adult attendants of the patients of Dhaka-Hospital, of the International Centre for Diarrheal Disease Research, Bangladesh (icddr,b) was conducted during 2012. Height, weight and MUAC of 260 male and 390 female aged 19–60 years were measured. Curve estimation was done to assess the linearity and correlation of BMI and MUAC. Sensitivity and specificity of MUAC against BMI<18.5 was determined. Separate Receiver-operating-characteristic (ROC) analyses were performed for male and female. Area under ROC curve and Youden's index were generated to aid selection of the most suitable cut-off value of MUAC for undernutrition. A value with highest Youden's index was chosen for cut-off. Results Our data shows strong significant positive correlation (linear) between MUAC and BMI, for males r = 0.81, (p<0.001) and for females r = 0.828, (p<0.001). MUAC cut-off <25.1 cm in males (AUC 0.930) and <23.9 cm in females (AUC 0.930) were chosen separately based on highest corresponding Youden's index. These values best correspond with BMI cut-off for under nutrition (BMI <18.5) in either gender. Conclusion MUAC correlates closely with BMI. For the simplicity and easy to remember MUAC <25 cm for male and <24 cm for female may be considered as a simpler alternative to BMI cut-off <18.5 to detect adult undernutrition. PMID:25875397

HOMA1-IR and HOMA2-IR indexes in identifying insulin resistance and metabolic syndrome: Brazilian Metabolic Syndrome Study (BRAMS).

PubMed

Geloneze, Bruno; Vasques, Ana Carolina Junqueira; Stabe, Christiane França Camargo; Pareja, José Carlos; Rosado, Lina Enriqueta Frandsen Paez de Lima; Queiroz, Elaine Cristina de; Tambascia, Marcos Antonio

2009-03-01

To investigate cut-off values for HOMA1-IR and HOMA2-IR to identify insulin resistance (IR) and metabolic syndrome (MS), and to assess the association of the indexes with components of the MS. Nondiabetic subjects from the Brazilian Metabolic Syndrome Study were studied (n = 1,203, 18 to 78 years). The cut-off values for IR were determined from the 90th percentile in the healthy group (n = 297) and, for MS, a ROC curve was generated for the total sample. In the healthy group, HOMA-IR indexes were associated with central obesity, triglycerides and total cholesterol (p < 0.001). The cut-off values for IR were: HOMA1-IR > 2.7 and HOMA2-IR > 1.8; and, for MS were: HOMA1-IR > 2.3 (sensitivity: 76.8%; specificity: 66.7%) and HOMA2-IR > 1.4 (sensitivity: 79.2%; specificity: 61.2%). The cut-off values identified for HOMA1-IR and HOMA2-IR indexes have a clinical and epidemiological application for identifying IR and MS in Westernized admixtured multi-ethnic populations.

Programmable Gain Amplifiers with DC Suppression and Low Output Offset for Bioelectric Sensors

PubMed Central

Carrera, Albano; de la Rosa, Ramón; Alonso, Alonso

2013-01-01

DC-offset and DC-suppression are key parameters in bioelectric amplifiers. However, specific DC analyses are not often explained. Several factors influence the DC-budget: the programmable gain, the programmable cut-off frequencies for high pass filtering and, the low cut-off values and the capacitor blocking issues involved. A new intermediate stage is proposed to address the DC problem entirely. Two implementations were tested. The stage is composed of a programmable gain amplifier (PGA) with DC-rejection and low output offset. Cut-off frequencies are selectable and values from 0.016 to 31.83 Hz were tested, and the capacitor deblocking is embedded in the design. Hence, this PGA delivers most of the required gain with constant low output offset, notwithstanding the gain or cut-off frequency selected. PMID:24084109

Estimation of Saliva Cotinine Cut-Off Points for Active and Passive Smoking during Pregnancy—Polish Mother and Child Cohort (REPRO_PL)

PubMed Central

Polanska, Kinga; Krol, Anna; Kaluzny, Pawel; Ligocka, Danuta; Mikolajewska, Karolina; Shaheen, Seif; Walton, Robert; Hanke, Wojciech

2016-01-01

A reliable assessment of smoking status has significant public health implications and is essential for research purposes. The aim of this study was to determine optimal saliva cotinine cut-off values for smoking during pregnancy. The analyses were based on data from 1771 women from the Polish Mother and Child Cohort. Saliva cotinine concentrations were assessed by high performance liquid chromatography coupled with tandem mass spectrometry (HPLC-ESI + MS/MS). The saliva cotinine cut-off value for active smoking was established at 10 ng/mL (sensitivity 96%, specificity 95%) and for passive smoking at 1.5 ng/mL (sensitivity 63%, specificity 71%). About 5% of the self-reported non-smoking women were classified as smokers based on the cotinine cut-off value. Significantly more younger, single, and less educated self-reported non-smokers had a cotinine concentration higher than 10 ng/mL compared to those who were older, married, and who had a university degree. Close to 30% of the non-smokers who indicated that smoking was not allowed in their home could be classified as exposed to passive smoking based on the cut-off value. The study suggests that self-reported smoking status is a valid measure of active smoking, whereas in the case of passive smoking, a combination of questionnaire data and biomarker verification may be required. PMID:27941658

Diagnostic value of sputum adenosine deaminase (ADA) level in pulmonary tuberculosis.

PubMed

Binesh, Fariba; Jalali, Hadi; Zare, Mohammad Reza; Behravan, Farhad; Tafti, Arefeh Dehghani; Behnaz, Fatemah; Tabatabaee, Mohammad; Shahcheraghi, Seyed Hossein

2016-06-01

Tuberculosis is still a considerable health problem in many countries. Rapid diagnosis of this disease is important, and adenosine deaminase (ADA) has been used as a diagnostic test. The aim of this study was to assess the diagnostic value of ADA in the sputum of patients with pulmonary tuberculosis. The current study included 40 patients with pulmonary tuberculosis (culture positive, smear ±) and 42 patients with non tuberculosis pulmonary diseases (culture negative). ADA was measured on all of the samples. The median value of ADA in non-tuberculosis patients was 2.94 (4.2) U/L and 4.01 (6.54) U/L in tuberculosis patients, but this difference was not statistically significant (p=0.100). The cut-off point of 3.1 U/L had a sensitivity of 61% and a specificity of 53%, the cut-off point of 2.81 U/L had a sensitivity of 64% and a specificity of 50% and the cut-off point of 2.78 U/L had a sensitivity of 65% and a specificity of 48%. The positive predictive values for cut-off points of 3.1, 2.81 and 2.78 U/L were 55.7%, 57.44% and 69.23%, respectively. The negative predictive values for the abovementioned cut-off points were 56.75%, 57.14% and 55.88%, respectively. Our results showed that sputum ADA test is neither specific nor sensitive. Because of its low sensitivity and specificity, determination of sputum ADA for the diagnosis of pulmonary tuberculosis is not recommended.

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.

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.

Categorization of low cardiorespiratory fitness using obesity indices in non-smoking Singaporean women.

PubMed

Pua, Yong-Hao; Lim, Cheng-Kuan; Ang, Adele

2006-11-01

To revisit cut-off values of BMI, waist circumference (WC), and waist-to-stature ratio (WSR) based on their association with cardiorespiratory fitness (CRF). The derived cut-off points were compared with current values (BMI, 25.0 kg/m(2); WC, 80 cm) as recommended by the World Health Organization. Anthropometric indices were measured in a cross sectional study of 358 Singaporean female employees of a large tertiary hospital (63% Singaporean Chinese, 28% Malays, and 9% Indians). CRF was determined by the 1-mile walk test. Receiver operating characteristic curves were constructed to determine cut-off points. The cut-off points for BMI, WC, and WSR were 23.6 kg/m(2), 75.3 cm, and 0.48, respectively. The areas under the curve of BMI, WC, and WSR were 0.68, 0.74, and 0.74, respectively. For a given BMI, women with low CRF had higher WSR compared with women with high CRF. These findings provide convergent evidence that the cut-off points for Singaporean women were lower than the World Health Organization's criteria but were in good agreement with those reported for Asians.

Detecting liver fibrosis with Gd-EOB-DTPA-enhanced MRI: A confirmatory study.

PubMed

Verloh, Niklas; Utpatel, Kirsten; Haimerl, Michael; Zeman, Florian; Beyer, Lukas; Fellner, Claudia; Brennfleck, Frank; Dahlke, Marc H; Stroszczynski, Christian; Evert, Matthias; Wiggermann, Philipp

2018-04-18

Strong correlations between the grade of fibrosis and cirrhosis, classified using the Ishak scoring system, and the uptake characteristics of Gd-EOB-DTPA with the relative enhancement (RE) of the liver parenchyma have been reported. To confirm the results of a retrospective analysis, patients undergoing liver surgery were prospectively examined with Gd-EOB-DTPA-enhanced liver 3 Tesla MRI to determine the degree of liver fibrosis. Correlations between the grade of fibrosis and cirrhosis, classified using the Ishak scoring system, and RE were investigated and compared with those derived from an initial retrospective study. After validating the cut-off values in the retrospective study (Ishak ≥ 1, RE-cut-off 0.90; Ishak ≥ 2, RE-cut-off 0.79; Ishak ≥ 4, RE-cut-off 0.60; and Ishak = 6, RE-cut-off 0.47), we showed that Gd-EOB-DTPA has a high sensitivity (≥86%) and a high positive predictive value (≥86%). These results support the use of Gd-EOB-DTPA-enhanced liver MRI as a non-invasive method for determining the degree of liver fibrosis and cirrhosis.

The role of urinary fractionated metanephrines in the diagnosis of phaeochromocytoma

PubMed Central

Jeyaraman, Kanakamani; Natarajan, Vasanthi; Thomas, Nihal; Jacob, Paul Mazhuvanchary; Nair, Aravindan; Shanthly, Nylla; Oommen, Regi; Varghese, Gracy; Joseph, Fleming Jude; Seshadri, Mandalam Subramaniam; Rajaratnam, Simon

2013-01-01

Background & objectives: Plasma and urinary metanephrines are used as screening tests for the diagnosis of phaeochromocytoma. The recommended cut-off levels are not standardized. This study was conducted to identify a cut-off level for 24 h urinary fractionated metanephrines viz. metanephrine (uMN) and normetanephrine (uNMN) using enzyme immunoassay for the diagnosis of phaeochromocytoma. Methods: Consecutive patients suspected to have phaeochromocytoma were included in the study. uMN and uNMN in 24 h urinary sample were measured using a commercial ELISA kit. Results: Overall, 72 patients were included over a period of 18 months. Twenty patients had histopathologically confirmed phaeochromocytoma and in 52 patients phaeochromocytoma was ruled out. Using the upper limit of normal stated by the assay manufacturer as the cut-off, uMN >350 μg/day had a low sensitivity and uNMN >600 μg/day had a poor specificity. By increasing the cut-off value of uNMN to twice the upper limit, specificity increased significantly without much loss in sensitivity. Combining uMN and uNMN using a cut-off twice the upper limit improved the diagnostic performance - sensitivity (95%); specificity (92.3%); positive predictive value (PPV - 82.6%); negative predictive value (NPV - 98%). In subsets of patients with a variable pretest probability for phaeochromocytoma, the PPV correlates well with the occurred of these tumors decreased, while the NPV remained at 100 per cent. Interpretation & conclusions: ELISA is a simple and reliable method for measuring uMN and uNMN. The test has a good NPV and can be used as an initial screening test for ruling out phaeochromocytoma. Each hospital will have to define the cut-off value for the assay being used, choosing a proper control population. PMID:23563375

The role of urinary fractionated metanephrines in the diagnosis of phaeochromocytoma.

PubMed

Jeyaraman, Kanakamani; Natarajan, Vasanthi; Thomas, Nihal; Jacob, Paul Mazhuvanchary; Nair, Aravindan; Shanthly, Nylla; Oommen, Regi; Varghese, Gracy; Joseph, Fleming Jude; Seshadri, Mandalam Subramaniam; Rajaratnam, Simon

2013-02-01

Plasma and urinary metanephrines are used as screening tests for the diagnosis of phaeochromocytoma. The recommended cut-off levels are not standardized. This study was conducted to identify a cut-off level for 24 h urinary fractionated metanephrines viz. metanephrine (uMN) and normetanephrine (uNMN) using enzyme immunoassay for the diagnosis of phaeochromocytoma. Consecutive patients suspected to have phaeochromocytoma were included in the study. uMN and uNMN in 24 h urinary sample were measured using a commercial ELISA kit. Overall, 72 patients were included over a period of 18 months. Twenty patients had histopathologically confirmed phaeochromocytoma and in 52 patients phaeochromocytoma was ruled out. Using the upper limit of normal stated by the assay manufacturer as the cut-off, uMN >350 μg/day had a low sensitivity and uNMN >600 μg/day had a poor specificity. By increasing the cut-off value of uNMN to twice the upper limit, specificity increased significantly without much loss in sensitivity. Combining uMN and uNMN using a cut-off twice the upper limit improved the diagnostic performance - sensitivity (95%); specificity (92.3%); positive predictive value (PPV - 82.6%); negative predictive value (NPV - 98%). In subsets of patients with a variable pretest probability for phaeochromocytoma, the PPV correlates well with the occurred of these tumors decreased, while the NPV remained at 100 per cent. ELISA is a simple and reliable method for measuring uMN and uNMN. The test has a good NPV and can be used as an initial screening test for ruling out phaeochromocytoma. Each hospital will have to define the cut-off value for the assay being used, choosing a proper control population.

Extended international (IOTF) body mass index cut-offs for thinness, overweight and obesity.

PubMed

Cole, T J; Lobstein, T

2012-08-01

The international (International Obesity Task Force; IOTF) body mass index (BMI) cut-offs are widely used to assess the prevalence of child overweight, obesity and thinness. Based on data from six countries fitted by the LMS method, they link BMI values at 18 years (16, 17, 18.5, 25 and 30 kg m(-2)) to child centiles, which are averaged across the countries. Unlike other BMI references, e.g. the World Health Organization (WHO) standard, these cut-offs cannot be expressed as centiles (e.g. 85th). To address this, we averaged the previously unpublished L, M and S curves for the six countries, and used them to derive new cut-offs defined in terms of the centiles at 18 years corresponding to each BMI value. These new cut-offs were compared with the originals, and with the WHO standard and reference, by measuring their prevalence rates based on US and Chinese data. The new cut-offs were virtually identical to the originals, giving prevalence rates differing by < 0.2% on average. The discrepancies were smaller for overweight and obesity than for thinness. The international and WHO prevalences were systematically different before/after age 5. Defining the international cut-offs in terms of the underlying LMS curves has several benefits. New cut-offs are easy to derive (e.g. BMI 35 for morbid obesity), and they can be expressed as BMI centiles (e.g. boys obesity = 98.9th centile), allowing them to be compared with other BMI references. For WHO, median BMI is relatively low in early life and high at older ages, probably due to its method of construction. © 2012 The Authors. Pediatric Obesity © 2012 International Association for the Study of Obesity.

Analysis of a quantitative PCR assay for CMV infection in liver transplant recipients: an intent to find the optimal cut-off value.

PubMed

Martín-Dávila, P; Fortún, J; Gutiérrez, C; Martí-Belda, P; Candelas, A; Honrubia, A; Barcena, R; Martínez, A; Puente, A; de Vicente, E; Moreno, S

2005-06-01

Preemptive therapy required highly predictive tests for CMV disease. CMV antigenemia assay (pp65 Ag) has been commonly used for rapid diagnosis of CMV infection. Amplification methods for early detection of CMV DNA are under analysis. To compare two diagnostic methods for CMV infection and disease in this population: quantitative PCR (qPCR) performed in two different samples, plasma and leukocytes (PMNs) and using a commercial diagnostic test (COBAS Amplicor Monitor Test) versus pp65 Ag. Prospective study conducted in liver transplant recipients from February 2000 to February 2001. Analyses were performed on 164 samples collected weekly during early post-transplant period from 33 patients. Agreements higher than 78% were observed between the three assays. Optimal qPCR cut-off values were calculated using ROC curves for two specific antigenemia values. For antigenemia >or=10 positive cells, the optimal cut-off value for qPCR in plasma was 1330 copies/ml, with a sensitivity (S) of 58% and a specificity (E) of 98% and the optimal cut-off value for qPCR-cells was 713 copies/5x10(6) cells (S:91.7% and E:86%). Using a threshold of antigenemia >or=20 positive cells, the optimal cut-off values were 1330 copies/ml for qPCR-plasma (S 87%; E 98%) and 4755 copies/5x10(6) cells for qPCR-cells (S 87.5%; E 98%). Prediction values for the three assays were calculated in patients with CMV disease (9 pts; 27%). Considering the assays in a qualitative way, the most sensitive was CMV PCR in cells (S: 100%, E: 54%, PPV: 40%; NPV: 100%). Using specific cut-off values for disease detection the sensitivity, specificity, PPV and NPV for antigenemia >or=10 positive cells were: 89%; 83%; 67%; 95%, respectively. For qPCR-cells >or=713 copies/5x10(6) cells: 100%; 54%; 33% and 100% and for plasma-qPCR>or=1330 copies/ml: 78%, 77%, 47%, 89% respectively. Optimal cut-off for viral load performed in plasma and cells can be obtained for the breakpoint antigenemia value recommended for initiating preemptive therapy with high specificities and sensitivities. Diagnostic assays like CMV pp65 Ag and quantitative PCR for CMV have similar efficiency and could be recommended as methods of choice for diagnosis and monitoring of active CMV infection after transplantation.

Estimation of test characteristics of real-time PCR and bacterial culture for diagnosis of subclinical intramammary infections with Streptococcus agalactiae in Danish dairy cattle in 2012 using latent class analysis.

PubMed

Mahmmod, Yasser S; Toft, Nils; Katholm, Jørgen; Grønbæk, Carsten; Klaas, Ilka C

2013-05-01

The misdiagnosis of intramammary infections (IMI) with Streptococcus agalactiae (S. agalactiae) could lead farmers to treat or cull animals unnecessarily. The objective of this field study was to estimate the sensitivity (Se) and specificity (Sp) of real-time PCR at different cut-offs for cycle threshold (Ct) values against bacterial culture (BC) for diagnosis of S. agalactiae IMI using latent class analysis to avoid the assumption of a perfect reference test. A total of 614 dairy cows were randomly selected from 6 herds with bulk tank PCR Ct value ≤ 39 for S. agalactiae and S. aureus. At milk recording, 2456 quarter milk samples were taken aseptically for BC and the routinely taken cow level milk samples were analyzed by PCR. Results showed that 53 cows (8.6%) were positive for S. agalactiae IMI by BC. Sensitivity of PCR at cut-offs; ≤ 39, ≤ 37, ≤ 34, and ≤ 32, was 96.2%, 91.9%, 87.2% and 73.9%, while Se of BC was 25.7%, 29.9%, 59.9% and 72.1%. Specificity of PCR at cut-offs; ≤ 39, ≤ 37, ≤ 34, and ≤ 32, was 96.8%, 96.9%, 96.7%, and 97.22%, while Sp of BC was 99.7%, 99.5%, 99.2%, and 98.9%. The estimated prevalence of S. agalactiae IMI by PCR was higher than the apparent prevalence at the tested cut-offs, indicating under estimation of S. agalactiae IMI in the examined dairy cows. In conclusion, Se of PCR is always higher than Se of BC at all tested cut-offs. The lower cut-off, the more comparable becomes Se of PCR and Se of BC. The changes in Se in both PCR and BC at different Ct-value cut-offs may indicate a change in the definition of the latent infection. The similar Se of both tests at cut-off ≤ 32 may indicate high concentrations of S. agalactiae viable cells, representing a cow truly/heavily infected with S. agalactiae and thus easier to detect with BC. At cut-off ≤ 39 the latent definition of infection may reflect a more general condition of cows being positive for S. agalactiae. Our findings indicate that PCR Ct-value cut-offs should be chosen according to the underlying latent infection definition of interest. Latent class analysis proposes a useful alternative to classic test evaluation of diagnostic tests used for detection of S. agalactiae IMI in milk. Copyright © 2012 Elsevier B.V. All rights reserved.

Role of sampling times and serum cortisol cut-off concentrations on the routine assessment of adrenal function using the standard cosyntropin test in an academic hospital from Spain: a retrospective chart review.

PubMed

Ortiz-Flores, Andrés E; Santacruz, Elisa; Jiménez-Mendiguchia, Lucía; García-Cano, Ana; Nattero-Chávez, Lia; Escobar-Morreale, Héctor F; Luque-Ramírez, Manuel

2018-05-05

Aiming to validate the use of a single poststimulus sampling protocol for cosyntropin test short standard high-dose test (SST) in our institution, our primary objectives were (1) to determine the concordance between 30 and 60 min serum cortisol (SC) measurements during SST; and (2) to evaluate the diagnostic agreement between both sampling times when using classic or assay-specific and sex-specific SC cut-off values. The secondary objectives included (1) estimating the specificity and positive predictive value of 30 and 60 min sampling times while considering the suspected origin of adrenal insufficiency (AI); and (2) obtaining assay-specific cut-off values for SC after SST in a group of subjects with normal hypothalamic-pituitary-adrenal (HPA) axis. This is a retrospective chart review study conducted at a Spanish academic hospital from 2011 to 2015. Two groups were evaluated: (1) a main study group including 370 patients in whom SC was measured at 30 and 60 min during SST; and (2) a confirmative group that included 150 women presenting with a normal HPA axis in whom SST was conducted to rule out late-onset congenital adrenal hyperplasia. Diagnostic agreement between both sampling times was assessed by considering both classic (500 nmol/L) and assay-specific SC cut-off concentrations. Diagnostic agreement between both sampling times was greater when applying sex-specific and assay-specific cut-off values instead of the classic cut-off values. For suspected primary AI, 30 min SC determination was enough to establish a diagnosis in over 95% of cases, without missing any necessary treatment. When central AI is suspected, 60 min SC measurement was more specific, establishing a diagnosis in over 97% of cases. Sex-specific and assay-specific SC cut-off values improve the diagnostic accuracy of SST. For primary disease, a subnormal SC response at 30 min is a reliable marker of adrenal dysfunction. On the contrary, when central AI is suspected, 60 min SC measurement improves the diagnostic accuracy of the test. © 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.

Optimal waist circumference cut-off values for predicting cardiovascular risk factors in a multi-ethnic Malaysian population.

PubMed

Cheong, Kee C; Ghazali, Sumarni M; Hock, Lim K; Yusoff, Ahmad F; Selvarajah, Sharmini; Haniff, Jamaiyah; Zainuddin, Ahmad Ali; Ying, Chan Y; Lin, Khor G; Rahman, Jamalludin A; Shahar, Suzana; Mustafa, Amal N

2014-01-01

Previous studies have proposed the lower waist circumference (WC) cutoffs be used for defining abdominal obesity in Asian populations. To determine the optimal cut-offs of waist circumference (WC) in predicting cardiovascular (CV) risk factors in the multi-ethnic Malaysian population. We analysed data from 32,703 respondents (14,980 men and 17,723 women) aged 18 years and above who participated in the Third National Health and Morbidity Survey in 2006. Gender-specific logistic regression analyses were used to examine associations between WC and three CV risk factors (diabetes mellitus, hypertension, and hypercholesterolemia). The Receiver Operating Characteristic (ROC) curves were used to determine the cut-off values of WC with optimum sensitivity and specificity for detecting these CV risk factors. The odds ratio for having diabetes mellitus, hypertension, and hypercholesterolemia, or at least one of these risks, increased significantly as the WC cut-off point increased. Optimal WC cut-off values for predicting the presence of diabetes mellitus, hypertension, hypercholesterolemia and at least one of the three CV risk factors varied from 81.4 to 85.5 cm for men and 79.8 to 80.7 cm for women. Our findings indicate that WC cut-offs of 81 cm for men and 80 cm for women are appropriate for defining abdominal obesity and for recommendation to undergo cardiovascular risk screening and weight management in the Malaysian adult population. © 2014 Asian Oceanian Association for the Study of Obesity . Published by Elsevier Ltd. 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.

Prevalence of overweight and obesity among children aged 2-5 years in Bahrain: a comparison between two reference standards.

PubMed

Al-Raees, Ghada Y; Al-Amer, Maryam A; Musaiger, Abdulrahman O; D'Souza, Reshma

2009-01-01

A cross-sectional study was carried out on Bahraini preschoolers aged 2-5 years (354 males and 344 females) to determine the prevalence of overweight and obesity using the World Health Organization and the International Obesity Task Force cut-off values. Weight and height were recorded and body mass index (BMI) was calculated to determine the proportion of overweight and obesity. Using the World Health Organization percentile cut-off values, overweight (12.3%) and obesity (8.4%) was higher in females between 2 and <4 years of age whereas, the proportion of both overweight (8.4%) and obesity (7.2%) were higher in males between 4 and <6 years of age. Relative to the International Obesity Task Force indicators, the World Health Organization cut-off values produced nearly a 2-fold increase in both overweight and obesity at most ages. It is therefore important to ensure that the same cut-off reference values are used to define overweight and obesity particularly in preschoolers. Shifting to the new World Health Organization child growth standards may have important implications for child health programmes.

Longer biopsy cores do not increase prostate cancer detection rate: A large-scale cohort study refuting cut-off values indicated in the literature

PubMed Central

Yılmaz, Hasan; Yavuz, Ufuk; Üstüner, Murat; Çiftçi, Seyfettin; Yaşar, Hikmet; Müezzinoğlu, Bahar; Uslubaş, Ali Kemal; Dillioğlugil, Özdal

2017-01-01

Objective Only a few papers in the literature aimed to evaluate biopsy core lengths. Additionally, studies evaluated the core length with different approaches. We aimed to determine whether prostate cancer (PCa) detection is affected from core lengths according to three different approaches in a large standard cohort and compare our cut-off values with the published cut-offs. Material and methods We retrospectively analyzed 1,523 initial consecutive transrectal ultrasound-guided 12-core prostate biopsies. Biopsies were evaluated with respect to total core length (total length of each patients’ core) average core length (total core length divided by total number of cores in each patient), and mean core length (mean length of all cores pooled), and compared our cut-off values with the published cut-offs. The prostate volumes were categorized into four groups (<30, 30–59.99, 60–119.99, ≥120 cm3) and PCa detection rates in these categories were examined. Results PCa was found in 41.5% patients. There was no difference between benign and malignant mean core lengths of the pooled cores (p>0.05). Total core length and average core length were not significantly associated with PCa in multivariate logistic regression analyses (p>0.05). The core lengths (mean, average and total core lengths) increased (p<0.001) and PCa rates decreased (p<0.001) steadily with increasing prostate volume categories. PCa percentages decreased in all categories above the utilized cut-offs for mean (p>0.05), average (p<0.05), and total core lengths (p>0.05). Conclusion There was no difference between mean core lengths of benign and malignant cores. Total core length and average core length were not significantly associated with PCa. Contrary to the cut-offs used for mean and average core lengths in the published studies, PCa rates decrease as these core lengths increase. Larger studies are necessary for the determination and acceptance of accurate cut-offs. PMID:28861301

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.

Variability of breathing during wakefulness while using CPAP predicts adherence.

PubMed

Fujita, Yukio; Yamauchi, Motoo; Uyama, Hiroki; Kumamoto, Makiko; Koyama, Noriko; Yoshikawa, Masanori; Strohl, Kingman P; Kimura, Hiroshi

2017-02-01

The standard therapy for obstructive sleep apnoea (OSA) is continuous positive airway pressure (CPAP) therapy. However, long-term adherence remains at ~50% despite improvements in behavioural and educational interventions. Based on prior work, we explored whether regularity of breathing during wakefulness might be a physiologic predictor of CPAP adherence. Of the 117 consecutive patients who were diagnosed with OSA and prescribed CPAP, 79 CPAP naïve patients were enrolled in this prospective study. During CPAP initiation, respiratory signals were collected using respiratory inductance plethysmography while wearing CPAP during wakefulness in a seated position. Breathing regularity was assessed by the coefficient of variation (CV) for breath-by-breath estimated tidal volume (V T ) and total duration of respiratory cycle (Ttot). In a derivation group (n = 36), we determined the cut-off CV value which predicted poor CPAP adherence at the first month of therapy, and verified the validity of this predetermined cut-off value in the remaining participants (validation group; n = 43). In the derivation group, the CV for estimated V T was significantly higher in patients with poor adherence than with good adherence (median (interquartile range): 44.2 (33.4-57.4) vs 26.0 (20.4-33.2), P < 0.001). The CV cut-off value for estimated V T for poor CPAP adherence was 34.0, according to a receiver-operating characteristic (ROC) curve. In the validation group, the CV value for estimated V T >34.0 confirmed to be predicting poor CPAP adherence (sensitivity, 0.78; specificity, 0.83). At the initiation of therapy, breathing regularity during wakefulness while wearing CPAP is an objective predictor of short-term CPAP adherence. © 2016 Asian Pacific Society of Respirology.

Usefulness of a simple self-administered joint condition assessment sheet to predict the need for orthopaedic intervention in the management of haemophilic arthropathy.

PubMed

Masaoka, T; Amano, K; Takedani, H; Suzuki, T; Otaki, M; Seita, I; Tateiwa, T; Shishido, T; Yamamoto, K; Fukutake, K

2017-03-01

Detecting signs of joint deterioration is important for early effective orthopaedic intervention in managing haemophilic arthropathy. We developed a simple, patient self-administered sheet to evaluate the joint condition, and assessed the predictive ability of this assessment sheet for the need for an orthopaedic intervention. This was a single-centre, cross-sectional study. The association between the score of each of the four items of the assessment sheet (bleeding, swelling, pain and physical impairment) and the results of radiological findings and physical examinations based on Haemophilia Joint Health Score 2.1 was assessed. An optimal scoring system was explored by the area under the curve (AUC). The cut-off value for the need for surgery or physiotherapy was determined using the receiver operating characteristic curve procedure. Forty-two patients were included. The 'physical impairment' item showed the highest correlation coefficient with the results of radiographic and physical examinations (range: 0.57-0.76). The AUC of finally adjusted scoring indicates good ability to discriminate between patients with and without a need for orthopaedic intervention. The positive predictive value was the highest at a cut-off value of 4 points for knees (63.0%) and ankles (70.0%), at 5 points for elbows (66.7%) and the highest predictive accuracy at the cut-off value of 4 points for all the joints. The linear trend of the need for an orthopaedic intervention was observed with an increasing score. The joint condition assessment sheet can help clinicians assess the need for orthopaedic intervention for haemophilic arthropathy in Japanese patients with haemophilia. © 2016 John Wiley & Sons Ltd.

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.

The Danish test battery for auditory processing disorder evaluated with patient and control data.

PubMed

Raben Pedersen, Ellen

2018-06-10

This study evaluates the Danish test battery for auditory processing disorder (APD). The battery consists of four behavioural tests, two speech and two non-speech stimuli tests. The evaluation includes determination of: (1) new cut-off values (pass-fail criteria), (2) the sensitivity and the specificity of the entire test battery and (3) the failure rate of different test combinations. For each test in the battery, cut-off values were determined using the weighted Youden index. Applying the newly derived cut-off values, the distribution of failing specific test combinations was determined. A group of 112 children diagnosed with APD (57 boys, 55 girls, aged 6-16 years) and a control group containing 158 children without auditory problems (75 boys, 83 girls, aged 6-16 years). Cut-off values for different weights of the sensitivity and the specificity have been determined. Using the criterion that at least two tests have to be failed for APD to be suspected, the sensitivity and the specificity of the entire test battery were 95.3% and 91.6%, respectively. Some test combinations were found to have higher failure rates than others. Due to the high sensitivity and specificity the test battery has good predictive value in APD assessment.

Factors influencing the robustness of P-value measurements in CT texture prognosis studies

NASA Astrophysics Data System (ADS)

McQuaid, Sarah; Scuffham, James; Alobaidli, Sheaka; Prakash, Vineet; Ezhil, Veni; Nisbet, Andrew; South, Christopher; Evans, Philip

2017-07-01

Several studies have recently reported on the value of CT texture analysis in predicting survival, although the topic remains controversial, with further validation needed in order to consolidate the evidence base. The aim of this study was to investigate the effect of varying the input parameters in the Kaplan-Meier analysis, to determine whether the resulting P-value can be considered to be a robust indicator of the parameter’s prognostic potential. A retrospective analysis of the CT-based normalised entropy of 51 patients with lung cancer was performed and overall survival data for these patients were collected. A normalised entropy cut-off was chosen to split the patient cohort into two groups and log-rank testing was performed to assess the survival difference of the two groups. This was repeated for varying normalised entropy cut-offs and varying follow-up periods. Our findings were also compared with previously published results to assess robustness of this parameter in a multi-centre patient cohort. The P-value was found to be highly sensitive to the choice of cut-off value, with small changes in cut-off producing substantial changes in P. The P-value was also sensitive to follow-up period, with particularly noisy results at short follow-up periods. Using matched conditions to previously published results, a P-value of 0.162 was obtained. Survival analysis results can be highly sensitive to the choice in texture cut-off value in dichotomising patients, which should be taken into account when performing such studies to avoid reporting false positive results. Short follow-up periods also produce unstable results and should therefore be avoided to ensure the results produced are reproducible. Previously published findings that indicated the prognostic value of normalised entropy were not replicated here, but further studies with larger patient numbers would be required to determine the cause of the different outcomes.

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.

Cut-off characterisation of energy spectra of bright fermi sources: Current instrument limits and future possibilities

NASA Astrophysics Data System (ADS)

Romoli, C.; Taylor, A. M.; Aharonian, F.

2017-02-01

In this paper some of the brightest GeV sources observed by the Fermi-LAT were analysed, focusing on their spectral cut-off region. The sources chosen for this investigation were the brightest blazar flares of 3C 454.3 and 3C 279 and the Vela pulsar with a reanalysis with the latest Fermi-LAT software. For the study of the spectral cut-off we first explored the Vela pulsar spectrum, whose statistics in the time interval of the 3FGL catalog allowed strong constraints to be obtained on the parameters. We subsequently performed a new analysis of the flaring blazar SEDs. For these sources we obtained constraints on the cut-off parameters under the assumption that their underlying spectral distribution is described by a power-law with a stretched exponential cut-off. We then highlighted the significant potential improvements on such constraints by observations with next generation ground based Cherenkov telescopes, represented in our study by the Cherenkov Telescope Array (CTA). Adopting currently available simulations for this future observatory, we demonstrate the considerable improvement in cut-off constraints achievable by observations with this new instrument when compared with that achievable by satellite observations.

Validation of the Alcohol Use Disorders Identification Test in university students: AUDIT and AUDIT-C.

PubMed

García Carretero, Miguel Ángel; Novalbos Ruiz, José Pedro; Martínez Delgado, José Manuel; O'Ferrall González, Cristina

2016-03-02

The aim of this study was to determine the psychometric properties of the Alcohol Use Disorders Identification Test (AUDIT and AUDIT-C) in order to detect problems related to the consumption of alcohol in the university population. The sample consisted of 1309 students.A Weekly Alcohol Consumption Diary was used as a gold standard; Cronbach's Alpha, the Kappa index, Spearman's correlation coefficient and exploratory factor analysis were applied for diagnostic reliability and validity, with ROC curves used to establish the different cut-off points. Binge Drinking (BD) episodes were found in 3.9% of men and 4.0% of women with otherwise low-risk drinking patterns. AUDIT identified 20.1% as high-risk drinkers and 6.4% as drinkers with physical-psychological problems and probable alcohol dependence.Cronbach's alpha of 0.75 demonstrates good internal consistency. The best cut-off points for high-risk drinking students were 8 for males and 6 for females. As for problem drinkers and probable ADS, 13 was the best cut-off point for both sexes. In relation to AUDIT-C, 5 and 4 were the best cut-off points for males and females with high-risk patterns, respectively. The criterion validity of AUDIT and AUDIT-C to detect binge drinking episodes was found to have a moderate K value. The results obtained show that AUDIT has good psychometric properties to detect early alcohol abuse disorders in university students; however, it is recommended that the cut-off point be reduced to 8 in men. AUDIT-C improves its predictive value by raising the cut-off point by one unit. Items 2 and 3 should be reviewed to increase its predictive value for BD.

Comparing Approaches to Optimize Cut-off Scores for Short Cognitive Screening Instruments in Mild Cognitive Impairment and Dementia

PubMed Central

O’Caoimh, Rónán; Gao, Yang; Svendovski, Anton; Gallagher, Paul; Eustace, Joseph; Molloy, D. William

2017-01-01

Background: Although required to improve the usability of cognitive screening instruments (CSIs), the use of cut-off scores is controversial yet poorly researched. Objective: To explore cut-off scores for two short CSIs: the Standardized Mini-Mental State Examination (SMMSE) and Quick Mild Cognitive Impairment (Qmci) screen, describing adjustments in scores for diagnosis (MCI or dementia), age (≤, >75 years), and education (<, ≥12 years), comparing two methods: the maximal accuracy approach, derived from receiver operating characteristic curves, and Youden’s Index. Methods: Pooled analysis of assessments from patients attending memory clinics in Canada between 1999–2010 : 766 with mild cognitive impairment (MCI) and 1,746 with dementia, and 875 normal controls. Results: The Qmci was more accurate than the SMMSE in differentiating controls from MCI or cognitive impairment (MCI and dementia). Employing the maximal accuracy approach, the optimal SMMSE cut-off for cognitive impairment was <28/30 (AUC 0.86, sensitivity 74%, specificity 88%) versus <63/100 for the Qmci (AUC 0.93, sensitivity 85%, specificity 85%). Using Youden’s Index, the optimal SMMSE cut-off remained <28/30 but fell slightly to <62/100 for the Qmci (sensitivity 83%, specificity 87%). The optimal cut-off for MCI was <29/30 for the SMMSE and <67/100 for the Qmci, irrespective of technique. The maximal accuracy approach generally produced higher Qmci cut-offs than Youden’s Index, both requiring adjustment for age and education. There were no clinically meaningful differences in SMMSE cut-off scores by age and education or method employed. Conclusion: Caution should be exercised selecting cut-offs as these differ by age, education, and method of derivation, with the extent of adjustment varying between CSIs. PMID:28222528

The Optimal Cut-Off Value of Neutrophil-to-Lymphocyte Ratio for Predicting Prognosis in Adult Patients with Henoch–Schönlein Purpura

PubMed Central

Park, Chan Hyuk; Han, Dong Soo; Jeong, Jae Yoon; Eun, Chang Soo; Yoo, Kyo-Sang; Jeon, Yong Cheol; Sohn, Joo Hyun

2016-01-01

Background The development of gastrointestinal (GI) bleeding and end-stage renal disease (ESRD) can be a concern in the management of Henoch–Schönlein purpura (HSP). We aimed to evaluate whether the neutrophil-to-lymphocyte ratio (NLR) is associated with the prognosis of adult patients with HSP. Methods Clinical data including the NLR of adult patients with HSP were retrospectively analyzed. Patients were classified into three groups as follows: (a) simple recovery, (b) wax & wane without GI bleeding, and (c) development of GI bleeding. The optimal cut-off value was determined using a receiver operating characteristics curve and the Youden index. Results A total of 66 adult patients were enrolled. The NLR was higher in the GI bleeding group than in the simple recovery or wax & wane group (simple recovery vs. wax & wane vs. GI bleeding; median [IQR], 2.32 [1.61–3.11] vs. 3.18 [2.16–3.71] vs. 7.52 [4.91–10.23], P<0.001). For the purpose of predicting simple recovery, the optimal cut-off value of NLR was 3.18, and the sensitivity and specificity were 74.1% and 75.0%, respectively. For predicting development of GI bleeding, the optimal cut-off value was 3.90 and the sensitivity and specificity were 87.5% and 88.6%, respectively. Conclusions The NLR is useful for predicting development of GI bleeding as well as simple recovery without symptom relapse. Two different cut-off values of NLR, 3.18 for predicting an easy recovery without symptom relapse and 3.90 for predicting GI bleeding can be used in adult patients with HSP. PMID:27073884

The impact of lowering the cut-off value on the sensitivity of the Platelia Elisa IgG (Bio-Rad) test for toxoplasmosis diagnosis

PubMed Central

Mouri, Oussama; Kendjo, Eric; Touafek, Feriel; Fekkar, Arnaud; Konte, Ousmane; Imbert, Sebastien; Courtin, Régis; Mazier, Dominique; Paris, Luc

2015-01-01

Determining specific immune status against Toxoplasma gondii is essential for assessing the risk of reactivation in immunocompromised patients or defining serological monitoring and appropriate prophylactic measures during pregnancy. In France, toxoplasmosis serological screening requires systematic testing for IgM and IgG antibodies. The Platelia Toxo IgG and IgM test (Bio-Rad) is one of the most widely used tests for anti-toxoplasmic antibody detection. We performed a study on 384 sera, including 123 IgG negative (<6 IU/mL) and 261 IgG equivocal (6–9 IU/mL) sera tested with Platelia Toxo IgG and collected during routine screening at Pitié-Salpêtrière Hospital, Paris, France to determine the best-performing IgG titer cut-off value. Out of these 383 sera, 298 were IgM negative by Platelia Toxo IgM and 86 were IgM positive. All sera were also tested against Toxo IgG II LD BIO western blot test as confirmation. Our results indicated that an IgG titer cut-off value of ≥4.4 IU/mL for the Platelia Toxo IgG met the definition of positivity, a value significantly lower than that indicated by the manufacturers. In the presence of IgM antibodies, the IgG titer cut-off decreased significantly to a value ≥0.2 IU/mL. This latter cut-off also allowed adequate diagnosis of proven toxoplasmosis seroconversion in 76.7% of cases (33/43). Our findings may improve toxoplasmosis care by reducing therapeutic intervention time and eliminating the need for further serological monitoring. PMID:26187780

Performance of a commercial serum ELISA for the detection of antibodies to Neospora caninum in whole and skim milk samples.

PubMed

Byrem, T M; Bartlett, P C; Donohue, H; Voisinet, B D; Houseman, J T

2012-11-23

Control of Neospora caninum infection in cattle depends on specific, ante-mortem detection of infected animals and limiting their use as breeding stock or by culling. The objective of the present study was to determine appropriate cut-off values and diagnostic performance of a milk ELISA test using whole and skim milk in a commercial serum ELISA test (IDEXX Neospora Ab). Serum and milk samples were obtained from a total of 475 lactating cows from two herds with and two herds without a previous history of N. caninum-associated abortion. Overall seroprevalence determined by the ELISA was 18.3%. Compared to serum ELISA values, correlation and overall performance assessed by receiver operating characteristic analysis was higher when either whole or skim milk samples were diluted 1:2 compared to undiluted or 1:5 diluted samples. Diagnostic performance for analysis of whole and skim milk was compared at cut-off values that achieved a desired operating characteristic of at least 95% specificity. For whole milk diluted 1:2 and a cut-off of 0.14 (S/P ratio), sensitivity and kappa values were 74.7% (95% CI 64.3-83.4) and 0.70 (95% CI 0.61-0.78), respectively. For skim milk diluted 1:2 and a cut-off of 0.30, sensitivity and kappa values were 77.0% (95% CI 66.8-85.4) and 0.72 (95% CI 0.64-0.80), respectively. Using the selected cut-offs, the IDEXX Neospora Ab Test is equally suited for the analysis of whole and skim milk as a screening tool in neosporosis control programs. Copyright © 2012 Elsevier B.V. All rights reserved.

Gestational Age-specific Cut-off Values Are Needed for Diagnosis of Subclinical Hypothyroidism in Early Pregnancy.

PubMed

Kim, Hye Sung; Kim, Byoung Jae; Oh, Sohee; Lee, Da Young; Hwang, Kyu Ri; Jeon, Hye Won; Lee, Seung Mi

2015-09-01

During the first trimester of pregnancy, thyroid-stimulating hormone (TSH) >2.5 mIU/L has been suggested as the universal criterion for subclinical hypothyroidism. However, TSH levels change continuously during pregnancy, even in the first trimester. Therefore the use of a fixed cut-off value for TSH may result in a different diagnosis rate of subclinical hypothyroidism according to gestational age. The objective of this study was to obtain the normal reference range of TSH during the first trimester in Korean gravida and to determine the diagnosis rate of subclinical hypothyroidism using the fixed cut-off value (TSH >2.5 mIU/L). The study population consisted of pregnant women who were measured for TSH during the first trimester of pregnancy (n=492) and nonpregnant women (n=984). Median concentration of TSH in pregnant women was lower than in non-pregnant women. There was a continuous decrease of median TSH concentration during the first trimester of pregnancy (median TSH concentration: 1.82 mIU/L for 3+0 to 6+6 weeks; 1.53 mIU/L for 7+0 to 7+6 weeks; and 1.05 mIU/L for 8+0 to 13+6 weeks). Using the fixed cut-off value of TSH >2.5 mIU/L, the diagnosis rate of subclinical hypothyroidism decreased significantly according to the gestational age (GA) at TSH (25% in 3+0 to 6+6 weeks, 13% in 7+0 to 7+6 weeks, and 9% for 8+0 to 13+6 weeks, P<0.001), whereas the diagnosis rate was 5% in all GA with the use of a GA-specific cut-off value (P=0.995). Therefore, GA-specific criteria might be more appropriate for the diagnosis of subclinical hypothyroidism.

The impact of lowering the cut-off value on the sensitivity of the Platelia Elisa IgG (Bio-Rad) test for toxoplasmosis diagnosis.

PubMed

Mouri, Oussama; Kendjo, Eric; Touafek, Feriel; Fekkar, Arnaud; Konte, Ousmane; Imbert, Sebastien; Courtin, Régis; Mazier, Dominique; Paris, Luc

2015-01-01

Determining specific immune status against Toxoplasma gondii is essential for assessing the risk of reactivation in immunocompromised patients or defining serological monitoring and appropriate prophylactic measures during pregnancy. In France, toxoplasmosis serological screening requires systematic testing for IgM and IgG antibodies. The Platelia Toxo IgG and IgM test (Bio-Rad) is one of the most widely used tests for anti-toxoplasmic antibody detection. We performed a study on 384 sera, including 123 IgG negative (<6 IU/mL) and 261 IgG equivocal (6-9 IU/mL) sera tested with Platelia Toxo IgG and collected during routine screening at Pitié-Salpêtrière Hospital, Paris, France to determine the best-performing IgG titer cut-off value. Out of these 383 sera, 298 were IgM negative by Platelia Toxo IgM and 86 were IgM positive. All sera were also tested against Toxo IgG II LD BIO western blot test as confirmation. Our results indicated that an IgG titer cut-off value of ≥4.4 IU/mL for the Platelia Toxo IgG met the definition of positivity, a value significantly lower than that indicated by the manufacturers. In the presence of IgM antibodies, the IgG titer cut-off decreased significantly to a value ≥0.2 IU/mL. This latter cut-off also allowed adequate diagnosis of proven toxoplasmosis seroconversion in 76.7% of cases (33/43). Our findings may improve toxoplasmosis care by reducing therapeutic intervention time and eliminating the need for further serological monitoring. © O. Mouri et al., published by EDP Sciences, 2015.

Diagnostic Value of Isolated Mentalis Versus Mentalis Plus Upper Limb Electromyography in Idiopathic REM Sleep Behavior Disorder Patients Eventually Developing a Neurodegenerative Syndrome.

PubMed

Fernández-Arcos, Ana; Iranzo, Alex; Serradell, Mónica; Gaig, Carles; Guaita, Marc; Salamero, Manel; Santamaria, Joan

2017-04-01

To compare two electromyographic (EMG) montages, isolated mentalis muscle versus mentalis in combination with upper limb muscles in the baseline diagnostic video-polysomnography (V-PSG) of patients with idiopathic REM sleep behaviors disorder (IRBD) who eventually were diagnosed with a clinically defined neurodegenerative syndrome. Forty-nine patients were included. At baseline, diagnosis of RBD was based on a typical history of dream enactment behaviors plus V-PSG showing REM sleep with qualitative increased EMG activity and/or abnormal behaviors. Quantification of EMG activity (tonic, phasic and "any") in the mentalis and upper limb muscles (biceps brachii-BB, n = 36 or flexor digitorum superficialis-FDS, n = 13) was performed manually and compared with published cut-offs. Nine (18.4%) patients had either tonic or phasic EMG below the cut-offs for the isolated mentalis and four of them (11.1 %) also had values below the cut-off for the mentalis combined with BB. All 13 patients recorded with the FDS were above the mentalis combined with FDS cut-off. For the diagnosis of IRBD, sensitivity of isolated mentalis was 81.6% and of the combination of mentalis plus upper limb muscles was 91.8% (p = .03). Audiovisual analysis showed abnormal REM sleep behaviors in all nine patients with values below the cut-offs. Quantification of EMG activity in the upper limbs combined with the mentalis increases the ability to diagnose IRBD when compared with the isolated measurement of the mentalis. Detection of typical abnormal behaviors during REM sleep with audiovisual analysis is essential for the diagnosis of IRBD in patients with EMG values below the published cut-offs. © Sleep Research Society 2017. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.

CA19-9 serum levels predict micrometastases in patients with gastric cancer

PubMed Central

Potrc, Stojan; Mis, Katarina; Plankl, Mojca; Mars, Tomaz

2016-01-01

Abstract Background We explored the prognostic value of the up-regulated carbohydrate antigen (CA19-9) in node-negative patients with gastric cancer as a surrogate marker for micrometastases. Patients and methods Micrometastases were determined using reverse transcription quantitative polymerase chain reaction (RT-qPCR) for a subgroup of 30 node-negative patients. This group was used to determine the cut-off for preoperative CA19-9 serum levels as a surrogate marker for micrometastases. Then 187 node-negative T1 to T4 patients were selected to validate the predictive value of this CA19-9 threshold. Results Patients with micrometastases had significantly higher preoperative CA19-9 serum levels compared to patients without micrometastases (p = 0.046). CA19-9 serum levels were significantly correlated with tumour site, tumour diameter, and perineural invasion. Although not reaching significance, subgroup analysis showed better five-year survival rates for patients with CA19-9 serum levels below the threshold, compared to patients with CA19-9 serum levels above the cut-off. The cumulative survival for T2 to T4 node-negative patients was significantly better with CA19-9 serum levels below the cut-off (p = 0.04). Conclusions Preoperative CA19-9 serum levels can be used to predict higher risk for haematogenous spread and micrometastases in node-negative patients. However, CA19-9 serum levels lack the necessary sensitivity and specificity to reliably predict micrometastases. PMID:27247553

Cut-Offs and Response Criteria for the Hospital Universitario La Princesa Index (HUPI) and Their Comparison to Widely-Used Indices of Disease Activity in Rheumatoid Arthritis.

PubMed

González-Álvaro, Isidoro; Castrejón, Isabel; Ortiz, Ana M; Toledano, Esther; Castañeda, Santos; García-Vadillo, Alberto; Carmona, Loreto

2016-01-01

To estimate cut-off points and to establish response criteria for the Hospital Universitario La Princesa Index (HUPI) in patients with chronic polyarthritis. Two cohorts, one of early arthritis (Princesa Early Arthritis Register Longitudinal [PEARL] study) and other of long-term rheumatoid arthritis (Estudio de la Morbilidad y Expresión Clínica de la Artritis Reumatoide [EMECAR]) including altogether 1200 patients were used to determine cut-off values for remission, and for low, moderate and high activity through receiver operating curve (ROC) analysis. The areas under ROC (AUC) were compared to those of validated indexes (SDAI, CDAI, DAS28). ROC analysis was also applied to establish minimal and relevant clinical improvement for HUPI. The best cut-off points for HUPI are 2, 5 and 9, classifying RA activity as remission if ≤2, low disease activity if >2 and ≤5), moderate if >5 and <9 and high if ≥9. HUPI's AUC to discriminate between low-moderate activity was 0.909 and between moderate-high activity 0.887. DAS28's AUCs were 0.887 and 0.846, respectively; both indices had higher accuracy than SDAI (AUCs: 0.832 and 0.756) and CDAI (AUCs: 0.789 and 0.728). HUPI discriminates remission better than DAS28-ESR in early arthritis, but similarly to SDAI. The HUPI cut-off for minimal clinical improvement was established at 2 and for relevant clinical improvement at 4. Response criteria were established based on these cut-off values. The cut-offs proposed for HUPI perform adequately in patients with either early or long term arthritis.

Cut-Offs and Response Criteria for the Hospital Universitario La Princesa Index (HUPI) and Their Comparison to Widely-Used Indices of Disease Activity in Rheumatoid Arthritis

PubMed Central

Castrejón, Isabel; Ortiz, Ana M.; Toledano, Esther; Castañeda, Santos; García-Vadillo, Alberto; Carmona, Loreto

2016-01-01

Objective To estimate cut-off points and to establish response criteria for the Hospital Universitario La Princesa Index (HUPI) in patients with chronic polyarthritis. Methods Two cohorts, one of early arthritis (Princesa Early Arthritis Register Longitudinal [PEARL] study) and other of long-term rheumatoid arthritis (Estudio de la Morbilidad y Expresión Clínica de la Artritis Reumatoide [EMECAR]) including altogether 1200 patients were used to determine cut-off values for remission, and for low, moderate and high activity through receiver operating curve (ROC) analysis. The areas under ROC (AUC) were compared to those of validated indexes (SDAI, CDAI, DAS28). ROC analysis was also applied to establish minimal and relevant clinical improvement for HUPI. Results The best cut-off points for HUPI are 2, 5 and 9, classifying RA activity as remission if ≤2, low disease activity if >2 and ≤5), moderate if >5 and <9 and high if ≥9. HUPI’s AUC to discriminate between low-moderate activity was 0.909 and between moderate-high activity 0.887. DAS28’s AUCs were 0.887 and 0.846, respectively; both indices had higher accuracy than SDAI (AUCs: 0.832 and 0.756) and CDAI (AUCs: 0.789 and 0.728). HUPI discriminates remission better than DAS28-ESR in early arthritis, but similarly to SDAI. The HUPI cut-off for minimal clinical improvement was established at 2 and for relevant clinical improvement at 4. Response criteria were established based on these cut-off values. Conclusions The cut-offs proposed for HUPI perform adequately in patients with either early or long term arthritis. PMID:27603313

Dynamic interaction between fetal adversity and a genetic score reflecting dopamine function on developmental outcomes at 36 months.

PubMed

Bischoff, Adrianne R; Pokhvisneva, Irina; Léger, Étienne; Gaudreau, Hélène; Steiner, Meir; Kennedy, James L; O'Donnell, Kieran J; Diorio, Josie; Meaney, Michael J; Silveira, Patrícia P

2017-01-01

Fetal adversity, evidenced by poor fetal growth for instance, is associated with increased risk for several diseases later in life. Classical cut-offs to characterize small (SGA) and large for gestational age (LGA) newborns are used to define long term vulnerability. We aimed at exploring the possible dynamism of different birth weight cut-offs in defining vulnerability in developmental outcomes (through the Bayley Scales of Infant and Toddler Development), using the example of a gene vs. fetal adversity interaction considering gene choices based on functional relevance to the studied outcome. 36-month-old children from an established prospective birth cohort (Maternal Adversity, Vulnerability, and Neurodevelopment) were classified according to birth weight ratio (BWR) (SGA ≤0.85, LGA >1.15, exploring a wide range of other cut-offs) and genotyped for polymorphisms associated with dopamine signaling (TaqIA-A1 allele, DRD2-141C Ins/Ins, DRD4 7-repeat, DAT1-10- repeat, Met/Met-COMT), composing a score based on the described function, in which hypofunctional variants received lower scores. There were 251 children (123 girls and 128 boys). Using the classic cut-offs (0.85 and 1.15), there were no statistically significant interactions between the neonatal groups and the dopamine genetic score. However, when changing the cut-offs, it is possible to see ranges of BWR that could be associated with vulnerability to poorer development according to the variation in the dopamine function. The classic birth weight cut-offs to define SGA and LGA newborns should be seen with caution, as depending on the outcome in question, the protocols for long-term follow up could be either too inclusive-therefore most costly, or unable to screen true vulnerabilities-and therefore ineffective to establish early interventions and primary prevention.

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.

Are different cut-off values of liver stiffness assessed by transient elastography according to the etiology of liver cirrhosis for predicting significant esophageal varices?

PubMed

Sporea, Ioan; Raţiu, Iulia; Bota, Simona; Şirli, Roxana; Jurchiş, Ana

2013-06-01

To determine if liver stiffness (LS) measurements by means of Transient Elastography (TE) vary according to the etiology of the underlying liver cirrhosis and to find if there are different TE cut-off values able to predict the presence of significant EV in alcoholic vs. viral etiology of cirrhosis. This retrospective study included patients diagnosed with liver cirrhosis of viral or alcoholic etiology. All patients were evaluated by means of TE (FibroScan) and upper gastrointestinal endoscopy. We performed 10 LS measurements in each patient and a median value expressed in kiloPascals (kPa) was calculated. Only those with a SR >/= 60% and an IQR<30% were considered as reliable MS measurements. According to the presence of EV the patients were divided in two categories: without significant EV and patients with significant EV (at least grade 2). The study included 697 cirrhotic patients with reliable LS measurements. The median LS values assessed by TE were significantly higher in cirrhotic patients with alcoholic etiology as compared with those with viral etiology of liver disease: 41 kPa vs. 21.1 kPa, p<0.0001. In the entire cohort of cirrhotic patients, LS assessed by means of TE for a cut-off value >29.5 kPa, had 77.5% sensitivity and 86.9% specificity for predicting the presence of significant EV (AUROC=0.871). The best LS cut-off value for predicting the presence of significant EV was higher in alcoholic cirrhosis as compared with those with viral etiology of liver cirrhosis: 32.5 kPa (AUROC=0.836) vs. 24.8 kPa (AUROC=0.867). LS cut-off values assessed by TE for predicting significant EV are significantly higher in patients with alcoholic cirrhosis as compared with patients with liver cirrhosis of viral etiology.

Classification of the height and flexibility of the medial longitudinal arch of the foot.

PubMed

Nilsson, Mette Kjærgaard; Friis, Rikke; Michaelsen, Maria Skjoldahl; Jakobsen, Patrick Abildgaard; Nielsen, Rasmus Oestergaard

2012-02-17

The risk of developing injuries during standing work may vary between persons with different foot types. High arched and low arched feet, as well as rigid and flexible feet, are considered to have different injury profiles, while those with normal arches may sustain fewer injuries. However, the cut-off values for maximum values (subtalar position during weight-bearing) and range of motion (ROM) values (difference between subtalar neutral and subtalar resting position in a weight-bearing condition) for the medial longitudinal arch (MLA) are largely unknown. The purpose of this study was to identify cut-off values for maximum values and ROM of the MLA of the foot during static tests and to identify factors influencing foot posture. The participants consisted of 254 volunteers from Central and Northern Denmark (198 m/56 f; age 39.0 ± 11.7 years; BMI 27.3 ± 4.7 kg/m2). Navicular height (NH), longitudinal arch angle (LAA) and Feiss line (FL) were measured for either the left or the right foot in a subtalar neutral position and subtalar resting position. Maximum values and ROM were calculated for each test. The 95% and 68% prediction intervals were used as cut-off limits. Multiple regression analysis was used to detect influencing factors on foot posture. The 68% cut-off values for maximum MLA values and MLA ROM for NH were 3.6 to 5.5 cm and 0.6 to 1.8 cm, respectively, without taking into account the influence of other variables. Normal maximum LAA values were between 131 and 152° and normal LAA ROM was between -1 and 13°. Normal maximum FL values were between -2.6 and -1.2 cm and normal FL ROM was between -0.1 and 0.9 cm. Results from the multivariate linear regression revealed an association between foot size with FL, LAA, and navicular drop. The cut-off values presented in this study can be used to categorize people performing standing work into groups of different foot arch types. The results of this study are important for investigating a possible link between arch height and arch movement and the development of injuries.

Resonant tunneling of surface plasmon polariton in the plasmonic nano-cavity.

PubMed

Park, Junghyun; Kim, Hwi; Lee, Il-Min; Kim, Seyoon; Jung, Jaehoon; Lee, Byoungho

2008-10-13

We investigate the reflection and transmission characteristics of the low-dielectric constant cut off barrier in the metal-insulator-metal (MIM) waveguide and propose a novel plasmonic nano-cavity made of two cut off barriers and the waveguide between them. It is shown that the anti-symmetric mode in the MIM waveguide with the core of the low dielectric constant below the specific value cannot be supported and this region can be regarded as a cut off barrier with high stability. The phase shift due to the reflection at the finite-length cut off barrier is calculated and the design scheme of the cavity length for the resonant tunneling is presented. The transmission spectra through the proposed nano-cavity are also discussed.

A description of disordered eating behaviors in Latino males

PubMed Central

Reyes-Rodríguez, Mae Lynn; Sala, Margarita; Von Holle, Ann; Unikel, Claudia; Bulik, Cynthia M.; Cámara-Fuentes, Luis; Suárez-Torres, Alba

2011-01-01

Objective To explore disordered eating and eating disorders (ED) in Latino males. Participants 722 male college students from a larger prevalence study conducted in the University of Puerto Rico (UPR) system. Method Participants were selected from a list of sections of required courses for first-year students on each campus. Self report instruments were used to explore ED symptoms (EAT-26 & BULIT-26) and depression (BDI). Results Overall, 2.26% scored above the cut-off point on the BULIT-R and 5.08% score above the cut-off point on the EAT-26. Of the males, 4.43% reported sufficient frequency and severity to approximate DSM-IV criteria for BN. Depression symptomatology was found in those who scored above the cut-off point on both instruments of ED. Conclusion College health practitioners should be aware of disordered eating in Latino males and include them in efforts to detect disordered eating behaviors in college students. PMID:21308586

[Toronto clinical scoring system in diabetic peripheral neuropathy].

PubMed

Liu, Feng; Mao, Ji-Ping; Yan, Xiang

2008-12-01

To evaluate the application value of Toronto clinical scoring system (TCSS) and its grading of neuropathy for diabetic peripheral neuropathy (DPN), and to explore the relationship between TCSS grading of neuropathy and the grading of diabetic nephropathy and diabetic retinopathy. A total of 209 patients of Type 2 diabtes (T2DM) underwent TCSS. Taking electrophysiological examination as a gold standard for diagnosing DPN, We compared the results of TCSS score > or = 6 with electrophysiological examination, and tried to select the optimal cut-off points of TCSS. The corresponding accuracy, sensitivity, and specificity of TCSS score > or = 6 were 76.6%, 77.2%, and 75.6%, respectively.The Youden index and Kappa were 0.53 and 0.52, which implied TCSS score > or = 6 had a moderate consistency with electrophysiological examination. There was a linear positive correlation between TCSS grading of neuropathy and the grading of diabetic nephropathy and diabetic retinopathy (P<0.05). The optimal cut-off point was 5 or 6 among these patients. TCSS is reliable in diagnosing DPN and its grading of neuropathy has clinical value.

Cut-off optimization for 13C-urea breath test in a community-based trial by mathematic, histology and serology approach.

PubMed

Li, Zhe-Xuan; Huang, Lei-Lei; Liu, Cong; Formichella, Luca; Zhang, Yang; Wang, Yu-Mei; Zhang, Lian; Ma, Jun-Ling; Liu, Wei-Dong; Ulm, Kurt; Wang, Jian-Xi; Zhang, Lei; Bajbouj, Monther; Li, Ming; Vieth, Michael; Quante, Michael; Zhou, Tong; Wang, Le-Hua; Suchanek, Stepan; Soutschek, Erwin; Schmid, Roland; Classen, Meinhard; You, Wei-Cheng; Gerhard, Markus; Pan, Kai-Feng

2017-05-18

The performance of diagnostic tests in intervention trials of Helicobacter pylori (H.pylori) eradication is crucial, since even minor inaccuracies can have major impact. To determine the cut-off point for 13 C-urea breath test ( 13 C-UBT) and to assess if it can be further optimized by serologic testing, mathematic modeling, histopathology and serologic validation were applied. A finite mixture model (FMM) was developed in 21,857 subjects, and an independent validation by modified Giemsa staining was conducted in 300 selected subjects. H.pylori status was determined using recomLine H.pylori assay in 2,113 subjects with a borderline 13 C-UBT results. The delta over baseline-value (DOB) of 3.8 was an optimal cut-off point by a FMM in modelling dataset, which was further validated as the most appropriate cut-off point by Giemsa staining (sensitivity = 94.53%, specificity = 92.93%). In the borderline population, 1,468 subjects were determined as H.pylori positive by recomLine (69.5%). A significant correlation between the number of positive H.pylori serum responses and DOB value was found (r s  = 0.217, P < 0.001). A mathematical approach such as FMM might be an alternative measure in optimizing the cut-off point for 13 C-UBT in community-based studies, and a second method to determine H.pylori status for subjects with borderline value of 13 C-UBT was necessary and recommended.

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.

Accuracy of transcutaneous bilirubin measured by the BiliCare device in late preterm and term neonates.

PubMed

Kitsommart, Ratchada; Yangthara, Buranee; Wutthigate, Punnanee; Paes, Bosco

2016-11-01

The objective of this study is to explore the accuracy and performance of a new transcutaneous bilirubinometer (TCB) for the screening of jaundice in late preterm and term infants. A cross-sectional study was conducted. TCB measurements were performed using the BiliCare(TM) bilirubinometer. Paired TCB and serum bilirubin (SB) measurements were analysed. One hundred and fourteen paired samples were collected from 93 healthy late preterm and term infants. Bilirubin measurements were done at median (interquartile range) of 50.5 (34, 72) hours. The mean (SD) difference between the TCB and SB was 1.87 (1.98) mg/dL. A TCB cut-off level at 8.0 mg/dL provides a sensitivity of 97.3% with a negative predictive value (NPV) of 87.5% to detect a SB level of at least 8.0 mg/dL. For SB levels of at least 10.0 mg/dL, a TCB cut-off at 9.0 mg/dL shows a sensitivity of 97.5%; NPV 95.4%. For a SB level of at least 13.0 mg/dL, a TCB cut-off at 12 or 13 mg/dL had a sensitivity of 92.9% and NPV of 98.7%. The BiliCare(TM) demonstrated good performance with positive bias for the screening of jaundice in healthy late preterm or term infants. However, if adopted, proper cut-off levels should be chosen because of sub-optimal device precision.

Improving discrimination in antepartum depression screening using the Edinburgh Postnatal Depression Scale.

PubMed

Venkatesh, Kartik K; Kaimal, Anjali J; Castro, Victor M; Perlis, Roy H

2017-05-01

Universal screening of pregnant women for postpartum depression has recently been recommended; however, optimal application of depression screening tools in stratifying risk has not been defined. The current study examines new approaches to improve the ability of the Edinburgh Postnatal Depression Scale (EPDS) to stratify risk for postpartum depression, including alternate cut points, use of a continuous measure, and incorporation of other putative risk factors. An observational cohort study of 4939 women screened both antepartum and postpartum with a negative EPDS screen antepartum(i.e. EPDS<10). The primary outcome was a probable postpartum major depressive episode(EPDS cut-off ≥10). Area under the receiver operating characteristics curve(AUC), sensitivity, specificity, and predictive values were calculated. 287 women(5.8%) screened positive for postpartum depression. An antepartum EPDS cut-off<5 optimally identified women with a low risk of postpartum depression with a negative predictive value of 97.6%; however, overall discrimination was modest(AUC 0.66, 95%CI: 0.64-0.69); sensitivity was 78.7%, and specificity was 53.8%, and the positive predictive value was low at 9.5%. The negative predictive values were similar(>95%) at all antepartum EPDS cut-off values from 4 to 8. Discrimination was improved(AUC ranging from 0.70 to 0.73) when the antepartum EPDS was combined with a prior history of major depressive disorder before pregnancy. An inability to assess EPDS subscales and a relatively low prevalence of depression in this cohort. Though an antepartum EPDS cut-off score <5 yielded the greatest discrimination identifying women at low risk for postpartum depression, the negative predictive value was insufficient to substitute for postpartum screening. Copyright © 2017. Published by Elsevier B.V.

A study of insulin resistance by HOMA-IR and its cut-off value to identify metabolic syndrome in urban Indian adolescents.

PubMed

Singh, Yashpal; Garg, M K; Tandon, Nikhil; Marwaha, Raman Kumar

2013-01-01

Insulin resistance (IR) and associated metabolic abnormalities are increasingly being reported in the adolescent population. Cut-off value of homeostasis model of assessment IR (HOMA-IR) as an indicator of metabolic syndrome (MS) in adolescents has not been established. This study aimed to investigate IR by HOMA-IR in urban Indian adolescents and to establish cut-off values of HOMA-IR for defining MS. A total of 691 apparently healthy adolescents (295 with normal body mass index (BMI), 205 overweight, and 199 obese) were included in this cross-sectional study. MS in adolescents was defined by International Diabetes Federation (IDF) and Adult Treatment Panel III (ATP III) criteria. IR was calculated using the HOMA model. Mean height, waist circumference (WC), waist/hip ratio (WHR), waist/height ratio (WHtR), and blood pressure were significantly higher in boys as compared to girls. The HOMA-IR values increased progressively from normal weight to obese adolescents in both sexes. Mean HOMA-IR values increased progressively according to sexual maturity rating in both sexes. HOMA-IR value of 2.5 had a sensitivity of >70% and specificity of >60% for MS. This cut-off identified larger number of adolescents with MS in different BMI categories (19.7% in normal weight, 51.7% in overweight, and 77.0% in obese subjects) as compared to the use of IDF or ATP III criteria for diagnosing MS. Odds ratio for having IR (HOMA-IR of >2.5) was highest with WHtR (4.9, p p<0.0001) and WC (4.8, p p<0.0001), compared to WHR (3.3, p p<0.0001). In Indian adolescents, HOMA-IR increased with sexual maturity and with progression from normal to obese. A HOMA-IR cut-off of 2.5 provided the maximum sensitivity and specificity in diagnosing MS in both genders as per ATP III and IDF criteria.

A Study of Insulin Resistance by HOMA-IR and its Cut-off Value to Identify Metabolic Syndrome in Urban Indian Adolescents

PubMed Central

Singh, Yashpal; Garg, MK; Tandon, Nikhil; Marwaha, Raman Kumar

2013-01-01

Objective: Insulin resistance (IR) and associated metabolic abnormalities are increasingly being reported in the adolescent population. Cut-off value of homeostasis model of assessment IR (HOMA-IR) as an indicator of metabolic syndrome (MS) in adolescents has not been established. This study aimed to investigate IR by HOMA-IR in urban Indian adolescents and to establish cut-off values of HOMA-IR for defining MS. Methods: A total of 691 apparently healthy adolescents (295 with normal body mass index (BMI), 205 overweight, and 199 obese) were included in this cross-sectional study. MS in adolescents was defined by International Diabetes Federation (IDF) and Adult Treatment Panel III (ATP III) criteria. IR was calculated using the HOMA model. Results: Mean height, waist circumference (WC), waist/hip ratio (WHR), waist/height ratio (WHtR), and blood pressure were significantly higher in boys as compared to girls. The HOMA-IR values increased progressively from normal weight to obese adolescents in both sexes. Mean HOMA-IR values increased progressively according to sexual maturity rating in both sexes. HOMA-IR value of 2.5 had a sensitivity of >70% and specificity of >60% for MS. This cut-off identified larger number of adolescents with MS in different BMI categories (19.7% in normal weight, 51.7% in overweight, and 77.0% in obese subjects) as compared to the use of IDF or ATP III criteria for diagnosing MS. Odds ratio for having IR (HOMA-IR of >2.5) was highest with WHtR (4.9, p <0.0001) and WC (4.8, p <0.0001), compared to WHR (3.3, p <0.0001). Conclusions: In Indian adolescents, HOMA-IR increased with sexual maturity and with progression from normal to obese. A HOMA-IR cut-off of 2.5 provided the maximum sensitivity and specificity in diagnosing MS in both genders as per ATP III and IDF criteria. Conflict of interest:None declared. PMID:24379034

Development and validation of optimal cut-off value in inter-arm systolic blood pressure difference for prediction of cardiovascular events.

PubMed

Hirono, Akira; Kusunose, Kenya; Kageyama, Norihito; Sumitomo, Masayuki; Abe, Masahiro; Fujinaga, Hiroyuki; Sata, Masataka

2018-01-01

An inter-arm systolic blood pressure difference (IAD) is associated with cardiovascular disease. The aim of this study was to develop and validate the optimal cut-off value of IAD as a predictor of major adverse cardiac events in patients with arteriosclerosis risk factors. From 2009 to 2014, 1076 patients who had at least one cardiovascular risk factor were included in the analysis. We defined 700 randomly selected patients as a development cohort to confirm that IAD was the predictor of cardiovascular events and to determine optimal cut-off value of IAD. Next, we validated outcomes in the remaining 376 patients as a validation cohort. The blood pressure (BP) of both arms measurements were done simultaneously using the ankle-brachial blood pressure index (ABI) form of automatic device. The primary endpoint was the cardiovascular event and secondary endpoint was the all-cause mortality. During a median period of 2.8 years, 143 patients reached the primary endpoint in the development cohort. In the multivariate Cox proportional hazards analysis, IAD was the strong predictor of cardiovascular events (hazard ratio: 1.03, 95% confidence interval: 1.01-1.05, p=0.005). The receiver operating characteristic curve revealed that 5mmHg was the optimal cut-off point of IAD to predict cardiovascular events (p<0.001). In the validation cohort, the presence of a large IAD (IAD ≥5mmHg) was significantly associated with the primary endpoint (p=0.021). IAD is significantly associated with future cardiovascular events in patients with arteriosclerosis risk factors. The optimal cut-off value of IAD is 5mmHg. Copyright © 2017 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

Feasibility of α-fetoprotein as a diagnostic tool for hepatocellular carcinoma in Korea

PubMed Central

Ahn, Dae Geon; Kim, Hyung Joon; Kang, Hyun; Lee, Hyun Woong; Bae, Si Hyun; Lee, Joon Hyoek; Paik, Yong Han; Lee, June Sung

2016-01-01

Background/Aims: The aim of this study was to evaluate the feasibility of α-fetoprotein (AFP) as a diagnostic tool for hepatocellular carcinoma (HCC) in Korean patients. Methods: We retrospectively reviewed the medical records of HCC and cirrhosis patients at three hospitals. For each HCC patient, a cirrhosis patient matched for age, sex, etiology, and Child-Pugh classification was selected by simple random sampling. The performance of AFP in the diagnosis of HCC was determined using receiver operating characteristic curve analysis. Results: A total of 732 patients with HCC or cirrhosis were selected for each case and the control groups. The mean age was 54 years, and 72.4% of patients were male. The mean serum AFP levels in the HCC group and cirrhosis group were 3,315.6 and 117.2 ng/mL, respectively (p < 0.001). The area under the receiver operating characteristic curve for all HCC patients was 0.757. The sensitivity, specificity, and positive predictive value of AFP was 50.55%, 87.70%, and 80.43%, respectively, at a cut-off of 20 ng/mL; 37.70%, 95.90%, and 90.20%, respectively, at a cut-off of 100 ng/mL, and 30.05%, 97.27%, and 91.67%, respectively, at a cut-off of 200 ng/mL. A cut-off of 100 ng/mL was more sensitive than one of 200 ng/mL with equivalent specificity and positive predictive value. Conclusions: The cut-off AFP value for early-stage HCC was 17.4 ng/mL. Our study cautiously suggests that AFP has a role in the diagnosis of HCC, and that the appropriate value of AFP for the diagnosis of HCC may be 100 ng/mL rather than 200 ng/mL. PMID:26767857

Feasibility of α-fetoprotein as a diagnostic tool for hepatocellular carcinoma in Korea.

PubMed

Ahn, Dae Geon; Kim, Hyung Joon; Kang, Hyun; Lee, Hyun Woong; Bae, Si Hyun; Lee, Joon Hyoek; Paik, Yong Han; Lee, June Sung

2016-01-01

The aim of this study was to evaluate the feasibility of α-fetoprotein (AFP) as a diagnostic tool for hepatocellular carcinoma (HCC) in Korean patients. We retrospectively reviewed the medical records of HCC and cirrhosis patients at three hospitals. For each HCC patient, a cirrhosis patient matched for age, sex, etiology, and Child-Pugh classification was selected by simple random sampling. The performance of AFP in the diagnosis of HCC was determined using receiver operating characteristic curve analysis. A total of 732 patients with HCC or cirrhosis were selected for each case and the control groups. The mean age was 54 years, and 72.4% of patients were male. The mean serum AFP levels in the HCC group and cirrhosis group were 3,315.6 and 117.2 ng/mL, respectively (p < 0.001). The area under the receiver operating characteristic curve for all HCC patients was 0.757. The sensitivity, specificity, and positive predictive value of AFP was 50.55%, 87.70%, and 80.43%, respectively, at a cut-off of 20 ng/mL; 37.70%, 95.90%, and 90.20%, respectively, at a cut-off of 100 ng/mL, and 30.05%, 97.27%, and 91.67%, respectively, at a cut-off of 200 ng/mL. A cut-off of 100 ng/mL was more sensitive than one of 200 ng/mL with equivalent specificity and positive predictive value. The cut-off AFP value for early-stage HCC was 17.4 ng/mL. Our study cautiously suggests that AFP has a role in the diagnosis of HCC, and that the appropriate value of AFP for the diagnosis of HCC may be 100 ng/mL rather than 200 ng/mL.

Insulin resistance in obese children and adolescents: HOMA-IR cut-off levels in the prepubertal and pubertal periods.

PubMed

Kurtoğlu, Selim; Hatipoğlu, Nihal; Mazıcıoğlu, Mümtaz; Kendirici, Mustafa; Keskin, Mehmet; Kondolot, Meda

2010-01-01

Childhood obesity is associated with an increased risk for insulin resistance. The underlying mechanism for the physiological increase in insulin levels in puberty is not clearly understood. The aim of the present study was to determine the cut-off values for homeostasis model assessment for insulin resistance (HOMA-IR) in obese children and adolescents according to gender and pubertal status. Two hundred and eight obese children and adolescents (141 girls, 127 boys) aged between 5 and 18 years were included in the study. The children were divided into prepubertal and pubertal groups. A standard oral glucose tolerance test (OGTT) was carried out in all children. A total insulin level exceeding 300 μU/mL in the blood samples, collected during the test period, was taken as the insulin resistance criterion. Cut-off values for HOMA-IR were calculated by receiver operating characteristic (ROC) analysis. In the prepubertal period, the rate of insulin resistance was found to be 37% in boys and 27.8% in girls,while in the pubertal period, this rate was 61.7% in boys and 66.7% in girls. HOMA-IR cut-off values for insulin resistance in the prepubertal period were calculated to be 2.67 (sensitivity 88.2%, specificity 65.5%) in boys and 2.22 (sensitivity 100%, specificity 42.3%) in girls, and in the pubertal period, they were 5.22 (sensitivity 56%, specificity 93.3%) in boys and 3.82 (sensitivity 77.1%, specificity 71.4%) in girls. Since gender, obesity and pubertal status are factors affecting insulin resistance, cut-off values which depend on gender and pubertal status, should be used in evaluation of insulin resistance.

Preoperative haemoglobin cut-off values for the prediction of post-operative transfusion in total knee arthroplasty.

PubMed

Yeh, Jared Ze Yang; Chen, Jerry Yongqiang; Bin Abd Razak, Hamid Rahmatullah; Loh, Bryan Huai Gu; Hao, Ying; Yew, Andy Khye Soon; Chia, Shi-Lu; Lo, Ngai Nung; Yeo, Seng Jin

2016-10-01

The purpose of this study is to determine preoperative haemoglobin cut-off values that could accurately predict post-operative transfusion outcome in patients undergoing primary unilateral total knee arthroplasty (TKA). This will allow surgeons to provide selective preoperative type and screen to only patients at high risk of transfusion. A total of 1457 patients diagnosed with osteoarthritis and underwent primary unilateral TKA between January 2012 and December 2014 were retrospectively reviewed. Logistic regression analyses were applied to identify factors that could predict transfusion outcome. A total of 37 patients (2.5 %) were transfused postoperatively. Univariate analysis revealed preoperative haemoglobin (p < 0.001), age (p < 0.001), preoperative haematocrit (p < 0.001), and preoperative creatinine (p < 0.001) to be significant predictors. In the multivariate analysis with patients dichotomised at 70 years of age, preoperative haemoglobin remained significant with adjusted odds ratio of 0.33. Receiver operating characteristic curve identified the preoperative haemoglobin cut-off values to be 12.4 g/dL (AUC = 0.86, sensitivity = 87.5 %, specificity = 77.2 %) and 12.1 g/dL (AUC = 0.85, sensitivity = 69.2 %, specificity = 87.1 %) for age above and below 70, respectively. The authors recommend preoperative haemoglobin cut-off values of 12.4 g/dL for age above 70 and 12.1 g/dL for age below 70 to be used to predict post-operative transfusion requirements in TKA. To maximise the utilisation of blood resources, the authors recommend that only patients with haemoglobin level below the cut-off should receive routine preoperative type and screen before TKA. IV.

A receiver operated curve-based evaluation of change in sensitivity and specificity of cotinine urinalysis for detecting active tobacco use.

PubMed

Balhara, Yatan Pal Singh; Jain, Raka

2013-01-01

Tobacco use has been associated with various carcinomas including lung, esophagus, larynx, mouth, throat, kidney, bladder, pancreas, stomach, and cervix. Biomarkers such as concentration of cotinine in the blood, urine, or saliva have been used as objective measures to distinguish nonusers and users of tobacco products. A change in the cut-off value of urinary cotinine to detect active tobacco use is associated with a change in sensitivity and sensitivity of detection. The current study aimed at assessing the impact of using different cut-off thresholds of urinary cotinine on sensitivity and specificity of detection of smoking and smokeless tobacco product use among psychiatric patients. All the male subjects attending the psychiatry out-patient department of the tertiary care multispecialty teaching hospital constituted the sample frame for the current study in a cross-sectionally. Quantitative urinary cotinine assay was done by using ELISA kits of Calbiotech. Inc., USA. We used the receiver operating characteristic (ROC) curve to assess the sensitivity and specificity of various cut-off values of urinary cotinine to identify active smokers and users of smokeless tobacco products. ROC analysis of urinary cotinine levels in detection of self-reported smoking provided the area under curve (AUC) of 0.434. Similarly, the ROC analysis of urinary cotinine levels in detection of self-reported smoking revealed AUC of 0.44. The highest sensitivity and specificity of 100% for smoking were detected at the urinary cut-off value greater than or equal to 2.47 ng/ml. The choice of cut-off value of urinary cotinine used to distinguish nonusers form active users of tobacco products impacts the sensitivity as well as specificity of detection.

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.

Urban and Education Disparity for Autism Spectrum Disorders in Taiwan Birth Cohort Study

ERIC Educational Resources Information Center

Lung, For-Wey; Chiang, Tung-Liang; Lin, Shio-Jean; Shu, Bih-Ching

2017-01-01

This study aimed to determine the optimal cut-off for autism spectrum disorder (ASD) screening in 66-month-old children, and to explore the distribution of ASD screening and diagnosis in Taiwan. The Taiwan Birth Cohort Study dataset was used (N = 20,095). The Modified Checklist for Autism in Toddlers (M-CHAT) cut-off point of 13/14 was considered…

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.

Abnormal glomerular filtration rate in children, adolescents and young adults starts below 75 mL/min/1.73 m(2).

PubMed

Pottel, Hans; Hoste, Liesbeth; Delanaye, Pierre

2015-05-01

The chronic kidney disease (CKD) classification system for children is similar to that for adults, with both mainly based on estimated glomerular filtration rate (eGFR) combined with fixed cut-off values. The main cut-off eGFR value used to define CKD is 60 mL/min/1.73 m(2), a value that is also applied for children older than 2 years of age, adolescents and young adults. Based on a literature search, we evaluated inclusion criteria for eGFR in clinical trials or research studies on CKD for children. We also collected information on direct measurements of GFR (mGFR) in children and adolescents, with the aim to estimate the normal reference range for GFR. Using serum creatinine (Scr) normal reference values and Scr-based eGFR-equations, we also evaluated the correspondence between Scr normal reference values and (e)GFR normal reference values. Based on our literature search, the inclusion of children in published CKD studies has been based on cut-off values for eGFR of >60 mL/min/1.73 m(2). The lower reference limits for mGFR far exceed this adult threshold. Using eGFR values calculated using Scr-based formulas, we found that abnormal Scr levels in children already correspond to eGFR values that are below a cut-off of 75 mL/min/1.73 m(2). Abnormal GFR in children, adolescents and young adults starts below 75 mL/min/1.73 m(2), and as abnormality is a sign of disease, we recommend referring children, adolescents and young adults with an (e)GFR of <75 mL/min/1.73 m(2) for further clinical assessment.

Evaluation of predictive capacities of biomarkers based on research synthesis.

PubMed

Hattori, Satoshi; Zhou, Xiao-Hua

2016-11-10

The objective of diagnostic studies or prognostic studies is to evaluate and compare predictive capacities of biomarkers. Suppose we are interested in evaluation and comparison of predictive capacities of continuous biomarkers for a binary outcome based on research synthesis. In analysis of each study, subjects are often classified into two groups of the high-expression and low-expression groups according to a cut-off value, and statistical analysis is based on a 2 × 2 table defined by the response and the high expression or low expression of the biomarker. Because the cut-off is study specific, it is difficult to interpret a combined summary measure such as an odds ratio based on the standard meta-analysis techniques. The summary receiver operating characteristic curve is a useful method for meta-analysis of diagnostic studies in the presence of heterogeneity of cut-off values to examine discriminative capacities of biomarkers. We develop a method to estimate positive or negative predictive curves, which are alternative to the receiver operating characteristic curve based on information reported in published papers of each study. These predictive curves provide a useful graphical presentation of pairs of positive and negative predictive values and allow us to compare predictive capacities of biomarkers of different scales in the presence of heterogeneity in cut-off values among studies. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Insulin sensitivity indices: a proposal of cut-off points for simple identification of insulin-resistant subjects.

PubMed

Radikova, Z; Koska, J; Huckova, M; Ksinantova, L; Imrich, R; Vigas, M; Trnovec, T; Langer, P; Sebokova, E; Klimes, I

2006-05-01

Demanding measurement of insulin sensitivity using clamp methods does not simplify the identification of insulin resistant subjects in the general population. Other approaches such as fasting- or oral glucose tolerance test-derived insulin sensitivity indices were proposed and validated with the euglycemic clamp. Nevertheless, a lack of reference values for these indices prevents their wider use in epidemiological studies and clinical practice. The aim of our study was therefore to define the cut-off points of insulin resistance indices as well as the ranges of the most frequently obtained values for selected indices. A standard 75 g oral glucose tolerance test was carried out in 1156 subjects from a Caucasian rural population with no previous evidence of diabetes or other dysglycemias. Insulin resistance/sensitivity indices (HOMA-IR, HOMA-IR2, ISI Cederholm, and ISI Matsuda) were calculated. The 75th percentile value as the cut-off point to define IR corresponded with a HOMA-IR of 2.29, a HOMA-IR2 of 1.21, a 25th percentile for ISI Cederholm, and ISI Matsuda of 57 and 5.0, respectively. For the first time, the cut-off points for selected indices and their most frequently obtained values were established for groups of subjects as defined by glucose homeostasis and BMI. Thus, insulin-resistant subjects can be identified using this simple approach.

Quantitative assessment of isolated rapid eye movement (REM) sleep without atonia without clinical REM sleep behavior disorder: clinical and research implications.

PubMed

Sasai-Sakuma, Taeko; Frauscher, Birgit; Mitterling, Thomas; Ehrmann, Laura; Gabelia, David; Brandauer, Elisabeth; Inoue, Yuichi; Poewe, Werner; Högl, Birgit

2014-09-01

Rapid eye movement (REM) sleep without atonia (RWA) is observed in some patients without a clinical history of REM sleep behavior disorder (RBD). It remains unknown whether these patients meet the refined quantitative electromyographic (EMG) criteria supporting a clinical RBD diagnosis. We quantitatively evaluated EMG activity and investigated its overnight distribution in patients with isolated qualitative RWA. Fifty participants with an incidental polysomnographic finding of RWA (isolated qualitative RWA) were included. Tonic, phasic, and 'any' EMG activity during REM sleep on PSG were quantified retrospectively. Referring to the quantitative cut-off values for a polysomnographic diagnosis of RBD, 7/50 (14%) and 6/50 (12%) of the patients showed phasic and 'any' EMG activity in the mentalis muscle above the respective cut-off values. No patient was above the cut-off value for tonic EMG activity or phasic EMG activity in the anterior tibialis muscles. Patients with RWA above the cut-off value showed higher amounts of RWA during later REM sleep periods. This is the first study showing that some subjects with incidental RWA meet the refined quantitative EMG criteria for a diagnosis of RBD. Future longitudinal studies must investigate whether this subgroup with isolated qualitative RWA is at an increased risk of developing fully expressed RBD and/or neurodegenerative disease. Copyright © 2014 Elsevier B.V. All rights reserved.

[Diagnostic value of radom spot albuminuria to creatinine ratio in women with preeclampsia].

PubMed

Gao, Yun-fei; Huang, Qi-tao; Zhong, Mei; Wang, Yan; Wang, Wei; Wang, Zhi-jian; Leng, Ling-zhi; Yu, Yan-hong

2012-03-01

To investigate the correlation between spot albuminuria to creatinine ratio (ACR) and 24 h urinary protein excretion in women with preeclampsia and determine the optimal cut-off values of spot ACR in mild preeclampsia and severe preeclampsia. Twenty-eight women with mild preeclampsia and 22 with severe preeclampsia at Nanfang Hospital, Southern Medical University between October 2010 and June 2011 were recruited. Maternal serum cystatin, uric acid, urea nitrogen, creatinine and albumin levels were collected and analyzed. Twenty-four hours urinary protein excretion was measured with immunoturbidimetric assay and ACR with automatic analyzer DCA2000. The correlation between ACR and 24 hours urinary protein excretion was explored. And the optimal cut-off values of the spot ACR for mild and severe preeclampsia were determined with receiver operating characteristic curve. (1) Maternal serum biochemical parameters: uric acid levels in mild and severe preeclampsia were (359 ± 114) µmol/L and (450 ± 132) µmol/L, while cystatin levels were (1.3 ± 0.3) mg/L and (1.6 ± 0.5) mg/L respectively. The differences were statistically significant (P < 0.05). Serum urea nitrogen, creatinine and albumin in mild preeclampsia were (3.6 ± 1.6) mmol/L, (52 ± 38) µmol/L and (33 ± 3) g/L, while in severe preeclampsia were (6.2 ± 3.1) mmol/L, (78 ± 59) µmol/L and (29 ± 6) g/L respectively. There were no statistical significant differences (P > 0.05). (2) Twenty-four hours urinary protein excretion and ACR: 24 hours urinary protein levels in mild and severe preeclampsia was (700 ± 160) mg and (4800 ± 2200) mg (P < 0.05). ACR in mild and severe preeclampsia was (72.7 ± 12.4) mg/mmol and (401 ± 245) mg/mmol respectively (P < 0.05). (3) There was a strong correlation between the spot ACR and 24 hours urine protein excretion (r = 0.938; P < 0.05). (4) The optimal spot ACR cut-off point for the diagnosis of preeclampsia: the optimal spot ACR cut-off point was 22.8 mg/mmol for 300 mg/24 hours of protein excretion in mild preeclampsia, the area under curve was 0.956, with a sensitivity, specificity of 82.4%, 99.4% respectively. And the optimal spot ACR cut-off point was 155.6 mol for 2000 mg/24 hours of protein excretion in severe preeclampsia, the area under curve was 0.956, with a sensitivity, specificity of 88.6%, 91.3% respectively. Compared with 24 hours urinary protein excretion, the spot ACR may be a simple, convenient and accurate indicator of early diagnosis of preeclampsia. Spot ACR may be used as a replacement for 24 hours urine protein excretion in assessment of preeclampsia. The optimal spot ACR cut off points were 22.8 mg/mmol for mild preeclampsia and 155.6 mg/mmol for severe preeclampsia.

Comparison of interferon-γ release assay to two cut-off points of tuberculin skin test to detect latent Mycobacterium tuberculosis infection in primary health care workers.

PubMed

de Souza, Fernanda Mattos; do Prado, Thiago Nascimento; Pinheiro, Jair dos Santos; Peres, Renata Lyrio; Lacerda, Thamy Carvalho; Loureiro, Rafaela Borge; Carvalho, Jose Américo; Fregona, Geisa; Dias, Elias Santos; Cosme, Lorrayne Beliqui; Rodrigues, Rodrigo Ribeiro; Riley, Lee Wood; Maciel, Ethel Leonor Noia

2014-01-01

An interferon-γ release assay, QuantiFERON-TB (QFT) test, has been introduced an alternative test for the diagnosis of latent Mycobacterium tuberculosis infection (LTBI). Here, we compared the performance of QFT with tuberculin skin test (TST) measured at two different cut-off points among primary health care work (HCW) in Brazil. A cross-sectional study was carried out among HCWs in four Brazilian cities with a known history of high incidence of TB. Results of the QFT were compared to TST results based on both ≥5 mm and ≥10 mm as cut-off points. We enrolled 632 HCWs. When the cut-off value of ≥10 mm was used, agreement between QFT and TST was 69% (k = 0.31), and when the cut-off of ≥5 mm was chosen, the agreement was 57% (k = 0.22). We investigated possible factors of discordance of TST vs QFT. Compared to the TST-/QFT- group, risk factors for discordance in the TST+/QFT- group with TST cut-off of ≥5 mm included age between 41-45 years [OR = 2.70; CI 95%: 1.32-5.51] and 46-64 years [OR = 2.04; CI 95%: 1.05-3.93], BCG scar [OR = 2.72; CI 95%: 1.40-5.25], and having worked only in primary health care [OR = 2.30; CI 95%: 1.09-4.86]. On the other hand, for the cut-off of ≥10 mm, BCG scar [OR = 2.26; CI 95%: 1.03-4.91], being a household contact of a TB patient [OR = 1.72; CI 95%: 1.01-2.92] and having had a previous TST [OR = 1.66; CI 95%: 1.05-2.62], were significantly associated with the TST+/QFT- group. No statistically significant associations were found among the TST-/QFT+ discordant group with either TST cut-off value. Although we identified BCG vaccination to contribute to the discordance at both TST cut-off measures, the current Brazilian recommendation for the initiation of LTBI treatment, based on information gathered from medical history, TST, chest radiograph and physical examination, should not be changed.

Validity of the rheumatoid arthritis impact of disease (RAID) score and definition of cut-off points for disease activity states in a population-based European cohort of patients with rheumatoid arthritis.

PubMed

Salaffi, Fausto; Di Carlo, Marco; Vojinovic, Jelena; Tincani, Angela; Sulli, Alberto; Soldano, Stefano; Andreoli, Laura; Dall'Ara, Francesca; Ionescu, Ruxandra; Simić Pašalić, Katarina; Balčune, Ineta; Ferraz-Amaro, Iván; Tlustochowicz, Malgorzata; Butrimienė, Irena; Punceviciene, Egle; Toroptsova, Natalia; Grazio, Simeon; Morović-Vergles, Jadranka; Masaryk, Pavol; Otsa, Kati; Bernardes, Miguel; Boyadzhieva, Vladimira; Cutolo, Maurizio

2018-05-01

To assess the validity of the rheumatoid arthritis impact of disease (RAID) for measuring disease activity of rheumatoid arthritis (RA) and to determine cut-off values for defining the disease activity states. A total of 622 RA patients from an European database have been included. Cross-validation was based on assessment of convergent and discriminant validity. Optimal cut-offs were determined against external criteria by calculating the respective 25th and 75th percentiles mean values of RAID. External criteria included definitions for remission (REM), low disease activity (LDA), moderate disease activity (MDA) and high disease activity (HDA), cut-offs of the 28-joint disease activity score-C-reactive protein (DAS28-CRP) score. The RAID showed a moderate degree of correlation with respect to DAS28-CRP (rho=0.417; P<0.0001). The receiver operating characteristic (ROC) curves to discriminate the ability of RAID to distinguish patients with active and non-active disease was very good with an area under the curve (AUC) of 0.847 (95% confidence interval [CI]: 0.816 to 0.878; P<0.0001). Based on the distributions of RAID in the different disease activity groups, we propose the following cut-off values for REM: RAID ≤3; for LDA: RAID >3 and ≤4; for MDA: RAID >4 and ≤6; for HDA: RAID >6. Mean RAID differed significantly between patients classified as REM, LDA, MDA or HDA (P=0.001). The cut-offs revealed good measurement characteristics in cross-validation analysis, had great discriminatory performance in distinguishing patients with different levels of disease activity and are suited for widespread use in everyday practice application and research. Copyright © 2017 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.

Diagnostic value of virtual touch tissue imaging quantification for benign and malignant breast lesions with different sizes

PubMed Central

Liu, Hui; Zhao, Li-Xia; Xu, Guang; Yao, Ming-Hua; Zhang, Ai-Hong; Xu, Hui-Xiong; Wu, Rong

2015-01-01

The study was to explore diagnostic value of the virtual touch tissue imaging quantification (VTIQ) in distinguishing benign and malignant breast lesions of variable sizes. We performed conventional ultrasound and VTIQ in 139 breast lesions. The lesions were categorized into three groups according to size (group 1, ≤ 10 mm; group 2, 10-20 mm; and group 3, > 20 mm), and their mean, min, and max shear wave velocities (SWVs) were measured. Diagnoses were confirmed by pathological examination after surgery or needle biopsy. Receiver-operating characteristic curves (ROC) were constructed to determine the optimum cut-off values, calculate the area under curve (AUC), the sensitivity, specificity and accuracy for each velocity. For all groups, the mean, min, and max SWVs of malignant lesions were significantly higher than those of benign lesions (P < 0.05). The cut-off values of mean, min, and max SWVs were not significantly different among the three groups. In addition, the diagnostic performance of mean, min, and max SWV values is analogous, regardless of lesion size. In conclusion, VTIQ is a strong complement to conventional ultrasound, which is a promising method in the differential diagnosis of the breast lesions with different sizes. Further studies validate our results as well as reduce the number of unnecessary biopsies, regardless of size is warranted. PMID:26550234

Comparison of the Farr radioimmunoassay, 3 commercial enzyme immunoassays and Crithidia luciliae immunofluorescence test for diagnosis and activity assessment of systemic lupus erythematosus.

PubMed

Launay, David; Schmidt, Jean; Lepers, Sébastien; Mirault, Tristan; Lambert, Marc; Kyndt, Xavier; Reumaux, Dominique; Duhamel, Alain; Hachulla, Eric; Hatron, Pierre-Yves; Prin, Lionel; Dubucquoi, Sylvain

2010-07-04

Among anti-double-strand (ds)DNA antibody assays, Farr radioimmunoassay is decreasingly used because it requires radioactive material and is labor intensive. We evaluated the performance of Farr, three commercial enzyme immunoassays (EIAs) and the Crithidia luciliae immunofluorescence test (CLIFT) in systemic lupus erythematosus (SLE). Anti-dsDNA antibodies were determined in 99 SLE patients, 101 healthy subjects, and 53 patients with autoimmune rheumatic diseases. Farr performed better than the 3 EIAs and CLIFT for the diagnosis of SLE at the manufacturer's cut off and at the cut off set to achieve a specificity of 95%. To achieve a similar level of specificity, some EIAs had a decrease in sensitivity which was dramatic for some tests. Farr was also the best at distinguishing patients with quiescent to mildly active disease from patients with more active disease at the cut off value of 93 IU/ml. Using manufacturer's cut off did not allow distinguishing between patients with quiescent and active SLE. Farr was the best global test to assess the level of anti-dsDNA antibodies for both diagnosis and disease activity evaluation in SLE with adequately determined cut off values. Some EIA had low performances limiting their use in decision-making regarding diagnosis and/or treatment. Copyright 2010 Elsevier B.V. All rights reserved.

Large calf circumference indicates non-sarcopenia despite body mass

PubMed Central

Kusaka, Satomi; Takahashi, Tetsuya; Hiyama, Yoshinori; Kusumoto, Yasuaki; Tsuchiya, Junko; Umeda, Masaru

2017-01-01

[Purpose] The purpose of this study is to evaluate the applicability of the calf circumference as a tool for screening sarcopenia. [Subjects and Methods] One hundred sixteen community-dwelling elderly females were enrolled. Calf circumference of the dominant leg was measured using a plastic measuring tape. Subjects were divided into 3 groups based on body mass index (BMI); subjects with the values for BMI <18.5 kg/m2; those with BMI 18.5 to 25.0; those with BMI ≥25.0 kg/m2. Positive predictive value and negative predictive value of sarcopenia were calculated based on the obtained cut off values of calf circumference and the diagnosis of sarcopenia in each group. [Results] Prevalence rate of sarcopenia was 9.4% (n=10). Cut off value of the calf circumference was 32.8 cm (sensitivity: 73.0%, specificity: 80.0%, AUC: 0.792). Each BMI group showed high negative predictive value of sarcopenia based on the calf circumference cut off value of 32.8 cm. [Conclusion] These results suggested that to identify non-sarcopenia by larger calf circumference is more reasonable and useful than to identify sarcopenia due to the smaller calf circumference regardless of BMI. PMID:29200625

[Normal and cut-off values of the cytokinesis-block micronucleus assay on peripheral blood lymphocytes in the Croatian general population].

PubMed

Kopjar, Nevenka; Kasuba, Vilena; Milić, Mirta; Rozgaj, Ruzica; Zeljezić, Davor; Gajski, Goran; Mladinić, Marin; Garaj-Vrhovac, Vera

2010-06-01

The cytokinesis-block micronucleus (CBMN) assay on peripheral blood lymphocytes is one of the most important methods employed in cytogenetic biomonitoring. For the purposes of biological dosimetry, it is important to know the spontaneous frequency of a biomarker and its normal values in general population. These values are used for population databases, which should be updated regularly. In this study, MN levels were investigated in cytokinesis-blocked lymphocytes of 200 healthy male and female blood donors selected at random from the general population of Croatia. The aim was to assess the variability and determine possible influences of external and/or internal factors on the background levels of MN and to establish the cut-off value for the CBMN assay. The background frequency of MN was (6.90+/-3.32) MN (median 7 MN) and the range was 0 to 18 MN per 1000 binuclear lymphocytes. The cut-off value, which corresponds to 95th percentile of the distribution of 200 individual values, was 12.5 MN. Spontaneous formation of MN was influenced by sex, age, and smoking. Women had higher MN levels than men. However, only age and smoking significantly increased the values of all parameters evaluated by the CBMN assay. Since the existing literature data on smoking-related formation of MN are contradictory, we will continue these investigations to resolve how the number of cigarettes smoked per day and the duration of smoking in years influence the results of the CBMN assay. Our results are consistent with the background MN frequencies reported by other cytogenetic laboratories worldwide. Normal and cut-off values estimated in this study will be used to update the current general population data and as reference for occupationally or accidental exposure.

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.

Dynamic interaction between fetal adversity and a genetic score reflecting dopamine function on developmental outcomes at 36 months

PubMed Central

Pokhvisneva, Irina; Léger, Étienne; Gaudreau, Hélène; Steiner, Meir; Kennedy, James L.; O’Donnell, Kieran J.; Diorio, Josie; Meaney, Michael J.; Silveira, Patrícia P.

2017-01-01

Background Fetal adversity, evidenced by poor fetal growth for instance, is associated with increased risk for several diseases later in life. Classical cut-offs to characterize small (SGA) and large for gestational age (LGA) newborns are used to define long term vulnerability. We aimed at exploring the possible dynamism of different birth weight cut-offs in defining vulnerability in developmental outcomes (through the Bayley Scales of Infant and Toddler Development), using the example of a gene vs. fetal adversity interaction considering gene choices based on functional relevance to the studied outcome. Methods 36-month-old children from an established prospective birth cohort (Maternal Adversity, Vulnerability, and Neurodevelopment) were classified according to birth weight ratio (BWR) (SGA ≤0.85, LGA >1.15, exploring a wide range of other cut-offs) and genotyped for polymorphisms associated with dopamine signaling (TaqIA-A1 allele, DRD2-141C Ins/Ins, DRD4 7-repeat, DAT1-10- repeat, Met/Met-COMT), composing a score based on the described function, in which hypofunctional variants received lower scores. Results There were 251 children (123 girls and 128 boys). Using the classic cut-offs (0.85 and 1.15), there were no statistically significant interactions between the neonatal groups and the dopamine genetic score. However, when changing the cut-offs, it is possible to see ranges of BWR that could be associated with vulnerability to poorer development according to the variation in the dopamine function. Conclusion The classic birth weight cut-offs to define SGA and LGA newborns should be seen with caution, as depending on the outcome in question, the protocols for long-term follow up could be either too inclusive—therefore most costly, or unable to screen true vulnerabilities—and therefore ineffective to establish early interventions and primary prevention. PMID:28505190

A description of disordered eating behaviors in Latino males.

PubMed

Reyes-Rodriguez, Mae Lynn; Sala, Margarita; Von Holle, Ann; Unikel, Claudia; Bulik, Cynthia M; Camara-Fuentes, Luis; Suarez-Torres, Alba

2011-01-01

To explore disordered eating and eating disorders (EDs) in Latino males. Participants are 722 male college students from a larger prevalence study conducted in the University of Puerto Rico system. Participants were selected from a list of sections of required courses for first-year students on each campus. Self-report instruments were used to explore ED symptoms (the Eating Attitudes Test [EAT-26] and the Bulimia Test-Revised [BULIT-26-R] and the Beck Depression Inventory depression (BDI). Overall, 2.26% scored above the cut-off point on the BULIT-R and 5.08% score above the cut-off point on the EAT-26. Of the males, 4.43% reported sufficient frequency and severity to approximate DSM-IV criteria for bulimia nervosa. Depression symptomatology was found in those who scored above the cut-off point on both instruments of EDs. College health practitioners should be aware of disordered eating in Latino males and include them in efforts to detect disordered eating behaviors in college students.

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

Prevalence of obesity in Italian adolescents: does the use of different growth charts make the difference?

PubMed

De Carli, Luca; Spada, Elena; Milani, Silvano; Ganzit, Gian Pasquale; Ghizzoni, Lucia; Raia, Melissa; Coscia, Alessandra; Bertino, Enrico; Bo, Simona

2018-04-01

Since populations are becoming increasingly multi-ethnic, the use of local or international charts is a matter of debate. This study aimed to evaluate how the choice of cut-off thresholds affected prevalence of underweight (UW), overweight (OW), obesity (OB) in 1200 11-12-year Italian adolescents, and how their somatic growth depended on parental origin. The height, weight and body mass index were expressed as standard deviation score (SDS) using Italian (ISPED-2006) and UK (UK-1990) charts. The classification of UW/OW/OB was computed with the IOTF international cut-offs, and thresholds were identified as centiles corresponding to BMI values of 18.5/25.0/30.0 kg/m 2 at 18-year in ISPED-2006 or UK-1990 references. About 30% participants had non-Italian parents, above all from North-Africa and Romania. Referring to the UK-1990 charts, all groups showed negative mean SDS for height, and positive SDS for weight and BMI. Referring to the ISPED-2006 charts, all mean SDS were negative. Percentage of UW individuals was higher in accordance with ISPED-2006 than with UK-1990 charts, whereas percentages of OW/OB were higher with UK-1990 than ISPED-2006 charts. The results obtained using IOFT cut-offs were similar to UK-1990 cut-offs. These results were due to the different shape of age-dependent cut-off centiles. Independently by the parental origin, the percentages of adolescents classified as OW/OB were closer to the expected values using the ISPED-2006 then the UK-1990 cut-offs. The results suggested the use of the Italian references for adolescents with immigrant parents. The use of local charts seems more appropriate at least in Italian adolescents in the age range studied.

Discussion about different cut-off values of conventional hamstring-to-quadriceps ratio used in hamstring injury prediction among professional male football players

PubMed Central

Michałowska, Martyna; Walczak, Tomasz; Owen, Adam; Grabski, Jakub Krzysztof; Pyda, Andrzej; Piontek, Tomasz; Kotwicki, Tomasz

2017-01-01

Objective To measure the sensitivity and specificity of differences cut-off values for isokinetic Hcon/Qcon ratio in order to improve the capacity to evaluate (retrospectively) the injury of hamstring muscles in professional soccer screened with knee isokinetic tests. Design Retrospective study. Methods Medical and biomechanical data of professional football players playing for the same team for at least one season between 2010 and 2016 were analysed. Hamstring strain injury cases and the reports generated via isokinetic testing were investigated. Isokinetic concentric(con) hamstring(H) and quadriceps(Q) absolute strength in addition with Hcon/Qcon ratio were examined for the injured versus uninjured limbs among injured players, and for the injured and non-injured players. 2 x 2 contingency table was used for comparing variables: predicted injured or predicted uninjured with actual injured or actual uninjured. Sensitivity, specificity, accuracy, positive and negative predictive values, and positive and negative likelihood ratio were calculated for three different cut-off values (0.47 vs. 0.6 vs. 0.658) to compare the discriminative power of an isokinetic test, whilst examining the key value of Hcon/Qcon ratio which may indicate the highest level of ability to predispose a player to injury. McNemar’s chi2 test with Yates’s correction was used to determine agreement between the tests. PQStat software was used for all statistical analysis, and an alpha level of p <0.05 was used for all statistical comparisons. Results 340 isokinetic test reports on both limbs of 66 professional soccer players were analysed. Eleven players suffered hamstring injuries during the analysed period. None of these players sustained recurrence of hamstring injury. One player sustained hamstring strain injury on both legs, thus the total number of injuries was 12. Application of different cut-off values for Hcon/Qcon significantly affected the sensitivity and specificity of isokinetic test used as a tool for muscle injury detection. The use of 0.47 of Hcon/Qcon as a discriminate value resulted in significantly lower sensitivity when compared to 0.658 threshold (sensitivity of 16.7% vs. 91.7%, respectively; t = 6.125,p = 0.0133). Calculated values of specificity (when three different cut-off were applied) were also significantly different. Threshold of 0.6 of Hcon/Qcon resulted with significantly lower specificity compared to 0.47 value (specificity of 46.9% vs. 94.5%, respectively; t = 153.0,p<0.0001), and significantly higher specificity when compared to 0.658 (specificity of 46.9% vs. 24.1%, respectively; t = 229.0, p<0.0001). Conclusion The use of different cut-off values for Hcon/Qcon significantly affected the sensitivity and specificity of isokinetic testing. The interpretation of usefulness of isokinetic test as a screening tool in a group of male professional football players to predict hamstring injury occurrence within the next 12 months might be therefore significantly biased due to the different threshold values of Hcon/Qcon. Using one “normative” value as a cut-off (e.g. 0.47 or 0.60, or 0.658) to quantify soccer players (or not) to the group with a higher risk of knee injury might result in biased outcomes due to the natural strength asymmetry that is observed within the group of soccer players. PMID:29216241

Discussion about different cut-off values of conventional hamstring-to-quadriceps ratio used in hamstring injury prediction among professional male football players.

PubMed

Grygorowicz, Monika; Michałowska, Martyna; Walczak, Tomasz; Owen, Adam; Grabski, Jakub Krzysztof; Pyda, Andrzej; Piontek, Tomasz; Kotwicki, Tomasz

2017-01-01

To measure the sensitivity and specificity of differences cut-off values for isokinetic Hcon/Qcon ratio in order to improve the capacity to evaluate (retrospectively) the injury of hamstring muscles in professional soccer screened with knee isokinetic tests. Retrospective study. Medical and biomechanical data of professional football players playing for the same team for at least one season between 2010 and 2016 were analysed. Hamstring strain injury cases and the reports generated via isokinetic testing were investigated. Isokinetic concentric(con) hamstring(H) and quadriceps(Q) absolute strength in addition with Hcon/Qcon ratio were examined for the injured versus uninjured limbs among injured players, and for the injured and non-injured players. 2 x 2 contingency table was used for comparing variables: predicted injured or predicted uninjured with actual injured or actual uninjured. Sensitivity, specificity, accuracy, positive and negative predictive values, and positive and negative likelihood ratio were calculated for three different cut-off values (0.47 vs. 0.6 vs. 0.658) to compare the discriminative power of an isokinetic test, whilst examining the key value of Hcon/Qcon ratio which may indicate the highest level of ability to predispose a player to injury. McNemar's chi2 test with Yates's correction was used to determine agreement between the tests. PQStat software was used for all statistical analysis, and an alpha level of p <0.05 was used for all statistical comparisons. 340 isokinetic test reports on both limbs of 66 professional soccer players were analysed. Eleven players suffered hamstring injuries during the analysed period. None of these players sustained recurrence of hamstring injury. One player sustained hamstring strain injury on both legs, thus the total number of injuries was 12. Application of different cut-off values for Hcon/Qcon significantly affected the sensitivity and specificity of isokinetic test used as a tool for muscle injury detection. The use of 0.47 of Hcon/Qcon as a discriminate value resulted in significantly lower sensitivity when compared to 0.658 threshold (sensitivity of 16.7% vs. 91.7%, respectively; t = 6.125,p = 0.0133). Calculated values of specificity (when three different cut-off were applied) were also significantly different. Threshold of 0.6 of Hcon/Qcon resulted with significantly lower specificity compared to 0.47 value (specificity of 46.9% vs. 94.5%, respectively; t = 153.0,p<0.0001), and significantly higher specificity when compared to 0.658 (specificity of 46.9% vs. 24.1%, respectively; t = 229.0, p<0.0001). The use of different cut-off values for Hcon/Qcon significantly affected the sensitivity and specificity of isokinetic testing. The interpretation of usefulness of isokinetic test as a screening tool in a group of male professional football players to predict hamstring injury occurrence within the next 12 months might be therefore significantly biased due to the different threshold values of Hcon/Qcon. Using one "normative" value as a cut-off (e.g. 0.47 or 0.60, or 0.658) to quantify soccer players (or not) to the group with a higher risk of knee injury might result in biased outcomes due to the natural strength asymmetry that is observed within the group of soccer players.

Derivation of the cut-off length from the quantum quadratic enhancement of a mass in vacuum energy constant Lambda

NASA Astrophysics Data System (ADS)

Fukushima, Kimichika; Sato, Hikaru

2018-04-01

Ultraviolet self-interaction energies in field theory sometimes contain meaningful physical quantities. The self-energies in such as classical electrodynamics are usually subtracted from the rest mass. For the consistent treatment of energies as sources of curvature in the Einstein field equations, this study includes these subtracted self-energies into vacuum energy expressed by the constant Lambda (used in such as Lambda-CDM). In this study, the self-energies in electrodynamics and macroscopic classical Einstein field equations are examined, using the formalisms with the ultraviolet cut-off scheme. One of the cut-off formalisms is the field theory in terms of the step-function-type basis functions, developed by the present authors. The other is a continuum theory of a fundamental particle with the same cut-off length. Based on the effectiveness of the continuum theory with the cut-off length shown in the examination, the dominant self-energy is the quadratic term of the Higgs field at a quantum level (classical self-energies are reduced to logarithmic forms by quantum corrections). The cut-off length is then determined to reproduce today's tiny value of Lambda for vacuum energy. Additionally, a field with nonperiodic vanishing boundary conditions is treated, showing that the field has no zero-point energy.

Round-off errors in cutting plane algorithms based on the revised simplex procedure

NASA Technical Reports Server (NTRS)

Moore, J. E.

1973-01-01

This report statistically analyzes computational round-off errors associated with the cutting plane approach to solving linear integer programming problems. Cutting plane methods require that the inverse of a sequence of matrices be computed. The problem basically reduces to one of minimizing round-off errors in the sequence of inverses. Two procedures for minimizing this problem are presented, and their influence on error accumulation is statistically analyzed. One procedure employs a very small tolerance factor to round computed values to zero. The other procedure is a numerical analysis technique for reinverting or improving the approximate inverse of a matrix. The results indicated that round-off accumulation can be effectively minimized by employing a tolerance factor which reflects the number of significant digits carried for each calculation and by applying the reinversion procedure once to each computed inverse. If 18 significant digits plus an exponent are carried for each variable during computations, then a tolerance value of 0.1 x 10 to the minus 12th power is reasonable.

The Long Exercise Test in Periodic Paralysis: A Bayesian Analysis.

PubMed

Simmons, Daniel B; Lanning, Julie; Cleland, James C; Puwanant, Araya; Twydell, Paul T; Griggs, Robert C; Tawil, Rabi; Logigian, Eric L

2018-05-12

The long exercise test (LET) is used to assess the diagnosis of periodic paralysis (PP), but LET methodology and normal "cut-off" values vary. To determine optimal LET methodology and cut-offs, we reviewed LET data (abductor digiti minimi (ADM) motor response amplitude, area) from 55 PP patients (32 genetically definite) and 125 controls. Receiver operating characteristic (ROC) curves were constructed and area-under-the-curve (AUC) calculated to compare 1) peak-to-nadir versus baseline-to-nadir methodologies, and 2) amplitude versus area decrements. Using Bayesian principles, optimal "cut-off" decrements that achieved 95% post-test probability of PP were calculated for various pre-test probabilities (PreTPs). AUC was highest for peak-to-nadir methodology and equal for amplitude and area decrements. For PreTP ≤50%, optimal decrement cut-offs (peak-to-nadir) were >40% (amplitude) or >50% (area). For confirmation of PP, our data endorse the diagnostic utility of peak-to-nadir LET methodology using 40% amplitude or 50% area decrement cut-offs for PreTPs ≤50%. This article is protected by copyright. All rights reserved. © 2018 Wiley Periodicals, Inc.

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.

Prediction of esophageal varices and variceal hemorrhage in patients with acute upper gastrointestinal bleeding.

PubMed

Rockey, Don C; Elliott, Alan; Lyles, Thomas

2016-03-01

In patients with upper gastrointestinal bleeding (UGIB), identifying those with esophageal variceal hemorrhage prior to endoscopy would be clinically useful. This retrospective study of a large cohort of patients with UGIB used logistic regression analyses to evaluate the platelet count, aspartate aminotransferase (AST) to platelet ratio index (APRI), AST to alanine aminotransferase (ALT) ratio (AAR) and Lok index (all non-invasive blood markers) as predictors of variceal bleeding in (1) all patients with UGIB and (2) patients with cirrhosis and UGIB. 2233 patients admitted for UGIB were identified; 1034 patients had cirrhosis (46%) and of these, 555 patients (54%) had acute UGIB due to esophageal varices. In all patients with UGIB, the platelet count (cut-off 122,000/mm(3)), APRI (cut-off 5.1), AAR (cut-off 2.8) and Lok index (cut-off 0.9) had area under the curve (AUC)s of 0.80 0.82, 0.64, and 0.80, respectively, for predicting the presence of varices prior to endoscopy. To predict varices as the culprit of bleeding, the platelet count (cut-off 69,000), APRI (cut-off 2.6), AAR (cut-off 2.5) and Lok Index (0.90) had AUCs of 0.76, 0.77, 0.57 and 0.73, respectively. Finally, in patients with cirrhosis and UGIB, logistic regression was unable to identify optimal cut-off values useful for predicting varices as the culprit bleeding lesion for any of the non-invasive markers studied. For all patients with UGIB, non-invasive markers appear to differentiate patients with varices from those without varices and to identify those with a variceal culprit lesion. However, these markers could not distinguish between a variceal culprit and other lesions in patients with cirrhosis. Copyright © 2016 American Federation for Medical Research.

Cultural adaptation into Spanish of the generalized anxiety disorder-7 (GAD-7) scale as a screening tool

PubMed Central

2010-01-01

Background Generalized anxiety disorder (GAD) is a prevalent mental health condition which is underestimated worldwide. This study carried out the cultural adaptation into Spanish of the 7-item self-administered GAD-7 scale, which is used to identify probable patients with GAD. Methods The adaptation was performed by an expert panel using a conceptual equivalence process, including forward and backward translations in duplicate. Content validity was assessed by interrater agreement. Criteria validity was explored using ROC curve analysis, and sensitivity, specificity, predictive positive value and negative value for different cut-off values were determined. Concurrent validity was also explored using the HAM-A, HADS, and WHO-DAS-II scales. Results The study sample consisted of 212 subjects (106 patients with GAD) with a mean age of 50.38 years (SD = 16.76). Average completion time was 2'30''. No items of the scale were left blank. Floor and ceiling effects were negligible. No patients with GAD had to be assisted to fill in the questionnaire. The scale was shown to be one-dimensional through factor analysis (explained variance = 72%). A cut-off point of 10 showed adequate values of sensitivity (86.8%) and specificity (93.4%), with AUC being statistically significant [AUC = 0.957-0.985); p < 0.001]. The scale significantly correlated with HAM-A (0.852, p < 0.001), HADS (anxiety domain, 0.903, p < 0.001), and WHO-DAS II (0.696, p > 0.001). Limitations Elderly people, particularly those very old, may need some help to complete the scale. Conclusion After the cultural adaptation process, a Spanish version of the GAD-7 scale was obtained. The validity of its content and the relevance and adequacy of items in the Spanish cultural context were confirmed. PMID:20089179

Equilibrium properties of blackbody radiation with an ultraviolet energy cut-off

NASA Astrophysics Data System (ADS)

Mishra, Dheeraj Kumar; Chandra, Nitin; Vaibhav, Vinay

2017-10-01

We study various equilibrium thermodynamic properties of blackbody radiation (i.e. a photon gas) with an ultraviolet energy cut-off. We find that the energy density, specific heat etc. follow usual acoustic phonon dynamics as have been well studied by Debye. Other thermodynamic quantities like pressure, entropy etc. have also been calculated. The usual Stefan-Boltzmann law gets modified. We observe that the values of the thermodynamic quantities with the energy cut-off is lower than the corresponding values in the theory without any such scale. The phase-space measure is also expected to get modified for an exotic spacetime appearing at Planck scale, which in turn leads to the modification of Planck energy density distribution and the Wien's displacement law. We found that the non-perturbative nature of the thermodynamic quantities in the SR limit (for both unmodified and modified cases), due to nonanalyticity of the leading term, is a general feature of the theory accompanied with an ultraviolet energy cut-off. We have also discussed the possible modification in the case of Big Bang and the Stellar objects and have suggested a table top experiment for verification in effective low energy case.

Waist circumference cut-off in relation to body mass index and percentage of body fat in adult women from Merida, Mexico.

PubMed

Datta Banik, Sudip; Dickinson, Federico

2015-01-01

Waist circumference (WC) as an index of central obesity is related to body mass index (BMI) and percent body fat (PBF). Waist circumference data were analyzed to identify a WC cut-off for adult women with respect to BMI-based obesity (≥ 30 kg/m²) and PBF. The sample was 138 women aged 22 to 41 years with Maya ancestry (based on surnames) in Merida, Yucatan, measured during 2011 - 2013. Anthropometric parameters included height, body weight (BW), and BMI. The PBF was estimated by bioelectrical impedance. Estimated cut-offs per centimeter WC (80 - 99 cm) were predicted by BMI for obesity (≥ 30 kg m⁻²; binomial: Yes = 1, No = 0) and PBF (continuous variable) using binary logistic regression analyses. Mean age was 32 years, mean BMI was 29 kg m(-2) and mean WC was 89 cm. The sample exhibited high PBF (44 %), and high rates of overweight (44%) and obesity (40%). The threshold WC (≥ 93 cm) had high sensitivity (80%), specificity (82%), Youden Index value (0.62), and correct classification rate (82%). The area under the receiver operating characteristic curve was 88 %. The WC ≥ 93 cm cut-off had corresponding values for mean BMI (34 kg m⁻²) and PBF (47%). The optimal WC cut-off at 93 cm significantly identified central obesity for BMI ≥ 30 kg m⁻² and PBF for this sample.

Recommended aerobic fitness level for metabolic health in children and adolescents: a study of diagnostic accuracy.

PubMed

Adegboye, Amanda R A; Anderssen, Sigmund A; Froberg, Karsten; Sardinha, Luis B; Heitmann, Berit L; Steene-Johannessen, Jostein; Kolle, Elin; Andersen, Lars B

2011-07-01

To define the optimal cut-off for low aerobic fitness and to evaluate its accuracy to predict clustering of risk factors for cardiovascular disease in children and adolescents. Study of diagnostic accuracy using a cross-sectional database. European Youth Heart Study including Denmark, Portugal, Estonia and Norway. 4500 schoolchildren aged 9 or 15 years. Aerobic fitness was expressed as peak oxygen consumption relative to bodyweight (mlO(2)/min/kg). Risk factors included in the composite risk score (mean of z-scores) were systolic blood pressure, triglyceride, total cholesterol/HDL-cholesterol ratio, insulin resistance and sum of four skinfolds. 14.5% of the sample, with a risk score above one SD, were defined as being at risk. Receiver operating characteristic analysis was used to define the optimal cut-off for sex and age-specific distribution. In girls, the optimal cut-offs for identifying individuals at risk were: 37.4 mlO(2)/min/kg (9-year-old) and 33.0 mlO(2)/min/kg (15-year-old). In boys, the optimal cut-offs were 43.6 mlO(2)/min/kg (9-year-old) and 46.0 mlO(2)/min/kg (15-year-old). Specificity (range 79.3-86.4%) was markedly higher than sensitivity (range 29.7-55.6%) for all cut-offs. Positive predictive values ranged from 19% to 41% and negative predictive values ranged from 88% to 90%. The diagnostic accuracy for identifying children at risk, measured by the area under the curve (AUC), was significantly higher than what would be expected by chance (AUC >0.5) for all cut-offs. Aerobic fitness is easy to measure, and is an accurate tool for screening children with clustering of cardiovascular risk factors. Promoting physical activity in children with aerobic fitness level lower than the suggested cut-points might improve their health.

[Formulation of combined predictive indicators using logistic regression model in predicting sepsis and prognosis].

PubMed

Duan, Liwei; Zhang, Sheng; Lin, Zhaofen

2017-02-01

To explore the method and performance of using multiple indices to diagnose sepsis and to predict the prognosis of severe ill patients. Critically ill patients at first admission to intensive care unit (ICU) of Changzheng Hospital, Second Military Medical University, from January 2014 to September 2015 were enrolled if the following conditions were satisfied: (1) patients were 18-75 years old; (2) the length of ICU stay was more than 24 hours; (3) All records of the patients were available. Data of the patients was collected by searching the electronic medical record system. Logistic regression model was formulated to create the new combined predictive indicator and the receiver operating characteristic (ROC) curve for the new predictive indicator was built. The area under the ROC curve (AUC) for both the new indicator and original ones were compared. The optimal cut-off point was obtained where the Youden index reached the maximum value. Diagnostic parameters such as sensitivity, specificity and predictive accuracy were also calculated for comparison. Finally, individual values were substituted into the equation to test the performance in predicting clinical outcomes. A total of 362 patients (218 males and 144 females) were enrolled in our study and 66 patients died. The average age was (48.3±19.3) years old. (1) For the predictive model only containing categorical covariants [including procalcitonin (PCT), lipopolysaccharide (LPS), infection, white blood cells count (WBC) and fever], increased PCT, increased WBC and fever were demonstrated to be independent risk factors for sepsis in the logistic equation. The AUC for the new combined predictive indicator was higher than that of any other indictor, including PCT, LPS, infection, WBC and fever (0.930 vs. 0.661, 0.503, 0.570, 0.837, 0.800). The optimal cut-off value for the new combined predictive indicator was 0.518. Using the new indicator to diagnose sepsis, the sensitivity, specificity and diagnostic accuracy rate were 78.00%, 93.36% and 87.47%, respectively. One patient was randomly selected, and the clinical data was substituted into the probability equation for prediction. The calculated value was 0.015, which was less than the cut-off value (0.518), indicating that the prognosis was non-sepsis at an accuracy of 87.47%. (2) For the predictive model only containing continuous covariants, the logistic model which combined acute physiology and chronic health evaluation II (APACHE II) score and sequential organ failure assessment (SOFA) score to predict in-hospital death events, both APACHE II score and SOFA score were independent risk factors for death. The AUC for the new predictive indicator was higher than that of APACHE II score and SOFA score (0.834 vs. 0.812, 0.813). The optimal cut-off value for the new combined predictive indicator in predicting in-hospital death events was 0.236, and the corresponding sensitivity, specificity and diagnostic accuracy for the combined predictive indicator were 73.12%, 76.51% and 75.70%, respectively. One patient was randomly selected, and the APACHE II score and SOFA score was substituted into the probability equation for prediction. The calculated value was 0.570, which was higher than the cut-off value (0.236), indicating that the death prognosis at an accuracy of 75.70%. The combined predictive indicator, which is formulated by logistic regression models, is superior to any single indicator in predicting sepsis or in-hospital death events.

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.

Low predictability of anthropometric indicators of obesity in metabolic syndrome (MS) risks among elderly women.

PubMed

Chu, Fu-Ling; Hsu, Chung-Huei; Jeng, Chii

2012-01-01

While diagnostic criteria for MS may vary depending on ethnicity, obesity remains a key risk factor in its development. In Taiwan, the incidence of obesity and MS among women has been increasing; however cut-off values for defining obesity for the diagnosis of MS among different groups of women have not been clearly established. The goal of this research was to examine the suitability of various anthropometric indicators of obesity in predicting the presence of MS criteria and to determine appropriate cut-off values of these indicators for women of different age and menstrual status. The sample was derived from the 2002 "Taiwan Three High Prevalence Survey" database. Women were divided into three groups based on age and menstrual status. Receiver-operating characteristic (ROC) curves was applied to the anthropometric indicators of obesity including, body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), to ascertain its value in predicting MS. 2848 cases were included. It was found that most MS component values were worse with age and following menopause. Obesity indicators showed poor predictability for MS risks in post-menopausal women over 65 years, but good predictability in women under 65 years; our study revealed the following as ideal cut-off values for non-menopausal female: WHtR<0.49, WC<78 cm, WHR<0.79, BMI<24 kg/m(2); for menopausal women, WHtR<0.54, WC<83 cm, WHR<0.84, BMI<24.4 kg/m(2). It was concluded that obesity alone is not a reliable predictor of MS risks in women over the age of 65, and cut-off values for obesity indicators need to be further reduced in non-menopausal women. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

The clinical value of adipokines in predicting the severity and outcome of acute pancreatitis.

PubMed

Karpavicius, Andrius; Dambrauskas, Zilvinas; Gradauskas, Audrius; Samuilis, Arturas; Zviniene, Kristina; Kupcinskas, Juozas; Brimas, Gintautas; Meckovski, Artur; Sileikis, Audrius; Strupas, Kestutis

2016-08-22

Recent data shows that patients with severe acute pancreatic might benefit from early intensive therapy, enteral nutrition and timely transfer to specialized centers. The early prophylactic use of antibiotics in AP remains controversial. The role and need for new markers in stratification of acute pancreatitis is also uncertain. This study aims to evaluate the prognostic usefulness of adipokines in prediction of the severity and outcome of acute pancreatitis (AP). Prospective study was conducted in four clinical centers. The diagnosis and severity assessment of AP was established according to the revised 2012 Atlanta classification. Adipokines, IL-6 and CRP levels were measured at admission and on 3rd day of hospital stay and compared with the control group. The predictive accuracy of each marker was measured by area under the receiver operating curve. Forty healthy controls and 102 patients were enrolled in to the study. Twenty seven (26.5 %) patients had mild, 55 (53.9 %) - moderate and 20 (19.6 %) - severe AP. Only resistin (cut-off value 13.7 ng/ml) and IL-6 (cut-off value 473.4 pg/ml) were reliable early markers of SAP. IL-6 with cut-off value of 157.0 pg/ml was a predictor of necrosis. The peripancreatic necrosis volume of 112.5 ml was a marker of SAP and 433.0 ml cut-off value could be used to predict the need of interventions. The prognostic value of adipokines in AP is limited. Only admission resistin levels could serve as an early predictor for SAP. The Lithuanian Regional Ethics Committee approved the study protocol (permission No. L-12-02/1/2/3/4) and all the patients and the control group provided written informed consent.

At-risk and intervention thresholds of occupational stress using a visual analogue scale

PubMed Central

Pereira, Bruno; Moustafa, Farès; Naughton, Geraldine; Lesage, François-Xavier; Lambert, Céline

2017-01-01

Background The visual analogue scale (VAS) is widely used in clinical practice by occupational physicians to assess perceived stress in workers. However, a single cut-off (black-or-white decision) inadequately discriminates between workers with and without stress. We explored an innovative statistical approach to distinguish an at-risk population among stressed workers, and to establish a threshold over which an action is urgently required, via the use of two cut-offs. Methods Participants were recruited during annual work medical examinations by a random sample of workers from five occupational health centres. We previously proposed a single cut-off of VAS stress in comparison with the Perceived Stress Scale (PSS14). Similar methodology was used in the current study, along with a gray zone approach. The lower limit of the gray zone supports sensitivity (“at-risk” threshold; interpreted as requiring closer surveillance) and the upper limit supports specificity (i.e. “intervention” threshold–emergency action required). Results We included 500 workers (49.6% males), aged 40±11 years, with a PSS14 score of 3.8±1.4 and a VAS score of 4.0±2.4. Using a receiver operating characteristic curve and the PSS cut-off score of 7.2, the optimal VAS threshold was 6.8 (sensitivity = 0.89, specificity = 0.87). The lower and upper thresholds of the gray zone were 5 and 8.2, respectively. Conclusions We identified two clinically relevant cut-offs on the VAS of stress: a first cut-off of 5.0 for an at-risk population, and a second cut-off of 8.2 over which an action is urgently required. Future investigations into the relationships between this upper threshold and deleterious events are required. PMID:28586383

The diagnostic value of the numeric pain rating scale in older postoperative patients.

PubMed

van Dijk, Jacqueline F M; Kappen, Teus H; van Wijck, Albert J M; Kalkman, Cor J; Schuurmans, Marieke J

2012-11-01

To measure the diagnostic value of the Numeric Rating Scale by comparing it to a Verbal Rating Scale in older patients. Pain management in older patients is an important challenge because of their greater susceptibility to adverse effects of analgesics. Nurses play an important role in applying guidelines for postoperative pain treatment. However, effective pain management is dependent upon valid and reliable pain assessment. Cross-sectional study. In total, 2674 older patients scored their postoperative pain on an 11-point numeric rating scale (NRS) and an adjective scale (VRS) including no pain, little pain, painful but bearable, considerable pain and terrible pain. The diagnostic value of different NRS cut-off values for administering analgesics is determined by an ROC curve. Sensitivity of NRS > 3 for 'unbearable' pain in older patients was 72% with a specificity of 97·2%. With a cut-off point NRS > 4, sensitivity increased to 83%, while specificity was 96·7%. With a cut-off point NRS > 5, sensitivity was 94%, while specificity was 85%. A high proportion (75%) of older old patients (≥ 75 years) with 'painful but bearable' considers NRS 4, 5 and 6 to this VRS category. Using an NRS cut-off point > 3 or > 4, a large group of older patients with 'bearable' pain would incorrectly classified as 'unbearable'. When we make the assumption that bearable pain means no wish for additional analgesics, this misclassification might result in overtreatment with analgesics, while 3% would be undertreated. With NRS cut-off point > 5, 6% have a risk of overtreatment and 15% of undertreatment. Nurses should not rely solely on the NRS score in determining pain treatment; they need to communicate with older patients about their pain, the need for analgesics and eventual misconceptions about analgesics. © 2012 Blackwell Publishing Ltd.

Early hyperglycaemia and the early-term death in patients with spontaneous intracerebral haemorrhage: a meta-analysis.

PubMed

Tan, X; He, J; Li, L; Yang, G; Liu, H; Tang, S; Wang, Y

2014-03-01

Stroke is often accompanied by hyperglycaemia, and this has an important impact on prognosis. The aim of this study was to investigate the relationship between early hyperglycaemia and the outcome of spontaneous intracerebral haemorrhage (sICH). A systematic literature search on PubMed, Embase, Cochran, WANFANG DATA, VIP and CNKI databases was conducted, and eight eligible studies were retrieved. Relative risks and 95% confidence interval (CI) in the hyperglycaemia group compared with the non-hyperglycaemia group were calculated and meta-analysed when possible. Eight controlled trials and cohort studies totalling 3756 patients addressing early hyperglycaemia and the outcome of sICH were compiled for this meta-analysis. Cut-off points for defining hyperglycaemia was 6.1-8.3 mmol/L, and the median cut-off value was 7.5 mmol/L. Studies were assigned to one of the two subgroups: the group A (for studies with the values of glucose concentrations above the median cut-off) and the group B (for studies with the values of glucose concentrations below the median cut-off). The RR for short-term death associated with hyperglycaemia was 3.65 (95% confidence interval (CI) (3.08, 4.33); P < 0.0001). In the subgroup analysis, the relative risk values were 3.46 (95% CI (1.66, 7.20); P = 0.0009) and 3.53 (95% CI (2.92, 4.26); P < 0.00001) for the groups A and B respectively. The publication bias showed that Egger's test (P > 0.1), Begg's test (P > 0.05) and Nfs0.05 exceeded included studies. Early hyperglycaemia can significantly increase the rate of early-term death in patients with sICH, independent of the cut-off points for hyperglycaemia. © 2013 The Authors; Internal Medicine Journal © 2013 Royal Australasian College of Physicians.

[Validation of the Eating Attitudes Test as a screening instrument for eating disorders in general population].

PubMed

Peláez-Fernández, María Angeles; Ruiz-Lázaro, Pedro Manuel; Labrador, Francisco Javier; Raich, Rosa María

2014-02-20

To validate the best cut-off point of the Eating Attitudes Test (EAT-40), Spanish version, for the screening of eating disorders (ED) in the general population. This was a transversal cross-sectional study. The EAT-40 Spanish version was administered to a representative sample of 1.543 students, age range 12 to 21 years, in the Region of Madrid. Six hundred and two participants (probable cases and a random sample of controls) were interviewed. The best diagnostic prediction was obtained with a cut-off point of 21, with sensitivity: 88.2%; specificity: 62.1%; positive predictive value: 17.7%; negative predictive value: 62.1%. Use of a cut-off point of 21 is recommended in epidemiological studies of eating disorders in the Spanish general population. Copyright © 2012 Elsevier España, S.L. All rights reserved.

Neutrophil to Lymphocyte Ratio in Patients with Nonarteritic Anterior Ischemic Optic Neuropathy

PubMed Central

Yigit, Musa; Tok, Levent; Tok, Ozlem

2017-01-01

Purpose To evaluate the neutrophil to lymphocyte ratio (NLR) in patients with nonarteritic anterior ischemic optic neuropathy (NAION). Methods We investigated 112 subjects comprising 56 patients with NAION and 56 healthy controls at Süleyman Demirel University. Complete blood count, demographic, and clinic data from NAION patients were evaluated in this study. The NLR was calculated in all individuals and compared between the patient and control groups. Cut-off values were also determined. Then, the relationship between NLR and visual outcomes was investigated. Results The cut-off value for NLR was 1.64. NLR values were significantly higher in NAION patients than in healthy subjects (p < 0.001) and were directly correlated with erythrocyte sedimentation rate levels (r = 0.263, p = 0.006). Also, the NLR value was associated with visual outcomes. Receiver operator characteristic curve analysis revealed a 0.63 area under the curve (confidence interval, 53.7% to 74.1%), 85% sensitivity and 41% specificity at the cut-off NLR value. Conclusions The NLR may be a biomarker with good sensitivity that is quick, cost effective and easily detected in serum. It can be used in clinical practice to predict a NAION patient's prognosis in terms of visual outcomes. PMID:28367045

Gamma-hydroxybutyric acid endogenous production and post-mortem behaviour - the importance of different biological matrices, cut-off reference values, sample collection and storage conditions.

PubMed

Castro, André L; Dias, Mário; Reis, Flávio; Teixeira, Helena M

2014-10-01

Gamma-Hydroxybutyric Acid (GHB) is an endogenous compound with a story of clinical use, since the 1960's. However, due to its secondary effects, it has become a controlled substance, entering the illicit market for recreational and "dance club scene" use, muscle enhancement purposes and drug-facilitated sexual assaults. Its endogenous context can bring some difficulties when interpreting, in a forensic context, the analytical values achieved in biological samples. This manuscript reviewed several crucial aspects related to GHB forensic toxicology evaluation, such as its post-mortem behaviour in biological samples; endogenous production values, whether in in vivo and in post-mortem samples; sampling and storage conditions (including stability tests); and cut-off reference values evaluation for different biological samples, such as whole blood, plasma, serum, urine, saliva, bile, vitreous humour and hair. This revision highlights the need of specific sampling care, storage conditions, and cut-off reference values interpretation in different biological samples, essential for proper practical application in forensic toxicology. Copyright © 2014 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

The Smartphone Addiction Scale: Development and Validation of a Short Version for Adolescents

PubMed Central

Kwon, Min; Kim, Dai-Jin; Cho, Hyun; Yang, Soo

2013-01-01

Objective This study was designed to investigate the revised and short version of the smartphone addiction scale and the proof of its validity in adolescents. In addition, it suggested cutting off the values by gender in order to determine smartphone addiction and elaborate the characteristics of smartphone usage in adolescents. Method A set of questionnaires were provided to a total of 540 selected participants from April to May of 2013. The participants consisted of 343 boys and 197 girls, and their average age was 14.5 years old. The content validity was performed on a selection of shortened items, while an internal-consistency test was conducted for the verification of its reliability. The concurrent validity was confirmed using SAS, SAPS and KS-scale. Receiver operating characteristics analysis was conducted to suggest cut-off. Results The 10 final questions were selected using content validity. The internal consistency and concurrent validity of SAS were verified with a Cronbach's alpha of 0.911. The SAS-SV was significantly correlated with the SAS, SAPS and KS-scale. The SAS-SV scores of gender (p<.001) and self-evaluation of smartphone addiction (p<.001) showed significant difference. The ROC analysis results showed an area under a curve (AUC) value of 0.963(0.888–1.000), a cut-off value of 31, sensitivity value of 0.867 and specificity value of 0.893 in boys while an AUC value of 0.947(0.887–1.000), a cut-off value of 33, sensitivity value of 0.875, and a specificity value of 0.886 in girls. Conclusions The SAS-SV showed good reliability and validity for the assessment of smartphone addiction. The smartphone addiction scale short version, which was developed and validated in this study, could be used efficiently for the evaluation of smartphone addiction in community and research areas. PMID:24391787

The smartphone addiction scale: development and validation of a short version for adolescents.

PubMed

Kwon, Min; Kim, Dai-Jin; Cho, Hyun; Yang, Soo

2013-01-01

This study was designed to investigate the revised and short version of the smartphone addiction scale and the proof of its validity in adolescents. In addition, it suggested cutting off the values by gender in order to determine smartphone addiction and elaborate the characteristics of smartphone usage in adolescents. A set of questionnaires were provided to a total of 540 selected participants from April to May of 2013. The participants consisted of 343 boys and 197 girls, and their average age was 14.5 years old. The content validity was performed on a selection of shortened items, while an internal-consistency test was conducted for the verification of its reliability. The concurrent validity was confirmed using SAS, SAPS and KS-scale. Receiver operating characteristics analysis was conducted to suggest cut-off. The 10 final questions were selected using content validity. The internal consistency and concurrent validity of SAS were verified with a Cronbach's alpha of 0.911. The SAS-SV was significantly correlated with the SAS, SAPS and KS-scale. The SAS-SV scores of gender (p<.001) and self-evaluation of smartphone addiction (p<.001) showed significant difference. The ROC analysis results showed an area under a curve (AUC) value of 0.963(0.888-1.000), a cut-off value of 31, sensitivity value of 0.867 and specificity value of 0.893 in boys while an AUC value of 0.947(0.887-1.000), a cut-off value of 33, sensitivity value of 0.875, and a specificity value of 0.886 in girls. The SAS-SV showed good reliability and validity for the assessment of smartphone addiction. The smartphone addiction scale short version, which was developed and validated in this study, could be used efficiently for the evaluation of smartphone addiction in community and research areas.

Diagnostic value of FIB-4 for liver fibrosis in patients with hepatitis B: a meta-analysis of diagnostic test.

PubMed

Yin, Zhi; Zou, Jin; Li, Qiongxuan; Chen, Lizhang

2017-04-04

This study is aimed at evaluating the diagnostic value of FIB-4 for liver fibrosis in patients with hepatitis B through a meta-analysis of diagnostic test. We conducted a comprehensive search in the Pubmed, Embase, Web of Science, and Chinese National Knowledge Infrastructure before October 31, 2016. Stata 14.0 software was used for calculation and statistical analyses. We used the sensitivity, specificity, positive and negative likelihood ratio (PLR, NLR), diagnostic odds ratio (DOR) and 95% confidence intervals (CIs) to evaluate the diagnostic value of FIB-4 for liver fibrosis in patients with hepatitis B. Twenty-six studies were included in the final analyses, with a total of 8274 individuals. The pooled parameters are calculated from all studies: sensitivity of 0.69 (95%CI:0.63-0.75), specificity of 0.81 (95%CI: 0.73-0.87), PLR of 3.63 (95%CI:2.66-4.94), NLR of 0.38 (95%CI:0.32-0.44), DOR of 9.57 (95%CI: 6.67-13.74), and area under the curve (AUC) of 0.80 (95%CI: 0.76-0.83). We also conducted subgroup based on the range of cut-off values. Results from subgroup analysis showed that cut-off was the source of heterogeneity in the present study. The sensitivity and specificity of cut-off>2 were 0.69 and 0.95 with the AUC of 0.90 (95%CI: 0.87-0.92). The overall diagnostic value of FIB-4 is not very high for liver fibrosis in patients with hepatitis B. However, the diagnostic value is affected by the cut-off value. FIB-4 has relatively high diagnostic value for detecting liver fibrosis in patients with hepatitis B when the diagnostic threshold value is more than 2.0.

Data analytics identify glycated haemoglobin co-markers for type 2 diabetes mellitus diagnosis.

PubMed

Jelinek, Herbert F; Stranieri, Andrew; Yatsko, Andrew; Venkatraman, Sitalakshmi

2016-08-01

Glycated haemoglobin (HbA1c) is being more commonly used as an alternative test for the identification of type 2 diabetes mellitus (T2DM) or to add to fasting blood glucose level and oral glucose tolerance test results, because it is easily obtained using point-of-care technology and represents long-term blood sugar levels. HbA1c cut-off values of 6.5% or above have been recommended for clinical use based on the presence of diabetic comorbidities from population studies. However, outcomes of large trials with a HbA1c of 6.5% as a cut-off have been inconsistent for a diagnosis of T2DM. This suggests that a HbA1c cut-off of 6.5% as a single marker may not be sensitive enough or be too simple and miss individuals at risk or with already overt, undiagnosed diabetes. In this study, data mining algorithms have been applied on a large clinical dataset to identify an optimal cut-off value for HbA1c and to identify whether additional biomarkers can be used together with HbA1c to enhance diagnostic accuracy of T2DM. T2DM classification accuracy increased if 8-hydroxy-2-deoxyguanosine (8-OhdG), an oxidative stress marker, was included in the algorithm from 78.71% for HbA1c at 6.5% to 86.64%. A similar result was obtained when interleukin-6 (IL-6) was included (accuracy=85.63%) but with a lower optimal HbA1c range between 5.73 and 6.22%. The application of data analytics to medical records from the Diabetes Screening programme demonstrates that data analytics, combined with large clinical datasets can be used to identify clinically appropriate cut-off values and identify novel biomarkers that when included improve the accuracy of T2DM diagnosis even when HbA1c levels are below or equal to the current cut-off of 6.5%. Copyright © 2016 Elsevier Ltd. All rights reserved.

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.

Stereometric parameters change vs. Topographic Change Analysis (TCA) agreement in Heidelberg Retina Tomography III (HRT-3) early detection of clinical significant glaucoma progression.

PubMed

Dascalu, A M; Cherecheanu, A P; Stana, D; Voinea, L; Ciuluvica, R; Savlovschi, C; Serban, D

2014-01-01

to investigate the sensitivity and specificity of the stereometric parameters change analysis vs. Topographic Change Analysis in early detection of glaucoma progression. 81 patients with POAG were monitored for 4 years (GAT monthly, SAP at every 6 months, optic disc photographs and HRT3 yearly). The exclusion criteria were other optic disc or retinal pathology; topographic standard deviation (TSD>30; inter-test variation of reference height>25 μm. The criterion for structural progression was the following: at least 20 adjacent super-pixels with a clinically significant decrease in height (>5%). 16 patients of the total 81 presented structural progression on TCA. The most useful stereometric parameters for the early detection of glaucoma progression were the following: Rim Area change (sensitivity 100%, specificity 74.2% for a "cut-off " value of -0.05), C/D Area change (sensitivity 85.7%, specificity 71.5% for a "cut off " value of 0.02), C/D linear change (sensitivity 85.7%, specificity 71.5% for a "cut-off " value of 0.02), Rim Volume change (sensitivity 71.4%, specificity 88.8% for a "cut-off " value of -0.04). RNFL Thickness change (<0) was highly sensitive (82%), but less specific for glaucoma progression (45,2%). Changes of the other stereometric parameters have a limited diagnostic value for the early detection of glaucoma progression. TCA is a valuable tool for the assessment of the structural progression in glaucoma patients and its inter-test variability is low. On long-term, the quantitative analysis according to stereometric parameters change is also very important. The most relevant parameters to detect progression are RA, C/D Area, Linear C/D and RV.

Evaluation of a microwave method for dry matter determination in faecal samples from weaned pigs with or without clinical diarrhoea.

PubMed

Pedersen, Ken Steen; Stege, Helle; Nielsen, Jens Peter

2011-07-01

Microwave drying as a procedure for determination of faecal dry matter in weaned pigs was evaluated and clinical relevant cut-off values between faecal consistency scores were determined. Repeatability and reproducibility were evaluated. Overall coefficient of variation was 0.03. The 95% confidence limits for any future faecal subsample examined by any operator in any replica were ± 0.85% faecal dry matter. Robustness in relation to weight of wet faeces was evaluated. The weight categories were 0.5, 1.0, 1.5, 2.0 and 3.0 g. Samples of 0.5 g gave significantly different mean faecal dry matter content compared to weighing of 1.0-3.0 g. Agreement with freeze-drying was evaluated. Lin's concordance correlation coefficient was 0.94. On average the faecal dry matter values was 1.7% (SD=1.99%) higher in freeze dried compared to micro waved samples. Non-parametric ROC analyses were used to determine optimal faecal dry matter cut-off values for clinical faecal consistency scores. The 4 consistency scores were score 1=firm and shaped, score 2=soft and shaped, score 3=loose and score 4=watery. The cut-off values were score 1: faecal dry matter content >19.5%, score 2: faecal dry matter content ≤ 19.5% and >18.0%, score 3: faecal dry matter content ≤ 18.0% and >11.3%, score 4: faecal dry matter content ≤ 11.3%. In conclusion, the microwave procedure has an acceptable repeatability/reproducibility and good agreement with freeze drying can be expected. A minimum of 1.0 g of wet faeces must be used for analyses. Faecal dry matter cut-off values between 4 different clinical consistency scores were determined. © 2011 Elsevier B.V. All rights reserved.

Optimal cut-off values for the homeostasis model assessment of insulin resistance (HOMA-IR) and pre-diabetes screening: Developments in research and prospects for the future.

PubMed

Tang, Qi; Li, Xueqin; Song, Peipei; Xu, Lingzhong

2015-12-01

Diabetes mellitus (DM) appears to be increasing rapidly, threatening to reduce life expectancy for humans around the globe. The International Diabetes Federation (IDF) has estimated that there will be 642 million people living with the disease by 2040 and half as many again who will be not diagnosed. This means that pre-DM screening is a critical issue. Insulin resistance (IR) has emerged as a major pathophysiological factor in the development and progression of DM since it is evident in susceptible individuals at the early stages of DM, and particularly type 2 DM (T2DM). Therefore, assessment of IR via the homeostasis model assessment of IR (HOMA-IR) is a key index for the primary prevention of DM and is thus found in guidelines for screening of high-risk groups. However, the cut-off values of HOMA-IR differ for different races, ages, genders, diseases, complications, etc. due to the complexity of IR. This hampers the determination of specific cut-off values of HOMA-IR in different places and in different situations. China has not published an official index to gauge IR for primary prevention of T2DM in the diabetic and non-diabetic population except for children and adolescents ages 6-12 years. Hence, this article summarizes developments in research on IR, HOMA-IR, and pre-DM screening in order to provide a reference for optimal cut-off values of HOMA-IR for the diagnosis of DM in the Chinese population.

The association between the low muscle mass and osteoporosis in elderly Korean people.

PubMed

Kim, Sunyoung; Won, Chang Won; Kim, Byung Sung; Choi, Hyun Rim; Moon, Min Young

2014-07-01

The purpose of this study was to predict osteoporosis risk as decreasing muscle mass and to declare the cut-off value of low muscle mass in an elderly Korean population. This study was based on data from the 2008-2010 Korea National Health and Nutritional Examination Surveys (KNHANES). The subjects included 1,308 men and 1,171 women over 65 yr. Bone mineral density (BMD) and appendicular skeletal muscle (ASM) were measured by dual energy X-ray absorptiometry (DXA), and appendicular skeletal muscle was adjusted by height as a marker of sarcopenia. After confirming the correlation between low muscle mass and BMD, the best cut-off value of muscle mass to estimate osteoporosis was suggested through the receiver operating characteristic (ROC) curve. For both men and women, BMD correlated positively with low muscle mass when ASM/Ht(2) was used as a marker for sarcopenia. The ROC curve showed that ASM/Ht(2) was the best marker for osteoporosis at a cut-off value of 6.85 kg/m(2) for men and 5.96 kg/m(2) for women. When these cut-off values were used to determine sarcopenia, the risk of osteoporosis increased 4.14 times in men and 1.88 times in women. In particular, men (OR 2.12) with sarcopenia were more greatly affected than women (OR 1.15), even after adjusting for osteoporosis risk factors. In elderly Korean people, sarcopenia is positively correlated with BMD and there is a strong correlation between sarcopenia and osteoporosis with risk of bone fracture.

Optimising the utility of pleural fluid adenosine deaminase for the diagnosis of adult tuberculous pleural effusion in Hong Kong.

PubMed

Chang, K C; Chan, M C; Leung, W M; Kong, F Y; Mak, C M; Chen, S Pl; Yu, W C

2018-02-01

Pleural fluid adenosine deaminase level can be applied to rapidly detect tuberculous pleural effusion. We aimed to establish a local diagnostic cut-off value for pleural fluid adenosine deaminase to identify patients with tuberculous pleural effusion, and optimise its utility. We retrospectively reviewed the medical records of consecutive adults with pleural fluid adenosine deaminase level measured by the Diazyme commercial kit (Diazyme Laboratories, San Diego [CA], United States) during 1 January to 31 December 2011 in a cluster of public hospitals in Hong Kong. We considered its level alongside early (within 2 weeks) findings in pleural fluid and pleural biopsy, with and without applying Light's criteria in multiple scenarios. For each scenario, we used the receiver operating characteristic curve to identify a diagnostic cut-off value for pleural fluid adenosine deaminase, and estimated its positive and negative predictive values. A total of 860 medical records were reviewed. Pleural effusion was caused by congestive heart failure, chronic renal failure, or hypoalbuminaemia caused by liver or kidney diseases in 246 (28.6%) patients, malignancy in 198 (23.0%), non-tuberculous infection in 168 (19.5%), tuberculous pleural effusion in 157 (18.3%), and miscellaneous causes in 91 (10.6%). All those with tuberculous pleural effusion had a pleural fluid adenosine deaminase level of ≤100 U/L. When analysis was restricted to 689 patients with pleural fluid adenosine deaminase level of ≤100 U/L and early negative findings for malignancy and non-tuberculous infection in pleural fluid, the positive predictive value was significantly increased and the negative predictive value non-significantly reduced. Using this approach, neither additionally restricting analysis to exudates by Light's criteria nor adding closed pleural biopsy would further enhance predictive values. As such, the diagnostic cut-off value for pleural fluid adenosine deaminase is 26.5 U/L, with a sensitivity of 87.3%, specificity of 93.2%, positive predictive value of 79.2%, negative predictive value of 96.1%, and accuracy of 91.9%. Sex, age, and co-morbidity did not significantly affect prediction of tuberculous pleural effusion using the cut-off value. We have established a diagnostic cut-off level for pleural fluid adenosine deaminase in the diagnosis of tuberculous pleural effusion by restricting analysis to a level of ≤100 U/L, and considering early pleural fluid findings for malignancy and non-tuberculous infection, but not Light's criteria.

Cut-off proposal for the detection of ketamine in hair.

PubMed

Salomone, A; Gerace, E; Diana, P; Romeo, M; Malvaso, V; Di Corcia, D; Vincenti, M

2015-03-01

Ketamine is a powerful anesthetic drug used in both human and veterinary surgery, but it is also commonly misused because of its psychotropic properties. Since the abuse of this drug has been reported in many countries worldwide, its determination in hair samples is offered as a specialist test by hundreds of laboratories. However, unlike other common drugs of abuse, a cut-off level for ketamine in hair has not been fixed yet. Therefore, aim of this study is to propose a concentration value for ketamine in hair analysis, in order to discriminate between chronic and occasional use, and between active use and external contamination. After considering the chemical properties of this molecule, and the experimental data collected in our laboratory or reported in several other published studies, we propose a cut-off level of 0.5ng/mg, as indicative of repeated exposure to ketamine. Additionally, we suggest that the detection of the metabolite norketamine should be mandatory to prove active intake and exclude false positive result from external contamination. Thus, a reasonable cut-off value for norketamine could be fixed at 0.1ng/mg, while the minimal concentration ratio norketamine/ketamine may be positively established at 0.05. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Comparative analysis of anthropometric indices of obesity as correlates and potential predictors of risk for hypertension and prehypertension in a population in Nigeria.

PubMed

Ononamadu, Chimaobi James; Ezekwesili, Chinwe Nonyelum; Onyeukwu, Onyemaechi Faith; Umeoguaju, Uchenna Francis; Ezeigwe, Obiajulu Christian; Ihegboro, Godwin Okwudiri

Obesity is a well-established independent risk factor for hypertension and other cardiometabolic disorders. However, the best anthropometric index of obesity that predicts or associates strongly with hypertension and related conditions remains controversial and inconclusive. This study compared the performance of eight anthropometric indices of obesity: body mass index (BMI), ponderal index (PI), waist circumference (WC), hip circumference (HC), waist-hip ratio (WHR), waist-height ratio (WHtR), body adiposity index (BAI) and conicity index (CI) as correlates and potential predictors of risk of hypertension and prehypertension in a Nigerian population, and also the possible effect of combining two or more indices in that regard. This church-based, cross-sectional study was conducted in Anambra state, south-eastern Nigeria from 2012 to 2013. A total of 912 persons (436 male and 476 female) drawn randomly from three major cities (Awka, Onitsha and Nnewi) in the state participated in the study. Information on demography, medical history and lifestyle were obtained using a well-structured and validated questionnaire. The systolic/diastolic blood pressure and anthropometric measurements were taken by well-trained personnel. The resulting data were analysed using descriptive statistics, logistic regression, Poisson regression and receiver operating characteristic curve analysis. The mean values of all the anthropometric indices studied increased from normotension, through prehypertension to hypertension in both genders. BMI, WC, HC and CI were significantly higher (p < 0.05) in females than males. All the anthropometric indices studied were significantly (p < 0.001 except for CI) correlated with systolic and diastolic blood pressure. BMI, WHtR, WC and PI (with higher correlation coefficients for blood pressure) showed the best potential to predict hypertension and prehypertension in the study: BMI (cut-off = 24.49, AUC = 0.698; cut-off = 23.62, AUC = 0.659), WHtR (cut-off = 0.55, AUC = 0.682; cut-off = 0.5, AUC = 0.636), WC (cut-off = 91.44, AUC = 0.692; cut-off = 82.55, AUC = 0.645), PI (cut-off = 14.45, AUC = 0.670; cut-off = 13.69, AUC = 0.639), in males; and BMI (cut-off = 24.44, AUC = 0.622; cut-off = 28.01, AUC = 0.609), WHtR (cut-off = 0.51, AUC = 0.624; cut-off = 0.6, AUC = 0.572), WC ( cut-off = 96.62, AUC = 0.616; cut-off = 96.52, AUC = 0.584), PI ( cut-off = 16.38, AUC = 0.619; cut-off = 17.65, AUC = 0.599), in females for hypertension and prehypertension, respectively. In predicting hypertension risk, WC and WHtR did not significantly improve the performance of BMI in the models when included using our decision rule. Overall, CI had a very poor discriminatory power for both conditions in this study. BMI, WHtR, WC and PI emerged the best predictors of hypertension risk, and BMI, WC and PI of prehypertension risk in this study. The combination of high-performing anthropometric indices in a model did not improve their performance. Therefore we recommend the simultaneous but independent use of BMI and either WC or WHtR for predicting hypertension, and BMI and WC for prehypertension risk, bearing in mind that both types of index (abdominal and general obesity) account for different forms of obesity.

Comparative analysis of anthropometric indices of obesity as correlates and potential predictors of risk for hypertension and prehypertension in a population in Nigeria

PubMed Central

Ononamadu, Chimaobi James; Ihegboro, Godwin Okwudiri; Ezekwesili, Chinwe Nonyelum; Onyeukwu, Onyemaechi Faith; Umeoguaju,, Uchenna Francis; Ezeigwe, Obiajulu Christian

2017-01-01

Summary Background: Obesity is a well-established independent risk factor for hypertension and other cardiometabolic disorders. However, the best anthropometric index of obesity that predicts or associates strongly with hypertension and related conditions remains controversial and inconclusive. Objective: This study compared the performance of eight anthropometric indices of obesity: body mass index (BMI), ponderal index (PI), waist circumference (WC), hip circumference (HC), waist–hip ratio (WHR), waist–height ratio (WHtR), body adiposity index (BAI) and conicity index (CI) as correlates and potential predictors of risk of hypertension and prehypertension in a Nigerian population, and also the possible effect of combining two or more indices in that regard. Methods: This church-based, cross-sectional study was conducted in Anambra state, south-eastern Nigeria from 2012 to 2013. A total of 912 persons (436 male and 476 female) drawn randomly from three major cities (Awka, Onitsha and Nnewi) in the state participated in the study. Information on demography, medical history and lifestyle were obtained using a well-structured and validated questionnaire. The systolic/diastolic blood pressure and anthropometric measurements were taken by well-trained personnel. The resulting data were analysed using descriptive statistics, logistic regression, Poisson regression and receiver operating characteristic curve analysis. Results: The mean values of all the anthropometric indices studied increased from normotension, through prehypertension to hypertension in both genders. BMI, WC, HC and CI were significantly higher (p < 0.05) in females than males. All the anthropometric indices studied were significantly (p < 0.001 except for CI) correlated with systolic and diastolic blood pressure. BMI, WHtR, WC and PI (with higher correlation coefficients for blood pressure) showed the best potential potential to predict hypertension and prehypertension in the study: BMI (cut-off = 24.49, AUC = 0.698; cut-off = 23.62, AUC = 0.659), WHtR (cut-off = 0.55, AUC = 0.682; cut-off = 0.5, AUC = 0.636), WC (cut-off = 91.44, AUC = 0.692; cut-off = 82.55, AUC = 0.645), PI (cut-off = 14.45, AUC = 0.670; cut-off = 13.69, AUC = 0.639), in males; and BMI (cut-off = 24.44, AUC = 0.622; cut-off = 28.01, AUC = 0.609), WHtR (cut-off = 0.51, AUC = 0.624; cut-off = 0.6, AUC = 0.572), WC (cut-off = 96.62, AUC = 0.616; cut-off = 96.52, AUC = 0.584), PI (cut-off = 16.38, AUC = 0.619; cut-off = 17.65, AUC = 0.599), in females for hypertension and prehypertension, respectively. In predicting hypertension risk, WC and WHtR did not significantly improve the performance of BMI in the models when included using our decision rule. Overall, CI had a very poor discriminatory power for both conditions in this study. Conclusion: BMI, WHtR, WC and PI emerged the best predictors of hypertension risk, and BMI, WC and PI of prehypertension risk in this study. The combination of high-performing anthropometric indices in a model did not improve their performance. Therefore we recommend the simultaneous but independent use of BMI and either WC or WHtR for predicting hypertension, and BMI and WC for prehypertension risk, bearing in mind that both types of index (abdominal and general obesity) account for different forms of obesity. PMID:27701484

Cut-off values for step count and TV viewing time as discriminators of hyperglycaemia in Brazilian children and adolescents.

PubMed

Gordia, Alex Pinheiro; Quadros, Teresa Maria Bianchini de; Silva, Luciana Rodrigues; Mota, Jorge

2016-09-01

The use of step count and TV viewing time to discriminate youngsters with hyperglycaemia is still a matter of debate. To establish cut-off values for step count and TV viewing time in children and adolescents using glycaemia as the reference criterion. A cross-sectional study was conducted on 1044 schoolchildren aged 6-18 years from Northeastern Brazil. Daily step counts were assessed with a pedometer over 1 week and TV viewing time by self-report. The area under the curve (AUC) ranged from 0.52-0.61 for step count and from 0.49-0.65 for TV viewing time. The daily step count with the highest discriminatory power for hyperglycaemia was 13 884 (sensitivity = 77.8; specificity = 51.8) for male children and 12 371 (sensitivity = 55.6; specificity = 55.5) and 11 292 (sensitivity = 57.7; specificity = 48.6) for female children and adolescents respectively. The cut-off for TV viewing time with the highest discriminatory capacity for hyperglycaemia was 3 hours/day (sensitivity = 57.7-77.8; specificity = 48.6-53.2). This study represents the first step for the development of criteria based on cardiometabolic risk factors for step count and TV viewing time in youngsters. However, the present cut-off values have limited practical application because of their poor accuracy and low sensitivity and specificity.

Measures of body adiposity and visceral adiposity index as predictors of metabolic syndrome among Thai women with PCOS.

PubMed

Techatraisak, Kitirat; Wongmeerit, Krissanee; Dangrat, Chongdee; Wongwananuruk, Thanyarat; Indhavivadhana, Suchada

2016-01-01

To evaluate the relationship between measures of body adiposity and visceral adiposity index (VAI) and risk of metabolic syndrome (MS) and to identify the optimal cut-off points of each measurement in Thai polycystic ovary syndrome (PCOS). A cross-sectional study was completed physical examination, fasting plasma glucose, lipid profiles of 399 PCOS and 42 age-matched normal controls. Body mass index (BMI), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and VAI were calculated. Associations between different measures and MS were evaluated and the receiver-operating characteristic (ROC) curve was performed to determine appropriate cut-off points for identifying MS. Percentage of MS in PCOS was 24.6%, whereas none MS in controls. Previously recommended cut-off values for body adiposity and VAI were significantly associated with MS. ROC curve analysis of the only PCOS showed newly obtained optimal cut-off points for BMI and VAI of ≥28 kg/m(2) (AUC = 0.90) and >5.6 (AUC = 0.94), respectively. Values found to be more accurate than the original ones. VAI was the best predictor, followed by BMI and WHtR. All body adiposity and VAI parameters can predict the risk of MS. Optimal values for Thai PCOS were ≥28 kg/m(2) for BMI, ≥0.85 for WHR, ≥0.5 for WHtR and >5.6 for VAI.

The Adjustment Disorder--New Module 20 as a Screening Instrument: Cluster Analysis and Cut-off Values.

PubMed

Lorenz, L; Bachem, R C; Maercker, A

2016-10-01

Adjustment disorder (AjD) is a transient mental health condition emerging after stressful life events. Its diagnostic criteria have recently been under revision which led to the development of the Adjustment Disorder--New Module 20 (ADNM-20) as a self-report assessment. To identify a threshold value for people at high risk for AjD. As part of a randomized controlled trial evaluating a self-help manual for burglary victims, the baseline data of all participants (n=80) were analyzed. Besides the ADNM-20, participants answered self-report questionnaires regarding the external variables post-traumatic stress disorder symptomatology, depression, anxiety, and stress levels. We used cluster analysis and ROC analysis to identify the most appropriate cut-off value. The cluster analysis identified three different subgroups. They differed in their level of AjD symptomatology from low to high symptom severity. The same pattern of impairment was found for the external variables. The ROC analysis testing the ADNM-20 sum scoreagainst the theory-based diagnostic algorithm, revealed an optimal cut-off score at 47.5 to distinguish between people at high risk for AjD and people at low risk. The ADNM-20 distinguishes between people with low, moderate, and high symptomatology. The recommendation for a cut-off score at 47.5 facilitates the use of the ADNM-20 in research and practice.

Comparison of commercial ELISA tests for the detection of Toxoplasma antibodies in the meat juice of naturally infected pigs.

PubMed

Felin, Elina; Näreaho, Anu; Fredriksson-Ahomaa, Maria

2017-04-30

Toxoplasmosis is a globally distributed protozoal zoonosis. Pigs are considered an important reservoir of Toxoplasma gondii and pork a major infection source of human toxoplasmosis. ELISA methods are commonly used diagnostic tools for detecting Toxoplasma infections. They are also used for slaughterhouse-based serological monitoring of toxoplasmosis in pigs to identify positive farms. The methods used are non-standardised with varying sensitivity and specificity. In our study, four commercial ELISA tests for the detection of Toxoplasma antibodies in the meat juice of slaughter pigs were compared with a modified agglutination test (MAT) as a reference. The cut-off values of the ELISA tests provided by the manufacturer varied between 0.20 and 0.50, and clearly influenced prevalence. The sensitivity of tests I, II and III varied between 96.4 and 78.6. Sensitivity was unacceptably low (3.6) for test IV (cut-off=0.30). Tests I, II and III had the highest accuracy and the best agreement with the reference test when a cut-off of 0.30 was used. Test II and III showed very good agreement (K=0.92 and 0.84, respectively) with the MAT. A very strong correlation (Pearson correlation >0.89) was observed between the S/P values of tests I, II and III. Our results demonstrate that the test and cut-off value used influence the results of the apparent seroprevalence studies. Copyright © 2017 Elsevier B.V. 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.

Cut-off of anthropometry measurement and nutritional status among elderly outpatient in Indonesia: multi-centre study.

PubMed

Setiati, Siti; Istanti, Rahmi; Andayani, Rejeki; Kuswardhani, R A Tuty; Aryana, I G P Suka; Putu, I Dewa; Apandi, M; Ichwani, Jusri; Soewoto, Sumarmi; Dinda, Rose; Mustika, Syifa

2010-10-01

To obtain the cut-off value of anthropometric measurements and nutritional status of elderly in Indonesia. A multicentre-cross sectional study was performed at 9 hospitals in Indonesia. The data collected comprises of samples characteristics, anthropometric measurements (weight, height, trisep, bisep, subscapular, suprailiac, and circumference of the hip, waist, arm, calf, and thigh), albumin value, MNA score and ADL Index of Barthel. A total of 702 subjects were collected. The average value of serum albumin is 4.28 g/dl, with 98% subjects had normal serum albumin (> 3.5 g/dl). The mean MNA score and BMI was 23.07 and 22.54 respectively. Most of subjects (56.70%) had risk of malnutrition based on MNA score, and 45.01% had normal nutritional status based on body mass index. Average value of several anthropometric measures (weight, stature, and body mass index; sub-scapular and supra-iliac skinfolds; thigh, calf, mid-arm, and waist circumferences) in various age groups in both groups of women and men were obtained. Cut-off values of various anthropometric indicators were also analyzed in this study with MNA as a gold standard. This study showed age related anthropometric measurement differences in both men and women aged 60 years and older.

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.

Taming cut-off induced artifacts in molecular dynamics studies of solvated polypeptides. The reaction field method.

PubMed

Schreiber, H; Steinhauser, O

1992-12-05

In this paper we present a model system of a solvated polypeptide, which is a suitable reference platform for the systematic exploration of methods for taming artifacts introduced by an incorrect treatment of long-range Coulomb forces. The essential feature of the system composed of an alpha-helical peptide and 1021 water molecules is the strict neutrality of all charge groups. The dynamical properties of the peptide, i.e. unfolding or maintenance of the helix, already give first hints on the influence of boundary effects. A rigorous and deeper insight is gained, however, if analyzing the system by means of the generalized Kirkwood g-factor, which projects the net dipole moment of concentric spheres onto the respective dipole moment of the reference charge group. The g-factor is a global measure for, and a sensitive probe of, the orientational structure, which in its turn reflects even the smallest inconsistencies in the treatment of long-range forces. While the cut-off scheme failed the g-factor test, the "reaction field" method, the simplest cut-off correction scheme, enables a consistent description. In other words, with the aid of the reaction field, the correct orientational structure is restored. As a consequence, the helix stability is regained and we were able to calculate the dielectric constant epsilon approximately 55 to 60 for our system, which is slightly below the corresponding value epsilon SPC = 66 of the pure solvent.

[Application of Ischemia Modified Albumin for Acute Ischemic Heart Disease in Forensic Science].

PubMed

Wang, P; Zhu, Z L; Zhu, N; Yu, H; Yue, Q; Wang, X L; Feng, C M; Wang, C L; Zhang, G H

2017-10-01

To explore the application value and forensic significance of ischemia modified albumin （IMA） in pericardial fluid to diagnose sudden cardiac death. IMA level in pericardial fluid was detected in acute ischemic heart disease group （ n =36）, acute myocardial infarction group （ n =6）, cardiomyopathy group （ n =4） and control group （ n =15） by albumin cobalt binding method. The levels of IMA were compared among these groups. The best cut-off IMA value was estimated and the sensitivity and specificity of acute myocardial ischemia group was distinguished from control group by receiver operating characteristics （ROC） curve. The IMA level in acute ischemic heart disease group was significantly higher than that of control group （ P <0.05）. Compared with acute myocardial infarction group and cardiomyopathy group, the IMA level in acute ischemic heart disease group had no significant difference （ P >0.05）. The cut-off value for the identification of acute myocardial ischemia which obtained by ROC analysis was 40.65 U/mL. And the sensitivity and specificity for distinguishing acute ischemia cardiac disease was 60.0% and 80.5%, respectively. The IMA value in pericardial fluid can be a reference marker for the diagnosis of acute myocardial ischemia, which also can provide objective basis for the forensic identification of sudden cardiac death. Copyright© by the Editorial Department of Journal of Forensic Medicine

[Validation of the nutritional index in Mexican pre-teens with the sensitivity and specificity method].

PubMed

Saucedo-Molina, T J; Gómez-Peresmitré, G

1998-01-01

To determine the diagnostic validity of the nutritional index (NI) in a sample of Mexican preadolescents. A total of 256 preadolescents, between 10 and 12 years old, male and female, students from Mexico City, were used to establish the diagnostic validity of NI using the sensitivity and specificity method. The findings show that the conventional NI cut-off points showed good sensitivity and specificity for the diagnosis of low weight, normality and obesity but not for overweight. When the cut-off points of NI were normalized, the sensitivity, specificity and prediction potency values were more suitable in all categories. When working with preadolescents, it is better to use the new cut-off points of NI, to obtain more reliable diagnosis.

The effect of CA125 on metastasis of ovarian cancer: old marker new function.

PubMed

Yuan, Qin; Song, Jiayin; Yang, Weiwei; Wang, Hongyan; Huo, Qianyu; Yang, Jie; Yu, Xiaoxu; Liu, Yunde; Xu, Chen; Bao, Huijing

2017-07-25

CA125 has been used extensively to screen for neoplasms, especially in ovarian cancer. The serum CA125 level can be used as a better prognosis evaluation and it may dynamic monitoring the disease progression. We explored the effect of CA125 on ovarian cancer cell migration and its underlying mechanism. Transwell assays showed that exposure to 0.2 μg/ml or 0.4 μg/ml CA125 for 48 h increased migration of A2780 and OVCAR-3 ovarian cancer cells. This effect of CA125 was blocked addition of 200 ng/ml DKK-1, a Wnt pathway inhibitor. Conversely, addition of CA125 reversed the inhibitory effect of Wnt inhibition in A2780 cells pretreated with DKK-1. Examination of CA125 levels in serum from 97 ovarian cancer patients revealed no relationship between a patient's age or CA125 level currently used clinically for ovarian cancer diagnosis and metastasis. However, using receiver operating characteristic (ROC) curves, we identified a new cut-off value for the serum CA125 concentration (82.9 U/ml) that is predictive of metastasis. The area under the curve is 0.632. This new cut-off value has the potential to serve as a clinically useful indicator of metastasis in ovarian cancer patients.

The effect of CA125 on metastasis of ovarian cancer: old marker new function

PubMed Central

Yang, Weiwei; Wang, Hongyan; Huo, Qianyu; Yang, Jie; Yu, Xiaoxu; Liu, Yunde; Xu, Chen; Bao, Huijing

2017-01-01

CA125 has been used extensively to screen for neoplasms, especially in ovarian cancer. The serum CA125 level can be used as a better prognosis evaluation and it may dynamic monitoring the disease progression. We explored the effect of CA125 on ovarian cancer cell migration and its underlying mechanism. Transwell assays showed that exposure to 0.2 μg/ml or 0.4 μg/ml CA125 for 48 h increased migration of A2780 and OVCAR-3 ovarian cancer cells. This effect of CA125 was blocked addition of 200 ng/ml DKK-1, a Wnt pathway inhibitor. Conversely, addition of CA125 reversed the inhibitory effect of Wnt inhibition in A2780 cells pretreated with DKK-1. Examination of CA125 levels in serum from 97 ovarian cancer patients revealed no relationship between a patient's age or CA125 level currently used clinically for ovarian cancer diagnosis and metastasis. However, using receiver operating characteristic (ROC) curves, we identified a new cut-off value for the serum CA125 concentration (82.9 U/ml) that is predictive of metastasis. The area under the curve is 0.632. This new cut-off value has the potential to serve as a clinically useful indicator of metastasis in ovarian cancer patients. PMID:28637006

Impact of anthropometric cut-off values in determining the prevalence of metabolic alterations.

PubMed

Almeda-Valdes, Paloma; Aguilar-Salinas, Carlos A; Uribe, Misael; Canizales-Quinteros, Samuel; Méndez-Sánchez, Nahum

2016-11-01

The prevalence of obesity has increased worldwide in parallel with associated metabolic disturbances such as diabetes and non-alcoholic fatty liver disease. The objective of this article is to underscore discrepancies in the standard anthropometric cut-off values and the presence of metabolic disturbances including diabetes and non-alcoholic fatty liver disease caused by biological and ethnic variations. We performed a literature review regarding the diagnosis and prevalence of obesity, diabetes, metabolic syndrome and non-alcoholic fatty liver disease and about the different available indicators to define obesity. There is an ongoing epidemic of these chronic diseases, partially attributed to the increased prevalence of obesity. The available markers to indicate adiposity are imperfect, and the selection of accurate cut-off points is still not clear. Methods to quantify adiposity that are useful in clinical practice should be developed to better classify individuals and to reflect metabolic risk more appropriately. © 2016 Stichting European Society for Clinical Investigation Journal Foundation.

Evaluation of a dysphagia screening system based on the Mann Assessment of Swallowing Ability for use in dependent older adults.

PubMed

Ohira, Mariko; Ishida, Ryo; Maki, Yoshinobu; Ohkubo, Mai; Sugiyama, Tetsuya; Sakayori, Takaharu; Sato, Toru

2017-04-01

Dysphagia is common in dependent older adults. Thus, a method of evaluating eating and swallowing functions that can be used to diagnose and manage dysphagia in a simple and robust manner is required. In 2002, the Mann Assessment of Swallowing Ability (MASA) was introduced to identify dysphagia in acute-stage stroke patients. As the MASA enables easy screening, it might also be applicable to dependent older adults if appropriate MASA cut-off values and the most useful assessment items could be determined. In the present study, we attempted to determine suitable MASA cut-off values, and the most useful assessment items for predicting aspiration and pharyngeal retention in dependent older adults. Using the MASA, we evaluated the eating and swallowing functions of 50 dependent older adults with dysphagia. All of the patients also underwent videoendoscopic-based swallowing evaluations to detect aspiration and pharyngeal retention. The participants' characteristics and the utility of each assessment item were compared between various groups. Using the patients' videoendoscopic findings as a reference, receiver operating characteristic curve analysis was carried out to determine appropriate cut-off values for predicting aspiration and pharyngeal retention in dependent older adults. The optimal MASA cut-off values for predicting aspiration and pharyngeal retention were 122 points and 151 points, respectively. A total of 17 of the 24 clinical items assessed by the MASA were found to be associated with aspiration in dependent older adults. The MASA is a useful screening tool for evaluating eating and swallowing functions in dependent older adults. Geriatr Gerontol Int 2017; 17: 561-567. © 2016 Japan Geriatrics Society.

Factors predictive of obstructive sleep apnea in patients undergoing pre-operative evaluation for bariatric surgery and referred to a sleep laboratory for polysomnography

PubMed Central

Duarte, Ricardo Luiz de Menezes; Magalhães-da-Silveira, Flavio José

2015-01-01

Objective: To identify the main predictive factors for obtaining a diagnosis of obstructive sleep apnea (OSA) in patients awaiting bariatric surgery. Methods: Retrospective study of consecutive patients undergoing pre-operative evaluation for bariatric surgery and referred for in-laboratory polysomnography. Eight variables were evaluated: sex, age, neck circumference (NC), BMI, Epworth Sleepiness Scale (ESS) score, snoring, observed apnea, and hypertension. We employed ROC curve analysis to determine the best cut-off value for each variable and multiple linear regression to identify independent predictors of OSA severity. Results: We evaluated 1,089 patients, of whom 781 (71.7%) were female. The overall prevalence of OSA-defined as an apnea/hypopnea index (AHI) ≥ 5.0 events/h-was 74.8%. The best cut-off values for NC, BMI, age, and ESS score were 42 cm, 42 kg/m2, 37 years, and 10 points, respectively. All eight variables were found to be independent predictors of a diagnosis of OSA in general, and all but one were found to be independent predictors of a diagnosis of moderate/severe OSA (AHI ≥ 15.0 events/h), the exception being hypertension. We devised a 6-item model, designated the NO-OSAS model (NC, Obesity, Observed apnea, Snoring, Age, and Sex), with a cut-off value of ≥ 3 for identifying high-risk patients. For a diagnosis of moderate/severe OSA, the model showed 70.8% accuracy, 82.8% sensitivity, and 57.9% specificity. Conclusions: In our sample of patients awaiting bariatric surgery, there was a high prevalence of OSA. At a cut-off value of ≥ 3, the proposed 6-item model showed good accuracy for a diagnosis of moderate/severe OSA. PMID:26578136

ARFI cut-off values and significance of standard deviation for liver fibrosis staging in patients with chronic liver disease.

PubMed

Goertz, Ruediger S; Sturm, Joerg; Pfeifer, Lukas; Wildner, Dane; Wachter, David L; Neurath, Markus F; Strobel, Deike

2013-01-01

Acoustic radiation force impulse (ARFI) elastometry quantifies hepatic stiffness, and thus degree of fibrosis, non-invasively. Our aim was to analyse the diagnostic accuracy of ARFI cut-off values, and the significance of a defined limit of standard deviation (SD) as a potential quality parameter for liver fibrosis staging in patients with chronic liver diseases (CLD). 153 patients with CLD (various aetiologies) undergoing liver biopsy, and an additional 25 patients with known liver cirrhosis, were investigated. ARFI measurements were performed in the right hepatic lobe, and correlated with the histopathological Ludwig fibrosis score (inclusion criteria: at least 6 portal tracts). The diagnostic accuracy of cut-off values was analysed with respect to an SD limit of 30% of the mean ARFI value. The mean ARFI elastometry showed 1.95 ± 0.87 m/s (range 0.79-4.40) in 178 patients (80 female, 98 male, mean age: 52 years). The cut-offs were 1.25 m/s for F ≥ 2, 1.72 m/s for F ≥ 3 and 1.75 m/s for F = 4, and the corresponding AUROC 80.7%, 86.2% and 88.7%, respectively. Exclusion of 31 patients (17.4%) with an SD higher than 30% of the mean ARFI improved the diagnostic accuracy: The AUROC for F ≥ 2, F ≥ 3 and F = 4 were 86.1%, 91.2% and 91.5%, respectively. The diagnostic accuracy of ARFI can be improved by applying a maximum SD of 30% of the mean ARFI as a quality parameter--which however leads to an exclusion of a relevant number of patients. ARFI results with a high SD should be interpreted with caution.

Evaluation of the GHRH-arginine retest for young adolescents with childhood-onset GH deficiency.

PubMed

Dreismann, Laura; Schweizer, Roland; Blumenstock, Gunnar; Weber, Karin; Binder, Gerhard

2016-04-01

Retesting of adolescents with childhood-onset GH deficiency (GHD) is recommended, but age-related reference data are scarce. We aimed to establish a cut-off value for the GHRH-arginine test (GHRH+ARG) at the typical age of retesting at near-adult height. We retrospectively studied 149 patients (108 males) with childhood-onset GHD aged 16.8 ± 1.7 years (mean ± SD) with a BMI of 20.9 ± 3.5 kg/m(2) who had received GHRH+ARG in one single center during 8 consecutive years. Based on the IGF-I serum concentration falling below -2 SDS when off GH, 22 patients suffered from severe GHD of adulthood while 122 were GH sufficient. Five patients could not be determined definitively. GH and IGF-I were measured by in-house RIAs. IGF-I values were transformed into age-related SDS values. ROC-analysis was used to determine the cut-off value. For GHRH+ARG, a cut-off limit of 15.9 ng/ml had the highest pair of sensitivity (91%) and specificity (88%). GH peaks of the patients with a normal BMI between -1 and 0 SDS were higher than those with a high BMI >1 SDS (p<0.01). When retesting adolescents at near-adult height for severe GHD of adulthood, a GH value of <15.9 ng/ml in GHRH+ARG is discriminatory with good accuracy. Conversion factors for other GH assays in use are provided. A rational decision for or against the continuation of GH therapy into adulthood can be made based on the clinical history of the patient and the combination of the GHRH+ARG retest result and the IGF-I serum concentrations when off GH. Copyright © 2016 Elsevier Ltd. All rights reserved.

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

Cutting the Cord

NASA Technical Reports Server (NTRS)

2004-01-01

This animation shows the view from the front hazard avoidance cameras on the Mars Exploration Rover Spirit as the rover turns 45 degrees clockwise. This maneuver is the first step in a 3-point turn that will rotate the rover 115 degrees to face west. The rover must make this turn before rolling off the lander because airbags are blocking it from exiting off the front lander petal. Before this crucial turn could take place, engineers instructed the rover to cut the final cord linking it to the lander. The turn took around 30 minutes to complete.

Rise time of proton cut-off energy in 2D and 3D PIC simulations

NASA Astrophysics Data System (ADS)

Babaei, J.; Gizzi, L. A.; Londrillo, P.; Mirzanejad, S.; Rovelli, T.; Sinigardi, S.; Turchetti, G.

2017-04-01

The Target Normal Sheath Acceleration regime for proton acceleration by laser pulses is experimentally consolidated and fairly well understood. However, uncertainties remain in the analysis of particle-in-cell simulation results. The energy spectrum is exponential with a cut-off, but the maximum energy depends on the simulation time, following different laws in two and three dimensional (2D, 3D) PIC simulations so that the determination of an asymptotic value has some arbitrariness. We propose two empirical laws for the rise time of the cut-off energy in 2D and 3D PIC simulations, suggested by a model in which the proton acceleration is due to a surface charge distribution on the target rear side. The kinetic energy of the protons that we obtain follows two distinct laws, which appear to be nicely satisfied by PIC simulations, for a model target given by a uniform foil plus a contaminant layer that is hydrogen-rich. The laws depend on two parameters: the scaling time, at which the energy starts to rise, and the asymptotic cut-off energy. The values of the cut-off energy, obtained by fitting 2D and 3D simulations for the same target and laser pulse configuration, are comparable. This suggests that parametric scans can be performed with 2D simulations since 3D ones are computationally very expensive, delegating their role only to a correspondence check. In this paper, the simulations are carried out with the PIC code ALaDyn by changing the target thickness L and the incidence angle α, with a fixed a0 = 3. A monotonic dependence, on L for normal incidence and on α for fixed L, is found, as in the experimental results for high temporal contrast pulses.

The diagnostic value of skin prick testing in children with food allergy.

PubMed

Hill, David J; Heine, Ralf G; Hosking, Clifford S

2004-10-01

The diagnostic accuracy of the skin prick test (SPT) in food allergy is controversial. We have developed diagnostic cut-off levels for SPT in children with allergy to cow milk, egg and peanut. Based on 555 open food challenges in 467 children (median age 3.0 yr) we defined food-specific SPT weal diameters that were '100% diagnostic' for allergy to cow milk (>or=8 mm), egg (>or=7 mm) and peanut (>or=8 mm). In children < 2 yr of age, the corresponding weal diameters were >or=6 mm, >or=5 mm and >or=4 mm, respectively. These SPT cut-off levels were prospectively validated in 90 consecutive children

AUDIT and AUDIT-C as screening instruments for alcohol problem use in adolescents.

PubMed

Liskola, Joni; Haravuori, Henna; Lindberg, Nina; Niemelä, Solja; Karlsson, Linnea; Kiviruusu, Olli; Marttunen, Mauri

2018-07-01

The Alcohol Use Disorders Identification Test (AUDIT) is commonly used in adults to screen for harmful alcohol consumption but few studies exist on its use among adolescents. Our aim was to validate the AUDIT and its derivative consumption questionnaire (AUDIT-C) as screening instruments for the detection of problem use of alcohol in adolescents. 621 adolescents (age-range, 12-19 years) were drawn from clinical and population samples who completed the AUDIT questionnaire. Psychiatric diagnoses were assessed using K-SADS-PL. A rating based on the K-SADS-PL was used to assess alcohol use habits, alcohol use disorders, screening and symptom criteria questions. Screening performance of the AUDIT and AUDIT-C sum scores and Receiver Operating Characteristic (ROC) curves were calculated. The diagnostic odds ratios (dOR) were calculated to express the overall discrimination between cut-offs. Comparisons of ROC between the AUDIT and AUDIT-C pairs indicated a slightly better test performance by AUDIT for the whole sample and in a proportion of the subsamples. Optimal cut-off value for the AUDIT was ≥5 (sensitivity 0.931, specificity 0.772, dOR 45.22; 95% CI: 24.72-83.57) for detecting alcohol problem use. The corresponding optimal cut-off value for the AUDIT-C was ≥3 in detecting alcohol problem use (sensitivity 0.952, specificity 0.663, dOR 39.31; 95% CI: 19.46-78.97). Agreement between the AUDIT and AUDIT-C using these cut-off scores was high at 91.9%. Our results for the cut-off scores for the early detection of alcohol problem use in adolescents are ≥5 for AUDIT, and ≥3 for AUDIT-C. Copyright © 2018 Elsevier B.V. All rights reserved.

Exploring the screening capacity of the Fear of Cancer Recurrence Inventory-Short Form for clinical levels of fear of cancer recurrence.

PubMed

Fardell, Joanna E; Jones, Georden; Smith, Allan Ben; Lebel, Sophie; Thewes, Belinda; Costa, Daniel; Tiller, Kerry; Simard, Sébastien; Feldstain, Andrea; Beattie, Sara; McCallum, Megan; Butow, Phyllis

2018-02-01

Fear of cancer recurrence (FCR) is a common concern among cancer survivors. Identifying survivors with clinically significant FCR requires validated screening measures and clinical cut-offs. We evaluated the Fear of Cancer Recurrence Inventory-Short Form (FCRI-SF) clinical cut-off in 2 samples. Level of FCR in study 1 participants (from an Australian randomized controlled trial: ConquerFear) was compared with FCRI-SF scores. Based on a biopsychosocial interview, clinicians rated participants as having nonclinical, subclinical, or clinical FCR. Study 2 participants (from a Canadian FCRI-English validation study) were classified as having clinical or nonclinical FCR by using the semistructured clinical interview for FCR (SIFCR). Receiver operating characteristic analyses evaluated the screening ability of the FCRI-SF against clinician ratings (study 1) and the SIFCR (study 2). In study 1, 167 cancer survivors (mean age: 53 years, SD = 10.1) participated. Clinicians rated 43% as having clinical FCR. In study 2, 40 cancer survivors (mean age: 68 years, SD = 7.0) participated; 25% met criteria for clinical FCR according to the SIFCR. For both studies 1 and 2, receiver operating characteristic analyses suggested a cut-off ≥22 on the FCRI-SF identified cancer survivors with clinical levels of FCR with adequate sensitivity and specificity. Establishing clinical cut-offs on FCR screening measures is crucial to tailoring individual care and conducting rigorous research. Our results suggest using a higher cut-off on the FCRI-SF than previously reported to identify clinically significant FCR. Continued evaluation and validation of the FCRI-SF cut-off is required across diverse cancer populations. Copyright © 2017 John Wiley & Sons, Ltd.

Accuracy of the WHO’s body mass index cut-off points to measure gender- and age-specific obesity in middle-aged adults living in the city of Rio de Janeiro, Brazil

PubMed Central

Wollner, Materko; Paulo Roberto, Benchimol-Barbosa; Alysson Roncally, Silva Carvalho; Jurandir, Nadal; Edil, Luis Santos

2017-01-01

Introduction. Obesity is defined by the World Health Organization (WHO) as a disease characterized by the excessive accumulation of body fat. Obesity is considered a public health problem, leading to serious social, psychological and physical problems. However, the appropriate cut-off point of body mass index (BMI) based on body fat percentage (BF%) for classifying an individual as obese in middle-aged adults living in Rio de Janeiro remains unclear. Materials and methods. This was a prospective cross-sectional study comprising of 856 adults (413 men and 443 women) living in Rio de Janeiro, Brazil ranging from 30-59 years of age. The data were collected over a two year period (2010-2011), and all participants were underwent anthropometric evaluation. The gold standard was the percentage of body fat estimated by bioelectrical impedance analysis. The optimal sensitivity and specificity were attained by adjusting BMI cut-off values to predict obesity based on the WHO criteria: BF% >25% in men and >35% in women, according to the receiver operating characteristic curve (ROC) analysis adjusted for age and for the whole group. Results. The BMI cut-offs for predicting BF% were 29.9 kg/m2 in men and 24.9 kg/m2 in women. Conclusions The BMI that corresponded to a BF% previously defining obesity was similar to that of other Western populations for men but not for women. Furthermore, gender and age specific cut-off values are recommended in this population. Significance for public health World Health Organization (WHO) defines obesity as a disease characterized by the excessive accumulation of body fat. Obesity is considered a public health problem, leading to serious social, psychological and physical problems. The WHO suggested cut-off point for obesity is a body mass index (BMI) of 30 kg/m2, which is associated with morbidity and mortality. An important issue in the debate over measuring obesity concerns the use of BMI to define obesity across different populations. However, it is not clear, what is an appropriate cut-off point of BMI based on body fat percentage (BF%) to classify an individual as obese within gender-age groups and to distinguish categories of BF% in middle-aged adults living in the city of Rio de Janeiro. PMID:29071256

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.

First trimester PAPP-A in the detection of non-Down syndrome aneuploidy.

PubMed

Ochshorn, Y; Kupferminc, M J; Wolman, I; Orr-Urtreger, A; Jaffa, A J; Yaron, Y

2001-07-01

Combined first trimester screening using pregnancy associated plasma protein-A (PAPP-A), free beta-human chorionic gonadotrophin, and nuchal translucency (NT), is currently accepted as probably the best combination for the detection of Down syndrome (DS). Current first trimester algorithms provide computed risks only for DS. However, low PAPP-A is also associated with other chromosome anomalies such as trisomy 13, 18, and sex chromosome aneuploidy. Thus, using currently available algorithms, some chromosome anomalies may not be detected. The purpose of the present study was to establish a low-end cut-off value for PAPP-A that would increase the detection rates for non-DS chromosome anomalies. The study included 1408 patients who underwent combined first trimester screening. To determine a low-end cut-off value for PAPP-A, a Receiver-Operator Characteristic (ROC) curve analysis was performed. In the entire study group there were 18 cases of chromosome anomalies (trisomy 21, 13, 18, sex chromosome anomalies), 14 of which were among screen-positive patients, a detection rate of 77.7% for all chromosome anomalies (95% CI: 55.7-99.7%). ROC curve analysis detected a statistically significant cut-off for PAPP-A at 0.25 MoM. If the definition of screen-positive were to also include patients with PAPP-A<0.25 MoM, the detection rate would increase to 88.8% for all chromosome anomalies (95% CI: 71.6-106%). This low cut-off value may be used until specific algorithms are implemented for non-Down syndrome aneuploidy. Copyright 2001 John Wiley & Sons, Ltd.

Bronchodilator response cut-off points and FEV 0.75 reference values for spirometry in preschoolers

PubMed Central

Burity, Edjane Figueiredo; Pereira, Carlos Alberto de Castro; Jones, Marcus Herbert; Sayão, Larissa Bouwman; de Andrade, Armèle Dornelas; de Britto, Murilo Carlos Amorim

2016-01-01

ABSTRACT Objective: To determine the cut-off points for FEV1, FEV0.75, FEV0.5, and FEF25-75% bronchodilator responses in healthy preschool children and to generate reference values for FEV0.75. Methods: This was a cross-sectional community-based study involving children 3-5 years of age. Healthy preschool children were selected by a standardized questionnaire. Spirometry was performed before and after bronchodilator use. The cut-off point of the response was defined as the 95th percentile of the change in each parameter. Results: We recruited 266 children, 160 (60%) of whom were able to perform acceptable, reproducible expiratory maneuvers before and after bronchodilator use. The mean age and height were 57.78 ± 7.86 months and 106.56 ± 6.43 cm, respectively. The success rate for FEV0.5 was 35%, 68%, and 70% in the 3-, 4-, and 5-year-olds, respectively. The 95th percentile of the change in the percentage of the predicted value in response to bronchodilator use was 11.6%, 16.0%, 8.5%, and 35.5% for FEV1, FEV0.75, FEV0.5, and FEF25-75%, respectively. Conclusions: Our results provide cut-off points for bronchodilator responsiveness for FEV1, FEV0.75, FEV0.5, and FEF25-75% in healthy preschool children. In addition, we proposed gender-specific reference equations for FEV0.75. Our findings could improve the physiological assessment of respiratory function in preschool children. PMID:27812631

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.

Use of hyperspectral imaging technology to develop a diagnostic support system for gastric cancer

NASA Astrophysics Data System (ADS)

Goto, Atsushi; Nishikawa, Jun; Kiyotoki, Shu; Nakamura, Munetaka; Nishimura, Junichi; Okamoto, Takeshi; Ogihara, Hiroyuki; Fujita, Yusuke; Hamamoto, Yoshihiko; Sakaida, Isao

2015-01-01

Hyperspectral imaging (HSI) is a new technology that obtains spectroscopic information and renders it in image form. This study examined the difference in the spectral reflectance (SR) of gastric tumors and normal mucosa recorded with a hyperspectral camera equipped with HSI technology and attempted to determine the specific wavelength that is useful for the diagnosis of gastric cancer. A total of 104 gastric tumors removed by endoscopic submucosal dissection from 96 patients at Yamaguchi University Hospital were recorded using a hyperspectral camera. We determined the optimal wavelength and the cut-off value for differentiating tumors from normal mucosa to establish a diagnostic algorithm. We also attempted to highlight tumors by image processing using the hyperspectral camera's analysis software. A wavelength of 770 nm and a cut-off value of 1/4 the corrected SR were selected as the respective optimal wavelength and cut-off values. The rates of sensitivity, specificity, and accuracy of the algorithm's diagnostic capability were 71%, 98%, and 85%, respectively. It was possible to enhance tumors by image processing at the 770-nm wavelength. HSI can be used to measure the SR in gastric tumors and to differentiate between tumorous and normal mucosa.

Diagnostic value of diffusion weighted MRI and ADC in differential diagnosis of cavernous hemangioma of the liver.

PubMed

Tokgoz, Ozlem; Unlu, Ebru; Unal, Ilker; Serifoglu, Ismail; Oz, Ilker; Aktas, Elif; Caglar, Emrah

2016-03-01

To investigate the use of diffusion weighted magnetic resonance imaging (DWI) and the apparent diffusion coefficient (ADC) values in the diagnosis of hemangioma. The study population consisted of 72 patients with liver masses larger than 1 cm (72 focal lesions). DWI examination with a b value of 600 s/mm2 was carried out for all patients. After DWI examination, an ADC map was created and ADC values were measured for 72 liver masses and normal liver tissue (control group). The average ADC values of normal liver tissue and focal liver lesions, the "cut-off" ADC values, and the diagnostic sensitivity and specificity of the ADC map in diagnosing hemangioma, benign and malignant lesions were researched. Of the 72 liver masses, 51 were benign and 21 were malignant. Benign lesions comprised 38 hemangiomas and 13 simple cysts. Malignant lesions comprised 9 hepatocellular carcinomas, and 12 metastases. The highest ADC values were measured for cysts (3.782±0.53×10(-3) mm(2)/s) and hemangiomas (2.705±0.63×10(-3) mm(2)/s). The average ADC value of hemangiomas was significantly higher than malignant lesions and the normal control group (p<0.001). The average ADC value of cysts were significantly higher when compared to hemangiomas and normal control group (p<0.001). To distinguish hemangiomas from malignant liver lesions, the "cut-off" ADC value of 1.800×10(-3) mm(2)/s had a sensitivity of 97.4% and a specificity of 90.9%. To distinguish hemangioma from normal liver parenchyma the "cut-off" value of 1.858×10(-3) mm(2)/s had a sensitivity of 97.4% and a specificity of 95.7%. To distinguish benign liver lesions from malignant liver lesions the "cut-off" value of 1.800×10(-3) mm(2)/s had a sensitivity of 96.1% and a specificity of 90.0%. DWI and quantitative measurement of ADC values can be used in differential diagnosis of benign and malignant liver lesions and also in the diagnosis and differentiation of hemangiomas. When dynamic examination cannot distinguish cases with vascular metastasis and lesions from hemangioma, DWI and ADC values can be useful in the primary diagnosis and differential diagnosis. The technique does not require contrast material, so it can safely be used in patients with renal failure.

A cross-sectional study on sarcopenia using different methods: reference values for healthy Saudi young men.

PubMed

Alkahtani, Shaea A

2017-03-21

The aim of this study was to determine reference values for sarcopenia indices using different methods in healthy Saudi young men. Participants included 232 Saudi men aged between 20 and 35 years. The study measured anthropometric indices, blood pressure, hand grip strength, and lean muscle mass using dual-energy X-ray absorptiometry (DXA), and bioelectrical impedance analysis (BIA) was performed using Inbody 770 and Tanita 980 devices. Using DXA, the mean value of appendicular lean mass divided by the height squared (ALM/ht 2 ) was found to be 8.97 ± 1.23 kg/m 2 ; hand grip strength measured 42.8 ± 7.6 kg. While the differences between DXA and BIA (Tanita) were significant for all parameters, the differences between DXA and Inbody values were significant only for ALM parameters. Inbody sensitivity and specificity values were 73% and 95.9%, respectively. The kappa (P = 0.80) and p values (P < 0.001) showed good agreement between Inbody and DXA, whereas Tanita sensitivity and specificity values were 54.2% and 98.3%, respectively. Bland-Altman plots for differences in lean mass values between Tanita, Inbody, and DXA methods showed very high bias for Tanita and DXA, with significant differences (P < 0.001). The cut-off values for sarcopenia indices for Saudi young men are different from those of other ethnicities. The use of tailored cut-off reference values instead of a general cut-off for BIA devices is recommended.

Propagation of waves in elliptic ducts. A theoretical study. [in view of jet engine compressor noise reduction

NASA Technical Reports Server (NTRS)

Baskaran, S.

1974-01-01

The cut-off frequencies for high order circumferential modes were calculated for various eccentricities of an elliptic duct section. The problem was studied with a view to the reduction of jet engine compressor noise by elliptic ducts, instead of circular ducts. The cut-off frequencies for even functions decrease with increasing eccentricity. The third order eigen frequencies are oscillatory as the eccentricity increases for odd functions. The eigen frequencies decrease for higher order odd functions inasmuch as, for higher orders, they assume the same values as those for even functions. Deformation of a circular pipe into an elliptic one of sufficiently large eccentricity produces only a small reduction in the cut-off frequency, provided the area of the pipe section is kept invariable.

OARSI-OMERACT definition of relevant radiological progression in hip/knee osteoarthritis.

PubMed

Ornetti, P; Brandt, K; Hellio-Le Graverand, M-P; Hochberg, M; Hunter, D J; Kloppenburg, M; Lane, N; Maillefert, J-F; Mazzuca, S A; Spector, T; Utard-Wlerick, G; Vignon, E; Dougados, M

2009-07-01

Joint space width (JSW) evaluated in millimeters on plain X-rays is the currently optimal recognized technique to evaluate osteoarthritis (OA) structural progression. Data obtained can be presented at the group level (e.g., mean+/-standard deviation of the changes). Such presentation makes difficult the interpretation of the clinical relevance of the reported results. Therefore, a presentation at the individual level (e.g., % progressors) seems more attractive but requires to determining a cut-off. Several methodologies have been proposed to define cut-offs in JSW: arbitrary chosen cut-off, cut-off based on the validity to predict a relevant end-point such as the requirement of total articular replacement or cut-off based on the measurement error such as smallest detectable difference (SDD). The objective of this OARSI-OMERACT initiative was to define a cut-off evaluated in millimeters on plain X-rays above which a change in JSW could be considered as relevant in patients with hip and knee OA. The first step consisted in a systematic literature research performed using Medline database up to July 2007 to obtain all manuscripts published between 1990 and 2007 reporting a cut-off value in JSW evaluated in millimeters at either the knee or hip level. The second step consisted in a consensus based on the best knowledge of the 11 experts with the support of the available evidence. Among the 506 articles selected by the search, 47 articles reported cut-off of JSW in millimeters. There was a broad heterogeneity in cut-off values, whatever the methodologies or the OA localization considered (e.g., from 0.12 to 0.84 mm and from 0.22 to 0.78 mm for Knee (seven studies) and hip (seven studies), respectively when considering the data obtained based on the reliability). Based on the data extracted in the literature, the expert committee proposed a definition of relevant change in JSW based on plain X-rays, on an absolute change of JSW in millimeters and on the measurement error e.g., calculation of the SDD using the Bland and Altman technique. The results of the analysis of JSW should be expressed in terms of a dichotomous variable (e.g., progressors yes/no): a patient with a change in JSW during the study over such SDD will fulfill the definition of "progressor". Moreover, the pilot study aimed at evaluating the measurement error should be designed to reflect the different characteristics of the primary study in which the analysis of the radiological findings will be based on (patient's characteristics, centers characteristics, readers). This initiative based on both an Evidence Based Medicine (Systematic Literature Research) and Expert Opinion approach resulted in a proposal of definition of relevant radiological progression in OA to be used as end-point in clinical trials and also recommendations on the conduct of the reliability study allowing such definition.

Keeping data continuous when analyzing the prognostic impact of a tumor marker: an example with cathepsin D in breast cancer.

PubMed

Bossard, N; Descotes, F; Bremond, A G; Bobin, Y; De Saint Hilaire, P; Golfier, F; Awada, A; Mathevet, P M; Berrerd, L; Barbier, Y; Estève, J

2003-11-01

The prognostic value of cathepsin D has been recently recognized, but as many quantitative tumor markers, its clinical use remains unclear partly because of methodological issues in defining cut-off values. Guidelines have been proposed for analyzing quantitative prognostic factors, underlining the need for keeping data continuous, instead of categorizing them. Flexible approaches, parametric and non-parametric, have been proposed in order to improve the knowledge of the functional form relating a continuous factor to the risk. We studied the prognostic value of cathepsin D in a retrospective hospital cohort of 771 patients with breast cancer, and focused our overall survival analysis, based on the Cox regression, on two flexible approaches: smoothing splines and fractional polynomials. We also determined a cut-off value from the maximum likelihood estimate of a threshold model. These different approaches complemented each other for (1) identifying the functional form relating cathepsin D to the risk, and obtaining a cut-off value and (2) optimizing the adjustment for complex covariate like age at diagnosis in the final multivariate Cox model. We found a significant increase in the death rate, reaching 70% with a doubling of the level of cathepsin D, after the threshold of 37.5 pmol mg(-1). The proper prognostic impact of this marker could be confirmed and a methodology providing appropriate ways to use markers in clinical practice was proposed.

Assessment of essential fatty acid and omega3-fatty acid status by measurement of erythrocyte 20:3omega9 (Mead acid), 22:5omega6/20:4omega6 and 22:5omega6/22:6omega3.

PubMed

Fokkema, M R; Smit, E N; Martini, I A; Woltil, H A; Boersma, E R; Muskiet, F A J

2002-11-01

Early suspicion of essential fatty acid deficiency (EFAD) or omega3-deficiency may rather focus on polyunsaturated fatty acid (PUFA) or long-chain PUFA (LCP) analyses than clinical symptoms. We determined cut-off values for biochemical EFAD, omega3-and omega3/22:6omega3 [docosahexaenoic acid (DHA)]-deficiency by measurement of erythrocyte 20:3omega9 (Mead acid), 22:5omega6/20:4omega6 and 22:5omega6/22:6omega3, respectively. Cut-off values, based on 97.5 percentiles, derived from an apparently healthy omnivorous group (six Dominica breast-fed newborns, 32 breast-fed and 27 formula+LCP-fed Dutch low-birth-weight infants, 31 Jerusalem infants, 33 Dutch 3.5-year-old infants, 69 omnivorous Dutch adults and seven Dominica mothers) and an apparently healthy group with low dietary LCP intake (81 formula-fed Dutch low-birth-weight infants, 12 Dutch vegans). Cut-off values were evaluated by their application in an EFAD suspected group of 108, mostly malnourished, Pakistani children, three pediatric patients with chronic fat-malabsorption (abetal-ipoproteinemia, congenital jejunal and biliary atresia) and one patient with a peroxisomal beta-oxidation disorder. Erythrocyte 20:3omega9, 22:5omega6/20:4omega6 and 22:5omega6/22:6omega3 proved age-dependent up to 0.2 years. Cut-off values for ages above 0.2 years were: 0.46mol% 20:3omega9 for EFAD, 0.068mol/mol 22:5omega6/20:4omega6 for omega3-deficiency, 0.22mol/mol 22:5omega6/22:6omega3 for omega3/DHA-marginality and 0.48mol/mol 22:5omega6/22:6omega3 for omega3/DHA-deficiency. Use of RBC 20:3omega9 and 22:5omega6/20:4omega6 cut-off values identified 20.4% of the Pakistani subjects as EFAD+omega3-deficient, 12.9% as EFAD+omega3-sufficient, 38.9% as EFA-sufficient+omega3-deficient and 27.8% as EFA-sufficient+omega3-sufficient. The patient with the peroxisomal disorder was classified as EFA-sufficient, omega3-sufficient (based on RBC 22:5omega6/20:4omega6) and omega3/DHA-deficient (based on RBC 22:5omega6/22:6omega3). The three other pediatric patients were classified as EFAD, omega3-deficient and omega3/DHA-deficient. Use of the combination of the present cut-off values for EFA, omega3 and omega3/DHA status assessment, as based on 97.5 percentiles, may serve for PUFA supplement intervention until better concepts have emerged.

Role of exponential apparent diffusion coefficient in characterizing breast lesions by 3.0 Tesla diffusion-weighted magnetic resonance imaging

PubMed Central

Kothari, Shweta; Singh, Archana; Das, Utpalendu; Sarkar, Diptendra K; Datta, Chhanda; Hazra, Avijit

2017-01-01

Objective: To evaluate the role of exponential apparent diffusion coefficient (ADC) as a tool for differentiating benign and malignant breast lesions. Patients and Methods: This prospective observational study included 88 breast lesions in 77 patients (between 18 and 85 years of age) who underwent 3T breast magnetic resonance imaging (MRI) including diffusion-weighted imaging (DWI) using b-values of 0 and 800 s/mm2 before biopsy. Mean exponential ADC and ADC of benign and malignant lesions obtained from DWI were compared. Receiver operating characteristics (ROC) curve analysis was undertaken to identify any cut-off for exponential ADC and ADC to predict malignancy. P value of <0.05 was considered statistically significant. Histopathology was taken as the gold standard. Results: According to histopathology, 65 lesions were malignant and 23 were benign. The mean ADC and exponential ADC values of malignant lesions were 0.9526 ± 0.203 × 10−3 mm2/s and 0.4774 ± 0.071, respectively, and for benign lesions were 1.48 ± 0.4903 × 10−3 mm2/s and 0.317 ± 0.1152, respectively. For both the parameters, differences were highly significant (P < 0.001). Cut-off value of ≤0.0011 mm2/s (P < 0.0001) for ADC provided 92.3% sensitivity and 73.9% specificity, whereas with an exponential ADC cut-off value of >0.4 (P < 0.0001) for malignant lesions, 93.9% sensitivity and 82.6% specificity was obtained. The performance of ADC and exponential ADC in distinguishing benign and malignant breast lesions based on respective cut-offs was comparable (P = 0.109). Conclusion: Exponential ADC can be used as a quantitative adjunct tool for characterizing breast lesions with comparable sensitivity and specificity as that of ADC. PMID:28744085

Aeromonas Diversity and Antimicrobial Susceptibility in Freshwater-An Attempt to Set Generic Epidemiological Cut-Off Values.

PubMed

Baron, Sandrine; Granier, Sophie A; Larvor, Emeline; Jouy, Eric; Cineux, Maelan; Wilhelm, Amandine; Gassilloud, Benoit; Le Bouquin, Sophie; Kempf, Isabelle; Chauvin, Claire

2017-01-01

The importance of the role of environment in the dissemination of antimicrobial resistant bacteria is now well recognized. Thus, bacterial indicators to monitor the phenomena are required. The Aeromonas genus is autochthonous in the aquatic environment and easy to detect in any water type, such as freshwater, or wastewater. These microorganisms are also causing infections in humans and animals (including fish). Furthermore, as Aeromonas spp. is able to acquire antimicrobial resistance mechanisms, it is candidate for indicator bacteria to follow antimicrobial resistance dissemination in aquatic environments. Unfortunately, to date, interpretation criteria for Aeromonas spp. for antimicrobial susceptibility tests are scarce in the literature. No epidemiological cut-off values for Aeromonas are currently available at EUCAST to interpret Minimum Inhibitory Concentrations (MIC). The only interpretation criteria available are clinical breakpoints from CLSI that are adapted from Enterobacteriaceae . Based on the results of MIC distributions obtained for a collection of environmental isolates of Aeromonas , this study aimed at proposing tentative epidemiological cut-off values (CO WT ) for Aeromonas spp. assessing whether the genus is an acceptable level of definition. Thus, 233 isolates collected from 16 rivers were identified at species level using Maldi-Tof (Bruker). Eleven different species were identified, the most abundant were A. bestiarum ( n = 54), A. salmonicida ( n = 45), A. sobria ( n = 41), and A. eucrenophila ( n = 37). 96-well micro-plates containing different concentrations of 15 antimicrobials, namely cefotaxime, ceftazidime, chloramphenicol, colistin, enrofloxacin, erythromycin, florfenicol, flumequine, gentamicin, nalidixic acid, oxolinic acid, streptomycin, temocillin, tetracycline, and trimethoprim-sulfamethoxazole, were prepared. The broth micro-dilution method was used to determine the antimicrobial susceptibility of each isolate. The estimation of CO WT values was satisfactory obtained at genus level for all antimicrobials except cefotaxime and erythromycin. This first step is an invitation for other research teams to increase the amount of antimicrobial resistance data collected. Then, robustness of our proposed provisional generic epidemiological cut-off values could be assessed by testing antimicrobial susceptibility of various Aeromonas collections.

Metabolic tumour volume and total lesion glycolysis, measured using preoperative 18F-FDG PET/CT, predict the recurrence of endometrial cancer.

PubMed

Shim, S-H; Kim, D-Y; Lee, D-Y; Lee, S-W; Park, J-Y; Lee, J J; Kim, J-H; Kim, Y-M; Kim, Y-T; Nam, J-H

2014-08-01

To investigate the prognostic value of metabolic tumour volume (MTV) and total lesion glycolysis (TLG), measured by preoperative positron emission tomography and computerised tomography (PET/CT), in women with endometrial cancer. Retrospective cohort study. A tertiary referral centre. Women with endometrial cancer who underwent preoperative (18)F-FDG PET/CT in the period 2004-2009. Clinicopathological data for 84 women with endometrial cancer were reviewed from medical records. Cox proportional hazards modelling identified recurrence predictors. The receiver operating characteristic (ROC) curve was used to determine the cut-off value for predicting recurrence. Disease-free survival (DFS). The number of patients with International Federation of Gynecology and Obstetrics (FIGO) stages were: I (58); II (11); III (13); and IV (2). The median DFS was 48 (1-85) months. By univariate analysis, DFS was significantly associated with FIGO stage, histology, peritoneal cytology, myometrial invasion, nodal metastasis, serum CA-125, MTV, and TLG. Using multivariate analysis, the MTV (P = 0.010; hazard ratio, HR = 1.010; 95% confidence interval, 95% CI = 1.002-1.018) and TLG (P = 0.024; HR = 1.001; 95% CI = 1.000-1.002) were associated with DFS. The area under the ROC curve was 0.679 (95% CI = 0.505-0.836) after discriminating for recurrence using an MTV cut-off value of 17.15 ml. Regarding TLG, the cut-off value was 56.43 g and the area under the ROC plot was 0.661 (95% CI = 0.501-0.827). Kaplan-Meier survival graphs demonstrated a significant difference in DFS between groups categorised using the cut-off values for MTV and TLG (P < 0.022 for MTV and P < 0.047 for TLG, by log-rank test). Preoperative MTV and TLG could be independent prognostic factors predicting the recurrence of endometrial cancer. © 2014 Royal College of Obstetricians and Gynaecologists.

Differences in daily in-hospital physical activity and geriatric nutritional risk index in older cardiac inpatients: preliminary results.

PubMed

Izawa, Kazuhiro P; Watanabe, Satoshi; Oka, Koichiro; Osada, Naohiko; Omiya, Kazuto; Brubaker, Peter H; Shimizu, Hiroyuki

2014-12-01

Little is known about the differences in the geriatric nutritional risk index (GNRI) status in older patients and their relationship to accelerometer-derived measures of physical activity (PA) levels. We determined both differences in daily measured PA based on the GNRI and related cut-off values for PA in elderly cardiac inpatients. We divided 235 consecutive elderly cardiac inpatients (mean age 73.6 years, men 70.6%) into four groups by age and GNRI: older-high group, 65-74 years with high GNRI (≥92 points) (n = 111); older-low group, low GNRI (<92 points) (n = 30); very old-high group, ≥75 years with high GNRI (n = 55); and very old-low group with low GNRI (n = 39). Average step count and physical activity energy expenditure (PAEE in kcal) per day for 2 days of these inpatients were assessed by accelerometer and compared between the four groups to determine cut-off values of PA. Step counts and PAEE were significantly lower in the low-GNRI versus high-GNRI groups in the older (2,742.1 vs. 4,198.1 steps, 55.4 vs. 101.3 kcal, P < 0.001), and very old (2,469.6 vs. 3,423.7 steps, 54.5 vs. 79.1 kcal, P < 0.001) cardiac inpatients. Respective cut-off values for step counts and PAEE were 3,017.6 steps/day and 69.4 kcal (P < 0.01) in the older and 2,579.4 steps/day and 58.8 kcal in the very old cardiac inpatients (P < 0.01). Poor nutritional status, as indicated by a low GNRI, may be a useful predictor of step counts and PAEE. The cut-off values determined in this study might be target values to be attained by older cardiac inpatients.

Insulin resistance (HOMA-IR) cut-off values and the metabolic syndrome in a general adult population: effect of gender and age: EPIRCE cross-sectional study

PubMed Central

2013-01-01

Background Insulin resistance has been associated with metabolic and hemodynamic alterations and higher cardio metabolic risk. There is great variability in the threshold homeostasis model assessment of insulin resistance (HOMA-IR) levels to define insulin resistance. The purpose of this study was to describe the influence of age and gender in the estimation of HOMA-IR optimal cut-off values to identify subjects with higher cardio metabolic risk in a general adult population. Methods It included 2459 adults (range 20–92 years, 58.4% women) in a random Spanish population sample. As an accurate indicator of cardio metabolic risk, Metabolic Syndrome (MetS), both by International Diabetes Federation criteria and by Adult Treatment Panel III criteria, were used. The effect of age was analyzed in individuals with and without diabetes mellitus separately. ROC regression methodology was used to evaluate the effect of age on HOMA-IR performance in classifying cardio metabolic risk. Results In Spanish population the threshold value of HOMA-IR drops from 3.46 using 90th percentile criteria to 2.05 taking into account of MetS components. In non-diabetic women, but no in men, we found a significant non-linear effect of age on the accuracy of HOMA-IR. In non-diabetic men, the cut-off values were 1.85. All values are between 70th-75th percentiles of HOMA-IR levels in adult Spanish population. Conclusions The consideration of the cardio metabolic risk to establish the cut-off points of HOMA-IR, to define insulin resistance instead of using a percentile of the population distribution, would increase its clinical utility in identifying those patients in whom the presence of multiple metabolic risk factors imparts an increased metabolic and cardiovascular risk. The threshold levels must be modified by age in non-diabetic women. PMID:24131857

Insulin resistance (HOMA-IR) cut-off values and the metabolic syndrome in a general adult population: effect of gender and age: EPIRCE cross-sectional study.

PubMed

Gayoso-Diz, Pilar; Otero-González, Alfonso; Rodriguez-Alvarez, María Xosé; Gude, Francisco; García, Fernando; De Francisco, Angel; Quintela, Arturo González

2013-10-16

Insulin resistance has been associated with metabolic and hemodynamic alterations and higher cardio metabolic risk. There is great variability in the threshold homeostasis model assessment of insulin resistance (HOMA-IR) levels to define insulin resistance. The purpose of this study was to describe the influence of age and gender in the estimation of HOMA-IR optimal cut-off values to identify subjects with higher cardio metabolic risk in a general adult population. It included 2459 adults (range 20-92 years, 58.4% women) in a random Spanish population sample. As an accurate indicator of cardio metabolic risk, Metabolic Syndrome (MetS), both by International Diabetes Federation criteria and by Adult Treatment Panel III criteria, were used. The effect of age was analyzed in individuals with and without diabetes mellitus separately. ROC regression methodology was used to evaluate the effect of age on HOMA-IR performance in classifying cardio metabolic risk. In Spanish population the threshold value of HOMA-IR drops from 3.46 using 90th percentile criteria to 2.05 taking into account of MetS components. In non-diabetic women, but no in men, we found a significant non-linear effect of age on the accuracy of HOMA-IR. In non-diabetic men, the cut-off values were 1.85. All values are between 70th-75th percentiles of HOMA-IR levels in adult Spanish population. The consideration of the cardio metabolic risk to establish the cut-off points of HOMA-IR, to define insulin resistance instead of using a percentile of the population distribution, would increase its clinical utility in identifying those patients in whom the presence of multiple metabolic risk factors imparts an increased metabolic and cardiovascular risk. The threshold levels must be modified by age in non-diabetic women.

Diagnostic value of CRP and Lp(a) in coronary heart disease.

PubMed

Erbağci, Ayşe Binnur; Tarakçioğlu, Mehmet; Aksoy, Mehmet; Kocabaş, Ramazan; Nacak, Muradiye; Aynacioğlu, A Sükrü; Sivrikoz, Cumhur

2002-06-01

Increased lipoprotein (a) [Lp(a)] concentration was reported to be an independent risk factor for coronary heart disease (CHD). Recent epidemiological studies affirmed the value of C-reactive protein (CRP) as the strongest, univariate predictor of the cardiovascular events. We decided to establish cut-off levels providing maximum diagnostic efficiency for CHD. In this study we measured CRP and Lp(a) concentrations in patients with angiographically demonstrated CHD (group A, n: 120), patients without any angiographically demonstrable lesion (group B, n: 62) and a group of healthy subjects (group C, n: 41). Data were evaluated correcting for lipid and lipoprotein concentrations, diabetes mellitus, hypertension, smoking, age, and body mass index in men and women. ROC curve based cut-off values (comparing group A versus groups B and C) and associated diagnostic performances of the assays were evaluated. Significant increases were noted in serum CRP concentrations in men and women, in groups A vs. B,A vs. C, B vs. C. Lp(a) concentrations were not different among groups in men but were higher in group A vs. B and C in women. Optimal cut-off levels for CRP in women and men were found as 2.1 and 3.0 mg/l with the diagnostic values of 0.792 and 0.770, respectively. For Lp(a) optimal cut-off levels were found as 22.6 and 9.8 mg/dl with the diagnostic values of 0.612 and 0.596 in women and men, respectively. The CRP level is quite efficient for separation of patients from controls. Therefore keeping in mind the lack of specificity, the CRP level may be a useful tool in the diagnosis of coronary heart disease. However, the Lp(a) level is not efficient enough to support the use of Lp(a) measurement for management of coronary heart disease.

The role of ascitic fluid viscosity in differentiating the nature of ascites and in the prediction of renal impairment and duration of ICU stay.

PubMed

Hanafy, Amr S

2016-09-01

Serum-ascites albumin gradient (SAAG) has been used in the classification of ascites for the last 20 years but it has some drawbacks. This study searches for possible correlations between ascitic fluid viscosity and the etiology of ascites, renal impairment, and length of ICU stay. The study was conducted in Zagazig University Hospital, Egypt. It included 240 patients with ascites due to various causes. The patients were divided into two groups: the cirrhotic ascites group, which included 120 patients, and the noncirrhotic ascites group, which included 120 patients. Ascitic patients on medical management with diuretics, antibiotics, paracentesis, and infusion of plasma or albumin were excluded.The laboratory analysis included routine investigations to detect the cause of ascites as well as specific investigations such as ascitic fluid viscosity using a falling ball viscosimeter (microviscosimeter) at 37°C. The mean ascitic viscosity of patients with SAAG at least 1.1 was 1.16±0.56, which was associated with serum creatinine 1.35±0.52 mg/dl and ICU stay of 3.3±1.2 days. In patients with SAAG less than 1.1 g/dl, the mean ascitic viscosity was 2.98±0.87, with serum creatinine 2.1±0.56 mg/dl and ICU stay of 7.1±1.3 days. Ascitic viscosity can discriminate ascites due to portal hypertension from those associated with nonportal hypertension at a cut-off value of 1.65; it can predict renal impairment in hepatic patients at a cut-off of 1.35 and long ICU stay at a cut-off of 1.995 using receiver operating characteristic analysis. Ascitic viscosity measurement is rapid, inexpensive, and requires small sample volumes. Ascitic viscosity can discriminate ascites due to portal hypertension from those associated with nonportal hypertension at a cut-off value of 1.65. It can predict renal impairment in hepatic patients at a cut-off of 1.35 and long ICU stay at a cut-off of 1.995.

Nailfold capillaroscopy for day-to-day clinical use: construction of a simple scoring modality as a clinical prognostic index for digital trophic lesions.

PubMed

Smith, Vanessa; De Keyser, Filip; Pizzorni, Carmen; Van Praet, Jens T; Decuman, Saskia; Sulli, Alberto; Deschepper, Ellen; Cutolo, Maurizio

2011-01-01

Construction of a simple nailfold videocapillaroscopic (NVC) scoring modality as a prognostic index for digital trophic lesions for day-to-day clinical use. An association with a single simple (semi)-quantitatively scored NVC parameter, mean score of capillary loss, was explored in 71 consecutive patients with systemic sclerosis (SSc), and reliable reduction in the number of investigated fields (F32-F16-F8-F4). The cut-off value of the prognostic index (mean score of capillary loss calculated over a reduced number of fields) for present/future digital trophic lesions was selected by receiver operating curve (ROC) analysis. Reduction in the number of fields for mean score of capillary loss was reliable from F32 to F8 (intraclass correlation coefficient of F16/F32: 0.97; F8/F32: 0.90). Based on ROC analysis, a prognostic index (mean score of capillary loss as calculated over F8) with a cut-off value of 1.67 is proposed. This value has a sensitivity of 72.22/70.00, specificity of 70.59/69.77, positive likelihood ratio of 2.46/2.32 and a negative likelihood ratio of 0.39/0.43 for present/future digital trophic lesions. A simple prognostic index for digital trophic lesions for daily use in SSc clinics is proposed, limited to the mean score of capillary loss as calculated over eight fields (8 fingers, 1 field per finger).

Cut-off Points for Muscle Mass - Not Grip Strength or Gait Speed - Determine Variations in Sarcopenia Prevalence.

PubMed

Masanés, F; Rojano I Luque, X; Salvà, A; Serra-Rexach, J A; Artaza, I; Formiga, F; Cuesta, F; López Soto, A; Ruiz, D; Cruz-Jentoft, A J

2017-01-01

The European Working Group on Sarcopenia in Older People (EWGSOP) has proposed different methods and cut-off points for the three parameters that define sarcopenia: muscle mass, muscle strength and physical performance. Although this facilitates clinical practice, it limits comparability between studies and leads to wide differences in published prevalence rates. The aim of this study was to assess how changes in cut-off points for muscle mass, gait speed and grip strength affected sarcopenia prevalence according to EWGSOP criteria. Cross-sectional analysis of elderly individuals recruited from outpatient clinics (n=298) and nursing homes (n=276). We measured muscle mass, grip strength and gait speed and assessed how changes in cut-off points changed sarcopenia prevalence in both populations. An increase from 5.45 kg/m2 to 6.68 kg/m2 in the muscle mass index for female outpatients and nursing-home residents increased sarcopenia prevalence from 4% to 23% and from 9% to 47%, respectively; for men, for an increase from 7.25 kg/m2 to 8.87 kg/m2, the corresponding increases were from 1% to 22% and from 6% to 41%, respectively. Changes in gait speed and grip strength had a limited impact on sarcopenia prevalence. The cut-off points used for muscle mass affect the reported prevalence rates for sarcopenia and, in turn, affect comparability between studies. The main factors influencing the magnitude of the change are muscle mass index distribution in the population and the absolute value of the cut-off points: the same difference between two references (e.g., 7.5 kg/m2 to 7.75 kg/m2 or 7.75 kg/m2 to 8 kg/m2) may produce different changes in prevalence. Changes in cut-off points for gait speed and grip strength had a limited impact on sarcopenia prevalence and on study comparability.

Reduced bispectrum seeded by helical primordial magnetic fields

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

Hortúa, Héctor Javier; Castañeda, Leonardo, E-mail: hjhortuao@unal.edu.co, E-mail: lcastanedac@unal.edu.co

In this paper, we investigate the effects of helical primordial magnetic fields (PMFs) on the cosmic microwave background (CMB) reduced bispectrum. We derive the full three-point statistics of helical magnetic fields and numerically calculate the even contribution in the collinear configuration. We then numerically compute the CMB reduced bispectrum induced by passive and compensated PMF modes on large angular scales. There is a negative signal on the bispectrum due to the helical terms of the fields and we also observe that the biggest contribution to the bispectrum comes from the non-zero IR cut-off for causal fields, unlike the two-point correlationmore » case. For negative spectral indices, the reduced bispectrum is enhanced by the passive modes. This gives a lower value of the upper limit for the mean amplitude of the magnetic field on a given characteristic scale. However, high values of IR cut-off in the bispectrum, and the helical terms of the magnetic field relaxes this bound. This demonstrates the importance of the IR cut-off and helicity in the study of the nature of PMFs from CMB observations.« less

Application of receiver operating characteristic curve in the assessment of the value of body mass index, waist circumference and percentage of body fat in the Diagnosis of Polycystic Ovary Syndrome in childbearing women.

PubMed

Dou, Pan; Ju, Huiyan; Shang, Jing; Li, Xueying; Xue, Qing; Xu, Yang; Guo, Xiaohui

2016-08-24

There are various parameters to analyze obesity, however, no standard reference to predict, screen or diagnose PCOS with various obesity parameters has been established, and the accuracy of these parameters still needs to be studied.This study was to use the receiver operating characteristic (ROC) curve to explore the different values of three obesity parameters, body mass index (BMI), waist circumference (WC) and percentage of body fat (PBF) in the diagnosis of polycystic ovary syndrome (PCOS) in Chinese childbearing women. Three hundred patients who were diagnosed with PCOS at Center of Reproductive Medicine and Genetics of Peking University First Hospital were enrolled in this study, and 110 healthy age-matched women were enrolled as controls. The characteristics of BMI, WC and PBF in PCOS patients were analyzed. Compared with the control group, all the three obesity parameters were significantly increased in PCOS group. In terms of ROC area under the curve, WC > PBF > BMI, and they were all significantly different from those of the control. At a cut-off point of 80.5 cm, WC has a sensitivity of 73.6 % and a specificity of 85 % in diagnosis of PCOS; At a cut-off point of 29 %, PBF has a sensitivity of 88.2 % and a specificity of 57.7 % in diagnosis of PCOS; and at a cut-off point of 26.6 kg/m(2), BMI has a sensitivity of 54.5 % and a specificity of 98 % in diagnosis of PCOS. WC, BMI and PBF are valuable in screening and diagnosis of PCOS in Chinese childbearing women. PBF can be used to screen PCOS as it has a better sensitivity, while BMI can be used in the diagnosis of PCOS as it has a better specificity.

Procalcitonin for the early diagnosis of sepsis in burn patients: A retrospective study.

PubMed

Cabral, Luís; Afreixo, Vera; Santos, Filipe; Almeida, Luís; Paiva, José Artur

2017-11-01

The gold standard for sepsis diagnosis in burn patient still relies on microbiological cultures, which take 48-72h to provide results, delaying the start of antimicrobial therapy. Thus, biomarkers allowing an earlier sepsis diagnosis in burn patients are needed. This retrospective observational study included 150 burn patients with total burned surface area ≥15%. Clinical diagnosis of sepsis among these patients was done according to the American Burn Association criteria. Biomarker (procalcitonin, white blood cells and platelet countings, prothrombinemia, D-dimers, C-reactive protein, blood lactate and temperature) values were available for 48 patients without sepsis (2767 timepoints) and 102 patients with sepsis (652 timepoints). Quantitative variables were compared with Mann-Whitney tests and qualitative variables were compared with Pearson chi-square test. Effect size was measured by the probability of superiority. Receiver operating characteristic (ROC) curves evaluate capacity for sepsis diagnosis. Sensitivity, specificity, positive and negative predictive values were calculated for some cut-off values, including the best cut-off defined by the maximum of Youden index. Statistically significant differences between the groups of septic and non-septic patients, with medium to large effect size, were detected for all the biomarkers considered, except temperature. PCT was the biomarker with the largest AUC and effect size (AUC=0.71). Analysis of the PCT ROC curve showed that 0.5ng/mL cut-off presented highest sensitivity and lowest specificity, whereas 1.5ng/mL cut-off was associated with lowest sensitivity and highest specificity. Procalcitonin showed to be the best of the biomarkers studied for an early diagnosis of sepsis. Its use should be considered in antimicrobial stewardship programs in Burn Units. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

Impact of grey zone sample testing by enzyme-linked immunosorbent assay in enhancing blood safety: Experience at a tertiary care hospital in North India.

PubMed

Solanki, Archana; Singh, Abhay; Chaudhary, Rajendra

2016-01-01

Enzyme-linked immunosorbent assay (ELISA) used for screening blood donors for transfusion transmitted infections (TTIs) can sometimes fail to detect blood donors who are recently infected or possessing the low strength of pathogen. Estimation of a grey zone in ELISA testing and repeat testing of grey zone samples can further help in reducing the risks of TTI in countries where nucleic acid amplification testing for TTIs is not feasible. Grey zone samples with optical density (OD) lying between cut-off OD and 10% below the cut-off OD (cut-off OD × 0.9) were identified during routine ELISA testing. On performing repeat ELISA testing on grey zone samples in duplicate, the samples showing both OD value below grey zone were marked nonreactive, and samples showing one or both OD value in the grey zone were marked indeterminate. The samples on repeat testing showing one or both OD above cut-off value were marked positive. About 119 samples (77 for hepatitis B virus [HBV], 23 for human immunodeficiency virus [HIV], and 19 for hepatitis C virus [HCV]) were found to be in grey zone. On repeat testing of these samples in duplicate, 70 (58.8%) samples (45 for HBV, 12 for HIV, and 13 for HCV) were found to be reactive. Six (5%) samples (four for HBV, one for HIV, and one for HCV) were found to be indeterminate. Seventy donors initially screened negative, were found out to be potentially infectious on repeat grey zone testing. Thus, estimation of grey zone samples with repeat testing can further enhance the safety of blood transfusion.

Proposal for new selection criteria considering pre-transplant muscularity and visceral adiposity in living donor liver transplantation.

PubMed

Hamaguchi, Yuhei; Kaido, Toshimi; Okumura, Shinya; Kobayashi, Atsushi; Shirai, Hisaya; Yao, Siyuan; Yagi, Shintaro; Kamo, Naoko; Okajima, Hideaki; Uemoto, Shinji

2018-04-01

The significance of pre-operative body composition has recently attracted much attention in various diseases. However, cut-off values for these parameters remain undetermined, and these factors are not currently included in selection criteria for recipients of living donor liver transplantation (LDLT). Using computed tomography of 657 donors for LDLT, skeletal muscle mass, muscle quality, and visceral adiposity were evaluated by using skeletal muscle mass index (SMI), intramuscular adipose tissue content (IMAC), and visceral-to-subcutaneous adipose tissue area ratio (VSR). Sex-specific cut-offs for SMI, IMAC, and VSR were determined, and correlations with outcomes after LDLT in 277 recipients were examined with the aim of establishing new selection criteria for LDLT. On the basis of younger donor data, we determined sex-specific cut-off values for low SMI, high IMAC, and high VSR (mean ± 2 standard deviations). Patients with all three factors showed the lowest survival rate after LDLT (1 year survival rate, 41.2%; P < 0.001). On multivariate analysis, low SMI (P = 0.002), high IMAC (P = 0.002), and high VSR (P = 0.001) were identified as independent risk factors for mortality after LDLT. Based on these findings, we have excluded patients showing all three factors (low SMI, high IMAC, and high VSR) as candidates for LDLT since October 2016. Using cut-off values determined from healthy donors, we have established new selection criteria for LDLT including body composition, which should improve post-transplant outcomes. © 2018 The Authors. Journal of Cachexia, Sarcopenia and Muscle published by John Wiley & Sons Ltd on behalf of the Society on Sarcopenia, Cachexia and Wasting Disorders.

Classification of walking ability of household walkers versus community walkers based on K-BBS, gait velocity and upright motor control.

PubMed

Joa, K L; Kwon, S Y; Choi, J W; Hong, S E; Kim, C H; Jung, H Y

2015-10-01

Few guidelines are available to assist clinicians with assessment of whether a patient is a household or community walker. To assess the Korean Berg balance scale (K-BBS) and gait velocity cut-off points of a household walker versus a community walker and evaluate which combinations of the three scales (K-BBS, upright motor control test (UMCT), and gait velocity) best assessed walking ability. Cross-sectional study. Outpatient. A total of 124 stroke patients with walking difficulty. Participants were classified into one of six walking classifications (three household walkers and three community walkers) and K-BBS, UMCT, and gait velocity were evaluated. The optimal cut-off scores for walking classification were determined based on received operator characteristic (ROC) analyses. The cut-off value of K-BBS for dividing the household walker versus the community walker was 42 points. The cut-off value of gait velocity was 48 m/s for the community walker. The area under the ROC curve of the combined K-BBS and gait velocity values was larger than that of each individual scale and those of the other combined scales. The results suggest that K-BBS, gait velocity, and UMCT are useful instruments for classifying household ambulation and community ambulation. The authors recommend K-BBS as single scale and K-BBS and gait velocity as combined scales for evaluating community ambulation in stroke patients In this report, we have some clinical implication. We recommend 3 outcome measures to assess walking ability about home or community; K-BBS (>42 points), gait speed (>48 m/min), UMCT (strong grade in either knee flexion of extension). Suggesting cut-off points of Korean Berg balance scale, gait velocity, and level of upright motor control test for community ambulation could be used as outcome measures to evaluate patient's actual performance level. It is also important to combine several scales for determining walking classification. We suggest to evaluate walking ability by combining K-BBS and UMCT to best predict community ambulation.

Criterion validity of a Wechsler-III Scale Short Form in a sample of brazilian elderly.

PubMed

Banhato, Eliane Ferreira Carvalho; Leite, Isabel Cristina Gonçalves; Guedes, Danielle Viveiros; Chaoubah, Alfredo

2010-01-01

Although a normative process, changes in cognitive functioning vary among older adults. The differential diagnosis between normal and pathological aging must be made early using psychometrically adequate measures. To assess the evidence of criterion validity of a Short Form (SF) of the Wechsler-III Scale containing eight subtests (SF8) by determining its sensitivity, specificity, positive and negative predictive values and cut-off points for Brazilian elderly from different age groups. 168 individuals, aged 60 years or above, living in the community or in an institution, were assigned to case and control groups, and investigated according to age range. Measures included a sociodemographic questionnaire, the Mini-Mental State Examination (MMSE), Verbal Fluency Test, Clock-Drawing Test and the SF8. More than two thirds of the sample was women (73.8%), mean age was 74.5 years (SD=8.9), mean education was 6.2 years (SD=4.8) and 40.5% were widows/widowers. In the total sample, the best cut-off point for the SF8 was 142 while cut offs among individuals aged 60 to 69 years, 70 to 79 years, and more than 80 years were 160, 129 and 129, respectively. The results demonstrated the importance of different cut-off points for different age ranges. Sensitivity and specificity values of the SF8 were sufficiently high to warrant the use of the SF8 as an instrument to identify cognitive impairment in the elderly.

Thromboxane Formation Assay to Identify High On-Treatment Platelet Reactivity to Aspirin.

PubMed

Mohring, Annemarie; Piayda, Kerstin; Dannenberg, Lisa; Zako, Saif; Schneider, Theresa; Bartkowski, Kirsten; Levkau, Bodo; Zeus, Tobias; Kelm, Malte; Hohlfeld, Thomas; Polzin, Amin

2017-01-01

Platelet inhibition by aspirin is indispensable in the secondary prevention of cardiovascular events. Nevertheless, impaired aspirin antiplatelet effects (high on-treatment platelet reactivity [HTPR]) are frequent. This is associated with an enhanced risk of cardiovascular events. The current gold standard to evaluate platelet hyper-reactivity despite aspirin intake is the light-transmittance aggregometry (LTA). However, pharmacologically, the most specific test is the measurement of arachidonic acid (AA)-induced thromboxane (TX) B2 formation. Currently, the optimal cut-off to define HTPR to aspirin by inhibition of TX formation is not known. Therefore, in this pilot study, we aimed to calculate a TX formation cut-off value to detect HTPR defined by the current gold standard LTA. We measured platelet function in 2,507 samples. AA-induced TX formation by ELISA and AA-induced LTA were used to measure aspirin antiplatelet effects. TX formation correlated nonlinearly with the maximum of aggregation in the AA-induced LTA (Spearman's rho R = 0.7396; 95% CI 0.7208-0.7573, p < 0.0001). Receiver operating characteristic analysis and Youden's J statistics revealed 209.8 ng/mL as the optimal cut-off value to detect HTPR to aspirin with the TX ELISA (area under the curve: 0.92, p < 0.0001, sensitivity of 82.7%, specificity of 90.3%). In summary, TX formation ELISA is reliable in detecting HTPR to aspirin. The calculated cut-off level needs to be tested in trials with clinical end points. © 2017 S. Karger AG, Basel.

Criterion validity of a Wechsler-III Scale Short Form in a sample of brazilian elderly

PubMed Central

Banhato, Eliane Ferreira Carvalho; Leite, Isabel Cristina Gonçalves; Guedes, Danielle Viveiros; Chaoubah, Alfredo

2010-01-01

Although a normative process, changes in cognitive functioning vary among older adults. The differential diagnosis between normal and pathological aging must be made early using psychometrically adequate measures. Objectives To assess the evidence of criterion validity of a Short Form (SF) of the Wechsler-III Scale containing eight subtests (SF8) by determining its sensitivity, specificity, positive and negative predictive values and cut-off points for Brazilian elderly from different age groups. Methods 168 individuals, aged 60 years or above, living in the community or in an institution, were assigned to case and control groups, and investigated according to age range. Measures included a sociodemographic questionnaire, the Mini-Mental State Examination (MMSE), Verbal Fluency Test, Clock-Drawing Test and the SF8. Results More than two thirds of the sample was women (73.8%), mean age was 74.5 years (SD=8.9), mean education was 6.2 years (SD=4.8) and 40.5% were widows/widowers. In the total sample, the best cut-off point for the SF8 was 142 while cut offs among individuals aged 60 to 69 years, 70 to 79 years, and more than 80 years were 160, 129 and 129, respectively. Conclusions The results demonstrated the importance of different cut-off points for different age ranges. Sensitivity and specificity values of the SF8 were sufficiently high to warrant the use of the SF8 as an instrument to identify cognitive impairment in the elderly. PMID:29213688

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.

Effectiveness of teaching International Caries Detection and Assessment System II and its e-learning program to freshman dental students on occlusal caries detection

PubMed Central

El-Damanhoury, Hatem M.; Fakhruddin, Kausar Sadia; Awad, Manal A.

2014-01-01

Objective: To assess the feasibility of teaching International Caries Detection and Assessment System (ICDAS) II and its e-learning program as tools for occlusal caries detection to freshmen dental students in comparison to dental graduates with 2 years of experience. Materials and Methods: Eighty-four freshmen and 32 dental graduates examined occlusal surfaces of molars/premolars (n = 72) after a lecture and a hands-on workshop. The same procedure was repeated after 1 month following the training with ICDAS II e-learning program. Validation of ICDAS II codes was done histologically. Intra- and inter-examiner reproducibility of ICDAS II severity scores were assessed before and after e-learning using (Fleiss's kappa). Results: The kappa values showed inter-examiner reproducibility ranged from 0.53 (ICDAS II code cut off ≥ 1) to 0.70 (ICDAS II code cut off ≥ 3) by undergraduates and 0.69 (ICDAS II code cut off ≥ 1) to 0.95 (ICDAS II code cut off ≥ 3) by graduates. The inter-examiner reproducibility ranged from 0.64 (ICDAS II code cut off ≥ 1) to 0.89 (ICDAS II code cut off ≥ 3). No statistically significant difference was found between both groups in intra-examiner agreements for assessing ICDAS II codes. A high statistically significant difference (P ≤ 0.01) in correct identification of codes 1, 2, and 4 from before to after e-learning were observed in both groups. The bias indices for the undergraduate group were higher than those of the graduate group. Conclusions: Early exposure of students to ICDAS II is a valuable method of teaching caries detection and its e-learning program significantly improves their caries diagnostic skills. PMID:25512730

Predicting posttraumatic stress disorder in children and parents following accidental child injury: evaluation of the Screening Tool for Early Predictors of Posttraumatic Stress Disorder (STEPP).

PubMed

van Meijel, Els P M; Gigengack, Maj R; Verlinden, Eva; Opmeer, Brent C; Heij, Hugo A; Goslings, J Carel; Bloemers, Frank W; Luitse, Jan S K; Boer, Frits; Grootenhuis, Martha A; Lindauer, Ramón J L

2015-05-12

Children and their parents are at risk of posttraumatic stress disorder (PTSD) following injury due to pediatric accidental trauma. Screening could help predict those at greatest risk and provide an opportunity for monitoring so that early intervention may be provided. The purpose of this study was to evaluate the Screening Tool for Early Predictors of Posttraumatic Stress Disorder (STEPP) in a mixed-trauma sample in a non-English speaking country (the Netherlands). Children aged 8-18 and one of their parents were recruited in two academic level I trauma centers. The STEPP was assessed in 161 children (mean age 13.9 years) and 156 parents within one week of the accident. Three months later, clinical diagnoses and symptoms of PTSD were assessed in 147 children and 135 parents. We used the Anxiety Disorders Interview Schedule for DSM-IV - Child and Parent version, the Children's Revised Impact of Event Scale and the Impact of Event Scale-Revised. Receiver Operating Characteristic analyses were performed to estimate the Areas Under the Curve as a measure of performance and to determine the optimal cut-off score in our sample. Sensitivity, specificity, positive and negative predictive values were calculated. The aim was to maximize both sensitivity and negative predictive values. PTSD was diagnosed in 12% of the children; 10% of their parents scored above the cut-off point for PTSD. At the originally recommended cut-off scores (4 for children, 3 for parents), the sensitivity in our sample was 41% for children and 54% for parents. Negative predictive values were 92% for both groups. Adjusting the cut-off scores to 2 improved sensitivity to 82% for children and 92% for parents, with negative predictive values of 92% and 96%, respectively. With adjusted cut-off scores, the STEPP performed well: 82% of the children and 92% of the parents with a subsequent positive diagnosis were identified correctly. Special attention in the screening procedure is required because of a high rate of false positives. The STEPP appears to be a valid and useful instrument that can be used in the Netherlands as a first screening method in stepped psychotrauma care following accidents.

Shear Stress-Normal Stress (Pressure) Ratio Decides Forming Callus in Patients with Diabetic Neuropathy

PubMed Central

Noguchi, Hiroshi; Takehara, Kimie; Ohashi, Yumiko; Suzuki, Ryo; Yamauchi, Toshimasa; Kadowaki, Takashi; Sanada, Hiromi

2016-01-01

Aim. Callus is a risk factor, leading to severe diabetic foot ulcer; thus, prevention of callus formation is important. However, normal stress (pressure) and shear stress associated with callus have not been clarified. Additionally, as new valuables, a shear stress-normal stress (pressure) ratio (SPR) was examined. The purpose was to clarify the external force associated with callus formation in patients with diabetic neuropathy. Methods. The external force of the 1st, 2nd, and 5th metatarsal head (MTH) as callus predilection regions was measured. The SPR was calculated by dividing shear stress by normal stress (pressure), concretely, peak values (SPR-p) and time integral values (SPR-i). The optimal cut-off point was determined. Results. Callus formation region of the 1st and 2nd MTH had high SPR-i rather than noncallus formation region. The cut-off value of the 1st MTH was 0.60 and the 2nd MTH was 0.50. For the 5th MTH, variables pertaining to the external forces could not be determined to be indicators of callus formation because of low accuracy. Conclusions. The callus formation cut-off values of the 1st and 2nd MTH were clarified. In the future, it will be necessary to confirm the effect of using appropriate footwear and gait training on lowering SPR-i. PMID:28050567

Validity of Simpson-Angus Scale (SAS) in a naturalistic schizophrenia population.

PubMed

Janno, Sven; Holi, Matti M; Tuisku, Katinka; Wahlbeck, Kristian

2005-03-17

Simpson-Angus Scale (SAS) is an established instrument for neuroleptic-induced parkinsonism (NIP), but its statistical properties have been studied insufficiently. Some shortcomings concerning its content have been suggested as well. According to a recent report, the widely used SAS mean score cut-off value 0.3 of for NIP detection may be too low. Our aim was to evaluate SAS against DSM-IV diagnostic criteria for NIP and objective motor assessment (actometry). Ninety-nine chronic institutionalised schizophrenia patients were evaluated during the same interview by standardised actometric recording and SAS. The diagnosis of NIP was based on DSM-IV criteria. Internal consistency measured by Cronbach's alpha, convergence to actometry and the capacity for NIP case detection were assessed. Cronbach's alpha for the scale was 0.79. SAS discriminated between DSM-IV NIP and non-NIP patients. The actometric findings did not correlate with SAS. ROC-analysis yielded a good case detection power for SAS mean score. The optimal threshold value of SAS mean score was between 0.65 and 0.95, i.e. clearly higher than previously suggested threshold value. We conclude that SAS seems a reliable and valid instrument. The previously commonly used cut-off mean score of 0.3 has been too low resulting in low specificity, and we suggest a new cut-off value of 0.65, whereby specificity could be doubled without loosing sensitivity.

Validity of Simpson-Angus Scale (SAS) in a naturalistic schizophrenia population

PubMed Central

Janno, Sven; Holi, Matti M; Tuisku, Katinka; Wahlbeck, Kristian

2005-01-01

Background Simpson-Angus Scale (SAS) is an established instrument for neuroleptic-induced parkinsonism (NIP), but its statistical properties have been studied insufficiently. Some shortcomings concerning its content have been suggested as well. According to a recent report, the widely used SAS mean score cut-off value 0.3 of for NIP detection may be too low. Our aim was to evaluate SAS against DSM-IV diagnostic criteria for NIP and objective motor assessment (actometry). Methods Ninety-nine chronic institutionalised schizophrenia patients were evaluated during the same interview by standardised actometric recording and SAS. The diagnosis of NIP was based on DSM-IV criteria. Internal consistency measured by Cronbach's α, convergence to actometry and the capacity for NIP case detection were assessed. Results Cronbach's α for the scale was 0.79. SAS discriminated between DSM-IV NIP and non-NIP patients. The actometric findings did not correlate with SAS. ROC-analysis yielded a good case detection power for SAS mean score. The optimal threshold value of SAS mean score was between 0.65 and 0.95, i.e. clearly higher than previously suggested threshold value. Conclusion We conclude that SAS seems a reliable and valid instrument. The previously commonly used cut-off mean score of 0.3 has been too low resulting in low specificity, and we suggest a new cut-off value of 0.65, whereby specificity could be doubled without loosing sensitivity. PMID:15774006

Learning curve for laparoscopic Heller myotomy and Dor fundoplication for achalasia

PubMed Central

Omura, Nobuo; Tsuboi, Kazuto; Hoshino, Masato; Yamamoto, Seryung; Akimoto, Shunsuke; Masuda, Takahiro; Kashiwagi, Hideyuki; Yanaga, Katsuhiko

2017-01-01

Purpose Although laparoscopic Heller myotomy and Dor fundoplication (LHD) is widely performed to address achalasia, little is known about the learning curve for this technique. We assessed the learning curve for performing LHD. Methods Of the 514 cases with LHD performed between August 1994 and March 2016, the surgical outcomes of 463 cases were evaluated after excluding 50 cases with reduced port surgery and one case with the simultaneous performance of laparoscopic distal partial gastrectomy. A receiver operating characteristic (ROC) curve analysis was used to identify the cut-off value for the number of surgical experiences necessary to become proficient with LHD, which was defined as the completion of the learning curve. Results We defined the completion of the learning curve when the following 3 conditions were satisfied. 1) The operation time was less than 165 minutes. 2) There was no blood loss. 3) There was no intraoperative complication. In order to establish the appropriate number of surgical experiences required to complete the learning curve, the cut-off value was evaluated by using a ROC curve (AUC 0.717, p < 0.001). Finally, we identified the cut-off value as 16 surgical cases (sensitivity 0.706, specificity 0.646). Conclusion Learning curve seems to complete after performing 16 cases. PMID:28686640

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.

A Meta-analysis for the Diagnostic Performance of Transient Elastography for Clinically Significant Portal Hypertension.

PubMed

You, Myung-Won; Kim, Kyung Won; Pyo, Junhee; Huh, Jimi; Kim, Hyoung Jung; Lee, So Jung; Park, Seong Ho

2017-01-01

We aimed to evaluate the correlation between liver stiffness measurement using transient elastography (TE-LSM) and hepatic venous pressure gradient and the diagnostic performance of TE-LSM in assessing clinically significant portal hypertension through meta-analysis. Eleven studies were included from thorough literature research and selection processes. The summary correlation coefficient was 0.783 (95% confidence interval [CI], 0.737-0.823). Summary sensitivity, specificity and area under the hierarchical summary receiver operating characteristic curve (AUC) were 87.5% (95% CI, 75.8-93.9%), 85.3 % (95% CI, 76.9-90.9%) and 0.9, respectively. The subgroup with low cut-off values of 13.6-18 kPa had better summary estimates (sensitivity 91.2%, specificity 81.3% and partial AUC 0.921) than the subgroup with high cut-off values of 21-25 kPa (sensitivity 71.2%, specificity 90.9% and partial AUC 0.769). In summary, TE-LSM correlated well with hepatic venous pressure gradient and represented good diagnostic performance in diagnosing clinically significant portal hypertension. For use as a sensitive screening tool, we propose using low cut-off values of 13.6-18 kPa in TE-LSM. Copyright © 2016 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

Learning curve for laparoscopic Heller myotomy and Dor fundoplication for achalasia.

PubMed

Yano, Fumiaki; Omura, Nobuo; Tsuboi, Kazuto; Hoshino, Masato; Yamamoto, Seryung; Akimoto, Shunsuke; Masuda, Takahiro; Kashiwagi, Hideyuki; Yanaga, Katsuhiko

2017-01-01

Although laparoscopic Heller myotomy and Dor fundoplication (LHD) is widely performed to address achalasia, little is known about the learning curve for this technique. We assessed the learning curve for performing LHD. Of the 514 cases with LHD performed between August 1994 and March 2016, the surgical outcomes of 463 cases were evaluated after excluding 50 cases with reduced port surgery and one case with the simultaneous performance of laparoscopic distal partial gastrectomy. A receiver operating characteristic (ROC) curve analysis was used to identify the cut-off value for the number of surgical experiences necessary to become proficient with LHD, which was defined as the completion of the learning curve. We defined the completion of the learning curve when the following 3 conditions were satisfied. 1) The operation time was less than 165 minutes. 2) There was no blood loss. 3) There was no intraoperative complication. In order to establish the appropriate number of surgical experiences required to complete the learning curve, the cut-off value was evaluated by using a ROC curve (AUC 0.717, p < 0.001). Finally, we identified the cut-off value as 16 surgical cases (sensitivity 0.706, specificity 0.646). Learning curve seems to complete after performing 16 cases.

Non-invasive assessment of liver fibrosis using two-dimensional shear wave elastography in patients with autoimmune liver diseases

PubMed Central

Zeng, Jie; Huang, Ze-Ping; Zheng, Jian; Wu, Tao; Zheng, Rong-Qin

2017-01-01

AIM To determine the diagnostic accuracy of two-dimensional shear wave elastography (2D-SWE) for the non-invasive assessment of liver fibrosis in patients with autoimmune liver diseases (AILD) using liver biopsy as the reference standard. METHODS Patients with AILD who underwent liver biopsy and 2D-SWE were consecutively enrolled. Receiver operating characteristic (ROC) curves were constructed to assess the overall accuracy and to identify optimal cut-off values. RESULTS The characteristics of the diagnostic performance were determined for 114 patients with AILD. The areas under the ROC curves for significant fibrosis, severe fibrosis, and cirrhosis were 0.85, 0.85, and 0.86, respectively, and the optimal cut-off values associated with significant fibrosis (≥ F2), severe fibrosis (≥ F3), and cirrhosis (F4) were 9.7 kPa, 13.2 kPa and 16.3 kPa, respectively. 2D-SWE showed sensitivity values of 81.7% for significant fibrosis, 83.0% for severe fibrosis, and 87.0% for cirrhosis, and the respective specificity values were 81.3%, 74.6%, and 80.2%. The overall concordance rate of the liver stiffness measurements obtained using 2D-SWE vs fibrosis stages was 53.5%. CONCLUSION 2D-SWE showed promising diagnostic performance for assessing liver fibrosis stages and exhibited high cut-off values in patients with AILD. Low overall concordance rate was observed in the liver stiffness measurements obtained using 2D-SWE vs fibrosis stages. PMID:28765706

Non-invasive assessment of liver fibrosis using two-dimensional shear wave elastography in patients with autoimmune liver diseases.

PubMed

Zeng, Jie; Huang, Ze-Ping; Zheng, Jian; Wu, Tao; Zheng, Rong-Qin

2017-07-14

To determine the diagnostic accuracy of two-dimensional shear wave elastography (2D-SWE) for the non-invasive assessment of liver fibrosis in patients with autoimmune liver diseases (AILD) using liver biopsy as the reference standard. Patients with AILD who underwent liver biopsy and 2D-SWE were consecutively enrolled. Receiver operating characteristic (ROC) curves were constructed to assess the overall accuracy and to identify optimal cut-off values. The characteristics of the diagnostic performance were determined for 114 patients with AILD. The areas under the ROC curves for significant fibrosis, severe fibrosis, and cirrhosis were 0.85, 0.85, and 0.86, respectively, and the optimal cut-off values associated with significant fibrosis (≥ F2), severe fibrosis (≥ F3), and cirrhosis (F4) were 9.7 kPa, 13.2 kPa and 16.3 kPa, respectively. 2D-SWE showed sensitivity values of 81.7% for significant fibrosis, 83.0% for severe fibrosis, and 87.0% for cirrhosis, and the respective specificity values were 81.3%, 74.6%, and 80.2%. The overall concordance rate of the liver stiffness measurements obtained using 2D-SWE vs fibrosis stages was 53.5%. 2D-SWE showed promising diagnostic performance for assessing liver fibrosis stages and exhibited high cut-off values in patients with AILD. Low overall concordance rate was observed in the liver stiffness measurements obtained using 2D-SWE vs fibrosis stages.

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.

How useful are ARFI elastography cut-off values proposed by meta-analysis for predicting the significant fibrosis and compensated liver cirrhosis?

PubMed

Bota, Simona; Sporea, Ioan; Sirli, Roxana; Popescu, Alina; Gradinaru-Tascau, Oana

2015-06-01

To evaluate how often do we "miss" chronic hepatitis C patients with at least significant fibrosis (F>/=2) and those with compensated cirrhosis, by using Acoustic Radiation Force Impulse (ARFI) elastography cut-off values proposed by meta-analysis. Our study included 132 patients with chronic hepatitis C, evaluated by means of ARFI and liver biopsy (LB), in the same session. Reliable measurements were defined as: median value of 10 liver stiffness (LS) measurements with a success rate>/=60% and an interquartile range interval<30%. For predicting F>/=2 and F=4 we used the LS cut-offs proposed in the last published meta-analysis: 1.35 m/s and 1.87 m/s, respectively. Reliable LS measurements by means of ARFI were obtained in 117 patients (87.9%). In our study, 58 patients (49.6%) had LS values <1.35 m/s; from these 75.8% had F>/=2 in LB. From the 59 patients (50.4%) with LS values>/=1.35 m/s, only 6.8% had F0 or F1 in LB. Also, in our study, 88 patients (75.3%) had LS values <1.87 m/s; from these only 2.2 % had F4 in LB. From the 29 patients (24.7%) with LS values>/=1.87 m/s, 41.3% had F4 in LB. Both for prediction of at least significant fibrosis and liver cirrhosis, higher aminotransferases levels were associated with wrongly classified patients, in univariate and multivariate analysis. ARFI elastography had a very good positive predictive value (93.2%) for predicting the presence of significant fibrosis and excellent negative predictive value (97.8%) for excluding the presence of compensated liver cirrhosis.

A clinical decision-making model for repeat surgical treatment of pectus Bar displacement: distance measurement after nuss procedure.

PubMed

Sa, Young Jo; Lee, Jongho; Jeong, Jin Yong; Choi, Moonhee; Park, Soo Seog; Sim, Sung Bo; Jo, Keon Hyon

2016-01-19

Bar displacement is one of the most common and serious complications after the Nuss procedure. However, measurements of and factors affecting bar displacement have not been reported. The objectives of this study were to develop a decision model to guide surgeons considering repeat treatment and to estimate optimal cut-off values to determine whether reoperation to correct bar displacement is warranted. From July 2011 to August 2013, ninety bars were inserted in 61 patients who underwent Nuss procedures for pectus excavatum. Group A did not need surgical intervention and Group B required reoperation for bar displacement. Bar position was measured as the distance from the posterior superior end of the sternal body to the upper border of the metal bar on lateral chest radiographs. The bar displacement index (BDI) was calculated using D0 - Dx / D0 x 100 (D0: bar position the day after surgery; Dx: minimal or maximal distance of bar position on the following postoperative days). The optimal cut-off values of BDI warranting reoperation were assessed on the basis of ROC curve analysis. Of the 61 patients, 32 had single bars inserted whereas 29 had parallel bars inserted. There was a significant difference in age (14.0 ± 7.5 vs. 23.3 ± 12.0, p = 0.0062), preoperative Haller index (HI) (4.0 ± 1.1 vs. 5.0 ± 1.0, p = 0.033), and postoperative HI (2.7 ± 0.4 vs. 3.2 ± 0.5 p = 0.006) between the two groups. The optimal cut-off value of BDI was 8.7. We developed a BDI model for surgeons considering performing reoperation after Nuss procedure. The optimal cut-off value of BDI was 8.7. This model may help surgeons to decide objectively whether corrective surgery should be performed. The main factors affecting the relationship between bar displacement and reoperation were age and preoperative HI.

Lactate clearance as the predictor of outcome in pediatric septic shock.

PubMed

Choudhary, Richa; Sitaraman, Sadasivan; Choudhary, Anita

2017-01-01

Septic shock can rapidly evolve into multiple system organ failure and death. In the recent years, hyperlactatemia has been found to be a risk factor for mortality in critically ill adults. To evaluate the predictive value of lactate clearance and to determine the optimal cut-off value for predicting outcome in children with septic shock. A prospective observational study was performed on children with septic shock admitted to pediatric Intensive Care Unit (PICU). Serial lactate levels were measured at PICU admission, 24 and 48 h later. Lactate clearance, percent decrease in lactate level in 24 h, was calculated. The primary outcome measure was survival or nonsurvival at the end of hospital stay. We performed receiver operating characteristic analyses to calculate optimal cut-off values. The mean lactate levels at admission were significantly higher in the nonsurvivors than survivors, 5.12 ± 3.51 versus 3.13 ± 1.71 mmol/L ( P = 0.0001). The cut-off for lactate level at admission for the best prediction of mortality was determined as ≥4 mmol/L (odds ratio 5.4; 95% confidence interval [CI] =2.45-12.09). Mean lactate clearance was significantly higher in survivors than nonsurvivors (17.9 ± 39.9 vs. -23.2 ± 62.7; P < 0.0001). A lactate clearance rate of <10% at 24 h had a sensitivity and specificity of 78.7% and 72.2%, respectively and a positive predictive value of 83.1% for death. Failure to achieve a lactate clearance of more than 10% was associated with greater risk of mortality (likelihood ratio + 2.83; 95% CI = 1.82-4.41). Serial lactate levels can be used to predict outcome in pediatric septic shock. A 24 h lactate clearance cut-off of <10% is a predictor of in-hospital mortality in such patients.

Burnout in the staff of a chronic care hospital.

PubMed

Merino-Plaza, Maria Jose; Carrera-Hueso, Francisco Javier; Arribas-Boscá, Nuria; Martínez-Asensi, Amparo; Trull-Maravilla, Emilia; Fikri-Benbrahim, Narjis

2018-01-01

OBJECTIVE To estimate the prevalence of Burnout in a medium or long-stay hospital, to monitor its evolution and to highlight the importance of cut-off points used to avoid distortions in the interpretation of the results. METHODS Two cross-sectional studies (2013-2016) were carried out, applying the Spanish version of the Maslach Burnout Inventory to the staff of a chronic care hospital (n = 323). Result variables were: Burnout prevalence and a high degree of affectation of the subscales and predictor variables: sociodemographic characteristics and factors that trigger and modulate the syndrome. The association between variables was quantified using odds ratio. RESULTS The participation rate went from 31.5% to 39.3%. The professionals presented a mean level of Burnout in both moments, observing a lower degree of affectation of the depersonalization subscales and personal accomplishment in the 2016 cut-off. The average score of the subscales in 2016 was 21.5 for emotional fatigue, 4.7 for depersonalization and 41.7 for personal fulfillment, compared to the values of emotional fatigue = 21.6, depersonalization = 6.9 and personal fulfillment = 36.3 obtained in 2013. The emotional fatigue score was slightly higher than the mean value of the national studies (19.9), while the rest of the values were similar to the mean values of the studies considered. The prevalence of Burnout and the interpretation of the results varied significantly according to the cut-off points considered. In both studies, sociodemographic variables showed little significance, while social support and interpersonal relationships were associated with the degree of burnout among professionals. CONCLUSIONS Our prevalence of Burnout was similar to that of other studies consulted, although the emotional component is more marked in our environment. The interpretation of the results varied significantly according to the cut-off points applied, due to the cross-cultural differences.

Transient elastography using Fibroscan is the most reliable noninvasive method for the diagnosis of advanced fibrosis and cirrhosis in alcoholic liver disease.

PubMed

Fernandez, Michael; Trépo, Eric; Degré, Delphine; Gustot, Thierry; Verset, Laurine; Demetter, Pieter; Devière, Jacques; Adler, Michael; Moreno, Christophe

2015-09-01

Fibroscan (FS) is a reliable noninvasive method for the diagnosis of advanced fibrosis and cirrhosis in chronic liver disease. However, there is no clear consensus with respect to the best FS cut-off values for use in alcoholic liver disease (ALD). The aims of this study were as follows: (a) to compare the performance of FS and different biochemical markers in ALD patients; (b) to assess the best FS cut-off values for the prediction of fibrosis stage in our ALD population; and (c) to assess the influence of aspartate aminotransferase (AST) values on FS. This retrospective study included 135 consecutive and compensated ALD patients who underwent liver biopsy between November 2006 and March 2012 at Erasme Hospital. FS, Fibrotest, FIB-4, aspartate aminotransferase to platelet ratio index (APRI), and Forns' scores were tested in all patients. The diagnostic accuracy of FS was 0.89 (95% confidence interval: 0.83-0.95) for the diagnosis of advanced fibrosis and 0.93 (95% confidence interval 0.90-0.97) for the diagnosis of cirrhosis. FS performed better than Fibrotest (0.81 and 0.88), APRI (0.65 and 0.75), Forns' (0.64 and 0.78), and FIB-4 (0.70 and 0.73). The optimal cut-off values of liver stiffness (LS) for predicting METAVIR fibrosis stage F≥3 and F4 disease were 10.3 and 18.0 kPa, respectively. AST showed a significant positive correlation with LS (r=0.24, P=0.001). However, exclusion of patients with AST more than 50 IU/l only lowered the LS cut-off for the diagnosis of F4 (14 vs. 18.0 kPa). FS is currently the most reliable noninvasive method for the diagnosis of advanced liver fibrosis and cirrhosis in ALD.

Burnout in the staff of a chronic care hospital

PubMed Central

Merino-Plaza, Maria Jose; Carrera-Hueso, Francisco Javier; Arribas-Boscá, Nuria; Martínez-Asensi, Amparo; Trull-Maravilla, Emilia; Fikri-Benbrahim, Narjis

2018-01-01

ABSTRACT OBJECTIVE To estimate the prevalence of Burnout in a medium or long-stay hospital, to monitor its evolution and to highlight the importance of cut-off points used to avoid distortions in the interpretation of the results. METHODS Two cross-sectional studies (2013–2016) were carried out, applying the Spanish version of the Maslach Burnout Inventory to the staff of a chronic care hospital (n = 323). Result variables were: Burnout prevalence and a high degree of affectation of the subscales and predictor variables: sociodemographic characteristics and factors that trigger and modulate the syndrome. The association between variables was quantified using odds ratio. RESULTS The participation rate went from 31.5% to 39.3%. The professionals presented a mean level of Burnout in both moments, observing a lower degree of affectation of the depersonalization subscales and personal accomplishment in the 2016 cut-off. The average score of the subscales in 2016 was 21.5 for emotional fatigue, 4.7 for depersonalization and 41.7 for personal fulfillment, compared to the values of emotional fatigue = 21.6, depersonalization = 6.9 and personal fulfillment = 36.3 obtained in 2013. The emotional fatigue score was slightly higher than the mean value of the national studies (19.9), while the rest of the values were similar to the mean values of the studies considered. The prevalence of Burnout and the interpretation of the results varied significantly according to the cut-off points considered. In both studies, sociodemographic variables showed little significance, while social support and interpersonal relationships were associated with the degree of burnout among professionals. CONCLUSIONS Our prevalence of Burnout was similar to that of other studies consulted, although the emotional component is more marked in our environment. The interpretation of the results varied significantly according to the cut-off points applied, due to the cross-cultural differences. PMID:29723388

Anatomic features of the neck as predictive markers of difficult direct laryngoscopy in men and women: A prospective study

PubMed Central

Chara, Liaskou; Eleftherios, Vouzounerakis; Maria, Moirasgenti; Anastasia, Trikoupi; Chryssoula, Staikou

2014-01-01

Background and Aims: Difficult airway assessment is based on various anatomic parameters of upper airway, much of it being concentrated on oral cavity and the pharyngeal structures. The diagnostic value of tests based on neck anatomy in predicting difficult laryngoscopy was assessed in this prospective, open cohort study. Methods: We studied 341 adult patients scheduled to receive general anaesthesia. Thyromental distance (TMD), sternomental distance (STMD), ratio of height to thyromental distance (RHTMD) and neck circumference (NC) were measured pre-operatively. The laryngoscopic view was classified according to the Cormack–Lehane Grade (1-4). Difficult laryngoscopy was defined as Cormack–Lehane Grade 3 or 4. The optimal cut-off points for each variable were identified by using receiver operating characteristic analysis. Sensitivity, specificity and positive predictive value and negative predictive value (NPV) were calculated for each test. Multivariate analysis with logistic regression, including all variables, was used to create a predictive model. Comparisons between genders were also performed. Results: Laryngoscopy was difficult in 12.6% of the patients. The cut-off values were: TMD ≤7 cm, STMD ≤15 cm, RHTMD >18.4 and NC >37.5 cm. The RHTMD had the highest sensitivity (88.4%) and NPV (95.2%), while TMD had the highest specificity (83.9%). The area under curve (AUC) for the TMD, STMD, RHTMD and NC was 0.63, 0.64, 0.62 and 0.54, respectively. The predictive model exhibited a higher and statistically significant diagnostic accuracy (AUC: 0.68, P < 0.001). Gender-specific cut-off points improved the predictive accuracy of NC in women (AUC: 0.65). Conclusions: The TMD, STMD, RHTMD and NC were found to be poor single predictors of difficult laryngoscopy, while a model including all four variables had a significant predictive accuracy. Among the studied tests, gender-specific cut-off points should be used for NC. PMID:24963183

Anatomic features of the neck as predictive markers of difficult direct laryngoscopy in men and women: A prospective study.

PubMed

Liaskou, Chara; Chara, Liaskou; Vouzounerakis, Eleftherios; Eleftherios, Vouzounerakis; Moirasgenti, Maria; Maria, Moirasgenti; Trikoupi, Anastasia; Anastasia, Trikoupi; Staikou, Chryssoula; Chryssoula, Staikou

2014-03-01

Difficult airway assessment is based on various anatomic parameters of upper airway, much of it being concentrated on oral cavity and the pharyngeal structures. The diagnostic value of tests based on neck anatomy in predicting difficult laryngoscopy was assessed in this prospective, open cohort study. We studied 341 adult patients scheduled to receive general anaesthesia. Thyromental distance (TMD), sternomental distance (STMD), ratio of height to thyromental distance (RHTMD) and neck circumference (NC) were measured pre-operatively. The laryngoscopic view was classified according to the Cormack-Lehane Grade (1-4). Difficult laryngoscopy was defined as Cormack-Lehane Grade 3 or 4. The optimal cut-off points for each variable were identified by using receiver operating characteristic analysis. Sensitivity, specificity and positive predictive value and negative predictive value (NPV) were calculated for each test. Multivariate analysis with logistic regression, including all variables, was used to create a predictive model. Comparisons between genders were also performed. Laryngoscopy was difficult in 12.6% of the patients. The cut-off values were: TMD ≤7 cm, STMD ≤15 cm, RHTMD >18.4 and NC >37.5 cm. The RHTMD had the highest sensitivity (88.4%) and NPV (95.2%), while TMD had the highest specificity (83.9%). The area under curve (AUC) for the TMD, STMD, RHTMD and NC was 0.63, 0.64, 0.62 and 0.54, respectively. The predictive model exhibited a higher and statistically significant diagnostic accuracy (AUC: 0.68, P < 0.001). Gender-specific cut-off points improved the predictive accuracy of NC in women (AUC: 0.65). The TMD, STMD, RHTMD and NC were found to be poor single predictors of difficult laryngoscopy, while a model including all four variables had a significant predictive accuracy. Among the studied tests, gender-specific cut-off points should be used for NC.

Reference Values and Utility of Serum Total Immunoglobulin E for Predicting Atopy and Allergic Diseases in Korean Schoolchildren

PubMed Central

2017-01-01

The present study aimed to investigate the distribution of total serum immunoglobulin E (IgE) levels in Korean schoolchildren and to evaluate its utility in the prediction of atopy and allergic diseases. A nationwide, cross-sectional survey was conducted in first grade students from randomly selected elementary and middle schools. Total IgE levels were measured by ImmunoCAP. Skin prick tests were performed for 18 common inhalant allergens to determine the presence of atopy. Children aged 12–13 years and parents of children aged 6–7 years were asked to complete questionnaire assessing allergic diseases. The cut-off levels of total IgE were determined by analyzing receiver operating characteristic curves. The median total IgE level was 86.7 kU/L (range: 1.5–4,523.1) in 3,753 children aged 6–7 years and 94.7 kU/L (range: 1.5–3,000.0) in 3,930 children aged 12–13 years. Total IgE concentrations were higher in children with atopy or allergic diseases than in those without (all P < 0.001). At the cut-off value of 127.7 kU/L, sensitivity, specificity, and positive and negative predictive values (PPV and NPV) were 67.1%, 75.4%, 65.4%, and 76.7%, respectively, in elementary schoolchildren. At the cut-off value of 63.0 kU/L, sensitivity, specificity, PPV, and NPV were 81.9%, 66.6%, 75.0%, and 75.1%, respectively, in middle schoolchildren. PPV and NPV were ≥ 70% when cut-offs of 258.8 kU/L and 38.4 kU/L were used for the diagnosis of atopy in 6–7 year-olds and 12–13 year-olds, respectively. This nationwide population-based study provided the first normal reference ranges of total IgE in Korean schoolchildren. PMID:28378554

Usefulness of neutrophil-to-lymphocyte ratio as a biomarker for diagnosing infections in patients with systemic lupus erythematosus.

PubMed

Kim, Hyoun-Ah; Jung, Ju-Yang; Suh, Chang-Hee

2017-11-01

Neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR) have been investigated as disease activity markers for systemic lupus erythematosus (SLE). Hence, we investigated the clinical significance of these parameters in diagnosing infection in patients with SLE. In total, 120 patients with SLE, who were admitted to hospital due to disease flares or infection, were recruited for the study. Of the 120 patients, 60 had a concurrent infection (SLE with infection), while the remaining 60 patients were admitted with a flare without any evidence of infection (SLE with flare). NLR was higher in the patients with SLE with infection, compared to patients with SLE with flare (14.2 ± 15.4 versus 3.3 ± 2.2, p < 0.001). Additionally, PLR was higher in the SLE with infection group than in the SLE with flare group (357.7 ± 350.1 versus 231.7 ± 152.9, p = 0.012), but not MLR. In the SLE with infection group, C-reactive protein (CRP) levels positively correlated with NLR and PLR. NLR with a cut-off value of 5.70 and an area under the curve (AUC) of 0.872 indicated good sensitivity (75%) and specificity (90%), for the diagnosis of SLE with infection. CRP with a cut-off value of 1.28 mg/dL (AUC 0.942) showed the sensitivity (93.3%) and specificity (91.7%). NLR with a cut-off value of 5.70 and CRP with a cut-off value of 1.28 mg/dL showed the increased specificity (98.3%) than only CRP, but not significant. NLR could be a good additive marker for diagnosing infection in patients with SLE.

Increased impedance near cut-off in plasma-like media leading to emission of high-power, narrow-bandwidth radiation

PubMed Central

Hur, M. S.; Ersfeld, B.; Noble, A.; Suk, H.; Jaroszynski, D. A.

2017-01-01

Ultra-intense, narrow-bandwidth, electromagnetic pulses have become important tools for exploring the characteristics of matter. Modern tuneable high-power light sources, such as free-electron lasers and vacuum tubes, rely on bunching of relativistic or near-relativistic electrons in vacuum. Here we present a fundamentally different method for producing narrow-bandwidth radiation from a broad spectral bandwidth current source, which takes advantage of the inflated radiation impedance close to cut-off in a medium with a plasma-like permittivity. We find that by embedding a current source in this cut-off region, more than an order of magnitude enhancement of the radiation intensity is obtained compared with emission directly into free space. The method suggests a simple and general way to flexibly use broadband current sources to produce broad or narrow bandwidth pulses. As an example, we demonstrate, using particle-in-cell simulations, enhanced monochromatic emission of terahertz radiation using a two-colour pumped current source enclosed by a tapered waveguide. PMID:28071681

Increased impedance near cut-off in plasma-like media leading to emission of high-power, narrow-bandwidth radiation

NASA Astrophysics Data System (ADS)

Hur, M. S.; Ersfeld, B.; Noble, A.; Suk, H.; Jaroszynski, D. A.

2017-01-01

Ultra-intense, narrow-bandwidth, electromagnetic pulses have become important tools for exploring the characteristics of matter. Modern tuneable high-power light sources, such as free-electron lasers and vacuum tubes, rely on bunching of relativistic or near-relativistic electrons in vacuum. Here we present a fundamentally different method for producing narrow-bandwidth radiation from a broad spectral bandwidth current source, which takes advantage of the inflated radiation impedance close to cut-off in a medium with a plasma-like permittivity. We find that by embedding a current source in this cut-off region, more than an order of magnitude enhancement of the radiation intensity is obtained compared with emission directly into free space. The method suggests a simple and general way to flexibly use broadband current sources to produce broad or narrow bandwidth pulses. As an example, we demonstrate, using particle-in-cell simulations, enhanced monochromatic emission of terahertz radiation using a two-colour pumped current source enclosed by a tapered waveguide.

An optimal cut-off point for the calving interval may be used as an indicator of bovine abortions.

PubMed

Bronner, Anne; Morignat, Eric; Gay, Emilie; Calavas, Didier

2015-10-01

The bovine abortion surveillance system in France aims to detect as early as possible any resurgence of bovine brucellosis, a disease of which the country has been declared free since 2005. It relies on the mandatory notification and testing of each aborting cow, but under-reporting is high. This research uses a new and simple approach which considers the calving interval (CI) as a "diagnostic test" to determine optimal cut-off point c and estimate diagnostic performance of the CI to identify aborting cows, and herds with multiple abortions (i.e. three or more aborting cows per calving season). The period between two artificial inseminations (AI) was considered as a "gold standard". During the 2006-2010 calving seasons, the mean optimal CI cut-off point for identifying aborting cows was 691 days for dairy cows and 703 days for beef cows. Depending on the calving season, production type and scale at which c was computed (individual or herd), the average sensitivity of the CI varied from 42.6% to 64.4%; its average specificity from 96.7% to 99.7%; its average positive predictive value from 27.6% to 65.4%; and its average negative predictive value from 98.7% to 99.8%. When applied to the French bovine population as a whole, this indicator identified 2-3% of cows suspected to have aborted, and 10-15% of herds suspected of multiple abortions. The optimal cut-off point and CI performance were consistent over calving seasons. By applying an optimal CI cut-off point to the cattle demographics database, it becomes possible to identify herds with multiple abortions, carry out retrospective investigations to find the cause of these abortions and monitor a posteriori compliance of farmers with their obligation to report abortions for brucellosis surveillance needs. Therefore, the CI could be used as an indicator of abortions to help improve the current mandatory notification surveillance system. Copyright © 2015 Elsevier B.V. All rights reserved.

A cautionary note about the cross-national and clinical validity of cut-off points for the Maslach Burnout Inventory.

PubMed

Schaufeli, W B; Van Dierendonck, D

1995-06-01

In the present study, burnout scores of three samples, as measured with the Maslach Burnout Inventory, were compared: (1) the normative American sample from the test-manual (N = 10,067), (2) the normative Dutch sample (N = 3,892), and (3) a Dutch outpatient sample (N = 142). Generally, the highest burnout scores were found for the outpatient sample, followed by the American and Dutch normative samples, respectively. Slightly different patterns were noted for each of the three components. Probably sampling bias, i.e., the healthy worker effect, or cultural value patterns, i.e., femininity versus masculinity, might be responsible for the results. It is concluded that extreme caution is required when cut-off points are used to classify individuals by burnout scores; only nation-specific and clinically derived cut-off points should be employed.

The effect of pair cascades on the high-energy spectral cut-off in gamma-ray bursts

NASA Astrophysics Data System (ADS)

Gill, Ramandeep; Granot, Jonathan

2018-03-01

The highly luminous and variable prompt emission in gamma-ray bursts (GRBs) arises in an ultra-relativistic outflow. The exact underlying radiative mechanism shaping its non-thermal spectrum is still uncertain, making it hard to determine the outflow's bulk Lorentz factor Γ. GRBs with spectral cut-off due to pair production (γγ → e+e-) at energies Ec ≳ 10 MeV are extremely useful for inferring Γ. We find that when the emission region has a high enough compactness, then as it becomes optically thick to scattering, Compton downscattering by non-relativistic e±-pairs can shift the spectral cut-off energy well below the self-annihilation threshold, Esa = Γmec2/(1 + z). We treat this effect numerically and show that Γ obtained assuming Ec = Esa can underpredict its true value by as much as an order of magnitude.

Phonon cross-plane transport and thermal boundary resistance: effect of heat source size and thermal boundary resistance on phonon characteristics

NASA Astrophysics Data System (ADS)

Ali, H.; Yilbas, B. S.

2016-09-01

Phonon cross-plane transport across silicon and diamond thin films pair is considered, and thermal boundary resistance across the films pair interface is examined incorporating the cut-off mismatch and diffusive mismatch models. In the cut-off mismatch model, phonon frequency mismatch for each acoustic branch is incorporated across the interface of the silicon and diamond films pair in line with the dispersion relations of both films. The frequency-dependent and transient solution of the Boltzmann transport equation is presented, and the equilibrium phonon intensity ratios at the silicon and diamond film edges are predicted across the interface for each phonon acoustic branch. Temperature disturbance across the edges of the films pair is incorporated to assess the phonon transport characteristics due to cut-off and diffusive mismatch models across the interface. The effect of heat source size, which is allocated at high-temperature (301 K) edge of the silicon film, on the phonon transport characteristics at the films pair interface is also investigated. It is found that cut-off mismatch model predicts higher values of the thermal boundary resistance across the films pair interface as compared to that of the diffusive mismatch model. The ratio of equilibrium phonon intensity due to the cut-off mismatch over the diffusive mismatch models remains >1 at the silicon edge, while it becomes <1 at the diamond edge for all acoustic branches.

Study of the O-mode in a relativistic degenerate electron plasma

NASA Astrophysics Data System (ADS)

Azra, Kalsoom; Ali, Muddasir; Hussain, Azhar

2017-03-01

Using the linearized relativistic Vlasov-Maxwell equations, a generalized expression for the plasma conductivity tensor is derived. The dispersion relation for the O-mode in a relativistic degenerate electron plasma is investigated by employing the Fermi-Dirac distribution function. The propagation characteristics of the O-mode (cut offs, resonances, propagation regimes, harmonic structure) are examined by using specific values of the density and the magnetic field that correspond to different relativistic dense environments. Further, it is observed that due to the relativistic effects the cut off and the resonance points are shifted to low frequency values, as a result the propagation regime is reduced. The dispersion relations for the non-relativistic and the ultra-relativistic limits are also presented.

A hepatic metabolomics-based diagnostic approach to assess lethal toxicity of dithiocarbamate fungicide polycarbamate in three marine fish species.

PubMed

Hano, Takeshi; Ohkubo, Nobuyuki; Mochida, Kazuhiko

2017-04-01

The present study was performed to evaluate the toxic effect of the dithiocarbamate fungicide polycarbamate (PC) on the hepatic metabolic profiles of three marine fish species, red sea bream (Pagrus major), spotted halibut (Verasper variegatus), and marbled flounder (Pleuronectes yokohamae). First, juvenile fish were exposed to graded concentrations of PC for 96h; the 96-h LC 50 values obtained were 22-29, 239-553, and 301-364µgL -1 for red sea bream, spotted halibut, and marbled flounder, respectively, indicating that red sea bream possessed higher sensitivity to PC than the two benthic species. Second, the fish were exposed to lethal-equivalent concentration (H group) or sub-lethal (one-tenth of the H group concentrations; L group) for 24 and 96h and gas-chromatography based metabolomics approach was employed to explore the crucial biomarker metabolite associated with lethal toxicity. Of the 53 metabolites identified, only reduced glutathione (GSH) was consistently elevated in the H group for the three fish species at 96h. The calculated cut-off value of GSH (mM) based on receiver operating curve analysis between H group and the other treatment groups (control, solvent control, and L group) was obtained at 0.56mM, which allowed to distinguish between the groups with high confidence for the three fish species. These results are the first to demonstrate the potential of using GSH as a possible biomarker metabolite and its usefulness of threshold cut-off value for diagnosing life-threatening health conditions of fish. Copyright © 2016 Elsevier Inc. All rights reserved.

Fat-to-muscle Ratio: A New Anthropometric Indicator for Predicting Metabolic Syndrome in the Han and Bouyei Populations from Guizhou Province, China.

PubMed

Xu, Ke; Zhu, Hui Juan; Chen, Shi; Chen, Lu; Wang, Xin; Zhang, Li Yuan; Pan, Li; Wang, Li; Feng, Kui; Wang, Ke; Dong, Fen; Wang, Ding Ming; Yu, Yang Wen; Pan, Hui; Shan, Guang Liang

2018-04-01

To investigate the prevalence and possible factors influencing metabolic syndrome in people from Guizhou Province and to explore the predictive value of the fat-to-muscle ratio in diagnosing metabolic syndrome. A multistage stratified sampling method was used in this cross-sectional study of 20-80 years old Han and Bouyei populations from Guizhou Province, southwestern China, from October-December 2012. The study included 4,553 cases of metabolic syndrome, that was defined according to 2005 International Diabetes Federation criteria. The receiver operating characteristic curve was used for determining the sensitivity, specificity, and predictive ability of the fat-to-muscle ratio for the diagnosis of metabolic syndrome. The age-standardized prevalence of metabolic syndrome was 11.38% (men: 9.76%; women: 12.72%) for Han and 4.78% (men: 4.43%; women: 5.30%) for Bouyei populations. In Guizhou Province, the cut-off value for the men fat-to-muscle ratio was 0.34, the area under the curve was 0.95, and the sensitivity and specificity were 0.94 and 0.85, respectively. The cut-off value for the women fat-to-muscle ratio was 0.55, the area under the curve was 0.91, and the sensitivity and specificity were 0.93 and 0.79, respectively. The fat-to-muscle ratio is highly predictive of metabolic syndrome in Guizhou Province, and a useful reference indicator. Copyright © 2018 The Editorial Board of Biomedical and Environmental Sciences. Published by China CDC. All rights reserved.

Sensitivity and specificity of the Distress Thermometer in screening for distress in long-term nasopharyngeal cancer survivors.

PubMed

Hong, J S; Tian, J

2013-12-01

The Distress Thermometer (dt) is a screening tool recommended to quickly identify cancer patients with distress. Our study aimed to examine the sensitivity and specificity of the dt in detecting psychological distress in long-term Chinese nasopharyngeal cancer (npc) survivors. Data for the 442 participating npc survivors were collected through a self-administered questionnaire based on the dt and the Hospital Anxiety and Depression Scale (hads). The hads was used to define cases of psychological distress. Positive and negative groups were defined based on 4 hads criteria (Anxiety, Depression, Anxiety or Depression, and overall score). Receiver operating characteristic (roc) curves were used to examine the ability of all possible cut-off values of the dt to detect positive and negative cases. For each roc curve, the area under the curve (auc) was used as an indicator of the overall accuracy of the dt to identify positive cases of distress. The positive auc values [with 95% confidence intervals (ci)] for the 4 hads criteria were 0.715 (95% ci: 0.667 to 0.764), 0.714 (95% ci: 0.661 to 0.768), 0.724 (95% ci: 0.677 to 0.771), and 0.724 (95% ci: 0.664 to 0.775) respectively. At a cut-off score of 4, the sensitivity of the dt to the four hads criteria was, respectively, 0.366 (95% ci: 0.296 to 0.436), 0.448 (95% ci: 0.364 to 0.532), 0.362 (95% ci: 0.299 to 0.425), and 0.421 (95% ci: 0.339 to 0.502), and the specificity of the dt to the 4 hads criteria was, respectively, 0.860 (95% ci: 0.818 to 0.902), 0.860 (95% ci: 0.821 to 0.899), 0.854 (95% ci: 0.814 to 0.894), and 0.854 (95% ci: 0.814 to 0.894). At a cut-off score of 5, the corresponding sensitivities were lower than those at the cut-off score of 4. All potential cut-off scores showed poor sensitivity (<0.90). The roc analysis showed poor discrimination. No potential dt cut-off score had an acceptable sensitivity. The dt showed poor sensitivity in npc survivors. Thus, the dt might not be a valid scale for psychological distress screening in long-term Chinese npc survivors.

Sensitivity and specificity of the Distress Thermometer in screening for distress in long-term nasopharyngeal cancer survivors

PubMed Central

Hong, J.S.; Tian, J.

2013-01-01

Background The Distress Thermometer (dt) is a screening tool recommended to quickly identify cancer patients with distress. Our study aimed to examine the sensitivity and specificity of the dt in detecting psychological distress in long-term Chinese nasopharyngeal cancer (npc) survivors. Methods Data for the 442 participating npc survivors were collected through a self-administered questionnaire based on the dt and the Hospital Anxiety and Depression Scale (hads). The hads was used to define cases of psychological distress. Positive and negative groups were defined based on 4 hads criteria (Anxiety, Depression, Anxiety or Depression, and overall score). Receiver operating characteristic (roc) curves were used to examine the ability of all possible cut-off values of the dt to detect positive and negative cases. For each roc curve, the area under the curve (auc) was used as an indicator of the overall accuracy of the dt to identify positive cases of distress. Results The positive auc values [with 95% confidence intervals (ci)] for the 4 hads criteria were 0.715 (95% ci: 0.667 to 0.764), 0.714 (95% ci: 0.661 to 0.768), 0.724 (95% ci: 0.677 to 0.771), and 0.724 (95% ci: 0.664 to 0.775) respectively. At a cut-off score of 4, the sensitivity of the dt to the four hads criteria was, respectively, 0.366 (95% ci: 0.296 to 0.436), 0.448 (95% ci: 0.364 to 0.532), 0.362 (95% ci: 0.299 to 0.425), and 0.421 (95% ci: 0.339 to 0.502), and the specificity of the dt to the 4 hads criteria was, respectively, 0.860 (95% ci: 0.818 to 0.902), 0.860 (95% ci: 0.821 to 0.899), 0.854 (95% ci: 0.814 to 0.894), and 0.854 (95% ci: 0.814 to 0.894). At a cut-off score of 5, the corresponding sensitivities were lower than those at the cut-off score of 4. All potential cut-off scores showed poor sensitivity (<0.90). Conclusions The roc analysis showed poor discrimination. No potential dt cut-off score had an acceptable sensitivity. The dt showed poor sensitivity in npc survivors. Thus, the dt might not be a valid scale for psychological distress screening in long-term Chinese npc survivors. PMID:24311958

Italian version of the organic brain syndrome and the depression scales from the CARE: evaluation of their performance in geriatric institutions.

PubMed

Spagnoli, A; Foresti, G; MacDonald, A; Williams, P

1987-05-01

The Organic Brain Syndrome (OBS) and the Depression (D) scales derived from the Comprehensive Assessment and Referral Evaluation (CARE) were translated into Italian and used in a survey of geriatric institutions in Milan. During the survey validity and reliability tests of the scales were conducted. Inter-rater reliability (total score weighted kappa) was highly satisfactory for both scales (0.96 for OBS and 0.83 for D scale). Reliability was assessed three times during the survey and showed good stability for both scales, with a slight but significant trend towards reduction over time for the D scale. Reliability of the D scale was significantly lower when the subjects interviewed scored highly on the OBS scale (severe cognitive impairment). Criterion validity was highly satisfactory both for the OBS scale (cut-off point 4/5: sensitivity 77%, specificity 96%, positive predictive value 91%) and the D scale (cut-off point 10/11: sensitivity 95%, specificity 92%, positive predictive value 84%). Results are discussed with special reference to longitudinal assessment of reliability, the choice of the cut-off point, and the context-dependent properties of questionnaires.

Modelling the effects of cutting off infected branches and replanting on fire-blight transmission using Filippov systems.

PubMed

Chen, Can; Li, Chentong; Kang, Yanmei

2018-02-14

Fire blight is one of the most devastating plant diseases in the world. This paper proposes a Filippov fire-blight model incorporating cutting off infected branches and replanting susceptible trees. The Filippov-type model is formulated by considering that no control strategy is taken if the number of infected trees is less than an infected threshold level I c ; further, we cut off infected branches once the number of infected trees exceeds I c ; meanwhile, we replant trees if the number of susceptible trees is less than a susceptible threshold level S c . The global dynamical behaviour of the Filippov system is investigated. It is shown that model solutions ultimately converge to the positive equilibrium that lies in the region above I c , or below I c , or on I=I c , as we vary the susceptible and infected threshold values S c and I c . Our results indicate that proper combinations of the susceptible and infected threshold values based on the threshold policy can lead the number of infected trees to an acceptable level, when complete eradication is not economically desirable. Copyright © 2017 Elsevier Ltd. All rights reserved.

Diagnostic performances of shear wave elastography: which parameter to use in differential diagnosis of solid breast masses?

PubMed

Lee, Eun Jung; Jung, Hae Kyoung; Ko, Kyung Hee; Lee, Jong Tae; Yoon, Jung Hyun

2013-07-01

To evaluate which shear wave elastography (SWE) parameter proves most accurate in the differential diagnosis of solid breast masses. One hundred and fifty-six breast lesions in 139 consecutive women (mean age: 43.54 ± 9.94 years, range 21-88 years), who had been scheduled for ultrasound-guided breast biopsy, were included. Conventional ultrasound and SWE were performed in all women before biopsy procedures. Ultrasound BI-RADS final assessment and SWE parameters were recorded. Diagnostic performance of each SWE parameter was calculated and compared with those obtained when applying cut-off values of previously published data. Performance of conventional ultrasound and ultrasound combined with each parameter was also compared. Of the 156 breast masses, 120 (76.9 %) were benign and 36 (23.1 %) malignant. Maximum stiffness (Emax) with a cut-off of 82.3 kPa had the highest area under the receiver operating characteristics curve (Az) value compared with other SWE parameters, 0.860 (sensitivity 88.9 %, specificity 77.5 %, accuracy 80.1 %). Az values of conventional ultrasound combined with each SWE parameter showed lower (but not significantly) values than with conventional ultrasound alone. Maximum stiffness (82.3 kPa) provided the best diagnostic performance. However the overall diagnostic performance of ultrasound plus SWE was not significantly better than that of conventional ultrasound alone. • SWE offers new information over and above conventional breast ultrasound • Various SWE parameters were explored regarding distinction between benign and malignant lesions • An elasticity of 82.3 kPa appears optimal in differentiating solid breast masses • However, ultrasound plus SWE was not significantly better than conventional ultrasound alone.

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

Ultrasound-Based Detection of Low Muscle Mass for Diagnosis of Sarcopenia in Older Adults.

PubMed

Minetto, Marco A; Caresio, Cristina; Menapace, Tommaso; Hajdarevic, Arnel; Marchini, Andrea; Molinari, Filippo; Maffiuletti, Nicola A

2016-05-01

To establish muscle-specific cut-off values for ultrasound-based detection of low muscle mass, and to assess its prevalence in a population of frail older subjects when applying the cut-points of different muscles and those of different sarcopenic indices. Cross-sectional study. Geriatric outpatient clinic and clinical research laboratory. A total of 44 older adults (30 women and 14 men, mean age 82 years, range 67-93 years) and 60 younger individuals (30 women and 30 men, mean age 26 years, range 20-36 years) participated. Body composition and thickness of 4 lower limb muscles (rectus femoris, vastus lateralis, tibialis anterior, medial gastrocnemius) were respectively assessed by bioelectrical impedance analysis (BIA) and ultrasonography. Site-specific cut-points for ultrasound-based assessment of low muscle mass (muscle thickness values 2 standard deviations below the gender-specific means of our sample of younger subjects) and comparative prevalence rates of low muscle mass. The following site-specific cut-points for muscle thickness were identified: rectus femoris: 20 mm in men and 16 mm in women; vastus lateralis: 17 mm in men and 15 mm in women; tibialis anterior: 23 mm in men and 22 mm in women; and medial gastrocnemius: 13 mm in both men and women. The prevalence of low muscle mass in older adults was highly dependent on the muscle being investigated; it varied from 86% for thigh muscles to 30% for leg muscles. Moreover, the prevalence of low muscle mass was highly dependent on the applied diagnostic criterion and on the adopted cut-off value; it ranged from 2% to 75% for different BIA-derived criteria. We suggest that muscle ultrasonography provides physiatrists with a practical and accurate tool for identifying individuals with low muscle mass. However, the usability of cut-off values established in our group of healthy younger subjects of white ethnicity to identify low muscle mass in older individuals of different ethnic groups remains to be demonstrated in future studies. Copyright © 2016 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Differentiation between microcystin contaminated and uncontaminated fish by determination of unconjugated MCs using an ELISA anti-Adda test based on receiver-operating characteristic curves threshold values: application to Tinca tinca from natural ponds.

PubMed

Moreno, Isabel María; Herrador, M Ángeles; Atencio, Loyda; Puerto, María; González, A Gustavo; Cameán, Ana María

2011-02-01

The aim of this study was to evaluate whether the enzyme-linked immunosorbent assay (ELISA) anti-Adda technique could be used to monitor free microcystins (MCs) in biological samples from fish naturally exposed to toxic cyanobacteria by using receiver operating characteristic (ROC) curve software to establish an optimal cut-off value for MCs. The cut-off value determined by ROC curve analysis in tench (Tinca tinca) exposed to MCs under laboratory conditions by ROC curve analysis was 5.90-μg MCs/kg tissue dry weight (d.w.) with a sensitivity of 93.3%. This value was applied in fish samples from natural ponds (Extremadura, Spain) in order to asses its potential MCs bioaccumulation by classifying samples as either true positive (TP), false positive (FP), true negative (TN), or false negative (FN). In this work, it has been demonstrated that toxic cyanobacteria, mainly Microcystis aeruginosa, Aphanizomenon issatchenkoi, and Anabaena spiroides, were present in two of these ponds, Barruecos de Abajo (BDown) and Barruecos de Arriba (BUp). The MCs levels were detected in waters from both ponds with an anti-MC-LR ELISA immunoassay and were of similar values (between 3.8-6.5-μg MC-LR equivalent/L in BDown pond and 4.8-6.0-μg MC-LR equivalent/L in BUp). The MCs cut-off values were applied in livers from fish collected from these two ponds using the ELISA anti-Adda technique. A total of 83% of samples from BDown pond and only 42% from BUp were TP with values of free MCs higher than 8.8-μg MCs/kg tissue (d.w.). Copyright © 2009 Wiley Periodicals, Inc.

Body composition-derived BMI cut-offs for overweight and obesity in Indians and Creoles of Mauritius: comparison with Caucasians

PubMed Central

Hunma, S; Ramuth, H; Miles-Chan, J L; Schutz, Y; Montani, J-P; Joonas, N; Dulloo, A G

2016-01-01

Background and Aims: Global estimates of overweight and obesity prevalence are based on the World Health Organisation (WHO) body mass index (BMI) cut-off values of 25 and 30 kg m−2, respectively. To validate these BMI cut-offs for adiposity in the island population of Mauritius, we assessed the relationship between BMI and measured body fat mass in this population according to gender and ethnicity. Methods: In 175 young adult Mauritians (age 20-42 years) belonging to the two main ethnic groups—Indians (South Asian descent) and Creoles (African/Malagasy descent), body weight, height and waist circumference (WC) were measured, total body fat assessed by deuterium oxide (D2O) dilution and trunk (abdominal) fat by segmental bioimpedance analysis. Results: Compared to body fat% predicted from BMI using Caucasian-based equations, body fat% assessed by D2O dilution in Mauritians was higher by 3–5 units in Indian men and women as well as in Creole women, but not in Creole men. This gender-specific ethnic difference in body composition between Indians and Creoles is reflected in their BMI–Fat% relationships, as well as in their WC–Trunk Fat% relationships. Overall, WHO BMI cut-offs of 25 and 30 kg m−2 for overweight and obesity, respectively, seem valid only for Creole men (~24 and 29.5, respectively), but not for Creole women whose BMI cut-offs are 2–4 units lower (21–22 for overweight; 27–28 for obese) nor for Indian men and women whose BMI cut-offs are 3–4 units lower (21–22 for overweight; 26–27 for obese). Conclusions: The use of BMI cut-off points for classifying overweight and obesity need to take into account both ethnicity and gender to avoid gross adiposity status misclassification in this population known to be at high risk for type-2 diabetes and cardiovascular diseases. This is particularly of importance in obesity prevention strategies both in clinical medicine and public health. PMID:27698347

[Validation of cut points of skeletal muscle mass index for identifying sarcopenia in Chilean older people].

PubMed

Lera, Lydia; Ángel, Bárbara; Sánchez, Hugo; Picrin, Yaisy; Hormazabal, María José; Quiero, Andrea; Albala, Cecilia

2014-09-28

To estimate and validate cut-off points of skeletal muscle mass index (SMI) in Chilean population, for using in an algorithm for a diagnosis of sarcopenia developed by European Working Group on Sarcopenia in Older People (EWGSOP). Secondary analysis of Cross-sectional data in 440 Chilean older subjects to estimate cut-off points of SMI determined by DEXA and predicted by an anthropometric equation. Afterward a cross-sectional validation in a sample of 164 older people was performed. Anthropometric measures, self-reported health status, physical performance tests and DEXA were carried out. Decreased muscle strength was defined as handgrip strength <15 kg in women and <27 kg in male. Cut-off points of SMI were defined as values under 20th percentile for DEXA measures and estimated through ROC curves for the anthropometric model. Biological validity of the algorithm was tested by contrasting the diagnosis with physical performance tests and functionality. Cut-off points of SMI obtained by DEXA were 7.19 kg/m² in men and 5.77 kg/m² in women and 7.45 kg/ m² and 5.88 kg/m², respectively for the predicted by the model. Sensibility and specificity of estimations vs DEXA measures were 80% and 92% in men and 77% and 89% in women. We obtained cut-off points of SMI for DEXA and for a prediction equation for older adults Chilean, with good sensibility and specificity for the measurement by DEXA. It will allow to apply the EWGSOP algorithm to the early diagnosis of sarcopenia and to develop programs for prevention, delay or reversion this syndrome. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

Use of the 50-g glucose challenge test to predict excess delivery weight.

PubMed

Beksac, M Sinan; Tanacan, Atakan; Hakli, Duygu A; Ozyuncu, Ozgur

2018-07-01

To identify a cut-off value for the 50-g glucose challenge test (GCT) that predicts excess delivery weight. A retrospective study was conducted among pregnant women who undertook a 50-g GCT at Hacettepe University Hospital, Ankara, Turkey, between January 1, 2000, and December 31, 2016. Patients with singleton pregnancies who delivered live neonates after 28 weeks of pregnancy were included. Patients were classified according to their 50-g GCT values into group 1 (<7.770 mmol/L); group 2 (7.770 to <8.880 mmol/L, group 3 (8.880-9.990 mmol/L); or group 4 (>9.990 mmol/L). Classification and regression tree data mining was performed to identify the 50-g GCT cut-off value corresponding to a substantial increase in delivery weight. Median delivery weight were 3100 g in group 1 (n=352), 3200 g in group 2 (n=165), 3720 g in group 3 (n=47), and 3865 g in group 4 (n=20). Gravidity, 50-g GCT value, and pregnancy duration at delivery explained 30.6% of the observed variance in delivery weight. The cut-off required for maternal blood glucose level to predict excessive delivery weight was 8.741 mmol/L. The 50-g GCT can be used to identify women at risk of delivering offspring with excessive delivery weight. © 2018 International Federation of Gynecology and Obstetrics.

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.

Their Budgets Slashed, Public Colleges Share the Pain with a Glut of Applicants

ERIC Educational Resources Information Center

Mangan, Katherine

2008-01-01

This article reports that as students flock to public two-year and four-year colleges amid an ailing economy, they find the colleges struggling with financial problems of their own. Midyear budget cuts are forcing many institutions to lay off faculty members, cut course sections, and freeze enrollment. Rising unemployment, slumping values of…

Lead, cadmium and mercury levels in pregnancy: the need for international consensus on levels of concern.

PubMed

Taylor, C M; Golding, J; Emond, A M

2014-02-01

For heavy metals that have any degree of transfer though the placenta to the fetus, it is unlikely that there are safe limits for maternal blood levels. The only means of reducing fetal exposure is to minimise maternal exposure. There are few recommendations for levels of concern. With the exception of US recommendations for maternal Pb levels, but there are no international levels of concern or cut-off levels specifically for pregnancy for heavy metals, so that comparisons can generally only be made with national reference values relating to similar physiological statuses or age groups. These include recommendations for Cd levels by Germany (reference value for non-smoking adults aged 18-69 years, 1 µg/l) and for Hg by Germany (reference value for adults age 18-60 years with fish intake < or =3 times per month, 2.0 µg/l) and the USA (cut-off level for women, 5.8 µg/dl). To illustrate the lack of cohesion, we present data on blood Pb, Cd and Hg levels from pregnant women enroled in the UK Avon Longitudinal Study of Parents and Children study and compare the values with present levels of concern and recommended cut-off values. We also compare the levels with those found in other groups of pregnant women worldwide to strengthen the database for the development of levels of concern in pregnancy. The need for clarity of terminology in describing levels of concern is discussed. There is a pressing need for international consensus on levels of concern for all age groups and physiological statuses, particularly for pregnancy.

Objective assessment of subjective tinnitus through contralateral suppression of otoacoustic emissions by white noise; suggested cut-off points.

PubMed

Riga, M; Komis, A; Maragkoudakis, P; Korres, G; Danielides, V

2016-12-01

Normative otoacoustic emission (OAE) suppression values are currently lacking and the role of cochlear efferent innervation in tinnitus is controversial. The aim of this study was to investigate the association between tinnitus and medial olivocochlear bundle (MOCB) malfunction. Potential suppression amplitude cut-off criteria that could differentiate participants with tinnitus from those without were sought. Mean suppression amplitudes of transient evoked OAEs and distortion product OAEs by contralateral white noise (50 dBSL) were recorded. Six mean suppression amplitudes criteria were validated as possible cut-off points. The population consisted of normal hearing (n = 78) or presbycusic adults (n = 19) with tinnitus or without (n = 28 and 13, respectively) chronic tinnitus (in total, n = 138 78 females/60males, aged 49 ± 14 years). Participants with mean suppression values lower than 0.5-1 dBSPL seem to present a high probability to report tinnitus (specificity 88-97%). On the other hand, participants with mean suppression values larger than 2-2.5dBSPL seem to present a high probability of the absence of tinnitus (sensitivity 87-99%). Correlations were stronger among participants with bilateral presence or absence of tinnitus. This study seem to confirm an association between tinnitus and low suppression amplitudes (<1 dBSPL), which might evolve into an objective examination tool, supplementary to conventional audiological testing.

Role of pulmonary hemodynamics in determining 6-minute walk test result in atrial septal defect: an observational study.

PubMed

Supomo, Supomo; Darmawan, Handy; Arjana, Adika Zhulhi

2018-05-22

The presence of altered pulmonary hemodynamics in adult patients with atrial septal defect (ASD) is common. However, there are no observational studies which evaluate the impact of altered pulmonary hemodynamics on the 6-min walk test (6MWT) result. This study aimed to investigate the role of pulmonary hemodynamics in determining 6MWT result of patients with ASD. Forty-six consecutive adult patients with ASD were included in this study. Right heart catheterization was performed to obtain the pulmonary hemodynamics profile. Meanwhile, 6MWT was presented as high or low with cut-off point 350 m. Receiver operating characteristic (ROC) was used for analytical methods. Abnormal functional capacity was indicated by ROC result of mPAP cut-off value of > 24 mmHg (p = 0.0243; AUC = 0.681). The value of PVR > 3.42 woods unit (WU) showed high specificity in determining abnormal functional capacity (p = 0.0069; AUC = 0.713). Flow ratio with cut-off point ≤4.89 had the highest sensitivity (100%) (p = 0.8300; AUC = 0.520). Pulmonary hemodynamics can serve as an indicator of 6MWT result in adult ASD patients with values of mPAP> 24 mmHg and PVR > 3.42 WU.

Antimicrobial susceptibility and distribution of inhibition zone diameters of bovine mastitis pathogens in Flanders, Belgium.

PubMed

Supré, K; Lommelen, K; De Meulemeester, L

2014-07-16

In dairy farms, antimicrobial drugs are frequently used for treatment of (sub)clinical mastitis. Determining the antimicrobial susceptibility of mastitis pathogens is needed to come to a correct use of antimicrobials. Strains of Staphylococcus aureus (n=768), Streptococcus uberis (n=939), Streptococcus dysgalactiae (n=444), Escherichia coli (n=563), and Klebsiella species (n=59) originating from routine milk samples from (sub)clinical mastitis were subjected to the disk diffusion method. Disks contained representatives of frequently used antibiotics in dairy. A limited number of clinical breakpoints were available through CLSI, and showed that susceptibility of Staph. aureus, E. coli, and Klebsiella was moderate to high. For streptococcal species however, a large variation between the tested species and the different antimicrobials was observed. In a next step, wild type populations were described based on epidemiological cut off values (EUCAST). Because of the limited number of official cut off values, the data were observed as a mastitis subpopulation and self-generated cut off values were created and a putative wild type population was suggested. The need for accurate clinical breakpoints for veterinary pathogens is high. Despite the lack of these breakpoints, however, a population study can be performed based on the distribution of inhibition zone diameters on the condition that a large number of strains is tested. Copyright © 2014 Elsevier B.V. All rights reserved.

Sensitivity and Specificity of Biochemical Tests for Diagnosis of Intrahepatic Cholestasis of Pregnancy.

PubMed

Jurate, Kondrackiene; Rimantas, Zalinkevicius; Jolanta, Sumskiene; Vladas, Gintautas; Limas, Kupcinskas

2017-01-01

Intrahepatic cholestasis of pregnancy (ICP) is linked with increased risk of fetal complications. An accurate diagnostic test is needed to diagnose this disorder on time. We aimed to assess sensitivity and specificity of laboratory tests used for diagnosis of intrahepatic cholestasis of pregnancy and determine more reliable cut-off values of transaminases. Sixty one symptomatic patients with ICP and 29 healthy pregnant women were included in the retrospective analysis. ICP patients had higher total bile acids (TBA) levels than healthy women (32 vs. 6; P < 0.0001) due to increase in cholic acid (CA) and chenodeoxycholic acid (CDCA). CA/CDCA ratio was significantly higher in ICP patients compared to healthy pregnant women (1.13 vs. 0.68; P < 0.00002). TBA, CA, CDCA and CA/CDCA ratio demonstrate the following sensitivity (94%, 96%, 89%, 71.9%) and specificity (63%, 63%, 59%, 79.3%, respectively) for ICP diagnosis. Lowering cut-off values for ALT (31 U/L) and AST (30 U/L) resulted only in minimal increase of sensitivity to 92.2% vs. 90.1% for ALT and to 92.2%, vs. 90.6% for AST. The present study did not reveal any single specific and sensitive marker for reliable diagnosis of ICP. Establishment of lower cut-off values for transaminases activity might only minimally increase the accuracy of diagnosing ICP.

Body mass index for predicting hyperglycemia and serum lipid changes in Brazilian adolescents.

PubMed

Vieira, Ana Carolina R; Alvarez, Marlene M; Kanaan, Salim; Sichieri, Rosely; Veiga, Gloria V

2009-02-01

To determine the best cut-offs of body mass index for identifying alterations of blood lipids and glucose in adolescents. A probabilistic sample including 577 adolescent students aged 12-19 years in 2003 (210 males and 367 females) from state public schools in the city of Niterói, Southeastern Brazil, was studied. The Receiver Operating Characteristic curve was used to identify the best age-adjusted BMI cut-off for predicting high levels of serum total cholesterol (> or =150 mg/dL), LDL-C (> or =100 mg/dL), serum triglycerides (> or =100 mg/dL), plasma glucose (> 100 mg/dL) and low levels of HDL-C (< 45 mg/dL). Four references were used to calculate sensitivity and specificity of BMI cut-offs: one Brazilian, one international and two American. The most prevalent metabolic alterations (>50%) were: high total cholesterol and low HDL-C. BMI predicted high levels of triglycerides in males, high LDL-C in females, and high total cholesterol and the occurrence of three or more metabolic alterations in both males and females (areas under the curve range: 0.59 to 0.67), with low sensitivity (57%-66%) and low specificity (58%-66%). The best BMI cut-offs for this sample (20.3 kg/m(2) to 21.0 kg/m(2)) were lower than those proposed in the references studied. Although BMI values lower than the International cut-offs were better predictor of some metabolic abnormalities in Brazilian adolescents, overall BMI is not a good predictor of these abnormalities in this population.

Three screening methods for cognitive dysfunction using the Mini-Mental State Examination and Korean Dementia Screening Questionnaire.

PubMed

Choi, Seong Hye; Park, Moon Ho

2016-02-01

To screen for and determine cognitive dysfunction, cognitive tests and/or informant reports are commonly used. However, these cognitive tests and informant reports are not always available. The present study investigated three screening methods using the Mini-Mental State Examination (MMSE) as the cognitive test, and the Korean dementia screening questionnaire (KDSQ) as the informant report. Participants were recruited from the Korea Clinical Research Center for Dementia of South Korea, and included 2861 patients with Alzheimer's disease (dementia), 3519 patients with mild cognitive impairment and 1375 controls with no cognitive dysfunction. Three screening methods were tested: (i) MMSE alone (MMSE(cut-off) ); (ii) a conventional combination of MMSE and KDSQ (MMSE+KDSQ(cut-off) ); and (iii) a decision tree with MMSE and KDSQ (MMSE+KDSQ(decision tree) ). For discriminating any cognitive dysfunction from controls, MMSE+KDSQ(cut-off) had the highest area under the receiver operating characteristic curve (0.784). For discriminating dementia from controls, MMSE+KDSQ(cut-off) had the highest area under the receiver operating characteristic curve (0.899). For discriminating mild cognitive impairment from controls, MMSE(cut-off) had the highest area under the receiver operating characteristic curve (0.683). MMSE+KDSQ(decision tree) showed the highest sensitivity for all discriminations. For overall classification accuracy, MMSE+KDSQ(decision tree) had the highest value (70.0%). These three methods had different advantageous properties for screening and staging cognitive dysfunction. As there might be different availability across clinical settings, these three methods can be selected and used according to situational needs. © 2015 Japan Geriatrics Society.

Derivation and validation of a simple clinical risk-model in heart failure based on 6 minute walk test performance and NT-proBNP status--do we need specificity for sex and beta-blockers?

PubMed

Frankenstein, L; Goode, K; Ingle, L; Remppis, A; Schellberg, D; Nelles, M; Katus, H A; Clark, A L; Cleland, J G F; Zugck, C

2011-02-17

It is unclear whether risk prediction strategies in chronic heart failure (CHF) need to be specific for sex or beta-blockers. We examined this problem and developed and validated the consequent risk models based on 6-minute-walk-test and NT-proBNP. The derivation cohort comprised 636 German patients with systolic dysfunction. They were validated against 676 British patients with similar aetiology. ROC-curves for 1-year mortality identified cut-off values separately for specificity (none, sex, beta-blocker, both). Patients were grouped according to number of cut-offs met (group I/II/III - 0/1/2 cut-offs). Widest separation between groups was achieved with sex- and beta-blocker-specific cut offs. In the derivation population, 1-year mortality was 0%, 8%, 31% for group I, II and III, respectively. In the validation population, 1-year rates in the three risk groups were 2%, 7%, 14%, respectively, after application of the same cut-offs. Risk stratification for CHF should perhaps take sex and beta-blocker usage into account. We derived and independently validated relevant risk models based on 6-minute-walk-tests and NT-proBNP. Specifying sex and use of beta-blockers identified three distinct sub-groups with widely differing prognosis. In clinical practice, it may be appropriate to tailor the intensity of follow-up and/or the treatment strategy according to the risk-group. Copyright © 2009 Elsevier Ireland Ltd. All rights reserved.

Evaluation of insulin resistance improvement after laparoscopic sleeve gastrectomy or gastric bypass surgery with HOMA-IR.

PubMed

Zhu, Yubing; Sun, Zhipeng; Du, Yanmin; Xu, Guangzhong; Gong, Ke; Zhu, Bin; Zhang, Nengwei

2017-01-01

Our purpose was to explore the remission of insulin resistance after bariatric surgery to discover the mechanism of diabetes remission excluding dietary factors. A retrospective case control study was conducted on patients with type 2 diabetes, who underwent laparoscopic sleeve gastrectomy (LSG) or laparoscopic gastric bypass surgery (LGB) in Beijing Shijitan Hospital from April 1, 2012 to April 1, 2013. The laboratory and anthropometric data was analyzed pre-surgery and during a 2-year follow-up. HOMA-IR was calculated and evaluated. The two surgical procedures were compared. No significant difference in complete remission rate was observed between the two groups (LGB group: 62.1%, LSG group: 60.0%, p = 0.892). HOMA-IR was reduced to a stable level at the 3 rd month after surgery. The cut-off value of HOMA-IR was 2.38 (sensitivity: 0.938, specificity: 0.75) and 2.33 (sensitivity: 0.941, specificity: 0.778) respectively for complete remission after LSG or LGB surgery. Insulin resistance was improved while GLP-1 and Ghrelin was changed significantly in patients with type 2 diabetes prior to weight loss either in the LSG or LGB group. HOMA-IR decreased to less than the cut-off value at the 3 rd month and was closely related to complete remission. The mechanism of bariatric surgery was not due just to simply dietary factors or body weight loss but also the remission of insulin resistance.

Psychological distress of residents in Kawauchi village, Fukushima Prefecture after the accident at Fukushima Daiichi Nuclear Power Station: the Fukushima Health Management Survey.

PubMed

Yoshida, Koji; Shinkawa, Tetsuko; Urata, Hideko; Nakashima, Kanami; Orita, Makiko; Yasui, Kiyotaka; Kumagai, Atsushi; Ohtsuru, Akira; Yabe, Hirooki; Maeda, Masaharu; Hayashida, Naomi; Kudo, Takashi; Yamashita, Shunichi; Takamura, Noboru

2016-01-01

To shed light on the mental health of evacuees after the accident at Fukushima Daiichi Nuclear Power Station (FDNPS), we evaluate the results of the Fukushima Health Management Survey (FHMS) of the residents at Kawauchi village in Fukushima, which is located less than 30 km from the FDNPS. We conducted the cross-sectional study within the framework of the FHMS. Exposure values were "anorexia," "subjective feelings about health," "feelings about sleep satisfaction," and "bereavement caused by the disaster," confounding variables were "age" and "sex," and outcome variables were "K6 points." We collected data from the FHMS, and employed the Kessler Psychological Distress Scale (K6) and the posttraumatic stress disorder (PTSD) Checklist Stressor-Specific Version (PCL-S) to carry out the research. A total of 13 or greater was the cut-off for identifying serious mental illness using the K6 scale. The study subjects included residents (n = 542) of over 30 years of age from Kawauchi village, and data were used from the period of January 1, 2012 to October 31, 2012. A total of 474 residents (87.5%) scored less than 13 points in the K6 and 68 (12.6%) scored 13 points or more. The proportion of elderly residents (over 65 years old) among people with K6 score above the cut-off was higher than that among people with K6 score below the cut-off (44.1 vs 31.0%, p < 0.05). In addition, the proportion of residents with anorexia and mental illness among people with K6 score above the cut-off was higher than among people with K6 score below the cut-off (p < 0.001 and p < 0.05, respectively). The amount of residents who scored 44 points or more in the PCL-S among people with K6 score above the cut-off was also considerably higher than among people with K6 score below the cut-off (79.4 vs 12.9%, p < 0.001). Interestingly, the proportion of residents who scored more than among people with K6 score above the cut-off and the among people with PCL-S score above the cut-off in Kawauchi was higher than in previous studies in other locations. These results suggest that there are severe mental health problems, such as depression and PTSD, among adults as a consequence of the accident at the FDNPS. Our study showed that residents who lived in the evacuation zone before the disaster are at high risk psychological distress. To facilitate local residents' recovery from Fukushima, there is a need to continue providing them with physical and mental support, as well as communication regarding the health risks of radiation.

On the high energy cut-off of accreting sources: Is general relativity relevant?

NASA Astrophysics Data System (ADS)

Tamborra, Francesco; Papadakis, Iossif; Dovčiak, Michal; Svoboda, Jiři

2018-04-01

The hard X-ray emission observed in accreting compact sources is believed to be produced by inverse Compton scattering of soft photons arising from the accretion disc by energetic electrons thermally distributed above the disc, the so-called X-ray corona. Many independent observations suggest that such coronae should be compact and located very close to the black hole. In this case, general relativistic (GR) effects should play an important role to the continuum X-ray emission from these sources, and, in particular, in the observed high energy cut-off, which is a measure of the intrinsic temperature of the corona. Our results show that the energy shift between the observed and intrinsic high energy cut-off due to GR effects can be as large as two to eight times, depending on the geometry and size of the corona as well as its inclination. We provide estimates of this energy shift in the case of a lamp-post and a flat, rotating corona, around a Kerr and a Schwartzschild black hole, for various inclinations, and coronal sizes. These values could be useful to correct the observed high energy cut-off and/or coronal temperatures, either in the case of individual or large sample of objects.

Evaluation of 18F-FDG PET/CT Parameters for Detection of Lymph Node Metastasis in Cutaneous Melanoma.

PubMed

Cha, Jongtae; Kim, Soyoung; Wang, Jiyoung; Yun, Mijin; Cho, Arthur

2018-02-01

The purpose of this study was to investigate the value of 18 F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) parameters in the detection of regional lymph node (LN) metastasis in patients with cutaneous melanoma. We evaluated patients with cutaneous melanoma who underwent FDG PET/CT for initial staging or recurrence evaluation. A total of 103 patients were enrolled, and 165 LNs were evaluated. LNs that were confirmed pathologically or by follow-up imaging were included in this study. PET parameters, including maximum standardized uptake value (SUVmax), total lesion glycolysis and tumour-to-liver ratio, were used to determine the presence of metastases, and the results were compared with CT-determined LN metastasis. Receiver operating characteristic (ROC) curve analysis was used to determine the optimal cut-off values of the FDG PET parameters. A total of 93 LNs were malignant, and 84 LNs were smaller than 10 mm. In all 165 LNs, an SUVmax of >2.51 showed a sensitivity of 73.1%, a specificity of 88.9%, and an accuracy of 80.0% in detecting metastatic LNs. CT showed a higher specificity (87.3%) and lower accuracy (65.5%). For non-enlarged regional LNs (<10 mm), an SUVmax cut-off value of 1.4 showed the highest negative predictive value (81.3%). For enlarged LNs (≥10 mm), an SUVmax cut-off value of 2.4 showed the highest sensitivity (90.7%) and accuracy (88.9%) in detecting metastatic LNs. In patients with cutaneous melanoma, an SUVmax of >2.4 showed a high sensitivity (91%) and accuracy (89%) in detecting metastasis in LNs ≥1 cm, and LNs <1 cm with an SUVmax <1.4 were likely to be benign.

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.

The prognostic value of the systemic inflammatory score in patients with unresectable metastatic colorectal cancer.

PubMed

Shibutani, Masatsune; Maeda, Kiyoshi; Nagahara, Hisashi; Fukuoka, Tatsunari; Matsutani, Shinji; Kimura, Kenjiro; Amano, Ryosuke; Hirakawa, Kosei; Ohira, Masaichi

2018-07-01

Inflammation has been widely recognized as a contributor to cancer progression and several inflammatory markers have been reported as associated with the clinical outcomes in patients with various types of cancer. Recently, a novel inflammatory marker, the systemic inflammatory score (SIS), which is based on a combination of the lymphocyte-to-monocyte ratio (LMR) and the serum albumin concentration has been reported as a useful prognostic marker. The aim of the present study was to assess the prognostic value of the SIS in patients with unresectable metastatic colorectal cancer (mCRC). The retrospective cohort study included 160 patients who underwent combination chemotherapy for unresectable mCRC between January 2008 and December 2016. The SIS was used to classify the patients into three groups based on their LMR and the serum albumin concentration. Patients with high-LMR and high serum albumin level were given a score of 0; patients with low-LMR or low serum albumin level were given a score of 1; patients with low-LMR and low serum albumin level were given a score of 2. There were significant differences in the overall survival among the three SIS groups and the SIS was an independent prognostic factor for the overall survival. Although the SIS was significantly associated with the overall survival rate even when using the original cut-off values, the SIS according to the new cut-off values had a more accurate prognostic value. The present study determined that the SIS was a useful biomarker for predicting the survival outcomes in patients with unresectable mCRC, although the optimum cut-off value of the SIS according to the patients' background needs to be examined in further studies.

Diagnostic accuracy of HbA1c in diabetes between Eastern and Western.

PubMed

Yan, Shuang; Liu, Siying; Zhao, Yashuang; Zhang, Wencui; Sun, Xiaohui; Li, Jianing; Jiang, Fuli; Ju, Jiaming; Lang, Ning; Zhang, Yingqi; Zhou, Weiyu; Li, Qiang

2013-07-01

In 2010, the American Diabetes Association recommended the use of HbA1c as a diagnostic criterion for diabetes. However, HbA1c is not an accepted diagnostic tool for diabetes in Eastern Asia, because genetic differences compromise the standardization of the diagnostic cut-off point. This study evaluated differences in the use of HbA1c for diagnosing diabetes in Eastern and Western populations and investigated whether HbA1c cut-off point of ≥ 6.5% is diagnostic of diabetes in patients from Eastern Asia. Literature was obtained from MEDLINE, EMBASE and Cochrane databases. The pooled sensitivity and specificity of each HbA1c cut-off point were extracted and compared between Western and Eastern populations. Differences in the cut-off point for diagnosing diabetes in each region were compared by examining differences in the area under summary receiver operating characteristic (SROC) curves. Twelve publications from Eastern countries (n = 59,735) and 13 from Western countries (n = 22,954) were included in the analysis. Areas under SROC curves in the Eastern and Western groups were 0.9331 and 0.9120, respectively (P = 0.98). The cut-off point of the highest Youden index was 6.0%. At the HbA1c cut-off point of 6.5%, the pooled sensitivity and specificity were 58.7% and 98.4% for Eastern countries and 65.5% and 98.1% for Western countries, respectively. HbA1c exhibits the same diagnostic value for diabetes in Eastern and Western populations. In both populations, HbA1c levels > 6.0% identify the population at high risk of diabetes, and HbA1c > 6.5% is diagnostic of clinically established diabetes. © 2013 Stichting European Society for Clinical Investigation Journal Foundation. Published by John Wiley & Sons Ltd.

Clinically Relevant Cut-off Points for the Diagnosis of Sarcopenia in Older Korean People.

PubMed

Choe, Yu-Ri; Joh, Ju-Youn; Kim, Yeon-Pyo

2017-11-09

The optimal criteria applied to older Korean people have not been defined. We aimed to define clinically relevant cut-off points for older Korean people and to compare the predictive validity with other definitions of sarcopenia. Nine hundred and sixteen older Koreans (≥65 years) were included in this cross-sectional observational study. We used conditional inference tree analysis to determine cut-off points for height-adjusted grip strength (GS) and appendicular skeletal muscle mass (ASM), for use in the diagnosis of sarcopenia. We then compared the Korean sarcopenia criteria with the Foundation for the National Institutes of Health and Asian Working Group for Sarcopenia criteria, using frailty, assessed with the Korean Frailty Index, as an outcome variable. For men, a residual GS (GSre) of ≤ 0.25 was defined as weak, and a residual ASM (ASMre) of ≤ 1.29 was defined as low. Corresponding cut-off points for women were a GSre of ≤ 0.17 and an ASMre of ≤ 0.69. GSre and ASMre values were adjusted for height. In logistic regression analysis with new cut-off points, the adjusted odds ratios for pre-frail or frail status in the sarcopenia group were 3.23 (95% confidence interval [CI] 1.33-7.83) for the men and 1.74 (95% CI 0.91-3.35) for the women. In receiver operating characteristic curve analysis, the unadjusted area under the curve for Korean sarcopenia criteria in men and women were 0.653 and 0.608, respectively (p < .001). Our proposed cut-off points for low GS and low ASM should be useful in the diagnosis of sarcopenia in older Korean people. © The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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...

Transformation of nonlinear behaviors: from bright- to dark-gap soliton in a one-dimensional photonic crystal containing a nonlinear indefinite metamaterial defect.

PubMed

Zhang, Wei; Chen, Yuanyuan; Hou, Peng; Shi, Jielong; Wang, Qi

2010-12-01

Nonlinear propagation characteristics are investigated theoretically in a one-dimensional photonic band-gap structure doped with a nonlinear indefinite metamaterial defect for five distinct frequency intervals. It is found from the electric field distribution that there exists the bright gap solitonlike when the nonlinear indefinite metamaterial defect is a cut-off medium, while the dark gap solitonlike can appear in the nonlinear never cut-off defect layer. It is also found that there exists corresponding bistable lateral shift the properties of which are strongly dependent on the permittivity and permeability of nonlinear indefinite metamaterials. Moreover, in contrast to the switch-down threshold value, the switch-up threshold value is more sensitive to the incident frequency.

Definition of improvement in juvenile idiopathic arthritis using the juvenile arthritis disease activity score.

PubMed

Horneff, Gerd; Becker, Ingrid

2014-07-01

The aim of this study was to define improvement thresholds for the Juvenile Arthritis Disease Activity Score (JADAS). Physicians' and parents' judgements on treatment efficacy, the ACR paediatric response measure (PedACR) and JADAS were extracted from BIKER. Patients were categorized by baseline classes in the 10-joint JADAS (JADAS10) as low (5 to <15), moderate (15 to <25) and high (25 to ≤40). Cut-offs for defining improvement following treatment with biologics or MTX were chosen by calculating the interquartile ranges (IQRs) of the judgement groups and considering the accuracy, sensitivity and specificity of the resulting model. Differences in the change of JADAS10 by JIA category were also analysed by analysis of variance (ANOVA). Sensitivity, specificity and accuracy were calculated. A total of 1315 treatment courses were analysed. The ANOVA of the JIA categories showed no significant differences of the mean JADAS10 in all baseline classes and IQRs also showed good overall limits. Therefore all JIA categories were combined for a collective cut-off. Analysis by baseline class revealed clear cut-off points. Improvement could be defined by the minimal decrease in the JADAS10 in baseline class low by 4 (41%), moderate by 10 (53%) and high by 17 (57%). The model shows values for accuracy from 75.6 to 85.5% and comparable values for sensitivity and specificity. Improvement after 3 months can be defined efficiently by the decrease of the JADAS10, depending on the baseline JADAS10 score, which specifies low, moderate or high disease activity. Our model demonstrates clear cut-off values. The JADAS10 may be used in addition to ACR criteria in clinical trials. Also, since the JADAS10 can easily be calculated at each patient visit, it also can be used for clinical decisions. © The Author 2014. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Serum AMH Level to Predict the Hyper Response in Women with PCOS and Non-PCOS Undergoing Controlled Ovarian Stimulation in ART.

PubMed

Vembu, Radha; Reddy, Nellepalli Sanjeeva

2017-01-01

It is essential to determine the cut-off value of serum anti-Mullerian hormone (AMH) to predict the hyper response in assisted reproductive technology (ART). There are few studies mentioning the cut-off value for the hyper response in infertile women but not specifically for polycystic ovary syndrome (PCOS) and non-PCOS groups. With this in background, this study was conducted. To determine the cut-off value of serum AMH to predict the hyper response in women with PCOS and non-PCOS undergoing a controlled ovarian stimulation (COS) in ART. To compare the outcome of stimulation in PCOS and non-PCOS groups. All 246 women enrolled for Intra Cytoplasmic Sperm Injection (ICSI) fulfilling the selection criteria were recruited. On the day 3 of the cycle, the serum AMH, Follicle Stimulating Hormone (FSH), Luteinizing Hormone (LH), estradiol and antral follicle count (AFC) were measured. They underwent COS as per the unit protocol. They were divided into PCOS and non-PCOS groups as per the Rotterdam's criteria. The mean age, duration of infertility, Body Mass Index (BMI), Ovarian reserve markers and outcome of stimulation were compared. Using the Statistical Package for the Social Sciences version 16.0 software, the significant difference was measured by multivariate analysis, as well as a one-way analysis of variance with Tukey's post-hoc test was used. Among 246 women, 31.3% were in PCOS group, and 68.7% were in non-PCOS group. Comparison of PCOS and non-PCOS groups showed a significant difference in the age with the mean age being 29.2 and 31.5 years, respectively. The mean AMH and AFC were 2-fold higher in PCOS group. The mean number of follicles, oocytes retrieved, MII and oocytes fertilised were significantly higher in PCOS group. The pregnancy rate was 52.6% in PCOS and 30.9% in non-PCOS group. In the PCOS group, 22.1% had ovarian hyper stimulation syndrome (OHSS), and only 4.7% had OHSS in non-PCOS group ( P = 0.0005). Receiving Operator Curve (ROC) curve was plotted to predict the hyper response, which showed a cut-off value of 6.85 ng/ml with a sensitivity of 66.7% and a specificity of 68.7% for PCOS group and 4.85 ng/ml with a sensitivity of 85.7% and a specificity of 89.7% in non-PCOS group. The cut-off value of serum AMH to predict the hyper response in PCOS group is 6.85 ng/ml and in non-PCOS group is 4.85 ng/ml.

Establishing the cut off values of androgen markers in the assessment of polycystic ovarian syndrome.

PubMed

Nadaraja, R N D; Sthaneshwar, P; Razali, N

2018-04-01

Hyperandrogenism remains as one of the key features in Polycystic Ovarian Syndrome (PCOS) and can be assessed clinically or determined by biochemical assays. Hirsutism is the most common clinical manifestation of hyperandrogenism. The clinical assessment is subjected to wide variability due to poor interobserver agreement and multiple population factors such as ethnic variation, cosmetic procedures and genetic trait. The difficulty in resolving the androgen excess biochemically is due to a lack of consensus as to which serum androgen should be measured for the diagnosis of PCOS. The aim of the study was to compare and establish the diagnostic cut off value for different androgen biomarker for the diagnosis of PCOS. A total of 312 patients classified to PCOS (n = 164) and non PCOS (n = 148) cohorts were selected from the Laboratory Information System (LIS) based on serum total testosterone (TT) and sex hormone binding globulin (SHBG) from the period of 1st April 2015 to 31st March 2016. PCOS was diagnosed based on Rotterdam criteria. Clinical hyperandrogenism and ultrasound polycystic ovarian morphology were obtained from the clinical records. The other relevant biochemical results such as serum luteinizing hormone (LH), follicle stimulating hormone (FSH) and albumin were also obtained from LIS. Free androgen index (FAI), calculated free testosterone (cFT) and calculated bioavailable testosterone (cBT) were calculated for these patients. Receiver Operating Characteristic (ROC) curve analysis were performed for serum TT, SHBG, FAI, cFT, cBT and LH: FSH ratio to determine the best marker to diagnose PCOS. All the androgen parameters (except SHBG) were significantly higher in PCOS patients than in control (p<0.0001). The highest area under curve (AUC) curve was found for cBT followed by cFT and FAI. TT and LH: FSH ratio recorded a lower AUC and the lowest AUC was seen for SHBG. cBT at a cut off value of 0.86 nmol/L had the highest specificity, 83% and positive likelihood ratio (LR) at 3.79. This is followed by FAI at a cut off value of 7.1% with specificity at 82% and cFT at a cut off value of 0.8 pmol/L with specificity at 80%. All three calculated androgen indices (FAI, cFT and cBT) showed good correlation with each other. Furthermore, cFT, FAI and calculated BT were shown to be more specific with higher positive likelihood ratio than measured androgen markers. Based on our study, the calculated testosterone indices such as FAI, cBT and cFT are useful markers to distinguish PCOS from non-PCOS. Owing to ease of calculation, FAI can be incorporated in LIS and can be reported with TT and SHBG. This will be helpful for clinician to diagnose hyperandrogenism in PCOS.

[Value of Neutrophil/Lymphocyte Ratio and Platelet/Lymphocyte Ratio for Prognostic Evaluation of Diffuse Large B-cell Lymphoma].

PubMed

Ni, Jing; Wang, Yong-Qing; Zhang, Ying-Ping; Wu, Wei; Zeng, Qing-Shu; Yang, Ming-Zhen; Xia, Rui-Xiang

2016-04-01

To investigate the predictive value of neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) for the patients with diffuse large B-cell lymphoma (DLBCL). The clinical data of 57 DLBCL patients admitted in the First Affiliated hospital of Anhui Medical University were analyzed retrospectively. According to ROC curve, the cut-off value for NLR and PLR was deterimined, and the patients were divided into high and low NLR/PLR groups before first chamotherapy. Then the relation of NLR and PLR with overall survival (OS) and progression-free survival (PFS) was analyzed by univariate and multivariate COX regression. The optimal cut-off value for NLR and PLR was 2.915 and 270.27, respectively. NLR at the diagnosis was found to be an independent predictor for OS and PFS by univariate and multivariate analysis, while the PLR was an independent predictor for PFS, but did not affect the OS. NLR and PLR may provide additional prognostic information for DLBCL patients.

Clinical value of preoperative serum CA 19-9 and CA 125 levels in predicting the resectability of hilar cholangiocarcinoma.

PubMed

Hu, Hai-Jie; Mao, Hui; Tan, Yong-Qiong; Shrestha, Anuj; Ma, Wen-Jie; Yang, Qin; Wang, Jun-Ke; Cheng, Nan-Sheng; Li, Fu-Yu

2016-01-01

To examine the predictive value of tumor markers for evaluating tumor resectability in patients with hilar cholangiocarcinoma and to explore the prognostic effect of various preoperative factors on resectability in patients with potentially resectable tumors. Patients with potentially resectable tumors judged by radiologic examination were included. The receiver operating characteristic (ROC) analysis was conducted to evaluate serum carbohydrate antigenic determinant 19-9 (CA 19-9), carbohydrate antigen 125 (CA 125) and carcino embryonie antigen levels on tumor resectability. Univariate and multivariate logistic regression models were also conducted to analysis the correlation of preoperative factors with resectability. In patients with normal bilirubin levels, ROC curve analysis calculated the ideal CA 19-9 cut-off value of 203.96 U/ml in prediction of resectability, with a sensitivity of 83.7 %, specificity of 80 %, positive predictive value of 91.1 % and negative predictive value of 66.7 %. Meanwhile, the optimal cut-off value for CA 125 to predict resectability was 25.905 U/ml (sensitivity, 78.6 %; specificity, 67.5 %). In a multivariate logistic regression model, tumor size ≤3 cm (OR 4.149, 95 % CI 1.326-12.981, P = 0.015), preoperative CA 19-9 level ≤200 U/ml (OR 20.324, 95 % CI 6.509-63.467, P < 0.001), preoperative CA 125 levels ≤26 U/ml (OR 8.209, 95 % CI 2.624-25.677, P < 0.001) were independent determinants of resectability in patients diagnosed as hilar cholangiocarcinoma. Preoperative CA 19-9 and CA 125 levels predict resectability in patients with radiological resectable hilar cholangiocarcinoma. Increased preoperative CA 19-9 levels and CA 125 levels are associated with poor resectability rate.

Evaluation of Diffusion-weighted MR Imaging as a Technique for Detecting Bone Marrow Edema in Patients with Osteitis Pubis.

PubMed

Toslak, Iclal Erdem; Cekic, Bulent; Turk, Aysen; Eraslan, Ali; Parlak, A Eda

2017-10-10

Our aims were to determine the feasibility of diffusion-weighted magnetic resonance imaging (DWI) in the detection of bone marrow edema (BME) and explore the apparent diffusion coefficient (ADC) alterations in patients with osteitis pubis (OP). 42 consecutive patients clinically suspected to have athletic pubalgia and 31 control subjects were enrolled in the study. All subjects underwent diagnostic focused magnetic resonance imaging (MRI) and DWI at b values of 0 and 600 s/mm 2 . Two radiologists reviewed the images for the presence of active OP. The presence of subchondral BME and contrast enhancement were considered to indicate active OP. ADC values were measured from public bodies of both groups. DWI results were correlated with routine MRI findings. Receiver-operating-characteristic curves were formed. Cut-off values for ADC, sensitivity and specificity values were measured. 36/42 (85%) of the cases had BME/enhancement on routine MRIs and identified as active OP. ADC measurements of the patients were greater than the controls (P < 0.05). For the optimal cut-off values DWI showed sensitivity and specificity values of 97.3%, and 90.3%, for the right, and 97.1%, and 96.7% for the left side, respectively (Area under the curve 0.965 and 0.973). Intra-and inter-rater reliability for readers were substantial-perfect for all sessions. DWI is fast, accurate, and highly reproducible technique for the detection of BME in patients with active OP. It allows distinct bone marrow contrast without the use of gadolinium contrast, increases visual perception of active lesions, gives objective information by quantifying the diffusion coefficients, thus increase diagnostic confidence. We suggest the use of DWI as a cost-effective adjunctive tool for the diagnosis of active OP particularly in early cases and inconclusive diagnostic MRI. Future studies are necessary to determine the utility of DWI to evaluate severity of the disease and treatment response before returning athletes to play.

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...

Validation of an Argentine version of Lupus Quality of Life questionnaire.

PubMed

Machado Escobar, M A; Yacuzzi, M S; Martinez, R N; González Lucero, L; Bellomio, V I; Santana, M; Galindo, L; Mayer, M M; Barreira, J C; Sarano, J; Gomez, G; Collado, M V; Martinez, A; Orozco, M C; Betancur, G; Dal Pra, F; Sanchez, A; Juarez, V; Lucero, E V

2016-12-01

To determine reproducibility and validity of an Argentine version of the Lupus Quality of Life questionnaire (LupusQoL) and to determine cut-off values in the questionnaire. One hundred and forty-seven systemic lupus erythematosus patients (American College of Rheumatology 1982/1997) were assessed from April 2014 to July 2014. Demographic and socioeconomic variables were collected, as well as SELENA/SLEDAI, Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index Score, comorbidities and treatment data. Patients completed LupusQoL-Argentine version and European Quality of Life Questionnaire (EuroQoL-5D). Internal consistency and reliability were examined. Convergent validity with EuroQoL-5D was assessed through analysis of latent classes, which established homogeneous categories from the responses of each domain of LupusQoL and for the total. Out of 147 patients, 93.2% were female, mean age 36.4 ± 11.1 years, mean disease duration 2.7 ± 9 years, mean SELENA/SLEDAI 2.7 ± 3 points. The cut-off point that defined good or bad quality of life was 0.739 for EuroQoL 5D and 63 for LupusQoL. Cut-off values for each LupusQoL domain were also defined, creating two classes in each of them. There was moderate to high concordance to classify quality of life (Kappa = 0.74, 95% confidence interval = 0.54, 0.95). The Argentine version of LupusQoL is a valid, reliable and reproducible instrument to assess quality of life. In this study, cut-off points that allow the classification of patients regarding whether they have good or bad quality of life are established for the first time. © The Author(s) 2016.

Association of imaging abnormalities of the subcallosal septal area with Alzheimer's disease and mild cognitive impairment.

PubMed

Gan, C L; O'Sullivan, M J; Metzler-Baddeley, C; Halpin, S

2017-11-01

To evaluate the use the distance between the adjacent septal nuclei as a surrogate marker of septal area atrophy seen in Alzheimer's disease (AD). Interseptal distance (ISD) was measured, blind to clinical details, in 250 patients who underwent computed tomography (CT) of the brain at University Hospital of Wales. Clinical details including memory problem history were retrieved. An ISD cut-off value that discriminated those with and without memory symptoms was sought. ISD measurements were also made in 20 AD patients. To test both the method and the defined cut-off, measurements were then made in an independent cohort of 21 mild cognitive impairment (MCI) patients and 45 age-matched healthy controls, in a randomised and blinded fashion. ISD measurement was achieved in all patients. In 28 patients with memory symptoms, the mean ISD was 5.9 mm compared with 2.3 mm in those without overt symptoms (p=0.001). The optimum ISD cut-off value was 4 mm (sensitivity 85.7% and specificity 85.8%). All AD patients had an ISD of >4 mm (mean ISD= 6.1 mm). The mean ISD for MCI patients was 3.84 mm compared with 2.18 mm in age-matched healthy controls (p=0.001). Using a 4 mm cut-off correctly categorised 10 mild cognitive impairment patients (47.6%) and 38 healthy controls (84.4%). ISD is a simple and reliable surrogate measurement for septal area atrophy, applicable to CT and magnetic resonance imaging (MRI). It can be used to help select patients for further investigation. Copyright © 2017 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Electrocardiographic Criteria for Left Ventricular Hypertrophy in Asians Differs from Criteria Derived from Western Populations--Community-based Data from an Asian Population.

PubMed

Xu, Chang Fen; Tan, Eugene S J; Feng, Liang; Santhanakrishnan, Rajalakshmi; Chan, Michelle M Y; Nyunt, Shwe Zin; Ng, Tze Pin; Ling, Lieng Hsi; Richards, A Mark; Lam, Carolyn S P; Lim, Toon Wei

2015-08-01

Electrocardiographic (ECG) criteria for left ventricular hypertrophy (LVH), such as the Cornell and Sokolow-Lyon voltage criteria were derived from Western populations. However, their utility and accuracy for diagnosing echocardiographic LVH in Asian populations is unclear. The objective of this study was to assess the accuracy of ECG criteria for LVH in Asians and to determine if alternative gender-specific ECG cut-offs may improve its diagnostic accuracy. ECG and echocardiographic assessments were performed on 668 community-dwelling Asian adults (50.9% women; 57 ± 10 years) in Singapore. The accuracy of ECG voltage criteria was compared to echocardiographic LVH criteria based on the American Society of Echocardiography guidelines, and Asian ethnicity and gender-specific partition values. Echocardiographic LVH was present in 93 (13.6%) adults. Cornell criteria had low sensitivity (5.5%) and high specificity (98.9%) for diagnosing LVH. Modified gender specific cut-offs (18 mm in women, 22 mm in men) improved sensitivity (8.8% to 17.5%, 0% to 14.7%, respectively) whilst preserving specificity (98.2% to 94.2%, 100% to 95.8%). Similarly, Sokolow-Lyon criteria had poor sensitivity (7.7%) and high specificity (96.1%) for diagnosing LVH. Lowering the cut-off value from 35 mm to 31 mm improved the sensitivity in women from 3.5% to 14% while preserving specificity at 94.2%. A cut-off of 36 mm was optimal in men (sensitivity of 14.7%, specificity of 95.5%). Current ECG criteria for LVH derived in Western cohorts have limited sensitivity in Asian populations. Our data suggests that ethnicity- and gender-specific ECG criteria may be needed.

The performance characteristics of prostate-specific antigen and prostate-specific antigen density in Chinese men.

PubMed

Teoh, Jeremy Yc; Yuen, Steffi Kk; Tsu, James Hl; Wong, Charles Kw; Ho, Brian Sh; Ng, Ada Tl; Ma, Wai-Kit; Ho, Kwan-Lun; Yiu, Ming-Kwong

2017-01-01

We investigated the performance characteristics of prostate-specific antigen (PSA) and PSA density (PSAD) in Chinese men. All Chinese men who underwent transrectal ultrasound-guided prostate biopsy (TRUS-PB) from year 2000 to 2013 were included. The receiver operating characteristic (ROC) curves for both PSA and PSAD were analyzed. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) at different cut-off levels were calculated. A total of 2606 Chinese men were included. For the ROC, the area under curve was 0.770 for PSA (P < 0.001) and 0.823 for PSAD (P < 0.001). PSA of 4.5 ng ml-1 had sensitivity of 94.4%, specificity of 14.1%, PPV of 29.5%, and NPV of 86.9%; PSAD of 0.12 ng ml-1 cc-1 had sensitivity of 94.5%, specificity of 26.6%, PPV of 32.8%, and NPV of 92.7%. On multivariate logistic regression analyses, PSA cut-off at 4.5 ng ml-1 (OR 1.61, 95% CI 1.05-2.45, P= 0.029) and PSAD cut-off at 0.12 ng ml-1 cc-1 (OR 6.22, 95% CI 4.20-9.22, P< 0.001) were significant predictors for prostate cancer detection on TRUS-PB. In conclusion, the performances of PSA and PSAD at different cut-off levels in Chinese men were very different from those in Caucasians. PSA of 4.5 ng ml-1 and PSAD of 0.12 ng ml-1 cc-1 had near 95% sensitivity and were significant predictors of prostate cancer detection in Chinese men.

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.

A simple 5-point scoring system, NaURSE (Na+, urea, respiratory rate and shock index in the elderly), predicts in-hospital mortality in oldest old.

PubMed

Wilson, Alexander H; Kidd, Andrew C; Skinner, Jane; Musonda, Patrick; Pai, Yogish; Lunt, Claire J; Butchart, Catherine; Soiza, Roy L; Potter, John F; Myint, Phyo Kyaw

2014-05-01

the mortality is high in acutely ill oldest old patients. Understanding the prognostic factors which influence mortality will help clinicians make appropriate management decisions. we analysed prospective mortality audit data (November 2008 to January 2009) to identify variables associated with in-patient mortality in oldest old. We selected those with P < 0.10 from univariate analysis and determined at which cut-point they served as the strongest predictor of mortality. Using these cut-off points, we constructed multivariate logistic regression models. A 5-point score was derived from cut-off points which were significantly associated with mortality tested in a smaller independent re-audit sample conducted in October 2011. a total of 405 patients (mean 93.5 ± 2.7 years) were included in the study. The mean length of stay was 18.5 ± 42.4 days and 13.8% died as in-patients. Variables (cut-off values) found to be significantly associated with in-patient mortality were admission sodium (>145 mmol/l), urea (≥14 mmol/l), respiratory rate (>20/min) and shock index (>1.0): creating a 5-point score (NaURSE: NaURS in the Elderly). The crude mortality rates were 9.5, 19.9, 34.4, 66.7, and 100% for scores 0, 1, 2, 3 and 4, respectively. Using the cut-off point of ≥2, the NaURSE score has a specificity of 87% (83.1-90.3) and sensitivity of 39% (28.5-50.0), with an AUC value of 0.69 (0.63-0.76). An external independent validation study (n = 121) showed similar results. the NaURSE score may be particularly useful in identifying oldest old who are likely to die in that admission to guide appropriate care.

Is waist circumference a better predictor of diabetes than body mass index or waist-to-height ratio in Iranian adults?

PubMed

Hajian-Tilaki, Karimollah; Heidari, Bezad

2015-01-01

Several measures of adiposity have been used for predicting diabetes. The results of studies regarding superiority of waist circumference (WC) to body mass index (BMI) are inconsistent. This study designed to compare the ability of different anthropometric measures in predicting diabetes and to determine their optimal cut-off values. A population-based cross-sectional study was conducted with 1,000 representative sample among adults aged 20-80 years in Babol, the Northern Iran. The demographic data were collected in a household survey, and the anthropometric measures of weight, height, waist, and hip circumference were measured with a standard method. Fasting blood sugar (FBS) ≥126 mg/dl was considered as diabetes. receiver operating characteristic analysis was used to estimate the predictive ability of different anthropometric indexes and their optimal cut-off values for high FBS. The overall prevalence rate of diabetes was 14.0% (14.4% in men vs. 13.5% in women, P = 0.65). The prevalence rate was significantly higher in older age (>60 years), low educated and obese (P = 0.001). The mean of BMI, WC, waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR) were significantly higher among diabetic in both sexes (P = 0.001). Among men, WC (area under the ROC curve [AUC] =0.64) and WHtR (AUC = 0.63) have slightly higher accuracy index compared with BMI (AUC = 0.62) or WHR (AUC = 0.60). In contrast, among women, WHtR (AUC = 0.69) and WC (AUC = 0.68) yielded slightly better predictive than BMI (AUC = 0.67). The optimal cut-off values obtained for BMI and WHtR were similar between two sexes (BMI = 24.95 kg/m(2) for men and BMI = 25.2 kg/m(2) for women, WHtR = 0.51 for both sexes) whereas the optimal cut-off value for WC was higher in men than women (98.5 cm men vs. 89.5 cm women). Overall WC and WHtR exhibited a slightly better discriminate performance than BMI for diabetes in both sexes, particularly in women.

Indications for Pelvic Nodal Treatment in Prostate Cancer Should Change. Validation of the Roach Formula in a Large Extended Nodal Dissection Series

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

Abdollah, Firas; Cozzarini, Cesare; Suardi, Nazareno

2012-06-01

Purpose: Previous studies have criticized the predicting ability of the Roach formula in assessing the risk of lymph node invasion (LNI) in contemporary patients with prostate cancer (PCa) due to a significant overestimation of LNI rates. However, all those studies included patients treated with limited pelvic lymph node dissection (PLND), which is associated with high rates of false negative findings. We hypothesized that the Roach formula is still an accurate tool for LNI predictions if an extended PLND (ePLND) is performed. Methods and Materials: We included 3,115 consecutive patients treated with radical prostatectomy and ePLND between 2000 and 2010 atmore » a single tertiary referral center. Extended PLND consisted of removal of obturator, external iliac, and hypogastric lymph nodes. We externally validated the Roach formula by using the area under the receiver operating characteristics curve and calibration plot method. Moreover, we tested the performance characteristics of different formula-generated cutoff values ranging from 1% to 20%. Results: The accuracy of the Roach formula was 80.3%. The calibration showed only a minor underestimation of the LNI risk in high-risk patients (6.7%). According to the Roach formula, the use of 15% cut off would have allowed 74.2% (2,311/3,115) of patients to avoid nodal irradiation, while up to 32.7% (111/336) of all patients with LNI would have been missed. When the cut off was lowered to 6%, nodal treatment would have been spared in 1,541 (49.5%) patients while missing 41 LNI patients. The sensitivity, specificity, and negative predictive values associated with the 6% cut off were 87.9%, 54%, and 97.3%, respectively. Conclusions: The Roach formula is still accurate and does not overestimate the rate of LNI in contemporary prostate cancer patients if they are treated with ePLND. However, the recommended cut off of 15% would miss approximately one-third of patients with LNI. Based on our results, the cut off should be lowered to 6%.« less

Comparison of FIB-4 index, NAFLD fibrosis score and BARD score for prediction of advanced fibrosis in adult patients with non-alcoholic fatty liver disease: A meta-analysis study.

PubMed

Sun, Wenjing; Cui, Hongli; Li, Ning; Wei, Yanling; Lai, Shujie; Yang, Yang; Yin, Xinru; Chen, Dong-Feng

2016-08-01

Non-alcoholic fatty liver disease (NAFLD)-related advanced hepatic fibrosis is associated with liver and cardiovascular morbidity and mortality. This study aims to compare the FIB-4 index, NAFLD fibrosis score (NFS) and BARD score for prediction of advanced liver fibrosis. Pooled sensitivity, specificity, diagnostic odds ratio (DOR), summary receiver-operator curves (SROC) and Spearman's rank correlation coefficient were used to examine the accuracy of each non-invasive scoring system for predicting NAFLD-related advanced fibrosis. Four studies with 1038 adult patients were included in this meta-analysis. A total of 135 patients (13.0%) had advanced fibrosis. In the FIB-4 index group, pooled sensitivity and specificity with 95% confidence interval (CI), and the area under the ROC (AUROC) were 0.844 (0.772-0.901), 0.685 (0.654-0.716) and 0.8496 ± 0.0680, respectively, at a cut-off of 1.30. At a threshold of 3.25, the same parameters were 0.38 (0.30-0.47), 0.96 (0.95-0.98) and 0.8445 ± 0.0981. At a cut-off of -1.455, values were 0.77 (0.69-0.84), 0.70 (0.67-0.73) and 0.8355 ± 0.0667, respectively. At a 0.676 cut-off, pooled sensitivity and specificity with 95% CI were 0.27 (0.19-0.35) and 0.98 (0.96-0.98), respectively; and the AUROC was 0.647 ± 0.2208. In the BARD score group, pooled sensitivity and specificity with 95% CI were 0.74 (0.66-0.81) and 0.66 (0.63-0.69), respectively; and the AUROC was 0.7625 ± 0.0285. FIB-4 index with a 1.30 cut-off has better diagnostic accuracy than the FIB-4 index with a 3.25 cut-off, NFS and BARD score, despite showing its limited value for predicting NAFLD-related advanced fibrosis. © 2016 The Japan Society of Hepatology.

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.

On Computations of Duct Acoustics with Near Cut-Off Frequency

NASA Technical Reports Server (NTRS)

Dong, Thomas Z.; Povinelli, Louis A.

1997-01-01

The cut-off is a unique feature associated with duct acoustics due to the presence of duct walls. A study of this cut-off effect on the computations of duct acoustics is performed in the present work. The results show that the computation of duct acoustic modes near cut-off requires higher numerical resolutions than others to avoid being numerically cut off. Duct acoustic problems in Category 2 are solved by the DRP finite difference scheme with the selective artificial damping method and results are presented and compared to reference solutions.

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.

Determination of combined sibship indices "gray zone" using 15 STR loci for central Bosnian human population.

PubMed

Musanovic, Jasmin; Filipovska-Musanovic, Marijana; Kovacevic, Lejla; Buljugic, Dzenisa; Dzehverovic, Mirela; Avdic, Jasna; Marjanovic, Damir

2012-05-01

In our previous population studies of Bosnia and Herzegovina human population, we have used autosomal STR, Y-STR, and X-STR loci, as well as Y-chromosome NRY biallelic markers. All obtained results were included in Bosnian referent database. In order of future development of applied population molecular genetics researches of Bosnia and Herzegovina human population, we have examined the effectiveness of 15 STR loci system in determination of sibship by using 15 STR loci and calculating different cut-off points of combined sibship indices (CSI) and distribution of sharing alleles. From the perspective of its application, it is very difficult and complicated to establish strict CSI cut-off values for determination of the doubtless sibship. High statistically significant difference between the means of CSI values and in distribution of alleles sharing in siblings and non-siblings was noticed (P < 0.0001). After constructing the "gray zone", only one false positive result was found in three CSI cut-off levels with the highest percent of determined sibship/non-sibship at the CSI = 0.067, confirming its practical benefit. Concerning the distribution of sharing alleles, it is recommended as an informative estimator for its usage within Bosnia and Herzegovina human population.

Reliability of N-terminal proBNP assay in diagnosis of left ventricular systolic dysfunction within representative and high risk populations.

PubMed

Hobbs, F D R; Davis, R C; Roalfe, A K; Hare, R; Davies, M K

2004-08-01

To determine the performance of a new NT-proBNP assay in comparison with brain natriuretic peptide (BNP) in identifying left ventricular systolic dysfunction (LVSD) in randomly selected community populations. Blood samples were taken prospectively in the community from 591 randomly sampled individuals over the age of 45 years, stratified for age and socioeconomic status and divided into four cohorts (general population; clinically diagnosed heart failure; patients on diuretics; and patients deemed at high risk of heart failure). Definite heart failure (left ventricular ejection fraction (LVEF) < 40%) was identified in 33 people. Samples were handled as though in routine clinical practice. The laboratories undertaking the assays were blinded. Using NT-proBNP to diagnose LVEF < 40% in the general population, a level of > 40 pmol/l had 80% sensitivity, 73% specificity, 5% positive predictive value (PPV), 100% negative predictive value (NPV), and an area under the receiver-operator characteristic curve (AUC) of 76% (95% confidence interval (CI) 46% to 100%). For BNP to diagnose LVSD, a cut off level of > 33 pmol/l had 80% sensitivity, 88% specificity, 10% PPV, 100% NPV, and AUC of 88% (95% CI 75% to 100%). Similar NPVs were found for patients randomly screened from the three other populations. Both NT-proBNP and BNP have value in diagnosing LVSD in a community setting, with similar sensitivities and specificities. Using a high cut off for positivity will confirm the diagnosis of LVSD but will miss cases. At lower cut off values, positive results will require cardiac imaging to confirm LVSD.

Effect of aging and diffuse chronic pancreatitis on pancreas elasticity evaluated using semiquantitative EUS elastography.

PubMed

Janssen, J; Papavassiliou, I

2014-06-01

Endosonographic elastography has been introduced as a method of estimating the stiffness of pancreatic tumors. This prospective single-center study was conducted to evaluate changes in the stiffness of the pancreas related to age and diffuse chronic pancreatitis. 46 individuals each up to age 60 (group 1) and over age 60 (group 2) with healthy pancreata and 26 patients with diffuse chronic pancreatitis (group 3) were included. Three elastograms were obtained in each case by endosonography in a defined section through the pancreatic body. Elastograms were further evaluated by histogram analysis. Mean strain values, based on a range from 0 (hardest) to 255 (softest), and their standard deviation were calculated from the histogram. The three groups were compared statistically with regard to pancreatic stiffness. A cut-off level for the diagnosis of chronic pancreatitis was defined by testing receiver operating characteristics curves. The strain values (mean, SD) measured in the pancreatic body in groups 1 - 3 were 110.2 (23.9), 80.0 (16.4), and 32.4 (11.9), respectively. Pairwise comparison of the groups revealed highly significant differences (p < 0.001). At a cut-off value of 50, the area under the curve was 0.993 for distinguishing between chronic pancreatitis and healthy pancreata in people aged over 60. Semiquantitative elastography shows that pancreata become significantly harder during aging, but remain softer than in chronic pancreatitis. A cut-off value of 50 is suggested as a possible diagnostic criterion for diffuse chronic pancreatitis. © Georg Thieme Verlag KG Stuttgart · New York.

The utility of the Edmonton Symptom Assessment System in screening for anxiety and depression.

PubMed

Bagha, S M; Macedo, A; Jacks, L M; Lo, C; Zimmermann, C; Rodin, G; Li, M

2013-01-01

The Edmonton Symptom Assessment System (ESAS) is a common screening tool in cancer, although its validity for distress screening is unproven. Here, screening performance of the ESAS anxiety (ESAS-A) and depression (ESAS-D) items were validated against the anxiety [Generalised Anxiety Disorder-7 (GAD-7)] and depression [Patient Health Questionnaire-9 (PHQ-9)] subscales of the PHQ. A total of 1215 cancer patients completed the Distress Assessment and Response Tool (DART), a computerised distress screening instrument. Spearman's rank correlation coefficients and receiver operating characteristic curve analyses were used to evaluate the ability of ESAS-A and ESAS-D to identify moderate distress (GAD-7/PHQ-9 ≥ 10). Spearman's rank correlation coefficients comparing ESAS-A and ESAS-D with GAD-7 and PHQ-9 were 0.74 and 0.72 respectively. Areas under the receiver operating characteristic curves were 0.89 and 0.88 for anxiety and depression respectively. A cut-off of ≥3 on ESAS-A demonstrated a sensitivity of 0.91, specificity of 0.68, positive predictive value of 0.34 and negative predictive value of 0.97. A cut-off of ≥2 on the ESAS-D demonstrated a sensitivity of 0.86, specificity of 0.72, positive predictive value of 0.46 and negative predictive value of 0.95. High sensitivities of ESAS-A and ESAS-D at certain cut-offs suggest they have use in ruling-out distress. However, their low specificities indicate secondary screening is needed to rule-in anxiety or depression for case-finding. © 2012 Blackwell Publishing Ltd.

IL-10 combined with procalcitonin improves early prediction of complications of febrile neutropenia in hematological patients.

PubMed

Vänskä, Matti; Koivula, Irma; Jantunen, Esa; Hämäläinen, Sari; Purhonen, Anna-Kaisa; Pulkki, Kari; Juutilainen, Auni

2012-12-01

Early diagnosis of complicated course in febrile neutropenia is cumbersome due to the non-specificity of clinical and laboratory signs of severe infection. This prospective study included 100 adult hematological patients with febrile neutropenia after intensive chemotherapy at the onset of fever (d0) and for 3 days (d1-d3) thereafter. The study aim was to find early predictors for complicated course of febrile neutropenia, defined as bacteremia or septic shock. Interleukin 6 (IL-6), interleukin 10 (IL-10), procalcitonin (PCT) and C-reactive protein (CRP) all predicted complicated course of febrile neutropenia on d0, but only PCT was predictive throughout the study period. For IL-10 on d0-1 with cut-off 37 ng/L, sensitivity was 0.71, specificity 0.82, positive predictive value 0.52 and negative predictive value 0.92. For PCT on d0-1 with cut-off 0.13 μg/L, the respective measures were 0.95, 0.53, 0.36, and 0.98. For the combination of IL-10 and PCT on d0-1 with the same cut-offs, specificity improved to 0.85 and positive predictive value to 0.56. In conclusion, the present study confirms the high negative predictive value of PCT and provides new evidence for IL-10 as an early predictor for complicated course of febrile neutropenia in hematological patients. Combining IL-10 with PCT improves the early prediction for complicated course of febrile neutropenia. Copyright © 2012 Elsevier Ltd. All rights reserved.

Usefulness of Mitral Valve Prosthetic or Bioprosthetic Time Velocity Index Ratio to Detect Prosthetic or Bioprosthetic Mitral Valve Dysfunction.

PubMed

Luis, Sushil Allen; Blauwet, Lori A; Samardhi, Himabindu; West, Cathy; Mehta, Ramila A; Luis, Chris R; Scalia, Gregory M; Miller, Fletcher A; Burstow, Darryl J

2017-10-15

This study aimed to investigate the utility of transthoracic echocardiographic (TTE) Doppler-derived parameters in detection of mitral prosthetic dysfunction and to define optimal cut-off values for identification of such dysfunction by valve type. In total, 971 TTE studies (647 mechanical prostheses; 324 bioprostheses) were compared with transesophageal echocardiography for evaluation of mitral prosthesis function. Among all prostheses, mitral valve prosthesis (MVP) ratio (ratio of time velocity integral of MVP to that of left ventricular outflow tract; odds ratio [OR] 10.34, 95% confidence interval [95% CI] 6.43 to 16.61, p<0.001), E velocity (OR 3.23, 95% CI 1.61 to 6.47, p<0.001), and mean gradient (OR 1.13, 95% CI 1.02 to 1.25, p=0.02) provided good discrimination of clinically normal and clinically abnormal prostheses. Optimal cut-off values by receiver operating characteristic analysis for differentiating clinically normal and abnormal prostheses varied by prosthesis type. Combining MVP ratio and E velocity improved specificity (92%) and positive predictive value (65%) compared with either parameter alone, with minimal decline in negative predictive value (92%). Pressure halftime (OR 0.99, 95% CI 0.98 to 1.00, p=0.04) did not differentiate between clinically normal and clinically abnormal prostheses but was useful in discriminating obstructed from normal and regurgitant prostheses. In conclusion, cut-off values for TTE-derived Doppler parameters of MVP function were specific to prosthesis type and carried high sensitivity and specificity for identifying prosthetic valve dysfunction. MVP ratio was the best predictor of prosthetic dysfunction and, combined with E velocity, provided a useful parameter for determining likelihood of dysfunction and need for further assessment. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

Finding SDSS Galaxy Clusters in 4-dimensional Color Space Using the False Discovery Rate

NASA Astrophysics Data System (ADS)

Nichol, R. C.; Miller, C. J.; Reichart, D.; Wasserman, L.; Genovese, C.; SDSS Collaboration

2000-12-01

We describe a recently developed statistical technique that provides a meaningful cut-off in probability-based decision making. We are concerned with multiple testing, where each test produces a well-defined probability (or p-value). By well-known, we mean that the null hypothesis used to determine the p-value is fully understood and appropriate. The method is entitled False Discovery Rate (FDR) and its largest advantage over other measures is that it allows one to specify a maximal amount of acceptable error. As an example of this tool, we apply FDR to a four-dimensional clustering algorithm using SDSS data. For each galaxy (or test galaxy), we count the number of neighbors that fit within one standard deviation of a four dimensional Gaussian centered on that test galaxy. The mean and standard deviation of that Gaussian are determined from the colors and errors of the test galaxy. We then take that same Gaussian and place it on a random selection of n galaxies and make a similar count. In the limit of large n, we expect the median count around these random galaxies to represent a typical field galaxy. For every test galaxy we determine the probability (or p-value) that it is a field galaxy based on these counts. A low p-value implies that the test galaxy is in a cluster environment. Once we have a p-value for every galaxy, we use FDR to determine at what level we should make our probability cut-off. Once this cut-off is made, we have a final sample of galaxies that are cluster-like galaxies. Using FDR, we also know the maximum amount of field contamination in our cluster galaxy sample. We present our preliminary galaxy clustering results using these methods.

The G8 screening tool detects relevant geriatric impairments and predicts survival in elderly patients with a haematological malignancy.

PubMed

Hamaker, Marije E; Mitrovic, M; Stauder, R

2014-06-01

The G8 screening tool was developed to separate fit older cancer patients who were able to receive standard treatment from those that should undergo a geriatric assessment to guide tailoring of therapy. We set out to determine the discriminative power and prognostic value of the G8 in older patients with a haematological malignancy. Between September 2009 and May 2013, a multi-dimensional geriatric assessment was performed in consecutive patients aged ≥67 years diagnosed with blood cancer at the Innsbruck University Hospital. The assessment included (instrumental) activities of daily living, cognition, mood, nutritional status, mobility, polypharmacy and social support. In parallel, the G8 was also administered (cut-off ≤ 14). Using a cut-off of ≥2 impaired domains, 70 % of the 108 included patients were considered as having an impaired geriatric assessment while 61 % had an impaired G8. The G8 lacked discriminative power for impairments on full geriatric assessment: sensitivity 69, specificity 79, positive predictive value 89 and negative predictive value 50 %. However, G8 was an independent predictor of mortality within the first year after inclusion (hazard ratio 3.93; 95 % confidence interval 1.67-9.22, p < 0.001). Remarkably, patients with impaired G8 fared poorly, irrespective of treatment choices (p < 0.001). This is the first report on the clinical and prognostic relevance of G8 in elderly patients with haematological malignancies. Although the G8 lacked discriminative power for outcome of multi-dimensional geriatric assessment, this score appears to be a powerful prognosticator and could potentially represent a useful tool in treatment decisions. This novel finding certainly deserves further exploration.

Waist circumference cut-off points for identification of abdominal obesity among the tunisian adult population.

PubMed

Bouguerra, R; Alberti, H; Smida, H; Salem, L B; Rayana, C B; El Atti, J; Achour, A; Gaigi, S; Slama, C B; Zouari, B; Alberti, K G M M

2007-11-01

Waist circumference (WC) is a convenient measure of abdominal adipose tissue. It itself is a cardiovascular disease (CVD) and diabetes-risk factor and is strongly linked to other CVD risk factors. There are, however, ethnic differences in the relationship of WC to the other risk factors. The aim of this study was to determine the optimal cut-off points of WC and body mass index (BMI) at which cardiovascular risk factors can be identified with maximum sensitivity and specificity in a representative sample of the Tunisian adult population and to investigate any correlation between WC and BMI. We used a sample of the Tunisian National Nutrition Survey, a cross-sectional population-based survey, conducted in 1996 on a large nationally representative sample, which included 3435 adults (1244 men and 2191 women) of 20 years or older. WC, BMI, blood pressure and fasting blood measurements (plasma glucose, total cholesterol, triglycerides) were recorded. Receiver operating characteristic (ROC) curve analysis was used to identify optimal cut-off values of WC and BMI to identify with maximum sensitivity and specificity the detection of high blood pressure, hyperglycaemia, high blood cholesterol and hypertriglyceridaemia. ROC curve analysis suggested WC cut-off points of 85 cm in men and 85 cm in women for the optimum detection of high blood pressure, diabetes and dyslipidaemia. The optimum BMI cut-off points for predicting cardiovascular risk factors were 24 kg/m(2) in men and 27 kg/m(2) in women. The cut-off points recommended for the Caucasian population differ from those appropriate for the Tunisian population. The data show a continuous increase in odds ratios of each cardiovascular risk factor, with increasing level of WC and BMI. WC exceeding 85 cm in men and 79 cm in women correctly identified subjects with a BMI of >/=25 kg/m(2), sensitivity of >90% and specificity of >83%. Based on the ROC analysis, we suggest a WC of 85 cm for both men and women as appropriate cut-off points to identify central obesity for the purposes of CVD and diabetes-risk detection among Tunisians. WCs of 85 cm in men and 79 cm in women were the most sensitive and specific to identify most subjects with a BMI >/=25 kg/m(2).

Validation of the salivary urea and creatinine tests as screening methods of chronic kidney disease in Vietnamese patients.

PubMed

Pham, Thuy Anh Vu

2017-11-01

The aims of this case control study were to correlate the serum and salivary urea as well as creatinine levels; and to evaluate salivary urea and creatinine as noninvasive alternatives to serum for creatinine estimation in chronic kidney disease (CKD) patients. Blood and saliva samples were collected from 112 CKD patients and 108 subjects without CKD for quantitative analysis of urea and creatinine. Spearman's correlation coefficients between salivary and serum urea as well as creatinine were obtained. Receiver operating characteristic analysis was done to assess the diagnostic tests of salivary urea and creatinine. Cut-off values were determined based on the best trade-off between the sensitivity and specificity for both salivary urea and creatinine. Salivary urea and creatinine concentrations were significantly higher in CKD patients than those in control subjects; and increased by the stages of the severity of the disease. The positive correlation was significantly found between salivary and serum creatinine (r  =  0.90) and between salivary and serum urea (r  =  0.73). Area under the curve for salivary urea was 0.76 and a cut-off value of 14.25 mmol/L gave a sensitivity of 82.9% and specificity of 57.8%. Area under the curve for salivary creatinine was 0.92 and a cut-off value of 0.24 mg/dL gave a sensitivity of 86.5% and specificity of 87.2%. Both salivary urea and creatinine have a high capacity for serum creatinine estimation. Salivary urea and creatinine tests can be used as low-cost, easily accessible and noninvasive tools for screening, diagnosing, monitoring treatment outcomes and ascertaining prognosis of chronic kidney disease.

Prevalence of Bovine Tuberculosis in Egyptian Cattle and the Standardization of the Interferon-gamma Assay as an Ancillary Test.

PubMed

Abdellrazeq, G S; Elnaggar, M M; Osman, H S; Davis, W C; Singh, M

2016-10-01

Bovine tuberculosis (bTB) caused primarily by Mycobacterium bovis continues to cause significant losses in the cattle industry and is a major public health problem. Despite its worldwide application, the IFN-γ assay has not been applied in Egypt. The aim of this study was to determine the appropriate cut-off value of IFN-γ assay to complement the skin test screening in Egypt. The relative sensitivity (Ser ) of PPD and antigen cocktail-based IFN-γ assays (IFN-γ-BA and IFN-γ-EC) was analysed retrospectively, relative to bTB confirmatory tests (culture and PCR), using single cervical tuberculin (SCT) test reactors during 2011-2013. The absolute specificity (Sp) was studied using blood samples collected from cattle from one bTB-free herd. Analysis of the bTB database-generated sheets indicates the infection rate had decreased from 2009 to 2012 and then increased in 2013. The disease is concentrated in the Egyptian Nile Delta and Valley relative to elsewhere in the country. The cut-offs for IFN-γ-EC assay could be optimized to provide higher sensitivity, comparable to cut-offs for IFN-γ-BA assay. Data analysis suggests (PPDbOD  > 0.1, PPDbOD  - NILOD  > 0.05 and PPDbOD  > PPDaOD ) and (ECOD  - NILOD  ≥ 0.1) cut-off strategies to get optimal IFN-γ-BA and IFN-γ-EC assays results respectively. To our knowledge, this is the first report describing the prevalence of bTB in cattle in Egypt and pointing out the appropriate cut-off criteria to optimize IFN-γ assay as a routine ancillary test for diagnosis of bTB in Egypt. © 2014 Blackwell Verlag GmbH.

Clinically significant changes in the emotional condition of relatives of patients with severe traumatic brain injury during sub-acute rehabilitation.

PubMed

Norup, Anne; Kristensen, Karin Spangsberg; Poulsen, Ingrid; Nielsen, Christina Löfvquist; Mortensen, Erik Lykke

2013-09-01

To investigate clinically significant change in the emotional condition of relatives of patients with severe traumatic brain injury during sub-acute rehabilitation. Participants were 62 pairs of relatives and patients. Relatives completed the anxiety and depression scales from the Symptom Checklist-90-R (SCL-90-R) when the patients were admitted to sub-acute rehabilitation and at discharge. Improvement in emotional condition was investigated using the following criteria: (i) statistically reliable improvement; and (ii) clinically significant change (CSC). At admission, 53.2% and 58.1% of relatives had scores above cut-off values on the anxiety and depression scales, respectively. On the anxiety scale 69.7% of these experienced a reliable improvement according to the Reliable Change Index (RCI) and 45.5% also obtained CSC, as their end-point was below the cut-off value. On the depression scale the corresponding figures were 44.4% and 41.7%, respectively. When comparing relatives with and without CSC, we found that CSC in symptoms of anxiety was associated with significantly better functional improvement during rehabilitation and a shorter period of post-traumatic amnesia in the patients. Of the relatives who reported scores above cut-off values on the anxiety and depression scales at patient's admission, approximately 40% experienced CSC in anxiety and depression during the patient's rehabilitation. Relatives of patients experiencing improvement during inpatient rehabilitation are more likely to experience CSC in anxiety.

The Total Urine Protein-to-Creatinine Ratio Can Predict the Presence of Microalbuminuria

PubMed Central

Yamamoto, Kyoko; Yamamoto, Hiroyuki; Yoshida, Katsumi; Niwa, Koichiro; Nishi, Yutaro; Mizuno, Atsushi; Kuwabara, Masanari; Asano, Taku; Sakoda, Kunihiro; Niinuma, Hiroyuki; Nakahara, Fumiko; Takeda, Kyoko; Shindoh, Chiyohiko; Komatsu, Yasuhiro

2014-01-01

Background The Kidney Disease: Improving Global Outcomes chronic kidney disease (CKD) guidelines recommend that CKD be classified based on the etiology, glomerular filtration rate (GFR) and degree of albuminuria. The present study aimed to establish a method that predicts the presence of microalbuminuria by measuring the total urine protein-to-creatinine ratio (TPCR) in patients with cardiovascular disease (CVD) risk factors. Methods and Results We obtained urine samples from 1,033 patients who visited the cardiovascular clinic at St. Luke's International Hospital from February 2012 to August 2012. We measured the TPCR and the urine albumin-to-creatinine ratio (ACR) from random spot urine samples. We performed correlation, receiver operating characteristic (ROC) curve, sensitivity, and subgroup analyses. There was a strong positive correlation between the TPCR and ACR (R2 = 0.861, p<0.001). A ROC curve analysis for the TPCR revealed a sensitivity of 94.4%, a specificity of 86.1%, and an area under the curve of 0.903 for detecting microalbuminuria for a TPCR cut-off value of 84 mg/g of creatinine. The subgroup analysis indicated that the cut-off value could be used for patients with CVD risk factors. Conclusions These results suggest that the TPCR with an appropriate cut-off value could be used to screen for the presence of microalbuminuria in patients with CVD risk factors. This simple, inexpensive measurement has broader applications, leading to earlier intervention and public benefit. PMID:24614247

Value of serum N-terminal B-type natriuretic peptide in asymptomatic structural heart disease in Taiwanese population: Comparisons with current ESC Guidelines.

PubMed

Hung, Ta-Chuan; Wang, Kuang-Te; Yun, Chun-Ho; Kuo, Jen-Yuan; Hou, Charles Jia-Yin; Liu, Chia-Yuan; Wu, Tung-Hsin; Bezerra, Hiram G; Cheng, Hsiao-Yang; Hung, Chung-Lieh; Yeh, Hung-I

2017-03-15

The relationship between N-terminal pro-brain natriuretic peptide (NT-proBNP) and cardiac structural or functional anomalies in pre-clinical, asymptomatic Asian populations has not been well identified. From October 2005 to March 2008, we enrolled consecutive asymptomatic adults with preserved global left ventricular (LV) function (ejection fraction>50%) who underwent annual cardiovascular health survey. Circulating NT-proBNP was used to identify echo-defined cardiac structural/functional anomalies and compared to current recommended cut-off from the European Society of Heart Failure. Among 976 eligible subjects, 371 (38%) had structural heart diseases. Echocardiography-based left atrial diameter (Coef: 71.2), diastolic dysfunction (Coef: 35.4), and presence of pulmonary hypertension (Coef: 83.1) or valvular heart disease (Coef: 56.1, all p<0.05) of any form independently predicted circulating NT-ProBNP. NT-ProBNP cut-off values of 32.8 and 115.4pg/ml for subjects aged ≤ and >75years, respectively, demonstrated areas under the receiver operating characteristic curve of 0.76 (95% CI: 0.73-0.80) and 0.70 (95% CI: 0.52-0.88) for predicting structural or functional anomaly. We examined the feasibility of NT-ProBNP for identifying cardiac structural and functional anomaly in an asymptomatic ethnic Taiwanese population with a relatively lower cut-off value, indicating its potential role for pre-clinical screening of Asian patients. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Likelihood-Based Clustering of Meta-Analytic SROC Curves

ERIC Educational Resources Information Center

Holling, Heinz; Bohning, Walailuck; Bohning, Dankmar

2012-01-01

Meta-analysis of diagnostic studies experience the common problem that different studies might not be comparable since they have been using a different cut-off value for the continuous or ordered categorical diagnostic test value defining different regions for which the diagnostic test is defined to be positive. Hence specificities and…

Access to water

NASA Astrophysics Data System (ADS)

Stein, Robyn; Niklaas, Lindie

This paper will examine the legal implications of the South African Constitutional judgement of Government of the Republic of South Africa and others vs Grootboom and others (2001(1) SA 46 (CC)) in view of the developing debate on socio-economic rights under the constitution on the constitutional right of access to sufficient water. It will look at the manner in which effect is being given to this right at municipal level through the provision of free water and the constitutional implications of an adequate basic minimum level set by the State and local authorities. The paper will also explore the implications of relevant legislation, which enables local authorities to cut off water supplies as well as the implications of the Grootboom decision for communities facing water cut-offs.

Dynamic behavior of the interaction between epidemics and cascades on heterogeneous networks

NASA Astrophysics Data System (ADS)

Jiang, Lurong; Jin, Xinyu; Xia, Yongxiang; Ouyang, Bo; Wu, Duanpo

2014-12-01

Epidemic spreading and cascading failure are two important dynamical processes on complex networks. They have been investigated separately for a long time. But in the real world, these two dynamics sometimes may interact with each other. In this paper, we explore a model combined with the SIR epidemic spreading model and a local load sharing cascading failure model. There exists a critical value of the tolerance parameter for which the epidemic with high infection probability can spread out and infect a fraction of the network in this model. When the tolerance parameter is smaller than the critical value, the cascading failure cuts off the abundance of paths and blocks the spreading of the epidemic locally. While the tolerance parameter is larger than the critical value, the epidemic spreads out and infects a fraction of the network. A method for estimating the critical value is proposed. In simulations, we verify the effectiveness of this method in the uncorrelated configuration model (UCM) scale-free networks.

Psychological distress of residents in Kawauchi village, Fukushima Prefecture after the accident at Fukushima Daiichi Nuclear Power Station: the Fukushima Health Management Survey

PubMed Central

Yoshida, Koji; Shinkawa, Tetsuko; Urata, Hideko; Nakashima, Kanami; Orita, Makiko; Yasui, Kiyotaka; Kumagai, Atsushi; Ohtsuru, Akira; Yabe, Hirooki; Maeda, Masaharu; Hayashida, Naomi; Kudo, Takashi; Yamashita, Shunichi

2016-01-01

Background To shed light on the mental health of evacuees after the accident at Fukushima Daiichi Nuclear Power Station (FDNPS), we evaluate the results of the Fukushima Health Management Survey (FHMS) of the residents at Kawauchi village in Fukushima, which is located less than 30 km from the FDNPS. Methods We conducted the cross-sectional study within the framework of the FHMS. Exposure values were “anorexia,” “subjective feelings about health,” “feelings about sleep satisfaction,” and “bereavement caused by the disaster,” confounding variables were “age” and “sex,” and outcome variables were “K6 points.” We collected data from the FHMS, and employed the Kessler Psychological Distress Scale (K6) and the posttraumatic stress disorder (PTSD) Checklist Stressor-Specific Version (PCL-S) to carry out the research. A total of 13 or greater was the cut-off for identifying serious mental illness using the K6 scale. The study subjects included residents (n = 542) of over 30 years of age from Kawauchi village, and data were used from the period of January 1, 2012 to October 31, 2012. Results A total of 474 residents (87.5%) scored less than 13 points in the K6 and 68 (12.6%) scored 13 points or more. The proportion of elderly residents (over 65 years old) among people with K6 score above the cut-off was higher than that among people with K6 score below the cut-off (44.1 vs 31.0%, p < 0.05). In addition, the proportion of residents with anorexia and mental illness among people with K6 score above the cut-off was higher than among people with K6 score below the cut-off (p < 0.001 and p < 0.05, respectively). The amount of residents who scored 44 points or more in the PCL-S among people with K6 score above the cut-off was also considerably higher than among people with K6 score below the cut-off (79.4 vs 12.9%, p < 0.001). Interestingly, the proportion of residents who scored more than among people with K6 score above the cut-off and the among people with PCL-S score above the cut-off in Kawauchi was higher than in previous studies in other locations. Conclusions These results suggest that there are severe mental health problems, such as depression and PTSD, among adults as a consequence of the accident at the FDNPS. Our study showed that residents who lived in the evacuation zone before the disaster are at high risk psychological distress. To facilitate local residents’ recovery from Fukushima, there is a need to continue providing them with physical and mental support, as well as communication regarding the health risks of radiation. PMID:27635326

CT acquisition technique and quantitative analysis of the lung parenchyma: variability and corrections

NASA Astrophysics Data System (ADS)

Zheng, Bin; Leader, J. K.; Coxson, Harvey O.; Scuirba, Frank C.; Fuhrman, Carl R.; Balkan, Arzu; Weissfeld, Joel L.; Maitz, Glenn S.; Gur, David

2006-03-01

The fraction of lung voxels below a pixel value "cut-off" has been correlated with pathologic estimates of emphysema. We performed a "standard" quantitative CT (QCT) lung analysis using a -950 HU cut-off to determine the volume fraction of emphysema (below the cut-off) and a "corrected" QCT analysis after removing small group (5 and 10 pixels) of connected pixels ("blobs") below the cut-off. CT examinations two dataset of 15 subjects each with a range of visible emphysema and pulmonary obstruction were acquired at "low-dose and conventional dose reconstructed using a high-spatial frequency kernel at 2.5 mm section thickness for the same subject. The "blob" size (i.e., connected-pixels) removed was inversely related to the computed fraction of emphysema. The slopes of emphysema fraction versus blob size were 0.013, 0.009, and 0.005 for subjects with both no emphysema and no pulmonary obstruction, moderate emphysema and pulmonary obstruction, and severe emphysema and severe pulmonary obstruction, respectively. The slopes of emphysema fraction versus blob size were 0.008 and 0.006 for low-dose and conventional CT examinations, respectively. The small blobs of pixels removed are most likely CT image artifacts and do not represent actual emphysema. The magnitude of the blob correction was appropriately associated with COPD severity. The blob correction appears to be applicable to QCT analysis in low-dose and conventional CT exams.

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.

Clinical value of serum anti-mullerian hormone and inhibin B in prediction of ovarian response in patients with polycystic ovary syndrome.

PubMed

Zhang, Fan; Liu, Xiao-Ling; Rong, Nan; Huang, Xiao-Wen

2017-02-01

The present study aimed to investigate the clinical value of serum anti-mullerian hormone (AMH) and inhibin B (INHB) in predicting the ovarian response of patients with polycystic ovary syndrome (PCOS). A total of 120 PCOS patients were enrolled and divided into three groups in terms of the ovarian response: a low-response group (n=36), a normal-response group (n=44), and a high-response group (n=40). The serum AMH and INHB levels were measured by enzyme-linked immunosorbent assay (ELISA). The follicle stimulating hormone (FSH), luteinizing hormone (LH), and estradiol (E2) levels were determined by chemiluminescence microparticle immunoassay. The correlation of the serum AMH and INHB levels with other indicators was analyzed. A receiver operating characteristic (ROC) curve was established to analyze the prediction of ovarian response by AMH and INHB. The results showed that there were significant differences in age, body mass index (BMI), FSH, total gonadotropin-releasing hormone (GnRH), LH, E2, and antral follicle counts (AFCs) between the groups (P<0.05). The serum AMH and INHB levels were increased significantly with the ovarian response of PCOS patients increasing (P<0.05). The serum AMH and INHB levels were negatively correlated with the age, BMI, FSH level, Gn, and E2 levels (P<0.05). They were positively correlated with the LH levels and AFCs (P<0.05). ROC curve analysis of serum AMH and INHB in prediction of a low ovarian response showed that the area under the ROC curve (AUC) value of the serum AMH level was 0.817, with a cut-off value of 1.29 ng/mL. The sensitivity and specificity were 71.2% and 79.6%, respectively. The AUC value of serum INHB was 0.674, with a cut-off value of 38.65 ng/mL, and the sensitivity and specificity were 50.7% and 74.5%, respectively. ROC curve analysis showed when the serum AMH and INHB levels were used to predict a high ovarian response, the AUC value of the serum AMH level was 0.742, with a cut-off value of 2.84 ng/mL, and the sensitivity and specificity were 72.7% and 65.9%, respectively; the AUC value of the serum INHB level was 0.551 with a cut-off of 45.76 ng/mL, and the sensitivity and specificity were 76.3% and 40.2%, respectively. It was suggested the serum AMH and INHB levels have high clinical value in predicting the ovarian response of PCOS patients.

A Hospital Based Study on Estimation of Adenosine Deaminase Activity (ADA) in Cerebrospinal Fluid (CSF) in Various Types of Meningitis.

PubMed

Agarwal, Ashok Kumar; Bansal, Sonia; Nand, Vidya

2014-02-01

Tuberculosis kills 3.70 lakh patients in India every year,out of which 7-12 % are meningeal involvement. Delay in its diagnosis and initiation of treatment results in poor prognosis and squeal in up to 25% of cases. The aim of the present study is to look for a simple, rapid, cost effective, and fairly specific test in differentiating tubercular aetiology from other causes of meningitis. In the present study we measured the adenosine deaminase activity (ADA) in Cerebrospinal Fluid (CSF) of Tubercular Meningitis (TBM) and non-TBM patients. Fifty six patients attending hospital with symptoms and signs of meningitis were selected and divided into three groups: tubercular, pyogenic, and aseptic meningitis, depending upon the accepted criteria. CSF was drawn and ADA estimated. Out of 32 tubercular patients, 28 had CSF-ADA at or above the cut-off value while four had below. Out of 24 non-tuberculous patients (pyogenic and aseptic meningitis), two aseptic meningitis (AM) patient had ADA levels at or above the cut-off value while 22 had below this value. RESULTS of our study indicate that ADA level estimation in CSF is not only of considerable value in the diagnosis of TBM, CSF, and ADA level 10 U/L as a cut-off value with sensitivity 87.5% and specificity 83.33% and positive predictive value of the test was 87.5%.and 83.3% negative predictive value. It can be concluded that ADA estimation in CSF is not only simple, inexpensive and rapid but also fairly specific method for making a diagnosis of tuberculous aetiology in TBM, especially when there is a dilemma of differentiating the tuberculous aetiology from non-tuberculous ones. For this reason ADA estimation in TBM may find a place as a routine investigation.

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...

A System for Discovering Bioengineered Threats by Knowledge Base Driven Mining of Toxin Data

DTIC Science & Technology

2004-08-01

RMSD cut - off and select a residue substitution matrix. The user is also allowed...in the sense that after super-positioning, the RMSD between the substructures is no more than the cut - off RMSD . * Residue substitutions are allowed...during super-positioning. Default RMSD cut - off and residue substitution matrix are provided. Users can specify their own RMSD cut - offs as well as

Systematic review of the evidence for Trails B cut-off scores in assessing fitness-to-drive.

PubMed

Roy, Mononita; Molnar, Frank

2013-01-01

Fitness-to-drive guidelines recommend employing the Trail Making B Test (a.k.a. Trails B), but do not provide guidance regarding cut-off scores. There is ongoing debate regarding the optimal cut-off score on the Trails B test. The objective of this study was to address this controversy by systematically reviewing the evidence for specific Trails B cut-off scores (e.g., cut-offs in both time to completion and number of errors) with respect to fitness-to-drive. Systematic review of all prospective cohort, retrospective cohort, case-control, correlation, and cross-sectional studies reporting the ability of the Trails B to predict driving safety that were published in English-language, peer-reviewed journals. Forty-seven articles were reviewed. None of the articles justified sample sizes via formal calculations. Cut-off scores reported based on research include: 90 seconds, 133 seconds, 147 seconds, 180 seconds, and < 3 errors. There is support for the previously published Trails B cut-offs of 3 minutes or 3 errors (the '3 or 3 rule'). Major methodological limitations of this body of research were uncovered including (1) lack of justification of sample size leaving studies open to Type II error (i.e., false negative findings), and (2) excessive focus on associations rather than clinically useful cut-off scores.

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.

Determining the cut-off point of osteoporosis based on the osteoporosis self-assessment tool, body mass index and weight in Taiwanese young adult women.

PubMed

Chang, Shu Fang; Yang, Rong Sen

2014-09-01

To examine the cut-off point of the osteoporosis self-assessment tool, age, weight and body mass index for osteoporosis among young adult Taiwanese women, using a large-scale health examination database containing bone mineral density tests. The cut-off points of osteoporosis risk factors identified earlier focus on menopausal or senior Caucasian and Asian women. However, young adult Asian women have seldom been identified. A retrospective historical cohort study. Using the 2009-2011 health examination database of a large-scale medical centre in northern Taiwan, this study investigated young adult Asian women (i.e. range in age from 30-49 years) in Taiwan who had received dual-energy X-ray absorptiometry test. This study also explored the cut-off point, sensitivity, specificity and diagnostic accuracy of receiver operating characteristics of osteoporosis among young adult females in Taiwan. This study collected 2454 young adult Asian women in Taiwan. Cochran-Armitage analysis results indicated that the prevalence of osteoporosis increased with decreasing weight, body mass index and osteoporosis self-assessment method quartiles. According to the results of receiver operating characteristics, weight, body mass index and osteoporosis self-assessment tool approaches can generally be used as indicators to predict osteoporosis among young adult Asian women. Results of this study demonstrate that Taiwanese women contracting osteoporosis tend to be young and underweight, as well as having a low body mass index and osteoporosis self-assessment scores. Those results further suggest that the assessment indicators for cut-off points are appropriately suitable for young adult women in Taiwan. Early detection is the only available means of preventing osteoporosis. Professional nurses should apply convenient and accurate assessment procedures to help young adult women to adopt preventive strategies against osteoporosis early, thus eliminating the probability of osteoporotic fracture. © 2013 John Wiley & Sons Ltd.

[Selective cervical dorsal root cutting off part of the vertebral lateral mass fixation combined with exercise therapy for treating spastic cerebral paralysis of the upper limbs caused by cerebral palsy].

PubMed

Zhang, Peng; Hu, Wei; Cao, Xu; Xu, Shi-gang; Li, De-kui; Xu, Lin

2009-10-01

To explore the feasibility and the result for the surgical treatment of spastic cerebral paralysis of the upper limbs in patients who underwent the selective cervical dorsal root cutting off part of the vertebral lateral mass fixation combined with exercise therapy. From March 2004 to April 2008, 27 patients included 19 boys and 8 girls, aging 13-21 years with an average of 15 years underwent selective cervical dorsal root cutting off part of the vertebral lateral mass fixation with exercise therapy. The AXIS 8 holes titanium plate was inserted into the lateral mass of spinous process through guidance of the nerve stimulator, choosed fasciculus of low-threshold nerve dorsal root and cut off its 1.5 cm. After two weeks, training exercise therapy was done in patients. Training will include lying position, turning body, sitting position, crawling, kneeling and standing position, walking and so on. Spastic Bobath inhibiting abnormal pattern was done in the whole process of training. The muscular tension, motor function (GMFM), functional independence (WeeFIM) were observed after treatment. All patients were followed up from 4 to 16 months with an average of 6 months. Muscular tension score were respectively 3.30 +/- 0.47 and 1.25 +/- 0.44 before and after treatment;GMFM score were respectively 107.82 +/- 55.17 and 131.28 +/- 46.45; WeeFIM score were respectively 57.61 +/- 25.51 and 87.91 +/- 22.39. There was significant improvement before and after treatment (P < 0.01). Selective cervical dorsal root cutting off part of the vertebral lateral mass fixation combined with exercise therapy was used to treat spastic cerebral paralysis of the upper limbs is safe and effective method, which can decrease muscular tension and improve motor function, which deserves more wide use.

Hair ethyl glucuronide concentrations in teetotalers: Should we re-evaluate the lower cut-off?

PubMed

Crunelle, Cleo L; Yegles, Michel; De Doncker, Mireille; Cappelle, Delphine; Covaci, Adrian; van Nuijs, Alexander L N; Neels, Hugo

2017-05-01

Ethyl glucuronide in hair (hEtG) can be used to assess the retrospective consumption of alcohol. A lower cut-off of 7pg/mg hair in the 0-3cm proximal scalp hair segment has been used for repeated alcohol consumption in the previous three months. While a concentration below this cut-off is stated not to contradict self reported abstinence, it is often used to assess whether an individual has remained abstinent in the period prior to hair sampling. Here, we address hEtG concentrations in alcohol consuming individuals and critically evaluate this cut-off value. Ten individuals remained abstinent from alcohol for 12 weeks. A lock of hair was cut before the start of the study, and the regrown hairs were cut after twelve weeks of abstinence. Hair EtG concentrations were measured both at baseline and after 12 weeks of abstinence. Study compliance was assessed by urine analysis every 2-3 days by liquid chromatography-tandem mass spectrometry with a lower limit of quantification (LLOQ) of 0.1μg/mL. HEtG concentrations were assessed in the first 3cm hair using gas chromatography-tandem mass spectrometry with an LLOQ of 0.2pg/mg. At the beginning of the study, participants had hEtG concentrations ranging between

Rapid exclusion of the diagnosis of immune HIT by AcuStar HIT and heparin-induced multiple electrode aggregometry.

PubMed

Minet, V; Baudar, J; Bailly, N; Douxfils, J; Laloy, J; Lessire, S; Gourdin, M; Devalet, B; Chatelain, B; Dogné, J M; Mullier, F

2014-06-01

Accurate diagnosis of heparin-induced thrombocytopenia (HIT) is essential but remains challenging. We have previously demonstrated, in a retrospective study, the usefulness of the combination of the 4Ts score, AcuStar HIT and heparin-induced multiple electrode aggregometry (HIMEA) with optimized thresholds. We aimed at exploring prospectively the performances of our optimized diagnostic algorithm on suspected HIT patients. The secondary objective is to evaluate performances of AcuStar HIT-Ab (PF4-H) in comparison with the clinical outcome. 116 inpatients with clinically suspected immune HIT were included. Our optimized diagnostic algorithm was applied to each patient. Sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV) of the overall diagnostic strategy as well as AcuStar HIT-Ab (at manufacturer's thresholds and at our thresholds) were calculated using clinical diagnosis as the reference. Among 116 patients, 2 patients had clinically-diagnosed HIT. These 2 patients were positive on AcuStar HIT-Ab, AcuStar HIT-IgG and HIMEA. Using our optimized algorithm, all patients were correctly diagnosed. AcuStar HIT-Ab at our cut-off (>9.41 U/mL) and at manufacturer's cut-off (>1.00 U/mL) showed both a sensitivity of 100.0% and a specificity of 99.1% and 90.4%, respectively. The combination of the 4Ts score, the HemosIL® AcuStar HIT and HIMEA with optimized thresholds may be useful for the rapid and accurate exclusion of the diagnosis of immune HIT. Copyright © 2014 Elsevier Ltd. All rights reserved.

Azimuth cut-off model for significant wave height investigation along coastal water of Kuala Terengganu, Malaysia

NASA Astrophysics Data System (ADS)

Marghany, Maged; Ibrahim, Zelina; Van Genderen, Johan

2002-11-01

The present work is used to operationalize the azimuth cut-off concept in the study of significant wave height. Three ERS-1 images have been used along the coastal waters of Terengganu, Malaysia. The quasi-linear transform was applied to map the SAR wave spectra into real ocean wave spectra. The azimuth cut-off was then used to model the significant wave height. The results show that azimuth cut-off varied with the different period of the ERS-1 images. This is because of the fact that the azimuth cut-off is a function of wind speed and significant wave height. It is of interest to find that the significant wave height modeled from azimuth cut-off is in good relation with ground wave conditions. It can be concluded that ERS-1 can be used as a monitoring tool in detecting the significant wave height variation. The azimuth cut-off can be used to model the significant wave height. This means that the quasi-linear transform could be a good application to significant wave height variation during different seasons.

Routine Chest X-ray: Still Valuable for the Assessment of Left Ventricular Size and Function in the Era of Super Machines?

PubMed Central

Morales, Maria-Aurora; Prediletto, Renato; Rossi, Giuseppe; Catapano, Giosuè; Lombardi, Massimo; Rovai, Daniele

2012-01-01

Objectives: The development of technologically advanced, expensive techniques has progressively reduced the value of chest X-ray in clinical practice for the assessment of left ventricular (LV) dilatation and dysfunction. Although controversial data are reported on the role of this widely available technique in cardiac assessment, it is known that the cardio-thoracic ratio is predictive of risk of progression in the NYHA Class, hospitalization, and outcome in patients with LV dysfunction. This study aimed to evaluate the reliability of the transverse diameter of heart shadow [TDH] by chest X-ray for detecting LV dilatation and dysfunction as compared to Magnetic Resonance Imaging (MRI) performed for different clinical reasons. Materials and Methods: In 101 patients, TDH was measured in digital chest X-ray and LV volumes and ejection fraction (EF) by MRI, both exams performed within 2 days. Results: A direct correlation between TDH and end-diastolic volumes (r = .75, P<0.0001) was reported. TDH cut-off values of 14.5 mm in females identified LV end-diastolic volumes >150 mL (sensitivity: 82%, specificity: 69%); in males a cut-off value of 15.5 mm identified LV end-diastolic volumes >210 mL (sensitivity: 84%; specificity: 72%). A negative relation was found between TDH and LVEF (r = -.54, P<0.0001). The above cut-off values of TDH discriminated patients with LV systolic dysfunction – LVEF <35% (sensitivity and specificity: 67% and 57% in females; 76% and 59% in males, respectively). Conclusions: Chest X-ray may still be considered a reliable technique in predicting LV dilatation by the accurate measurement of TDH as compared to cardiac MRI. Technologically advanced, expensive, and less available imaging techniques should be performed on the basis of sound clinical requests. PMID:22754739

Routine Chest X-ray: Still Valuable for the Assessment of Left Ventricular Size and Function in the Era of Super Machines?

PubMed

Morales, Maria-Aurora; Prediletto, Renato; Rossi, Giuseppe; Catapano, Giosuè; Lombardi, Massimo; Rovai, Daniele

2012-01-01

The development of technologically advanced, expensive techniques has progressively reduced the value of chest X-ray in clinical practice for the assessment of left ventricular (LV) dilatation and dysfunction. Although controversial data are reported on the role of this widely available technique in cardiac assessment, it is known that the cardio-thoracic ratio is predictive of risk of progression in the NYHA Class, hospitalization, and outcome in patients with LV dysfunction. This study aimed to evaluate the reliability of the transverse diameter of heart shadow [TDH] by chest X-ray for detecting LV dilatation and dysfunction as compared to Magnetic Resonance Imaging (MRI) performed for different clinical reasons. In 101 patients, TDH was measured in digital chest X-ray and LV volumes and ejection fraction (EF) by MRI, both exams performed within 2 days. A direct correlation between TDH and end-diastolic volumes (r = .75, P<0.0001) was reported. TDH cut-off values of 14.5 mm in females identified LV end-diastolic volumes >150 mL (sensitivity: 82%, specificity: 69%); in males a cut-off value of 15.5 mm identified LV end-diastolic volumes >210 mL (sensitivity: 84%; specificity: 72%). A negative relation was found between TDH and LVEF (r = -.54, P<0.0001). The above cut-off values of TDH discriminated patients with LV systolic dysfunction - LVEF <35% (sensitivity and specificity: 67% and 57% in females; 76% and 59% in males, respectively). Chest X-ray may still be considered a reliable technique in predicting LV dilatation by the accurate measurement of TDH as compared to cardiac MRI. Technologically advanced, expensive, and less available imaging techniques should be performed on the basis of sound clinical requests.

Diagnostic values for the viral load in peripheral blood mononuclear cells of patients with chronic active Epstein-Barr virus disease.

PubMed

Ito, Yoshinori; Suzuki, Michio; Kawada, Jun-ichi; Kimura, Hiroshi

2016-04-01

Chronic active Epstein-Barr virus disease (CAEBV) is a distinct EBV-associated lymphoproliferative disease with a poor prognosis. Although the viral load in blood samples has been widely used for diagnosing CAEBV, well-defined viral load thresholds to guide clinicians are currently lacking. The aim of the present study was to determine standardized diagnostic values for EBV load in blood samples of CAEBV patients using the World Health Organization international standard for reporting. Levels of EBV DNA in 103 peripheral blood mononuclear cells (PBMCs) and 95 plasma/serum samples from 107 cases with CAEBV were quantified and expressed in international units. Receiver operating characteristic curves were analyzed to assess the most appropriate cut-off values for levels of EBV DNA to distinguish CAEBV from EBV-associated infectious mononucleosis (IM) and controls with past EBV infection. Levels of EBV DNA in PBMCs were significantly higher in the CAEBV group (median, 10(4.2) IU/μgDNA) compared to the IM (median, 10(2.1) IU/μgDNA) and control groups. An inconsistent qualitative result was seen in 13 of 86 CAEBV patients; in these, EBV-DNA was positive in PBMCs, but negative in plasma. Diagnostic cut-off values for viral load in PBMCs from CAEBV patients, as compared to those of healthy controls and IM patients, were 10(2.0) IU/μgDNA and 10(3.2) IU/μgDNA, respectively. For diagnostic purposes, the viral load of PBMCs was better than of plasma/serum. A diagnostic cut-off EBV load for CAEBV may be useful for the management of CAEBV patients. Copyright © 2015 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

A novel computer-assisted image analysis of [123I]β-CIT SPECT images improves the diagnostic accuracy of parkinsonian disorders.

PubMed

Goebel, Georg; Seppi, Klaus; Donnemiller, Eveline; Warwitz, Boris; Wenning, Gregor K; Virgolini, Irene; Poewe, Werner; Scherfler, Christoph

2011-04-01

The purpose of this study was to develop an observer-independent algorithm for the correct classification of dopamine transporter SPECT images as Parkinson's disease (PD), multiple system atrophy parkinson variant (MSA-P), progressive supranuclear palsy (PSP) or normal. A total of 60 subjects with clinically probable PD (n = 15), MSA-P (n = 15) and PSP (n = 15), and 15 age-matched healthy volunteers, were studied with the dopamine transporter ligand [(123)I]β-CIT. Parametric images of the specific-to-nondisplaceable equilibrium partition coefficient (BP(ND)) were generated. Following a voxel-wise ANOVA, cut-off values were calculated from the voxel values of the resulting six post-hoc t-test maps. The percentages of the volume of an individual BP(ND) image remaining below and above the cut-off values were determined. The higher percentage of image volume from all six cut-off matrices was used to classify an individual's image. For validation, the algorithm was compared to a conventional region of interest analysis. The predictive diagnostic accuracy of the algorithm in the correct assignment of a [(123)I]β-CIT SPECT image was 83.3% and increased to 93.3% on merging the MSA-P and PSP groups. In contrast the multinomial logistic regression of mean region of interest values of the caudate, putamen and midbrain revealed a diagnostic accuracy of 71.7%. In contrast to a rater-driven approach, this novel method was superior in classifying [(123)I]β-CIT-SPECT images as one of four diagnostic entities. In combination with the investigator-driven visual assessment of SPECT images, this clinical decision support tool would help to improve the diagnostic yield of [(123)I]β-CIT SPECT in patients presenting with parkinsonism at their initial visit.

Diagnostic value of cerebrospinal fluid Aβ ratios in preclinical Alzheimer's disease.

PubMed

Adamczuk, Katarzyna; Schaeverbeke, Jolien; Vanderstichele, Hugo M J; Lilja, Johan; Nelissen, Natalie; Van Laere, Koen; Dupont, Patrick; Hilven, Kelly; Poesen, Koen; Vandenberghe, Rik

2015-12-18

In this study of preclinical Alzheimer's disease (AD) we assessed the added diagnostic value of using cerebrospinal fluid (CSF) Aβ ratios rather than Aβ42 in isolation for detecting individuals who are positive on amyloid positron emission tomography (PET). Thirty-eight community-recruited cognitively intact older adults (mean age 73, range 65-80 years) underwent (18)F-flutemetamol PET and CSF measurement of Aβ1-42, Aβ1-40, Aβ1-38, and total tau (ttau). (18)F-flutemetamol retention was quantified using standardized uptake value ratios in a composite cortical region (SUVRcomp) with reference to cerebellar grey matter. Based on a prior autopsy validation study, the SUVRcomp cut-off was 1.57. Sensitivities, specificities and cut-offs were defined based on receiver operating characteristic analysis with CSF analytes as variables of interest and (18)F-flutemetamol positivity as the classifier. We also determined sensitivities and CSF cut-off values at fixed specificities of 90 % and 95 %. Seven out of 38 subjects (18 %) were positive on amyloid PET. Aβ42/ttau, Aβ42/Aβ40, Aβ42/Aβ38, and Aβ42 had the highest accuracy to identify amyloid-positive subjects (area under the curve (AUC) ≥ 0.908). Aβ40 and Aβ38 had significantly lower discriminative power (AUC = 0.571). When specificity was fixed at 90 % and 95 %, Aβ42/ttau had the highest sensitivity among the different CSF markers (85.71 % and 71.43 %, respectively). Sensitivity of Aβ42 alone was significantly lower under these conditions (57.14 % and 42.86 %, respectively). For the CSF-based definition of preclinical AD, if a high specificity is required, our data support the use of Aβ42/ttau rather than using Aβ42 in isolation.

Cutoff values for bacteria and leukocytes for urine sediment analyzer FUS200 in culture-positive urinary-tract infections.

PubMed

Kocer, Derya; Sarıguzel, Fatma M; Karakukcu, Cıgdem

2014-08-01

The microscopic analysis of urine is essential for the diagnosis of patients with urinary tract infections. Quantitative urine culture is the 'gold standard' method for definitive diagnosis of urinary-tract infections, but it is labor-intensive, time consuming, and does not provide the same-day results. The aim of this study was to evaluate the analytical and diagnostic performance of the FUS200 (Changchun Dirui Industry, China), a new urine sedimentation analyzer in comparison to urine culture as the reference method. We evaluated 1000 urine samples, submitted for culture and urine analysis with a preliminary diagnosis of urinary-tract infection. Cut-off values for the FUS200 were determined by comparing the results with urine cultures. The cut-off values by the receiver operating characteristic (ROC) curve technique, sensitivity, and specificity were calculated for bacteria and white blood cells (WBCs). Among the 1000 urine specimens submitted for culture, 637 cultures (63.7%) were negative, and 363 were (36.3%) positive. The best cut-off values obtained from ROC analysis were 16/μL for bacteriuria (sensitivity: 82.3%, specificity: 58%), and 34/μL for WBCs (sensitivity: 72.3%, specificity: 65.2%). The area under the curve (AUC) for the bacteria and WBCs count were 0.71 (95% CI: 0.67-0.74) and, 0.72 (95% CI: 0.69-0.76) respectively. The most important requirement of a rapid diagnostic screening test is sensitivity, and, in this perspective, an unsatisfactory sensitivity by using bacteria recognition and quantification performed by the FUS200 analyzer has been observed. After further technical improvements in particle recognition and laboratory personnel training, the FUS200 might show better results.

Serum cortisol concentration with exploratory cut-off values do not predict the effects of hydrocortisone administration in children with low cardiac output after cardiac surgery.

PubMed

Verweij, E J; Hogenbirk, Karin; Roest, Arno A W; van Brempt, Ronald; Hazekamp, Mark G; de Jonge, Evert

2012-10-01

Low cardiac output syndrome is common after paediatric cardiac surgery. Previous studies suggested that hydrocortisone administration may improve haemodynamic stability in case of resistant low cardiac output syndrome in critically ill children. This study was set up to test the hypothesis that the effects of hydrocortisone on haemodynamics in children with low cardiac output syndrome depend on the presence of (relative) adrenal insufficiency. A retrospective study was done on paediatric patients who received hydrocortisone when diagnosed with resistant low cardiac output syndrome after paediatric cardiac surgery in the period from 1 November 2005 to 31 December 2008. We studied the difference in effects of treatment with hydrocortisone administration between patients with adrenal insufficiency defined as an exploratory cut-off value of total cortisol of <100 nmol/l and patients with a serum total cortisol of ≥ 100 nmol/l. A total of 62 of patients were enrolled, meeting the inclusion criteria for low cardiac output syndrome. Thirty-two patients were assigned to Group 1 (<100 nmol/l) and 30 were assigned to Group 2 (≥ 100 nmol/l). Haemodynamics improved after hydrocortisone administration, with an increase in blood pressure, a decrease in administered vasopressors and inotropic drugs, an increase in urine production and a decrease in plasma lactate concentrations. The effects of treatment with hydrocortisone in children with low cardiac output after cardiac surgery was similar in patients with a low baseline serum cortisol concentration and those with normal baseline cortisol levels. A cortisol value using an exploratory cut-off value of 100 nmol/l for adrenal insufficiency should not be used as a criterion to treat these patients with hydrocortisone.

The pharmacokinetic-pharmacodynamic modeling and cut-off values of tildipirosin against Haemophilus parasuis

PubMed Central

Lei, Zhixin; Liu, Qianying; Yang, Bing; Ahmed, Saeed; Cao, Jiyue; He, Qigai

2018-01-01

The goal of this study was to establish the epidemiological, pharmacodynamic cut-off values, optimal dose regimens for tildipirosin against Haemophilus parasuis. The minimum inhibitory concentrations (MIC) of 164 HPS isolates were determined and SH0165 whose MIC (2 μg/ml ) were selected for PD analysis. The ex vivo MIC in plasma of SH0165 was 0.25 μg/ml which was 8 times lower than that in TSB. The bacteriostatic, bactericidal and elimination activity (AUC24h/MIC) in serum were 26.35, 52.27 and 73.29 h based on the inhibitory sigmoid Emax modeling. The present study demonstrates that 97.9% of the wild-type (WT) isolates were covered when the epidemiological cut-off value (ECV) was set at 8 μg/ml. The parameters including AUC24h, AUC, T1/2, Cmax, CLb and MRT in PELF were 19.56, 60.41, 2.32, 4.02, 56.6, and 2.63 times than those in plasma, respectively. Regarding the Monte Carlo simulation, the COPD was defined as 0.5 μg/ml in vitro, and the optimal doses to achieve bacteriostatic, bactericidal and elimination effect were 1.85, 3.67 and 5.16 mg/kg for 50% target, respectively, and 2.07, 4.17 and 5.78 mg/kg for 90% target, respectively. The results of this study offer a more optimised alternative for clinical use and demonstrated that 4.17 mg/kg of tildipirosin by intramuscular injection could have an effect on bactericidal activity against HPS. These values are of great significance for the effective treatment of HPS infections, but it also be deserved to be validated in clinical practice in the future research. PMID:29416722

Correlation of transient elastography with hepatic venous pressure gradient in patients with cirrhotic portal hypertension: A study of 326 patients from India.

PubMed

Kumar, Ashish; Khan, Noor Muhammad; Anikhindi, Shrihari Anil; Sharma, Praveen; Bansal, Naresh; Singla, Vikas; Arora, Anil

2017-01-28

To study the diagnostic accuracy of transient elastography (TE) for detecting clinically significant portal hypertension (CSPH) in Indian patients with cirrhotic portal hypertension. This retrospective study was conducted at the Institute of Liver, Gastroenterology, and Pancreatico-Biliary Sciences, Sir Ganga Ram Hospital, New Delhi, on consecutive patients with cirrhosis greater than 15 years of age who underwent hepatic venous pressure gradient (HVPG) and TE from July 2011 to May 2016. Correlation between HVPG and TE was analyzed using the Spearman's correlation test. Receiver operating characteristic (ROC) curves were prepared for determining the utility of TE in predicting various stages of portal hypertension. The best cut-off value of TE for the diagnosis of CSPH was obtained using the Youden index. The study included 326 patients [median age 52 (range 16-90) years; 81% males]. The most common etiology of cirrhosis was cryptogenic (45%) followed by alcohol (34%). The median HVPG was 16.0 (range 1.5 to 30.5) mmHg. Eighty-five percent of patients had CSPH. A significant positive correlation was noted between TE and HVPG (rho 0.361, P < 0.001). The area under ROC curve for TE in predicting CSPH was 0.740 (95%CI: 0.662-0.818) ( P < 0.01). A cut-off value of TE of 21.6 kPa best predicted CSPH with a positive predictive value (PPV) of 93%. TE has a fair positive correlation with HVPG; thus, TE can be used as a non-invasive modality to assess the degree of portal hypertension. A cut-off TE value of 21.6 kPa identifies CSPH with a PPV of 93%.

Correlation of transient elastography with hepatic venous pressure gradient in patients with cirrhotic portal hypertension: A study of 326 patients from India

PubMed Central

Kumar, Ashish; Khan, Noor Muhammad; Anikhindi, Shrihari Anil; Sharma, Praveen; Bansal, Naresh; Singla, Vikas; Arora, Anil

2017-01-01

AIM To study the diagnostic accuracy of transient elastography (TE) for detecting clinically significant portal hypertension (CSPH) in Indian patients with cirrhotic portal hypertension. METHODS This retrospective study was conducted at the Institute of Liver, Gastroenterology, and Pancreatico-Biliary Sciences, Sir Ganga Ram Hospital, New Delhi, on consecutive patients with cirrhosis greater than 15 years of age who underwent hepatic venous pressure gradient (HVPG) and TE from July 2011 to May 2016. Correlation between HVPG and TE was analyzed using the Spearman’s correlation test. Receiver operating characteristic (ROC) curves were prepared for determining the utility of TE in predicting various stages of portal hypertension. The best cut-off value of TE for the diagnosis of CSPH was obtained using the Youden index. RESULTS The study included 326 patients [median age 52 (range 16-90) years; 81% males]. The most common etiology of cirrhosis was cryptogenic (45%) followed by alcohol (34%). The median HVPG was 16.0 (range 1.5 to 30.5) mmHg. Eighty-five percent of patients had CSPH. A significant positive correlation was noted between TE and HVPG (rho 0.361, P < 0.001). The area under ROC curve for TE in predicting CSPH was 0.740 (95%CI: 0.662-0.818) (P < 0.01). A cut-off value of TE of 21.6 kPa best predicted CSPH with a positive predictive value (PPV) of 93%. CONCLUSION TE has a fair positive correlation with HVPG; thus, TE can be used as a non-invasive modality to assess the degree of portal hypertension. A cut-off TE value of 21.6 kPa identifies CSPH with a PPV of 93%. PMID:28216976

Erythropoietin in Predicting Prognosis in Patients with Acute-on-Chronic Liver Failure.

PubMed

Alempijevic, Tamara; Zec, Simon; Nikolic, Vladimir; Veljkovic, Aleksandar; Milivojevic, Vladimir; Dopsaj, Violeta; Stankovic, Sanja; Milosavljevic, Tomica

2016-12-01

Acute-on-chronic liver failure (ACLF) is characterized by a rapid progression to multiple organ failure and is associated with a very high mortality rate of 50-90%. Novel therapies are being investigated such as Erythropoietin (EPO). The aim of this prospective cohort study was to analyse the value of EPO in predicting prognosis and determine which patients may benefit most from EPO therapy. According to the EASL-CLIF criteria, 104 consecutive patients were diagnosed with ACLF, and separated into two groups based on the type of insult: bleeding (Group A=31) or non-bleeding (Group B=73). In addition to a complete biochemical work-up and calculation of relevant prognostic scores, levels of EPO were measured on admission and correlated to the type of insult and final outcome. Fifteen patients from Group A (mean age 60.32+/-9.29 years) had a lethal outcome and higher values of EPO on admission (319.26+/-326.58 mIU/ml) (p<0.005), compared to the 37 patients from Group B (mean age 59.9+/-10.19 years) with EPO levels at admission of 29.88+/-34.6 mIU/mL. In Group B, a cut-off EPO value of 30.65 mIU/mL had a sensitivity of 87.5% and a specificity 57.4% in predicting lethal outcome with an AUROC of 0.823. In Group A, a cut-off value of 229.95 mlU/mL had a sensitivity and specificity of 53.3% and 92.7%, respectively. The AUROC for this cut-off was 0.847. Erythropoietin is superior to the standard prognostic scores in predicting 28-day mortality. Lower levels of EPO were detected in patients without bleeding as an insult indicating a possible therapeutic benefit in these patients.

Harmonization of the Bayer ADVIA Centaur and Abbott AxSYM automated B-type natriuretic peptide assay in patients on hemodialysis.

PubMed

Barak, Mira; Weinberger, Ronit; Marcusohn, Jerom; Froom, Paul

2005-01-01

There are two fully automated high-throughput clinical instruments for brain natriuretic peptide (BNP) assays, the Bayer ADVIA Centaur assay, and the Abbott AxSYM assay. Although both recommend a cut-off value of 100 pg/mL, we are unaware of previous studies that have compared the unadjusted results of the two methods, required for proper evaluation of patients undergoing this test on different platforms. From 43 hemodialysis patients, 80 paired samples were collected by venipuncture into plastic evacuated tubes containing EDTA. The Bayer assay yielded lower values than the Abbott assay, with linear regression of 0.53 x Abbott assay (95% confidence interval, 0.50-0.56) being forced through 0, demonstrating an r(2)-value of 0.954. Regression for the Abbott assay was 1.79 x Bayer assay (95% CI, 1.69-1.89). The cut-off values for abnormal BNP results analyzed on the Abbott system are not identical to those on the Bayer system, and this needs to be taken into account when comparing studies on the clinical utility of these systems.

Nasal potential difference outcomes support diagnostic decisions in cystic fibrosis.

PubMed

Tridello, Gloria; Menin, Laura; Pintani, Emily; Bergamini, Gabriella; Assael, Baroukh Maurice; Melotti, Paola

2016-09-01

When cystic fibrosis (CF) is suspected Nasal Potential Difference (NPD) measurements are proposed to support controversial diagnosis: we investigated appropriate outcomes at the CF Centre of Verona. NPD were measured in 196 subjects: 50 non-CF, 65 classical CF (the reference group) and 81 with uncertain CF (case group). Discriminating power was determined by comparison between several outcomes from the CF reference group versus non-CF: basal, amiloride, 0Cl, isoproterenol, ATP, Delta-amiloride, Delta-0Cl, Delta-isoproterenol, Delta-ATP, Delta-isoproterenol+Delta-0Cl, Wilschanski Index (WI) and Sermet score (SS). The most appropriate cut-off values for variables with the best discriminating power were then applied to the case group. Descriptive statistics, logistic regression models and ROC curve analysis were applied. WI and SS were the most powerful in discriminating CF from non-CF subjects. In the reference group sensitivity of the 0.82 WI cut-off was 98%, specificity 96%; both sensitivity and specificity of the -0.44 SS cut-off value were 100%. For the case group, WI and SS were, respectively, consistent with CF diagnosis in 94% and 92% of the cases. Formulae have the highest discriminating power and can support the diagnosis in uncertain cases; they should be utilized for standardized interpretation of NPD for diagnosis and possibly for clinical research. Copyright © 2016. Published by Elsevier B.V.

New method of paired thyrotropin assay as a screening test for neonatal hypothyroidism. [/sup 125/I tracer technique

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

Miyai, K.; Oura, T.; Kawashima, M.

1978-11-01

A simple and reliable method of paired TSH assay was developed and used in screening for neonatal primary hypothyroidism. In this method, a paired assay is first done. Equal parts of the extracts of dried blood spots on filter paper (9 mm diameter) from two infants 4 to 7 days old are combined and assayed for TSH by double antibody RIA. If the value obtained is over the cut-off point, the extracts are assayed separately for TSH in a second assay to identify the abnormal sample. Two systems, A and B, with different cut-off points were tested. On the basismore » of reference blood samples (serum levels of TSH, 80 ..mu..U/ml in system A and 40 ..mu..U/ml in system B), the cut-off point was selected as follows: upper 5 (A) or 4 (B) percentile in the paired assay and values of reference blood samples in the second individual assay. Four cases (2 in A and 2 in B) of neonatal primary hypothyroidism were found among 25 infants (23 in A and 2 in B) who were recalled from a general population of 41,400 infants (24,200 in A and 17,200 in B) by 22,700 assays. This paired TSH assay system saves labor and expense for screening neonatal hypothyroidism.« less

Diagnostic accuracy of APRI, FIB-4 and Forns for the detection of liver cirrhosis in HIV/HCV-coinfected patients.

PubMed

Merli, Marco; Galli, Laura; Castagna, Antonella; Salpietro, Stefania; Gianotti, Nicola; Messina, Emanuela; Poli, Andrea; Morsica, Giulia; Bagaglio, Sabrina; Cernuschi, Massimo; Bigoloni, Alba; Uberti-Foppa, Caterina; Lazzarin, Adriano; Hasson, Hamid

2016-04-01

We determined the diagnostic accuracy and optimal cut off of three indirect fibrosis biomarkers (APRI, FIB-4, Forns) compared with liver stiffness (LS) for the detection of liver cirrhosis in HIV/HCV-coinfected patients. An observational retrospective study on HIV/HCV-coinfected patients with concomitant LS measurement and APRI, FIB-4 and Forns was performed. The presence of liver cirrhosis was defined as a LS ≥13 KPa. The diagnostic accuracy and optimal cut-off values, compared with LS categorization (<13 vs ≥13 KPa), were determined by receiver operating characteristics (ROC) curves. The study sample included 646 patients. The area-under-the ROC curve (95% confidence interval) for the detection of liver cirrhosis were 0.84 (0.81-0.88), 0.87 (0.84-0.91) and 0.87 (0.84-0.90) for APRI, FIB-4 and Forns, respectively. According to the optimal cut off values for liver cirrhosis (≥0.97 for APRI, ≥2.02 for FIB-4 and ≥7.8 for Forns), 80%, 80% and 82% of subjects were correctly classified by the three indirect fibrosis biomarkers, respectively. Misclassifications were mostly due to false positive cases. The study suggests that indirect fibrosis biomarkers can help clinicians to exclude liver cirrhosis in the management of HIV/HCV co-infected patients, reducing the frequency of more expensive or invasive assessments.

Systematic review of the evidence for Trails B cut-off scores in assessing fitness-to-drive

PubMed Central

Roy, Mononita; Molnar, Frank

2013-01-01

Background Fitness-to-drive guidelines recommend employing the Trail Making B Test (a.k.a. Trails B), but do not provide guidance regarding cut-off scores. There is ongoing debate regarding the optimal cut-off score on the Trails B test. The objective of this study was to address this controversy by systematically reviewing the evidence for specific Trails B cut-off scores (e.g., cut-offs in both time to completion and number of errors) with respect to fitness-to-drive. Methods Systematic review of all prospective cohort, retrospective cohort, case-control, correlation, and cross-sectional studies reporting the ability of the Trails B to predict driving safety that were published in English-language, peer-reviewed journals. Results Forty-seven articles were reviewed. None of the articles justified sample sizes via formal calculations. Cut-off scores reported based on research include: 90 seconds, 133 seconds, 147 seconds, 180 seconds, and < 3 errors. Conclusions There is support for the previously published Trails B cut-offs of 3 minutes or 3 errors (the ‘3 or 3 rule’). Major methodological limitations of this body of research were uncovered including (1) lack of justification of sample size leaving studies open to Type II error (i.e., false negative findings), and (2) excessive focus on associations rather than clinically useful cut-off scores. PMID:23983828

Evaluation of the prognostic value of neutrophil to lymphocyte ratio in patients with hypertriglyceridemia-induced acute pancreatitis.

PubMed

Wang, Yuchen; Fuentes, Harry E; Attar, Bashar M; Jaiswal, Palash; Demetria, Melchor

Recent studies attribute promising prognostic values to various inflammatory biomarkers in acute pancreatitis, including the following: the neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and red cell distribution width (RDW). We aimed to determine the performance of these biomarkers for detecting disease severity in patients with hypertriglyceridemia-induced acute pancreatitis (HTG-AP). We retrospectively reviewed 110 patients with HTG-AP and compared the NLR, PLR, and RDW in different severity groups. We performed receiver-operating characteristic (ROC) analysis to identify the optimal cut-off value for NLR to predict severe AP. NLR was significantly higher in patients with severe AP than mild and moderately severe AP (14.6 vs. 6.9, p < 0.001), and higher with organ failure upon presentation (9.1 vs. 7.1, p = 0.026). After dichotomization by the optimal cut-off value of 10 as determined by the ROC curve, the high-NLR group had a significantly longer length of stay (9.1 vs. 6.6 days, p = 0.001), duration of nil per os (4.9 vs. 3.7 days, p = 0.007), and higher rates of complications, including systemic inflammatory response syndrome (81.5% vs. 44.6%, p = 0.001) and persistent acute kidney injury (25.9% vs. 3.6%, p < 0.001). High NLR independently predicted severe acute pancreatitis in multivariate analysis (Odds ratio 6.71, p = 0.019). NLR represents an inexpensive, readily available test with a promising value to predict disease severity in HTG-AP. Among the three inflammatory biomarkers, NLR has the highest discriminatory capacity for severe HTG-AP, with an optimal cut-off value of 10. Copyright © 2017 IAP and EPC. Published by Elsevier B.V. All rights reserved.

Mapping tissue inhomogeneity in acute myocarditis: a novel analytical approach to quantitative myocardial edema imaging by T2-mapping.

PubMed

Baeßler, Bettina; Schaarschmidt, Frank; Dick, Anastasia; Stehning, Christian; Schnackenburg, Bernhard; Michels, Guido; Maintz, David; Bunck, Alexander C

2015-12-23

The purpose of the present study was to investigate the diagnostic value of T2-mapping in acute myocarditis (ACM) and to define cut-off values for edema detection. Cardiovascular magnetic resonance (CMR) data of 31 patients with ACM were retrospectively analyzed. 30 healthy volunteers (HV) served as a control. Additionally to the routine CMR protocol, T2-mapping data were acquired at 1.5 T using a breathhold Gradient-Spin-Echo T2-mapping sequence in six short axis slices. T2-maps were segmented according to the 16-segments AHA-model and segmental T2 values as well as the segmental pixel-standard deviation (SD) were analyzed. Mean differences of global myocardial T2 or pixel-SD between HV and ACM patients were only small, lying in the normal range of HV. In contrast, variation of segmental T2 values and pixel-SD was much larger in ACM patients compared to HV. In random forests and multiple logistic regression analyses, the combination of the highest segmental T2 value within each patient (maxT2) and the mean absolute deviation (MAD) of log-transformed pixel-SD (madSD) over all 16 segments within each patient proved to be the best discriminators between HV and ACM patients with an AUC of 0.85 in ROC-analysis. In classification trees, a combined cut-off of 0.22 for madSD and of 68 ms for maxT2 resulted in 83% specificity and 81% sensitivity for detection of ACM. The proposed cut-off values for maxT2 and madSD in the setting of ACM allow edema detection with high sensitivity and specificity and therefore have the potential to overcome the hurdles of T2-mapping for its integration into clinical routine.

Comparison of conventional versus three-dimensional ultrasound in fetal renal pelvis measurement and their potential prediction of neonatal uropathies.

PubMed

Duin, L K; Nijhuis, J G; Scherjon, S A; Vossen, M; Willekes, C

2016-01-01

To establish a threshold value for fetal renal pelvis dilatation measured by automatic volume calculation (SonoAVC) in the third trimester of pregnancy to predict neonatal uropathies, and to compare these results with conventional antero-posterior (AP) measurement, fetal kidney 3D volume and renal parenchymal thickness. In a prospective cohort study, 125 fetuses with renal pelvis AP diameter of ≥5 mm both at 20 weeks of gestation and in the third trimester, underwent an additional 3D volume measurement of the fetal kidney in the third trimester. Receiver operating characteristic (ROC) curves for establishing threshold values for fetal renal pelvis volume, AP measurement, fetal kidney volume and renal parenchymal thickness to predict neonatal uropathies were analyzed. Also, sensitivity, specificity, area under the curve (AUC) and likelihood ratios were calculated. A cut-off point of 1.58 cm³ was identified in the third trimester of pregnancy (AUC 0.865 (95% CI 0.789-0.940), sensitivity 76.3%, specificity 87.4%, LR+ 6.06, LR- 0.27) for measurements with SonoAVC. A cut-off value of 11.5 mm was established in the third trimester of pregnancy (AUC 0.828 (95% CI 0.737-0.918), sensitivity 71.1%, specificity 85.1%, LR+ 4.77, LR- 0.34) for the conventional AP measurement. A cut-off point for fetal kidney volume was calculated at 13.29 cm³ (AUC 0.769 (95% CI 0.657-0.881), sensitivity 71%, specificity 66%, LR+ 2.09, LR- 0.44). For renal parenchymal thickness, a cut-off point of 8.4 mm was established (AUC 0.216 (95% CI 0.117-0.315), sensitivity 31.6%, specificity 32.6%, LR+ 0.47, LR- 2.10). This study demonstrates that 3D fetal renal pelvis volume measurements and AP measurements both have a good and comparable diagnostic performance, fetal renal volume a fair accuracy and renal parenchymal thickness a poor accuracy in predicting postnatal renal outcome.

Comparison of different strategies in prenatal screening for Down's syndrome: cost effectiveness analysis of computer simulation.

PubMed

Gekas, Jean; Gagné, Geneviève; Bujold, Emmanuel; Douillard, Daniel; Forest, Jean-Claude; Reinharz, Daniel; Rousseau, François

2009-02-13

To assess and compare the cost effectiveness of three different strategies for prenatal screening for Down's syndrome (integrated test, sequential screening, and contingent screenings) and to determine the most useful cut-off values for risk. Computer simulations to study integrated, sequential, and contingent screening strategies with various cut-offs leading to 19 potential screening algorithms. The computer simulation was populated with data from the Serum Urine and Ultrasound Screening Study (SURUSS), real unit costs for healthcare interventions, and a population of 110 948 pregnancies from the province of Québec for the year 2001. Cost effectiveness ratios, incremental cost effectiveness ratios, and screening options' outcomes. The contingent screening strategy dominated all other screening options: it had the best cost effectiveness ratio ($C26,833 per case of Down's syndrome) with fewer procedure related euploid miscarriages and unnecessary terminations (respectively, 6 and 16 per 100,000 pregnancies). It also outperformed serum screening at the second trimester. In terms of the incremental cost effectiveness ratio, contingent screening was still dominant: compared with screening based on maternal age alone, the savings were $C30,963 per additional birth with Down's syndrome averted. Contingent screening was the only screening strategy that offered early reassurance to the majority of women (77.81%) in first trimester and minimised costs by limiting retesting during the second trimester (21.05%). For the contingent and sequential screening strategies, the choice of cut-off value for risk in the first trimester test significantly affected the cost effectiveness ratios (respectively, from $C26,833 to $C37,260 and from $C35,215 to $C45,314 per case of Down's syndrome), the number of procedure related euploid miscarriages (from 6 to 46 and from 6 to 45 per 100,000 pregnancies), and the number of unnecessary terminations (from 16 to 26 and from 16 to 25 per 100,000 pregnancies). Contingent screening, with a first trimester cut-off value for high risk of 1 in 9, is the preferred option for prenatal screening of women for pregnancies affected by Down's syndrome.

Double burden: a cross-sectional survey assessing factors associated with underweight and overweight status in Danang, Vietnam

PubMed Central

2013-01-01

Background Many low- to middle-income countries are faced with an increasing prevalence of overweight/obesity while that for underweight remains high, a duality termed “double burden”; both are key risk factors for chronic diseases. This cross-sectional study assesses the prevalence and factors for underweight and overweight/obesity among adults in Danang, Vietnam, using WHO standard and suggested Asian-specific BMI cut-offs. Methods In 2010, 1713 residents age ≥35 years from 900 households in 6 of 56 urban, rural and mixed urban–rural communes in Danang were selected using multistage-cluster sampling methodology to participate; 1621 qualified adults enrolled. Participants completed a health survey based on WHO STEPwise Approach to Chronic Disease Risk Factor Surveillance and additional questions on chest pain and stroke symptoms. Anthropometric and other measurements were conducted. Relative risk regression was used to identify independent risk factors for underweight or overweight/obesity according to WHO standard cut-offs and suggested Asian-specific cut-offs (<18.5 kg/m2 or 23–27.49 kg/m2; and ≥27.5 kg/m2). Results We observed 12.4% prevalence of underweight and 16.0% for overweight/obesity using WHO standard. The prevalence of overweight/obesity doubled (33.7%) when Asian-specific cut-offs were applied. For both definitions, rural communes had the highest prevalence of underweight while urban communes had the highest prevalence of overweight/obesity. Being underweight was associated with less urbanization. Factors independently associated with being underweight included older age, rural living, current smoking, and lower systolic pressure. Factors independently associated with Asian-specific BMI definition for being overweight/obese included older age, urbanization, higher systolic pressure, and diabetes. Age was not an independent factor with WHO standard cut-offs; however, myocarial infarction and diabetes showed strong associations. Conclusions The double burden of underweight and overweight/obesity observed in Danang is consistent with patterns found for large cities in Vietnam that are undergoing rapid economic growth and urbanization of lifestyle. Factors independently associated with underweight and overweight/obesity status by WHO standard and Asian-specific definitions include urbanization and modifiable lifestyle factors. Further studies are needed to define ethnic specific BMI cut-offs for Vietnam and to explore strategies to reduce the rising prevalence of overweight/obesity. PMID:23316727

Concurrence of the strengths and difficulties questionnaire and developmental behaviour checklist among children with an intellectual disability.

PubMed

Rice, L J; Emerson, E; Gray, K M; Howlin, P; Tonge, B J; Warner, G L; Einfeld, S L

2018-02-01

The Strengths and Difficulties Questionnaire (SDQ) is widely used to measure emotional and behavioural problems in typically developing young people, although there is some evidence that it may also be suitable for children with intellectual disability (ID). The Developmental Behaviour Checklist - Parent version (DBC-P) is a measure of emotional and behavioural problems that was specifically designed for children and adolescents with an ID. The DBC-P cut-off has high agreement with clinical diagnosis. The aim of this study was to estimate the relationship between DBC-P and SDQ scores in a sample of children with ID. Parents of 83 young people with ID aged 4-17 years completed the parent versions of the SDQ and the DBC-P. We evaluated the concurrent validity of the SDQ and DBC-P total scores, and the agreement between the DBC-P cut-off and the SDQ cut-offs for 'borderline' and 'abnormal' behaviour. The SDQ total difficulties score correlated well with the DBC-P total behaviour problem score. Agreement between the SDQ borderline cut-off and the DBC-P cut-off for abnormality was high (83%), but was lower for the SDQ abnormal cut-off (75%). Positive agreement between the DBC-P and the SDQ borderline cut-off was also high, with the SDQ borderline cut-off identifying 86% of those who met the DBC-P criterion. Negative agreement was weaker, with the SDQ borderline cut-off identifying only 79% of the participants who did not meet the DBC-P cut-off. The SDQ borderline cut-off has some validity as a measure of overall levels of behavioural and emotional problems in young people with ID, and may be useful in epidemiological studies that include participants with and without ID. However, where it is important to focus on behavioural profiles in children with ID, a specialised ID instrument with established psychometric properties, such as the DBC-P, may provide more reliable and valid information. © 2017 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.

Producing genetic knowledge and citizenship through the Internet: mothers, pediatric genetics, and cybermedicine.

PubMed

Schaffer, Rebecca; Kuczynski, Kristine; Skinner, Debra

2008-01-01

This article analyses data from a longitudinal, ethnographic study conducted in the United States to examine how 100 mothers of children with genetic disorders used the Internet to interpret, produce, and circulate genetic knowledge pertaining to their child's condition. We describe how they came to value their own experiential knowledge, helped shift the boundaries of what counts as authoritative knowledge, and assumed the role of genetic citizen, fighting for specific rights while shouldering and contesting concomitant duties and obligations. This exploration of e-health use contributes to our understanding of the social practices and power relations that cut across online and off-line worlds to co-produce genetic knowledge and genetic citizenship in multiple contexts.

Urban and Education Disparity for Autism Spectrum Disorders in Taiwan Birth Cohort Study.

PubMed

Lung, For-Wey; Chiang, Tung-Liang; Lin, Shio-Jean; Shu, Bih-Ching

2017-03-01

This study aimed to determine the optimal cut-off for autism spectrum disorder (ASD) screening in 66-month-old children, and to explore the distribution of ASD screening and diagnosis in Taiwan. The Taiwan Birth Cohort Study dataset was used (N = 20,095). The Modified Checklist for Autism in Toddlers (M-CHAT) cut-off point of 13/14 was considered optimal for screening of children at 66 months. More children were diagnosed with ASD in urban areas. Parents of children diagnosed with ASD had a higher level of education, but parents of children with a lower level of education were screened as being at higher risk of ASD. Urban disparity and parental level of education effected parental awareness of the illness and the rate of ASD diagnosis.

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.

Medial temporal lobe atrophy ratings in a large 75-year-old population-based cohort: gender-corrected and education-corrected normative data.

PubMed

Velickaite, V; Ferreira, D; Cavallin, L; Lind, L; Ahlström, H; Kilander, L; Westman, E; Larsson, E-M

2018-04-01

To find cut-off values for different medial temporal lobe atrophy (MTA) measures (right, left, average, and highest), accounting for gender and education, investigate the association with cognitive performance, and to compare with decline of cognitive function over 5 years in a large population-based cohort. Three hundred and ninety 75-year-old individuals were examined with magnetic resonance imaging of the brain and cognitive testing. The Scheltens's scale was used to assess visually MTA scores (0-4) in all subjects. Cognitive tests were repeated in 278 of them after 5 years. Normal MTA cut-off values were calculated based on the 10th percentile. Most 75-year-old individuals had MTA score ≤2. Men had significantly higher MTA scores than women. Scores for left and average MTA were significantly higher in highly educated individuals. Abnormal MTA was associated with worse results in cognitive test and individuals with abnormal right MTA had faster cognitive decline. At age 75, gender and education are confounders for MTA grading. A score of ≥2 is abnormal for low-educated women and a score of ≥2.5 is abnormal for men and high-educated women. Subjects with abnormal right MTA, but normal MMSE scores had developed worse MMSE scores 5 years later. • Gender and education are confounders for MTA grading. • We suggest cut-off values for 75-year-olds, taking gender and education into account. • Males have higher MTA scores than women. • Higher MTA scores are associated with worse cognitive performance.

Can Fetuin-A Be a Marker for Insulin Resistance and Poor Glycemic Control in Children with Type 1 Diabetes Mellitus?

PubMed

Şiraz, Ülkü Gül; Doğan, Murat; Hatipoğlu, Nihal; Muhtaroğlu, Sabahattin; Kurtoğlu, Selim

2017-12-15

Metabolic impairment in type 1 diabetes mellitus (T1DM) with poor glycemic control causes insulin resistance, non-alcoholic fatty liver disease (NAFLD), atherosclerosis, and increased carotid intima-media thickness (CIMT). Fetuin-A has a protective effect in cardiovascular disorders and is increased in hepatosteatosis. We aimed to investigate the reliability of fetuin-A levels in early detection of diabetic complications in children with T1DM and to identify a cut-off value that may show poor metabolic control. The study included 80 patients who had T1DM for at least 5 years and who had no chronic complications or an auto-immune disorder. Blood samples were drawn to measure hemoglobin A1c (HbA1c), biochemical parameters, and fetuin-A levels. Anthropometric parameters were also measured. Percent body fat was calculated. Hepatosteatosis and CIMT were assessed by sonography. Mean age of the patients was 13.5 years. Grade 1 hepatosteatosis was detected in 10%. Patients were stratified into 2 groups based on presence of NAFLD. Fetuin-A level was increased in patients with NAFLD. We identified a fetuin-A cut-off value (514.28 ng/mL; sensitivity: 47.34; specificity: 96.72) that may predict NAFLD. HbA1c and total cholesterol levels were found to be higher in patients with fetuin-A levels above higher the cut-off value. Fetuin-A is a reliable parameter in the prediction of complications and poor glycemic control in patients with T1DM.

Radiological assessment of breast density by visual classification (BI-RADS) compared to automated volumetric digital software (Quantra): implications for clinical practice.

PubMed

Regini, Elisa; Mariscotti, Giovanna; Durando, Manuela; Ghione, Gianluca; Luparia, Andrea; Campanino, Pier Paolo; Bianchi, Caterina Chiara; Bergamasco, Laura; Fonio, Paolo; Gandini, Giovanni

2014-10-01

This study was done to assess breast density on digital mammography and digital breast tomosynthesis according to the visual Breast Imaging Reporting and Data System (BI-RADS) classification, to compare visual assessment with Quantra software for automated density measurement, and to establish the role of the software in clinical practice. We analysed 200 digital mammograms performed in 2D and 3D modality, 100 of which positive for breast cancer and 100 negative. Radiological density was assessed with the BI-RADS classification; a Quantra density cut-off value was sought on the 2D images only to discriminate between BI-RADS categories 1-2 and BI-RADS 3-4. Breast density was correlated with age, use of hormone therapy, and increased risk of disease. The agreement between the 2D and 3D assessments of BI-RADS density was high (K 0.96). A cut-off value of 21% is that which allows us to best discriminate between BI-RADS categories 1-2 and 3-4. Breast density was negatively correlated to age (r = -0.44) and positively to use of hormone therapy (p = 0.0004). Quantra density was higher in breasts with cancer than in healthy breasts. There is no clear difference between the visual assessments of density on 2D and 3D images. Use of the automated system requires the adoption of a cut-off value (set at 21%) to effectively discriminate BI-RADS 1-2 and 3-4, and could be useful in clinical practice.

Asymptotic analysis of the local potential approximation to the Wetterich equation

NASA Astrophysics Data System (ADS)

Bender, Carl M.; Sarkar, Sarben

2018-06-01

This paper reports a study of the nonlinear partial differential equation that arises in the local potential approximation to the Wetterich formulation of the functional renormalization group equation. A cut-off-dependent shift of the potential in this partial differential equation is performed. This shift allows a perturbative asymptotic treatment of the differential equation for large values of the infrared cut-off. To leading order in perturbation theory the differential equation becomes a heat equation, where the sign of the diffusion constant changes as the space-time dimension D passes through 2. When D  <  2, one obtains a forward heat equation whose initial-value problem is well-posed. However, for D  >  2 one obtains a backward heat equation whose initial-value problem is ill-posed. For the special case D  =  1 the asymptotic series for cubic and quartic models is extrapolated to the small infrared-cut-off limit by using Padé techniques. The effective potential thus obtained from the partial differential equation is then used in a Schrödinger-equation setting to study the stability of the ground state. For cubic potentials it is found that this Padé procedure distinguishes between a -symmetric theory and a conventional Hermitian theory (g real). For an theory the effective potential is nonsingular and has a stable ground state but for a conventional theory the effective potential is singular. For a conventional Hermitian theory and a -symmetric theory (g  >  0) the results are similar; the effective potentials in both cases are nonsingular and possess stable ground states.

Optimal cut-off points for waist circumference in the definition of metabolic syndrome in Brazilian adults: baseline analyses of the Longitudinal Study of Adult Health (ELSA-Brasil).

PubMed

Cardinal, Thiane Ristow; Vigo, Alvaro; Duncan, Bruce Bartholow; Matos, Sheila Maria Alvim; da Fonseca, Maria de Jesus Mendes; Barreto, Sandhi Maria; Schmidt, Maria Inês

2018-01-01

Waist circumference (WC) has been incorporated in the definition of the metabolic syndrome (MetS) but the exact WC cut-off points across populations are not clear. The Joint Interim Statement (JIS) suggested possible cut-offs to different populations and ethnic groups. However, the adequacy of these cut-offs to Brazilian adults has been scarcely investigated. The objective of the study is to evaluate possible WC thresholds to be used in the definition of MetS using data from the Longitudinal Study of Adult Health (ELSA-Brasil), a multicenter cohort study of civil servants (35-74 years old) of six Brazilian cities. We analyzed baseline data from 14,893 participants (6772 men and 8121 women). A MetS was defined according to the JIS criteria, but excluding WC and thus requiring 2 of the 4 remaining elements. We used restricted cubic spline regression to graph the relationship between WC and MetS. We identified optimal cut-off points which maximized joint sensitivity and specificity (Youden's index) from Receiver Operator Characteristic Curves. We also estimated the C-statistics using logistic regression. We found no apparent threshold for WC in restricted cubic spline plots. Optimal cut-off for men was 92 cm (2 cm lower than that recommended by JIS for Caucasian/Europids or Sub-Saharan African men), but 2 cm higher than that recommended for ethnic Central and South American. For women, optimal cut-off was 86, 6 cm higher than that recommended for Caucasian/Europids and ethnic Central and South American. Optimal cut-offs did not very across age groups and most common race/color categories (except for Asian men, 87 cm). Sex-specific cut-offs for WC recommended by JIS differ from optimal cut-offs we found for adult men and women of Brazil´s most common ethnic groups.

Measurement and interpretation of skin prick test results.

PubMed

van der Valk, J P M; Gerth van Wijk, R; Hoorn, E; Groenendijk, L; Groenendijk, I M; de Jong, N W

2015-01-01

There are several methods to read skin prick test results in type-I allergy testing. A commonly used method is to characterize the wheal size by its 'average diameter'. A more accurate method is to scan the area of the wheal to calculate the actual size. In both methods, skin prick test (SPT) results can be corrected for histamine-sensitivity of the skin by dividing the results of the allergic reaction by the histamine control. The objectives of this study are to compare different techniques of quantifying SPT results, to determine a cut-off value for a positive SPT for histamine equivalent prick -index (HEP) area, and to study the accuracy of predicting cashew nut reactions in double-blind placebo-controlled food challenge (DBPCFC) tests with the different SPT methods. Data of 172 children with cashew nut sensitisation were used for the analysis. All patients underwent a DBPCFC with cashew nut. Per patient, the average diameter and scanned area of the wheal size were recorded. In addition, the same data for the histamine-induced wheal were collected for each patient. The accuracy in predicting the outcome of the DBPCFC using four different SPT readings (i.e. average diameter, area, HEP-index diameter, HEP-index area) were compared in a Receiver-Operating Characteristic (ROC) plot. Characterizing the wheal size by the average diameter method is inaccurate compared to scanning method. A wheal average diameter of 3 mm is generally considered as a positive SPT cut-off value and an equivalent HEP-index area cut-off value of 0.4 was calculated. The four SPT methods yielded a comparable area under the curve (AUC) of 0.84, 0.85, 0.83 and 0.83, respectively. The four methods showed comparable accuracy in predicting cashew nut reactions in a DBPCFC. The 'scanned area method' is theoretically more accurate in determining the wheal area than the 'average diameter method' and is recommended in academic research. A HEP-index area of 0.4 is determined as cut-off value for a positive SPT. However, in clinical practice, the 'average diameter method' is also useful, because this method provides similar accuracy in predicting cashew nut allergic reactions in the DBPCFC. Trial number NTR3572.

[Development of competency to stand trial rating scale in offenders with mental disorders].

PubMed

Chen, Xiao-Bing; Cai, Wei-Xiong

2013-04-01

According with Chinese legal system, to develop a competency to stand trial rating scale in offenders with mental disorders. Proceeding from the juristical elements, 15 items were extracted and formulated a preliminary instrument named the competency to stand trial rating scale in offenders with mental disorders. The item analysis included six aspects, which were critical ratio, item-total correlation, corrected item-total correlation, alpha value if item deleted, communalities of items, and factor loading. The Logistic regression equation and cut-off score of ROC curve were used to explore the diagnostic efficiency. The data of critical ratio of extreme group were 18.390-46.763; item-total correlation, 0.639-0.952; corrected item-total correlation, 0.582-0.944; communalities of items, 0.377-0.916; and factor loadings, 0.614-0.957. Seven items were included in the regression equation and the accuracy of back substitution test was 96.0%. The score of 33 was ascertained as the cut-off score by ROC fitting curve, the overlapping ratio compared with the expertise was 95.8%. The sensibility and the specificity were 0.938 and 0.966, respectively, while the positive and negative likelihood ratios were 27.67 and 0.06, respectively. With all items satisfied the requirement of homogeneity test, the rating scale has a reasonable construct and excellent diagnostic efficiency.

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

Cometto-Muniz, J. Enrique; Cain, William S.; Abraham, Michael H.

Previous research showed a cut-off along homologous volatile organic compounds (VOCs) in their ability to produce acute human mucosal irritation. The present study sought to specify the particular cut-off homolog for sensory eye irritation in an acetate and n-alcohol series. A 1900-ml glass vessel system and a three-alternative forced-choice procedure served to test nonyl, decyl, and dodecyl acetate, and 1-nonanol, 1-decanol, and 1-undecanol. Flowrate to the eye ranged from 2 to 8 L/min and time of exposure from 3 to 24 s. Decyl acetate and 1-undecanol were the shortest homologs that failed to produce eye irritation under all conditions, producingmore » a cut-off effect. Increasing the vapor concentration of decyl acetate and 1-undecanol by 3 and 8 times, respectively, via heating them to 37 deg C made either or both VOCs detectable to only half of the 12 subjects tested, even though the higher vapor concentration was well above a predicted eye irritation threshold. When eye irritation thresholds for homologous acetates and n-alcohols were plotted as a function of the longest unfolded length of the molecule, the values for decyl acetate and 1-undecanol fell within a restricted range of 18 to 19 A. The outcome suggests that the basis for the cut-off is biological, that is, the molecule lacks a key size or structure to trigger transduction, rather than physical, that is, the vapor concentration is too low to precipitate detection.« less

Standardized Index of Shape (DCE-MRI) and Standardized Uptake Value (PET/CT): Two quantitative approaches to discriminate chemo-radiotherapy locally advanced rectal cancer responders under a functional profile

PubMed Central

Petrillo, Antonella; Fusco, Roberta; Petrillo, Mario; Granata, Vincenza; Delrio, Paolo; Bianco, Francesco; Pecori, Biagio; Botti, Gerardo; Tatangelo, Fabiana; Caracò, Corradina; Aloj, Luigi; Avallone, Antonio; Lastoria, Secondo

2017-01-01

Purpose To investigate dynamic contrast enhanced-MRI (DCE-MRI) in the preoperative chemo-radiotherapy (CRT) assessment for locally advanced rectal cancer (LARC) compared to18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT). Methods 75 consecutive patients with LARC were enrolled in a prospective study. DCE-MRI analysis was performed measuring SIS: linear combination of percentage change (Δ) of maximum signal difference (MSD) and wash-out slope (WOS). 18F-FDG PET/CT analysis was performed using SUV maximum (SUVmax). Tumor regression grade (TRG) were estimated after surgery. Non-parametric tests, receiver operating characteristic were evaluated. Results 55 patients (TRG1-2) were classified as responders while 20 subjects as non responders. ΔSIS reached sensitivity of 93%, specificity of 80% and accuracy of 89% (cut-off 6%) to differentiate responders by non responders, sensitivity of 93%, specificity of 69% and accuracy of 79% (cut-off 30%) to identify pathological complete response (pCR). Therapy assessment via ΔSUVmax reached sensitivity of 67%, specificity of 75% and accuracy of 70% (cut-off 60%) to differentiate responders by non responders and sensitivity of 80%, specificity of 31% and accuracy of 51% (cut-off 44%) to identify pCR. Conclusions CRT response assessment by DCE-MRI analysis shows a higher predictive ability than 18F-FDG PET/CT in LARC patients allowing to better discriminate significant and pCR. PMID:28042958

Standardized Index of Shape (DCE-MRI) and Standardized Uptake Value (PET/CT): Two quantitative approaches to discriminate chemo-radiotherapy locally advanced rectal cancer responders under a functional profile.

PubMed

Petrillo, Antonella; Fusco, Roberta; Petrillo, Mario; Granata, Vincenza; Delrio, Paolo; Bianco, Francesco; Pecori, Biagio; Botti, Gerardo; Tatangelo, Fabiana; Caracò, Corradina; Aloj, Luigi; Avallone, Antonio; Lastoria, Secondo

2017-01-31

To investigate dynamic contrast enhanced-MRI (DCE-MRI) in the preoperative chemo-radiotherapy (CRT) assessment for locally advanced rectal cancer (LARC) compared to18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT). 75 consecutive patients with LARC were enrolled in a prospective study. DCE-MRI analysis was performed measuring SIS: linear combination of percentage change (Δ) of maximum signal difference (MSD) and wash-out slope (WOS). 18F-FDG PET/CT analysis was performed using SUV maximum (SUVmax). Tumor regression grade (TRG) were estimated after surgery. Non-parametric tests, receiver operating characteristic were evaluated. 55 patients (TRG1-2) were classified as responders while 20 subjects as non responders. ΔSIS reached sensitivity of 93%, specificity of 80% and accuracy of 89% (cut-off 6%) to differentiate responders by non responders, sensitivity of 93%, specificity of 69% and accuracy of 79% (cut-off 30%) to identify pathological complete response (pCR). Therapy assessment via ΔSUVmax reached sensitivity of 67%, specificity of 75% and accuracy of 70% (cut-off 60%) to differentiate responders by non responders and sensitivity of 80%, specificity of 31% and accuracy of 51% (cut-off 44%) to identify pCR. CRT response assessment by DCE-MRI analysis shows a higher predictive ability than 18F-FDG PET/CT in LARC patients allowing to better discriminate significant and pCR.

Return to Work: A Cut-Off of FIM Gain with Montebello Rehabilitation Factor Score in Order to Identify Predictive Factors in Subjects with Acquired Brain Injury.

PubMed

Franceschini, Marco; Massimiani, Maria Pia; Paravati, Stefano; Agosti, Maurizio

2016-01-01

Return to work (RTW) for people with acquired brain injury (ABI) represents a main objective of rehabilitation: this work presents a strong correlation between personal well-being and quality of life. The aim of this study is to investigate the prognostic factors that can predict RTW after ABI (traumatic or non- traumatic aetiology) in patients without disorders of consciousness (e.g. coma, vegetative or minimally conscious state) at the beginning of their admission to rehabilitation. At the end of a 6-month follow-up after discharge, data were successfully collected in 69 patients. The rehabilitation effectiveness (functional Recovery) between admission and discharge was assessed by Functional Independent Measure (FIM) gain, through the Montebello Rehabilitation Factor Score (MRFS), which was obtained as follows: (discharge FIM-admission FIM)/(Maximum possible FIM-Admission FIM) x 100. The cut-off value (criterion) deriving from MRFS, which helped identify RTW patients, resulted in .659 (sn 88.9%; sp 52.4%). Considering the Mini Mental State Examination (MMSE) and the MRFS data, the multivariable binary logistic regression analysis presented 62.96% of correct RTW classification cases, 80.95% of non-RTW leading to an overall satisfactory predictability of 73.91%. The results of the present study suggest that occupational therapy intervention could modify cut-off in patients with an MFRS close to target at the end of an in-hospital rehabilitative program thus developing their capabilities and consequently surpassing cut-off itself.

Autism characteristics and behavioural disturbances in ~ 500 children with Down's syndrome in England and Wales.

PubMed

Warner, Georgina; Moss, Joanna; Smith, Patrick; Howlin, Patricia

2014-08-01

Recent research shows that a significant minority of children with Down's syndrome (DS) also meet diagnostic criteria for an autism spectrum disorder (ASD). The present study investigated what proportion of children aged 6-15 years with a confirmed diagnosis of DS in England and Wales display autistic-type behaviours, and explored the characteristics of this group of children. The Social Communication Questionnaire (SCQ) was used to screen for autism characteristics and the Strengths and Difficulties Questionnaire (SDQ) to explore behavioural difficulties. The proportion of children who met the cut-off score for ASD on the SCQ (total score ≥ 15) was 37.7% (95% CI: 33.4-42.0%); for autism (total score ≥ 22) the proportion was 16.5% (95% CI: 13.2-19.8%). Children who met the cut-off for ASD were significantly more likely to be reported as having emotional symptoms, conduct problems and hyperactivity on the SDQ than children who scored well below cut-off (total score < 10). However, the profile of their autism characteristics on the SCQ was atypical compared with individuals with idiopathic ASD. The pervasiveness of ASD in children with DS in England and Wales is substantially higher than in the general population. These children also experience significantly greater behavioural problems than children with DS only. Early detection of autism characteristics is important for appropriate intervention. However, the unusual profile of autism characteristics in this group may affect the recognition of the disorder and hinder the implementation of appropriate interventions. © 2014 International Society for Autism Research, Wiley Periodicals, Inc.

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.

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.

Lipoprotein(a) levels are associated with subclinical calcific aortic valve disease in Caucasian and Black individuals: The Multi-Ethnic Study of Atherosclerosis

PubMed Central

Cao, Jing; Steffen, Brian T.; Budoff, Matthew; Post, Wendy S.; Thanassoulis, George; Kestenbaum, Bryan; McConnell, Joseph P.; Warnick, Russell; Guan, Weihua; Tsai, Michael Y.

2016-01-01

Objective Lipoprotein(a) [Lp(a)] is a risk factor for calcific aortic valve disease (CAVD) but has not been evaluated across multiple races/ethnicities. This study aimed to determine whether Lp(a) cut-off values used in clinical laboratories to assess risk of cardiovascular disease identify subclinical CAVD and its severity and whether significant relations are observed across race/ethnicity. Approach and Results Lp(a) concentrations were measured using a turbidimetric immunoassay, and subclinical CAVD was measured by quantifying aortic valve calcification (AVC) through computed tomography scanning in 4,678 participants of the Multi-Ethnic Study of Atherosclerosis. Relative risk (RR) and ordered logistic regression analysis determined cross-sectional associations of Lp(a) with AVC and its severity, respectively. The conventional 30 mg/dL Lp(a) clinical cut-off was associated with AVC in Caucasian (RR: 1.56; CI: 1.24–1.96) and was borderline significant (p=0.059) in Black study participants (RR: 1.55; CI: 0.98–2.44). Caucasians with levels ≥50 mg/dL also showed higher prevalence of AVC (RR: 1.72; CI: 1.36–2.17) than those below this level. Significant associations were observed between Lp(a) and degree of AVC in both Caucasians and Black individuals. The presence of existing coronary artery calcification did not affect these associations of Lp(a) and CAVD. There were no significant findings in Hispanics or Chinese. Conclusions Lp(a) cut-off values that are currently used to assess cardiovascular risk appear to be applicable to CAVD, but our results suggest race/ethnicity may be important in cut-off selection. Further studies are warranted to determine whether race/ethnicity influences Lp(a) and risk of CAVD incidence and its progression. PMID:26941019

The presence of anti-endomysial antibodies and the level of anti-tissue transglutaminases can be used to diagnose adult coeliac disease without duodenal biopsy.

PubMed

Tortora, R; Imperatore, N; Capone, P; De Palma, G D; De Stefano, G; Gerbino, N; Caporaso, N; Rispo, A

2014-11-01

The new ESPGHAN guidelines for diagnosis of paediatric coeliac disease suggest to avoid biopsy in genetically pre-disposed and symptomatic individuals with positive anti-endomysial antibodies (EMA) and anti-tissue transglutaminases (a-tTG). However, duodenal biopsy remains the gold standard in adult coeliac disease. To establish the cut-off values of a-tTG, which would: predict the presence of duodenal histology (Marsh ≥2) diagnostic for coeliac disease; and predict the presence of villous atrophy (Marsh 3) in adults. We performed an observational prospective study including all consecutive adult patients with suspected coeliac disease. All subjects were tested for EMA and a-tTG. Coeliac disease diagnosis was made in presence of Marsh ≥2, a-tTG >7 U/mL and positive EMA. A ROC curve was constructed to establish the best specificity cut-off of a-tTG levels, which would predict the presence of Marsh ≥2 and Marsh 3 at histology. The study included 310 patients with positive antibodies. Histology showed Marsh 1 in 8.7%, Marsh 2 in 3.5%, Marsh 3 in 87.7%. The best cut-off value of a-tTG for predicting Marsh ≥2 was 45 U/mL (sensitivity 70%; specificity 100%; PPV 100%; NPV 24.1%); the best cut-off for predicting villous atrophy was 62.4 U/mL (sensitivity 69%, specificity 100%; PPV 100%; NPV 31%). The diagnosis of coeliac disease can be reached without histology in adult patients with positive EMA and a-tTG levels >45 U/mL. An a-tTG level >62.4 was diagnostic for villous atrophy. These results could contribute to improving the diagnosis of coeliac disease by allowing for a significant reduction in diagnosis-related costs. © 2014 John Wiley & Sons Ltd.

Evaluation of a multiplex immunoassay for bovine respiratory syncytial virus and bovine coronavirus antibodies in bulk tank milk against two indirect ELISAs using latent class analysis.

PubMed

Toftaker, Ingrid; Toft, Nils; Stokstad, Maria; Sølverød, Liv; Harkiss, Gordon; Watt, Neil; O' Brien, Amanda; Nødtvedt, Ane

2018-06-01

Bovine respiratory syncytial virus (BRSV) and bovine coronavirus (BCV) are responsible for respiratory disease and diarrhea in cattle worldwide. The Norwegian control program against these infections is based on herd-level diagnosis using a new multiplex immunoassay. The objective of this study was to estimate sensitivity and specificity across different cut-off values for the MVD-Enferplex BCV/BRSV multiplex, by comparing them to a commercially available ELISA, the SVANOVIR ® BCV-Ab and SVANOVIR ® BRSV-Ab, respectively. We analyzed bulk tank milk samples from 360 herds in a low- and 360 herds in a high-prevalence area. As none of the tests were considered perfect, estimation of test characteristics was performed using Bayesian latent class models. At the manufacturers' recommended cut-off values, the median sensitivity for the BRSV multiplex and the BRSV ELISA was 94.4 [89.8-98.7 95% Posterior Credibility Interval (PCI)] and 99.8 [98.7-100 95% PCI], respectively. The median specificity for the BRSV multiplex was 90.6 [85.5-94.4 95% PCI], but only 57.4 [50.5-64.4 95% PCI] for the BRSV ELISA. However, increasing the cut-off of the BRSV ELISA increased specificity without compromising sensitivity. For the BCV multiplex we found that by using only one of the three antigens included in the test, the specificity increased, without concurrent loss in sensitivity. At the recommended cut-off this resulted in a sensitivity of 99.9 [99.3-100 95% PCI] and specificity of 93.7 [88.8-97.8 95% PCI] for the multiplex and a sensitivity of 99.5 [98.1-100 95% PCI] and a specificity of 99.6 [97.6-100 95% PCI] for the BCV ELISA. Copyright © 2018 Elsevier B.V. All rights reserved.

Clinical validation of the C-VAT 2.0 assessment tool for gaming disorder: A sensitivity analysis of the proposed DSM-5 criteria and the clinical characteristics of young patients with 'video game addiction'.

PubMed

van Rooij, Antonius J; Schoenmakers, Tim M; van de Mheen, Dike

2017-01-01

Clinicians struggle with the identification of video gaming problems. To address this issue, a clinical assessment tool (C-VAT 2.0) was developed and tested in a clinical setting. The instrument allows exploration of the validity of the DSM-5 proposal for 'internet gaming disorder'. Using C-VAT 2.0, the current study provides a sensitivity analysis of the proposed DSM-5 criteria in a clinical youth sample (13-23years old) in treatment for video gaming disorder (N=32). The study also explores the clinical characteristics of these patients. The patients were all male and reported spending extensive amounts of time on video games. At least half of the patients reported playing online games (n=15). Comorbid problems were common (n=22) and included (social) anxiety disorders, PDD NOS, ADHD/ADD, Parent-Child relationship problem, and various types of depressive mood problems. The sensitivity of the test was good: results further show that the C-VAT correctly identified 91% of the sample at the proposed cut-off score of at least 5 out of 9 of the criteria. As our study did not include healthy, extreme gamers, we could not assess the specificity of the tool: future research should make this a priority. Using the proposed DSM-5 cut-off score, the C-VAT 2.0 shows preliminary validity in a sample of gamers in treatment for gaming disorder, but the discriminating value of the instrument should be studied further. In the meantime, it is crucial that therapists try to avoid false positives by using expert judgment of functional impairment in each case. Copyright © 2015 Elsevier Ltd. All rights reserved.

Cutting the Cord-2

NASA Technical Reports Server (NTRS)

2004-01-01

This animation shows the view from the rear hazard avoidance cameras on the Mars Exploration Rover Spirit as the rover turns 45 degrees clockwise. This maneuver is the first step in a 3-point turn that will rotate the rover 115 degrees to face west. The rover must make this turn before rolling off the lander because airbags are blocking it from exiting from the front lander petal. Before this crucial turn took place, engineers instructed the rover to cut the final cord linking it to the lander. The turn took around 30 minutes to complete.

Total motile sperm count has a superior predictive value over the WHO 2010 cut-off values for the outcomes of intracytoplasmic sperm injection cycles.

PubMed

Borges, E; Setti, A S; Braga, D P A F; Figueira, R C S; Iaconelli, A

2016-09-01

The objective of this study was to compare (i) the intracytoplasmic sperm injection outcomes among groups with different total motile sperm count ranges, (ii) the intracytoplasmic sperm injection outcomes between groups with normal and abnormal total motile sperm count, and (iii) the predictive values of WHO 2010 cut-off values and pre-wash total motile sperm count for the intracytoplasmic sperm injection outcomes, in couples with male infertility. This study included data from 518 patients undergoing their first intracytoplasmic sperm injection cycle as a result of male infertility. Couples were divided into five groups according to their total motile sperm count: Group I, total motile sperm count <1 × 10(6) ; group II, total motile sperm count 1-5 × 10(6) ; group III, total motile sperm count 5-10 × 10(6) ; group IV, total motile sperm count 10-20 × 10(6) ; and group V, total motile sperm count >20 × 10(6) (which was considered a normal total motile sperm count value). Then, couples were grouped into an abnormal and normal total motile sperm count group. The groups were compared regarding intracytoplasmic sperm injection outcomes. The predictive values of WHO 2010 cut-off values and total motile sperm count for the intracytoplasmic sperm injection outcomes were also investigated. The fertilization rate was lower in total motile sperm count group I compared to total motile sperm count group V (72.5 ± 17.6 vs. 84.9 ± 14.4, p = 0.011). The normal total motile sperm count group had a higher fertilization rate (84.9 ± 14.4 vs. 81.1 ± 15.8, p = 0.016) and lower miscarriage rate (17.9% vs. 29.5%, p = 0.041) compared to the abnormal total motile sperm count group. The total motile sperm count was the only parameter that demonstrated a predictive value for the formation of high-quality embryos on D2 (OR: 1.18, p = 0.013), formation of high-quality embryos on D3 (OR: 1.12, p = 0.037), formation of blastocysts on D5 (OR: 1.16, p = 0.011), blastocyst expansion grade on D5 (OR: 1.27, p = 0.042), and the odds of miscarriage (OR: 0.52, p < 0.045). The total motile sperm count has a greater predictive value than the WHO 2010 cut-off values for laboratory results and pregnancy outcomes in couples undergoing intracytoplasmic sperm injection as a result of male infertility. © 2016 American Society of Andrology and European Academy of Andrology.

Assessment of Lean Patients with Non-alcoholic Fatty Liver Disease in a Middle Income Country; Prevalence and Its Association with Metabolic Disorders: A Cross-sectional Study.

PubMed

Naderian, Mohammadreza; Kolahdoozan, Shadi; Sharifi, Amir Sina; Garmaroudi, Gholamreza; Yaseri, Mehdi; Poustchi, Hossein; Sohrabpour, Amir Ali

2017-04-01

Recent data has proven that the WHO (world health organization) cut-off for obesity is not applicable to the Asian population. This study aims to estimate the prevalence of lean NAFLD (non-alcoholic fatty liver disease) in the capital of Iran and extract probable predictors for this growing health issue in this population. This is a population-based cross-sectional study on apparently healthy subjects over 18 years of age. The participants were interviewed for baseline demographic and clinical information. They were subsequently referred for physical examination and blood sampling. NAFLD was diagnosed using abdominal ultrasonography by a single expert radiologist. Of 927 eligible participants who entered the study, 314 were lean; BMI (body mass index) <25 kg/m2. The prevalence of NAFLD was 17.52% (95% Exact CI: 13.48%-22.18%). BMI, SBP (systolic blood pressure), DBP (diastolic blood pressure), total cholesterol, HDL (high-density lipoprotein), LDL (low-density lipoprotein) and triglyceride were significantly different in patients with NAFLD. In the final multiple analysis, higher levels of triglyceride, upper SBP and higher BMI even in the range of less than 25 kg/m2 were independent predictors of NAFLD in lean participants. In lean participants with more components of metabolic syndrome, the prevalence of NAFLD increased significantly (all P < 0.01). BMI cut-offs in men and women along with waist circumference cut-off in men could significantly predict the presence of NAFLD in lean patients. After comparing these values, McNemar test showed that BMI cut-offs are more robust than waist circumference cut-offs for predicting the presence of NAFLD in lean subjects (P < 0.01). The prevalence of NAFLD in lean subjects in a sample of Iranian population is 17.52%. Hypertriglyceridemia, higher SBP, and higher BMI especially over 23.2 are independent factors associated with the presence of NAFLD in lean subjects.

Kink Waves in Non-isothermal Stratified Solar Waveguides: Effect of the External Magnetic Field

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

Lopin, I.; Nagorny, I., E-mail: lopin78@mail.ru

We study the effect of an external magnetic field on the properties of kink waves, propagating along a thin non-isothermal stratified and diverging magnetic flux tube. A wave equation, governing the propagation of kink waves under the adopted model is derived. It is shown that the vertical gradient of temperature introduces a spatially local cut-off frequency ω {sub c}. The vertical distribution of the cut-off frequency is calculated for the reference VAL-C model of the solar atmosphere and for different values of a ratio of external to internal magnetic fields. The results show that the cut-off frequency is negative belowmore » the temperature minimum due to the negative temperature gradient. In the chromosphere the cut-off frequency at a given height is smaller for a stronger external magnetic field. For the appropriate range of a ratio B{sub e} / B{sub i}  ≈ 0–0.8, the cutoff lies in the range ω{sub c}  ≈ 0.003–0.010 s{sup −1} (periods 600 < P{sub c} < 2000 s). The estimate of the cut-off frequency in the transition region is provided as well. In the propagating wave regime, the effective wave energy flux in the non-isothermal diverging flux tubes is the same as in the straight and homogeneous cylindrical waveguides. The obtained wave equation in the limit β  = 0 is used to study the kink oscillations of non-isothermal coronal loops. It is found that the gradient of temperature along the coronal loops reduces the frequency ratio of the first overtone to the fundamental mode, i.e., ω{sub 2}/ ω{sub 1} < 2. This reduction grows for a larger ratio of temperature at the loop top to the temperature at the footpoints. Moreover, the effect of reduction is most pronounced for the steeper temperature profiles.« less

Systematic optimization of ethyl glucuronide extraction conditions from scalp hair by design of experiments and its potential effect on cut-off values appraisal.

PubMed

Alladio, Eugenio; Biosa, Giulia; Seganti, Fabrizio; Di Corcia, Daniele; Salomone, Alberto; Vincenti, Marco; Baumgartner, Markus R

2018-05-11

The quantitative determination of ethyl glucuronide (EtG) in hair samples is consistently used throughout the world to assess chronic excessive alcohol consumption. For administrative and legal purposes, the analytical results are compared with cut-off values recognized by regulatory authorities and scientific societies. However, it has been recently recognized that the analytical results depend on the hair sample pretreatment procedures, including the crumbling and extraction conditions. A systematic evaluation of the EtG extraction conditions from pulverized scalp hair was conducted by design of experiments (DoE) considering the extraction time, temperature, pH, and solvent composition as potential influencing factors. It was concluded that an overnight extraction at 60°C with pure water at neutral pH represents the most effective conditions to achieve high extraction yields. The absence of differential degradation of the internal standard (isotopically-labeled EtG) under such conditions was confirmed and the overall analytical method was validated according to SGWTOX and ISO17025 criteria. Twenty real hair samples with different EtG content were analyzed with three commonly accepted procedures: (a) hair manually cut in snippets and extracted at room temperature; (b) pulverized hair extracted at room temperature; (c) hair treated with the optimized method. Average increments of EtG concentration around 69% (from a to c) and 29% (from b to c) were recorded. In light of these results, the authors urge the scientific community to undertake an inter-laboratory study with the aim of defining more in detail the optimal hair EtG detection method and verifying the corresponding cut-off level for legal enforcements. This article is protected by copyright. All rights reserved.

Reference values for anxiety questionnaires: the Leiden Routine Outcome Monitoring Study.

PubMed

Schulte-van Maaren, Yvonne W M; Giltay, Erik J; van Hemert, Albert M; Zitman, Frans G; de Waal, Margot W M; Carlier, Ingrid V E

2013-09-25

The monitoring of patients with an anxiety disorder can benefit from Routine Outcome Monitoring (ROM). As anxiety disorders differ in phenomenology, several anxiety questionnaires are included in ROM: Brief Scale for Anxiety (BSA), PADUA Inventory Revised (PI-R), Panic Appraisal Inventory (PAI), Penn State Worry Questionnaire (PSWQ), Worry Domains Questionnaire (WDQ), Social Interaction, Anxiety Scale (SIAS), Social Phobia Scale (SPS), and the Impact of Event Scale-Revised (IES-R). We aimed to generate reference values for both 'healthy' and 'clinically anxious' populations for these anxiety questionnaires. We included 1295 subjects from the general population (ROM reference-group) and 5066 psychiatric outpatients diagnosed with a specific anxiety disorder (ROM patient-group). The MINI was used as diagnostic device in both the ROM reference group and the ROM patient group. To define limits for one-sided reference intervals (95th percentile; P95) the outermost 5% of observations were used. Receiver Operating Characteristics (ROC) analyses were used to yield alternative cut-off values for the anxiety questionnaires. For the ROM reference-group the mean age was 40.3 years (SD=12.6), and for the ROM patient-group it was 36.5 years (SD=11.9). Females constituted 62.8% of the reference-group and 64.4% of the patient-group. P95 ROM reference group cut-off values for reference versus clinically anxious populations were 11 for the BSA, 43 for the PI-R, 37 for the PAI Anticipated Panic, 47 for the PAI Perceived Consequences, 65 for the PAI Perceived Self-efficacy, 66 for the PSWQ, 74 for the WDQ, 32 for the SIAS, 19 for the SPS, and 36 for IES-R. ROC analyses yielded slightly lower reference values. The discriminative power of all eight anxiety questionnaires was very high. Substantial non-response and limited generalizability. For eight anxiety questionnaires a comprehensive set of reference values was provided. Reference values were generally higher in women than in men, implying the use of gender-specific cut-off values. Each instrument can be offered to every patient with MAS disorders to make responsible decisions about continuing, changing or terminating therapy. © 2013 Elsevier B.V. All rights reserved.

Evaluation of Diffusion-weighted MR Imaging as a Technique for Detecting Bone Marrow Edema in Patients with Osteitis Pubis

PubMed Central

Toslak, Iclal Erdem; Cekic, Bulent; Turk, Aysen; Eraslan, Ali; Parlak, A. Eda

2017-01-01

Purpose: Our aims were to determine the feasibility of diffusion-weighted magnetic resonance imaging (DWI) in the detection of bone marrow edema (BME) and explore the apparent diffusion coefficient (ADC) alterations in patients with osteitis pubis (OP). Materials and Methods: 42 consecutive patients clinically suspected to have athletic pubalgia and 31 control subjects were enrolled in the study. All subjects underwent diagnostic focused magnetic resonance imaging (MRI) and DWI at b values of 0 and 600 s/mm2. Two radiologists reviewed the images for the presence of active OP. The presence of subchondral BME and contrast enhancement were considered to indicate active OP. ADC values were measured from public bodies of both groups. DWI results were correlated with routine MRI findings. Receiver-operating-characteristic curves were formed. Cut-off values for ADC, sensitivity and specificity values were measured. Results: 36/42 (85%) of the cases had BME/enhancement on routine MRIs and identified as active OP. ADC measurements of the patients were greater than the controls (P < 0.05). For the optimal cut-off values DWI showed sensitivity and specificity values of 97.3%, and 90.3%, for the right, and 97.1%, and 96.7% for the left side, respectively (Area under the curve 0.965 and 0.973). Intra-and inter-rater reliability for readers were substantial-perfect for all sessions. Conclusion: DWI is fast, accurate, and highly reproducible technique for the detection of BME in patients with active OP. It allows distinct bone marrow contrast without the use of gadolinium contrast, increases visual perception of active lesions, gives objective information by quantifying the diffusion coefficients, thus increase diagnostic confidence. We suggest the use of DWI as a cost-effective adjunctive tool for the diagnosis of active OP particularly in early cases and inconclusive diagnostic MRI. Future studies are necessary to determine the utility of DWI to evaluate severity of the disease and treatment response before returning athletes to play. PMID:28190854

Dynamic susceptibility contrast (DSC) perfusion MRI in differential diagnosis between radionecrosis and neoangiogenesis in cerebral metastases using rCBV, rCBF and K2.

PubMed

Muto, Mario; Frauenfelder, Giulia; Senese, Rossana; Zeccolini, Fabio; Schena, Emiliano; Giurazza, Francesco; Jäger, Hans Rolf

2018-07-01

Distinction between treatment-related changes and tumour recurrence in patients who have received radiation treatment for brain metastases can be difficult on conventional MRI. In this study, we investigated the ability of dynamic susceptibility contrast (DSC) perfusion in differentiating necrotic changes from pathological angiogenesis and compared measurements of relative cerebral blood volume (rCBV), relative cerebral blood flow (rCBF) and K2, using a dedicated software. Twenty-nine patients with secondary brain tumors were included in this retrospective study and underwent DSC perfusion MRI with a 3-month follow-up imaging after chemo- or radiation-therapy. Region-of-interests were drawn around the contrast enhancing lesions and measurements of rCBV, rCBF and K2 were performed in all patients. Based on subsequent histological examination or clinico-radiological follow-up, the cohort was divided in two groups: recurrent disease and stable disease. Differences between the two groups were analyzed using the Student's t test. Sensitivity, specificity and diagnostic accuracy of rCBV measurements were analyzed considering three different cut-off values. Between patients with and without disease, only rCBV and rCBF values were significant (p < 0.05). The only cut-off value giving the best diagnostic accuracy of 100% was rCBV = 2.1 (sensitivity = 100%; specificity = 100%). Patients with tumor recurrence showed a higher mean value of rCBV (mean = 4.28, standard deviation = 2.09) than patients with necrotic-related changes (mean = 0.77, standard deviation = 0.44). DSC-MRI appears a clinically useful method to differentiate between tumor recurrence, tumor necrosis and pseudoprogression in patients treated for cerebral metastases. Relative CBV using a cut-off value of 2.1 proved to be the most accurate and reliable parameter.

Evaluation of prognostic value and stage migration effect using positive lymph node ratio in gastric cancer.

PubMed

Komatsu, S; Ichikawa, D; Nishimura, M; Kosuga, T; Okamoto, K; Konishi, H; Shiozaki, A; Fujiwara, H; Otsuji, E

2017-01-01

To detect the best cut-off value of the positive lymph node ratio (PLNR) for stratifying the prognosis and analyzing its value with regard to stage migration effect using PLNR in gastric cancer. We retrospectively analyzed 1069 consecutive gastric cancer patients, who underwent curative gastrectomy with radical lymphadenectomy from 1997 through 2009. 1) The mean number of dissected lymph nodes was 42.6 in pStage I, 32.4 in pStage II and 37.1 in pStage III. The PLNR of 0.2 was proved to be the best cut-off value to stratify the prognosis of patients into two groups (P < 0.0001; PLNR <0.2 vs. PLNR ≥0.2), and patients were correctly classified into four groups: PLNR 0, PLNR 0-<0.2, PLNR 0.2-<0.4 and PLNR ≥0.4 by the Kaplan-Meier method. 2) Compared patients with the PLNR <0.2, those with the PLNR ≥0.2 had a significantly higher incidence of pT3 or greater, pN2 or greater, lymphatic invasion, vascular invasion and undifferentiated cancer. Multivariate analysis showed that the PLNR ≥0.2 was an independent prognostic factor [P < 0.0001, HR 2.77 (95% CI: 1.87-4.09)]. 2) The PLNR cut-off value of 0.2 could discriminate a stage migration effect in pN2-N3 and pStage II-III, which patients with PLNR ≥0.2 might be potentially diagnosed as a lower stage after gastrectomy. The PLNR contributes to evaluating prognosis and stage migration effect even in a single institute and enable to identify those who need meticulous treatments and follow-up in patients with gastric cancer. Copyright © 2016 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

HDL cholesterol as a diagnostic tool for clinical differentiation of GCK-MODY from HNF1A-MODY and type 1 diabetes in children and young adults.

PubMed

Fendler, Wojciech; Borowiec, Maciej; Antosik, Karolina; Szadkowska, Agnieszka; Deja, Grazyna; Jarosz-Chobot, Przemyslawa; Mysliwiec, Malgorzata; Wyka, Krystyna; Pietrzak, Iwona; Skupien, Jan; Malecki, Maciej T; Mlynarski, Wojciech

2011-09-01

Confirmation of monogenic diabetes caused by glucokinase mutations (GCK-MODY) allows pharmacogenetic intervention in the form of insulin discontinuation. This is especially important among paediatric and young adult populations where GCK-MODY is most prevalent. The study evaluated the utility of lipid parameters in screening for patients with GCK-MODY. Eighty-nine children with type 1 diabetes and 68 with GCK-MODY were screened for triglyceride (TG), total and HDL cholesterol levels. Standardization against a control group of 171 healthy children was applied to eliminate the effect of development. Clinical applicability and cut-off value were evaluated in all available patients with GCK-MODY (n = 148), hepatocyte nuclear factor 1-alpha-MODY (HNF1A MODY) (n = 37) or type 1 diabetes (n = 221). Lower lipid parameter values were observed in GCK-MODY than in patients with type 1 diabetes. Standard deviation scores were -0·22 ± 2·24 vs 1·31 ± 2·17 for HDL cholesterol (P < 0·001), -0·16 ± 2·14 vs 0·60 ± 1·77 for total cholesterol (P = 0·03) and -0·57 ± 0·97 vs-0·22 ± 0·97 for TG (P = 0·05). Validation analysis confirmed that HDL cholesterol was the best parameter for GCK-MODY selection [sensitivity 87%, specificity 54%, negative predictive value (NPV) 86%, positive PV 56%]. A threshold HDL concentration of 1·56 mm offered significantly better diagnostic efficiency than total cholesterol (cut-off value 4·51 mm; NPV 80%; PPV 38%; P < 0·001). TG did not offer a meaningful cut-off value. HDL cholesterol levels measured in individuals with likely monogenic diabetes may be useful in screening for GCK-MODY and differentiation from T1DM and HNF1A-MODY, regardless of treatment or metabolic control. © 2011 Blackwell Publishing Ltd.

Diversity of Poissonian populations.

PubMed

Eliazar, Iddo I; Sokolov, Igor M

2010-01-01

Populations represented by collections of points scattered randomly on the real line are ubiquitous in science and engineering. The statistical modeling of such populations leads naturally to Poissonian populations-Poisson processes on the real line with a distinguished maximal point. Poissonian populations are infinite objects underlying key issues in statistical physics, probability theory, and random fractals. Due to their infiniteness, measuring the diversity of Poissonian populations depends on the lower-bound cut-off applied. This research characterizes the classes of Poissonian populations whose diversities are invariant with respect to the cut-off level applied and establishes an elemental connection between these classes and extreme-value theory. The measures of diversity considered are variance and dispersion, Simpson's index and inverse participation ratio, Shannon's entropy and Rényi's entropy, and Gini's index.

Electron path control of high-order harmonic generation by a spatially inhomogeneous field

NASA Astrophysics Data System (ADS)

Mohebbi, Masoud; Nazarpoor Malaei, Sakineh

2016-04-01

We theoretically investigate the control of high-order harmonics cut-off and as-pulse generation by a chirped laser field using a metallic bow tie-shaped nanostructure. The numerical results show that the trajectories of the electron wave packet are strongly modified, the short quantum path is enhanced, the long quantum path is suppressed and the low modulated spectrum of the harmonics can be remarkably extended. Our calculated results also show that, by confining electron motion, a broadband supercontinuum with the width of 1670 eV can be produced which directly generates an isolated 34 as-pulse without phase compensation. To explore the underlying mechanism responsible for the cut-off extension and the quantum path selection, we perform time-frequency analysis and a classical simulation based on the three-step model.

Concentrating phenolic acids from Lonicera japonica by nanofiltration technology

NASA Astrophysics Data System (ADS)

Li, Cunyu; Ma, Yun; Li, Hongyang; Peng, Guoping

2017-03-01

Response surface analysis methodology was used to optimize the concentrate process of phenolic acids from Lonicera japonica by nanofiltration technique. On the basis of the influences of pressure, temperature and circulating volume, the retention rate of neochlorogenic acid, chlorogenic acid and 4-dicaffeoylquinic acid were selected as index, molecular weight cut-off of nanofiltration membrane, concentration and pH were selected as influencing factors during concentrate process. The experiment mathematical model was arranged according to Box-Behnken central composite experiment design. The optimal concentrate conditions were as following: nanofiltration molecular weight cut-off, 150 Da; solutes concentration, 18.34 µg/mL; pH, 4.26. The predicted value of retention rate was 97.99% under the optimum conditions, and the experimental value was 98.03±0.24%, which was in accordance with the predicted value. These results demonstrate that the combination of Box-Behnken design and response surface analysis can well optimize the concentrate process of Lonicera japonica water-extraction by nanofiltration, and the results provide the basis for nanofiltration concentrate for heat-sensitive traditional Chinese medicine.

Nerve ultrasound normal values - Readjustment of the ultrasound pattern sum score UPSS.

PubMed

Grimm, Alexander; Axer, Hubertus; Heiling, Bianka; Winter, Natalie

2018-07-01

Reference values are crucial for nerve ultrasound. Here, we reevaluated normal nerve and fascicle cross-sectional area (CSA) values in humans and compared them to published values. Based on these data, ultrasound pattern sum score (UPSS) boundary values were revisited and readjusted. Ultrasound of different peripheral nerves was performed in 100 healthy subjects at anatomically defined landmarks. Correlations with age, gender, height and weight were calculated. Overall, correspondence to other published reference values was high. Gender-dependency was found for the proximal median nerve. Dependency from height occurred in the tibial nerve (TN). Weight-dependency was not found. However, the most obvious differences were found in the TN between men >60 years and women <60 years. Thus, general boundary values were defined using the mean plus the twofold standard deviation for all subjects and nerve segments except for the TN, in which different cut-offs were proposed for elder men. Accordingly, the cut-offs for the UPSS were re-adjusted, none of the individuals revealed more than 2 points at maximum. The influence of distinct epidemiological factors on nerve size is most prominent in the TN, for which thus several normal values are useful. Adjusted reference values improve the accuracy of the UPSS. Copyright © 2018 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.

Survey and analysis for impact factors of psychological distress in HIV-infected pregnant women who continue pregnancy.

PubMed

Qin, Shouxue; Tan, Yanping; Lu, Bingyan; Cheng, Yuqing; Nong, Yanli

2018-05-15

The objective of this study is to explore the psychological distress of HIV-infected pregnant women who continue pregnancy, and analyze the possible influencing factors. A total of 194 HIV-infected pregnant women who continue pregnancy were enrolled for this study by a convenient sampling method during June 2012-August 2016. Participants completed questionnaires including Hospital Anxiety and Depression Scale (HADS), Berger HIV Stigma Scale (BHSS), Distress Thermometer (DT) and Problem List (PL), and to determine the cut-off value of DT in the group. The positive detection rate of psychological distress in the HIV-infected pregnant women who continue pregnancy was 69.1%, and the highest frequency of PL was the emotional problems. The positive detection rate of anxiety was 60.8%, the positive detection rate of depression was 54.1%, and the discrimination score was 113.16 ± 19.21. Spearman relevant analysis showed that psychological distress score was positively correlated with anxiety, depression and discrimination score (p < .001). Multiple linear regression analysis showed that relationship between husband and wife, family misfortune, Medicaid, chronic disease or high-risk pregnancy, viral load, CD 4 + T cell count, infection and confidentiality could affect the psychological distress (p < .05). The ideal cut-off value of DT in the group was 5. HIV-infected pregnant women who continue pregnancy have higher incidence of psychological distress, and the psychological distress is not inferior to cancer patients. The influencing factors are mainly related to the infection and pregnancy characteristics, and have nothing to do with the general social demographic characteristics. The DT can be used as a screening tool to quickly identify psychological distress of the group.

Highly specific preoperative selection of solitary parathyroid adenoma cases in primary hyperparathyroidism by quantitative image analysis of the early-phase Technetium-99m sestamibi scan.

PubMed

Kim, DaeHee; Rhodes, Jeffrey A; Hashim, Jeffrey A; Rickabaugh, Lawrence; Brams, David M; Pinkus, Edward; Dou, Yamin

2018-06-07

Highly specific preoperative localizing test is required to select patients for minimally invasive parathyroidectomy (MIP) in lieu of traditional four-gland exploration. We hypothesized that Tc-99m sestamibi scan interpretation incorporating numerical measurements on the degree of asymmetrical activity from bilateral thyroid beds can be useful in localizing single adenoma for MIP. We devised a quantitative interpretation method for Tc-99m sestamibi scan based on the numerically graded asymmetrical activity on early phase. The numerical ratio value of each scan was obtained by dividing the number of counts from symmetrically drawn regions of interest (ROI) over bilateral thyroid beds. The final pathology and clinical outcome of 109 patients were used to perform receiver operating curve (ROC) analysis. Receiver operating curve analysis revealed the area under the curve (AUC) was calculated to be 0.71 (P = 0.0032), validating this method as a diagnostic tool. The optimal cut-off point for the ratio value with maximal combined sensitivity and specificity was found with corresponding sensitivity of 67.9% (56.5-77.2%, 95% CI) and specificity of 75.0% (52.8-91.8%, 95% CI). An additional higher cut-off with higher specificity with minimal possible sacrifice on sensitivity was also selected, yielding sensitivity of 28.6% (18.8-38.6%, 95% CI) and specificity of 90.0% (69.6-98.8%, 95% CI). Our results demonstrated that the more asymmetrical activity on the initial phase, the more successful it is to localize a single parathyroid adenoma on sestamibi scans. Using early-phase Tc-99m sestamibi scan only, we were able to select patients for minimally invasive parathyroidectomy with 90% specificity. © 2018 The Royal Australian and New Zealand College of Radiologists.

Mammographic breast density and breast cancer: evidence of a shared genetic basis

PubMed Central

Varghese, Jajini S; Thompson, Deborah J; Michailidou, Kyriaki; Lindström, Sara; Turnbull, Clare; Brown, Judith; Leyland, Jean; Warren, Ruth ML; Luben, Robert N; Loos, Ruth J; Wareham, Nicholas J; Rommens, Johanna; Paterson, Andrew D; Martin, Lisa J; Vachon, Celine M; Scott, Christopher G; Atkinson, Elizabeth J; Couch, Fergus J; Apicella, Carmel; Southey, Melissa C; Stone, Jennifer; Li, Jingmei; Eriksson, Louise; Czene, Kamila; Boyd, Norman F; Hall, Per; Hopper, John L; Tamimi, Rulla M; Rahman, Nazneen; Easton, Douglas F

2012-01-01

Percent mammographic breast density (PMD) is a strong heritable risk factor for breast cancer. However, the pathways through which this risk is mediated are still unclear. To explore whether PMD and breast cancer have a shared genetic basis, we identified genetic variants most strongly associated with PMD in a published meta-analysis of five genome-wide association studies (GWAS) and used these to construct risk scores for 3628 breast cancer cases and 5190 controls from the UK2 GWAS of breast cancer. The signed per-allele effect estimates of SNPs were multiplied with the respective allele counts in the individual and summed over all SNPs to derive the risk score for an individual. These scores were included as the exposure variable in a logistic regression model with breast cancer case-control status as the outcome. This analysis was repeated using ten different cut-offs for the most significant density SNPs (1-10% representing 5,222-50,899 SNPs). Permutation analysis was also performed across all 10 cut-offs. The association between risk score and breast cancer was significant for all cut-offs from 3-10% of top density SNPs, being most significant for the 6% (2-sided P=0.002) to 10% (P=0.001) cut-offs (overall permutation P=0.003). Women in the top 10% of the risk score distribution had a 31% increased risk of breast cancer [OR= 1.31 (95%CI 1.08-1.59)] compared to women in the bottom 10%. Together, our results demonstrate that PMD and breast cancer have a shared genetic basis that is mediated through a large number of common variants. PMID:22266113

Screening for anxiety and depression: reassessing the utility of the Zung scales.

PubMed

Dunstan, Debra A; Scott, Ned; Todd, Anna K

2017-09-08

While the gold standard for the diagnosis of mental disorders remains the structured clinical interview, self-report measures continue to play an important role in screening and measuring progress, as well as being frequently employed in research studies. Two widely-used self-report measures in the area of depression and anxiety are Zung's Self-Rating Depression Scale (SDS) and Self Rating Anxiety Scale (SAS). However, considerable confusion exists in their application, with clinical cut-offs often applied incorrectly. This study re-examines the credentials of the Zung scales by comparing them with the Depression Anxiety Stress Scale (DASS) in terms of their ability to predict clinical diagnoses of anxiety and depression made using the Patient Health Questionnaire (PHQ). A total sample of 376 adults, of whom 87 reported being in receipt of psychological treatment, completed the two-page version of the PHQ relating to depression and anxiety, together with the SDS, the SAS and the DASS. Overall, although the respective DASS scales emerged as marginally stronger predictors of PHQ diagnoses of anxiety and depression, the Zung indices performed more than acceptably in comparison. The DASS also had an advantage in discriminative ability. Using the current recommended cut-offs for all scales, the DASS has the edge on specificity, while the Zung scales are superior in terms of sensitivity. There are grounds to consider making the Zung cut-offs more conservative, and doing this would produce comparable numbers of 'Misses' and 'False Positives' to those obtained with the DASS. Given these promising results, further research is justified to assess the Zung scales ability against full clinical diagnoses and to further explore optimum cut-off levels.

ROC-king onwards: intraepithelial lymphocyte counts, distribution & role in coeliac disease mucosal interpretation

PubMed Central

Rostami, Kamran; Marsh, Michael N; Johnson, Matt W; Mohaghegh, Hamid; Heal, Calvin; Holmes, Geoffrey; Ensari, Arzu; Aldulaimi, David; Bancel, Brigitte; Bassotti, Gabrio; Bateman, Adrian; Becheanu, Gabriel; Bozzola, Anna; Carroccio, Antonio; Catassi, Carlo; Ciacci, Carolina; Ciobanu, Alexandra; Danciu, Mihai; Derakhshan, Mohammad H; Elli, Luca; Ferrero, Stefano; Fiorentino, Michelangelo; Fiorino, Marilena; Ganji, Azita; Ghaffarzadehgan, Kamran; Going, James J; Ishaq, Sauid; Mandolesi, Alessandra; Mathews, Sherly; Maxim, Roxana; Mulder, Chris J; Neefjes-Borst, Andra; Robert, Marie; Russo, Ilaria; Rostami-Nejad, Mohammad; Sidoni, Angelo; Sotoudeh, Masoud; Villanacci, Vincenzo; Volta, Umberto; Zali, Mohammad R; Srivastava, Amitabh

2017-01-01

Objectives Counting intraepithelial lymphocytes (IEL) is central to the histological diagnosis of coeliac disease (CD), but no definitive ‘normal’ IEL range has ever been published. In this multicentre study, receiver operating characteristic (ROC) curve analysis was used to determine the optimal cut-off between normal and CD (Marsh III lesion) duodenal mucosa, based on IEL counts on >400 mucosal biopsy specimens. Design The study was designed at the International Meeting on Digestive Pathology, Bucharest 2015. Investigators from 19 centres, eight countries of three continents, recruited 198 patients with Marsh III histology and 203 controls and used one agreed protocol to count IEL/100 enterocytes in well-oriented duodenal biopsies. Demographic and serological data were also collected. Results The mean ages of CD and control groups were 45.5 (neonate to 82) and 38.3 (2–88) years. Mean IEL count was 54±18/100 enterocytes in CD and 13±8 in normal controls (p=0.0001). ROC analysis indicated an optimal cut-off point of 25 IEL/100 enterocytes, with 99% sensitivity, 92% specificity and 99.5% area under the curve. Other cut-offs between 20 and 40 IEL were less discriminatory. Additionally, there was a sufficiently high number of biopsies to explore IEL counts across the subclassification of the Marsh III lesion. Conclusion Our ROC curve analyses demonstrate that for Marsh III lesions, a cut-off of 25 IEL/100 enterocytes optimises discrimination between normal control and CD biopsies. No differences in IEL counts were found between Marsh III a, b and c lesions. There was an indication of a continuously graded dose–response by IEL to environmental (gluten) antigenic influence. PMID:28893865

Digital Filtering of Three-Dimensional Lower Extremity Kinematics: an Assessment

PubMed Central

Sinclair, Jonathan; Taylor, Paul John; Hobbs, Sarah Jane

2013-01-01

Errors in kinematic data are referred to as noise and are an undesirable portion of any waveform. Noise is typically removed using a low-pass filter which removes the high frequency components of the signal. The selection of an optimal frequency cut-off is very important when processing kinematic information and a number of techniques exists for the determination of an optimal frequency cut-off. Despite the importance of cut-off frequency to the efficacy of kinematic analyses there is currently a paucity of research examining the influence of different cut-off frequencies on the resultant 3-D kinematic waveforms and discrete parameters. Twenty participants ran at 4.0 m•s−1 as lower extremity kinematics in the sagittal, coronal and transverse planes were measured using an eight camera motion analysis system. The data were filtered at a range of cut-off frequencies and the discrete kinematic parameters were examined using repeated measures ANOVA’s. The similarity between the raw and filtered waveforms were examined using intra-class correlations. The results show that the cut-off frequency has a significant influence on the discrete kinematic measure across displacement and derivative information in all three planes of rotation. Furthermore, it was also revealed that as the cut-off frequency decreased the attenuation of the kinematic waveforms became more pronounced, particularly in the coronal and transverse planes at the second derivative. In conclusion, this investigation provides new information regarding the influence of digital filtering on lower extremity kinematics and re-emphasizes the importance of selecting the correct cut-off frequency. PMID:24511338

Assessment of second (I2M) and third (I3M) molar indices for establishing 14 and 16 legal ages and validation of the Cameriere's I3M cut-off for 18 years old in Chilean population.

PubMed

Cameriere, Roberto; Velandia Palacio, Luz Andrea; Pinares, Jorge; Bestetti, Fiorella; Paba, Rossella; Coccia, Erminia; Ferrante, Luigi

2018-04-01

This retrospective cross-sectional study has two-fold aims: the first is to assess new cut-offs at the legal age thresholds (LATs) of 14 and 16 years old and the second is to validate the cut-off of third molar index I 3M =0.08 for 18 years of age in Chilean people. Orthopantomographs from 822 Chilean children aged from 11 to 22 (472 girls and 350 boys) were analysed. For LAT of 14 years, cut-offs were found using the ROC curves singly for boys and girls. The cut-offs for boys were I 2M =0.16 and I 3M =0.73 while for girls we obtained I 2M =0.10 and I 3M =0.77. For LAT of 16 years we obtained the same cut-offs regardless of gender, which were 0.06 and 0.36 for I 2M and I 3M respectively. Concerning the validity of I 3M cut-off for 18 years old in Chilean population, the proportion of correctly classified individuals was 83% and estimated post-test probability, PPV, was 93.2%, with a 95% confidence interval equals to 91.3%, 94.6%. Hence, the probability that a subject positive on the test was 18 years of age or older was 93.2%, confirming the validation of the I 3M cut-off for Chilean population. Copyright © 2018 Elsevier B.V. All rights reserved.

Modulation transfer function measurement of microbolometer focal plane array by Lloyd's mirror method

NASA Astrophysics Data System (ADS)

Druart, Guillaume; Rommeluere, Sylvain; Viale, Thibault; Guerineau, Nicolas; Ribet-Mohamed, Isabelle; Crastes, Arnaud; Durand, Alain; Taboury, Jean

2014-05-01

Today, both military and civilian applications require miniaturized and cheap optical systems. One way to achieve this trend consists in decreasing the pixel pitch of focal plane arrays (FPA). In order to evaluate the performance of the overall optical systems, it is necessary to measure the modulation transfer function (MTF) of these pixels. However, small pixels lead to higher cut-off frequencies and therefore, original MTF measurements that are able to extract frequencies up to these high cut-off frequencies, are needed. In this paper, we will present a way to extract 1D MTF at high frequencies by projecting fringes on the FPA. The device uses a Lloyd mirror placed near and perpendicular to the focal plane array. Consequently, an interference pattern of fringes can be projected on the detector. By varying the angle of incidence of the light beam, we can tune the period of the interference fringes and, thus, explore a wide range of spatial frequencies, and mainly around the cut-off frequency of the pixel which is one of the most interesting area. Illustration of this method will be applied to a 640×480 microbolometer focal plane array with a pixel pitch of 17µm in the LWIR spectral region.

A comparison of bone-related biomarkers and CA27.29 to assess response to treatment of osseous metastatic breast cancer.

PubMed

Lüfter, D; Richter, A; Günther, S; Flath, B; Akrivakis, C; Geppert, R; Wernecke, K D; Possinger, K

2000-01-01

The assessment of bone metastases by clinical examination or imaging techniques is still considered unreliable. We compared a specific marker of bone resorption, urinary deoxypyridinoline (DPD)-crosslinks, with serum calcium (Ca), alkaline phosphatase (AP) and CA27.29, to evaluate the status of bone metastases in patients with breast cancer. Second morning voided urine was collected from 2 groups of patient (pts), those without evidence of disease (n = 118), and those with bone metastases (n = 85) under specific therapy plus pamidronate. DPD and CA27.29 were measured on the automated ACS180 system (Bayer Diagnostics, Tarrytown, NY, USA). Receiver operating characteristics (ROC) curves were established for each of the 4 biomarkers to determine whether they could distinguish the 2 subsets of pts with clinically sufficient validity, and to establish the corresponding cut-off values. Neither Ca nor AP was useful in discriminating the 2 subgroups. At a DPD cut-off of 13 nmol/mmol, we found a specificity of 69% and a sensitivity of 53% for diagnosing bone metastases. Best results, however, were seen for CA27.29. A cut-off value of 30 U/ml resulted in a specificity of 62% and a sensitivity of 81%. CA27.29 was the best parameter for the discrimination of stage IV breast cancer with bone metastases. The primary advantage of DPD lies in the monitoring of bone metastases under specific therapy.

Pentraxin 3 predicts complicated course of febrile neutropenia in haematological patients, but the decision level depends on the underlying malignancy.

PubMed

Juutilainen, Auni; Vänskä, Matti; Pulkki, Kari; Hämäläinen, Sari; Nousiainen, Tapio; Jantunen, Esa; Koivula, Irma

2011-11-01

This study aimed at assessing the cut-off levels for pentraxin 3 (PTX3) in predicting complications of neutropenic fever (bacteraemia, septic shock) in haematological patients. A prospective study during 2006-2009 was performed at haematology ward in Kuopio University Hospital. A patient was eligible for the study if having neutropenic fever after intensive therapy for acute myeloid leukaemia (AML) (n = 32) or non-Hodgkin lymphoma (NHL) (n = 35). Blood cultures were taken, and maximal PTX3 and C-reactive protein (CRP) were evaluated during d0 to d3 from the beginning of fever onset. The level of PTX3 was associated with both the underlying malignancy and the presence of complications, with highest level in NHL patients with complicated course of febrile neutropenia and lowest in AML patients with non-complicated course. The cut-off level of PTX3 to predict complications was ten-fold in patients with NHL (115 μg/L) in comparison with patients with AML (11.5 μg/L). In combined analysis based on separate cut-offs, PTX3 predicted complications of febrile neutropenia with sensitivity of 0.86, specificity of 0.83, positive predictive value of 0.57 and negative predictive value of 0.96.   PTX3 was superior to CRP in predicting complicated course of febrile neutropenia, but only when the effect of the underlying malignancy had been taken into account. © 2011 John Wiley & Sons A/S.

Statistical Considerations for Establishing CBTE Cut-Off Scores.

ERIC Educational Resources Information Center

Trzasko, Joseph A.

This report gives the basic definition and purpose of competency-based teacher education (CBTE) cut-off scores. It describes the basic characteristics of CBTE as a yes-no dichotomous decision regarding the presence of a specific ability or knowledge, which necesitates the establishment of a cut-off point to designate competency vs. incompetency on…

75 FR 13636 - Self-Regulatory Organizations; International Securities Exchange, LLC; Order Approving Proposed...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-22

... Rules Related to Cut-Off Time for Contrary Exercise Advice Submissions March 15, 2010. I. Introduction... to the cut-off time for submitting contrary exercise advices to the Exchange. The proposed rule... proposed to amend Rule 1100 to extend the cut-off time to submit contrary exercise advices (``CEAs'') \\4...

Cut-off characterisation of energy spectra of bright Fermi sources: Current instrument limits and future possibilities

NASA Astrophysics Data System (ADS)

Romoli, Carlo; Taylor, Andrew M.; Aharonian, Felix

2017-01-01

The cut-off region of the gamma-ray spectrum of astrophysical sources encodes important information about the acceleration processes producing the parent particle population. For bright AGNs the cut-off happens in an energy range around a few tens of GeV, a region where satellites are limited by their effective area and current ground based telescopes by energy threshold. In the attempt to maximise the statistics, we have looked at two of the brightest AGNs seen by the Fermi-LAT (3C 454.3 and 3C 279) during extremely luminous flares. Our analysis showed the difficulty to obtain good constraints on the cut-off parameters when a power-law with modified exponential cut-off was assumed to fit the SEDs. We discuss the potential of future low-threshold Cherenkov telescope arrays, in particular CTA, showing the impact that a much bigger effective area can have on the determination of spectral parameters in the cut-off region. This preliminary study serves as an example, demonstrating the importance of having good wide-energy coverage around 10 GeV.

The impact of an underground cut-off wall on nutrient dynamics in groundwater in the lower Wang River watershed, China.

PubMed

Kang, Pingping; Xu, Shiguo

2017-03-01

Underground cut-off walls in coastal regions are mainly used to prevent saltwater intrusion, but their impact on nutrient dynamics in groundwater is not clear. In this study, a combined analysis of multiple isotopes ([Formula: see text]) and nitrogen and phosphorus concentrations is used in order to assess the impact of the underground cut-off walls on the nutrient dynamics in groundwater in the lower Wang River watershed, China. Compared with the nitrogen and phosphorus concentrations in groundwater downstream of the underground cut-off walls, high [Formula: see text] and total dissolved nitrogen concentrations and similar concentration levels of [Formula: see text] and total dissolved phosphorus are found in groundwater upstream of the underground cut-off walls. The isotopic data indicated the probable occurrence of denitrification and nitrification processes in groundwater upstream, whereas the fingerprint of these processes was not shown in groundwater downstream. The management of fertilizer application is critical to control nitrogen concentrations in groundwater restricted by the underground cut-off walls.

Lactulose/mannitol test and specificity, sensitivity, and area under curve of intestinal permeability parameters in patients with liver cirrhosis and Crohn's disease.

PubMed

Dastych, Milan; Dastych, Milan; Novotná, Hana; Cíhalová, J

2008-10-01

The purpose of this study was to investigate and compare the specificity, sensitivity, and area under curve (AUC) of the lactulose/mannitol ratio, lactulose/creatinine ratio, and lactulose recovery and their diagnostic value for intestinal permeability assessment within the absorption lactulose/mannitol (L/M) test. The value of the lactulose/mannitol ratio, lactulose/creatinine ratio, and the percentage of lactulose recovery in Crohn's disease (0.0763 +/- 0.0369; 99.62 +/- 67.87; 1.0478 +/- 0.6148) and in liver cirrhosis (0.0517 +/- 0.0365; 54.65 +/- 53.26; 0.838 +/- 0.929) were significantly different from the values measured in the control group (0.0123 +/- 0.0081; 10.95 +/- 7.07; 0.2438 +/- 0.1568), P < 0.0001-0.002). In Crohn's disease, specificity, sensitivity, and AUC were 100%, 89.5%, and 0.987, respectively, of the lactulose/mannitol ratio at a cut-off level of 0.022. In liver cirrhosis, the test characteristics were 88.5%, 84.2%, and 0.910 at a cut-off level of 0.018. The lactulose/mannitol ratio was evaluated to have the highest diagnostic value to assess intestinal permeability.

Safety of tomatillos and products containing tomatillos canned by the water-bath canning method.

PubMed

McKee, L H; Remmenga, M D; Bock, M A

1998-01-01

Three studies were conducted to evaluate the safety of tomatillos and products containing tomatillos canned by the water-bath processing method. In the first study, plain tomatillos were processed for 25, 37.5, 50 and 62.5 min. In the second study, five tomatillo/onion combinations were prepared while five tomatillo/green chile combinations were prepared in the third study. pH evaluations were conducted to determine safety in all studies using pH 4.2 as the cut-off value. No differences in the pH of plain tomatillos were detected due to processing time. All jars of plain tomatillos had pH values below 4.1. All combinations of tomatillos/onions and tomatillos/green chile containing more than 50% tomatillo had pH values below the 4.2 cut-off value. Results of the three studies indicate (1) acidification of plain tomatillos is probably unnecessary for canning by the water-bath processing method and (2) combinations of acidic tomatillos and low-acid onions or green chile must contain more than 50% tomatillos to have a pH low enough for safe water-bath processing.

The Effect of Technological Devices on Cervical Lordosis.

PubMed

Öğrenci, Ahmet; Koban, Orkun; Yaman, Onur; Dalbayrak, Sedat; Yılmaz, Mesut

2018-03-15

There is a need for cervical flexion and even cervical hyperflexion for the use of technological devices, especially mobile phones. We investigated the effect of this use on the cervical lordosis angle. A group of 156 patients who applied with only neck pain between 2013-2016 and had no additional problems were included. Patients are specifically questioned about mobile phone, tablet, and other devices usage. The value obtained by multiplying the year of usage and the average usage (hour) in daily life was determined as the total usage value (an average hour per day x year: hy). Cervical lordosis angles were statistically compared with the total time of use. In the general ROC analysis, the cut-off value was found to be 20.5 hy. When the cut-off value is tested, the overall accuracy is very good with 72.4%. The true estimate of true risk and non-risk is quite high. The ROC analysis is statistically significant. The use of computing devices, especially mobile telephones, and the increase in the flexion of the cervical spine indicate that cervical vertebral problems will increase even in younger people in future. Also, to using with attention at this point, ergonomic devices must also be developed.

Importance of Metastatic Lymph Node Ratio in Non-Metastatic, Lymph Node-Invaded Colon Cancer: A Clinical Trial

PubMed Central

Isik, Arda; Peker, Kemal; Firat, Deniz; Yilmaz, Bahri; Sayar, Ilyas; Idiz, Oguz; Cakir, Coskun; Demiryilmaz, Ismail; Yilmaz, Ismayil

2014-01-01

Background The aim of this study was to evaluate the prognostic importance of the metastatic lymph node ratio for stage III colon cancer patients and to find a cut-off value at which the overall survival and disease-free survival change. Material/Methods Patients with pathological stage III colon cancer were retrospectively evaluated for: age; preoperative values of Crp, Cea, Ca 19-9, and Afp; pathologic situation of vascular, perineural, lymphatic, and serosal involvement; and metastatic lymph node ratio values were calculated. Results The study included 58 stage III colon cancer patients: 20 (34.5%) females and 38 (65.5%) males were involved in the study. Multivariate analysis was applied to the following variables to evaluate significance for overall survival and disease-free survival: age, Crp, Cea, perineural invasion, and metastatic lymph node ratio. The metastatic lymph node ratio (<0.25 or ≥0.25) is the only independent variable significant for overall and disease-free survival. Conclusions Metastatic lymph node ratio is an ideal prognostic marker for stage III colon cancer patients, and 0.25 is the cut-off value for prognosis. PMID:25087904

Cerebrospinal fluid lactate: a differential biomarker for bacterial and viral meningitis in children.

PubMed

Nazir, Mudasir; Wani, Wasim Ahmad; Malik, Muzaffar Ahmad; Mir, Mohd Rafiq; Ashraf, Younis; Kawoosa, Khalid; Ali, Syed Wajid

To assess the performance of cerebrospinal fluid (CSF) lactate as a biomarker to differentiate bacterial meningitis from viral meningitis in children, and to define an optimal CSF lactate concentration that can be called significant for the differentiation. Children with clinical findings compatible with meningitis were studied. CSF lactate and other conventional CSF parameters were recorded. At a cut-off value of 3mmol/L, CSF lactate had a sensitivity of 0.90, specificity of 1.0, positive predictive value of 1.0, and negative predictive value of 0.963, with an accuracy of 0.972. The positive and negative likelihood ratios were 23.6 and 0.1, respectively. When comparing between bacterial and viral meningitis, the area under the curve for CSF lactate was 0.979. The authors concluded that CSF lactate has high sensitivity and specificity in differentiating bacterial from viral meningitis. While at a cut-off value of 3mmol/L, CSF lactate has high diagnostic accuracy for bacterial meningitis, mean levels in viral meningitis remain essentially below 2mmol/L. Copyright © 2017 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

Receiver operating characteristic analysis of prediction for gastric cancer development using serum pepsinogen and Helicobacter pylori antibody tests.

PubMed

Hamashima, Chisato; Sasazuki, Shizuka; Inoue, Manami; Tsugane, Shoichiro

2017-03-09

Chronic Helicobacter pylori infection plays a central role in the development of gastric cancer as shown by biological and epidemiological studies. The H. pylori antibody and serum pepsinogen (PG) tests have been anticipated to predict gastric cancer development. We determined the predictive sensitivity and specificity of gastric cancer development using these tests. Receiver operating characteristic analysis was performed, and areas under the curve were estimated. The predictive sensitivity and specificity of gastric cancer development were compared among single tests and combined methods using serum pepsinogen and H. pylori antibody tests. From a large-scale population-based cohort of over 100,000 subjects followed between 1990 and 2004, 497 gastric cancer subjects and 497 matched healthy controls were chosen. The predictive sensitivity and specificity were low in all single tests and combination methods. The highest predictive sensitivity and specificity were obtained for the serum PG I/II ratio. The optimal PG I/II cut-off values were 2.5 and 3.0. At a PG I/II cut-off value of 3.0, the sensitivity was 86.9% and the specificity was 39.8%. Even if three biomarkers were combined, the sensitivity was 97.2% and the specificity was 21.1% when the cut-off values were 3.0 for PG I/II, 70 ng/mL for PG I, and 10.0 U/mL for H. pylori antibody. The predictive accuracy of gastric cancer development was low with the serum pepsinogen and H. pylori antibody tests even if these tests were combined. To adopt these biomarkers for gastric cancer screening, a high specificity is required. When these tests are adopted for gastric cancer screening, they should be carefully interpreted with a clear understanding of their limitations.

Can the CAMCOG be a good cognitive test for patients with Alzheimer's disease with low levels of education?

PubMed

Aprahamian, Ivan; Martinelli, José Eduardo; Cecato, Juliana; Izbicki, Rafael; Yassuda, Mônica Sanches

2011-02-01

The Cambridge Cognitive Examination (CAMCOG) is a useful test in screening for Alzheimer's disease (AD). However, the interpretation of CAMCOG cut-off scores is problematic and reference values are needed for different educational strata. Given the importance of earlier diagnoses of mild dementia, new cut-off values are required which take into account patients with low levels of education. This study aims to evaluate whether the CAMCOG can be used as an accurate screening test among AD patients and normal controls with different educational levels. Cross-sectional assessment was undertaken of 113 AD and 208 elderly controls with heterogeneous educational levels (group 1: 1-4 years; group 2: 5-8 years; and group 3: ≥ 9 years) from a geriatric clinic. submitted to a thorough diagnostic evaluation for AD including the Cambridge Examination for Mental Disorders of the Elderly (CAMDEX). Controls had no cognitive or mood complaints. Sensitivity (SE) and specificity (SP) for the CAMCOG in each educational group was assessed with receiver-operator-characteristic (ROC) curves. CAMCOG mean values were lower when education was reduced in both diagnostic groups (controls - group 1: 87; group 2: 91; group 3: 96; AD - group 1: 63; group 2: 62; group 3: 77). Cut-off scores for the three education groups were 79, 80 and 90, respectively. SE and SP varied among the groups (group 1: 88.1% and 83.5%; group 2: 84.6% and 96%; group 3: 70.8% and 90%). The CAMCOG can be used as a cognitive test for patients with low educational level with good accuracy. Patients with higher education showed lower scores than previously reported.

Anthropometric Indices Predict the Development of Hypertension in Normotensive and Pre-Hypertensive Middle-Aged Women in Tianjin, China: A Prospective Cohort Study

PubMed Central

Wang, Qing; Wang, Zhuoqun; Yao, Wei; Wu, Xianming; Huang, Jingjing; Huang, Lei

2018-01-01

Background The aims of this study were to investigate the relationship between optimal anthropometric indices and their cut-off values and the incidence of hypertension in a cohort of middle-aged women in China. Material/Methods A cohort of 812 women, aged between 40–70 years were recruited between May 2011 and June 2013. An ideal baseline blood pressure was defined as <120/80 mmHg; pre-hypertension was 120–139/80–89 mmHg; hypertension was ≥140/≥90 mmHg. Anthropometric measurements included waist circumference (WC), body mass index (BMI), waist-hip ratio (WHR), and waist-height ratio (WHtR). The cohort was divided into an ideal blood pressure group (Group 1) and a pre-hypertensive group (Group 2). Two-year follow-up blood pressure measurements were performed. Receiver-operating characteristic (ROC) curve analysis determined the optimal anthropometric indices and cut-off values for developing hypertension. Results At two-year follow-up, hypertension developed in 9.0% (n=31) in Group 1 and 32.3% (n=121) in Group 2. Logistic regression analysis showed that in both groups, women in the highest quartile for WC, BMI, WHR, and WHtR had a significantly increased risk of developing hypertension compared with the lowest quartile (P<0.05). ROC curve area under the curve (AUC) for these anthropometric indices were greater in Group 1, and for WC in Groups 1 and 2, with the optimal cut-off values greater in Group 1. Conclusions In a cohort of middle-aged women in China, anthropometric indices of obesity were predictive of the development of hypertension during a two-year follow-up period. PMID:29601569

Body mass index and body adiposity index in relation to percent body fat: a study in adult men of three endogamous groups of South Bengal.

PubMed

Datta Banik, Sudip; Das, Subal

2015-02-01

Body adiposity index (BAI), based on height and hip circumference data from Mexican-Americans and African-Americans established its relation to body fat (BF). The aim of our study was to compare body mass index (BMI) and BAI in relation to BF%. Participants were adult men of three endogamous social groups (Brahmin, Muslim and Namasudra) in a village of South 24 Parganas district in West Bengal, India. Height, weight and hip circumference of 952 individuals (370 Brahmins, 307 Muslims and 275 Namasudras) were recorded. The BMI-based nutritional status and bioelectrical impedance-based BF% were evaluated. Namasudras (33.8%) and Muslims (33.6%) had high frequency undernutrition compared to Brahmins (7.3%). High prevalence (46.22%) of excess weight (overweight+obesity) was recorded only among Brahmins. There was significant social group difference in rates of nutritional status (χ(2) = 93.10, p < 0.0001). The BF% had higher correlation with BMI than BAI. A cut-off value of BAI (22%) was determined by binomial logistic regression analysis (BLRA). The value had best estimated relation to BF% and also coincided with WHO standard mean BF (22%) for overweight adults at BMI (≥ 25 kg/m(2)). However, greater area under the receiver operating characteristic curve, higher correct prediction rate, and other results of BLRA for the cut-off value of BMI-based overweight (≥ 25 kg/m(2)) showed its better relation to BF% than that observed for BAI cut-off at 22%. The BMI was observed to be a better indicator of adiposity compared to BAI in relation with body fat (%). Copyright © 2014 Elsevier GmbH. All rights reserved.

Evaluation of three sample preparation methods for the direct identification of bacteria in positive blood cultures by MALDI-TOF.

PubMed

Tanner, Hannah; Evans, Jason T; Gossain, Savita; Hussain, Abid

2017-01-18

Patient mortality is significantly reduced by rapid identification of bacteria from sterile sites. MALDI-TOF can identify bacteria directly from positive blood cultures and multiple sample preparation methods are available. We evaluated three sample preparation methods and two MALDI-TOF score cut-off values. Positive blood culture bottles with organisms present in Gram stains were prospectively analysed by MALDI-TOF. Three lysis reagents (Saponin, SDS, and SepsiTyper lysis bufer) were applied to each positive culture followed by centrifugation, washing and protein extraction steps. Methods were compared using the McNemar test and 16S rDNA sequencing was used to assess discordant results. In 144 monomicrobial cultures, using ≥2.000 as the cut-off value, species level identifications were obtained from 69/144 (48%) samples using Saponin, 86/144 (60%) using SDS, and 91/144 (63%) using SepsiTyper. The difference between SDS and SepsiTyper was not statistically significant (P = 0.228). Differences between Saponin and the other two reagents were significant (P < 0.01). Using ≥1.700 plus top three results matching as the cut-off value, species level identifications were obtained from 100/144 (69%) samples using Saponin, 103/144 (72%) using SDS, and 106/144 (74%) using SepsiTyper and there was no statistical difference between the methods. No true discordances between culture and direct MALDI-TOF identification were observed in monomicrobial cultures. In 32 polymicrobial cultures, MALDI-TOF identified one organism in 34-75% of samples depending on the method. This study demonstrates two inexpensive in-house detergent lysis methods are non-inferior to a commercial kit for analysis of positive blood cultures by direct MALDI-TOF in a clinical diagnostic microbiology laboratory.

Mitral annulus motion as determined by M-mode echocardiography in normal dogs and dogs with cardiac disease.

PubMed

Schober, K E; Fuentes, V L

2001-01-01

M-mode echocardiography was used to assess apical mitral annulus motion (MAM) in 103 normal dogs and 101 dogs with cardiac disease, to obtain information on systolic left ventricular long axis function. In normal dogs, a close relationship was found between MAM and body weight (r = 0.80, P < 0.001). There was a weak correlation between MAM and heart rate (r = -0.25, P < 0.05), but no correlation between MAM and age or left ventricular shortening fraction (P > 0.05). Mean MAM (95% confidence intervals) were established for normal dogs of differing body weight, and were 0.70 cm (0.65 to 0.75) in dogs < 15 kg, 1.08 cm (1.03 to 1.13) in dogs weighing 15 to 40 kg, and 1.51 cm (1.21 to 1.81) in dogs > 40 kg. "Cut-off" values to define decreased MAM for normal dogs of differing body weight were 0.45 cm (dogs < 15 kg), 0.80 cm (dogs 15-40 kg), and 1.20 cm (dogs > 40 kg). In dogs with cardiac disease, median MAM was normal in mitral valve endocardiosis or aortic stenosis, but significantly decreased (P < 0.05) in dilated cardiomyopathy. All dogs with mitral valve endocardiosis (n = 54) or aortic stenosis (n = 26) had MAM above the above-mentioned "cut-off" values, suggesting normal or increased left ventricular longitudinal systolic shortening, whereas 81% (17/21) of dogs with dilated cardiomyopathy had MAM below the "cut-off" value, indicating decreased long axis systolic function. It is concluded that MAM may be used to evaluate systolic left ventricular long axis performance in dogs and may add useful information on global left ventricular contraction dynamics.

The optimum cut-off value to differentiate Echinococcus granulosus sensu stricto from other species of E. granulosus sensu lato using larval rostellar hook morphometry.

PubMed

Soriano, S V; Pierangeli, N B; Pianciola, L A; Mazzeo, M; Lazzarini, L E; Debiaggi, M F; Bergagna, H F J; Basualdo, J A

2015-01-01

Cystic echinococcosis caused by Echinococcus granulosus sensu lato is one of the most important helminth zoonoses in the world; it affects both humans and livestock. The disease is endemic in Argentina and highly endemic in the province of Neuquén. Considerable genetic and phenotypic variation has been demonstrated in E. granulosus, and ten different genotypes (G1-G10) have been identified using molecular tools. Echinococcus granulosus sensu lato may be considered a species complex, comprised of E. granulosus sensu stricto (G1-G3), E. equinus (G4), E. ortleppi (G5) and E. canadensis (G6-G10). In endemic areas, the characterization of cystic echinococcosis molecular epidemiology is important in order to apply adequate control strategies. A cut-off value for larval large hook total length to distinguish E. granulosus sensu stricto isolates from those produced by other species of the complex was defined for the first time. Overall, 1780 larval hooks of 36 isolates obtained from sheep (n= 11, G1), goats (n= 10, G6), cattle (n= 5, G6) and pigs (n= 10, G7) were analysed. Validation against molecular genotyping as gold standard was carried out using the receiver operating characteristic (ROC) curve analysis. The optimum cut-off value was defined as 26.5 μm. The proposed method showed high sensitivity (97.8%) and specificity (91.1%). Since in most endemic regions the molecular epidemiology of echinococcosis includes the coexistence of the widely distributed E. granulosus sensu stricto G1 strain and other species of the complex, this technique could be useful as a quick and economical tool for epidemiological and surveillance field studies, when fertile cysts are present.

Bronchoalveolar lavage fluid in Standardbred racehorses: influence of unilateral/bilateral profiles and cut-off values on lower airway disease diagnosis.

PubMed

Depecker, Marianne; Richard, Eric A; Pitel, Pierre-Hugues; Fortier, Guillaume; Leleu, Claire; Couroucé-Malblanc, Anne

2014-01-01

The aim of this study was to determine whether the lung side being sampled would significantly influence bronchoalveolar lavage (BAL) cytological profiles and subsequent diagnosis in Standardbred racehorses. One hundred and thirty-eight French Trotters in active training and racing were included in a prospective observational study. BAL was performed using videoendoscopy in both right and left lungs during summer meetings in 2011 (64 horses) and 2012 (74 horses). Cytological data performed 24h later from right and left lungs were compared and specifically used to classify horses as affected with exercise-induced pulmonary haemorrhage (EIPH), inflammatory airway disease (IAD), or were 'controls'. For IAD, cytological definition was based on two different cut off values. Neutrophil percentages, haemosiderophage percentages and the haemosiderophage/macrophage (H/M) ratios were significantly higher in the right compared to the left lung. Measures of intra-class correlation coefficients revealed a fair agreement between left and right lungs for percentages of mast cells, eosinophils, and for the H/M ratio, and a moderate agreement for neutrophil percentages. Fair to moderate agreements were observed between left and right lungs for the diagnosis of IAD and/or EIPH based on kappa coefficients. When sampling one lung only, the risk of incorrectly classifying a horse as a 'control' increased with the use of the restraint cut-off values for IAD. As BAL from one lung is not representative of the other lung in the same horse, both lungs should be sampled for a better assessment of lung cellularity and for a precise diagnosis of lower airway diseases. Copyright © 2013 Elsevier Ltd. All rights reserved.

Mandibular position and movements: Suitability for diagnosis of sleep apnoea.

PubMed

Martinot, Jean-Benoit; Borel, Jean-Christian; Cuthbert, Valérie; Guénard, Hervé Jean-Pierre; Denison, Stéphane; Silkoff, Philip E; Gozal, David; Pepin, Jean-Louis

2017-04-01

Mandibular movements (MMs) and position during sleep reflect respiratory efforts related to increases in upper airway resistance and micro-arousals. The study objective was to assess whether MM identifies sleep-disordered breathing (SDB) in patients with moderate to high pre-test probability. This was a prospective study of 87 consecutive patients referred for an in-laboratory sleep test. Magnetometer-derived MM signals were incorporated into standard polysomnography (PSG). Respiratory events detected with MM analysis were compared with PSG for respiratory disturbance index (RDI) with a blinded scoring. All records were scored manually according to American Academy of Sleep Medicine rules. Primary outcome was to rule-in obstructive sleep apnoea syndrome (OSAS) defined as RDI cut-off value ≥5 or 15/h total sleep time (TST). High concordance emerged between MM and PSG-derived RDI with high temporal coincidence between events (R 2  = 0.906; P < 0.001). The mean diagnostic accuracy of MM for OSAS using RDI MM cut-off values of 5.9 and 13.5 was 0.935 (0.86-0.97) and 0.913 (0.84-0.95), with a mean positive likelihood ratio (LLR+) of 3.73 (2.7-20.4) and 8.46 (2.3-31.5), respectively. Receiver operating characteristic (ROC) curves at PSG cut-off values of 5 and 15/h TST had areas under the curve (AUC) of 0.96 (95% CI: 0.89-0.99) and 0.97 (95% CI: 0.91-0.99) (P < 0.001), respectively. MM analysis accurately identified SDB at different levels of severity. RDI assessed by MM is highly concordant with PSG, suggesting a role of ambulatory MM recordings to screen for SDB in patients with moderate to high pre-test probability. © 2016 Asian Pacific Society of Respirology.

Infused autograft lymphocyte-to-monocyte ratio and survival in T-cell lymphoma post-autologous peripheral blood hematopoietic stem cell transplantation.

PubMed

Porrata, Luis F; Inwards, David J; Ansell, Stephen M; Micallef, Ivana N; Johnston, Patrick B; Hogan, William J; Markovic, Svetomir N

2015-07-03

The infused autograft lymphocyte-to-monocyte ratio (A-LMR) is a prognostic factor for survival in B-cell lymphomas post-autologous peripheral hematopoietic stem cell transplantation (APHSCT). Thus, we set out to investigate if the A-LMR is also a prognostic factor for survival post-APHSCT in T-cell lymphomas. From 1998 to 2014, 109 T-cell lymphoma patients that underwent APHSCT were studied. Receiver operating characteristic (ROC) and area under the curve (AUC) were used to identify the optimal cut-off value of A-LMR for survival analysis and k-fold cross-validation model to validate the A-LMR cut-off value. Univariate and multivariate Cox proportional hazard models were used to assess the prognostic discriminator power of A-LMR. ROC and AUC identified an A-LMR ≥ 1 as the best cut-off value and was validated by k-fold cross-validation. Multivariate analysis showed A-LMR to be an independent prognostic factor for overall survival (OS) and progression-free survival (PFS). Patients with an A-LMR ≥ 1.0 experienced a superior OS and PFS versus patients with an A-LMR < 1.0 [median OS was not reached vs 17.9 months, 5-year OS rates of 87% (95% confidence interval (CI), 75-94%) vs 26% (95% CI, 13-42%), p < 0.0001; median PFS was not reached vs 11.9 months, 5-year PFS rates of 72% (95% CI, 58-83%) vs 16% (95% CI, 6-32%), p < 0.0001]. A-LMR is also a prognostic factor for clinical outcomes in patients with T-cell lymphomas undergoing APHSCT.

Home blood pressure measurement as a screening tool for hypertension in a web-based worksite health promotion programme.

PubMed

Niessen, Maurice A J; van der Hoeven, Niels V; van den Born, Bert-Jan H; van Kalken, Coen K; Kraaijenhagen, Roderik A

2014-10-01

Guidelines on home blood pressure measurement (HBPM) recommend taking at least 12 measurements. For screening purposes, however, it is preferred to reduce this number. We therefore derived and validated cut-off values to determine hypertension status after the first duplicate reading of a HBPM series in a web-based worksite health promotion programme. Nine hundred forty-five employees were included in the derivation and 528 in the validation cohort, which was divided into a normal (n = 297) and increased cardiometabolic risk subgroup (n = 231), and a subgroup with a history of hypertension (n = 98). Six duplicate home measurements were collected during three consecutive days. Systolic and diastolic readings at the first duplicate measurement were used as predictors for hypertension in a multivariate logistic model. Cut-off values were determined using receiver operating characteristics analysis. Upper (≥ 150 or ≥ 95 mmHg) and lower limit (<135 and <80 mmHg) cut-off values were derived to confirm or reject presence of hypertension after one duplicate reading. The area under the curve was 0.94 (standard error 0.01, 95% confidence interval 0.93-0.95). In 62.5% of participants, hypertension status was determined, with 1.1% false positive and 4.7% false negatives. Performance was similar in participants with high and low cardiometabolic risk, but worse in participants with a history of hypertension (10.4% false negatives). One duplicate home reading is sufficient to accurately assess hypertension status in 62.5% of participants, leaving 37.5% in which the whole HBPM series needs to be completed. HBPM can thus be reliably used as screening tool for hypertension in a working population. © The Author 2013. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

RISK FACTORS FOR SLOW GAIT SPEED: A NESTED CASE-CONTROL SECONDARY ANALYSIS OF THE MEXICAN HEALTH AND AGING STUDY.

PubMed

Pérez-Zepeda, M U; González-Chavero, J G; Salinas-Martinez, R; Gutiérrez-Robledo, L M

2015-01-01

Physical performance tests play a major role in the geriatric assessment. In particular, gait speed has shown to be useful for predicting adverse outcomes. However, risk factors for slow gait speed (slowness) are not clearly described. To determine risk factors associated with slowness in Mexican older adults. A two-step process was adopted for exploring the antecedent risk factors of slow gait speed. First, the cut-off values for gait speed were determined in a representative sample of Mexican older adults. Then, antecedent risk factors of slow gait speed (defined using the identified cut-points) were explored in a nested, cohort case-control study. One representative sample of a cross-sectional survey for the first step and the Mexican Health and Aging Study (a cohort characterized by a 10-year follow-up). A 4-meter usual gait speed test was conducted. Lowest gender and height-stratified groups were considered as defining slow gait speed. Sociodemographic characteristics, comorbidities, psychological and health-care related variables were explored to find those associated with the subsequent development of slow gait speed. Unadjusted and adjusted logistic regression models were performed. In the final model, age, diabetes, hypertension, and history of fractures were associated with the development of slow gait speed. Early identification of subjects at risk of developing slow gait speed may halt the path to disability due to the robust association of this physical performance test with functional decline.

Identifying the source of super-high energetic electrons in the presence of pre-plasma in laser–matter interaction at relativistic intensities

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

Wu, D.; Krasheninnikov, S. I.; Luan, S. X.

The generation of super-high energetic electrons influenced by pre-plasma in relativistic intensity laser–matter interaction is studied in a one-dimensional slab approximation with particle-in-cell simulations. Different pre-plasma scale lengths and laser intensities are considered, showing an increase in both particle number and cut-off kinetic energy of electrons with the increase of pre-plasma scale length and laser intensity, the cut-off kinetic energy greatly exceeding the corresponding laser ponderomotive energy. A two-stage electron acceleration model is proposed to explain the underlying physics. The first stage is attributed to the synergetic acceleration by longitudinal electric field and counter-propagating laser pulses, and a scaling lawmore » is obtained with efficiency depending on the pre-plasma scale length and laser intensity. These electrons pre-accelerated in the first stage could build up an intense electrostatic potential barrier with maximal value several times as large as the initial electron kinetic energy. Some of the energetic electrons could be further accelerated by reflection off the electrostatic potential barrier, with their finial kinetic energies significantly higher than the values pre-accelerated in the first stage.« less

Identifying the source of super-high energetic electrons in the presence of pre-plasma in laser–matter interaction at relativistic intensities

DOE PAGES

Wu, D.; Krasheninnikov, S. I.; Luan, S. X.; ...

2016-10-03

The generation of super-high energetic electrons influenced by pre-plasma in relativistic intensity laser–matter interaction is studied in a one-dimensional slab approximation with particle-in-cell simulations. Different pre-plasma scale lengths and laser intensities are considered, showing an increase in both particle number and cut-off kinetic energy of electrons with the increase of pre-plasma scale length and laser intensity, the cut-off kinetic energy greatly exceeding the corresponding laser ponderomotive energy. A two-stage electron acceleration model is proposed to explain the underlying physics. The first stage is attributed to the synergetic acceleration by longitudinal electric field and counter-propagating laser pulses, and a scaling lawmore » is obtained with efficiency depending on the pre-plasma scale length and laser intensity. These electrons pre-accelerated in the first stage could build up an intense electrostatic potential barrier with maximal value several times as large as the initial electron kinetic energy. Some of the energetic electrons could be further accelerated by reflection off the electrostatic potential barrier, with their finial kinetic energies significantly higher than the values pre-accelerated in the first stage.« less

Screening for hypoglycemia at the bedside in the neonatal intensive care unit (NICU) with the Abbott PCx glucose meter.

PubMed

Balion, Cynthia; Grey, Vijaylaxmi; Ismaila, Afisi; Blatz, Susan; Seidlitz, Wendy

2006-11-03

Point of care (POC) glucose meters are routinely used as a screening tool for hypoglycemia in a neonatal setting. Glucose meters however, lack the same accuracy as laboratory instruments for glucose measurement. In this study we investigated potential reasons for this inaccuracy and established a cut off value for confirmatory testing. In this prospective study, all patients in the neonatal intensive care unit who had a plasma glucose test ordered were eligible to participate. Demographic information, sample collection information (nine variables) and a recent hematocrit value were recorded for each sample. Glucose measurements were taken at the bedside on the glucose meter (RN PCx) as well as in the laboratory on both the glucose meter (LAB PCx) and the laboratory analyzer (PG). Data were analyzed by simple and mixed-effects regression analysis and by analysis of a receiver operator characteristics (ROC) curve. There were 475 samples analyzed from 132 patients. RN PCx values were higher than PG values (mean = 4.9%), while LAB PCx results were lower (mean = -5.2%) than PG values. Only 31% of the difference between RN PCx--PG and 46% of the difference for LAB PCx--PG could be accounted for by the variables tested. The largest proportion of variance between PCx and PG measurements was explained by hematocrit (about 30%) with a greater effect seen at glucose concentrations < or =4.0 mmol/L (< or =72 mg/dL)(48% and 40% for RN PCx and LAB PCx, respectively). The ROC analysis showed that for detection of all cases of hypoglycemia (PG < 2.6 mmol/L)(PG < 47 mg/dL) the PCx screening cut off value would need to be set at 3.8 mmol/L (68 mg/dL) requiring 20% of all samples to have confirmatory analysis by the laboratory method. The large difference between glucose results obtained by PCx glucose meter compared to the laboratory analyzer can be explained in part by hematocrit and low glucose concentration. These results emphasize that the glucose meter is useful only as a screening device for neonatal hypoglycemia and that a screening cut off value must be established.

Characteristics of Drainage Divide Migration through Coseismic and Storm-Triggered Landslides

NASA Astrophysics Data System (ADS)

Dahlquist, M. P.; West, A. J.; Li, G.

2016-12-01

Drainage basin reorganization is a fundamental but poorly understood process in landscape evolution. Capture and loss of drainage area by rivers redistributes erosive power and can drive the response of a landscape to tectonic/climatic forcing. Evidence of discrete capture of tributaries is widespread and common, but study of gradual migration of divides by hillslope processes (e.g. landsliding) has been minimal. Much scholarship is devoted to the geometric characteristics of rivers as they respond to tectonic forces, and divide migration has been proposed to result from contrasts in fluvial channel form. However, fluvial processes do not extend to basin divides, so fluvial controls on drainage reorganization should be mediated by hillslope processes such as slope failure. Here we explore whether the mediating role of hillslopes can be observed over the timescale of a single earthquake or major storm. We examine landslides in steep landscapes caused by three major events in the past decade: the 2008 Mw 7.9 Wenchuan earthquake in Sichuan, China, the 2009 Typhoon Morakot in Taiwan, and the 2015 Mw 7.8 Gorkha earthquake in Nepal. These events generated landslides that cut off ridges, causing area gain and loss in the drainage basins outlined by those ridges. We compare the location of these ridge-cutting landslides to values of Χ, an integral value of upstream drainage area over the length of a river. Comparing the Χ values of rivers which share a drainage divide is thought to show which river is likely to gain area at the expense of the other as the divide migrates, defining an "aggressor" (smaller Χ at divide) and a "victim" (greater Χ). We compute Χ for the rivers draining ridge-cutting landslides and consider whether landslides favor drainage area gain in basins with lower X values. Our preliminary results suggest that divide migration in areas with small to moderate disparities in Χ appears to be stochastic, with divides frequently migrating in the opposite direction to that indicated as favorable by Χ values. We are currently exploring whether Χ is predictive of area loss and/or gain in areas with larger disparities, aiming to test the hypothesis that event-driven hillslope failures can link fluvial process with divide migration.

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.

Return to Work: A Cut-Off of FIM Gain with Montebello Rehabilitation Factor Score in Order to Identify Predictive Factors in Subjects with Acquired Brain Injury

PubMed Central

2016-01-01

Return to work (RTW) for people with acquired brain injury (ABI) represents a main objective of rehabilitation: this work presents a strong correlation between personal well-being and quality of life. The aim of this study is to investigate the prognostic factors that can predict RTW after ABI (traumatic or non- traumatic aetiology) in patients without disorders of consciousness (e.g. coma, vegetative or minimally conscious state) at the beginning of their admission to rehabilitation. At the end of a 6-month follow-up after discharge, data were successfully collected in 69 patients. The rehabilitation effectiveness (functional Recovery) between admission and discharge was assessed by Functional Independent Measure (FIM) gain, through the Montebello Rehabilitation Factor Score (MRFS), which was obtained as follows: (discharge FIM—admission FIM)/(Maximum possible FIM—Admission FIM) x 100. The cut-off value (criterion) deriving from MRFS, which helped identify RTW patients, resulted in .659 (sn 88.9%; sp 52.4%). Considering the Mini Mental State Examination (MMSE) and the MRFS data, the multivariable binary logistic regression analysis presented 62.96% of correct RTW classification cases, 80.95% of non-RTW leading to an overall satisfactory predictability of 73.91%. The results of the present study suggest that occupational therapy intervention could modify cut-off in patients with an MFRS close to target at the end of an in-hospital rehabilitative program thus developing their capabilities and consequently surpassing cut-off itself. PMID:27780215

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.

Modelling of Electron and Proton Beams in a White-light Solar Flare

NASA Astrophysics Data System (ADS)

Milligan, R. O.; Procházka, O.; Reid, A.; Allred, J. C.; Mathioudakis, M.

2017-12-01

Observations of an X1 class WL solar flare on 2014 June 11 showed a surprisingly weak emission in both higher order Balmer and Lyman lines and continua. The flare was observed by RHESSI but low energy cut-off of non-thermal component was indeterminable due to the unusually hard electron spectrum (delta = 3). An estimate of power in non-thermal electron beams together with an area of WL emission observed by HMI yielded to an upper and lower estimate of flux 1E9 and 3E10 erg/cm2/s, respectively. We performed a grid of models using a radiative hydrodynamic code RADYN in order to compare synthetic spectra with observations. For low energy cut-off we chose a range from 20 to 120 keV with a step of 20 keV and delta parameter equal to 3. Electron beam-driven models show that higher low energy cut-off is more likely to produce an absorption Balmer line profile, if the total energy flux remains relatively low. On the other hand a detectable rise of HMI continuum (617 nm) lays a lower limit on the beam flux. Proton beam-driven models with equivalent fluxes indicate a greater penetration depth, while the Balmer lines reveal significantly weaker emission. Atmospheric temperature profiles show that for higher values of low energy cut-off the energy of the beam is deposited lower in chromosphere or even in temperature minimum region. This finding suggests, that suppressed hydrogen emission can indicate a formation of white-light continuum below chromosphere.

Upper and lower bounds for the speed of pulled fronts with a cut-off

NASA Astrophysics Data System (ADS)

Benguria, R. D.; Depassier, M. C.; Loss, M.

2008-02-01

We establish rigorous upper and lower bounds for the speed of pulled fronts with a cut-off. For all reaction terms of KPP type a simple analytic upper bound is given. The lower bounds however depend on details of the reaction term. For a small cut-off parameter the two leading order terms in the asymptotic expansion of the upper and lower bounds coincide and correspond to the Brunet-Derrida formula. For large cut-off parameters the bounds do not coincide and permit a simple estimation of the speed of the front.

Immunohistochemistry of cytokeratins 7, 8, 17, 18, and 19, and GLUT-1 aids differentiation of desmoplastic malignant mesothelioma from fibrous pleuritis.

PubMed

Horiuchi, Toshikatsu; Ogata, Sho; Tominaga, Susumu; Hiroi, Sadayuki; Kawahara, Kunimitsu; Hebisawa, Akira; Irei, Isao; Ito, Ichiro; Kameya, Toru; Tsujimura, Tohru; Nakano, Takashi; Nakanishi, Kuniaki; Kawai, Toshiaki

2013-05-01

It is difficult to distinguish desmoplastic malignant mesothelioma (DMM) from fibrous pleuritis (FP). We investigated the utility of immunohistochemistry as a way of differentiating between DMM and FP. We examined 11 DMMs and 46 FPs with the aid of antibodies against 18 cytokeratin (CK) subtypes, calponin, caldesmon, desmin, and GLUT-1. The best sensitivity and specificity cut-off values in the receiver operating characteristic curves (ROC) for CKs 7, 8, 17, 18, and 19, and GLUT-1 were each above 60%. When cases with either DMM or FP were partitioned by the staining score associated with the best sensitivity and specificity cut-off values in ROC, the incidence of a positive expression for CKs 7, 8, 17, 18, and 19, and GLUT-1 was significantly higher in DMM than in FP. In conclusion, immunohistochemistry for CKs 7, 8, 17, 18, and 19, and GLUT-1 may be useful, alongside histological characteristics, for separating DMM from FP.

C-reactive Protein Versus Neutrophil/lymphocyte Ratio in Differentiating Bacterial and Non-bacterial Pneumonia in Children.

PubMed

Gauchan, E; Adhikari, S

2016-09-01

Pneumonia is a leading cause of childhood mortality in a low resource country. Simple laboratory markers can help differentiate between bacterial and non-bacterial pneumonias for appropriate management. In children aged one to 60 months with features of lower respiratory infection, C-reactive protein (CRP) and neutrophil-lymphocyte ratio (NLR) were used to differentiate between bacterial and non-bacterial pneumonias. The cutoff values for detecting bacterial pneumonias were evaluated by statistical tools. Bacterial pneumonia was diagnosed in 285 (43.6%) children out of 654 studied. At a cut-off value of 36 mg/L CRP was predictive of bacterial pneumonias with sensitivity and specificity of 61.8% and 91.3% respectively while the sensitivity and specificity for predicting bacterial pneumonia using NLR was 45.6% and 64% respectively with 1.28 used as a cut-off. Our study shows that CRP is superior to NLR in differentiating bacterial from non-bacterial pneumonias in children.

Role of pharmacogenetics on deferasirox AUC and efficacy.

PubMed

Cusato, Jessica; Allegra, Sarah; De Francia, Silvia; Massano, Davide; Piga, Antonio; D'Avolio, Antonio

2016-04-01

We evaluated deferasirox pharmacokinetic according to SNPs in genes involved in its metabolism and elimination. Moreover, we defined a plasma area under the curve cut-off value predicting therapy response. Allelic discrimination was performed by real-time PCR. Drug plasma concentrations were measured by a high performance liquid chromatography system coupled with an ultraviolet method. Pharmacokinetic parameters were significantly influenced by UGT1A1 rs887829C>T, UGT1A3 rs1983023C>T and rs3806596A>G SNPs. Area under the curve cut-off values of 360 μg/ml/h for efficacy were here defined and 250 μg/ml/h for nonresponse was reported. UGT1A3 rs3806596GG and ABCG2 rs13120400CC genotypes were factors able to predict efficacy, whereas UGT1A3 rs3806596GG was a nonresponse predictor. These data show how screening patient's genetic profile may help clinicians to optimize iron chelation therapy with deferasirox.

Threshold value of home pulse pressure predicting arterial stiffness in patients with type 2 diabetes: KAMOGAWA-HBP study.

PubMed

Kitagawa, Noriyuki; Ushigome, Emi; Matsumoto, Shinobu; Oyabu, Chikako; Ushigome, Hidetaka; Yokota, Isao; Asano, Mai; Tanaka, Muhei; Yamazaki, Masahiro; Fukui, Michiaki

2018-03-01

This cross-sectional multicenter study was designed to evaluate the threshold value of home pulse pressure (PP) and home systolic blood pressure (SBP) predicting the arterial stiffness in 876 patients with type 2 diabetes. We measured the area under the receiver-operating characteristic curve (AUC) and estimated the ability of home PP to identify arterial stiffness using Youden-Index defined cut-off point. The arterial stiffness was measured using the brachial-ankle pulse wave velocity (baPWV). AUC for arterial stiffness in morning PP was significantly greater than that in morning SBP (P < .001). AUC for arterial stiffness in evening PP was also significantly greater than that in evening SBP (P < .001). The optimal cut-off points for morning PP and evening PP, which predicted arterial stiffness, were 54.6 and 56.9 mm Hg, respectively. Our findings indicate that we should pay more attention to increased home PP in patients with type 2 diabetes. ©2018 Wiley Periodicals, Inc.

Disruption of basement membrane, extracellular matrix metalloproteinases and E-cadherin in renal-cell carcinoma.

PubMed

Morell-Quadreny, L; Rubio, Jose; Lopez-Guerrero, Jose Antonio; Casanova, Juan; Ramos, D; Iborra, Inmaculada; Solsona, Eduardo; Llombart-Bosch, A

2003-01-01

A retrospective study was performed to determine the prognostic value of Basement Membrane (BM) integrity, Matrix Metalloproteinases (MMPs) and E-Cadherin expression in renal cell carcinoma (RCC). An immunohistochemical study on laminin and collagen IV, MMPs 1 and 2, and E-Cadherin was carried out on 71 RCCs. BM fragmentation was considered taking 75% as a cut-off. MMP 1 and MMP2 immunostaining, as well as E-Cadherin was considered taking 25% as a cut-off. An inverse relationship was seen between E-Cadherin with laminin, collagen IV and MMPs. More than 75% loss of laminin, collagen IV and E-Cadherin, as well as higher expression of MMPs, were associated with symptoms, tumoral size and worse grade. Loss of collagen IV and E-Cadherin were of prognostic value. Both BM and E-Cadherin are good prognostic markers. MMPs patterns show a relationship between BM proteins and E-Cadherin, but evaluation is more time-consuming and provide no better prognostication; consequently they are not useful in routine clinical applications.

Positioning stability improvement with inter-system biases on multi-GNSS PPP

NASA Astrophysics Data System (ADS)

Choi, Byung-Kyu; Yoon, Hasu

2018-07-01

The availability of multiple signals from different Global Navigation Satellite System (GNSS) constellations provides opportunities for improving positioning accuracy and initial convergence time. With dual-frequency observations from the four constellations (GPS, GLONASS, Galileo, and BeiDou), it is possible to investigate combined GNSS precise point positioning (PPP) accuracy and stability. The differences between GNSS systems result in inter-system biases (ISBs). We consider several ISB values such as GPS-GLONASS, GPS-Galileo, and GPS-BeiDou. These biases are compliant with key parameters defined in the multi-GNSS PPP processing. In this study, we present a unified PPP method that sets ISB values as fixed or constant. A comprehensive analysis that includes satellite visibility, position dilution of precision, position accuracy is performed to evaluate a unified PPP method with constrained cut-off elevation angles. Compared to the conventional PPP solutions, our approach shows more stable positioning at a constrained cut-off elevation angle of 50 degrees.

The predictive value of mean platelet volume, plateletcrit and red cell distribution width in the differentiation of autoimmune gastritis patients with and without type I gastric carcinoid tumors.

PubMed

Tüzün, Ali; Keskin, Onur; Yakut, Mustafa; Kalkan, Cagdas; Soykan, Irfan

2014-01-01

Autoimmune gastritis is an autoimmune and inflammatory condition that may predispose to gastric carcinoid tumors or adenocarcinomas. The early diagnosis of these tumors is important in order to decrease morbidity and mortality. Platelet indices such as mean platelet volume and plateletcrit levels increase in inflammatory, infectious and malign conditions. The primary aim of this study was to explore wheter platelet indices and red cell distribution width have any predictive role in the discrimination of autoimmune gastritis patients with and without gastric carcinoid tumors. Also secondary aim of this study was to investigate whether any changes exist betwenn autoimmune gastritis and functional dyspepsia patients by means of platelet indices. Plateletcrit (0.22 ± 0.06 vs. 0.20 ± 0.03%, p < 0.001) and red cell distribution width (16.11 ± 3.04 vs. 13.41 ± 0.95%, p < 0.001) were significantly higher in autoimmune gastritis patients compared to control group. Receiver operating curve analysis suggested that optimum plateletcrit cut-off point was 0.20% (AUC: 0.646), and 13.95% as the cut off value for red cell distribution width (AUC: 0.860). Although plateletcrit (0.22 ± 0.06 vs. 0.21 ± 0.04%, p = 0.220) and mean platelet volume (8.94 ± 1.44 vs. 8.68 ± 0.89 fl, p = 0.265) were higher in autoimmune gastritis patients without carcinoid tumor compared to patients with carcinoid tumors, these parameters were not statistically significant. Changes in plateletcrit and red cell distribution width values may be used as a marker in the discrimination of autoimmune gastritis and fucntional dyspepsia patients but not useful in patients with gastric carcinoid tumor type I.

Classifying post-stroke fatigue: Optimal cut-off on the Fatigue Assessment Scale.

PubMed

Cumming, Toby B; Mead, Gillian

2017-12-01

Post-stroke fatigue is common and has debilitating effects on independence and quality of life. The Fatigue Assessment Scale (FAS) is a valid screening tool for fatigue after stroke, but there is no established cut-off. We sought to identify the optimal cut-off for classifying post-stroke fatigue on the FAS. In retrospective analysis of two independent datasets (the '2015' and '2007' studies), we evaluated the predictive validity of FAS score against a case definition of fatigue (the criterion standard). Area under the curve (AUC) and sensitivity and specificity at the optimal cut-off were established in the larger 2015 dataset (n=126), and then independently validated in the 2007 dataset (n=52). In the 2015 dataset, AUC was 0.78 (95% CI 0.70-0.86), with the optimal ≥24 cut-off giving a sensitivity of 0.82 and specificity of 0.66. The 2007 dataset had an AUC of 0.83 (95% CI 0.71-0.94), and applying the ≥24 cut-off gave a sensitivity of 0.84 and specificity of 0.67. Post-hoc analysis of the 2015 dataset revealed that using only the 3 most predictive FAS items together ('FAS-3') also yielded good validity: AUC 0.81 (95% CI 0.73-0.89), with sensitivity of 0.83 and specificity of 0.75 at the optimal ≥8 cut-off. We propose ≥24 as a cut-off for classifying post-stroke fatigue on the FAS. While further validation work is needed, this is a positive step towards a coherent approach to reporting fatigue prevalence using the FAS. Copyright © 2017 Elsevier Inc. All rights reserved.

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.

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.

Sensitivity and specificity of the Beck Depression Inventory in cardiologic inpatients: how useful is the conventional cut-off score?

PubMed

Forkmann, Thomas; Vehren, Thomas; Boecker, Maren; Norra, Christine; Wirtz, Markus; Gauggel, Siegfried

2009-10-01

The Beck Depression Inventory (BDI) is widely used for depression screening in various patient populations. However, there are still insufficient data about its sensitivity and specificity in nonpsychiatric patients. Furthermore, some research suggests that somatic BDI items heighten its sum score artificially in physically ill patients. The aim of the present study was to validate the conventional BDI cut-off score by examination of its sensitivity and specificity in a mixed sample of cardiac inpatients and compare it to a modified "cognitive-emotional" BDI (BDI(c/e)) after exclusion of somatic items. A total of 126 cardiologic inpatients were assessed. Receiver operating characteristic curves (ROC) were calculated for total BDI (BDI(t)) and BDI(c/e). Screening performance of cut-off scores was evaluated using the Youden Index (Y). With the application of the conventional BDI cut-off score, ROC analysis revealed a moderate overall screening performance with Y=52.6 and an area under the curve (AUC) of 0.83. In contrast, Y improved to 57.5 at a cut-off score of >9, but screening performance was still not optimal. BDI(c/e) showed also a moderate screening performance (AUC=.82); Y was maximized at a cut-off score of >8 (Y=0.53.5). Again, no cut-off score provided optimal screening performance. The BDI cannot be recommended as a formal screening instrument in cardiac inpatients since no cut-off score for either BDI(t) or BDI(c/e) combined both sufficiently high sensitivity and specificity. However, the shorter BDI(c/e) could be used as alternative to BDI(t) which may be confounded in physically ill patients. Generally, researchers should consider using alternative screening instruments (e.g., the Hospital Anxiety and Depression Scale) instead.

On-Line Pattern Analysis and Recognition System. OLPARS VI. Software Reference Manual,

DTIC Science & Technology

1982-06-18

Discriminant Analysis Data Transformation, Feature Extraction, Feature Evaluation Cluster Analysis, Classification Computer Software 20Z. ABSTRACT... cluster /scatter cut-off value, (2) change the one-space bin factor, (3) change from long prompts to short prompts or vice versa, (4) change the...value, a cluster plot is displayed, otherwise a scatter plot is shown. if option 1 is selected, the program requests that a new value be input

Essays from the Edge: Citizenship and the Outsider in Literature and History.

ERIC Educational Resources Information Center

Leder, Priscilla, Comp.; And Others

This book of essays and poetry by participants in a National Endowment for the Humanities summer seminar explores the portrayal in arts and literature of the "outsider" or "alien" who is cut off from country and citizenship, either by choice or circumstance. The book is divided into seven categories. Part 1,…

Fatty acids and plasmalogens of the phospholipids of the sperm membranes and their relation with the post-thaw quality of stallion spermatozoa.

PubMed

Macías García, B; González Fernández, L; Ortega Ferrusola, C; Morillo Rodríguez, A; Gallardo Bolaños, J M; Rodríguez Martinez, H; Tapia, J A; Morcuende, D; Peña, F J

2011-03-15

Fatty acids and plasmalogens were extracted from the phospholipids of the plasma membrane of stallion spermatozoa, to determine their relation with sperm quality after freezing and thawing. Sperm quality was rated using a quality index that combined the results of the analysis of sperm motility and velocity (CASA analysis), membrane status and mitochondrial membrane potential (flow cytometry) post thaw. Receiving operating system (ROC) curves were used to evaluate the value of specific lipid components of the sperm membrane herein studied as forecast of potential freezeability. From all parameters studied the ratio of percentage of C16 plasmalogens related to total phospholipids was the one with the better diagnostic value. For potentially bad freezers, the significant area under the ROC-curve was 0.74, with 75% sensitivity and 79.9% specificity for a cut off value of 26.9. Also the percentage of plasmalogens respect to total phospholipids gave good diagnostic value for bad freezers. On the other hand, the percentage of C18 fatty aldehydes related to total phospholipids of the sperm membrane properly forecasted freezeability with an area under the ROC curve of 0.70 with 70% sensitivity and 62.5% specificity for a cut off value of 0.32. Copyright © 2011 Elsevier Inc. All rights reserved.

Dose-effect relation between daily ethanol intake in the range 0-70 grams and %CDT value: validation of a cut-off value.

PubMed

Schellenberg, François; Schwan, Raymund; Mennetrey, Louise; Loiseaux, Marie-Nadia; Pagès, Jean Christophe; Reynaud, Michel

2005-01-01

To evaluate the ability to infer alcohol consumption using the %CDT (carbohydrate deficient transferrin) immunoassay (Axis Shield). One hundred and eighty-three healthy subjects (143 men, 40 women) undergoing a routine medical check-up at their workplace declared frequency and quantity of alcohol consumption covering the last 4 weeks. Seven sub-groups were made up from this population, according to daily ethanol intake and by increments of 10 g from 0 to 70 g/day. A reference group that consisted of 133 healthy teetotallers (74 men, 59 women) was recruited by occupational medicine in the same conditions as the 183 subjects of the study. Percentage CDT and gamma glutamyl transferase (GGT) were assayed on a fasting blood sample. There was a proportional dose-response effect of daily ethanol intake on %CDT values in the range of 0-70 g per day. A threshold effect on %CDT values for patients having an alcohol intake of over 40 g per day was found, an effect which was not observed for GGT activity. The kit has clinical usefulness, and the value of 2.6% proposed by the manufacturer for the cut-off for hazardous drinking in both sexes has been validated.

Ore Reserve Estimation of Saprolite Nickel Using Inverse Distance Method in PIT Block 3A Banggai Area Central Sulawesi

NASA Astrophysics Data System (ADS)

Khaidir Noor, Muhammad

2018-03-01

Reserve estimation is one of important work in evaluating a mining project. It is estimation of the quality and quantity of the presence of minerals have economic value. Reserve calculation method plays an important role in determining the efficiency in commercial exploration of a deposit. This study was intended to calculate ore reserves contained in the study area especially Pit Block 3A. Nickel ore reserve was estimated by using detailed exploration data, processing by using Surpac 6.2 by Inverse Distance Weight: Squared Power estimation method. Ore estimation result obtained from 30 drilling data was 76453.5 ton of Saprolite with density of 1.5 ton/m3 and COG (Cut Off Grade) Ni ≥ 1.6 %, while overburden data was 112,570.8 tons with waste rock density of 1.2 ton/m3 . Striping Ratio (SR) was 1.47 : 1 smaller than Stripping Ratio ( SR ) were set of 1.60 : 1.

Prognostic value of preoperative serum CA 242 in Esophageal squamous cell carcinoma cases.

PubMed

Feng, Ji-Feng; Huang, Ying; Chen, Qi-Xun

2013-01-01

Carbohydrate antigen (CA) 242 is inversely related to prognosis in many cancers. However, few data regarding CA 242 in esophageal cancer (EC) are available. The aim of this study was to determine the prognostic value of CA 242 and propose an optimum cut-off point in predicting survival difference in patients with esophageal squamous cell carcinoma (ESCC). A retrospective analysis was conducted of 192 cases. A receiver operating characteristic (ROC) curve for survival prediction was plotted to verify the optimum cuf- off point. Univariate and multivariate analyses were performed to evaluate prognostic parameters for survival. The positive rate for CA 242 was 7.3% (14/192). The ROC curve for survival prediction gave an optimum cut-off of 2.15 (U/ml). Patients with CA 242 ≤ 2.15 U/ml had significantly better 5-year survival than patients with CA 242 >2.15 U/ml (45.4% versus 22.6%; P=0.003). Multivariate analysis showed that differentiation (P=0.033), CA 242 (P=0.017), T grade (P=0.004) and N staging (P<0.001) were independent prognostic factors. Preoperative CA 242 is a predictive factor for long-term survival in ESCC, especially in nodal-negative patients. We conclude that 2.15 U/ml may be the optimum cuf-off point for CA 242 in predicting survival in ESCC.

Protein C: a potential biomarker in severe sepsis and a possible tool for monitoring treatment with drotrecogin alfa (activated)

PubMed Central

Shorr, Andrew F; Nelson, David R; Wyncoll, Duncan LA; Reinhart, Konrad; Brunkhorst, Frank; Vail, George Matthew; Janes, Jonathan

2008-01-01

Introduction Drotrecogin alfa (activated; DrotAA) treatment, a 96-hour infusion, reduces 28-day mortality in severe sepsis to approximately 25%. The question remains whether a longer infusion or higher dose could increase rate of survival. The goal of this study was to identify a dependable, sensitive measure with which to monitor disease progression and response in patients during DrotAA treatment. Methods Data on severe sepsis patients included in PROWESS (placebo-controlled, double-blind, randomized study of 850 DrotAA and 840 placebo individuals) and ENHANCE (single-arm, open-label study of 2,375 DrotAA patients) studies were analyzed. In these studies, DrotAA (24 μg/kg per hour) or placebo was infused for 96 hours and patients were followed for 28 days. Data on six laboratory measures and five organ dysfunctions were systematically analyzed to identify a potential surrogate end-point for monitoring DrotAA therapy and predicting 28-day mortality at the end of therapy. To allow comparison across variables, sensitivity and specificity analyses identified cut-off values for preferred outcome, and relative risks for being above or below cut-offs were calculated, as was the 'proportion of treatment effect explained' (PTEE) to identify biomarkers that contribute to benefit from DrotAA. Results Protein C was the only variable that correlated with outcome across all analyses. Using placebo data, a baseline protein C under 40% was established as a useful predictor of outcome (odds ratio 2.12). Similar odds ratios were associated with cut-off values of other biomarkers, but the treatment benefit associated with DrotAA was significantly greater below the cut-off than above the cut-off only for protein C (relative risk for 28-day mortality 0.66 versus 0.88; P = 0.04). Protein C was the only end-of-infusion biomarker that potentially explained at least 50% of the benefit from DrotAA (PTEE 57.2%). The PTEE was 41% for cardiovascular Sequential Organ Failure Assessment score and for d-dimer. At the end of infusion (day 4), protein C categories (≤40%, 41% to 80%, and > 80%) remained significantly related to mortality, regardless of treatment assignment. Conclusion Based on systematic analyses of 11 variables measured in severe sepsis clinical trials, protein C was the only variable consistently correlated with both DrotAA treatment effect and survival. Further study is needed to determine whether longer infusions or higher doses of DrotAA would achieve the goal of normalizing protein C in more patients with severe sepsis. PMID:18394162

SFN-SIQ, SFNSL and skin biopsy of 55 cases with small fibre involvement.

PubMed

Sun, Bo; Li, Yifan; Liu, Lizhi; Chen, Zhaohui; Ling, Li; Yang, Fei; Liu, Jiexiao; Liu, Hong; Huang, Xusheng

2018-05-01

Purpose/aim of the study: To date, there are no validated screening scales for small fibre neuropathy. This study investigated the small-fibre neuropathy and the symptom inventory questionnaire as well as the small fibre neuropathy screening list for small fibre neuropathy diagnosis. Fifty-five patients were divided into small fibre neuropathy and mixed fibre damage groups. Relevant scales, nerve conduction studies and skin biopsies were performed. Relationships between the intraepidermal nerve fibre density and different scales as well as the diagnostic and cut-off values (score at which Youden's index is largest) were determined. Compared with healthy Chinese participants, 20 patients were diagnosed with small fibre neuropathy. Intraepidermal nerve fibre density was moderately and highly correlated with the small fibre neuropathy-symptom inventory questionnaire and small fibre neuropathy screening list, respectively. The diagnostic values were moderate and high for the small fibre neuropathy-symptom inventory questionnaire (cut-off value = 5, sensitivity = 80%, specificity = 81.8%) and small fibre neuropathy screening list (cut-off value = 8, sensitivity = 94.1%, specificity = 90.9%), respectively. There were no significant differences in the visual analogue scale between the small fibre neuropathy group, mixed small and large fibre neuropathy group, pure large fibre neuropathy group and the normal group. Small fibre neuropathy-symptom inventory questionnaire and small fibre neuropathy screening list represent potential small fibre neuropathy screening tools. Abbreviations EMG electromyography ENA anti-extractable nuclear antigens ESR erythrocyte sedimentation rate IENFD intraepidermal nerve fibre density IGT impaired glucose tolerance NCS nerve conduction studies NDS neuropathy disability score OGTT oral glucose tolerance test PGP protein gene product PN peripheral neuropathy ROC receiver operating characteristic curve ROC-AUC area under the ROC curve SFN small fibre neuropathy SFN-SIQ small-fibre neuropathy and symptom inventory questionnaire SFNSL small fibre neuropathy screening list VAS visual analogue scale WHO World Health Organization.

Validity of triglyceride-glucose index as an indicator for metabolic syndrome in children and adolescents: the CASPIAN-V study.

PubMed

Angoorani, Pooneh; Heshmat, Ramin; Ejtahed, Hanieh-Sadat; Motlagh, Mohammad Esmaeil; Ziaodini, Hasan; Taheri, Majzoubeh; Aminaee, Tahereh; Goodarzi, Azam; Qorbani, Mostafa; Kelishadi, Roya

2018-02-16

The purpose of this study was to determine the cut-off values of triglycerides and glucose (TyG) index as one of the indirect indices for metabolic syndrome (MetS) in a pediatric population. This national study was conducted in 2015 on 14400 students, aged 7-18 years. They were selected by random cluster sampling from 30 provinces of our country during the fifth survey of a national school-based surveillance program. MetS was defined based on the Adult Treatment Panel III (ATP III) criteria modified for the pediatric age group. The cut-off values of TyG index for MetS were obtained using the receiver operation characteristic (ROC) curve analysis by gender and age groups. Totally, 3843 students (52.3% boys) with mean (SD) age of 12.45 (3.04) years were assessed. The area under the ROC curve of TyG index for MetS was 0.83 in total participants. According to the ATP III criteria the cut-off values of the TyG index were 8.33 (8.21-8.45) in total students, 8.47 (8.36-8.58) in boys, and 8.33 (8.18-8.48) in girls. In the 7-12 and 13-18 years' age groups, these values were 8.47 (8.32-8.63) and 8.34 (8.22-8.45) in total, 8.39 (8.26-8.52) and 8.47 (8.33-8.61) in boys, 8.33 (8.11-8.55) and 8.35 (8.22-8.47) in girls, respectively. The findings of this study can be clinically helpful for screening MetS in children and adolescents but the effectiveness of these criteria needs to be evaluated by further longitudinal surveys. Level V, cross-sectional descriptive study (National surveillance study).

75 FR 51140 - Self-Regulatory Organizations; Notice of Filing and Immediate Effectiveness of a Proposed Rule...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-18

... NASDAQ Stock Market LLC To Amend Exchange Rules Related to the Cut-off Time for Contrary Exercise Advice... Options Contracts) to make changes to extend the cut-off time to submit contrary exercise advices... Chapter VIII, Section 1 to extend the cut-off time to submit Contrary Exercise Advices to the Exchange; to...

A field test of cut-off importance sampling for bole volume

Treesearch

Jeffrey H. Gove; Harry T. Valentine; Michael J. Holmes

2000-01-01

Cut-off importance sampling has recently been introduced as a technique for estimating bole volume to some point below the tree tip, termed the cut-off point. A field test of this technique was conducted on a small population of eastern white pine trees using dendrometry as the standard for volume estimation. Results showed that the differences in volume estimates...

Modal density function and number of propagating modes in ducts

NASA Technical Reports Server (NTRS)

Rice, E. J.

1976-01-01

The question of the number of propagating modes within a small range of mode cut off ratio was raised. The population density of modes were shown to be greatest near cut off and least for the well propagating modes. It was shown that modes of nearly the same cut off ratio behave nearly the same in a sound absorbing duct as well as in the way they propagate to the far. Handling all of the propagating modes individually, they can be grouped into several cut off ratio ranges. It is important to know the modal density function to estimate acoustic power distribution.

Third molar cut-off value in assessing the legal age of 18 in Saudi population.

PubMed

AlQahtani, Sakher; Kawthar, Alemad; AlAraik, Ayman; AlShalan, Ahmad

2017-03-01

Teeth plays a major role in forensic sciences especially in age assessment of an individual, which can be used to aid in criminal or civil matters. The importance of teeth comes from their ability to survive inhumation well and because they are hardly affected by exogenous and endogenous factors. Third molars are the only teeth still developing after the age of 14 years and during the legal age of adulthood, which is 18 years. The consequences of criminal violation can strongly affect the individual's life, it is important to set different parameters to decide whether an individual is a minor or an adult in the absence of documents. Depending on the different legal requirement, such parameters can set above 90% probability for criminal matters and from 51% to civil matters. The aim of this research was to find the cut-off value of third molar development for the legal age of 18 amongst Saudi individuals using the third molar maturity index method by Cameriere et al. (2008) [17]. This was a cross sectional study on 300 archived orthopantomogram (OPG) of healthy Saudi patients between the ages 14 and 22 years attending the Dental Hospital at King Saud University, Riyadh, Saudi Arabia. All OPGs were taken by PLANMECA - ProMax machine and evaluated by the Romaxis software. The inclusion criteria were good quality OPGs taken during the course of treatment. All patients were healthy with no systemic diseases or disorders with the presence of third molars and clear root apex. The lower left mandibular third molar (LL3rdM) was assessed using third molar maturity index (I3m) to determine if the individual is younger or older than 18 years old. The cut-off value of I3m for the Saudi population was (I3m<0.08). The sensitivity of this method was 51.7% and the specificity was 98.5%. Early mineralization was found in males except when I3m was ranging from (0.0 to 0.4) and (0.9 to 1.7). Cameriere et al. (2014, 2008) [16,17] test was reproducible with good measure of reliability. This method is suitable for assessing the attainment of legal age of adulthood in Saudi population and the cut-off value of I3m is similar to other populations. Although dental age assessment by means of third molar development is useful, it still has its limitation because of its variation in position, morphology and development. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

Evaluation of Glycated Hemoglobin (HbA1c) for Diagnosing Type 2 Diabetes and Prediabetes among Palestinian Arab Population

PubMed Central

Kharroubi, Akram T.; Darwish, Hisham M.; Abu Al-Halaweh, Ahmad I.; Khammash, Umaiyeh M.

2014-01-01

The purpose of the study is to compare the potential of HbA1c to diagnose diabetes among Palestinian Arabs compared to fasting plasma glucose (FPG). A cross-sectional sample of 1370 Palestinian men (468) and women (902) without known diabetes and above the age of 30 years were recruited. Whole blood was used to estimate HbA1c and plasma for FPG and total lipid profile. Fasting plasma glucose was used as a reference to diagnose diabetes (≥ 126 mg/dL) and prediabetes (100–125 mg/dL). The area under the receiver operating characteristic curve (AUC) for HbA1c was 81.9% to diagnose diabetes and 63.9% for prediabetes. The agreement between HbA1c and diabetes as diagnosed by FPG was moderate (ĸ  =  0.498) and low with prediabetes (ĸ = 0.142). The optimal cut-off value for HbA1c to diagnose diabetes was ≥ 6.3% (45 mmol/mol). The sensitivity, specificity and the discriminant ability were 65.6% (53.1–76.3%), 94.5% (93.1–95.6%), 80.0% (72.8–87.3%), respectively. However, using cut-off value of ≥ 6.5% (48 mmol/mol) improved specificity. At this cut-off value, the sensitivity, specificity and the discriminant ability were 57.4% (44.9–69.0%), 97.1% (96.0–97.9%) and 77.3% (71.0–83.5%). For diagnosing prediabetes with HbA1c between 5.7–6.4% (39–46 mmol/mol), the sensitivity, specificity and the discriminant ability were 62.7% (57.1–67.9%), 56.3% (53.1–59.4%) and 59.5% (56.3–62.5%), respectively. HbA1c at cut-off value of ≥ 6.5% (48 mmol/mol) by itself diagnosed 5.3% and 48.3% as having diabetes and prediabetes compared to 4.5% and 24.2% using FPG, respectively. Mean HbA1c and FPG increase significantly with increasing body mass index. In conclusion, the ROC curves showed HbA1c could be used for diagnosing diabetes when compared to FPG but not for prediabetes in Palestinians Arabs even though only about 50% of the diabetic subjects were identified by the both HbA1c and FPG. PMID:24505401

Evaluation of the Efficiency of the Reticulocyte Hemoglobin Content on Diagnosis for Iron Deficiency Anemia in Chinese Adults.

PubMed

Cai, Jie; Wu, Meng; Ren, Jie; Du, Yali; Long, Zhangbiao; Li, Guoxun; Han, Bing; Yang, Lichen

2017-05-02

Our aim was to evaluate the cut-off value and efficiency of using reticulocyte hemoglobin content as a marker to diagnose iron deficiency anemia in Chinese adults. 140 adults who needed bone marrow aspiration for diagnosis at the hematology department of the Peking Union Medical College Hospital were enrolled according to the inclusive and exclusive criteria. Venous blood samples were collected to detect complete blood count, including hemoglobin, reticulocyte hemoglobin content, hematocrit, mean cellular volume, corpuscular hemoglobin concentration, hemoglobin content, free erythrocyte protoporphyrin; iron indexes of serum ferritin, serum transferrin receptor, and unsaturated iron-binding capacity; and inflammation markers of C-reactive protein and α-acid glycoprotein. Bone marrow samples were obtained for the bone marrow iron staining, which was used as the standard for the evaluation of iron status in this study. Subjects were divided into three groups according to hemoglobin levels and bone marrow iron staining results: the IDA (iron deficiency anemia) group, the NIDA (non-iron deficiency anemia) group, and the control group. The differences of the above-mentioned indexes were compared among the three groups and the effect of inflammation was also considered. The cut-off value of reticulocyte hemoglobin content was determined by receiver operation curves. The IDA group ( n = 56) had significantly lower reticulocyte hemoglobin content, mean cellular volume, corpuscular hemoglobin concentration, hemoglobin content, and serum ferritin; and higher free erythrocyte protoporphyrin, unsaturated iron-binding capacity, and serum transferrin receptor ( p < 0.05) compared with the NIDA group ( n = 38) and control group ( n = 46). Hematocrit, serum ferritin, and unsaturated iron-binding capacity were significantly affected by inflammation while reticulocyte hemoglobin content and other parameters were not. The cut-off value of reticulocyte hemoglobin content for diagnosing iron deficiency anemia was 27.2 pg, with a sensitivity of 87.5% and a specificity of 92.9%. The cut-off values for mean cellular volume, serum ferritin, and serum transferrin receptor were 76.6, 12.9, and 4.89 mg/L, respectively. Reticulocyte hemoglobin content had the largest area under the curve of 0.929, while those for mean cellular volume, serum ferritin, serum transferrin receptor were 0.922, 0.887, and 0.900, respectively. Reticulocyte hemoglobin content has a high sensitivity and specificity in the diagnosis of iron deficiency anemia, and its comprehensive diagnostic efficacy is better than other traditional indicators-such as serum ferritin and serum transferrin receptor.

The Diagnostic Value of Urine Lipoarabinomannan (LAM) Antigen in Childhood Tuberculosis.

PubMed

Iskandar, Agustin; Nursiloningrum, Erlin; Arthamin, Maimun Zulhaidah; Olivianto, Ery; Chandrakusuma, Mas Slamet

2017-03-01

Diagnosis of Tuberculosis (TB) in children is difficult because the clinical presentation is not specific, the chest X-ray interpretation has low accuracy and sputum sample is difficult to obtain. Antigen detection test such as rapid urine LAM is a non-invasive alternative for diagnosing TB . Lipoarabinomannan (LAM) is the main component of M.tuberculosis cell wall. To determine the diagnostic value of urinary LAM antigen for diagnosis of childhood TB. In the present cross-sectional study, subjects were included using consecutive sampling method. All the children aged 0-14 years Suspected of pulmonary or extra pulmonary TB suffering from cough more than two weeks, fever without clear aetiology, loss of body weight or poor weight gain, fatigue, malaise, chronic lymph node enlargement, spine angulation, joint swelling and had history of contact with positive sputum smear adult TB patient were enrolled in the study. Pulmonary and extra pulmonary diagnosis was based on clinical presentation, Tuberculin Skin Test (TST), chest X-ray, Acid Fast Bacillus (AFB) staining and or sputum culture. Urinary LAM level was measured by using Enzyme-Linked Immunosorbent Assay (ELISA). Cut off value and Area Under the Curve (AUC) were determined using ROC statistical analysis (SPSS 21.0). Sensitivity and specificity was measured from 2x2 cross table. Out of 61 subjects suspected as TB, 49 (80.3%) were eventually diagnosed with TB. Of those diagnosed with TB, 21 (42.9%) were microbiologically confirmed cases either by sputum microscopy (34.7%) or culture (8.2%), whereas 28 subjects were unconfirmed cases (57.1%). The urinary LAM level was higher in subjects with TB (1.80+1.02) mg/l compared to non-TB group (0.46+0.3) mg/l; p<0.001(independent t-test). Urine LAM had 83% sensitivity and 85% specificity with cut off value 0.98 mg/l using microbiological and clinical confirmation as standard reference and 33% sensitivity and 60% specificity with cut off value 1.69 mg/l using microbiological confirmation only. Urinary LAM has good diagnostic value for childhood TB diagnosis.

The Diagnostic Value of Urine Lipoarabinomannan (LAM) Antigen in Childhood Tuberculosis

PubMed Central

Nursiloningrum, Erlin; Arthamin, Maimun Zulhaidah; Olivianto, Ery; Chandrakusuma, Mas Slamet

2017-01-01

Introduction Diagnosis of Tuberculosis (TB) in children is difficult because the clinical presentation is not specific, the chest X-ray interpretation has low accuracy and sputum sample is difficult to obtain. Antigen detection test such as rapid urine LAM is a non-invasive alternative for diagnosing TB . Lipoarabinomannan (LAM) is the main component of M.tuberculosis cell wall. Aim To determine the diagnostic value of urinary LAM antigen for diagnosis of childhood TB. Materials and Methods In the present cross-sectional study, subjects were included using consecutive sampling method. All the children aged 0-14 years Suspected of pulmonary or extra pulmonary TB suffering from cough more than two weeks, fever without clear aetiology, loss of body weight or poor weight gain, fatigue, malaise, chronic lymph node enlargement, spine angulation, joint swelling and had history of contact with positive sputum smear adult TB patient were enrolled in the study. Pulmonary and extra pulmonary diagnosis was based on clinical presentation, Tuberculin Skin Test (TST), chest X-ray, Acid Fast Bacillus (AFB) staining and or sputum culture. Urinary LAM level was measured by using Enzyme-Linked Immunosorbent Assay (ELISA). Cut off value and Area Under the Curve (AUC) were determined using ROC statistical analysis (SPSS 21.0). Sensitivity and specificity was measured from 2x2 cross table. Results Out of 61 subjects suspected as TB, 49 (80.3%) were eventually diagnosed with TB. Of those diagnosed with TB, 21 (42.9%) were microbiologically confirmed cases either by sputum microscopy (34.7%) or culture (8.2%), whereas 28 subjects were unconfirmed cases (57.1%). The urinary LAM level was higher in subjects with TB (1.80+1.02) mg/l compared to non-TB group (0.46+0.3) mg/l; p<0.001(independent t-test). Urine LAM had 83% sensitivity and 85% specificity with cut off value 0.98 mg/l using microbiological and clinical confirmation as standard reference and 33% sensitivity and 60% specificity with cut off value 1.69 mg/l using microbiological confirmation only. Conclusion Urinary LAM has good diagnostic value for childhood TB diagnosis. PMID:28511392

Variations in the short wavelength cut-off of the solar UV spectra.

PubMed

Parisi, A V; Turner, J

2006-03-01

Cloud and solar zenith angle (SZA) are two major factors that influence the magnitude of the biologically damaging UV (UVBD) irradiances for humans. However, the effect on the short wavelength cut-off due to SZA and due to clouds has not been investigated for biologically damaging UV for cataracts. This research aims to investigate the influence of cloud and SZA on the short wavelength cut-off of the spectral UVBD for cataracts. The spectral biologically damaging UV for cataracts on a horizontal plane was calculated by weighting the spectral UV measured with a spectroradiometer with the action spectrum for the induction of cataracts in a porcine lens. The UV spectra were obtained on an unshaded plane at a latitude of 29.5 degrees S. The cut-off wavelength (lambdac) was defined as the wavelength at which the biologically damaging spectral irradiance was 0.1% of the maximum biologically damaging irradiance for that scan. For the all sky conditions, the short wavelength cut-off ranged by 12 nm for the SZA range of 5 to 80 degrees and the maximum in the spectral UVBD ranged by 15 nm. Similarly, for the cloud free cases, the short wavelength cut-off ranged by 9 nm for the same SZA range. Although, cloud has a large influence on the magnitude of the biologically damaging UV for cataracts, the influence of cloud on the short wavelength cut-off for the biologically damaging UV for cataracts is less than the influence of the solar zenith angle.

Diagnostic performance and optimal cut-off scores of the Massachusetts youth screening instrument-second version in a sample of Swiss youths in welfare and juvenile justice institutions.

PubMed

Dölitzsch, Claudia; Leenarts, Laura E W; Schmeck, Klaus; Fegert, Jorg M; Grisso, Thomas; Schmid, Marc

2017-02-08

There is a growing consensus about the importance of mental health screening of youths in welfare and juvenile justice institutions. The Massachusetts Youth Screening Instrument-second version (MAYSI-2) was specifically designed, normed and validated to assist juvenile justice facilities in the United States of America (USA), in identifying youths with potential emotional or behavioral problems. However, it is not known if the USA norm-based cut-off scores can be used in Switzerland. Therefore, the primary purpose of the current study was to estimate the diagnostic performance and optimal cut-off scores of the MAYSI-2 in a sample of Swiss youths in welfare and juvenile justice institutions. As the sample was drawn from the French-, German- and Italian-speaking parts of Switzerland, the three languages were represented in the total sample of the current study and consequently we could estimate the diagnostic performance and the optimal cut-off scores of the MAYSI-2 for the language regions separately. The other main purpose of the current study was to identify potential gender differences in the diagnostic performance and optimal cut-off scores. Participants were 297 boys and 149 girls (mean age = 16.2, SD = 2.5) recruited from 64 youth welfare and juvenile justice institutions (drawn from the French-, German- and Italian-speaking parts of Switzerland). The MAYSI-2 was used to screen for mental health or behavioral problems that could require further evaluation. Psychiatric classification was based on the Schedule for Affective Disorders and Schizophrenia for School-Age Children, Present and Lifetime version (K-SADS-PL). The MAYSI-2 scores were submitted into Receiver-Operating Characteristic (ROC) analyses to estimate the diagnostic performance and optimal 'caution' cut-off scores of the MAYSI-2. The ROC analyses revealed that nearly all homotypic mappings of MAYSI-2 scales onto (cluster of) psychiatric disorders revealed above chance level accuracy. The optimal 'caution' cut-off scores derived from the ROC curve for predicting (cluster of) psychiatric disorders were, for several MAYSI-2 scales, comparable to the USA norm-based 'caution' cut-off scores. For some MAYSI-2 scales, however, higher optimal 'caution' cut-off scores were found. With adjusted optimal 'caution' cut-off scores, the MAYSI-2 screens potential emotional or behavioral problems well in a sample of Swiss youths in welfare and juvenile justice institutions. However, as for choosing the optimal 'caution' cut off score for the MAYSI-2, both language as well as gender seems to be of importance. The results of this study point to a compelling need to test the diagnostic performance and optimal 'caution' cut-off scores of the MAYSI-2 more elaborately in larger differentiated language samples in Europe.

EXPLORING VALUES OF HEALTH TECHNOLOGY ASSESSMENT AGENCIES USING REFLECTIVE MULTICRITERIA AND RARE DISEASE CASE.

PubMed

Goetghebeur, Mireille M; Wagner, Monika; Samaha, Dima; O'Neil, William; Badgley, Danielle; Castro-Jaramillo, Hector; Abrishami, Payam; Sarria-Santamera, Antonio; Cleemput, Irina; Tringali, Michele

2017-01-01

Tackling ethical dilemmas faced by reimbursement decision makers requires deeper understanding of values on which health technology assessment (HTA) agencies are founded and how trade-offs are made. This was explored in this study including the case of rare disease. Representatives from eight HTA explored values on which institutions are founded using a narrative approach and reflective multicriteria (developed from EVIDEM, criteria derived from ethical imperatives of health care). Trade-offs between criteria and the impact of incorporating defined priorities (including for rare diseases) were explored through a quantitative values elicitation exercise. Participants reported a diversity of substantive and procedural values with a common emphasis on scientific excellence, stakeholder involvement, independence, and transparency. Examining the ethical imperatives behind EVIDEM criteria was found to be useful to further explore substantive values. Most criteria were deemed to reflect institutions' values, while 70 percent of the criteria were reported by at least half of participants to be considered formally by their institutions. The quantitative values elicitation highlighted the difficulty to balance imperatives of "alleviating or preventing patient suffering," "serving the whole population equitably," "upholding healthcare system sustainability," and "making decisions informed by evidence and context" but may help share the ethical reasoning behind decisions. Incorporating "Priorities" (including for rare diseases) helped reveal trade-offs from other criteria and their underlying ethical imperatives. Reflective multicriteria are useful to explore substantive values of HTAs, reflect how these values and their ethical underpinnings can be operationalized into criteria, and explore the ethical reasoning at the heart of the healthcare debate.

[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.

75 FR 51308 - Self-Regulatory Organizations; Chicago Board Options Exchange, Incorporated; Notice of Filing and...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-19

... Effectiveness of Proposal To Extend the Cut-Off Time To Submit Contrary Exercise Advices August 12, 2010... to amend Rule 11.1 to extend the cut-off time to submit contrary exercise advices. The text of the.... Purpose The purpose of the proposed rule change is to amend Rule 11.1 to extend the cut-off time to submit...

Adult or not? Accuracy of Cameriere's cut-off value for third molar in assessing 18 years of age for legal purposes.

PubMed

Cameriere, R; Pacifici, A; Viva, S; Carbone, D; Pacifici, L; Polimeni, A

2014-09-01

The discovery of reliable means to determine the age of an individual is a fundamental objective in forensic medicine, in consideration of the constant increase of illegal immigration into the European community. In 2008 Cameriere et al. developed a method based on the relationship between age and the third molar index (I3m), which assesses the degree of maturation of the third molar through measurements made on orthopantomography. The purpose of this work was to test the accuracy of Cameriere's cut-off for I3m as a tool to assess full age (18) on a new sample of living subjects. Orthopantomographs of 287 Italian living subjects aged between 13 and 22 years have been randomly selected and included in the study. Identification number, gender, date of birth and date of execution of the radiograph were recorded for each patient on a Microsoft Excel® spreadsheet. Radiographs were digitalized and analyzed using a computerized image-processing program (Adobe® Photoshop® CS4). The results show that the sensitivity of the test was 84.1% and the specificity was 92.5%. The estimated post-test probability was 90.1%, with a confidence interval of 95% (83.6%, 95.2%). Thus, the probability that a person being positive to the test has 18 or more years of age was 90.1%. The results highlight the contribution of Cameriere's cut-off value for the I3m in the assessment of full age, always remembering that the simultaneous employment of previously introduced complementary methods is essential for the purpose.

Evidence Based Weighing Policy during the First Week to Prevent Neonatal Hypernatremic Dehydration while Breastfeeding.

PubMed

Boer, Suzanne; Unal, Sevim; van Wouwe, Jacobus P; van Dommelen, Paula

2016-01-01

Neonatal hypernatremic dehydration is prevented by daily neonatal weight monitoring. We aim to provide evidence-based support of this universally promoted weighing policy and to establish the most crucial days of weighing. Weight measurements of 2,359 healthy newborns and of 271 newborns with clinical hypernatremic dehydration were used within the first seven days of life to simulate various weighting policies to prevent hypernatremic dehydration; its sensitivity, specificity and positive predictive value (PPV) of these policies were calculated. Various referral criteria were also evaluated. A policy of daily weighing with a cut-off value of -2.5 Standard Deviation Score (SDS) on the growth chart for weight loss, had a 97.6% sensitivity, 97.6% specificity and a PPV of 2.80%. Weighing at birth and only at days two, four and seven with the same -2.5 SDS cut-off, resulted in 97.3% sensitivity, 98.5% specificity and a PPV of 4.43%. A weighing policy with measurements restricted to birth and day two, four and seven applying the -2.5 SDS cut-off seems an optimal policy to detect hypernatremic dehydration. Therefore we recommend to preferably weigh newborns at least on day two (i.e. ~48h), four and seven, and refer them to clinical pediatric care if their weight loss increases below -2.5 SDS. We also suggest lactation support for the mother, full clinical assessment of the infant and weighing again the following day in all newborns reaching a weight loss below -2.0 SDS.

Serological Tests Do Not Predict Residual Fibrosis in Hepatitis C Cirrhotics with a Sustained Virological Response to Interferon.

PubMed

D'Ambrosio, Roberta; Degasperi, Elisabetta; Aghemo, Alessio; Fraquelli, Mirella; Lampertico, Pietro; Rumi, Maria Grazia; Facchetti, Floriana; Grassi, Eleonora; Casazza, Giovanni; Rosenberg, William; Bedossa, Pierre; Colombo, Massimo

2016-01-01

Liver biopsy (LB) has lost popularity to stage liver fibrosis in the era of highly effective anti-hepatitis C virus (HCV) therapy, yet diagnosis of persistent cirrhosis may have important implications following HCV eradication. As performance of serological non-invasive tests (NITs) to predict residual fibrosis in non-viremic HCV patients is unknown, we investigated accuracy of NITs to predict residual fibrosis in cirrhotics after a sustained virological response (SVR) to interferon (IFN). Thirty-eight patients with a pre-treatment histological diagnosis of cirrhosis and a 48-104 months post-SVR LB were tested with APRI, CDS, FIB-4, FibroQ, Forns Score, GUCI Index, King Score, Lok Index, PLF, ELF. In 23 (61%) patients, cirrhosis had histologically regressed. All NITs values declined after SVR without any significant difference between regressors and non-regressors (AUROC 0.52-0.75). Using viremic cut-offs, PPV ranged from 34% to 100%, with lower NPV (63% - 68%). NITs performance did not improve using derived cut-offs (PPV: 40% - 80%; NPV: 66% - 100%). PLF, which combines several NITs with transient elastography, had the best diagnostic performance (AUROC 0.75, Sn 61%, Sp 90%, PPV 80%, NPV 78%). After treatment, none of the NITs resulted significantly associated with any of the histological features (activity grade, fibrosis stage, area of fibrosis). The diagnostic estimates obtained using both viremic and derived cut-off values of NITs were suboptimal, indicating that none of these tests helps predicting residual fibrosis and that LB remains the gold standard for this purpose.

Adjusting CA19-9 values to predict malignancy in obstructive jaundice: Influence of bilirubin and C-reactive protein

PubMed Central

La Greca, Gaetano; Sofia, Maria; Lombardo, Rosario; Latteri, Saverio; Ricotta, Agostino; Puleo, Stefano; Russello, Domenico

2012-01-01

AIM: To find a possible relationship between inflammation and CA19-9 tumor marker by analyzing data from patients with benign jaundice (BJ) and malignant jaundice (MJ). METHODS: All patients admitted for obstructive jaundice, in the period 2005-2009, were prospectively enrolled in the study, obtaining a total of 102 patients. On admission, all patients underwent complete standard blood test examinations including C-reactive protein (CRP), bilirubin, CA19-9. Patients were considered eligible for the study when they presented obstructive jaundice confirmed by instrumental examinations and increased serum bilirubin levels (total bilirubin > 2.0 mg/dL). The standard cut-off level for CA19-9 was 32 U/mL, whereas for CRP this was 1.5 mg/L. The CA19-9 level was adjusted by dividing it by the value of serum bilirubin or by the CRP value. The patients were divided into 2 groups, MJ and BJ, and after the adjustment a comparison between the 2 groups of patients was performed. Sensitivity, specificity and positive predictive values were calculated before and after the adjustment. RESULTS: Of the 102 patients, 51 were affected by BJ and 51 by MJ. Pathologic CA19-9 levels were found in 71.7% of the patients. In the group of 51 BJ patients there were 29 (56.9%) males and 22 (43.1%) females with a median age of 66 years (range 24-96 years), whereas in the MJ group there were 24 (47%) males and 27 (53%) females, with a mean age of 70 years (range 30-92 years). Pathologic CA19-9 serum level was found in 82.3% of MJ. CRP levels were pathologic in 66.6% of the patients with BJ and in 49% with MJ. Bilirubin and CA19-9 average levels were significantly higher in MJ compared with BJ (P = 0.000 and P = 0.02), while the CRP level was significantly higher in BJ (P = 0.000). Considering a CA19-9 cut-off level of 32 U/mL, 82.3% in the MJ group and 54.9% in the BJ group were positive for CA19-9 (P = 0.002). A CA19-9 cut-off of 100 U/mL increases the difference between the two groups: 35.3% in BJ and 68.6% in MJ (P = 0.0007). Adjusting the CA19-9 value by dividing it by serum bilirubin level meant that 21.5% in the BJ and 49% in the MJ group remained with a positive CA19-9 value (P = 0.003), while adjusting the CA19-9 value by dividing it by serum CRP value meant that 31.4% in the BJ group and 76.5% in the MJ group still had a positive CA19-9 value (P = 0.000004). Sensitivity, specificity, positive predictive values of CA19-9 > 32 U/mL were 82.3%, 45% and 59.1%; when the cut-off was CA19-9 > 100 U/mL they were, respectively, 68.6%, 64.7% and 66%. When the CA19-9 value was adjusted by dividing it by the bilirubin or CRP values, these became 49%, 78.4%, 69.4% and 76.5%, 68.6%, 70.9%, respectively. CONCLUSION: The present study proposes CRP as a new and useful correction factor to improve the diagnostic value of the CA19-9 tumor marker in patients with cholestatic jaundice. PMID:22919247

Did you drink alcohol during pregnancy? Inaccuracy and discontinuity of women's self-reports: On the way to establish meconium ethyl glucuronide (EtG) as a biomarker for alcohol consumption during pregnancy.

PubMed

Eichler, Anna; Grunitz, Juliane; Grimm, Jennifer; Walz, Lisa; Raabe, Eva; Goecke, Tamme W; Beckmann, Matthias W; Kratz, Oliver; Heinrich, Hartmut; Moll, Gunther H; Fasching, Peter A; Kornhuber, Johannes

2016-08-01

Consuming alcohol during pregnancy is one of the most verified prenatal risk factors for impaired child development. Information about the amount of alcohol consumed prenatally is needed to anticipate negative effects and to offer timely support. Women's self-reports are not reliable, often influenced by social stigmas and retrospective recall bias, causing biomarkers of intrauterine ethanol exposure to become more and more relevant. The present study compares both women's gestational and retrospective self-reports of prenatal alcohol consumption with levels of ethyl glucuronide (EtG) in meconium. Women (n = 180) gave self-reports of prenatal alcohol consumption both during their 3rd trimester (gestational self-report) and when their children were 6-8 years old (retrospective self-report). Child meconium was collected after birth and analyzed for EtG. No individual feedback of children's EtG level was given to the women. All analyses were run separately for two cut-offs: 10 ng/g (limit of detection) and 120 ng/g (established by Goecke et al., 2014). Mothers of children with EtG values above 10 ng/g (n = 42) tended to report prenatal alcohol consumption more frequently. There was no trend or significance for the EtG cut-off of 120 ng/g (n = 26) or for retrospective self-report. When focusing on women who retrospectively reported alcohol consumption during pregnancy, a claim to five or more consumed glasses per month made an EtG over the 10 ng/g and the 120 ng/g cut-off more probable. Women whose children were over the 10 ng/g EtG cut-off were the most inconsistent in their self-report behavior, whereas the consistency in the above 120 ng/g EtG group was higher than in any other group. The next step to establish EtG as a biomarker for intrauterine alcohol exposure is to correlate EtG values in meconium with child developmental impairments. Copyright © 2016 Elsevier Inc. All rights reserved.

Exposure of wild boar to Mycobacterium tuberculosis complex in France since 2000 is consistent with the distribution of bovine tuberculosis outbreaks in cattle.

PubMed

Richomme, Céline; Boadella, Mariana; Courcoul, Aurélie; Durand, Benoît; Drapeau, Antoine; Corde, Yannick; Hars, Jean; Payne, Ariane; Fediaevsky, Alexandre; Boschiroli, María Laura

2013-01-01

The Eurasian wild boar (Sus scrofa) is increasingly considered as a relevant actor in the epidemiology of animal tuberculosis (TB). Therefore, monitoring TB in wild boar becomes a key tool for establishing comprehensive control schemes for this disease. To estimate the exposure of free living wild boar to Mycobacterium tuberculosis complex (MTC) in France, a bovine-purified protein derivative based ELISA was used to test 2,080 archived serum samples of hunter-harvested animals in 58 French "départements". Two cut-off values were used for diagnostic interpretation: 0.2, recommended by the manufacturer (specificity: 96.43%; sensitivity: 72.6%), and 0.5 (specificity: 100%; sensitivity: 64%). During the same period, at the 0.2 cut-off, global true seroprevalence was 5.9% (IC95%: 4.3%-7.7%) and 76% of the sampled "départements" had seropositive wild boar, including seven cattle TB-free "départements. At the 0.5 cut-off, global true seroprevalence was 2.2% (IC95%: 1.5-3.2) and positive wild boar belonged to 21% of the "départements". All but one of these positive "départements" had reported at least one cattle TB outbreak since 2000. A good consistence between seropositive wild boar and TB outbreaks in cattle was found, especially at the 0.5 cut-off value (the mean distance to the nearest cattle TB outbreak was 13 km and 27 km for seropositive and seronegative wild boar, respectively; P<0.05). The use of an ELISA to detect MTC antibodies in wild boar has permitted the description of the geographic distribution of MTC contact in wild boar in France. Our results suggest that the ELISA could be used as a first screening tool to conduct TB surveillance in wild boar at a population level. High-risk wild boar populations (e.g. overabundant) could be tested and if identified positive by ELISA they should be surveyed in detail by combining pathology and culture.

Exposure of Wild Boar to Mycobacterium tuberculosis Complex in France since 2000 Is Consistent with the Distribution of Bovine Tuberculosis Outbreaks in Cattle

PubMed Central

Richomme, Céline; Boadella, Mariana; Courcoul, Aurélie; Durand, Benoît; Drapeau, Antoine; Corde, Yannick; Hars, Jean; Payne, Ariane; Fediaevsky, Alexandre; Boschiroli, María Laura

2013-01-01

The Eurasian wild boar (Sus scrofa) is increasingly considered as a relevant actor in the epidemiology of animal tuberculosis (TB). Therefore, monitoring TB in wild boar becomes a key tool for establishing comprehensive control schemes for this disease. To estimate the exposure of free living wild boar to Mycobacterium tuberculosis complex (MTC) in France, a bovine-purified protein derivative based ELISA was used to test 2,080 archived serum samples of hunter-harvested animals in 58 French “départements”. Two cut-off values were used for diagnostic interpretation: 0.2, recommended by the manufacturer (specificity: 96.43%; sensitivity: 72.6%), and 0.5 (specificity: 100%; sensitivity: 64%). During the same period, at the 0.2 cut-off, global true seroprevalence was 5.9% (IC95%: 4.3%-7.7%) and 76% of the sampled “départements” had seropositive wild boar, including seven cattle TB-free “départements. At the 0.5 cut-off, global true seroprevalence was 2.2% (IC95%: 1.5-3.2) and positive wild boar belonged to 21% of the “départements”. All but one of these positive “départements” had reported at least one cattle TB outbreak since 2000. A good consistence between seropositive wild boar and TB outbreaks in cattle was found, especially at the 0.5 cut-off value (the mean distance to the nearest cattle TB outbreak was 13km and 27km for seropositive and seronegative wild boar, respectively; P<0.05). The use of an ELISA to detect MTC antibodies in wild boar has permitted the description of the geographic distribution of MTC contact in wild boar in France. Our results suggest that the ELISA could be used as a first screening tool to conduct TB surveillance in wild boar at a population level. High-risk wild boar populations (e.g. overabundant) could be tested and if identified positive by ELISA they should be surveyed in detail by combining pathology and culture. PMID:24167584

Assessment of nodal involvement in non-small-cell lung cancer with 18F-FDG-PET/CT: mediastinal blood pool cut-off has the highest sensitivity and tumour SUVmax/2 has the highest specificity.

PubMed

Mallorie, Amy; Goldring, James; Patel, Anant; Lim, Eric; Wagner, Thomas

2017-08-01

Lymph node involvement in non-small-cell lung cancer (NSCLC) is a major factor in determining management and prognosis. We aimed to evaluate the accuracy of fluorine-18-fluorodeoxyglucose-PET/computed tomography (CT) for the assessment of nodal involvement in patients with NSCLC. In this retrospective study, we included 61 patients with suspected or confirmed resectable NSCLC over a 2-year period from April 2013 to April 2015. 221 nodes with pathological staging from surgery or endobronchial ultrasound-guided transbronchial needle aspiration were assessed using a nodal station-based analysis with original clinical reports and three different cut-offs: mediastinal blood pool (MBP), liver background and tumour standardized uptake value maximal (SUVmax)/2. Using nodal station-based analysis for activity more than tumour SUVmax/2, the sensitivity was 45%, the specificity was 89% and the negative predictive value (NPV) was 87%. For activity more than MBP, the sensitivity was 93%, the specificity was 72% and NPV was 98%. For activity more than liver background, the sensitivity was 83%, the specificity was 84% and NPV was 96%. Using a nodal staging-based analysis for accuracy at detecting N2/3 disease, for activity more than tumour SUVmax/2, the sensitivity was 59%, the specificity was 85% and NPV was 80%. For activity more than MBP, the sensitivity was 95%, the specificity was 61% and NPV was 96%. For activity more than liver background, the sensitivity was 86%, the specificity was 81% and NPV was 92%. Receiver-operating characteristic analysis showed the optimal nodal SUVmax to be more than 6.4 with a sensitivity of 45% and a specificity of 95%, with an area under the curve of 0.85. Activity more than MBP was the most sensitive cut-off with the highest sensitivity and NPV. Activity more than primary tumour SUVmax/2 was the most specific cut-off. Nodal SUVmax more than 6.4 has a high specificity of 95%.

The impact of wave number selection and spin up time when using spectral nudging for dynamical downscaling applications

NASA Astrophysics Data System (ADS)

Gómez, Breogán; Miguez-Macho, Gonzalo

2017-04-01

Nudging techniques are commonly used to constrain the evolution of numerical models to a reference dataset that is typically of a lower resolution. The nudged model retains some of the features of the reference field while incorporating its own dynamics to the solution. These characteristics have made nudging very popular in dynamic downscaling applications that cover from shot range, single case studies, to multi-decadal regional climate simulations. Recently, a variation of this approach called Spectral Nudging, has gained popularity for its ability to maintain the higher temporal and spatial variability of the model results, while forcing the large scales in the solution with a coarser resolution field. In this work, we focus on a not much explored aspect of this technique: the impact of selecting different cut-off wave numbers and spin-up times. We perform four-day long simulations with the WRF model, daily for three different one-month periods that include a free run and several Spectral Nudging experiments with cut-off wave numbers ranging from the smallest to the largest possible (full Grid Nudging). Results show that Spectral Nudging is very effective at imposing the selected scales onto the solution, while allowing the limited area model to incorporate finer scale features. The model error diminishes rapidly as the nudging expands over broader parts of the spectrum, but this decreasing trend ceases sharply at cut-off wave numbers equivalent to a length scale of about 1000 km, and the error magnitude changes minimally thereafter. This scale corresponds to the Rossby Radius of deformation, separating synoptic from convective scales in the flow. When nudging above this value is applied, a shifting of the synoptic patterns can occur in the solution, yielding large model errors. However, when selecting smaller scales, the fine scale contribution of the model is damped, thus making 1000 km the appropriate scale threshold to nudge in order to balance both effects. Finally, we note that longer spin-up times are needed for model errors to stabilize when using Spectral Nudging than with Grid Nudging. Our results suggest that this time is between 36 and 48 hours.

Power of resting echocardiographic measurements to classify pulmonary hypertension patients according to European society of cardiology exercise testing risk stratification cut-offs.

PubMed

Rehman, Michaela B; Garcia, Rodrigue; Christiaens, Luc; Larrieu-Ardilouze, Elisa; Howard, Luke S; Nihoyannopoulos, Petros

2018-04-15

Right ventricular function is the major determinant of morbidity and mortality in pulmonary arterial hypertension (PAH). The ESC risk assessment strategy for PAH is based on clinical status, exercise testing, NTproBNP, imaging and haemodynamics but does not include right ventricular function. Our aims were to test the power of resting echocardiographic measurements to classify PAH patients according to ESC exercise testing risk stratification cut-offs and to determine if the classification power of echocardiographic parameters varied in chronic thrombo-embolic pulmonary hypertension (CTEPH). We prospectively and consecutively recruited 46 PAH patients and 42 CTEPH patients referred for cardio-pulmonary exercise testing and comprehensive transthoracic echocardiography. Exercise testing parameters analyzed were peak oxygen consumption, percentage of predicted maximal oxygen consumption and the slope of ventilation against carbon dioxide production. Receiver operator characteristic curves were used to determine the optimal diagnostic cut-off values of echocardiographic parameters for classifying the patients in intermediate or high risk category according to exercise testing. Measurements of right ventricular systolic function were the best for classifying in PAH (area under the curve 0.815 to 0.935). Measurements of right ventricular pressure overload (0.810 to 0.909) were optimal for classifying according to exercise testing in CTEPH. Measurements of left ventricular function were of no use in either group. Measurements of right ventricular systolic function can classify according to exercise testing risk stratification cut-offs in PAH. However, this is not the case in CTEPH where pressure overload, rather than right ventricular function seems to be linked to exercise performance. Copyright © 2018 Elsevier B.V. All rights reserved.

Assimilation of ASCAT near-surface soil moisture into the French SIM hydrological model

NASA Astrophysics Data System (ADS)

Draper, C.; Mahfouf, J.-F.; Calvet, J.-C.; Martin, E.; Wagner, W.

2011-06-01

The impact of assimilating near-surface soil moisture into the SAFRAN-ISBA-MODCOU (SIM) hydrological model over France is examined. Specifically, the root-zone soil moisture in the ISBA land surface model is constrained over three and a half years, by assimilating the ASCAT-derived surface degree of saturation product, using a Simplified Extended Kalman Filter. In this experiment ISBA is forced with the near-real time SAFRAN analysis, which analyses the variables required to force ISBA from relevant observations available before the real time data cut-off. The assimilation results are tested against ISBA forecasts generated with a higher quality delayed cut-off SAFRAN analysis. Ideally, assimilating the ASCAT data will constrain the ISBA surface state to correct for errors in the near-real time SAFRAN forcing, the most significant of which was a substantial dry bias caused by a dry precipitation bias. The assimilation successfully reduced the mean root-zone soil moisture bias, relative to the delayed cut-off forecasts, by close to 50 % of the open-loop value. The improved soil moisture in the model then led to significant improvements in the forecast hydrological cycle, reducing the drainage, runoff, and evapotranspiration biases (by 17 %, 11 %, and 70 %, respectively). When coupled to the MODCOU hydrogeological model, the ASCAT assimilation also led to improved streamflow forecasts, increasing the mean discharge ratio, relative to the delayed cut off forecasts, from 0.68 to 0.76. These results demonstrate that assimilating near-surface soil moisture observations can effectively constrain the SIM model hydrology, while also confirming the accuracy of the ASCAT surface degree of saturation product. This latter point highlights how assimilation experiments can contribute towards the difficult issue of validating remotely sensed land surface observations over large spatial scales.

Use of HbA1c to diagnose type 2 diabetes mellitus among high risk Sri Lankan adults.

PubMed

Herath, H M M; Weerarathna, T P; Dahanayake, M U; Weerasinghe, N P

Even though, glycosylated hemoglobin (HbA1c) was found to be effective in predicting diabetes especially in Caucasians there is limited evidence of its diagnostic utility in high risk Sri Lankan adults. This study aimed to determine the optimal HbA1c cut-off points for detecting diabetes in a high risk population in Sri Lanka. This community based study consisted of 254 previously healthy adults with history of diabetes in one or more first-degree relatives. Fasting plasma glucose (FPG) , glucose tolerance test (GTT) and HbA1c were measured in all and GTT was used as a reference to diagnose diabetes. Receiver operating characteristic curve was created to find the optimum HbA1c cut-off value to predict diabetes. Prevalence of diabetes was 12.2% (n=31) with FPG and 16.1% (n=41) with GTT. Prevalence rose to 27.6% (P<0.01) when HbA1c with cut-off of ≥6.5% was used as the diagnostic test. The ROC curves showed the HbA1c threshold of 6.3% provided the optimum balance between sensitivity (80.5%) and specificity (79%). In compared to GTT, FPG had only a modest sensitivity (65%) in diagnosing diabetes in this high risk population. Our study showed that optimum HbA1C cut-off for detecting diabetes was 6.3% and it had better sensitivity, but lower specificity than FPG. This study further showed that the prevalence of diabetes would become double if HbA1c is used over FPG to screen this high risk population. Copyright © 2016 Diabetes India. Published by Elsevier Ltd. All rights reserved.

The utility of serum tryptase in the diagnosis of food-induced anaphylaxis.

PubMed

Wongkaewpothong, Patcharaporn; Pacharn, Punchama; Sripramong, Chaweewan; Boonchoo, Siribangon; Piboonpocanun, Surapon; Visitsunthorn, Nualanong; Vichyanond, Pakit; Jirapongsananuruk, Orathai

2014-07-01

This study investigates the utility of serum tryptase for the confirmation of shrimp-induced anaphylaxis. Patients with a history of shrimp allergy and positive skin prick tests (SPT) to commercial shrimp extract were recruited for shrimp challenges. Serum total tryptase was obtained at baseline and 60 min (peak) after the onset of symptoms. Thirty-nine patients were challenged. There were 12 patients with anaphylaxis, 20 with mild reactions and 7 without symptoms (control group). Characteristic features and baseline tryptase were not different among the 3 groups. The peak tryptase levels were higher than the baseline in anaphylaxis and mild reaction groups (P<0.05). The delta-tryptase (peak minus baseline) and the tryptase ratio (peak divided by baseline) in the anaphylaxis group were higher than the mild reaction and control groups (P<0.01). The optimum cut-off for peak tryptase to confirm anaphylaxis was 2.99 µg/L with 50% sensitivity, 85% specificity, 3.33 positive likelihood ratio (LR) and 0.59 negative LR. The manufacturer's cut-off for peak tryptase was >11.4 µg/L with 17% sensitivity, 100% specificity, infinity positive LR and 0.83 negative LR. The best cut-off for delta-tryptase was ≥0.8 µg/L with 83% sensitivity, 93% specificity, 11.86 positive LR and 0.18 negative LR. The best cut-off for tryptase ratio was ≥1.5 with 92% sensitivity, 96% specificity, 23 positive LR and 0.08 negative LR. The peak tryptase level should be compared with the baseline value to confirm anaphylaxis. The tryptase ratio provide the best sensitivity, specificity, positive and negative LR than a single peak serum tryptase for the confirmation of shrimp-induced anaphylaxis.

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.

Substantial advantage of a combined Bayesian and genotyping approach in testosterone doping tests.

PubMed

Schulze, Jenny Jakobsson; Lundmark, Jonas; Garle, Mats; Ekström, Lena; Sottas, Pierre-Edouard; Rane, Anders

2009-03-01

Testosterone abuse is conventionally assessed by the urinary testosterone/epitestosterone (T/E) ratio, levels above 4.0 being considered suspicious. A deletion polymorphism in the gene coding for UGT2B17 is strongly associated with reduced testosterone glucuronide (TG) levels in urine. Many of the individuals devoid of the gene would not reach a T/E ratio of 4.0 after testosterone intake. Future test programs will most likely shift from population based- to individual-based T/E cut-off ratios using Bayesian inference. A longitudinal analysis is dependent on an individual's true negative baseline T/E ratio. The aim was to investigate whether it is possible to increase the sensitivity and specificity of the T/E test by addition of UGT2B17 genotype information in a Bayesian framework. A single intramuscular dose of 500mg testosterone enanthate was given to 55 healthy male volunteers with either two, one or no allele (ins/ins, ins/del or del/del) of the UGT2B17 gene. Urinary excretion of TG and the T/E ratio was measured during 15 days. The Bayesian analysis was conducted to calculate the individual T/E cut-off ratio. When adding the genotype information, the program returned lower individual cut-off ratios in all del/del subjects increasing the sensitivity of the test considerably. It will be difficult, if not impossible, to discriminate between a true negative baseline T/E value and a false negative one without knowledge of the UGT2B17 genotype. UGT2B17 genotype information is crucial, both to decide which initial cut-off ratio to use for an individual, and for increasing the sensitivity of the Bayesian analysis.

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.

Ice Atlas 1985 - 1986. Monongahela River, Allegheny River, Ohio River, Illinois River and Kankakee River.

DTIC Science & Technology

1987-11-01

Des P/o,,nes River Grant Cut -off V 1Kankrokee Cut- off Drsdn slndCountyI Line Bordwell Isi. V _ KankakeKRiver 2 */0 7r Prairle Cr 6 0 1 M1 Survey date...2 x 10 6t 81 279 River 279 13 February 1986 275 Kankak Des P/amnes RIver Gran7 Cree Cut-off DrsenIladCount y Line Bordwell Isr. 0 1 M1 ’kornkokee A...Gat Cut - off KankakeeFiver ’e Drsdn slndCounty Line Bordwell s 1 mi 2urve date FerarM1,i Kankakee River :2.4 oCr. 󈧢 X9Kankakcee River :14 ML 0- 5𔃿

Effectiveness of sequential automatic-manual home respiratory polygraphy scoring.

PubMed

Masa, Juan F; Corral, Jaime; Pereira, Ricardo; Duran-Cantolla, Joaquin; Cabello, Marta; Hernández-Blasco, Luis; Monasterio, Carmen; Alonso-Fernandez, Alberto; Chiner, Eusebi; Vázquez-Polo, Francisco-José; Montserrat, Jose M

2013-04-01

Automatic home respiratory polygraphy (HRP) scoring functions can potentially confirm the diagnosis of sleep apnoea-hypopnoea syndrome (SAHS) (obviating technician scoring) in a substantial number of patients. The result would have important management and cost implications. The aim of this study was to determine the diagnostic cost-effectiveness of a sequential HRP scoring protocol (automatic and then manual for residual cases) compared with manual HRP scoring, and with in-hospital polysomnography. We included suspected SAHS patients in a multicentre study and assigned them to home and hospital protocols at random. We constructed receiver operating characteristic (ROC) curves for manual and automatic scoring. Diagnostic agreement for several cut-off points was explored and costs for two equally effective alternatives were calculated. Of 366 randomised patients, 348 completed the protocol. Manual scoring produced better ROC curves than automatic scoring. There was no sensitive automatic or subsequent manual HRP apnoea-hypopnoea index (AHI) cut-off point. The specific cut-off points for automatic and subsequent manual HRP scorings (AHI >25 and >20, respectively) had a specificity of 93% for automatic and 94% for manual scorings. The costs of manual protocol were 9% higher than sequential HRP protocol; these were 69% and 64%, respectively, of the cost of the polysomnography. A sequential HRP scoring protocol is a cost-effective alternative to polysomnography, although with limited cost savings compared to HRP manual scoring.

Screening for anxiety and depression in dialysis patients: comparison of the Hospital Anxiety and Depression Scale and the Beck Depression Inventory.

PubMed

Preljevic, Valjbona T; Østhus, Tone Brit Hortemo; Sandvik, Leiv; Opjordsmoen, Stein; Nordhus, Inger Hilde; Os, Ingrid; Dammen, Toril

2012-08-01

Although anxiety and depression are frequent comorbid disorders in dialysis patients, they remain underrecognized and often untreated. The aim of the study was to evaluate the Hospital Anxiety and Depression Scale (HADS), the Beck Depression Inventory (BDI) and a truncated version of the BDI, the Cognitive Depression Index (CDI), as screening tools for anxiety and depression in dialysis patients. A total of 109 participants (69.7% males), from four dialysis centers, completed the self-report symptom scales HADS and BDI. Depression and anxiety disorders were diagnosed with the Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I). The sensitivity, specificity, positive and negative predictive value, overall agreement, kappa and receiver operating characteristic (ROC) curves were assessed. Depressive disorders were found in 22% of the patients based on the SCID-I, while anxiety disorders occurred in 17%. The optimal screening cut-off score for depression was ≥ 7 for the HADS depression subscale (HADS-D), ≥ 14 for the HADS-total, ≥ 11 for the CDI and ≥ 17 for the BDI. The optimal screening cut-off for anxiety was ≥ 6 for the HADS anxiety subscale (HADS-A) and ≥ 14 for the HADS-total. At cut-offs commonly used in clinical practice for depression screening (HADS-D: 8; BDI: 16), the BDI performed slightly better than HADS-D. The BDI, CDI and HADS demonstrated acceptable performance as screening tools for depression, as did the HADS-A for anxiety, in our sample of dialysis patients. The recommended cut-off scores for each instrument were: ≥ 17 for BDI, ≥ 11 for CDI, ≥ 7 for HADS depression subscale, ≥ 6 for HADS anxiety subscale and ≥ 14 for HADS total. The CDI did not perform better than the BDI in our study. Lower cut-off for the HADS-A than recommended in medically ill patients may be considered when screening for anxiety in dialysis patients. Copyright © 2012 Elsevier Inc. All rights reserved.

Diagnostic performance of 68Gallium-PSMA-11 PET/CT to detect significant prostate cancer and comparison with 18FEC PET/CT.

PubMed

Hoffmann, Manuela A; Miederer, Matthias; Wieler, Helmut J; Ruf, Christian; Jakobs, Frank M; Schreckenberger, Mathias

2017-12-19

Radiolabeled prostate-specific membrane antigen (PSMA) has proven to be a highly accurate method to detect recurrence and metastases of prostate cancer, but only sparse data is available about its performance in the diagnosis of clinically significant primary prostate cancer. We compared 68 Ga-PSMA-11 PET/CT in 25 patients with 18 FEC PET/CT in 40 patients with suspected prostate carcinoma based on an increased PSA level.The PET/CT results were compared with the histopathologic Gleason Score (GS) of biopsies. The 68 Ga-PSMA-11 PET/CT revealed highly suspect prostatic lesions (maximum standardized uptake value/SUV max >2.5) in 21/25 patients (84%), associated with GS≥6 (low-grade/high-grade carcinoma). Two histopathologic non-malignancy-relevant cases (GS<6) had PSMA-SUV max ≤2.5; all histopathologic high-grade cases (GS≥7b) showed PSMA-SUV max >12.0 which further increased with rising GS. There were 2 false positives and no false negative findings for high-grade prostate cancer using a cut off-level for SUV max of 2.5.In contrast, the 18 FEC PET/CT showed suspected malignant lesions in 38/40 patients (95%), which included 3 lesions with GS<6. The mean SUV max values did not differ with different GS. There were 11 false positives and 1 false negative for detection of high-grade prostate cancer (cut off 2.5).By means of ROC analysis a SUV max of 5.4 was found to be an optimal cut off-level to distinguish between low- and high-grade carcinoma in 68 Ga-PSMA-11 PET/CT (AUC=0.9692; 95% CI 0.9086;1.0000;SD(AUC)=0.0309)). Choosing a cut off-level of SUV max 5.4, 68 Ga-PSMA-11 PET/CT was able to distinguish between GS ≤7a/≥7b with a sensitivity of 84%, a specificity of 100%, a negative predictive value (NPV) of 67%, and an efficiency of 88% ( p <0.001).The ROC analysis revealed a SUV max 6.5 as an optimal cut off-level to distinguish between low- and high-grade carcinoma in 18 FEC PET/CT (AUC=0.7470; 95% CI 0.5919;0.9020;SD(AUC)=0.0791) with a sensitivity of 61% and a specificity of 92%; but the efficiency was only 70% and the NPV 50% ( p =0.01). 68 Ga-PSMA-11 PET/CT guided biopsy of the prostate increases diagnostic precision and is likely to help to reduce overtreatment of low-grade malignant disease as well as detect the foci of the highest Gleason pattern. Both methods ( 68 Ga-PSMA-11, 18 FEC) were suitable to detect primary prostate cancer, but the excellent image quality, the higher specificity and the good correlation of positive scans with GS are advantages of 68 Ga-PSMA-11.

Glucose-6-phosphate dehydrogenase deficiency among Yemeni children residing in malaria-endemic areas of Hodeidah governorate and evaluation of a rapid diagnostic test for its detection.

PubMed

Abdul-Ghani, Rashad; Mahdy, Mohammed A K; Saif-Ali, Reyadh; Alkubati, Sameer A; Alqubaty, Abdulhabib R; Al-Mikhlafy, Abdullah A; Al-Eryani, Samira M; Al-Mekhlafi, Abdusalam M; Alhaj, Ali

2016-06-21

Glucose-6-phosphate dehydrogenase (G6PD) deficiency, the most common genetic enzymopathy worldwide, is associated with an acute haemolytic anaemia in individuals exposed to primaquine. The present study aimed to determine G6PD deficiency among Yemeni children in malaria-endemic areas as well as to assess the performance of the CareStart™ G6PD rapid diagnostic test (RDT) for its detection. A cross-sectional study recruiting 400 children from two rural districts in Hodeidah governorate was conducted. Socio-demographic data and blood samples were collected and G6PD deficiency was qualitatively detected in fresh blood in the field using the CareStart™ G6PD RDT, while the enzymatic assay was used to quantitatively measure enzyme activity. Performance of the CareStart™ G6PD RDT was assessed by calculating its sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) against the reference enzymatic assay. The ranges of enzyme activity were 0.14-18.45 and 0.21-15.94 units/g haemoglobin (U/gHb) for males and females, respectively. However, adjusted male median G6PD activity was 5.0 U/gHb. Considering the adjusted male median as representing 100 % normal enzyme activity, the prevalence rates of G6PD deficiency were 12.0 and 2.3 % at the cut-off activities of ≤60 and ≤10 %, respectively. Multivariable analysis showed that gender, district of residence and consanguinity between parents were independent risk factors for G6PD deficiency at the cut-off activity of ≤30 % of normal. The CareStart™ G6PD RDT showed 100 % sensitivity and NPV for detecting G6PD deficiency at the cut-off activities of ≤10 and ≤20 % of normal activity compared to the reference enzymatic method. However, it showed specificity levels of 90.0 and 95.4 % as well as positive/deficient predictive values (PPVs) of 18.0 and 66.0 % at the cut-off activities of ≤10 and ≤20 %, respectively, compared to the reference method. G6PD deficiency with enzyme activity of ≤60 % of normal is prevalent among 12.0 % of children residing in malaria-endemic areas of Hodeidah governorate, with 2.3 % having severe G6PD deficiency. Gender, district of residence and consanguinity between parents are significant independent predictors of G6PD deficiency at the cut-off activity of ≤30 % of normal among children in malaria-endemic areas of Hodeidah. The CareStart™ G6PD RDT proved reliable as a point-of-care test to screen for severely G6PD-deficient patients, with 100 % sensitivity and NPV, and it can be used for making clinical decisions prior to the administration of primaquine in malaria elimination strategies.

Spectrally selective solar absorber with sharp and temperature dependent cut-off based on semiconductor nanowire arrays

NASA Astrophysics Data System (ADS)

Wang, Yang; Zhou, Lin; Zheng, Qinghui; Lu, Hong; Gan, Qiaoqiang; Yu, Zongfu; Zhu, Jia

2017-05-01

Spectrally selective absorbers (SSA) with high selectivity of absorption and sharp cut-off between high absorptivity and low emissivity are critical for efficient solar energy conversion. Here, we report the semiconductor nanowire enabled SSA with not only high absorption selectivity but also temperature dependent sharp absorption cut-off. By taking advantage of the temperature dependent bandgap of semiconductors, we systematically demonstrate that the absorption cut-off profile of the semiconductor-nanowire-based SSA can be flexibly tuned, which is quite different from most of the other SSA reported so far. As an example, silicon nanowire based selective absorbers are fabricated, with the measured absorption efficiency above (below) bandgap ˜97% (15%) combined with an extremely sharp absorption cut-off (transition region ˜200 nm), the sharpest SSA demonstrated so far. The demonstrated semiconductor-nanowire-based SSA can enable a high solar thermal efficiency of ≳86% under a wide range of operating conditions, which would be competitive candidates for the concentrated solar energy utilizations.

75 FR 51324 - Self-Regulatory Organizations; NASDAQ OMX BX, Inc.; Notice of Filing of Proposed Rule Change...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-19

... Organizations; NASDAQ OMX BX, Inc.; Notice of Filing of Proposed Rule Change Relating To Extend the Cut-Off Time... Deliveries) of the Rules of the Boston Options Exchange Group, LLC (``BOX'') to extend the cut-off time to... proposed rule change is to amend Chapter VII, Section 1 of the BOX Trading Rules to extend the cut-off time...

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).

Lactate clearance cut off for early mortality prediction in adult sepsis and septic shock patients

NASA Astrophysics Data System (ADS)

Sinto, R.; Widodo, D.; Pohan, H. T.

2018-03-01

Previous lactate clearance cut off for early mortality prediction in sepsis and septic shock patient was determined by consensus from small sample size-study. We investigated the best lactate clearance cut off and its ability to predict early mortality in sepsis and septic shock patients. This cohort study was conducted in Intensive Care Unit of CiptoMangunkusumo Hospital in 2013. Patients’ lactate clearance and eight other resuscitationendpoints were recorded, and theoutcome was observed during the first 120 hours. The clearance cut off was determined using receiver operating characteristic (ROC) analysis, and its ability was investigated with Cox’s proportional hazard regression analysis using other resuscitation endpoints as confounders. Total of 268 subjects was included, of whom 70 (26.11%) subjects died within the first 120 hours. The area under ROC of lactate clearance to predict early mortality was 0.78 (95% % confidence interval [CI] 0.71-0.84) with best cut off was <7.5% (sensitivity and specificity 88.99% and 81.4% respectively). Compared with group achieving lactate clearance target, group not achieving lactate clearance target had to increase early mortality risk (adjusted hazard ratio 13.42; 95%CI 7.19-25.07). In conclusion, the best lactate clearance cut off as anearly mortality predictor in sepsis and septic shock patients is 7.5%.

Behavior of B-type natriuretic peptide during mechanical ventilation and spontaneous breathing after extubation.

PubMed

Principi, T; Falzetti, G; Elisei, D; Donati, A; Pelaia, P

2009-04-01

The behavior of B-type natriuretic peptide (BNP) is assessed during mechanical ventilation (MV) and spontaneous breathing after extubation in critical patients. Thirty patients admitted in the Intensive Care Unit (ICU) were enrolled. BNP, fluid balance (FB), airway pressure (AP) and dobutamine infusion needing (DP) were registered in three stages: T0, admission to ICU; T1, before extubation; T2, 24 h after extubation. Patients with congestive heart failure (CHF) had BNP values higher than other patients. The value of BNP during MV was greater than normal in all patients. The cut-off to discriminate patients with heart failure during MV was 286 pgxmL(-1)(sensitivity: 86%; specificity: 90%). The increase of BNP during MV directly correlated with FB and inversely correlated with AP and DP. The plasmatic level of BNP remained higher than normal values 24 h after extubation. The underlying disease of an ICU patient seems to play a relevant role for BNP production and is probably linked to different aspects of therapeutic approach required by the patient. Our data suggest a cut-off value of BNP higher than the usual is necessary to discriminate mechanically-ventilated patients without CHF. This study should be repeated with an enlarged population.

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.

The Effect of Technological Devices on Cervical Lordosis

PubMed Central

Öğrenci, Ahmet; Koban, Orkun; Yaman, Onur; Dalbayrak, Sedat; Yılmaz, Mesut

2018-01-01

PURPOSE: There is a need for cervical flexion and even cervical hyperflexion for the use of technological devices, especially mobile phones. We investigated the effect of this use on the cervical lordosis angle. MATERIAL AND METHODS: A group of 156 patients who applied with only neck pain between 2013–2016 and had no additional problems were included. Patients are specifically questioned about mobile phone, tablet, and other devices usage. The value obtained by multiplying the year of usage and the average usage (hour) in daily life was determined as the total usage value (an average hour per day x year: hy). Cervical lordosis angles were statistically compared with the total time of use. RESULTS: In the general ROC analysis, the cut-off value was found to be 20.5 hy. When the cut-off value is tested, the overall accuracy is very good with 72.4%. The true estimate of true risk and non-risk is quite high. The ROC analysis is statistically significant. CONCLUSION: The use of computing devices, especially mobile telephones, and the increase in the flexion of the cervical spine indicate that cervical vertebral problems will increase even in younger people in future. Also, to using with attention at this point, ergonomic devices must also be developed. PMID:29610602

Determining the Optimum Cut-Off Grades in Sulfide Copper Deposits / Określanie Optymalnej Wartości Odcięcia Zawartości Procentowej Pierwiastka Użytecznego W Złożach Siarczku Miedzi

NASA Astrophysics Data System (ADS)

Rahimi, Esmaeil; Oraee, Kazem; Shafahi, Zia Aldin; Ghasemzadeh, Hasan

2015-03-01

Optimum cut-off grades determination in mining life affects production planning and ultimate pit limit and it is also important from social, economical and environmental aspects. Calculation of optimum cut-off grades has been less considered for mines containing various mineral processing methods. In this paper, an optimization technique is applied to obtain optimum cut-off grades for both concentration and heap leaching processes. In this technique, production costs and different recoveries of heap leaching method directed into modeling different annual cash flows in copper mines. Considering the governing constraints, the Lagrange multiplier method is practiced to optimize the cut-off grades in which the objective function is supposed to maximize Net Present Value. The results indicate the effect of heap leaching process on the optimum cut-off grades of primary and secondary sulfide deposits. Określanie optymalnego poziomu odcięcia dla zawartości procentowej pierwiastka użytecznego ma poważny wpływ na planowanie produkcji, określanie ostatecznych limitów zasobów złoża; jest to także ważna kwestia z punktu widzenia kwestii społecznych, ekonomicznych i środowiskowych. Obliczanie optymalnego poziomu odcięcia dla zawartości procentowej pierwiastka użytecznego nie było zwykle szeroko rozważane w przypadku kopalni prowadzących ciągły system przeróbki. W pracy tej przedstawiono technikę optymalizacji określania poziomu zawartości procentowej pierwiastka użytecznego z uwzględnieniem zarówno procesów koncentracji jak i ługowania. W metodzie uwzględniono koszty produkcji i różne wskaźniki odzysku rudy, wielkości te wykorzystane zostały do modelowania rocznych przepływów gotówki w kopalniach miedzi. Uwzględniając narzucone ograniczenia, zastosowano metodę mnożników Lagrange'a w celu optymalizacji określania poziomu zawartości procentowej pierwiastka użytecznego, gdzie przyjętą funkcją celu jest maksymalizacja wartości bieżącej netto. Wyniki wskazują wpływ procesów ługowania na zawartość procentową pierwiastka użytecznego w rudzie pochodzącej z pierwotnych lub wtórnych złóż siarczku miedzi.

Quantitative diagnostic method for biceps long head tendinitis by using ultrasound.

PubMed

Huang, Shih-Wei; Wang, Wei-Te

2013-01-01

To investigate the feasibility of grayscale quantitative diagnostic method for biceps tendinitis and determine the cut-off points of a quantitative biceps ultrasound (US) method to diagnose biceps tendinitis. Design. Prospective cross-sectional case controlled study. Outpatient rehabilitation service. A total of 336 shoulder pain patients with suspected biceps tendinitis were recruited in this prospective observational study. The grayscale pixel data of the range of interest (ROI) were obtained for both the transverse and longitudinal views of the biceps US. A total of 136 patients were classified with biceps tendinitis, and 200 patients were classified as not having biceps tendinitis based on the diagnostic criteria. Based on the Youden index, the cut-off points were determined as 26.85 for the transverse view and 21.25 for the longitudinal view of the standard deviation (StdDev) of the ROI values, respectively. When the ROI evaluation of the US surpassed the cut-off point, the sensitivity was 68% and the specificity was 90% in the StdDev of the transverse view, and the sensitivity was 81% and the specificity was 73% in the StdDev of the longitudinal view to diagnose biceps tendinitis. For equivocal cases or inexperienced sonographers, our study provides a more objective method for diagnosing biceps tendinitis in shoulder pain patients.

Broadband spatial optical filtering with a volume Bragg grating and a blazed grating pair

NASA Astrophysics Data System (ADS)

Chen, Guanjin; Sun, Xiaojie; Yuan, Xiao; Zhang, Guiju

2017-10-01

A broadband spatial optical filtering system is presented in this paper, which is composed of a Volume Bragg Grating (VBG) and a blazed grating pair. The diffraction efficiency and filtering properties are calculated and simulated by using Fourier diffraction analysis and Coupled Wave Theory. A blazed grating pair and VBG structures are designed and optimized in our simulation. The diffraction efficiency of filtering system shows more than 77.2% during the wavelength period from 953nm to 1153nm, especially 84.1% at the center wavelength. The beam quality is described with near-field modulation (M) and contrast ratio (C). The M of filtering beam are 1.44, 1.49 and 1.55, respectively and the C of filtering beam are 10.1%, 10.2% and 10.5% , respectively and the beam intensity distribution is great improved. The cut-off frequencies of three filtering systems are 1.57mm-1 , 2.06 mm-1 and 2.38 mm-1 , respectively from power spectral density (PSD) curve. It's clear that the cut-off frequency of filtering system is closely related to the angular selectivity of VBG, and the value of cut-off frequency is decided by VBG's Half Width at First Zero (HWFZ) and center wavelength.

Prevalence of normal weight central obesity among Thai healthcare providers and their association with CVD risk: a cross-sectional study.

PubMed

Thaikruea, Lakkana; Thammasarot, Jiraporn

2016-11-16

This study aims to determine the prevalence of health personnel with normal weight central obesity and to investigate whether this group had higher cardiovascular disease (CVD) risk factors than those of the people with normal weight and without central obesity. A waist-to-height ratio was calculated as waist circumference (at umbilical level) in cm divided by height in cm. The central obesity cut-off level was 0.5. The body mass index was calculated as weight in kg divided by height in meters squared. The obesity cut-off level was 25 kg/m 2 . The prevalence of health personnel with normal weight central obesity was 15.4% (499 out of 3235). When compare this group to 1787 health personnel who had normal weight and without central obesity, they were 2.03 times (95% CI of adjusted OR; 1.62 to 2.54) more likely to have at least one CVD factor. The waist-to-height ratio cut-off value of 0.5 can be used as a self-assessment tool for central obesity without the need for a standard measuring tape. It is feasible to be implemented in screening or self-monitoring for the general population.

Correcting haemoglobin cut-offs to define anaemia in high-altitude pregnant women in Peru reduces adverse perinatal outcomes.

PubMed

Gonzales, Gustavo F; Tapia, Vilma; Gasco, Manuel

2014-07-01

To determine if correction of cut-offs of haemoglobin levels to define anaemia at high altitudes affects rates of adverse perinatal outcomes. Data were obtained from 161,909 mothers and newborns whose births occurred between 1,000 and 4,500 m above sea level (masl). Anaemia was defined with or without correction of haemoglobin (Hb) for altitude as Hb <11 g/dL. Correction of haemoglobin per altitude was performed according to guidelines from the World Health Organization. Rates of stillbirths and preterm births were also calculated. Stillbirth and preterm rates were significantly reduced in cases of anaemia calculated after correction of haemoglobin for altitude compared to values obtained without Hb correction. At high altitudes (3,000-4,500 masl), after Hb correction, the rate of stillbirths was reduced from 37.7 to 18.3 per 1,000 live births (p < 0.01); similarly, preterm birth rates were reduced from 13.1 to 8.76 % (p < 0.01). The odds ratios for stillbirths and for preterm births were also reduced after haemoglobin correction. At high altitude, correction of maternal haemoglobin should not be performed to assess the risks for preterm birth and stillbirth. In fact, using low altitude Hb cut-off is associated with predicting those at risk.

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

Comparison of strain and shear wave elastography for qualitative and quantitative assessment of breast masses in the same population.

PubMed

Kim, Hyo Jin; Kim, Sun Mi; Kim, Bohyoung; La Yun, Bo; Jang, Mijung; Ko, Yousun; Lee, Soo Hyun; Jeong, Heeyeong; Chang, Jung Min; Cho, Nariya

2018-04-18

We investigated addition of strain and shear wave elastography to conventional ultrasonography for the qualitative and quantitative assessment of breast masses; cut-off points were determined for strain ratio, elasticity ratio, and visual score for differentiating between benign and malignant masses. In all, 108 masses from 94 patients were evaluated with strain and shear wave elastography and scored for suspicion of malignancy, visual score, strain ratio, and elasticity ratio. The diagnostic performance between ultrasonography alone and ultrasonography combined with either type of elastography was compared; cut-off points were determined for strain ratio, elasticity ratio, and visual score. Of the 108 masses, 44 were malignant and 64 were benign. The areas under the curves were significantly higher for strain and shear wave elastography-supplemented ultrasonography (0.839 and 0.826, respectively; P = 0.656) than for ultrasonography alone (0.764; P = 0.018 and 0.035, respectively). The diagnostic performances of strain and elasticity ratios were similar when differentiating benign from malignant masses. Cut-off values for strain ratio, elasticity ratio, and visual scores for strain and shear wave elastography were 2.93, 4, 3, and 2, respectively. Both forms of elastography similarly improved the diagnostic performance of conventional ultrasonography in the qualitative and quantitative assessment of breast masses.